Judgment:
Oral Order:-
Per Justice Mr. B.B. Vagyani, Honble President
We heard Mr.M.M. Mahajan, Advocate for the appellant. None present for respondents.
District Consumer Forum Satara partly allowed consumer complaint No.257/2006 filed by respondents herein and directed the present appellant, who was O.P.No.1 to pay compensation of Rs.1,50,000/- to the respondents. District Consumer Forum further directed to pay Rs.5,000/- by way cost of the litigation. Org. O.P.No.1 has taken exception to the order passed by District Consumer Forum and has come up in appeal.
Ratna Yedage, deceased wife of respondent No.1 and mother of respondent No.2 was admitted in the hospital of appellant. Appellant is a Gynaecologist. He is M.B.B.S. and D.G.O. He has got his hospital at Vaduj. Deceased Ratna Yedage had pain in abdomen. She was 9 months 20 days pregnant. Therefore, she was taken to the hospital of appellant at about 5.30 p.m. on 04/05/2006. Blood Pressure of patient was 150/100. P.V. was 4 cm dilated with 50% effaced. Heartbeat was 140 per minute. Appellant being qualified to make delivery, admitted patient for further treatment. He went on examining patient by every half an hour. He prepared case papers and noted his observations. In order to control High Blood Pressure, tablet Depin of 10 mg was administered to the patient. Injection Pitosin was also administered. At 8.00 p.m. Blood Pressure of patient was 142/96, Heartbeat of foetus was 130 per minute. P.V. was fully dilated. Head of foetus was station -1. Patient was planned for episiotomy. Superficial (small) episiotomy was taken. Appellant waited for 10 minutes for head descend. Appellant noticed capute formation. He also noticed obstructed head. At 8.10 p.m. episiotomy was sutured and bleeding was prevented. Patient was planned for Caesarean operation at 8.10 p.m. Blood sample was collected and sent for Laboratory Report. Services of Anesthetist were requisitioned. At 8.40 p.m. Blood Pressure of patient was 150/100, Heartbeat of foetus was 130 per minute. P.V. was found fully dilated. Station was -1 and capute was ++. Appellant received Laboratory Report at 8.40 p.m. Haemoglobin was 7.1 gm. Haemoglobin was very low. Anesthetist Dr.Tasgaonkar arrived in the Hospital of the appellant. After having noticed High Blood Pressure and low haemoglobin, he refused to administer anesthesia to the patient. He thereafter left the Hospital. At 8.45 p.m. appellant referred the patient to Civil Hospital, Satara. At that particular point of time, Blood Pressure of the patient was 150/100 and Heartbeat of foetus was 120 per minute. Patient was taken to Civil Hospital by her parents at 10.30 p.m. On 04/05/2006 patient died at 11.50 p.m. in the Civil Hospital. At the time of admission, physical condition of the patient was very critical. Heartbeat of foetus had already stopped. Saline bottles and blood bottles were already requisitioned. However, blood pressure was dropped suddenly and pulse rate found increased. Because of serious critical condition of the patient Caesarean operation was not performed.
Post-mortem examination was done on the dead body. Autopsy Surgeon opined in the Post-mortem Report that cause of death was Antepartum Haemorrhage due to Abruptio placentae and severe Anaemia.
Husband of deceased Ratna Yedage filed consumer complaint in District Consumer Forum Satara. The said complaint was resisted by the present appellant. Appellant denied to have committed medical negligence. Appellant has also contended in his written statement that all the care and precautions were taken while treating the patient. Because of low haemoglobin and high blood pressure, Anesthetist refused to administer anesthesia and therefore, patient was referred to Civil Hospital, Satara. He denied to have committed any kind of medical negligence. The matter was referred to Civil Surgeon, Satara. A Committee of experts was constituted. All the relevant papers were placed before the Committee and the Committee opined that the appellant was not at fault. Patient died because of Haemorrhage. Report of Civil Surgeon exonerating the appellant is not a valid document. The Civil Surgeon did not at all consider the conduct of the appellant in refusing to treat the delivery patient, who was already admitted for the purpose of delivery.
The District Consumer Forum after appreciation of material placed on record concluded that it was a case of medical negligence and passed the order, which is under challenge.
The Supreme Court observed in Jacob Mathew V/s. State of Punjab, (2005) 6 SCC-1 that the practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence is what the law requires. In India, principle laid down in the case of Bolam is well recognized. The basic principle relating to medical negligence is laid down in the judgement of Justice McNair in Bolam V/s. Friern Hospital Management Committee, (1957) 1 WLR 582, which runs as under :-
âWhere you get a situation which involves the use of some special skill or competence, then the test as to whether there has been negligence or not is not the test of the man on the top of a Clapham omnibus, because he has not got this special skill. The test is the standard of the ordinary skilled man exercising and professing to have that special skill. A man need not possess the highest expert skillâ¦. It is well established law that it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art.â
A medical practitioner is not liable to be held negligent simply because things went wrong from mischance or misadventure or through an error of judgement in choosing one reasonable course of treatment in preference to another. He would be liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field.
In this particular case, appellant is found to be qualified for the purpose of treatment of a patient having labour pains. Patient was 9 months 20 days pregnant. She had labour pains. Therefore, she was admitted in the Hospital of the appellant. Patient was admitted at 5.30 p.m. After examination, treatment was started. Appellant accepted the case for treatment. From reading entries made in the case papers, one can jump to a conclusion that treatment which was planned at 8.00 p.m. was wrong because, position of head of foetus was at station -1. Therefore, it was not a case of normal delivery. It was a case for caesarean. Episiotomy was wrong decision. Appellant should not have waited for 10 minutes for head descend. He noticed obstructed head. Head was not found in the delivery track. Without wasting time, appellant should have taken patient for caesarean.
It is true that haemoglobin was low. But, further treatment cannot be stopped simply because haemoglobin was low. The fact cannot be ignored that patient was in labour pains. Patient was admitted for delivery. Treatment was already started. Haemoglobin can be raised by transfusing 2 or 3 blood bottles. Low blood pressure was not a serious problem. No doctor can say that he would give treatment to the patient who is safe in all respects. If doctor adopted such obstructive attitude, then who would treat serious patient and what is remedy for the serious patient. Except bare entry in the case papers, there is nothing on record to show that Anesthetist Dr.Tasgaonkar had visited the Hospital and finding low haemoglobin, he refused to administer anesthesia. Affidavit of Dr.Tasgaonkar is not forthcoming. Depin tablets are already administered to bring down the blood pressure. Having regard to the condition of the patient and no alternative, appellant should have started further treatment after giving an idea about critical condition of the patient to the members of the family of the patient. Refusal to treat is nothing but omission in performance of legitimate duties. Doctor cannot refuse to treat accepted patient after having noticed serious condition of the patient. The fact cannot be ignored that patient was at Vaduj. District place Satara is far away from Vaduj. Considerable time is required to reach at Satara. Without giving any kind of assistance, the patient was transferred in a hopeless condition. Having regard to the condition of the patient and having regard to the condition, which was noticed in the Civil Hospital at Satara, we are constrained to observe that appellant made the patient to embrace death. Appellant forced the relatives of the patient to shift the patient to the Civil Hospital at Satara in odd hours of night that too without any medical assistance. After having taking into consideration serious condition of the patient and visualizing further complications and adverse effects, appellant ought to have accompanied the patient to the Civil Hospital at Satara. All these lapses are very serious in nature. Appellant, if was unable to give treatment he would have advise relatives of the patient to shift the patient to the Civil Hospital at Satara at 5.30 p.m. itself. Appellant got admitted the patient having labour pains at 5.30 p.m. and after having noticed refusal of Anesthetist to administer anesthesia, at 8.40 p.m. advised to shift patient to a remote place, is nothing but a cruel joke. Appellant played with the life of the patient.
A reference with profit can be made to the decision of the Supreme Court in the case of Pt. Parmanand Katara V/s. Union of India and Ors., AIR 1989 SC 2039. The Supreme Court has observed in the said case that once having undertaken a case, the physician should not neglect the patient nor should he withdraw from the case without giving notice to the patient, his relatives or his responsible friends sufficiently in advance of his withdrawal to allow them to secure medical attendants. The Supreme Court has observed that no provisionally or fully registered medical practitioner shall willfully commit an act of negligence that may deprive his patient or patients from necessary medical care. The Supreme Court observed that it is paramount obligations of the doctors to save human life and bring the patient out of risk zone at the earliest with a view to preserve life. It is stated that there can be no second opinion that preservation of human life is of paramount importance. That is so, on account of fact that once life is lost, statusquo ante cannot be restored as resurrection is beyond the capacity of the man. The Supreme Court further observed that every doctor whether at Government Hospital or otherwise has professional obligations to extend his services with a due expertise for protecting the life. The Supreme Court concluded that whenever on such occasions, man of medical profession is approached and he finds that whatever assistance he could give is not sufficient really to save life of a person, but some better assistance is necessary, it is also duty of the man in the medical profession so approached to render all the help which he would and also see that person reaches the proper expert as early as possible.
The appellant failed in professional obligations to extend services with a due expertise for protecting the life of the patient. He had not given an advice to shift the patient to Satara at the very juncture when the patient was admitted in his Hospital. He did not visualize the difficulties that would arise in future in case of complications. Having noticed the critical nature of the patient, he should have accompanied the patient to Satara.
Hippocrates â the father of medicine recommended certain principles to be followed by health workers. These principles with some modifications are accepted by the new practitioners in the form of oath. Every medical practitioner before registering him with Medical Council takes oath of Hippocrates. Item No.4 of oath of Hippocrates is very important. It reads as under :-
â4) I will use treatment to help the sick according to my ability and judgement, but I will never use it to injure or wrong them.â
In the case in hand, refusing to treat further, the appellant caused serious wrong to the patient.
The world Medical Association at its third General Assembly at Geneva in September 1948 adopted a certain code of ethics in the form of an oath to be taken by all members of the Medical Profession at the time of entering in to the Medical Profession. The Declaration is as follows :-
â1) I solemnly pledge myself to consecrate my life to the service of humanity.
2) I will give to my teachers, the respect and gratitude which is their due.
3) I will practice my profession with conscience and dignity.
4) The health of my patient will be my first consideration.
5) I will respect the secrets which are confided in me.
6) I will maintain by all the means in my power, the honour and noble traditions of the Medical Profession.
7) My colleagues will be my brothers.
8) I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.
9) I will maintain the utmost respect for human life from time of conception even under threat, I will not use my medical knowledge contrary to the laws of Humanity.
10) I make these promises solemnly, freely, and upon my honour.â
In the case in hand, the appellant is found to have ignored item Nos.3,4 and 9 of the Declaration of Geneva Convention 1948. The appellant was not conscience in his medical profession. He did not consider the health of his patient as his first consideration. He did not show the utmost respect for human life.
After having scanned the evidence on record and after having considered the facts and circumstances of the case, we are of the clear opinion that treatment administered by appellant to the patient was blameworthy. He did not act promptly in advising patient to shift to Civil Hospital at Satara where better facilities are available. Appellants advice to shift patient at 8.40 p.m. was wrong. Appellant should not have refused medical treatment after having found obstructed head. He could have requisitioned services of another Anesthetist. Nothing is placed on record to show that Dr.Tasgaonkar was the only Anesthetist at Vaduj or in the vicinity. Appellant failed to transfuse blood to increase haemoglobin. Appellant refused to treat after condition of the patient become some what critical. After requisitioning another Anesthetist and after giving information about seriousness of the case, appellant ought to have given further treatment. All these lapses are serious in nature and therefore, impugned order passed by the District Consumer Forum is perfectly legal and correct. The appeal filed by the appellant is devoid of any merits. In the result, we pass the following order :-
Order:
1. Appeal stands dismissed with no order as to costs.
2. Misc. Appl. No.493/2008, which is for stay stands disposed of.
3. Copies of the order be furnished to the parties.