Kirti B. Nayak vs Sonalben S. Vyas

THIS present First Appeal has been filed by the Appellant/Opposite party No. 1 against the order passed by the State Commission of Gujarat directed the Appellant to pay an amount of Rs. 2.5 lacs along with 6% interest from the date of complaint, plus Rs. 10,000 as a cost to the Complainant. The relevant facts are in brief that, on 17.10.1997 the Complainant Mrs. Sonalben, 24 years, during her pregnancy suffered pain and consulted the OP -1 Dr. Prakash L. Nayak, Harikripa Maternity and Surgical Nursing Home, at Kodi. The OP -1 after examination, informed her that, the bleeding was due to separation of foetus from placenta. Hence, the OP -1 without giving any emergency treatment referred her to the OP -2 Dr. Kirti B. Nayak, Mahalaxmi General Hospital at Kalol. The OP -2 without examining her, informed about need of immediate operation and, accordingly, the OP -2 performed caesarean operation (LSCS), took out the dead foetus. The complainant alleged that, the consent was taken afterwards. Even though the bleeding did not stop, hence, the OP proceeded for hysterectomy operation without her and her husband''s consent. She was very young married woman and due to loss of uterus, her active life became pathetic. Hence, alleging that, the OPs acted negligently, it was a medical negligence and deficiency in service to remove the uterus, the Complainant filed a complaint before State Commission and prayed for compensation of Rs. 5,30,000 from OPs.

AFTER hearing the parties and going through the evidence, the State Commission partly allowed the complaint against OP -2 and dismissed the complaint against OP -1. The OP -2 was directed to pay Rs. 2,00,000 and Rs. 50,000 towards mental agony and Rs. 10,000 as cost. Aggrieved by the order the OP -2 approached this Commission through the first appeal for setting aside the order passed by the State Commission. We have heard both the parties. The Counsel for the Appellant/OP vehemently argued that the State Commission has favoured the complainant, some of the facts are untouched, the Complainant brought fresh plea at the Appeal stage. The State Commission erroneously held that the consent was not taken prior to hysterectomy operation. It was a dire emergency as the patient was bleeding continuously, uterus was flabby (atonic uterus) and in such cases the hysterectomy was the lifesaving treatment. Therefore, the Appellant/OP -2 conducted the operation to save the life of the patient. Hence, it was not a negligence. The Counsel submitted that, the Kodi was the small place, and the medical facilities were not adequate, up to the mark. Hence, the OP -1 referred the patient to OP -2 for further the delivery and treatment.

THE Counsel for the Complainant, argued that, as per the medical literature there was no need of LSCS for the delivery of dead foetus, which caused haemorrhages leading to subsequent hysterectomy. He brought our attention towards the text from Morrison Book which is reproduced as follows: Abruption placentae: It the clinical signs are indicative of retroplacental bleeding and the infant is still alive and of reasonable viability, prompt abdominal delivery affords the only sound prospect of a live birth. I believe there is virtually no place for caesarean section when the fetal heart is no longer audible.

ON perusal of medical records and the evidence of OP -2, we are of the considered view that, the patient suffered Abruptio Placentae which caused haemorrhages. At first instance the OP -2 performed LSCS for extraction of dead fetus, but still the bleeding did not stop, hence the OP -2 performed hysterectomy. We have perused several medical text books and literature on "Obstetric Haemorrhages", the Anesthetic and Obstetric Management of High -Risk Pregnancy by Sanjay Datta, Springer edition. A Textbook of Postpartum Haemorrhage: A Comprehensive Guide to Evaluation, edited by Christopher B -Lynch. Accordingly, the Abruptio Placentate is an emergency condition. Obstetric haemorrhage is the most common emergency indication for peri partal bleeding caused by "Couvelaire" uteri resulting from abruption placentae. Placental abruption often happens suddenly. Left untreated, placental abruption puts both mother and baby in jeopardy. Current understanding of coagulopathies and replacement of clotting factors along with increasing confidence in current oxytocic agents have reduced the necessity to remove the Couvelaire uterus to a rare circumstances. But, the Obstetric haemorrhage that remains unresponsive to medical and obstetric management may require treatment via hysterectomy. The decision to proceed with a hysterectomy should take into account several factors. Obviously mother''s life is of paramount concern. It should be judged taking into account maternal safety, the urgency of situation, likelihood of success with other options, and desires to have a patient to have additional children. We have perused the consent form, the OP -2 took a Consent prior to caesarean operation, it was informed, valid consent is reproduced as below: "I undersigned Chandrikaben Pramodbhai Naik, Ajaybhai Kanhiya Lal Naik, age...resi. of illegible, hereby give my consent for my operation and authorize him that in case of necessity during operation, he can act in my favour."

THEREFORE , to summarise that, the OP -2 was a qualified and experienced Obstetrician and Gynaecologist, his clinical decision was correct as per the standard of practice during the emergency like "obstetric haemorrhages due to abruption placentae or by Couvelaire uterus. He has made all efforts like blood transfusion, and medical management to arrest the bleeding, which remained unresponsive. Hence, his decision to conduct hysterectomy was not wrong, as obviously mother''s life was of paramount concern. Her life was saved by hysterectomy.

IN the case of Kusum Sharma v. Batra Hospital, : (2010) 3 SCC 480, discussed several principles to decide negligence have been laid down, the relevant Para is reproduced as: "(xi) The medical professionals are entitled to get protection so long as they perform their duties with reasonable skill and competence and in the interest of the patients. The interest and welfare of the patients have to be paramount for the medical professionals."

We would like to put more reliance upon the Bolam''s Test and the several judgments of Hon''ble Supreme Court on Medical Negligence, accordingly we do not find any negligence caused by the Appellant/OP -2 who took proper decision at proper time to save the life of patient. We do not find any negligence committed by OP -2. We therefore, accept the Appeal filed by the Appellant and set aside the order passed by the State Commission. The complaint is dismissed. No order as to costs.