State Of Gujarat & Ors vs Premadevi Vidyadhar Tiwari & Anr

V.K. Jain, J

The complainant / respondent No.1 Smt. Premadevi Vidyadhar Tiwari, was admitted in the Gynec Ward of Bapunagar General Hospital at Ahmedabad on 26.9.1999 at about 7.40 pm. for delivering a child. On her examination it was noted that she had an old cervical tear on the mouth of her uterus. At about 8.50 a.m. on 27.9.1999, the doctors detected that the child had expired in the womb itself, due to strangulation caused by umbilical cord around the neck. Instead of attempting a forced delivery, the doctors waited for the delivery to happen in the normal course. It was detected at about 10.30 pm on 28.9.1999 that her uterus had ruptured. An operation was thereupon performed for removal of her uterus. Alleging negligence on her treatment, the complainant approached the concerned State Commission by way of a consumer complaint, impleading State of Gujarat, Director of General Hospital, Dr. Laxmiben, Incharge of Gynec Ward of Bapunagar Hospital and Dr. Ilaben of the aforesaid hospital as the opposite parties.

The complaint was resisted by opposite party No3. Dr. Laxmiben, who inter-alia stated in her reply that there was no negligence or defect in the services provided to the complainant and that the uterus had to be removed in order save the life of the complainant, after obtaining written consent of her husband.

Vide impugned order dated 14.5.2010, the State Commission allowed the complaint against the appellants State of Gujarat, Director of General Hospital and Dr. Ilaben of Bapunagar General Hospital. Being aggrieved from the order of the State Commission, the appellants are before this Commission by way of this appeal.

During the course of arguments on 01.11.2018, I specifically asked the learned counsel for the complainant as to what, according to the complainant was the negligence of the doctors, who treated her in the hospital. The learned counsel stated that the negligence was in waiting for normal delivery for 36 hours despite the child having already died in the womb in the morning of 27.9.1999. The surgery for removal of the uterus was performed in the morning of 29.9.1999 and according to the learned counsel for the complainant, the uterus had got ruptured on account of the doctors having waited till the morning of 29.9.1999 despite the child having died in the morning of 27.9.1999. This was recorded in the proceedings of 01.11.2018. In his written submissions filed on 06.11.2018, the learned counsel for the complainant has relied upon the noting indicating rupture of the uterus at 11.20 p.m. on 28.09.1999.

It is not in dispute that on sonography performed in the morning of 27.9.1999 it was detected that the child had died in the womb due to strangulation caused by umbilical cord. It is also an admitted position that the rupture of the uterus was detected at about 11.20 pm on 28.9.1999 and the surgery for removal of the uterus was performed in the morning of 29.9.1999. The case of the appellants is that in case of death in the womb, the foetus is ordinarily delivered in the normal course and doctors can wait upto two weeks or the normal delivery of a dead child. This is also their case that the uterus had not ruptured on account of the doctors having waited for the normal delivery to happen and that it had happened on account of an old tear in the mouth of the uterus coupled with the rather feeble health of the complainant who was hospitalized for her seventh delivery and had grown weak.

No Medical Literature has been produced by the complainant to satisfy this Commission that the doctors were not justified in waiting for the delivery of the dead child to happen in the normal course and that they should have attempted a forced delivery as soon as the foetus had died in the womb of the mother. The appellants on the other hand have relied upon the Williams Obstetrics, Eighteenth Edition, F. Gary Cunningham, M.D, Professor and Chairman, Department of Obstetrics & Gynaecology, University of Texas, Paul C. MacDonald, M.D. Professor, Department of Obstetrics & Gynaecology and Biochemistry, University of Texas and Norman F. Gant, M.D., Professor, Department of Obstetrics & Gynaecology, University of Texas. The above referred work to the extent it relates to foetal death and delayed delivery reads as under:

" In general, during the past two decades, the management for the woman whose foetus has died and who fails to go into labor spontaneously has changed from watchful waiting to more active intervention. Although most women will eventually go into labor spontaneously, the psychological stress imposed upon the mother carrying a dead foetus, the dangers of blood coagulation defects that may develop, and the advent of more effective methods of induction of labor have increased the desirability of early delivery. With the widespread availability of real-time ultrasound equipment, any doubts about foetal death can be resolved quickly and reliably. Still, since the majority of women enter spontaneous labor within two weeks of foetal death (Goldstein and Reid, 1963, Tricomi and Kohl, 1957), and in the absence of other complications, attempts to evacuate the uterus may be delayed for this interval."

It would thus be seen that though the emerging trend for the management of the women whose foetus dies in the womb is towards an active intervention instead of keeping a watch and waiting for the normal delivery to happen, most of the women do deliver the dead baby in the normal course. It further shows that majority of women go into spontaneous labour within two weeks of foetal death and unless there are other complications in the meanwhile, evacuation of the uterus can be delayed for upto two weeks.

It can hardly be disputed that a forced evacuation has its own complications and side-effects upon the mother. Therefore, it not be an act of negligence on the part of the doctor to wait for about two weeks, for the delivery to happen in normal course, unless there are complications justifying immediate evacuation of the uterus. In the present case, there is no evidence of the complainant having developed such complications between the morning of 27.9.1999 and the night of 28.9.1999, justifying immediate evacuation. Therefore, in the interest of health and welfare of the complainant herself, the treating doctor in my opinion was justified in deciding to wait for the delivery to happen in the normal course. The appellants therefore cannot be said to be negligent in the treatment of the complainant only because they did not attempt a forced delivery before the morning of 29.9.1999.

As regards, the rupture of the uterus, there is no evidence to prove that the said rupture happened on account of the doctor having not attempted evacuation of the uterus between the morning of 27.9.1999 and 29.9.1999. No expert evidence was produced to prove that the uterus was not likely to rupture had the force evacuation been attempted immediately after the morning of 27.9.1999. No Medical Literature has been produced before me to prove that the rupture of the uterus is a probable consequence in case the delivery of a dead child is delayed even for 48 hours. Moreover, it also has to be kept in mind that there was already a tear at the mouth of the uterus of the complainant when she was admitted in the hospital. Therefore, there is a reasonable probability of the rupture having happened on account of the said tear coupled with the frail health of the complainant. In any case, the onus was upon the complainant to prove that the rupture of the uterus had happened on account of the doctor having waited till the morning of the 29.9.1999 instead of attempting forced delivery of the dead child immediately after the morning of 27.9.1999 and no expert evidence has been produced to substantiate the said allegations.

For the reasons stated hereinabove, the impugned order cannot be sustained and the same is hereby set aside. The complaint is consequently dismissed.