New Delhi:TheDistrict Consumer Disputes Redressal Commission (DCDRC) New Delhi recently exonerated a Hospital and its four doctors- including Medical Superintendent, Gynecologist,General Surgeonand Anaesthetist, from charges of medical negligence while treating a patient suffering from complete placenta praevia Grade-IV, a high-risk obstetric condition. In order to save the patient's life, the general surgeon performed an emergency termination of pregnancy after obtaining consent and since the patient's attendants did not give consent for a hysterotomy, the patient was later referred to Lady Hardinge Hospital, observed the Commission. The history of the case goes back to 2015, when at R.P. Memorial Hospital, an MTP procedure was carried out on the complainant's wife by the treating doctors at the hospital. It was alleged that due to the negligence in treatment, the patient died on 13.07.2015 at Lady Hardinge Hospital. It was submitted by the complainant that after the patient was admitted to the treating hospital, her pregnancy was terminated by a team of doctors. At that time, she was about 18-19 weeks pregnant. Further, allegedly, her condition became serious and critical due to the negligent performance of an illegal MTP procedure without following prescribed protocols, and thereafter she was shifted toLady Hardinge Medical College& Smt. Sucheta Kriplani Hospital (LHMC), New Delhi, where she was left unattended in front of the emergency ward. He further alleged that the doctors of RP Memorial Hospital performed an 'illegal' hysterectomy (termination of pregnancy) without the consent of the patient, without obtaining a second opinion from any senior gynecologist, and without the involvement of any expert or experienced doctor. During the procedure, the patient’s condition deteriorated due to heavy blood loss, resulting in hemorrhage, disseminated intravascular coagulation, hypovolemia, and ultimately multiple organ failure. The patient was then shifted to LHMC without a discharge slip or referral letter, in a private van, and without adequate medical staff. The complainant alleged that she was left unattended in front of the gynecology casualty at LHMC and remained unattended for more than four hours, and when the treatment finally started, despite the best and genuine efforts by the LHMC staff, the patient died on 13.07.2015 at 4:30 a.m. during treatment. An FIR was registered in this connection at PS Nangloi under Section 315 IPC. After conducting an inquiry through its Disciplinary Committee regarding the role of the doctors, the Delhi Medical Council passed an order dated 17.10.2019 holding the treating doctors guilty of medical negligence. It observed that one of the treating doctors- a general surgeon, performed procedure beyond his competence. Vitals, anaesthesia chart and proper consent were not maintained, piecemeal removal of the placenta led to torrential bleeding, and the hospital also lacked adequate facilities. Further, the Council held that the patient should have been referred earlier. The registration of the general surgeon was suspended and warnings were issued to the other three doctors. Later, the Ethics Committee of the National Medical Commission (NMC) affirmed the DMC findings. The complainants filed a consumer complaint and sought compensation for unnatural death caused by negligence, loss of companionship and life amenities, deprivation of maternal care, love and affection, emotional distress and suffering, etc. On the other hand, the hospital and the treating doctors denied that the patient's pregnancy was terminated by a team of doctors. It was alleged that the Medical Superintendent of the hospital and the Gynecologist were not involved in any surgical procedure or assistance and it was not a case of pregnancy termination, but a case of hysterotomy performed by the general surgeon and anaesthetist to save the patient's life and it was done in good faith. A dead male baby was extracted, the placenta was badly adhered and did not separate spontaneously. Placenta was removed manually in pieces, but the bleeding did not stop as it was a case of placenta accreta, which is a known medical complication. They also denied the allegation that the patient's condition became serious and critical due to any alleged negligent or illegal MTP procedure, or that, when the situation went out of control, the doctors shifted the patient to Lady Hardinge Medical College (LHMC) & Smt. Sucheta Kriplani Hospital, New Delhi and left her unattended in front of the emergency ward. It is stated that no abortion procedure was done at by the treating doctors, but a hysterectomy was performed with the consent of the patient, and the consent form (R-3) was duly signed by both the patient and her husband. It was also stated that proper care was taken to control the bleeding- both iliac arteries were ligated, blood transfusion was arranged, Haemaccel and Dopamine drip were administered, oxygen support and vaginal packing were provided. Thereafter, the patient was referred to Lady Hardinge Hospital in a stable condition, with all preventive measures and protocols duly followed. Alleging that the patient was left unattended at LHMC for about three hours even after receiving the referral slip, the treating hospital and doctors denied any negligence on their part. Claiming that the NMC order suffered from non-appreciation of facts, the hospital and doctors submitted that the evidence produced by the general surgeon, including the death summary of the deceased patient and the treatment procedure adopted by the doctors at LHMC were not considered. It was also submitted that the general surgeon operated on the patient as it was an emergent situation and gynaecologists were not available. On examination, the general surgeon found that the patient was about 18–19 weeks pregnant with severe bleeding per vaginum due to placenta previa grade IV. The patient had been bleeding profusely even before arrival. It was a case of spontaneous abortion. In such an emergent situation, immediate surgical intervention was necessary to save her life. Therefore, the doctor decided to operate and evacuate the uterus (hysterotomy) to control the profuse bleeding as a life-saving measure. The treatment provided under such emergency does not amount to transgression from general surgery into gynecology, but was a life-saving necessity, they argued. The surgeon submitted that a dead foetus with two loops of cord around the neck was delivered. The placenta did not separate spontaneously due to previous LSCS and was adherent to the scar. So, the doctor manually removed the placenta, but part remained adherent, which was later separated by blunt curettage and sponge. However, bleeding continued. Since the consent for hysterectomy was not given by the patient's attendants, considering the patient's critical condition and lack of ICU facilities, the anaesthetist advised referral to a higher center. Accordingly, the patient was referred to Lady Hardinge Medical College with a referral slip, dopamine drip, packed RBCs, and oxygen support. The death summary at LHMC recorded that the cause of death was: “exploratory laparotomy with obstetric hysterectomy (total) with bilateral internal iliac artery ligation with DIC, multi-organ failure, and cardiorespiratory arrest.” Subsequent forensic opinion confirmed that termination of pregnancy was done as a life-saving measure considering the imminent danger to the patient’s life. Observations by Commission: While considering the matter, the Commission observed that it is a settled principle of law that to fasten liability ofmedical negligence, it must be shown that the medical professional failed to exercise a reasonable degree of care, skill, and knowledge which an ordinary competent practitioner would have exercised in similar circumstances. Applying the principles set by the Supreme Court in the case ofJacob Mathew vs State of Punjab,Kusum Sharma & Ors. vs. Batra Hospital & Medical Research Centre & Ors,and in the recent case ofDeep Nursing Home and Another vs. Manmeet Singh Mattewal and Others,the consumer court observed, Referring to the Delhi Medical Council's order, the Consumer Court further observed that the hospital maintained operative notes, referral information, and post-operative management records. While some vitals were not recorded continuously, the hospital staff documented key interventions, including blood transfusions, administration of necessary medications, and the surgical steps undertaken. Opining that the complainant was treated as per standard medical protocol, the Commission held that the treating doctors and hospital cannot be held negligent. It observed, Apart from this, the Commission also observed that even though the complainant alleged medical negligence, no expert evidence was filed to substantiate such allegations. "It is well settled by judicial pronouncements that in cases of alleged medical negligence, especially involving complex medical procedures, the burden lies upon the complainant to establish negligence by producing cogent evidence, which generally includes expert medical opinion. The Hon’ble Supreme Court in Jacob Mathew v. State of Punjab [(2005) 6 SCC 1] held that a doctor cannot be held guilty of negligence simply because the treatment was unsuccessful or resulted in an adverse outcome. To establish negligence, it must be shown that the doctor acted in a manner that no reasonable medical professional would have acted in similar circumstances,"it further noted. Holding that the allegations of medical negligence remained unsubstantiated, the Commission observed, Regarding the issue of proper medical consent, the Commission observed that the patient was suffering from completeplacenta praeviaGrade-IV, a life-threatening obstetric condition and the medical records showed that the consent for termination of pregnancy was signed by the patient herself and duly witnessed by her husband. Therefore, the procedure was not performed in secrecy or without authorization. "Even otherwise, in cases where the condition is emergent and delay in treatment may endanger the life of the patient, the law recognizes that doctors are permitted to act in good faith for the best interests of the patient. This principle is consistent with the exception carved out by Hon’ble Supreme Court in Samira Kohli (supra),"noted the Commission. With all these observations, the Consumer Court dismissed the complaint and noted,"Thus in view of the above findings, we hold that the complainant has failed to establish medical negligence or deficiency in service on the part of the Opposite Parties No.1 to 5. Consequently, the complaint stands dismissed. There shall be no order as to costs." To view the order, click on the link below: https://.in/pdf_upload/dcdrc-new-delhi-no-medical-negligence-304586.pdf Also Read: Consumer Court clears Lucknow hospital, doctor of medical negligence in bedsore death case