ORIGINAL PETITION NO.250 OF 1997

C.H. Jayaram & Ors. … Complainants

V/s.

Dr. Mallika Samuel & Anr. … Opp. Parties

BEFORE:

HON’BLE MR. JUSTICE M.B. SHAH, PRESIDENT

MRS. RAJYALAKSHMI RAO, MEMBER

For the Complainants : Mr. Rajan Khosla, Advocate

For the Opp. Party No.1 : Mr. Siddhartha Dave, and

Mr. T.S. Sridharan, Advocates

For the Opp. Party No.2 : Ms. Surekha Raman, Advocate

DATED: 24.10.2005

O R D E R

M.B. SHAH, J. , PRESIDENT

Heard the Learned Counsel for the parties.

This complaint is filed by the father, the husband and the child of the deceased, Mrs. Sangeeta S. (hereinafter referred to as the patient). At the time of the expected date of delivery she was aged about 29 years. It is the contention of the Complainants that the patient was taking psychiatric treatment for years, hence, prior to death and before the delivery her psychiatrist in Bombay was consulted for a normal vaginal delivery. It is also stated that the first opponent, Dr. Mallika Samuel had also also obtained the opinion of the psychiatrist in Madras. As she was not having any labour pains on the expected date of delivery, she was, therefore, admitted in the hospital of Opposite Party No.2 on 19^th February, 1996 under the care of Opposite Party No.1. After the admission, as the patient was not having any labour pains opposite party No.1 decided to induce labour pains by means of drugs. Ultimately she delivered a male baby at 3.31 p.m. (Complainant No.3).

It is contended that after delivery, the patient never came out alive. She died on the same day as opposite parties mismanaged and neglected her which led to her ultimate death. Hence this complaint was filed for deficiency of service with a prayer that the opposite parties be directed to pay Rs.7 lakhs to the Complainant No.1 (Father), Rs.7 lakhs to Complainant No.2 (Husband) and Rs.2 lakh to Complainant No.1 for having to bring up the baby as his mother died and to pay Rs.5 lakhs to the third Complainant for depriving him of the love, affection, care of a mother since his birth.

In the written version the opposite parties denied that there was any deficiency in service or negligence in treatment on the part of the opposite party No.1.

It has been pointed out that patient Smt. Sangeeta S died due to Amniotic Fluid Embolism leading to afibrinogenimia and defective clotting mechanism. For this purpose, opposite parties have filed affidavit of O.P.No.1 and two other experts; one is Dr. (Mrs.) Devambigai, M.D.D.G.O., Consultant Obstetrician & Gynaecologist, who was working as a Senior Consultant Obstetrician at Wellingdon Hospital, Madras. It is her say that at about 5 O’ Clock O.P.No.1, Dr. (Mrs.) Mallika Samuel asked her to come to the labour room at Wellingdon Hospital. She went there at about 5.35/5.40 P.M. and found the patient very restless. She was on oxygen. Her uterus was well contracted and the patient was further examined for any tears during the delivery and none were found and the corrective steps which are the standard protocol for prevention of PPH (Post Partum Haemorrhage) were taken by Dr. Mallika. She had suggested giving blood only as a supportive therapy. In her opinion, the patient must have had an embolism at the time of delivery or just thereafter and the treatment of amniotic fluid embolism is mostly unsuccessful. Dr. Mallika Samuel has also stated to the same effect and her affidavit is in detail. These Doctors are not cross-examined. Their version stands accepted.

However, in support of their case the Complainants have examined Dr. I.B. Bandookwala who had given opinion previously to the effect that the death was not due to Amniotic Fluid Embolism. In cross-examination he was virtually required to admit that it was because of erroneous reason or against the medical texts. The relevant part of the cross-examination is given below :

“8) In medicine we never use word ‘Never’ as there may be a possibility. According to me “a remote” in last lines means almost nil. “Little Bleeding” means none. I deny the suggestion that I am now playing with the words and want to wriggle out of the fact that there was a possibility of embolism occurring as alleged by the Opp. Party. In para 15 sub-para 3, I have stated in inverted commas as follows “In the typical case of Amniotic Fluid Embolism, the woman is labouring vigorously or, having just done so, is in the process of being delivered when she develops varying degrees of respiratory distress and circulatory collapse.” This observation is from Willams Obstetrics. I am now shown Text Book published in 2001 Page 662 by same author marked red, which says that that the diagnosis is generally made by identifying clinically characteristic signs and symptoms. This is correct now and not correct when the event occurred.

Q) I put it to you that symptoms of a.f.e. (amniotic fluid embolism) were present at that time and doctor attending the patient viz. Opp. No.1 correctly diagnosed it.

A) I deny this.

9) I am now shown page 660 Ed.2201 by the same author – marked red “In obvious cases, the clinical picture frequently is dramatic. Classically a woman in the late stages of labour or immediately postpartum begins gasping for air, and then rapidly suffers seizue or cardiorespiratory arrest complicated by disseminated intravascular coagulation, massive hemorrhage, and death.” These observations are of later date and I have not relied on them since the event is of earlier date.

Q) In the light of new developments adumbrated above, whether you would stick to your opinion or modify it in the light of observation.

A) I would modify my opinion but not completely.

10) I have seen the book by Clarke “Critical Care Obstetrics, 2001 Ed. On manifestation of A.F.E. and it throws a new light on the subject of A.F.E.I still stand by my opinion but certainly modify in the light of these observations (Page 405). I however deny that with this medical literature my opinion stands totally subverted.

11) According to me for the diagnosis of AFE hypotension, hypoxia and consumptive coagulopathy, torrential bleeding must be present. This was not reported. I am now shown D-3, page 405 rt. Side bottom of Critical care Obstetrics (Clarke). I find that the author says any of the above symptoms would be absent. I do not agree totally since this is the opinion of a particular author. I am now shown Ex.D-2 of later edition Page 660 ‘Williams’ whom I have relied upon for opinion (marked red) I do not fully agree with authors 21^st Edition.”

From the aforesaid admissions in the cross-examination, it is apparent that the opinion given by the witness is not of any importance.

Further, the treatment which was given to the deceased was in accordance with the medical practice. For this the learned Counsel for the Opposite Party No.1 Mr. T.S. Sridharan has referred to medical books on Critical Care Obsetetrics old edition, new edition and third edition by Steven L. Clarke & Ors. In Clarke’s Clinical Presentation on Critical Care Obstetrics it has been pointed out as under :

“It must be emphasized, however, that in any individual patient, any of three principal phases (hypoxia, hypotension, or coagulopathy) may either dominate or be entirely absent (Clarke, 1995; Porter, 1996). Clinical variations in this syndrome appear to be related to variations in both antigenic exposure and maternal response.

Maternal outcome is dismal in patients with AFE syndrome. The overall maternal mortality rate appears to be 60% to 80% (Clarke, 1990, 1995). Only 15% of patients, however, survive neurologically intact.”

In Willams Obstetrics (Old Edition) under heading of Amniotic Fluid Embolism, it has been stated as under :

“ In the typical case of amniotic fluid embolism, the woman is laboring vigorously, or has just done so, and is in the process of being delivered when she develops varying degrees of respiratory distress and circulatory collapse. If the woman does not die immediately, serious hemorrhage with severe coagulation defects is soon evident from the genital tract and all other sites of trauma.

Treatment. Therapy for amnionic fluid embolism is notoriously unsuccessful.”

Similarly, in Willams Obstetrics (new edition) it has been pointed out that :

“Thus this finding is neither sensitive nor specific, and the diagnosis is generally made by identifying clinically characteristic signs and symptoms. In less typical cases, diagnosis is contingent upon careful exclusion of other causes.”

Considering the evidence on record and the medical texts on the subject, it cannot be said that there was any deficiency on the part of the Opposite Party No. 1 in giving treatment to the deceased. Learned Counsel for the Complainants was not in a position to point out any deficiency in the treatment given to her.

Learned Counsel for the Complainants, now submitted that Opposite Party No.1, Dr. Mallika Samuel was not qualified to practice as a specialist in Obstetrics & Gynaecology & Ultrasonology as she was having diploma from University of Dublin, Trinity College which is not recognized by the Medical Council of India.

As against this it has been pointed out that Opposite Party No.1 is fully qualified as she has passed M.B.B.S. from Christian Medical College, Vellore in April 1979; she had internship at Christian Medical College, Vellore from 16.6.79 to 15.6.80; and thereafter obtained Diploma in Licentiate of Midwifery at the Rotunda Hospital,Dublin, Ireland in February 1990 which is recognised by the Medical Council of India. Again she obtained diploma in Obstetrics and Gynaecology, Dublin; She obtained training in Obstetrics and Gynaecological Ultrasound at Rotunda Hospital, Dublin, Ireland from April to May 1990. Thereafter, she obtained training in Gynaecological Endoscopy (Laproscopy and Hysteroscopy) at Wadia Hospital, Bombay in 1995. She has also performed duties at various hospitals as Obstetrics and Gynaecology. She has published various papers and attended workshops. It is also not in dispute that the deceased was admitted to the hospital for normal delivery and that normal delivery could be carried out by Doctor having qualification of MBBS or a person having Diploma in licentiate of midwifery. Admittedly, she is having those qualifications. Therefore, it cannot be said that opposite party No.1 was not having necessary qualifications.

Learned Counsel for the Complainants, however, submitted that in the affidavit dated November, 2003 filed before this Commission she has stated that she was a specialist in Obstetrics and Gynaecology and Ultrasonography and that this is in violation of rules framed by the Medical Council of India. As against this, Learned Counsel for the opposite parties submitted that rules which are framed by the Medical Council of India in 2002 would have no bearing in the present case as the patient was admitted in the Hospital in 1996. In our view the said question is not required to be dealt with as the Doctor was duly qualified because the case was of normal delivery.

In this view of the matter, there is no substance in this complaint. Hence, it is dismissed. There shall be no order as to costs.

Sd/-

……………………………J

(M.B. SHAH)

PRESIDENT

Sd/-

……………………………….

(RAJYALAKSHMI RAO)

MEMBER