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Lack of proper informed consent costed Hospital Rs.464000

Lack of proper informed consent costed Hospital Rs.464000

“Whether in C-Section delivery, PPH (postpartum hemorrhage) can be avoided ” ?

“When anemic patient is about to deliver Twins, whether delivery is to be done C-Section and whether blood transfusion had to be given at the initial stage itself” ?

The National Commission was dealing with above referred questions in the case of GOVIND SHAMRA V/s. SEVAYATAM HOSPITAL SODALA, in R.P. No.3540/2008 and by its judgment dated 15th march, 2016, it decided, on facts, against the Doctors thereby imposing damages of Rs. 4,50,000/-.…

The brief facts

Complaint submitted that:-
1. The Complainant’s wife was treated in the Opposite Party Hospital and on 13.10.1998 the Patient was admitted in the Hospital for delivery. She had delivered twins, but her hemoglobin was only 7.5 gm and that she was anemic, but proper care was not taken because of which she died due to postpartum hemorrhage (PPH).
2. The Hospital was in the knowledge of the Patient’s anemic condition, but did not make arrangements for Blood Transfusion (BT) and at prime moment patient was referred to another hospital for BT.

Lack of proper informed consent costed Hospital Rs.464000

Case of the Doctors :
1. The Opposite Party filed contended that there was no negligence on their part. Proper informed consent was taken and that all the preliminary necessary tests were done and the results were found normal.
2. The Hospital pleaded after three months, her hemoglobin percentage increased to
8.6 gm which level is found in 50% of the women in India and for which immediate transfusion is never done. They denied that as per Medical Standard, at the time of delivery the hemoglobin ought to be 10 to 12 gm. and that had the delivery been done by C-Section, the Patient would not have suffered from postpartum hemorrhage (PPH). PPH may arise even when sometimes uterus has to be removed.

3 : The National Commission held :
It referred to the State Commission’s observations that
a) “…Despite finding the lesser quantity & percentage of hemoglobin and that the patient was to give birth to twins, nor arranging for blood and not even instructing the complainant for bringing blood, shows that the opposite party respondent has been completely negligent in his regard. The PPH was obvious in the twins. If caesarean delivery was done, then due to lesser quantity of hemoglobin blood transmission was obvious and if it was a normal delivery of twins then also there was every possibility of haemorrhage. In such a situation pre-arrangement for blood was very essential. It is also proved from the record that death of Smt. Usha occurred due to her anemic condition.

b) It may be right that on part of hospital to contend that the decision to go for a normal or C-section delivery depends on various parameters and not merely on whether the delivery was for twins or not, but the fact remains that when the Patient was in an anemic condition delivering twins, no proper care or caution was taken by the Hospital by making arrangement for blood transfusion.

c) It rejected the argument of Hospital that had the delivery been done by C-Section, PPH would not have occurred, as according to medical science PPH can take place at any time.

d) In the medical record it is mentioned that on admission, the patient was diagnosed as anemic and in the indoor ticket that the first twin was delivered using low mid cavity forceps and the second twin was delivered through assisted breech delivery. But the record is completely silent about the precautionary arrangements which ought to have been made for procurement of blood and if necessary blood transfusion, in such situation. The subsequent “requisition for blood” appeared to be inserted afterwards as the handwringing was different. It is came on record that the patient was brought to subsequent Hospital in a very serious condition and in requirement of urgent blood. The Sr. Doctor also opined that in case of delivery of twins, chances of PPH are increased.

e) The proper informed consent for forceps delivery, knowing all consequences was not taken by the Hospital as per the norms laid down by the Hon’ble Apex Court in its landmark judgment of Samira Kohli Vs. Dr. Prabha Manchanda (2008) 2 SCC 1. (Please see the link and BY HEART the guidelines)
f) Thus deceased who died at very early age of 22, leaving behind two small children, the commission increased the compensation from 2 lacks to Rs.4,64,000/-

Lack of proper informed consent costed Hospital Rs.464000

Thanks & regards

Adv. Rohit Erande

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