DMC/DC/F.14/Comp.794/2012/
18th July, 2012
ORDER
The Delhi Medical Council through its Disciplinary Committee examined a
complaint of Shri Mumtaz Ahmed, forwarded by Medical Council of India, alleging
medical negligence, in the treatment administered to complainant’s wife late
Rashida resulting in her death on 10.9.2010 at Lok Nayak Hospital, New Delhi110002.
The Order of the Disciplinary Committee dated 8th June, 2012 is reproduced
hereinbelow:The Disciplinary Committee of Delhi Medical Council examined a complaint of Shri Mumtaz Ahmed
r/o. 156/22, Jakhir Nagar, Okhla, New Delhi– 110025 (referred hereinafter as the complainant),
forwarded by Medical Council of India, alleging medical negligence, in the treatment administered to
complainant’s wife late Rashida (referred hereinafter as the patient), resulting in her death on
10.9.2010 at Lok Nayak Hospital, New Delhi-110002.
The Disciplinary Committee perused the complaint, written statement of Dr. Rita Malik, Dr.
Kamleshwar Prasad Sinha, Dr. Ravindra Sabharwal, Medical Superintendent, Jeewan Hospital &
Nursing Home-2, Jeewan Nagar, Opp. Maharani Bagh, New Delhi-110014, joint written statement of
Dr. Raka Guleria and Dr. Y. Pande, Medical Superintendent, Holy Family Hospital, Okhla Road, New
Delhi-110025, medical records of Jeewan Hospital & Nursing Home-2, Holy Family Hospital, and
other documents on record.
Contd/:
(2)
The following were heard in person :1) Dr. Rita Malik
Consultant Gynaecologist
2) Dr. Kamleshwar Prasad Sinha
Consultant, Jeewan Hospital &
Nursing
Home-2
3) Dr. Ravindra Sabharwal
Medical Superintendent, Jeewan Hospital &
Nursing Home-2
4) Dr. Raka Guleria
Consultant
Gynaecologist,
Holy
Family
Hospital
5) Dr. Y. Pande
Medical Superintendent, Holy Family Hospital
The complainant failed to appear inspite of notice.
It is alleged in the complaint that due to medical negligence committed by Dr. Rita Malik in the
delivery performed by her on complainant’s wife Rashida on 31 st August, 2010, the patient suffered
from bleeding and pain and had to be hospitalized at Holy Family Hospital (2-9-10 to 10-9-2010)
where she underwent surgery and lot of blood transfusion. On 10 th September, 2010, the patient was
referred to Lok Nayak Hospital, New Delhi. The patient expired on 10th September, 2010 at Lok
Nayak Hospital.
Dr. Rita Malik in her written statement averred that the patient was admitted in Jeewan Hospital &
Nursing Home on 29th August, 2010 at 11.20 p.m. under Dr. Kamleshwar Prasad Sinha (physician)
with a diagnosis of dengue. The patient’s platelet count was fourteen thousand and the patient was
being treated for that. She had gone to the hospital to see some other patient and noticed the patient
on the next bed. She recognized the patient because the patient had been coming to her clinic often for
her antenatal check-up. The patient was full term pregnant and the patient’s expected date of delivery
was 1st September, 2010, but the patient was not in labour, confirmed by ultrasound. The patient went
into labour spontaneously on 31st August, 2010 at 8.00 a.m. inspite of Duvadilan drip and was shifted
to the labour room. The patient delivered normally at 12.53 p.m. Mild post partum haemorrhage was
noticed. The patient was explored and shifted to operation theatre; cervical tear (Lt) was stitched
under G.A and two units of blood was transfused. The patient’s condition was stable overnight
and next afternoon. The next day in the afternoon the patient went home against medical advice at
Contd/:
(3)
2.30 p.m. on 1st September, 2010 without paying hospital dues. The patient was taking food orally and
went home walking. The complainant called at 4.00 a.m. on 2nd September, 2010 to say that the
patient was not passing urine. She was told by Dr. Rita Malik to give oral fluids and if the condition
did not improve, to attend Jeewan Hospital & Nursing Home-2. Dr. Rita Malik further stated that she
did not see or admit or advise the patient to go to Holy Family Hospital.
Dr. Kamleshwar Prasad in his written statement averred that the patient was admitted on 29 th August,
2010 at 11.20 p.m. with high grade fever for two to three days and gum bleed one day before
admission with pregnancy alongwith some blood report done outside (Blood group B positive, Hb13.7. TLC 8,700, platelets 14,000). At the time of admission, no gum bleed was there. During
admission urgent blood investigation was done. According to outside blood reports, urgent jumbo
pack platelets was advised and urgent obstetric consultation was taken. The blood report of patient
during admission showed Hb 12.7, TLC 7,200, platelets 19,000, RBS-99, SGOT 57, SGPT 22. During
hospitalization two jumbo pack platelets were transfused and daily platelet count was done. The
platelet count gradually increased to 28,000 on 30th August, 2010, 40,000 on 31st August, 2010 in
morning and 52,000 in the evening.
The patient suddenly went into labour.
The patient was
transferred under the care of Dr. Rita Malik, Consultant Obstetrician. After the delivery, the patient
was advised to stay in hospital for observation but the complainant got the patient discharged as
LAMA on 1st September, 2010 at 2.30 p.m.
Dr. Ravinder Sabharwal, Proprietor of Jeewan Hospital & Nursing Home-2 in his written statement
submitted that the patient was admitted at Jeewan Hospital & Nursing Home-2 on 29th August, 2010 at
11.20 p.m. with high grade fever with pregnancy. The patient was treated for fever with low platelet
count and the patient went into labour and was transferred under the care of Dr. Rita Malik,
Consultant Obstetrician.
Dr. Raka Guleria Consultant Obst. & Gynae and Dr. Y. Pande, Medical Superintendent, Holy Family
Hospital in their joint written statement stated that the patient was brought to the casualty of Holy
Family Hospital on 2nd September, 2010 at 6.21 a.m. with complaints of inability to pass urine and
constipation for one day, accompanied by pain in the perineal region. According to the attendants of
the patient, the patient (P1 L1) had undergone a full term normal vaginal delivery with right
Contd/:
(4)
mediolateral episiotomy on 31st August, 2010 at Jeewan Hospital & Nursing Home-2 and was
discharged from there on 1st September, 2010. The complainant also gave a history of previous
admission in Jeewan Hospital & Nursing Home-2 for the treatment of dengue fever (seven days prior
to delivery), during which the patient received three units of FFP and four units of whole blood. No
documents were available. On arrival at the casualty of Holy Family Hospital, the patient was pale,
dehydrated with PR-120 per minute, blood-pressure-110/60 mm Hg.
P/A-slight tenderness over
abdomen. Local examination- there was diffuse swelling and oedema over the perineum with bluish
discolouration of the skin. The episiotomy site was swollen and 4x4 cm haematoma was felt on the left
side (Labial area). There was a lot of tenderness on examination. There was no active bleeding at the
time of examination. The patient was catheterized and 600 ml of concentrated urine was drained.
Subsequently, the patient was shifted to the ward for evaluation and management. The patient was
diagnosed as a Vulvo- vaginal hematoma of the left side and was posted for an examination under
anaesthesia and hematoma evacuation. After explaining the condition of the patient to the complainant
and father-in-law of the patient and with their consent, the patient underwent a haematoma evacuation
on 2nd September, 2010 under general anaesthesia. As per the operation notes, the episiotomy site was
swollen-after cutting open the sutures, the site was checked for any active bleeders and re-sutured. A
tear in the left vaginal wall was noted which had been sutured. A haematoma was noted under this
laceration. The lateral vaginal wall sutures were reopened and tear explored-800ml clots were
removed. Re-suturing of the tear was done. No cervical tear seen. Generalized oozing was seen from
the stitch line. Tight vaginal packing was done. The patient received three units of packed cells and
two units of FFP before and during this procedure.
NCCT lower abdomen done on 4th September,
2009 showed a large heterogeneous pelvic collection, likely a large haematoma related to the cervix.
The patient’s condition was explained to the attendants of the patient and informed high risk consent
was taken. The patient was then taken up for an emergency re-exploration on 4th September, 2010 at
5.45 a.m.
Laparotomy and bilateral internal iliac artery ligation were also done.
The patient
received a total of seven units of FFP and seven units of packed cells and four cryoprecipitate on 4 th
September, 2010 and 5th September, 2010. The patient remained in ICU on ventilatory support and
high grade antibiotics. The patient developed dense consolidation of left mid zone of lung, for which
bronchoscopy was done on 8th September, 2010. This revealed the trachea and airways filed with
blood (due to alveolar haemorrhage consequent to DIC). Aspiraton and bronchial lavage led to
Contd/:
(5)
improvement in the patient’s respiratory function. The patient remained on ventilatory support (IPPV
mode), high dose antibiotics and supportive treatment. The patient received thirteen unites of packed
cells, four CPP, eleven units of FFP and four platelet concentrates. The attendants of the patient
requested for a case summary as they (attendants of the patient) wanted to shift the patient to Lok
Nayak Hospital. The case summary was issued to the attendants of the patient. All risks and
prognosis of the patient was explained to the attendants of the patient at every stage of the patient’s
treatment.
On 10th September, 2010, the complainant informed the doctors at Holy Family Hospital
that the complainant wanted to shift the patient to some other centre. The seriousness of the patient’s
condition had been explained to the complainant. On 10th September, 2010 at 4.30 p.m., attendants of
the patient wanted to take the patient against all medical advice. The LAMA form was signed by the
complainant. The patient was shifted to Lok Nayak Hospital with ventilator support in the ambulance
with a doctor in attendance, where she succumbed to her illness.
In light of the above, the Disciplinary Committee makes the following observations :1. The patient suffering from dengue fever underwent Full Term Normal Delivery (FTND) with
right medio lateral episiotomy on 31st August, 2010 in Jeewan Hospital & Nursing Home-2.
She subsequently developed post partum Vulvo-vaginal haematoma for which she was
operated as per standard protocol at Holy Family Hospital. Unfortunately the patient went
into DIC with pulmonary haemorrhage and succumbed to her ailments.
2. It is noted that Dr. Rita Malik in her written statement asserted that she stitched cervical tear
(left) of the patient on 31st August, 2010 during the delivery, however, the same was not
documented in the operation notes of Jeewan Hospital & Nursing Home-2.
Infact on
exploration of vagina as per operation notes of Holy Family Hospital, a lateral vaginal wall
tear was found. Similarly documentation of episiotomy site examination on 1st September, 2010
was also absent. This reflects inadequate and poor record keeping by Rita Malik at Jeewan
Hospital & Nursing Home.
In light of the observations made hereinabove, it is the decision of the Disciplinary Committee that no
medical negligence can be attributed in treatment administered to late Rashida at Jeewan
Hospital & Nursing Home-2 and Holy Family Hospital. However, Dr. Rita Malik and Medical
Superintendent, Jeewan Hospital & Nursing Home-2 are directed to ensure better record keeping for
future.
Contd/:
(6)
Complaint stands disposed.
Sd/(Dr.O.P. Kalra)
Chairman
Disciplinary Committee
Sd/(Dr. Prem Aggarwal)
Eminent Publicman
Member
Disciplinary Committee
Sd/(Dr. Shalini Raja Ram
Expert Member
Disciplinary Committee
The Order of the Disciplinary Committee dated 8th June, 2012 was confirmed by
Delhi Medical Council in its meeting held on 4th July, 2012.
By the Order & in the name of
Delhi Medical Council
Copy to :-
(Dr. GirishTyagi)
Secretary
1) Shri Mumtaz Ahmed, r/o. 156/22, Zakir Nagar, Okhla, New Delhi – 110025
2) Medical Superintendent, Holy Family Hospital, Okhla Road, New Delhi
3) Dr. Raka Guleria, Through Medical Superintendent, Holy Family Hospital,
Okhla Road, New Delhi
4) Dr. Rita Malik, C-557, Residence-cum-Clinic, New Friends Colony,
New Delhi-110065
5) Medical Superintendent, Jeewan Nursing Home-2, Jeewan Nagar,
New Delhi-110014
6) Dr. Sinha, Through Medical Superintendent, Jeewan Nursing Home,
Gate No.-2, Jeewan Nagar, New Delhi-110014
7) Deputy Secretary, Medical Council of India, Pocket-14, Sector-8,
Dwarka, New Delhi – 110077 – with reference to letter No. MCI211(2)(702)/2010-Ethics/32452 – for information
(Dr. GirishTyagi)
Secretary