Going against the law does not bode well. A hospital and obstetrician realised this fact in a rather unpleasant manner.
Irrefutable Facts
The patient, herself a gynaecologist, and a known case of asthma, was under the ANC of the obstetrician at the hospital during her second pregnancy. USG study and Amniocentesis revealed a single umbilical artery and an abnormal short arm of Chromosome No. 22 (pq22+).
The patient had apprehension about an abnormal foetus and Intrauterine Growth Restriction (IUGR) and therefore, approached another obstetrician for termination of pregnancy in the 26th week.
Accordingly, the patient was admitted to the hospital for preterm induction of delivery and delivered a gasping foetus. The foetus did not survive despite resuscitative measures.
Due to non-expulsion of the placenta even after one hour of delivery, it was decided to perform manual removal of the placenta (MRP) under General Anaesthesia (GA) in the OT.
Before induction of anaesthesia, the patient suffered severe bronchospasm and vomited, which caused aspiration pneumonia, and despite taking resuscitative measures, the patient had a cardiac arrest and died.
The hospital neither referred the dead body for post-mortem nor treated it as a ‘Medico-Legal Case’ (MLC) by informing the police.
Patient’s family sued the hospital and second obstetrician. It was alleged that the obstetrician jumped to the conclusion of immediate termination of pregnancy after chromosome 22ps+ in the foetus, and a single umbilical artery with foetal IUGR was reported in investigations.
It was further alleged that the obstetrician conducted preterm induction of labour and performed MTP in 26th week of pregnancy which was against the law.
Doctor’s Plea
The hospital and obstetrician pointed out that the patient was irregular in ANC follow-up; was reluctant to undergo Karyotyping test to confirm any foetal anomaly due to the fear of wasting 2-3 weeks for investigations, and by that time, the pregnancy would reach 28th – 29th weeks with a viable foetus.
It was stated that the couple was explained the risks and complications associated with MTP, given patient’s history of asthma. However, they requested an abortion to get rid of the abnormal foetus.
It was further stated that patient’s attendants were satisfied with the treatment provided at the hospital, and requested not to perform a post-mortem. Therefore, there was no question of informing the police.
Court’s Observations
The court observed that the hospital “was duty bound to duly conduct the post-mortem and it cannot take a defence that the attendants or relatives of the deceased wanted otherwise”. An adverse inference was drawn against the hospital for not treating patient’s death on the operation table as a medico-legal case and for not informing the local police.
The court did not accept the defence that MTP was performed at patient’s insistence. The court pointed out following glaring lapses on the part of the hospital, which violated the MTP Act 1971:
- Informed consent was not taken in the prescribed format to perform MTP
- Opinion of 2 gynaecologists was not obtained before performing MTP
- MTP was performed at the 26th – 28th weeks of pregnancy
The court perused expert evidence and opined that it was a case of the single umbilical artery and minor chromosomal abreaction (pq22+) which does not warrant any drastic measures to terminate the pregnancy. The court concluded that the “instant case appears to be therapeutic misadventure”.
Hence, the hospital and obstetrician were held negligent and directed to pay compensation of INR 1 crore.
Prevention Is Better Than Cure
- All cases of ‘Death-on-table’ (DOT) should undoubtedly be treated as medico-legal cases (MLC). The treating doctor / hospital should inform the nearby police about the same and refer the dead body for post-mortem. The patient’s attendants have absolutely no role to play in this decision.
- Statutory law (written law) must be followed strictly, both in letter and spirit. Failure to follow the same has well-defined consequences. In this judgment, the National Consumer Commission has gone a step further and held that “the violation of the statute per se constitutes an act of ‘commission’ and as such ‘negligence’.” In this case, the patient, herself a gynaecologist, underwent MTP at 28th week of pregnancy. This is clearly prohibited under the MTP Act.
Source : Atanu Dutta & Ors. v/s Shri Mool Chand Khairati Ram Hospital & Ayurvedic Research Institute & Ors.
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