Case Study - By Mohit
Popli
Dr. Nisha M. Shrotria,
Versus Shri Pradeep Shukla
Appeal No. FA-1001/2005
(Arising from the order dated 04-10-2005 passed by
District Forum (East) Saini Enclave, Delhi in Complaint Case
No.491/2005)
Negligence: During
DNC Doctor left some piece/lump inside womb “
What is DNC?
Dilation and curettage refers to the dilation (means opening) of the cervix and surgical
removal of the contents of the uterus.
It is a therapeutic gynecological procedure a rarely
used method of first trimester abortion.
Intro:
Appellant Doctor runs a Clinic predominantly with
DNC and MTP facilities. On account of having committed medical
negligence while conducting operation for DNC upon the wife of the respondent
which ultimately resulted in her death, the District Forum has vide impugned
order dated 4th October, 2005 awarded compensation of
Rs. 2 lacs and Rs. 5,000/- towards litigation charges. Feeling aggrieved, the Doctor has preferred this appeal”
Brief Facts: Respondent (Husband of Victim)
approached Doctor for abortion of his wife. He paid a sum of Rs.
1,800/- to the Doctor for this purpose. A DNC was carried out by Doctor
on 19-02-2005. She was discharged on the same
day. A day after procedure, the condition of
wife of the respondent deteriorated. The Doctor was consulted but there
was no improvement in the condition of the wife of the respondent. Subsequently another operation was conducted by the doctors
of Lady Harding, New Delhi. It was revealed that during DNC Doctor left some piece/lump
inside her womb causing severe infection resulting in death.
Defence/Plea Taken By Doctor
At the outset the Doctor
denied having conducted DNC upon the deceased and came up with the
version that she only prescribed the medicine when she came to her with the problem
of excessive bleeding. In support of this she
relied upon the prescription slip dated 19-02-2005. On 23-02-2005 she was referred to Kailash Hospital Medical
Research Centre, NOIDA wherein she was diagnosed as a case of ‘severe anemia’. After prescribing certain medicines and pathological tests
it referred the deceased to the
Government Hospital.
Negligence Proved: She
was taken to Lady Harding Medical College where it was revealed that DNC done
was partial leaving some piece or lump inside the womb that caused severe
infection.
Finding:
It was observed by the Hon’ble Commission and
they said “After perusing the prescription slip closely. It is not understandable as to why such medicines were
prescribed by the Doctor without noting down or recording the history of the
patient. The medicines prescribed were –
(i) Ciplox
(ii) Tab. Methergen
(iii) Zincovit
(iv) Misoprost
(v) Dysmen”
Effect of Medicines
prescribed:
Ciplox is a broad-sprectrum antibiotic given
for mixed gram positive/gram negative and aerobic infections whereas ‘Zincovit’
capsule is a vitamin to restore general health and used in conjunction with
antibiotics. As regards the other medicine namely ‘Methergin’ the medical literature
provides that it is a drug to control bleeding. It has powerful contracting activity on the uterus and so
used to control bleeding and expelling incomplete products if any. It also helps in restoring size of the uterus to normal. As regards ‘misoprost’,
this medicine belongs to a group of hormones called prostaglandin. Among other things they lead to uterine contractions and
opening of the cervix. They are highly effective drugs. But their efficacy depends on the number of prostaglandin
receptors in the uterus and this varies according to whether the woman is
pregnant and at what stage of pregnancy she is. In early pregnancy there are a few receptors and misoprostol
may need to be given repeatedly in order to have an effect. For the first trimester 800 mcg 24-hoursly can be
safely used. In incomplete abortion with 0s open and
vaginal bleeding 600 mcg can be given orally and then no surgical intervention
is needed. It is very effective and if some pain
due to uterine contractions occurs painkillers can take care of the same.
Some bleeding may persist upto one week but without any serious side effects.
It has been observed and
said by the Hon’ble Commission that “Doctor prescribed these medicines without having
recorded history or without having the knowledge as to for what problem the
patient had approached her and this single circumstance does not inspire
confidence as to the version of the Doctor that she did not conduct DNC and
when the patient came to her first time she was having extensive bleeding. It appears that the Doctor Dr.Nisha M. Srotria had full
knowledge and was fully aware that some piece or lump inside her womb had been
left while performing operation and to complete the process the aforesaid two
very strong medicines were prescribed. Even if we accept
the version that she did not conduct the DNC still the medicines prescribed by
her were such which could have been prescribed only if there is a
pregnancy. It is only in case of pregnancy that
the group of hormones which are commonly called prostaglandin receptors in the
uterus are prescribed. In early pregnancy there are few
receptors and therefore ‘misoprost’ is prescribed repeatedly.
Which Type Of Case It
Was?
It was not the case of
pregnancy. It was simple case of incomplete
clinical termination of pregnancy and in the process some pieces or lump was
left inside the womb.
Conclusion:
The cumulative of all
these facts and circumstances lead the Judges to ineluctable conclusion that
the Doctor committed negligence in conducting DNC as is suggested by subsequent
treatment given to her after having been taken to some private nursing home and
ultimately to the Government hospital and due to delay in attending to her
actual problem that infection and septicemia became incurable.
However, taking over all
view of the matter and there being negligence
on the part of the Doctor in leaving some piece or lump in the womb which
should have been attended to subsequently by some expert to avoid her death,
Appeal partly allowed.
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