Bengaluru hospital told to pay ₹1.6 crore compensation to family for death of patient during C-section surgery

The National Consumer Disputes Redressal Commission ordered the Santosh Hospital and its doctor to compensate family.

BySumit Jha

Published Jun 05, 2023 | 5:41 PM Updated Jun 05, 2023 | 5:42 PM

Bengaluru hospital told to pay ₹1.6 crore compensation to family for death of patient during C-section surgery

The National Consumer Disputes Redressal Commission (NCDRC) has ordered the Santosh Hospital in Bengaluru and its anaesthetist to compensate the family of a patient who passed away during a Caesarean section (C-section) surgery, along with the unborn child.

The total compensation amount determined by the NCDRC, in the order that was pronounced on Tuesday, 23 May, is ₹1.6 crore. The incident dates back to 2010 while the case dates back to 2012.

While the hospital and the doctors involved maintained that the patient’s death was the result of an “anaphylactic reaction”, the NCDRC reached a different conclusion.

After considering the post-mortem findings and expert opinions, the bench at NCDRC concluded that the patient’s demise was caused by a “haemorrhagic shock” (the body going into shock due to internal bleeding), which could only have resulted from “trauma within the operation theatre”.

The case

Kapali Patne, a pregnant woman seeking medical care, tragically lost her life during a C-section procedure in April 2010.

Dr Indira Rao, a senior gynaecologist, informed the couple that their baby was larger than average and recommended a Caesarean delivery.

Patne was conscious of her allergies to sulpha drugs and her congenital (L5-vertebrae) birth defect, and shared this information with Rao before the scheduled surgery.

However, her concerns regarding the administration of general anaesthesia (GA) during the C-section procedure were dismissed by anaesthetist Dr P Ashok, who assured her husband, Prakshit Dalal, that there would be no complications.

The family was apprehensive as, under GA, the patient is completely unconscious and unaware of their surroundings.

However, the other anaesthetic procedure — epidural anaesthesia, administered surrounding the spinal cord during childbirth — was not on the cards because of Patne’s congenital defect.

On the day of the operation, Dalal noticed a sudden flurry of activity in the operating theatre as senior doctors, hospital staff, and even the chief medical officer (CMO) rushed in.

Approximately an hour later, Rao explained to the patient’s family that Kapali Patne had experienced a severe anaphylactic shock — an allergic reaction — caused by the anaesthetic agent sodium pentothal, leading to her critical condition.

Despite the medical team’s efforts to revive her, the patient was transferred to the Intensive Care Unit (ICU) where, tragically, she and her unborn child were declared dead.

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The immediate aftermath

The grieving family levelled serious allegations against the doctors and the hospital.

They alleged that both doctors displayed little concern or anxiety while monitoring the patient. They also claimed that Rao attempted to distance herself from the situation, stating, “Look, I have not even touched your wife.”

Dalal said he firmly believed that his wife died during the operation itself and that the doctors sought to cover up their negligence by falsely claiming she had been transferred to the ICU.

“To cover up their negligence, the doctors tried to show she was shifted to ICU. Therefore, the actual reading of monitors was not available on record. The ICU monitor showed zero reading, which confirms that the patient and unborn child were already expired in the OT at 11.30 a.m. The OP-2(Dr Rao) made a casual attempt to note the Foetal Heart Sound (FHS) on the dead body and even the USG was actually done at 12.05-12.08 pm, which was 15 minutes after death,” alleged the family in its petition.

The suspicious circumstances prompted Dalal to file a First Information Report (FIR) at the Pulakeshinagar Police Station in Bengaluru the same evening.

A post-mortem examination was conducted the following day, revealing several injuries, including a fracture of the left sacroiliac joint (which links the pelvis and lower spine), clots in the muscles in front of the joint, and internal bleeding in the peritoneal cavity — the space within the abdomen that contains the intestines, the stomach, and the liver.

The viscera and blood samples were sent for forensic analysis, while the organs were submitted for histo-pathological examination (HPE).

The HPE report indicated haemorrhages and severe congestion in the affected areas, while the Forensic Science Laboratory (FSL) report did not detect the presence of the anaesthetic drug Thiopentone.

Based on the preliminary post-mortem report and the injuries observed, a subsequent FIR was filed at the Pulakeshinagar Police Station under Sections 304A (causing death by negligence), 315 (act done with intent to prevent a child being born alive), and 201 (causing disappearance of evidence) of the Indian Penal Code (IPC) against the accused.

The case took a significant turn when the police arrested Rao, Ashok, and four other members of the hospital staff. They were later released on bail.

In August 2010, the Crime Investigation Department (CID) of Karnataka took over the investigation, conducting a thorough nine-month probe.

Subsequently, they filed a charge-sheet against Rao, Ashok, and the other staff members, invoking Sections 304A, 315, and 201 read with section 34 (acts done by several persons in furtherance of a common intention) of the IPC.

Meanwhile, Dalal, as the complainant, also filed a complaint with the Karnataka Medical Council (KMC), alleging professional misconduct and malpractice by the doctors under medical regulations.

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In defence

The hospital and doctors in their reply to the NCDRC denied the allegations of negligence, claiming the complaint was filed with ulterior motives.

They argued that the complaint was premature, as the complainants had already filed complaints with the Karnataka Medical Council (KMC) and a criminal complaint, both of which were still pending.

They asserted that prosecuting them under the Consumer Protection Act of 1986 would be contrary to Article 20(3) of the Constitution, which prohibits double jeopardy.

Rao, one of the accused gynaecologists, defended her actions and said that after preparing for the surgery, she began painting the abdomen with Povidone when Ashok noticed an increasing appearance of allergic rashes. He treated the allergic reaction by administering intravenous Efcorlin.

Based on Ashok’s observations of bradycardia (slower-than-usual heart rate), a sudden drop in blood pressure, and a fall in oxygen saturation, it was determined that the patient had experienced a severe “anaphylactic shock” caused by the anaesthetic drug thiopentone sodium, which occurred before the surgery could commence.

Ashok, the anaesthetist, explained that after intubating the patient and administering 100-percent oxygen, he noticed severe rashes, bradycardia, and hypotension.

Despite emergency measures such as giving adrenaline, hydrocortisone, and dopamine, as well as initiating external cardiac massage, the patient’s condition deteriorated rapidly, and she was declared dead without the surgery being performed.

Dr S Bikkamchand, the medical director, emphasised that resuscitation efforts were focused on the mother for approximately 45 minutes to an hour, but unfortunately, all measures failed, leading to the patient’s demise.

He denied any possibility of record fabrication and stated that the police had taken the hospital’s case sheet for investigation immediately after the incident.

Dr MK Inayathulla Sharieff, the CMO, confirmed that he was informed about the emergency in the operating theatre.

He arranged for an ICU bed with ventilator support and oversaw the patient’s transfer to the ICU, he said.

He denied responsibility for maintaining OT records, as that was the responsibility of the OT in-charge.

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The family’s allegations

The family’s further submission claimed that prior to the surgery, the pregnant woman was dropped from the operating table. They also accused the doctors of fabricating the “anaphylactic reaction” story to divert attention from their actions.

The family’s accusations were bolstered by the findings of forensic expert Dr Bheemappa Havanur, as revealed in the post-mortem report.

The CID sought clarification from Havanur on multiple occasions regarding the fracture, its connection to haemorrhagic shock, and the observed rashes.

Havanur clarified that the fracture was antemortem (occurring before death), likely caused by a fall from a height of three-four feet.

He also emphasised that the fracture site was a primary source of blood loss, and explained that a reddish spot observed on the body could be attributed to post-mortem stain fixation.

Supporting the family’s claims, expert opinions presented by the complainants highlighted that the cause of death was shock and haemorrhage resulting from the sustained pelvic injury.

The medical records were seized by the investigating officer, and it was argued that the opinions provided by the doctors which supported the hospital’s stance failed to substantiate the theory of “anaphylactic shock”.

Additionally, a report from CFSL in Hyderabad confirmed that OT monitor readings, ICU monitor records, and digital copies of ultrasound were deliberately deleted, raising concerns about potential tampering and unethical medical practices.

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The commission’s order

The commission in its order said Ashok failed to substantiate the theory of anaphylaxis caused by sodium pentothal.

Instead, it observed, the evidence pointed towards a traumatic injury to the patient’s sacroiliac joint — linking the pelvis to the spine — inside the operating theatre.

The post-mortem findings and opinions from experts overwhelmingly established that the patient and her foetus died due to the fall in the OT and subsequent haemorrhagic shock, said the commission.

However, Ashok conspicuously portrayed the cause of death as anaphylactic shock resulting from the administration of pentothal, it noted, adding that this unfortunate incident resulted in the loss of two precious lives.

The crucial question it raised was: Why were there significant blood clots and bleeding in the peritoneal cavity if the cause of death was an anaphylactic drug reaction?

The commission found it implausible that an anaphylactic reaction would cause such traumatic haemorrhage.

“The question before us is that why there were massive blood clots and intra-peritoneal bleed, if it was an anaphylactic drug reaction. Such a bleed could occur due to a fall or any blunt trauma to the internal organs. We do not accept that an anaphylactic reaction by any stretch of the imagination would cause such a traumatic haemorrhage. At full-term pregnancy, the pelvic bones of the woman are more vascular and fragile due to increased vascularity in the venous plexus (a congregation of nerves). Any trauma may lead to vascular injury and severe bleeding,” the commission observed.

“It is evident from the available medical records that the OPs (opposite parties, meaning the hospital and the doctors) were trying to establish the story of anaphylaxis. The report of the CFSL in Hyderabad clearly establishes that the OPs deleted the readings of the OT Monitor, ICU Monitor and the digital copy of USG,” it added.

This, it said, was an attempt by the OPs to destroy the evidence, and thus, “unethical practice”.

The NCDRC ordered a lumpsum compensation of ₹1.6 crore to be paid to the family. It asked the hospital to pay ₹1.5 crore, while Ashok, the anaesthetist, would contribute ₹10 lakh to the complainants.

The commission found no evidence of negligence or failure of duty of care on the part of the obstetrician, Rao, and thus exonerated her from any liability.

Additionally, the NCDRC awarded ₹2 lakh to cover the litigation costs incurred by the complainants.

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