A woman, Dr. I. Sharma, during her first pregnancy, was under observation and follow-up of Dr. S. Verma, at Indraprastha Apollo Hospital. On 10.6.1999, after midnight, due to rupture of membranes, she got admitted in the Hospital for her delivery. No senior doctor was available at that time and the resident doctor examined her. In the morning, at around 7.00 a.m., Dr. S. Verma examined her and advised her medicines to speed up the process of delivery. But, the patient noticed that the dose was maximum, and the CTG machine showed that the heart rate of the child began to sink by midnight. Thereafter, the patient was shifted to operation theatre at 2.00 a.m. for emergency caesarean (LSCS), and at 3.36 a.m. a female baby (“Nistha”) was delivered by LSCS. The baby took almost five minutes after birth to cry. The baby was kept on ventilator in NICU. The doctor assured that all the reports were normal. The condition of baby deteriorated further, till 29.6.1999. Meanwhile, the patient was discharged on 16.6.1999, while the baby was discharged on 30.6.1999. The Hospital did not issue entire medical record, CTG graphs etc. The child seemed mentally challenged due to asphyxiation. Further, from 21.09.1999 to 03.12.2002, the child was treated at AIIMS, where, the paediatric Neurologist, Dr. Veena Kalra, opined that, a full term baby having such problems were because of the negligence during the delivery. The Disability Board of AIIMS, New Delhi certified the baby as ‘95% disability’. Nishtha survived for 12 years with disabilities and with mental retardation. Unfortunately, baby Nistha died on 15.1.2012. The patient complained before a NCDRC alleging medical negligence by the Hospital and the Doctors who were part of her delivery team.

Complainants’ allegations of medical negligence: 

1. Complainant alleged that the Hospital and the Doctor made number of corrections on the case sheets. The neo-natal record was also tempered.
2. The complainant alleged that the Doctor failed to perform LSCS within, 12 to 18 hours after rupture of membrane.
3. The Hospital and the Doctor purposely concealed Cardiotocograms (CTG) tracings, which was the vital document in this case. The Doctor failed to take proper care during delivery, which resulted in birth of an asphyxiated baby.

Doctor’s defense:

1. Duration of trial of induction of labour by use of Syntocinon was about 17 hours, which was well within the normal range. The time interval between the rupture of the amniotic membrane and the delivery of baby is a different matter altogether and depending upon the circumstances of the case, the treating Gynaecologist could wait for a few hours to a few days.
2. The patient was obese 88 kg; hers was a case of initial infertility and late conception. The Ultrasonography (USG) done on 27.03.1999 showed abnormality in growth of fetal head size, i.e. one of the diameters of fetal head at 29th week corresponds to 35 weeks; thus repeat USG was advised after one week, but patient chose not to follow instructions. During 8th visit on 2.5.1999 at 33 weeks, patient complained of significant reduction of fetal movements from preceding, so Doctor advised USG, Colour Doppler and repeat CTG tracings, which were found to be within normal limits.

Findings of the Court:

1. It was the duty of hospital to preserve CTG tracings. Thus the Hospital and the Doctors did not follow the standard of medical practice and have not maintained medical records.
2. Medical record maintenance has evolved into a science of itself and form an important aspect of the management of a patient. It is important for the doctors and hospitals to properly maintain the records of patients. It will help the doctor to prove that the treatment was carried out properly. The proper medical record it will help them in the scientific evaluation of their patient profile, helping in analyzing the treatment results, and to plan treatment protocols. It is wise to remember that “Poor records mean poor defense, no records mean no defense”. The medical record in doctor’s and sister’s charts, show several cutting, erasing, rewriting at the place of Syntocinon  dose, thus it was apparently manipulated and fabricated one.
3. The Doctor claimed that the patient was reluctant to undergo C-section, but preferred to wait for vaginal delivery but it was the bounden duty of the doctor to decide, the correct line of treatment; doctor wouldn’t just blindly obey the wishes of the patient, which is unethical.
4. The corporate hospitals and Specialists, as might be expected, must perform at a higher level than other hospitals/ general practitioners. They, after all, represent themselves as possessing highest standard facilities and care; also possess superior skills and additional training. The hospital charges and the doctor’s fees normally reflect this.
5. Poor pattern recognition, failure to correlate to the pathophysiology that causes the CTG changes, not taking into consideration the clinical situation that may suggest fetal distress and delay in taking appropriate action due to poor communication and team work were reasons for the poor outcome.
6. The Hospital and the Doctors are held responsible for medical negligence and a total compensation of Rs. One crore has to be paid to the patient. Further, we impose Rs.10 lacs as punitive cost which the Hospital shall deposit in the Consumer Legal Aid Account.