Good news for obstetricians
Amniotic Fluid Embolism death : Latest Judgment from National Consumer Commission
Dr Lalit Kapoor Founder Medico-Legal cell AMC
A judgment which should bring relief and reassurance to practicing Obstetricians was delivered on 18th June, 2020 by the National Consumer Disputes redressal Commission.
BRIEF FACTS OF THE CASE:
On 4th November, 2012, Dr Manisha Agarwal, an Ob/Gyn consultant in Ghaziabad district, U.P, admitted a patient in her Nursing home with labour pains. In spite of good labour pains there was no progress of labour and in view of foetal distress , the patient and relatives were informed the need for LSCS . However, they were reluctant to give consent for the same. It is only when they were told to either give consent or take the patient to another hospital did they relent and give their informed consent and the operation was commenced under SA administered by Dr Neelam. A healthy female baby was delivered but soon after the patient suddenly developed cardio-respiratory arrest. CPR was initiated, patient was intubated and positive pressure respiration started. Amniotic Fluid Embolism was suspected. The patient responded to the resuscitative measures and the operation was speedily completed.
The relatives were informed of this sudden unfortunate development and the need to transfer the patient to a tertiary care hospital. Accordingly, the patient was shifted to the nearby Yashoda hospital in an ambulance accompanied by Dr Manisha. The patient was put on ventilator support.
Subsequently, the patient did not recover from the cerebral hypoxia and continued to be comatose.
Thereafter the relatives filed a complaint before the UP State Consumer Forum alleging negligence and deficiency in service (including incompetence and lack of facilities in the Nursing home) and seeking a compensation of Rs 99 lakhs. The complainant also filed a complaint before the UP State Medical Council for disciplinary action.
On 16th May 2018, the State Commission, Lucknow held the doctor and Nursing home liable for negligence and awarded compensation.
Soon after Dr Manisha appealed against this judgment before the National Consumer Disputes Redressal Commission in Delhi .The case lasted about 2 years and the National Commission passed its Order as recently as 18th June 2020.The Order of the State Commission was set aside and the complaint was dismissed thus giving relief to Dr Manisha.
A few important excerpts from the judgment:
“In the instant case the OP 1 is qualified as an Obstetrician and experienced one. LSCS was performed as per standard procedure, but unfortunately the patient suffered cardiac arrest due to unpredictable Amniotic Fluid Embolism (AFE). Though immediately resuscitative steps were performed by the doctors in OT, but the patient suffered cerebral hypoxia, It was not due to negligence or deficiency while conducting the LSCS or management of AFE. The State Commission has erred in law to hold it as medical negligence”
“We have gone through the literature on Amniotic Fluid Embolism from the various published Articles the and medical text from William’s Obstetrics (23rd Ed). It is stated therein that Amniotic fluid Embolism is a rare but often fatal complication of pregnancy and its onset can neither be predicted nor prevented. AFE is an infrequent, unpredictable, and the catastrophic complication of pregnancy in which amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse. AFE is a syndrome typically occurs during labor, soon after vaginal or caesarean delivery, or during second-trimester dilation and evacuation procedures. It is virtually impossible to predict which patients are at risk for AFE. Diagnosis must be based on a spectrum of clinical signs and symptoms and by exclusion of other causes. Most cases of AFE are associated with dismal maternal and fetal outcomes, regardless of the quality of care rendered. Early recognition of AFE with prompt intervention is paramount to a successful outcome. Management is resuscitative, geared toward maintaining vital signs and treating hemodynamic and coagulopathy derangements as they occur. A team approach among obstetrician, anesthesiologist and intensivist is necessary for a successful outcome. Despite early intervention, maternal and fetal mortality remain high. Thus, owing to its uncertain etiology, varying symptoms, rapid onset, and high fatality rate the AFE is one of the most challenging obstetric emergencies leading to cardiac arrest.”
The following wise words appear at the top of the judgment :
The blame of tragic misfortune for unexpected, unavoidable, unpredictable, unpreventable Amniotic Fluid Embolism ( AFE), most of the times the obstetrician is a scapegoat. Unfortunately in some cases, despite the doctor’s best intentions, patients suffer injury or die, and the clinicians involved often become the secondary victims.
Conclusion: This judgment puts allegations of medical negligence in a case of Amniotic Fluid Embolism in the correct medical and legal perspective Thank God !. It will form a good precedent to be appropriately quoted in a similar case in future.
The case was heard by Hon,ble Justice R.K.Agarwal and Hon.ble Dr S.M.Kantikar , Member and dictated by the latter