1. Case of the complainant is that respondent Dr. Asma Batool is running private medical center known as Fatima Hospital at Hafizabad. Wife of the complainant Sughra Javed was admitted by the respondent in her hospital with labour pains. Due to mishandling by unqualified staff employed by the respondent, patient's condition become serious as a result of which through major surgery a male baby was taken out of the womb who died sooner due to respondent's carelessness and substandard service. Complainant further alleged that blood of his wife was tested in the hospital lab by the respondent according to which on 11-10-08 patient blood sugar level was 302 and screening resulted as HCV +ve whereas blood test on 01-11-08 from another lab resulted into HCV negative and blood sugar as 110.6. Complainant demanded that strict legal action be taken, besides, awarding damages.
2. Respondent appeared and stated that a frivolous case has been filed to blackmail a well experienced and highly qualified doctor. Baby expired due to badly effected physical condition of mother who has undergone through a sudden shock due to death of her brother. Any deficiency in service during treatment the patient was denied, instead, good and grand service provided to patient was claimed by the respondent.
3. In order to prove his case complainant himself appeared as PW3, Sughra Bibi as PW2 and Bushra Bano as PW1. Complainant also produced the following documentary evidence:- Pregnancy scanning reports of Dr. Asma Batool Exh. "PA"&"PB", Screening test reports Exh. "PC", Description receipts of patient Exh. "PD"&"PE", Certificate Fatima Hospital Exh. "PF" and Blood test report of Sajjida Ghuman Hospital Exh. "PG".
On the other hand respondent himself appeared as RW1, Muhammad Mushtaq as RW2 and Dr. Shahid Iqbal as RW3. Respondent also produced the following documents:- Photo copy of I.D card of Muhammad Mushtaq Lab: Technician nark "RA", copy of technician training certificates mark "RB", copy of Nursing Diploma mark "RC", copy of experience certificates mark "RD", copy of diploma laboratory technician mark "RE", copy of medical certificate of house job of Dr. Shahid Iqbal mark "RF", "RG" & "RH", copy of MBBS degree mark "RJ"&"RL", copy of ultrasound training certificate mark "RK", copy of PMDC registration certificate mark "RM", copy of membership of ultrasound executive counsel mark "RN" , copy of registration training certificate mark "RP", copy of MBBS degree of Dr. Asma Batool mark "RQ", copy of house job of Dr. Asma Batool mark "RR","RS"& "RT", copy of diploma of Nosheen Younas midwife mark "RU", Brochure of Glandin- E2 tablet mark "RV", Brochure of screening test of Hepatitis-C mark "RW", copy of book of preventive medicine mark "RX" & "RY", Brochure of machineries mark "RZ-1/22 and CD mark "RA1"
4. I have heard the arguments and perused the record.
5. Contention of the complainant in this case is that his wife Sughra Bibi remained under the treatment and consultancy of respondent Dr. Asma Batool during the pregnancy and at the time of delivery, when the labour pains started the patient was shifted to private hospital of respondent Dr. Asma Batool who did not manage the case with due care and diligence as a result of her mishandling and negligence to deal with the case the baby (male) who had to be taken out of womb through C-section died soon after the birth.
6. On the other hand contention of respondent lady doctor is that complainant and his wife were responsible for all that happened in her hospital. The child was born dead because of stubborn attitude of the complainant who at proper time did not allow her to perform surgery and persisted for delivery of child through normal passage; Whereas patient was also responsible for poor antenatal care through out the pregnancy as it was a case of polyhydramnios and death of the featus was indispensible as usually happens in most of the cases suffering from such diseases.
7. As it is a case of two versions entirely opposing each other and shifting responsibility, we have to analyze the evidence lead by the parties in the light of approved principles in the field of gynecology and obstetrics. Besides, we also have to decide that what actually happened and who was the responsible for the same.
8. Admission of Sughra Bibi in the private hospital run by Dr. Asma Batool for the purpose of delivery is an admitted fact. Ante-natal care by the patient from Dr. Asma Batool is also not denied although with some reservations from both sides about number of visits viz: patient claims to have visited the Dr. Asma Batool for 5/6 times, whereas, Dr. Asma Batool has admitted three visits excluding the last visit for delivery. There can be no two opinions that Sughra Bibi came to the hospital of Dr. Asma Batool with a live child in her womb to deliver the same. However, we will have to decide that was it a still born baby or Sughra Bibi parturated a live tomato baby who died later?
Overall we have to answer the question as to whether the patient was treated in the hospital by Dr. Asma Batool with carelessness and negligence and death of the baby inside or outside the womb was the result of irresponsible attitude of Dr. Asma Batool. In order to find out the answer, with accuracy, of the above said questions first of all, we have to go through the evidence of complainant party. From the statements of Bushra Bano PW-1, Sughra Javed PW-2 and Amjad Javed PW-3 it transpires that sughra Bibi had already given birth to three children through "normal delivery". One of her child was born at the hands of Dr. Asma Batool prior to the present case. She has visited Dr. Asma Batool to get herself examined 5/6 times during pregnancy. On the night between 10/11-10-08 she came to the private hospital, run by Dr. Asma Batool and her husband, with labour pains. Dr. Asma admitted her but left her at the mercy of midwives. She went to sleep and did not come back inspite of repeated requests. Next morning she arrived in and announced that she has to perform surgery to take the baby out. On account of her late decision and leaving the patient at the disposal of staff, a baby was born out who died sooner. Before proceeding ahead, we have to examine the claim of Dr. Asma Batool that Sughra Bibi was suffering from Gestational Diabetes as she has already diagnosed polyhydramnios in the ultrasound report dated 19-06-08 Exh. "PA". According to the statement of Dr. Asma Batool, as RW1, patient was admitted in her hospital at 11:30pm on 10-10-08 with labour pains. At that very time she clarified to the attendants that patient's height is small, abdomen is large and in case of any difficulty in the delivery through normal way she may have to operate. She was asked by the attendants that patient had already given birth to children through normal delivery therefore, efforts be made for normal delivery. She inserted a tablet Glandin-E2 in the Vagina at 12:00-o-clock at night, injected IV solution and asked the patient and her attendants to wait for six hours. After two hours attendants started raising hue and cry for inducing labour which was impossible at that time because Glandin-E2 takes at least two hours to start its action to dilate the cervix. She offered the attendants C-Section in case they are not willing to wait any more but she was asked to attempt for normal delivery. She again examined the patient early in the morning at about 05:30am, Cervix was dilated upto three fingers only, Labour pains were of normal intensity. Patient's abdomen was extra ordinary large due to good size baby. At that time patient's attendants stated that there had been a death in the house and patient had to see the face of dead body. Complainant was allowed to enter in the labour room who told her (Dr. Asma Batool) that patient is not in such a condition to visit the house and saw the dead body, therefore, incidence of death may not be disclosed to the patient. He again insisted for normal delivery. At 06:30am she re-examined the patient. After 15 mints patient was re-examined. The Cervix was found dilated upto 7/8 C.m. Featus head was above in the uterus. She awaited for some time, asked the patient to walk. Such attempts were carried on till 07:30am then she finally told the attendants for granting permission for surgery otherwise to take the patient elsewhere. After getting permission she operated the patient at 08:00am. According to this witness, it was a swollen baby of 10 pounds whose head had been stuck in the pubic bone. It was a still born child. Respondent claimed that height of mother was less than 4 Ft who was having gestational diabetes and it was a case of polyhydramnios. The only way of delivery in such cases could be C-section but her advise for surgery were ignored by the attendants and due to gestational diabetes weights of the featus was increased. The time of delivery in such cases is extended and featus may go into distress. She has already diagnosed polyhydramnios on 19-06-08.
9. At this juncture, let it be decided what is polyhydramnios and was it present? If so, what is its treatment? and whether the respondent provided the requisite treatment?
10. Polyhydramnios is defined as presence of excessive fluid in the membranes surrounding the featus inside the womb. Poly means---much, Hydro---water, Amnios-- the membranes around the featus. During gestational life baby floats in the fluid present in the membranes which has surrounded the baby inside the mother's womb; Nature maintains certain volume of this fluid through out pregnancy. Under certain conditions there is increase in the volume of this fluid which is called liquor amnie and abnormal increase is called polyhydramnios. Now we come to the statement of Dr. Asma Batool as RW-1 according to which she examined the patient on 19-06-08 and diagnosed polyhydramnios. There is a report of ultrasounoghraphy of Sughra Bibi on the record as Exh. "PA". According to Dr. Asma Batool she herself performed this ultrasonography, irrespective of the rival claim of RW3, her husband Dr. Shahid Iqbal, the administrator of hospital, that all ultrasounds of this patient were done by him. To this extent it is settled by the respondent that there was polyhydramnios. Having found and diagnosed polyhydramnios Dr. Asma Batool was duty bound to investigate the cause of polyhydramnios and start its treatment. According to Dr. Asma Batool the cause of polyhydramnios as per her knowledge was gestational diabetes of the patient which can be controlled only through insulin therapy. It is admitted by Dr. Asma Batool that she did not prescribe the treatment of gestational diabetes. She herself stated in the examination- in-chief that blood sugar of the patient is examined at different time in a day and heamoglobin is also monitored once in a month. Similarly urine chart is also maintained. But Dr. Asma Batool did not prescribe any medicine to control the gestational diabetes. She did not advise the patient to go through any such test and adopt any remedial measure. On the back of the Exh. "PA" she has prescribed some medicines but not a single medicine is for polyhydramnios. The prescription does not contain any advise for blood test and urine sugar chart etc. Even on the subsequent visit i.e on 23-07-08 prescription of Dr. Asma Batool is entirely silent about the treatment of polyhydramnios.
In her cross examination Dr. Asma Batool admitted that existence of excessive fluid in the amnie indicates some disease either to the featus or to the mother and she has asked the patient to get her blood sugar tested but she did not, therefore, the treatment was not given of polyhydramnios to the patient. Contrary to this oral claim, on the prescription of Dr. Asma Batool, I have not found any such advise to the patient. In the medical profession as a matter of routine all the required test are mentioned in side margin of the prescription by the doctor but none of the available prescription of this patient contain any such advise. Dr. Asma Batool has stated in the cross examination that she has prescribed the patient general tonics only on each visit. She could not prescribe the medicine for polyhydramnios because she could not diagnose the cause of it as the patient had not produced the test report as per her advise. I am failed to understand that on subsequent visit when patient came to her without tests suggested by her she again did not bother to go into the detail and again prescribed medicine for weakness. Dr. Asma Batool in her statement stated that the only option in such cases for delivery of child is through surgery but in her cross examination she stated that during the ante-natal care when patient visited her clinic she never told the patient about surgery/operation because she determined this fact at the time when patient came to her clinic with labour pains. I am not convinced with this plea of Dr. Asma Batool that attendants of the patient granted permission for surgery at belated stage and without this permission she was unable to perform surgery because her own conduct negates the same. I am again failed to understand if she knows that only option was surgery and even if at the time of the admission of the patient with labour pains had determined the option of surgery then why she inserted Glanden-E2 inside Vagina for dilatation of Cervix and put the patient long agonized path of awaiting the child to come through Vaginal canal. A professional who is competent should be decisive and determined about the course of treatment to be adopted keeping in view the particular condition of the patient and can not be expected to act upon the advise or desire of attendants of the patient. I am also not agreed with Dr. Asma Batool that it was a case of polyhydramnios. Admittedly, patient came to her on 19-06-08 and she carried out ultrasonography Exh. "PA" and found polyhydramnios. Again on 23-07-08 ultrasound of this patient was done by her husband Dr. Shahid Iqbal who claimed to be an extra ordinary expert in the field of ultrasonography, having a lot of experience and also having extra ordinary precious as well as sofiscated ultrasound machines which according to him is rarely installed elsewhere in the Pakistan. According to Exh. "PB" ultrasound report, there was not polyhydramnios as the liquor has been shown as normal. For convenience I would like to dilate upon this situation in the light of approved principles of Gynaechology and Radiology. Polyhydramnios may be due to three major causes:-
(A) Conjenital Anomalies viz;
(i) Ancephaly -- neural tube (ii) GIT atrasia-Kidny dysfunction
(B) Diabetes millitus (gestational diabetes).
(C) without any cause.
11. In almost 35% of the cases polyhydramnios is found without any cause. Medically there can be no two opinions on the point that at 24th week of pregnancy the existence of polyhydramnios is remote. Usually it is evident after 24th week and if it is present then the situation demands high concern because the only and only reason of this extra ordinary situation may be due to a severe featal chromosomal Anomaly not compatible with life and in such a case in the existence of this extra ordinary abnormal circumstance, the anomaly scan of the featus was indispensible. It is beyond my imagination that presence of polyhydramnios at 24th week of pregnancy did not alert Dr. Asma Batool and his husband Dr. Shahid Iqbal and why they took it lightly either due to their ignorance in the field or acted negligently. Statement of Dr. Asma can not be taken as gospel truth that polyhydramnios is only due to gestational diabetes and she was unable to prescribe the medicine because the patient has not produced the test report suggested by her. She has nowhere stated that she has sensitized the patient at that very time. One of the important element which, in polyhydramnios determines the real facter is the weight of the child. I am sorry to say that both the husband and the wife who in the witness box were boosting off their extra ordinary precious machines failed to determine the body weight of the featus in all their ultrasound examination reports if it was due to gestational diabetes. Moreover, Dr. Asma Batool and her husband in all circumstances should not have ignored the ultrasonography of this patient when she was admitted in their hospital with labour pains in order to know the position of featus, volume of liquor and weight of featus. As per their wisdom polyhydramnios if present affects the fetal outcome adversely by predisposing to pre-mature Labour and malpresentation. I am of the firm opinion that had ultrasonography at the time of admission been done and body weight of featus calculated, this could have been a decisive factor for adopting the mode of delivery, either through elective or surgical procedure. I have also not found biophysical profile in the ultrasonography.
Amniotic fluid index in four quadrants should have been calculated by the doctor.
12. From the circumstances the only conclusion which can be drawn is that the polyhydramnios, if it was present at 24th week was the subjective observation only. Subsequently as per admitted report of ultrasonography of the patient done by Dr. Asma Batool or her husband Dr. Shahid Iqbal it was not present. The baby was post mature, the E.D.D was calculated as 05-10-10. The patient after starting labour pains came to hospital on 10-10-08. It was a good size baby, Dr. Asma Batool was fully aware as shown by her reports that the patient has already given birth three children through normal delivery. One of the baby was delivered in her own hospital, therefore, she put the patient on trial as matter of routine. Therefore, this plea of Dr. Asma Batool does not appeal to one's reasons that patient's height was too small to deliver a child. Size of pelvic bone is not important in this case.
13. Another important question in this case is as to whether the child was born alive? PW1 Bushra Bano one of the attendant of the patient stated that after surgical operation a staff nurse came out of the theater with live child and congratulated handing over the child to her who was at that time under stress. PW3 stated that his Bhabi congratulated him on the birth of male child. He saw the baby in the hands of staff nurse in a bad condition. The staff nurse was trying to resuscitate the child. He asked for calling Dr. Asma Batool or any child specialist but the child died.
14. I have given my anxious consideration to this point. On the date of admission of patient in the hospital her brother has died early in the morning due to hepatic failure. When she gave birth to a baby funeral precession of her brother was to be carried on. On the same day before taking out the funeral procession of brother of Sughra Bibi, dead body of child was buried. Why both the dead bodies were not taken to graveyard through single funeral procession and what was the urgency to dispose off the dead body of the child in early hours before burial of child's maternal uncle who had died a day before. In my view the child was still born and he was buried without Namaz-e- Janaza at the earliest and after that in later part of the day dead body of brother of Sughra was buried with Namaz-e-Janaza. As far as congratulation by nursing staff to sister of Sughra Bibi is concerned she has done so, in order to receive some Bakhsheesh, PWs have seen the hospital staff while resuscitating the new born which was an attempt that proved abortive.
15. What actually had happened can be easily ascertained after going through the statement of RW1 Dr. Asma Batool according to which at 06:30am she deliberately ruptured the liquor Amnie. At 06:45am she found the cervix dilated upto 7/8 c.m. She further awaited and asked the patient to walk in the hospital till 07:30 am and thereafter, she moved for surgery at 08:00 am. I have already said that the child was post mature, some extra manipulation was done through out the night with the child. Even after rupturing the liquor Amnie further manipulation was done for a period of about one and half hour and due to decreased amount of liquor child has gone into cardiac arrest. In this scenario if statements of patient sughra bibi, her attendant Bushra are read together, what both the house hold ladies have stated in a simplest, straight forward, and innocent manners, seems to be more plausible about the manipulation done with patient in the labour room, through out the night by the staff. Statements of Dr. Asam Batool and her husband Dr. Shahid Iqbal contradict each other at various points.
16. Apart from all this Dr. Asma did not monitor A.F.I &BSL of the patient when the patient was admitted in hospital with labour pains and at night the ultrasound examination of the patient was not done. Dr. Asma failed to perform C.T.G monitoring. Had the cardiac activity been checked at different intervals, life of the baby could have been saved. As a matter of routine, during the three stages of labour, cardiac activity of the featus is constantly monitored even with conservational method, if facility of ultrasound is not available and as and when some irregularity is noticed immediate decisive and remedial steps can be taken at emergent basis. Respondent lady Dr. Asma Batool even ignored Bishop scoring or apgar scoring. In sooth, she did noting towards featus well being. There is another thing which was ignored and that is non availability of neonatologist in the hospital to meet with any such emergency. If, for the sake of arguments, statement of Dr. Asma Batool is admitted that due to polyhydramnios the going of a child into distress was essential than question arises having prior knowledge of this fact why she did not arrange a child specialist for management of stress or any other untoward situation. A competent neonatologist should be present at the time of delivery, so that the pediatric care of the baby can be started immediately after birth. There were only two attendants namely Nosheen and Rasheed Bibi which assisted Dr. Asma Batool while doing C-section. After taking out the baby from the womb, if one of them was extending her helping hand the other staff member was left only to deal with the new born. Who was administering anesthesia? what kind of anesthesia was provided Dr. Asma Batool did not say a single word on record. She has stated that before surgical operation blood sugar of the patient was tested as 302. According to her the test was done at 07:30 am. At the same breath Dr. Asma Batool admitted that through out the night no blood or urine test could be done because the lab was closed at night time. RW2 the lab technician when appeared in the witness box stated that he comes on duty at 09:00am till 05:00pm. This RW stated that he does not remember at what time 10 of 14 he performed this test. This lab: Technician dare not to reject the suggestion of counsel for the complainant that blood and urine test was received by him after the delivery, therefore, it can not be said that how and who did the blood sugar test in the lab at 07:30am. Which of the RW should be believed when RW3 Dr. Shahid stated that laboratory remains open for 24 house. Some documents have been produced by respondent in order to show that high-tech costly machines are installed in the hospital. In my view the machinery how much sophiscated it may be is always operator dependant.
17. "Deficiency in service" by a medical professional implies failure of a reasonable degree of skill, knowledge and care on the part of the medical expert while treating the patient. The duties which a doctor owes to his patient are clear. A person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose.
Such a person when consulted by a patient owes him certain duties, viz; a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient. The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires; The doctor no doubt has a discretion in choosing treatment which he proposes to give to the patient and such discretion is relatively ampler in cases of emergency. A medical person is required to exercise a reasonable degree of skill and knowledge. It is not possible for him to cure all patients. If a patient dies due to his lack of skill or knowledge, he is liable to pay damages, but not otherwise. The law does not require highest degree of competence from a medical person. He is answerable when he falls below the standard of a reasonably competent medical person or he departs from a normal course.
18. A charge of professional negligence against a medical man is serious. It stands on a different footing to a charge of negligence against the driver of motor car. The consequences are far more serious. It affects his professional status and reputation. The burden of proof is correspondingly greater. As the charge is so grave, so should the proof be clear. With the best will in the world things sometimes went amiss in surgical operations or medical treatment. A doctor is not to be held negligent simply because something went wrong. He is not liable for mischance or misadventure; for an error of judgment. He is not liable for taking one choice out of two or favouring one school rather than another. He is only liable when he falls below the standard of a reasonably competent practitioner in his field so much so that his conduct might be deserving of censure or inexcusable.
In the realm of diagnosis and treatment there is ample scope for genuine difference of opinion, and one man clearly is not negligent merely because his conclusion differs from that of other professional men, nor because he has displayed less skill or knowledge than others would have shown. The true test for establishing negligence in diagnoses or treatment on the part of a doctor is whether he has been proved to be guilty of such failure as no doctor of ordinary skill would be guilty of, if acting with ordinary care.
19. Where we got a situation which involves the use of some special skill of competence, then the test whether there has negligence or not is not the test of the man on the top of the clapham omnibus, because he has not got this special skill. The test is the standard of the ordinary skilled man exercising and progressing to have that special skill. A man need not possess the highest expert skill at the risk of being found negligent. It is well-established law that it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art. The counsel for the complainant put is in this way, that in the case of a medical man negligence means failure to act in accordance with standards of reasonably competent medical men at the time. That is a perfectly accurate statement, as long as it is remembered that there may be one or more perfectly proper standard; and if a medical man conforms with one of these proper standards then he is not negligent.
20. There are four stages in the treatment of a patient where a doctor acts with a reasonable degree of skill, care and knowledge. These are (a) ascertaining the history of the case; (b) investigation of the case both clinically and laboratory and other tests; (c) giving treatment; and finally (d) the follow up of the case. The skill of medical practitioner differs from doctor to doctor.
The very nature of the profession is such that there may be more than one course of treatment which may be advisable for treating a patient. Courts would indeed be slow in attributing negligence on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution. Medical opinion may differ with regard to the course of action to be taken by a doctor treating a patient, but as long as, a doctor acts in manner which is acceptable to the medical profession and the court finds that he has attended on the patient with due care, skill and diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold the doctor to be guilty of negligence. However, in cases where the doctors act carelessly and in a manner which is not expected of a medical practitioner, then in such a case an action in under the penal provisions of Punjab Consumer Protection Act, 2005 would be maintainable. As held in Laxman Balkrishna Joshi v. Dr. Trimbak Bapu Godbole, AIR 1969 SC 128, a medical practitioner has various duties towards his patient and he must act with a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. This is the least which a patient expects from a doctor. It is a matter of high concern that at peripheries in our country our doctors who are simply qualified having basic degree in the field of medicine and surgery are daring to deal with cases requiring exercise of skill by highly specialized persons in a particular field. It is an era of specialty rather sub specialty but in our country just spending of few weeks during the house job in a specialty the knowledge equal to a specialist is presumed to have been achieved with idiotic confidence. The authorities concerned should at least draw a line in this regard otherwise the ratio of worsening of cases by our respected general practitioners is becoming such a high. No doubt they are rendering great services to the poor saving them from the unskilled hands of quacks but sometimes themselves advertently or inadvertently jump into the same pool of quackery only for material gain which is not so higher then the loss to the other side.
21. Dr. Asma Batool respondent when examined as RW1, stated that patient, soon after admission was given conservational line of treatment with keeping tablets of Glandin-E2 (oxcytocic) inside the vaginal canal. if for the sake of arguments statement, of Dr. Asma Batool that it was explained to the patient that there was the only choice of C-section is admitted true, then still Dr. Asma Batool agreed to give trial to the patient for normal delivery and in case of their refusal to give consent for surgery did not ask the patient to go to any other hospital, remained unexplained on the part of respondent doctor. In this case Dr. having previous history of patient, ante-natal examination and as per her own diagnoses of polyhydramnios, after assessing the condition should have settled the method of excavation of baby through surgery and should not have awaited for loosening of Os.
Why she did not ask the patient or her attendants decisively to give consent for surgery at the door step of her hospital is also a question mark. However, insertion of Glandin-E2 into vagina reflects very clearly the conduct and the state of mind of Dr. Asma Batool to deal with the patient. No record was produced in the Court by Dr. Asma Batool which suggests that with great hesitation the patient agreed for operation. Whether the patient was suffering from gestational diabetes remained a question mark. Dr. Asma Batool speculated gestational diabetes only keeping in view polyhydramnios. She should have constantly monitored the blood sugar and urine sugar of the patient through out the pregnancy. There is nothing on the record to show a least effort on the part of the lady Dr. Asma Batool that she maintained the chart for monitoring blood sugar. We went through evidence of the witnesses especially of RW1&3. Admittedly there was no facility of neonatalogist.
22. This forum is required to make an attempt to serve the ends of justice so that compensation is awarded in an established case which not only serve the purpose of recompensing the individual, but which also at the same time aims to bring about qualitative change in the attitude of service provider. In emergency and critical case, the code of conduct, that is the duty and that what is required to be implemented. In emergency or critical cases doctor should have discharged her duty / social obligation of rendering service without waiting for fees or for consent.
23. The last but not the least is that having claim of extra ordinary costly machines the doctor did not realized to ascertain the position of baby, the volume of liquor in the amnie, the monitoring of cardiac activity intermittently which was a basic necessity towards the featal well being after the patient was admitted in the hospital. Had the Dr. Asma Batool present through out the night with the patient, it would not have been possible for Dr. Asma Batool to remain idle awaiting the loosening of Os. In the circumstances version of complainant side seems more probable and convincing that Dr. Asma Batool leaving the patient at the mercy of staff went to sleep considering it to be a case of normal delivery and did not consider necessary to deal with it causiously whereas doctor's casual behavior reflects that she never assessed it a case of gestational diabetes and plea of polyhydramnios is an after thought to make out a defense only. The excessive fluid at 24th week coupled with one time test of blood sugar after the delivery of child is not the conclusive evidence to make out a case of gestational diabetes
24. From the foregoing analysis of the material available on the record a charge of professional negligence against Dr. Asma Batool is proved beyond any shadow of doubt. Although having no post graduate degree or diploma in the specialist field of Gynae: and obstetrics she badly failed to exercise even the ordinary skill of an ordinary competent person. She acted negligently. Again I reiterate that negligence is that breach of duty caused by omission to do something which a reasonable would do, or doing something which a prudent man would not do.
25. In this case complainant and his family has to suffer immense loss of a male child in their family. Although such loss can not be measured in material terms, however, this Court directs the respondent to pay Rs.10,000,00/- as compensation to the complainant inclusive of the litigation charges. Besides, Dr. Asma Batool is also burdened the fine of Rs.2,000,00/- to be deposited in the state treasury within 30 days of the passing of this judgment with a warning to be careful in all respect while dealing with her professional life in future. File be consigned to the record room after its due completion.