Justice for Nitika?

Four doctors of a renowned private hospital in Delhi found guilty of negligence by Medical Council of India following the victim's death two days after delivering a baby

The fight that began two years ago has almost reached culmination for the Manchanda family. Four doctors of Max Hospital, Pitampura have been held guilty by Medical Council of India (MCI) of negligence in patient care due to which the victim died.


Deepika Manchanda sister of Nitika. File pic

On May 29, 2009, MiD DAY had carried a story on how Nitika Manchanda (30), died two days after delivering her child because of alleged medical negligence. On May 5, she was declared dead at half past twelve within hours of complaining of severe backache. The cause of death was put down as "acute circulatory failure".
Nitika, who worked as an assistant manager with Genpact, had delivered a baby boy through caesarean section on May 3. According to the death summary submitted by then consulting gynaecologist Dr Alka Gupta, Nitika complained of backache on the morning of May 5, and despite all resuscitative procedures, she could not be revived. However Nitika's family maintained that no proper attention was given to the patient when she complained about her problem.

'Little solace'
Expressing satisfaction, SP Manchanda, the complainant and father of Nikita said, "The loss was big enough for us and could never be compensated. But this was a small step to pay tribute to our late daughter. We had filed over 50 RTI applications to various government departments to get entire details. We lost the case in Delhi Medical Council (DMC) and appealed at MCI. Finally we received a RTI reply letter from MCI regarding minutes of the meeting held on March 8, 2011, which confirmed medical negligence on part of Max doctors."

The MCI held four doctors guilty for the death. The RTI reply by Ethics Committee of MCI said the patient was managed efficiently for delivery of baby with breech presentation, and both mother and baby were fine till nearly 39 hours of surgery. But with the onset of clinical symptoms of complications, mind was not applied properly and no investigations were done to ascertain the cause of symptoms. Painkillers were used indiscreetly till the patient went into irreversible shock and cardiac arrest.

According to the MCI, Dr Alka Gupta and Dr Pooja Bhatia were immediate treating doctors and hence were held guilty of negligence in patient care, whereas Dr Navita Kumari as per records was involved in pre-terminal care which was done as per the recommended protocol and hence not guilty. Dr Vikas Mangla advised medications without examining the patient hence guilty of his conduct. Dr Mohammed Nabi and Dr Preeti Bobal were the junior doctors and did not have any major contribution towards the negligent management. Dr Rajeev Kapoor was negligent in providing the wrong information, the reply added.

Long wait
In the judgement delivered on June 7, 2010, DMC took up two issues into consideration for determination of this case. Firstly, whether any medical negligence was committed during the lower section segment caesarean section procedure. And secondly, whether any medical negligence was committed in the post delivery treatment.

In both cases the disciplinary committee of DMC ordered in favour of the hospital. In the first, it said that the surgical procedure was conducted as per the standard guidelines and no medial negligence was committed during the said procedure. After going through the written statements of all the doctors responsible that time, on the second issue DMC said it was of the opinion that no medical negligence can be attributed on the part of doctors of Max Hospital, Pitampura in the treatment administered by them to late Nikita Manchanda.

However quashing the judgement of DMC, MCI on March 8, 2011 said that the treating team was negligent in not picking up the gravity of the situation, did not act in scientific manner of looking at alternatives but continued to attempt at symptomatic relief hence the contentions of appellant is upheld.

"There are basically three options which MCI can take in this case. They can either give the doctors a warning or let them go or temporarily suspend revoke their license. However in extreme cases, doctors' license can also be permanently cancelled. The hospital can appeal against the order in the High Court," said a medico-legal expert who didn't wish to be named.

'Shut them down'
The Delhi Medical Council (DMC) on March 21 asked the Directorate of Health Services (DHS) to close down a hospital and a clinic and take legal action against them after they were found to have caused deaths due to medical negligence. The DMC recommendation came after Mid DAY had reported how doctors at these two establishments had administered injections to two children leading to their deaths. On April 7, an infant had die after he was administered an injection by a doctor of Bharatiya Clinic at Daya Basti. On April 15, a five-year-old died after he was allegedly administered a wrong injection by doctor at Sharma Hospital and Maternity Centre in Rajeev Nagar. The DMC then called the concerned doctors to look into these cases of negligence. "We called the doctors to check their degrees and found that none of them had a recognised degree. The Sharma Hospital and Maternity Clinic was not even registered with DHS and the doctor was practicing Allopathy without holding requisite medical qualification," said Dr Girish Tyagi, Secretary, DMC. The council then asked DHS to close down both Sharma Hospital and Bharatiya Clinic with immediate effect and take legal action against them. "These kinds of practitioners should not be allowed to continue their practice. Two kids have lost their lives, it is a criminal offence. Sadly, as the victims belonged to poor families, no one has taken them seriously and did not even listen to their complaints. But we will not allow any such quacks to wander around the city," said Dr Anil Bansal, Chairman, Anti- Quackery Cell, DMC.

The Other Side
When MiD DAY contacted Max Hospital, the authorities were surprised and said they were ignorant about the MCI decision. The hospital spokesperson said, "We are surprised to learn that a document dated March 8, 2011 is stated to have been released by the MCI under RTI, for a case whose hearing is yet to be concluded by the MCI. In fact, we have received a notice from MCI dated April 9, 2011 indicating that the appeal has been admitted for hearing on May 10, 2011. The decision on the said appeal can only be given after hearing both the parties on May 10, 2011. Since the matter is still subjudice, any comment on the same may prejudice opinion. We don't consider it appropriate till the appeal is heard by the MCI."