2017 July - Note 1

Cross examination in court of an obstetrician (Uday Kant Jha & Ors. v/s Moolchand Khairati Ram Hospital & Ors.)

Relevant excerpts from the cross examination of the obstetrician (OP) in the case of
Uday Kant Jha & Ors. v/s  Moolchand Khairati Ram Hospital & Ors. published in this issue

Ques: Are you aware that your authorization for medical or surgical treatment exhibited as exhibit OP-2/C4 mandatorily requires that authorisation must be signed by the patient herself if she is mentally sound?
Ans:  No. I was not aware of the legal position. volunteered. The patient was in agony due to labour pain and distress due to less fetal movement and for that reason she called her father.
The test for bleeding time and clotting time (BTCT) was not done in the present case, because in routine this test is not done before doing LSCS.
Did not get the patient checked up for LFT. Protocol for LSCS requires routine test of haemoglobin, blood sugar fasting and p.p., TSH, VDRL, ABORH, Urine Routine. The LFT therefore was not got done.

Ques: I put it to you that as per your version there was no complaint of liver?
Ans: The patient never complained of any liver problem. volunteered. She complained of palpitation and we got ECG done by her examination from gynaecologist who do ECG.

Ques: Please refer to para 22 of the written version, written version exhibited as exhibit OP-2/C1?
Ans:  My statement in Para 22 of my reply where it states “in the night intervening of 18.04.1993 and 19.04.1993 the patient had convulsion at 01:00 am is right.

Ques: Is it correct that according to you the patient had convulsions for the first time on the intervening night of 18.04.1993 and 19.04.1993. I put it to you that you are lying on oath before this court as you have already stated in exhibit OP-2/C1 (written version). In your document dated 21.07.1993 (death summary) you stated that the patient developed general convulsion in the night of 3rd postoperative date?
Ans: The convulsion referred to in para 22 of the written version on the night of 18th and 19th April, 1993 was a massive one whereas the convulsion on 3rd postoperative day was a mild one.
Hepatorenal failure might have occurred either due to fulminating hepatitis or during G I Tract infection. I cannot specifically state as to what was the basic reason of hepatorenal failure resulting into cardiac arrest. I am stating above on the basis of the reports given by other doctors.

Ques: I put it to you that you stated that you closed abdomen after securing complete haemostasis and the bleedings at a stage whereas the patient had been bleeding even after one week thereafter continuously after surgery?
Ans: During caesarean section, after delivery the baby was out, the uterus was well contracted haemostasis was secured and abdomen closed. Slight bleedings, from vagina is the normal postpartum uterine bleedings which occur for week to 10 days. ‘Bleeding in this case might have been due to some other reasons as it was more than the normal uterine bleeding’.

Ques: You are wrongly stating that there was no bleeding and complete haemostasis was done whereas because of wrong performance of operation LSCS wrong cutting of the tissues and bands the patient Anjana continuously bleeded for next 7 days even from mouth, nose etc. and as well as the cut ends. Refer to your own record pages 16, 16a and 18 medical notes dated 12.04.1993, 13.04.1993, 14.04.1993, 15.04.1993, 16.04.1993, 17.04.1993 and 18.04.1993 submitted by you?
Ans: During caesarean section the amount of bleeding which normally occurs is around 1000 to 1500 ml and in her case it was slightly more than normal. I have already mentioned the uterus was well contracted and there was no abnormal bleeding before closing. In the meantime there was excessive oozing from the tissue which happens if she has a bleeding disorder or abnormal liver functioning and not due to LSCS.

Ques: I put it to you that it was not oozing but excessive bleeding coupled with excessive oozing what have you to say?
Ans: It was not excessive bleeding but more bleeding. volunteered. transfusion of one unit of blood was done.

Ques: I put it to you that you are lying as it was not only one unit of blood but many units of blood on successive days as well as fresh frozen plasma it had to be transferred in the patient because of your wrong performance of LSCS?
Ans: During caesarean section the amount of bleeding was slightly more but in view of the oozing we decided to give one unit blood transfusion and two units FFP. Later on, on the advice of the liver expert further transfusion were done as the complications were the result of the liver disorder.

Ques: Are you aware that you are stating on oath and before the court?
Ans: Yes.

Ques: Are you aware that your statement is on record?
Ans: Yes.

Ques: Are you aware that you can be prosecuted for a false statement?
Ans: Yes.

Ques: I put it to that you are lying as per your own record you have given more than one unit blood before any consent of liver expert?
Ans: I have clearly said that during caesarean and post operation one schedule blood and two FFP were given. After that we have not calculated. After operation the condition was reviewed by anesthetist and Dr. A.K.Gour physician and on his instructions further three units were given, before any consent of the liver expert.

Ques: I put it to you that you are lying when you say that it was only oozing of blood whereas patient because of wrong performing of operation by you was actually bleeding from mouth as well as nasal bleeding?
Ans: I am not lying first. Second the caesarean section was performed correctly. I have mentioned the bleeding was slightly more than normal and oozing was there for which appropriate action was taken. As far as bleeding from the nose, mouth in the postoperative third, fourth day had occurred in the ICU that was because of deranged liver enzymes or weak liver for which she was already referred to physician, hepatologist and haematologist.

Ques: I put it to you that you are lying because as per your own record during LSCS excessive oozing was noticed from the cut surfaces?
Ans: I have already mentioned that the excessive oozing was there. Oozing means small artery bleeded which is taken care of during operation by pack. Does not need any extra precaution. When oozing was controlled by soft packing and complete haemostasis was secured only then the surgery was completed.

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