Hyderabad: The District Consumer Disputes Redressal Commission in Nalgonda has directed to pay Rs 1 crore as compensation to the family of a 23-year-old woman who died during childbirth in July 2018.
The court found the hospital vicariously liable for medical negligence by its doctors.
What is the case about?
Asnala Swathi, 23, went to Kamineni Hospital in Narketpally of Nalgonda district for a C-section in July 2018. Doctors administered anaesthesia twice during the procedure—a violation of standard protocol. She never regained consciousness and died the next morning, leaving behind her newborn son.
Seven years later, the District Consumer Disputes Redressal Commission in Nalgonda has ordered the hospital to pay Rs 1 crore to her family. The court found doctors gave her anaesthesia ‘without knowing the condition of the patient’ and failed to manage life-threatening complications.
“Doctors were duty-bound to treat the patient with a reasonable degree of skill and care, but they failed to exercise due care and diligence, which constitutes medical negligence,” the commission ruled.
The timeline of the operation leading to the double dose of anaesthesia
Swathi checked into Kamineni Hospital on July 9, 2018. She was 38 weeks pregnant. On July 9, at 10 am, Dr Madhavi, Professor and Head of Department, Obstetrics and Gynaecology and Consulting Doctor attended the patient. She confirmed that the patient and the baby in her womb are fine and good after carrying out all the relevant tests.
The complainants stated that from July 10 to 13, doctors checked the patient’s blood pressure and condition, ‘duly informing that the patient and the foetus in the womb are quite well and good and delivery can happen any time.’
By July 13, labour induction had failed, and the foetal heart rate looked abnormal. At 9:30 pm, Consulting Doctor, Obstetrics and Gynaecology, Sunita Mishra, decided on emergency C-section surgery.
Anaesthesia Senior Resident Dr Prasad gave Swathi spinal anaesthesia at 10:40 pm. The baby was born at 10:55 pm. Then, during stitching, doctors added general anaesthesia: fentanyl, propofol, succinylcholine and vecuronium.
The violation of the patient’s safety protocol
The family asked why Swathi remained unconscious for hours later, too. Dr Prasad told them she had woken during stitching and would not let them finish, so they gave anaesthesia again. No emergency doctor was available, he said.
The commission found this violated protocol.
“Dr Prasad had administered anaesthesia twice, i.e. spinal anaesthesia and other general anaesthesia, which is against the protocol of C-section delivery,” it stated. “Generally, anaesthesia is regional, like spinal or epidural, to numb the lower part of the body.”
Dr Prasad admitted in court he gave anaesthesia ‘without knowing the condition of the patient nor verifying from other doctors’ notes.’
The cascade of complications
At 12:30 am, doctors removed Swathi’s breathing tube. Ten minutes later, she complained of breathlessness. Her breathing volume dropped. They put the tube back in and moved her to the ICU on a ventilator.
By 4:15 am on July 14, her urine output had decreased. At 5 am, her blood pressure crashed. Doctors gave fluids and two powerful drugs to raise it. Nothing worked.
Tests revealed a cascade of failures: low platelets, clotting problems, severe acidosis, and white blood cells at 36,200, suggesting infection. The ECG showed pulmonary embolism—a blood clot in her lungs. The heart scan showed peripartum cardiomyopathy—heart failure around delivery.
At 6:30 am, doctors could not record her blood pressure despite the drugs. At 7:30 am, they transfused blood and plasma. Multiple senior doctors examined her.
At 9 am, Dr Madhavi arrived and told the family, “What they have to do, they have done.”
At 10:25 am, Swathi’s heart stopped. CPR failed. She was declared dead at 10:55 am.
The commission found doctors ‘ignored the possibility of pulmonary embolism 'despite the ventilator and ‘failed to give the right treatment in order to save the patient.’
What the medical records hid
When Swathi’s father lodged a police complaint, investigators found problems in the hospital records.
The case sheet showed ‘uterus well retracted with clear dressing.’ The post-mortem report showed ‘massive broad ligament hematoma and hematoma below the rectus sheath’—massive internal bleeding that the doctors had not documented.
Dr Sunita Mishra admitted in court that ‘if the suturing is not done properly, it would result in hematoma.’
Assistant Professor of Emergency Medicine Department, Dr Maruthi admitted the post-mortem report mentioned, ‘massive blood collection near the uterus’ but ‘it is not recorded in the case sheet.’
The family found more discrepancies. Someone had obtained high-risk consent at 9:15 am on July 14, when Swathi already lay in a coma. The case sheet recorded a blood transfusion between 7:30 pm and 8 pm on July 14, hours after death at 10:55 am.
Dr Madhavi admitted the investigation report mentioned ‘overwriting in the case on different page numbers.’
Government Maternity Hospital in Hyderabad reviewed the case and found ‘rewritings in findings and variations in the line of treatment’ with ‘discrepancy between the findings in the case sheet’ and the post-mortem report.
Based on this opinion, the police charged all four doctors under Section 304-A IPC for causing death by negligence.
The doctors had no coordination
In court proceedings after the police case, the doctors made admissions that contradicted their written defence.
Dr Prasad, the anaesthetist, admitted ‘he had no personal knowledge about the condition and complications of the patient prior to attending the patient and that he had not explained the high risk of the patient to the attendants.’
He confirmed doctors told the family Swathi would have a normal delivery. He admitted ‘none of the doctors have suggested that the patient or her attendants shift to any better hospital.’
“Generally, anaesthesia is regional, like spinal or epidural, to numb the lower part of the body, but in the instant case, there is an overdose of anaesthesia that the patient did not regain consciousness for more than 24 hours, and the doctor administered anaesthesia without knowing the condition of the patient or verifying with other doctors,” said the commission.
The commission found this proved coordination failure: “This shows that there was no coordination between the doctors in treating the patient Swathi.”
Dr Madhavi admitted she was not present during the surgery.
The hospital’s defence
The hospital argued that Swathi had not been healthy. She came on June 25 with hypertension and swollen feet, had seen a private doctor who prescribed blood pressure medication, but she did not take it regularly. She also had thyroid problems.
The hospital said these were rare complications. “The risk of thromboembolism in pregnancy and post-partum period is 0.5 to 3 per cent,” they stated. “Pulmonary embolism is fatal in almost 15 per cent of the patients.” Peripartum cardiomyopathy has mortality rates of 18-50 per cent.
They filed a December 2023 decision from Telangana State Medical Council finding ‘no negligence’ by the doctors.
The commission rejected this. “The findings of the Ethics Committee are of only advisory nature, but not an expert opinion. As such, the report of the Ethics Committee cannot be considered and believed. There are clear findings about discrepancies between the case sheet and the PME report. Thus, the principle of Res ipsa loquitur is applicable as the record itself speaks about the negligence and improper treatment given by the doctors of the hospital, as there were variations in findings in the PME report and in the chargesheet.”
The verdict
The commission found the cause of death was ‘refractory hypotension with severe metabolic acidosis with severe coagulopathy, antecedent cause is due to cardiogenic shock with pericardial tamponade with presence of amniotic fluid/Thromboembolism.’
“Thus, the above factors were not managed and the hospital and doctors have failed to give the right treatment in order to save the patient. It is only due to sheer negligence and improper treatment that Swathi lost her life.”
The hospital must deposit Rs 90 lakh in a bank account for Swathi’s son until he turns 18, with interest available for his care. The remaining Rs 10 lakh goes to the family, along with Rs 1 lakh for legal costs. Payment is due within 30 days, or the amount will carry 9 per cent annual interest.
