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Petitioner: Dr. SADAF USMAN VS Respondent: AHMED YAR Honorable Justice Gul Hassan Tareen Behlol Khan Kasi , Talal Rind
CITATION: 2026 PLD 117 CASE: 2026Q16 TITLE: Dr. SADAF USMAN VS AHMED YAR Honorable Justice Gul Hassan Tareen Behlol Khan Kasi , Talal Rind COURT: QUETTA-HIGH-COURT-BALOCHISTAN YEAR: 2026 JOURNAL: PLD ============================================================
305 P L D 2026 Balochistan 117 Before Gul Hassan Tareen, J Dr. SADAF USMAN ---Petitioner Versus AHMED YAR ---Respondent Civil Revision No. 48 of 2024, decided on 14th June, 2024. (a) Negligence--- ----Medical negligence---Suit for damages---Obstetric management---Thrombocytopenia in late pregnancy---Duty to assess CBC/platelets and plan delivery/management accordingly---Post-partum hemorrhage---Emergency response---Standard of care---Failure to timely manage bleeding and arrange requisite transfusion/critical care---Liability---Proceeding with major surgery despite known lack of facilities---Assumption of risk---Professional lapse---Duty of attending doctor not to abandon patient in critical condition---Consequences---Quantum of damages---Determination---Vicarious liability, principle of---Applicability---Through present civil revision the petitioner/defendant (gynecologist) challenged the decrees whereby the respondent s suit for Rs.50 million damages was decreed and the appeal was dismissed with cross-objections allowed---The claim arose from treatment of the respondent s wife during her third pregnancy; her platelet counts were recorded as 144,000, later 101,000 and 91,000, after which she delivered a stillborn baby, developed uncontrolled bleeding, underwent hysterectomy, and was then transported to another hospital where she was found dead on arrival/first examination---Issue requiring determination in the present matter was as to whether, on the facts, the petitioner/defendant was legally liable in damages for alleged medical negligence in the management of the patient s pregnancy/delivery and post-operative care culminating in death, and whether such concurrent findings/decrees of the courts below warranted interference in revisional jurisdiction under S.115, C.P.C.? ---Held: The deceased was just 35 years and was not suffering from any fatal disease---Petitioner/defendant had not even pleaded that the deceased had some bodily disorder or irreversible complications---The baby was born through normal viginal delivery which showed that there was no complication during pregnancy and at the time of delivery except low platelet count which could have been overcome by the petitioner if the delivery would have been postponed and, through immediate, transfused platelet---Petitioner was well-conversant that ICU facility was not available but she took risk and operated the deceased for removal of uterus at a very low platelet count which ultimately resulted in profuse bleeding and finally, the same resulted on the premature death of a healthy patient---In the departmental inquiry the petitioner doctor admitted that she had not gone through the platelets report of the deceased and she could not answer as to why she had operated the patient when platelet count was below the average range---Inquiry was not challenged by the petitioner doctor and same had attained finality---Petitioner doctor had not managed and taken care of the deceased as a professional skilled medical person showing even no reasonable skill in managing ordinary case of delivery---Petitioner also failed to prove that she had removed the uterus of deceased with the consent in writing of the respondent---Hospital was vicariously liable for the negligent act of the petitioner doctor---Hospital authority had to use care in carrying on the hospital and was liable for the acts and omissions of the surgeons, physician and nurses---Under Art.25 of the Qanun-e-Shahadat, 1984 in suits which damages were claimed, any fact which could enable the Court to determine the amount of damages ought to be awarded was relevant---Respondent had not pleaded special damages to have accrued from negligence of petitioner neither led any evidence thereof---Hence, special damages could not be implied or presumed---Damages of Rs.500,00,000/- awarded were not proper and were extremely high and more punitive than compensatory---Pain and mental torture could not be measured in terms of money and the compensation awarded on these counts was just a solatium---Impugned judgment and decree was modified to the extent of general damages and the suit of the respondent was decreed to a sum of Rs.10,00,000/- as general damges---Civil revision was partly allowed, in circumstances. Atta Muhammad Khanzada v. Muhammad Shirin 1996 CLC 1440 rel. (b) Civil Procedure Code (V of 1908)--- ----S.115---Revisional jurisdiction of the High Court---Concurrent findings, interference in---Scope---Interference in concurrent findings under revisional jurisdiction is permissible where such findings are found to be suffering from misreading of evidence; or it has resulted due to non-reading of material evidence or based on no legal evidence, but on conjectures, and the subordinate Courts have acted illegally inasmuch as the findings rendered are against law or against the law declared by superior Courts. Abdul Hakeem v. Habibullah 1997 SCMR 1139 rel. (c) Tort--- ----Plaintiff s election of suing principal tort feasor alone---Effect---Joint and several liability of joint tort feasors---Scope---If there are more than one tort feasor, all are jointly and severally liable, however, it is a prerogative of the plaintiff to institute suit against the principle wrong doer alone or join other tort feasor as well. Government of Punjab v. Salamat Ali Khan PLD 1991 SC 699 rel. Rahat Ali v. Saeeda Begum 2002 CLC 96 ref. (d) Tort--- ----Professional negligence by medical practitioner---Action in tort for compensation/damages---Scope---Where a professional like a doctor acts negligently and in a manner, which is unbecoming of a medical practitioner then an action in torts for claiming compensation and damages would be maintainable. Achutrao Haribhau Khodwa v. State of Maharashtra 1996 PSC 1200
ref. (e) Damages--- ----General and specific damages---Distinction---General damages are implied or presumed to have accrued to the plaintiff from the wrong complained of as they are direct result from the wrong---Special damages are those which are actual but not the necessary outcome of the injury complained of, which should be specifically pleaded---Wrong done to the plaintiff must be proved to be immediate result of the act of negligence attributed to a defendant. Mrs. Aalia Tareen v. Amanullah Khan PLD 2005 SC 99 ref. Behlol Khan Kasi for Petitioner. Talal Rind for Respondent. Date of hearing: 30th May, 2024. JUDGMENT GUL HASSAN TAREEN, J.--- The petitioner has filed this civil revision petition under section 115, the Civil Procedure Code, 1908 ( C.P.C. ) from the judgment and decree dated 08 May 2023 rendered by the learned Senior Civil Judge-I, Quetta ( Trial Court ), whereby respondent s civil suit for recovery of rupees 50 million as damages was decreed and the judgment and decree dated 01 December 2023 rendered by the learned Additional District Judge-III, Quetta ( Appellate Court ), whereby appeal preferred by the petitioner from the decree of the Trial Court was dismissed and cross-objections filed by the respondent were allowed. 2. Precisely, facts of the case are that respondent entered into a matrimonial union with Atiya Ahmed ( deceased/patient ). The union was blessed with two children. She conceived for the third time and started visiting the clinic of petitioner at the Lady Dufferin Hospital, Quetta ( LDH ). In the 8th month of pregnancy, her platelet count was found below the normal and on the advice of petitioner; she visited on 01 August 2018, the Command Military Hospital Quetta Cantt. ( CMH ) and did her Complete Blood Count ( CBC ) test. Her platelet count was 144,000. On 03 August 2018, she visited petitioner for medical check up, however, petitioner did not examine the CBC test report dated 01 August 2018 and advised that, what she had prescribed on 18 May 2018, should be followed. She visited the petitioner at LDH on 09 September 2018 at 10:00 a.m. She was admitted to the LDH under the care of petitioner and CBC test was done. The platelet count was 101,000, therefore, it was advised to repeat the CBC from the Children Hospital, Quetta ( CHQ ). According to the subsequent CBC report, the platelet count was 91,000. She had a normal spontaneous vaginal delivery of a still born baby boy. Later, she started profuse bleeding which could not be managed by the petitioner. Informal consent was taken from the respondent for removing the uterus of patient through surgery. Petitioner performed surgery, despite the fact, that there were no infection signs in the uterus. After removing uterus, abnormal bleeding was continuing which could not be stopped by the petitioner and at 12:00 (night), petitioner left the patient in serious condition in the LDH and went home and refused to come back and attend the patient. On telephonic conversation, petitioner advised that patient should be shifted to the CMH and instructed female junior nurses namely Maryam and Shaista to assist the patient to the CMH at 1:45 a.m. On the instruction of petitioner, one Assistant Doctor issued a written report of the patient. The patient was taken to the CMH, where she was not admitted and the CMH s staff declined to handle her case. The CMH could not arrange the platelets. Respondent called the petitioner on her cell phone and requested for attending the patient at the CMH but she did not bother rather refused to come, as such, petitioner had to shift the deceased at 3:30 a.m. to the Sandeman Provincial Civil Hospital Quetta ( SPCH ) where she was admitted. Blood and platelets were transfused to the patient but she got improved just 1%. The Authority in SPCH informed that she is not getting improvement and advised, for shifting the patient to the Karachi for better care and issued a detail report and blood reports. At then, the platelet count of the deceased was just 18,000. Respondent arranged EDHI s Air Ambulance and on 11th September, 2018, deceased was taken to the Aga Khan University Hospital, Karachi early in the morning. In the Emergency Room, the deceased was found dead on first examination at 11:45 hours. In the suit, respondent pleaded that the deceased lost her life because of recklessness and negligence of petitioner before and after delivery of the baby. It was expedient for the petitioner to examine the CBC report dated 01 August 2018 on 03 August 2018 and should have had to advise the deceased for transfusion of 6 pints of platelets and 1 pint of blood so that the platelet count would increase to the 150,000 at least, however, petitioner failed to, advise for blood tests and, examine the general fitness of the deceased. After delivery, because of serious condition of the patient, petitioner should have given emergency treatment. Petitioner should have informed the respondent about the serious medical condition of the deceased, however, informal consent of respondent was taken for removing the uterus. After conducting surgical surgery, petitioner should have, admitted the deceased in the Intensive Care Unit ( ICU ) and, monitored the pulse and B.P on hourly basis. Petitioner did not monitor the heart beats of the patient through ECG and, take care of blood transfusion. After surgery, the deceased was bleeding, however, petitioner could not manage bleeding and in the midnight left the patient in serious condition. Respondent further pleaded that due to gross professional negligence of petitioner, she has rendered herself liable for payment of suit amount as damages. He is facing hardships due to death of his life partner in early age of just 35 years and he alone has to take care of his three children ages 11 years, 10 years and newborn of two and half months. Because of acts of recklessness of petitioner, all three minors have lost the love and kindness of their mother which caused irreparable loss to the respondent and to the minors. On 17 September 2018, respondent filed a complaint before the President, Management Committee, LDH which was entertained and on 02 October 2018, respondent along with his counsel and a doctor and members of the committee were summoned by the committee. After examination of petitioner by the Inquiry Committee and the expert doctor, petitioner admitted her professional lapses and admitted it correct that she had not examined the blood reports of the deceased. On 25 October 2018, committee compiled its report and held liable the petitioner for gross negligence and recklessness and recommended for her immediate termination from the position of M.S, the LDH. On 30 October 2018, petitioner tendered her resignation to the President, Management Committee, LDH which was accepted. On 30 October 2018, respondent issued legal notice to the petitioner claiming damages which was duly served upon the petitioner on 06 November 2018, but petitioner did not answer the same. Being a responsible professional lawyer, the unfortunate incident has damaged respondent s fame in the legal fraternity as well as in the general public. He suffers severe depression, as such, cannot perform his professional job and is facing great hardship in dealing with day to day affairs. 3. In prayer clause, respondent claimed recovery of an amount of rupees 50 million as damages. 4. On service of summons, respondent submitted written statement and denied the attributed professional recklessness and negligence. On such pleadings, the Trial Court framed following issues: - 1. Whether Atiya Ahmed the wife of plaintiff (patient) was under the treatment of defendant from the first month of her pregnancy? 2. Whether defendant had not checked the blood test report of patient indicating her platelet count? 3. Whether defendant had negligently handled the delivery case of patient and without adopting the standard procedures operated upon her? 4. Whether defendant had not taken the consent of patient s husband (plaintiff) after sensitizing him of the serious condition of patient and worst-case scenario? 5. Whether defendant did not attend the patient, post-operation, and shifted patient to Combined Military Hospital (CMH) Quetta and also did not care to come to CMH when the authorities there refused to attend the patient? 6. Whether due to the gross negligence on the part of defendant, patient lost her life? 7. Whether defendant s negligence makes her liable to pay damages to plaintiff? 8. Whether plaintiff is entitled for the claimed reliefs, if so, then to what extent? After recording oral and documentary evidences of both sides, the Trial Court decided issues Nos.1 and 4 in negative while the remaining in affirmative, and, as such, decreed the suit as prayed for vide judgment and decree dated 08 May 2023. 5. Petitioner assailed the judgment by filing appeal before the Appellate Court. Respondent also assailed the findings of Trial Court on the issues Nos.1 and 4 by filing cross-objections. Vide common judgment and decree dated 01 December 2023, the Appellate Court dismissed petitioner s appeal, however, allowed the cross-objections. 6. Mr. Behlol Khan Kasi, learned counsel representing petitioner to begin with, contended that the deceased had a normal vaginal delivery, however, she was oozing from uterus and with consent of respondent, petitioner removed the uterus which was the sole option to save the life of the deceased and, with the assistance of medical team, petitioner conducted a successful surgery of removing the uterus, but since platelet count was low and facilities of platelets and ICU were not available at the LDH, consequently, she advised the respondent for shifting the patient and arranged ambulance and shifted the patient to the CMH where she was lying on stretcher for several hours without any medical aid by the medical staff of the CMH, which fact was admitted by the deceased s brother, PW-14. In addition, learned counsel contended that later, patient was shifted to the SPCH, where she was not treated for 9 to 10 hours and PW-7, PW-8 and PW-9 had admitted it correct in their examinations. Furthermore, contended that cause of death of the patient could only be determined through post mortem, therefore, without confirmation of the cause of death, recklessness attributed to the petitioner was totally unfounded. He placed reliance on the case reported as Gul Muhammad v. The State (2021 SCMR 381) . He added that petitioner is outstanding Gynecologist in the Quetta City and she had performed what a professional doctor could be expected to do in such like situation and the PW-1 had admitted that the CBC test was advised by the petitioner to be carried out. In conclusion, learned counsel contended that the Courts below have relied upon the statement of petitioner in piecemeal, and, since patient s relatives couldn t arrange platelets, as such, negligence couldn t be attributed to the petitioner. He added that suit suffered from non-joinder of petitioner s medical team members; however, all such facts have been overlooked by the subordinate Courts. 7. Mr. Talal Rind, learned counsel representing respondent, at the outset, raised objection on the maintainability of the civil revision petition by contending that concurrent findings of facts recorded by the Courts below are immune from interference in the limited revisional jurisdiction. To begin with, contended that petitioner was accused of commission of gross negligence for, she had not examined the CBC reports of the patient and after the findings of the committee, she herself tendered resignation and did not resort to any legal action against the inquiry committee s report and findings thereof. In addition, contended that documents produced by the petitioner were forged, as such, have rightly been discarded by the subordinate Courts, whereas, the two nurses who were associated with the patient to the CMH were not examined by the petitioner as witnesses. Furthermore, contended that death of deceased occurred because of removal of uterus of which respondent had not extended legal consent. In conclusion, contended that petitioner had not furnished the names of her medical team in the written statement, therefore, suit not defective on account of non-joinder of necessary party. Learned counsel placed reliance on the following case laws:- Abdul Basit v. Saeeda Anwar (PLD 2011 Karachi) 117
and MEPCO Chief Executive Officer v. Fazal Cloth Mills Ltd. (2022 CLC 1996) . 8. Heard and have gone through the record. 9. At the outset learned counsel representing respondent raised objection to the maintainability of the revision petition by stating that the concurrent findings of facts are not open to scrutiny in revisional jurisdiction. A clear statement of law about the limits of revisional jurisdiction of the High Court qua concurrent findings of facts appears in the case reported as Abdul Hakeem v. Habibullah (1997 SCMR 1139) , wherein it was inter alia held as follows: - 6. Before considering the contentions of the parties on merit, we would like to mention here that the scope of interference with concurrent finding of fact by the High Court in exercise of its revisional jurisdiction under section 115, C.P.C. is very limited. The High Court while examining the legality of the judgment and decree in exercise of its power under section 115, C.P.C. cannot upset a finding of fact, however erroneous it may be, on reappraisal of evidence and taking a different view of the evidence. Such findings of facts can only be interfered with by the High Court under section 115, C.P.C. if the Courts below have either misread the evidence on record or while assessing or evaluating the evidence have omitted from consideration some important piece of evidence which has direct bearing on the issues involved in the case. The findings of facts will also be open to interference by the High Court under section 115, C.P.C. if the approach of the Courts below to the evidence is perverse meaning thereby that no reasonable person would reach the conclusions arrived at by the Courts below on the basis of the evidence on record. However, interference is permissible in revisional jurisdiction with concurrent findings of facts which findings are found to be suffering from misreading of evidence; or it has resulted due to non-reading of material evidence or based on no legal evidence, but on conjectures; and the subordinate Courts have acted illegally inasmuch as the findings rendered are against law or against the law declared by the superior Courts. 10. Keeping in consideration, afore stated broad principles which may justify interference by the Court with concurrent findings of facts on issues Nos. 2, 3 and 5 to 8 by the subordinate Courts, I proceed to examine whether there is any justification for interference by this Court with the concurrent findings of facts recorded by the Trial Court and the Appellate Court. 11. In her written statement, petitioner had pleaded that the deceased was under her care from the fifth month of pregnancy. Petitioner, however, admitted that on 01 August 2018, platelet count of the deceased was 144,000, which according to her was acceptable for normal delivery, however, contrarily, petitioner pleaded that during her antenatal period, deceased was advised to have blood transfusion, however, she refused to have it. Such pleading transpires that blood transfusion was the ultimate medical need which the patient had allegedly denied. However, petitioner could not bring on record any such advice slip or prescription on record suggesting that indeed, she had prescribed blood transfusion. In reply of para No. 2 of the plaint, petitioner admitted that on the date of admission to the LDH i.e. 09.09.2018, she had prescribed CBC and as per the LDH Lab report, the platelet count of deceased was 101,000, and fresh blood of 2 pints were arranged and blood transfusion was commenced prior to the delivery. However, on 09 September 2018, CBC was also done at the CHQ and the report of CHQ stated the blood count of deceased as 91,000. Such fact was not denied by the petitioner in reply of para No. 2 of the plaint. Petitioner pleaded that one hour after the delivery, the patient was bleeding for, the uterus was not contracting, as such, patient was shifted to the Operation Theatre. The respondent was apprised that the uterus fails to contract and bleeding is profuse which could lead to a potentially life threatening condition and with his formal consent, all necessary measures were taken to manage the bleeding and F.F.P.S (Fresh Frozen Plasma) was transfused to the patient. Since bleeding could not stop, consequently, consent in writing of respondent was obtained for Hysterectomy (it is surgery to remove the uterus), which was the sole option for saving the life of the patient. After treatment of Hysterectomy, patient got recovered and bleeding prevented. Patient was stable, and for such reason, was shifted to the observation room as ICU facility was not available in the LDH. Later, petitioner observed oozing from the wound. Petitioner called the ICU at CMH and arranged the shifting of the patient to CMH and a duty Medical Officer was deputed to shift the patient. 12. Following facts emerge from the written statement of petitioner:- (a) the patient was treated as Gynecologist by the petitioner from the fifth month of pregnancy; (b) on 01 August 2018, the platelet count of the deceased was 144,000; (c) patient was advised, by the petitioner, to have blood transfusion which she had denied; (d) on 09 September 2018, patient was admitted to the LDH and she had 101,000 platelet count prior to the delivery; (e) two pints blood were arranged and blood transfusion was started before the delivery; (f) patient started bleeding after an hour of delivery because of Atony of the uterus; (g) uterus was removed to save the life of deceased with consent in writing of the respondent for, all other treatments failed; (h) five pints blood and F.F.P.S were transfused to the patient; (i) patient was stable after surgery and bleeding prevented and was shifted to the observation room for, ICU facility was not available at the LDH; and (j) blood was oozing from the wound, patient was serious and petitioner deputed a duty Medical Officer for shifting the deceased to the CMH. Platelets are small, colorless cell fragments in human s blood that form clots and prevent bleeding. Platelets are made in our bone marrow, the sponge like tissue inside our bones. Bone marrow contains stem cells that develop into Red Blood Cells, White Blood Cells and Platelets. Raising the patient s blood platelet count reduces the life risk or even fatal bleeding. A low platelet count occurs when, platelets have been lost due to severe bleeding, such as following a traumatic injury or during…
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