SUPREME COURT HOLDS RESPONDENTS NOT LIABLE FOR MEDICAL NEGLIGENCE IN CONDUCTING POST-OPERATIVE CARE

INTRODUCTION

A two- Judge Bench of the Supreme Court comprising of Justice A.S Bopanna and Justice Prashant Kumar Mishra passed an Order dated 17.10.2023 in Civil Appeal No. 10347 Of 2010 in Mrs. Kalyani Rajan Vs. Indraprastha Apollo Hospital & Ors. and held that there was no negligence on the part of the Respondent-Hospital and Doctor in taking post-operative medical care of the Deceased Patient.

FACTS

1) That the Complainant- Appellant, Mrs. Kalyani Rajan, wife of Mr. Sankar Rajan (“Deceased / Patient”), filed a Complaint before the Hon’ble National Consumer Dispute Redressal Commission (“Commission”), against the Respondent no. 1, namely, Indraprastha Apollo Hospital and Respondent No. 2, namely Dr. Ravi Bhatia for causing negligence in taking due care of the Patient post-surgery.

2) The Deceased was suffering from Chiari Malformations (Type II) with Hydrocephalous. The Deceased had consulted Respondent No. 2, who is a Senior Consultant, Department of Neurosurgery of Respondent No. 1 on 21.10.1998 and was advised to get admitted to Respondent No. 1- Hospital by Respondent No. 2 where the surgery would be performed.

3) The Deceased, on the advice of Respondent No. 2, got himself admitted to Respondent No.1- Hospital on 29.10.1998.

4) Thereafter, after conducting the preoperative examinations, the Respondent No. 2 conducted the operation on the Deceased. The Deceased was shifted to a private room at around 4:15 p.m.

5) Further, the Doctors visited the Deceased at around 4.30 p.m, wherein the Deceased informed them about the pain in the neck region, which seemed to have transferred downward lower than the region where the pain used to occur prior to the operation.

6) Thereafter, at 6:30 p.m. due to the increase in the pain, the Deceased was given a pain reliever intravenously, but the pain increased along with severe sweat spells.

7) Later, the Appellant called the Respondent No. 2-Doctor at his residential phone number but he was unavailable. Again, at 11:00 p.m. the Complainant-Deceased’s wife called and spoke to Respondent No. 2 at his residence, and informed him that the Deceased had suffered a heart attack around 11:00 p.m.

8) Thereafter, the Deceased was declared brain dead on 31.10.1998 and was kept on life support till 06.11.1998.

9) The Appellant then, filed a Complaint against the Respondents before the Commission under Section 2 (c)(iii) of the Consumer Protection Act, 1986 (“Complaint”)[1] for the reason that the Deceased was not attended to by any doctor from the neurosurgery team who had operated on the Deceased after he was shifted into the private room.

COMMISSION’S ANALYSIS

a) The Commission was of the opinion that the Appellant has not been able to establish any cogent evidence or material on record that the heart attack suffered by the Deceased had any connection with the operation in question or on account of any negligence in the post operative care.

b) The Commission further said that the Deceased did not have any history of diabetes or hypertension as has been stated by Respondent No. 2 in his evidence, neither did he have any heart problem.

c) Further, it was held by the Commission that there was no case of medical negligence on the part of Respondents. The Principle of Res Ipsa Locutore. the circumstances of the case make it obvious that negligence occurred, does not apply to the facts and circumstances of this case.

d) Aggrieved by the said Order dated 08.2010 of the Commission, the Appellant filed Civil Appeal No. 10347 Of 2010 in the Supreme Court.

SUPREME COURT ANALYSIS

The Apex Court vide Order dated 17.10.2023, made the following observations:

i) The crucial issue to be decided was whether the Respondents have committed negligence in not providing proper post-operative medical care to the Patient and, accordingly, whether the Commission has committed any illegality while dismissing the Complaint filed by the Appellant.

ii) The Supreme Court observed that the Appellant had never questioned the diagnosis and recommended surgical treatment given to him by Respondent No. 2. The entire case of the Appellant was about lack of proper post-operative medical care. The allegation of the Appellant was that the Deceased should have been shifted to the Intensive Care Unit (“ICU”) instead of a private room.

iii) Further, the material available on record demonstrates that as per the standard practice, all patients who show no post or pre-operative complications are sent to the ward/room.

iv) Thereafter, the symptoms that emerged after the Deceased was discharged from the Operation Theatre, were not the symptoms that typically precede a cardiac arrest.

v) That, since the Deceased did not have any known or identifiable heart ailments, it was impossible for the Respondents to have prior knowledge that the Patient may develop a cardiac problem after a few hours of successful operation.

vi) That, the symptoms, including dizziness, sweating, and pain in the neck area, experienced by the Deceased post-surgery, could not be treated as post-surgery reactions. The Patient would have been shifted to the ICU immediately, if serious complications had arisen after the surgery. Therefore, in the absence of complications in the surgery or soon thereafter, the Patient was not required to be shifted to the ICU and there is no negligence on this count by either of the Respondents.

vii) That the Court on the issue as to when a medical officer may be held liable for negligence relied on the observations in Jacob Mathew Vs. State of Punjab and Anr. (2005) 6 SCC 1 which were as follows:

“A professional may be held liable for negligence on one of the two findings: either he was not possessed of the requisite skill which he professed to have possessed, or, he did not exercise, with reasonable competence in the given case, the skill which he did possess. The standard to be applied for judging, whether the person charged has been negligent or not, would be that of an ordinary competent person exercising ordinary skill in that profession. It is not possible for every professional to possess the highest level of expertise or skills in that branch which he practices. A highly skilled professional may be possessed of better qualities, but that cannot be made the basis or the yardstick for judging the performance of the professional proceeded against on indictment of negligence.”

viii) Further, the next limb of allegation for negligence is that the Deceased was not attended to by any doctor from the neurosurgery team after he was shifted into the private room till 11:00 p.m. when he suffered cardiac arrest.

ix) The Supreme Court said that, according to the material evidence placed before the Court including the records maintained by the Hospital revealed that the Patient was examined by Dr. Brahm Prakash, Dr. Ravi Bhatia and Dr. Tyagi after the Patient was shifted to the private room. The Patient complained of pain in the neck region to Dr. Ravi Bhatia and the Patient was told that it was on account of the operation.

x) That, the said pain started increasing at 6.00 p.m. for which injection was given. When the doctor on duty contacted Dr. Tyagi, he was instructed to give the tablet Nimulid. The Patient, except for the pain in the neck region, did not complain about any pain in any other part of the body.

xi) That, the attending nurse called Dr. Tyagi at around 08:15 p.m. to inform him that the Patient was complaining about the problem of sweating, pain and dizziness which, according to Dr. Tyagi, were normal post-operative reactions.

xii) That, there was no evidence put forth by the Appellant to establish that the heart attack suffered by the Patient had any connection with the operation in question or that it was on the account of negligent post-operative care.

xiii) Further, the Apex Court considered the case of Martin F. D’Souza v. Mohd. Ishfaq (2009) 3 SCC 1, the Supreme Court observed that the doctor cannot be held liable for medical negligence by applying the Doctrine of Res Ipsa Loquitur for the reason that a Patient has not favourably responded to a treatment given by a doctor or a surgery has failed. There is a tendency to blame the doctor when a Patient dies or suffers some mishap. This is an intolerant conduct of the family members to not accept the death in such cases. The increased cases of manhandling of medical professionals who work day and night without their comfort has been very well seen during this Pandemic. The Apex Court held as under:

“40. Simply because a Patient has not favourably responded to a treatment given by a doctor or a surgery has failed, the doctor cannot be held straightaway liable for medical negligence by applying the doctrine of res ipsa loquitur. No sensible professional would intentionally commit an act or omission which would result in harm or injury to the Patient since the professional reputation of the professional would be at stake. A single failure may cost him dear in his lapse.

When a Patient dies or suffers some mishap, there is a tendency to blame the doctor for this. Things have gone wrong and, therefore, somebody must be punished for it. However, it is well known that even the best professionals, what to say of the average professional, sometimes have failures. A lawyer cannot win every case in his professional career but surely he cannot be penalised for losing a case provided he appeared in it and made his submissions.”

xiv) The Supreme Court held that the applicability of Principle of Res Ipsa Locutor, in the fact and circumstances of the case, is to bear in mind that the principles get attracted where circumstances strongly suggest partaking in negligent behaviour by the person against whom an accusation of negligence is made. For applying the Principle of Res Ipsa Locutor, it is necessary that a ‘Res’ is present to establish the allegation of negligence. Strong incriminating circumstantial or documentary evidence is required for the application of the Doctrine.

xv) The Supreme Court held that there was no mistake in the diagnosis or a negligent diagnosis by Respondent No. 2. In the absence of the Patient having any history of diabetes, hypertension, or cardiac problem, it is difficult to foresee a possible cardiac problem only because the Patient had suffered pain in the neck region.

CONCLUSION

Thus, based on the aforesaid analysis, the Apex Court held that the Appellant has failed to establish negligence on the part of the Respondents in taking post-operative care and the findings in this regard recorded by the Commission do not suffer from any illegality or perversity. The Appeal was, thereby, dismissed.

 

Kartik Khandekar

Associate

The Indian Lawyer

 

[1]  Section 2 of the Consumer Protection Act, 1986 -Definitions-

 (c) “Complaint” means any allegation in writing made by a complainant that—

[(i) an unfair trade practice or a restrictive trade practice has been adopted by 6 [any trader or service provider];]

(ii) [the goods bought by him or agreed to be bought by him] suffer from one or more defects;

(iii) [the services hired or availed of or agreed to be hired or availed of by him] suffer from deficiency in any respect;