"Merely a patient dies in the Hospital does not lead to a presumption that there was Negligence on part of the Doctors and Hospital"

A new year gift in form of Judgment for the Medicos by Hon. Delhi State Consumer Forum.  A case claiming Rs.50 lakhs compensation mainly on the allegation that a mask was put in patient's  nose amounted to Negligence was dismissed, underlining the principle that :

 "A simple lack of care, an error of judgment or an accident, is not proof of negligence on the part of medical professional. So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alternative course or method of treatment was also available or simply because a more skilled doctor would not have chosen to follow or resort to that practice or procedure which the accused followed. "

Case Details :

Manohar Lal V/s. Karla Hospital SRCNC, New Delhi

Compliant No.47/2011, decided on 18/01/2019

By : Hon. Anil Shrivastava

Judgment Link :

http://cms.nic.in/ncdrcusersWeb/GetJudgement.do?method=GetJudgement&caseidin=8%2F0%2FCC%2F11%2F47&dtofhearing=2019-01-11

Facts in Short :

1. This is the case of unfortunate parents who lost their 22 years Son to Dengue Shock syndrome and the related complications. The patient was admitted in the Hospital and on very next day he was shifted to ICU. It was alleged that there was no need to put a mask on his nose and it amounts to Negligence.

2. The allegations made against the Doctors and the Hospital can be summarized as under :

1. The doctor does not give immediate treatment when required.
2. The doctor does not take precaution as per the medical jurisprudence of giving the test dose of medicines which are likely to be fatal in some cases or may cause allergy.
3. The post-operative treatment is not given properly.
4. The surgical wound is caused at a different place than required.
5. After operation, septicaemia or gangrene takes place.
6. Improper prescription of drugs. In case of fever, without knowing the cause of fever, combination of tablets and injections for malaria, thypoid, etc are freely used on trial and error basis.
7. Medical instruments are left in the body.
8. Mal-practice by the doctors, such as uncalled for pathological reports or investigations prescribed.

 3. The Doctors refuted all the allegations.

a)  It was contended by them that the patient was initially admitted in Recovery Room keeping in view his persistent fever with rashes and low BP. However as the patient developed respiratory distress with fall in oxygen level he was shifted to the main Heart Command (ICU). Further investigations revealed low Hemoglobin (9.1), low platelet counts (1,20,000) and positive Dengue Serology (IgG and IgM +ve) alongwith deranged liver function tests. 

b)  As he developed features of Dengue Shock Syndrome with breathing difficulty which can happen in Dengue +ve cases, the patient was shifted to Heart Command and put on O2 therapy with close cardiac monitoring. 

c) As the patient’s oxygen saturation did not stabilize with this, he was put on BIPAP with O2 (Non-invasive ventilation) at around 4p.m. The patient was also reviewed by Dr. Puneet Khanna (Chest specialist and intensivist) whose advise was duly followed.

d) It was further submitted that the family of the patient was informed about the situation that any patient who develops Dengue Shock Syndrome has a low survival rate and improvement if any takes a prolonged period. Despite all the best efforts and rigorous and intensive therapy and monitoring, the son of the complainant could not be saved though every intervention as required was done.

e) The cause of the death was Dengue +ve Shock Syndrome) and supported by investigations done.

Held :

1. After going through the documents on record and after hearing of the parties at length, the Commission dismissed the Compliant. 

It was observed that "this Commission has all the sympathy and consideration for the family which lost their young child but the decision has to be arrived at or adjudication of the complaint has to be done based on the facts and circumstances of the case and the legal position settled by the Hon’ble Apex Court and Hon’ble NCDRC from time to time."

2. The Commission referred to various judgments of Hon'ble Apex Court as well as NCRDC which have clarified the principles of deciding the Negligence on part of Doctors.

3. The Commission solicited the  expert opinion of the Maulana Azad Medical College  during the pendency of the case. It was opined by the Committee that Hospital have carried out appropriate investigation and the treatment done was also considered by the Expert Committee as appropriate. The Expert Committee also held that placing of mask through nose  was no Negligence on part of Doctors. It was also observed by the Commission that No allegations or mala fide have been attributed against the expert opinion received from Maulana Azad Medical College by the Complainant nor there was any adverse expert opinion was procured. 

4. It was observed that death is a very unfortunate incident and a cruel act but whether the act of doctor treating the patient has resulted in the end of the life has to be assessed or evaluated in the right and objective perspective, before reaching to a conclusion regarding the negligence. In the given case the the Doctors and the Hospital have done their duty without any slackness. 

 Mere fact that a patient dies in a hospital does not lead to a presumption that the death occurred due to the negligence of the doctor and in order to make a doctor responsible for death of his patient, it must be established that there was negligence or incompetence on his part and that he did something in disregard for the life and safety of the patient. 

 It is trite law that if the doctor has taken proper precaution and despite that if the patient does not survive then the court should be very slow in attributing negligence on the part of the doctor. 

5. The Commission also held that the Complainant failed to discharge burden of proving Negligence on part of the Opponents. It was also observed that 

"The very nature of the profession is such that there may be more than one course of treatment which may be advisable for treating a patient. Courts would indeed be slow in attributing negligence on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution."

Ultimately it dismissed the Compliant of Rs.50 lakhs.

6. It's really very unfortunate for any one to lose the near and dear one that too at an early age.  We always tell in our lectures of importance of making WILL that "Death is certain, but its time is most uncertain". This case tells us the bitter truth of life. We also have to keep in mind that there would be hardly any Doctor who would not want the patient to get recovered and go home happily.

From Doctors point of view, once again proper documentation and maintaining record  and giving treatment as per protocol have saved Doctors. In these days Doctors are afraid of declaring deaths as they fear that they will be attacked as such incidences are happening frequently. This judgment might help them to make people aware about the the limitations of Medical Science.

Thanks and regards,

Adv. Rohit Erande

Pune. ©