One judgment but "manifold Reliefs" to Doctors by Hon. Supreme Court. "No assurance of full recovery can be given", "Wrong diagnosis is not a negligence" "Its the prerogative of Doctors to decide line of treatment" and few more...

A recent Judgement of Hon. Apex Court may be referred to oasis for Doctors in these days. Their Lordships Observed, "We have sympathy for the appellant (who lost his beloved wife) , but sympathy cannot translate into a legal remedy"

Case Details :

Vinod Jain V/s. Santokba Durlabhji Memorial Hospital & ors.

(2020) 1 SCC (civ.) 256 = (2019) 12 SCC 229.

Civil Appeal No.2024/2019, decided on 25/02/2019

Coram :

Hon. Sanjay Kisan Kaul and L. Nageswara Rao)

Link :

https://www.supremecourtofindia.nic.in/supremecourt/2017/34426/34426_2017_Judgement_25-Feb-2019.pdf

Facts in short :

The Appellant after consulting various Doctors and with his Doctor Son, settled in USA, decided to file the case against Doctors and Hospital.

1. The Appellant , who lost his beloved wife, case for Medical Negligence in Rajasthan State Forum against the Respondent. The State Forum allowed the Compliant, however the National Forum reversed the said Judgment and hence the Appellant approached Hon. Supreme Court.

2. The  Appellant's wife, Smt. Sudha (deceased patient) was suffering from Esophageal cancer (earlier history of breast and colon cancer), hypertension, type-II diabetics. On 15/10/2011 the patient was admitted to hospital for the treatment of chill & fever (104 degree Fahrenheit)  and also for re-insertion of Nasal Feed Tube. 

3. The treating Doctor while re-insertion of the Tube suggested few tests. Blood report showed high count of WBC indicating infection. The canula used for intravenous treatment also stopped working in between, the antibiotics was prescribed to be taken through the nasal tube and she was discharged on 18/10/2011 accordingly. It was contended by the Appellant that she ought not to have been discharged in such circumstances. The Appellant contended that on 23/10/2011, his wife went into Coma and had to be shifted to Fortis Hospital and was deteriorating and ultimately she succumbed to death on 31/10/2011.

4. The Appellant thereafter filed the compliant with consumer forum and also filed compliant with Medical Council of Rajasthan, but in vain. The further appeal of the Appellant made to Medical Council of India was also dismissed as barred by limitation. 

5. The Appellant's main allegations may be summarised as under :

(a) inappropriate and ineffective medication; 

(b) failure to restart the cannula for IV medication; 

(c) premature discharge of the deceased despite her condition warranting treatment in the ICU; 

(d) oral administration of Polypod antibiotic, despite her critical condition, which actually required intravenous administration of the medicines.

6. The Hospital/Doctors on the contrary refuted all the allegations and contended that when the patient was discharged, all her vitals were normal, she was afebrile, there was no infection in chest and in urinary tract and such she was clinically discharged and therefore she was discharged.

 7. The State Forum allowed the Compliant and directed the Respondents to pay Rs.15 lakhs + Rs.51,000/- as costs to the Appellant.  However in the Appeal, the National Forum reversed the finding and exonerated Respondents and it was further observed that at the most conduct of the Respondents may be termed ass Wrong Diagnosis, but not as Medical Negligence.

The Hon. Apex Court held that :

1. At the outset, their Lordships dealt with what is meant by "Negligence" by referring to various earlier judgments of The Supreme Court itself and also referring to some of English Judgments. It has given reliefs to Doctors almost in each Paragraph.

Let's see the bullet points :

2. If Doctor is following normally accepted practice, he is not negligent.

It has been observed that  A fundamental aspect, which has to be kept in mind is that a doctor cannot be said to be negligent if he is acting in accordance with a practice accepted as proper by a reasonable body of medical men skilled in that particular art, accepted as proper by a reasonable body of medical men skilled in that particular art, 
 

3. Doctor is expected to exercise reasonable amount of skill and not any highest degree of skill :

While referring to the term coined by English Courts , it was observed that it was emphasized that the test of negligence cannot be the test of the man on the top of a 'Clapham omnibus'. In cases of medical negligence, where a special skill or competence is attributed to a doctor, a doctor need not possess the highest expert skill, at the risk of being found negligent, and it would suffice if he exercises the ordinary skill of an ordinary competent man exercising that particular art.

4. A situation should not be created where Doctor would start thinking of his safety, than the patients. :

. These observations have grater meaning in these 'scary' days, as medicos often referred to so.  A situation thus, cannot be countenanced, which would be a disservice to the community at large, by making doctors think more of their own safety than the good of their patients. 

5. Doctor can not give Assurance of Result of Treatment :

A physician, thus, would not assure a full recovery in every case, and the only assurance given, by implication, is that he possesses the requisite skills in the branch of the profession, and while undertaking the performance of his task, he would exercise his skills with reasonable competence. 

“To establish liability on that basis it must be shown (1) that there is a usual and normal practice; (2) that the defendant has not adopted it; and (3) that the course in fact adopted is one no professional man of ordinary skill would have taken had he been acting with ordinary care.”

6. A Doctor is not negligent merely because his opinion differs from other Doctors and its the prerogative of Doctor to decide line of Treatment. :

 One professional doctor is clearly not negligent merely because his conclusion differs from that of other professional doctor. The medical professional is often called upon to adopt a procedure which involves higher element of risk, but which he honestly believes as providing greater chances of success for the patient rather than a procedure involving lesser risk but higher chances of failure. Just because a professional looking to the gravity of illness has taken higher element of risk to redeem the patient out of his/her suffering which did not yield the desired result may not amount to negligence.

7. On these observations, it was held that the Respondents gave prompt treatment to the patient. The nasal-feed tube was inserted properly, but cannula stopped functioning and instead of re-cannulating the patient, oral administration of the antibiotic Polypod was found justified. It does not amount to negligence as alleged by the Appellant. Because the treating Doctor also gave explanation that he found that the drip had been disconnected, on account of all peripheral veins being blocked due to past chemotherapies, and that the drip had been stopped, the night before itself, at the instance of the appellant himself.

8. The Apex Court relied upon the finding of NCDRC which observed that the Doctor cannot be held negligent as he found that the patient was normal, afebrile, well-hydrated and displayed normal vitals, he rightly prescribed the oral administration of the tablet. He took this decision based on his own skill, knowledge and care and after understanding the situation of patient.

9. The Court also rejected the contention of Appellant that the Blood Culture report of the deceased required that she ought to have been kept in the Hospital. The Court said that the decision to discharge the patient was based on other stable conditions and increased WBC could have been treated by oral antibiotics.

10. In the perception of the doctor, the increase in lymphocytes in the blood count was the result of the patient displaying an improved immune response to the infection and thus  the NCDRC in this context correctly opined that at best, it could be categorised as a possible case of wrong diagnosis. 

 11. The Apex Court also questioned the reasoning of State Commission which  granted damages of Rs.15 lakhs on a premise that respondent No.2-Doctor could have pursued an alternative mode of treatment. Such a course of action, as a super-appellate medical authority, could not have been performed by the State Commission. It was further observed by the Apex Court that there was no evidence to show any unexplained deviation from standard protocol. It is also relevant to note that the deceased was medically compromised by the reason of her past illnesses. 

12. Lastly it was observed that the death did not occur due to untimely discharge of the patient from the Hospital as alleged, but the patient died because of multiple factors like multiple organ failures, heavy diabetics, previous history of cancer and effects of radiation and chemotherapy, it all contributed to the death of the patient.

13. Last but not the least, it was observed that We appreciate the pain of the appellant, but then, that by itself cannot be a cause for awarding damages for the passing away of his wife. We have sympathy for the appellant, but sympathy cannot translate into a legal remedy.

This is indeed a very important judgement and gives some positive vibes for Doctors. Obviously, every case is decided on its own merits and a Doctor can be held liable if the facts are so, but the observations in the judgment would certainly act as guiding factor. 

Thanks and regards,

Adv. Rohit Erande.

Pune. ©