Facts in short :
1. The Petitioner Doctor having MBBS Degree with a Diploma in Anesthesia was held negligent for debridement of diabetic wound since it was not his duty and therefore for such rash and negligent act he was saddled with of the compensation of Rs.5,00,000/ by the District Forum.
2. The Appeal filed before the state Commission was also dismissed, hence the Dr. filed the instant Revision Petition.
Defense of the Petitioner :
3. It was argued that On 15.10.2009 the patient came back with lot of damage to the treated toe and it became gangrenous. Therefore, the Petitioner performed emergency debridement of the diabetic foot under General and Local anesthesia using analgesic Ketamin and Pyrolate.
4. Further, the enquiry was conducted by the Civil Surgeon at Giridih for the death of patient. It was held that the OP Dr. S.B. Chaudhary was a qualified MBBS doctor and registered by Bihar Medical Council, Patna. He was eligible to do general medical and surgical treatment after taking proper precautions. He was a diploma holder in anesthesiology from Patna University and competent to give anesthesia. He performs minor surgical procedure in the OT attached to his clinic like incision and drainage (I & D), circumcision, debridement, dressing of wounds etc. In the instant case, the patient was old diabetic. The OP had performed the routine investigations including blood sugar before administration of anesthesia.
Held :
1. It was observed by both the Lower Foras that there were the discrepancies in the evidence filed by the Doctor and the treatment record. There was no informed consent (Exhibit-A/2) from the patient. It was written in Hindi just above the signature of Shashi Jaiswal (Complainant) that too also in seal by using ink-pad. No initial was put by OP below this seal. Moreover, the signature of the Complainant on Vakalatnama and in her affidavit statement does not tally.
2. the NCDRC held that though the Petitioner was qualified to administer anesthesia but he was not qualified and competent to do the debridement of diabetic wound toe/foot. As the patient was highly diabetic patient. In the instant case the patient was high diabetic and more prone to develop gangrene.
3. Thus the petitioner failed in his duty of care to refer the patient to the Surgeon or to any higher center for proper treatment. The Hon’ble Supreme Court elaborated what constitutes medical negligence in case of failure of duty. In the case of Dr. Laxman Balkrishan Joshi Vs. Dr. Trimbak Bapu Godbole and Anr. (AIR 1969 SC 128) it was held that:
"The duties which a doctor owes to his patient are clear. A person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties, viz., a duty of care in deciding whether to undertake the case, a duty of care in deciding whether treatment to give or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient. The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged. In the light of the particular circumstances of each case is what the law requires.
The above principle was again applied by this court in the case of A.S. Mittal and Ors. vs. State of U.P. and Ors. (AIR 1989 SC 1570). It observed "A mistake by a medical practitioner which no reasonably competent and a careful practitioner would have committed is a negligent one."
3. To conclude it was held that debridement of diabetic wound was not the duty of the Petitioner and the concurrent finding of facts are noted from both the fora below cannot be challenged by using the Revisional Jurisdiction which is a settled Law and as held by Hon. SC . The revisional jurisdiction of this Commission is limited and within the meaning and scope of section 21(b), I find no jurisdictional error, or a legal principle ignored, or miscarriage of justice, as may necessitate interference in the exercise of the revisional jurisdiction from this Commission. I would like to rely upon the decision of the Hon’ble Supreme Court in the case of ‘Rubi (Chandra) Dutta Vs. M/s United India Insurance Co. Ltd.’ 2011 11 SCC 269 and in ‘Sunil Kumar Maity vs. State Bank of India & Anr.’ (Civil Appeal No. 432 / 2022 Order dated 21.01.2022)
12. The Revision Petition, being misconceived and devoid of merit, is dismissed.
What an MBBS Doctor can do and what he/she cannot has always been the arguable issue like in case of MD Medicine. Debridement in simple words can be termed as a procedure used to clean out dead or infected skin and tissue from a foot ulcer. So if we consider the MBBS degree, the Petitioner should be capable of doing that. Doesn't he ? Perhaps the evidence produced in the Trial forums must be against the Doctor. So what's the take home message is in case of a doubt, refer the patient to the Higher Center and please do take a proper informed consent, even if you may examine 2-3 patients less or do 1-2 surgeries less.
Thanks and Regards,
Adv. ROHiT ERANDE. ©
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