5 years after Appendectomy, it was found that a sharp needle left in the abdominal wall of a patient and a Doctor held liable for damages of Rs.2 laks for Medical Negligence by applying Doctrine of "Eggshell-Skull rule", but the SC enhanced the compensation !!!!!!
Facts of the case in short :
1. In a rare but interesting case the National Commission reduced the the damages to Rs.2 lakhs on a Doctor, because of whose negligence, a sharp needle remained the abdominal wall of the Complainant in appendectomy, one of the most common surgical procedures performed in its recent judgment dated 01/09/2015, in the case of Jyoti Devi V/s. SUKET HOSPITAL & 3 ORS. (R.P. No.57/2015) link of NCDRC Judgment - http://cms.nic.in/ncdrcusersWeb/GetJudgement.do... 2. The complainant underwent appendectomy operation on 28-06-2005 at Suket Hospital, Sundernagar, Himachal Pradesh. She was discharged on 30-06-2015. During follow up, she complained of pain at the site of surgery. Again on 30-09-2006 she was admitted at same Hospital and discharged on 02-10-2006 wherein she was treated conservatively for cellulites of abdominal wall, but the pain persisted continuously. Thus she went to another Hospital at Mandi, where re-exploration for surgical wound was done and drain was placed for draining out the pus.
3. It's really interesting that the patient was having pain for nearly 5 years and finally in the year 2010 she went to PGI Chandigarh and a foreign body, about 2.5 cm straight needle, was detected at the site of previous surgery, which was removed and thus the Complainant filed the case for claiming compensation to the tune of Rs.19.80 lacs.!!
4. However, the National Commission observed that most important question to decide in the instant case is, whether, a straight needle about 2.5 cm in length, can be retained for a long period, in the interior abdominal wall i.e. just medial to previous abdominal appendectomy scar? After taking reference from various surgical books and came to know that, in very rare occasion foreign body or sharp object were found after a decade also.
a) Sharp metallic bodies (needles) penetrate the abdominal wall usually accidentally. Incidence of their deliberate insertion is rare. Such foreign bodies usually produce a pricking sensation but surprisingly they may remain silent. Patient may present with unrelated symptoms and the discovery of the foreign body on radiological examination may come as a surprise.
b) Generally, early postoperative masses are easier to diagnose and treat, while late postoperative abdominal wall masses could be of various etiologies that warrant the use of a wide spectrum of diagnostic modalities and consequently different treatment options. All these facts signify the importance of preoperative diagnosis. Thus, abdominal ultrasound, contrast-enhanced multi-slice CT and other diagnostic modalities should be used according to clinical findings.
The Commission also observed that the Doctor should have been careful during follow up treatment. It is apparent that, the post-operative care from the OPs was casual; it was not as per standards. It was the duty of the OPs to investigate the non-healing surgical wound. Hence, it was held to be a deficiency in service, not a standard of practice.
5. However the Commission reduced the Compensation of Rs.2 lakcs against Rs.19.80 lacks as prayed for by applying the Doctrine of “Egg Skull Rule” because the Doctor took a plea that a patient took treatment from few other hospitals which might have caused retention of needle in the abdominal wall.
6. The Commission observed that it is difficult to fathom who had left behind the straight needle by relying on its earlier judgment in Smt. Vidya Devi Vs. Mrs.(Dr.) P.N. Mohanty & Anr., Original Petition No.67 of 1999, decided on 04-05-2010, In this case, surgical mop was left in the body for more than two years and patient had continuous pain and pus discharge. The patient underwent further treatment from different hospitals, at one point of time.
In Achutrao Haribhau Khodwa vs State Of Maharashtra And Ors 1996 SCC (2) 634, JT 1996 (2)624, the Apex Court came heavily on the Doctors because of whose Negligence, a mop (towel) had been left inside the body of one Smt. Chandrikabai, when sterilization operation was performed on her.......
7. The “Eggshell skull” or “Eggshell plaintiff” rule states that a defendant is liable for a plaintiff’s unforeseeable and uncommon reactions to the defendant’s negligent or intentional act.The term “thin skull” or "eggsheel skull" - plaintiff, finally emerged in 1901 in an English case and the English Courts are following the said rule. E.g. In the case of Bruneau v. Quick 9447 A.2d 742 (Conn. 1982). , the defendant performed an operation on the plaintiff’s feet, which worsened an existing foot condition that the plaintiff had struggled with her entire life.The defendant argued that his actions did not aggravate an unknown pre-existing condition. The court nonetheless concluded that application of the eggshell plaintiff rule was appropriate and held the defendant liable for injuries that were “different in degree” because of plaintiff’s condition. This rule is being criticised also on the ground that it conflicts with the fundamental principle that legal liability should be limited to foreseeable harm.
8. Feeling aggrieved the Complainant approached Hon'ble Supreme Court for enhancement of the compensation. The bench comprising of Hon. Justices Sanjay Karol and Hon. Justice Aravind Kumar in its order dated 24/04/2024 refused the application of this rule by NCDRC and pointed out that for this rule to be appropriately invoked and applied, the person in whose case an adjudicatory authority applies must have a pre-existing conditions.
9. The Apex court further held that the jurisprudence of the application of this rule, as has developed, (needless to add, in countries other than India) has fit into four categories -
a.) when a latent condition of the plaintiff has been unearthed;
b) , when the negligence on the part of the wrongdoer re-activates a plaintiff’s pre-existing condition that had subsided due to treatment; c) Wrongdoer's actions aggravate known, pre-existing conditions, that have not yet received medical attention; and
d) when the Wrongdoer's actions accelerate an inevitable disability or loss of life due to a condition possessed by the plaintiff, even when the eventuality would have occurred with time, in the absence of the wrongdoer’s actions.
Their Lordships thus observed :
"As these categories and, the name of the rule itself suggest, the persons to whose, this rule can be applied, are persons who have pre-existing conditions,"
10. While disagreeing with the Judgment of NCDRC, the bench said, "We find the manner in which compensation stood reduced by the State Commission as also the NCDRC, vis-à-vis the District Forum to be based on questionable reasoning".
11. The Hon. Apex Court pointed out that the NCDRC observed that the claimant-appellant’s treatment at the respondent-Hospital was ‘casual’; that the excuse of having sought treatment at other hospitals was not available to the respondents and that she had suffered pain for more than five years apart from the case having been dragged on for more than a decade, and yet lump sum compensation was only Rs two lakhs.
12. The Bench observed somewhat unpleasantly that "How could such compensation be justified, after observations having been made regarding the service rendered by the Hospital, being deficient, and the continuous pain and suffering on the part of the claimant-appellant, is something we fail to comprehend. Compensation by its very nature, has to be just. For suffering, no part of which was the claimant-appellant’s own fault, she has been awarded a sum which can, at best, be described as ‘paltry’," the bench said.
With regard to the application of the eggshell-skull rule, the court observed that the impugned judgment was silent as to how this rule applied to the present case and observed : .
"Nowhere is it mentioned, as to what criteria had been examined, and then, upon analysis, found to be met by the claimant-appellant for it to be termed that she had an eggshell skull, or for that matter, what sort of pre-existing condition was she afflicted by, making her more susceptible to such a reaction brought on because of surgery for appendicitis," the bench said.
13. The Apex Court lastly pointed out that none of the orders - be it District, State Commission or the NCDRC referred to any such condition which showed that the complainant had a pre-existing vulnerability or medical condition, because of which she might have suffered ‘unusual damage’.
14. Therefore the Court set aside the orders of lower Foras and enhanced the compensation and directed the respondents to pay within four weeks Rs.5 lakhs plus Rs 50,000 cost of litigation, alongwith simple interest @ 9% p.a. from the date of award by the district forum.
(SLP (C) No. 242/2016, decided on 23rd April 2024.)
https://webapi.sci.gov.in/supremecourt/2015/41235/41235_2015_9_1501_52474_Judgement_23-Apr-2024.pdf
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