NCDRC: Death Of Former CJI J.S. Verma Cannot Be Attributed To The Treatment Given By Doctors, Complaint Filed By Wife And Children Dismissed

The National Consumer Dispute Redressal Commission (NCDRC) absolved the doctors and the hospitals involved in the treatment of Late Justice J.S. Verma, Former Chief Justice of India (CJI) and Chairman of the National Human Rights Commission (NHRC). Justice Verma passed away in 2013. He’s known for heading a three-member panel which suggested modifications to criminal legislation in response to the 2012 Nirbhaya gangrape incident. The NCDRC referred to relevant literature, medical records, reports, opinion of the Medical Council of India (MCI) and the catena of Supreme Court decisions in cases of medical negligence, to hold that the doctors took reasonable care and due diligence during the treatment and the unfortunate death of Justice Verma cannot be attributed their actions.

Facts:

Justice J.S. Verma, former Chief Justice of India and Chairman of the National Human Rights Commission was diagnosed with coronary artery disease in 1993. In November 2012, he had abnormal liver function test results and developed swelling in his left leg. He sought treatment at Bhardwaj Nursing & Maternity Home (“Bhardwaj Hospital”), where he was diagnosed with atrial fibrillation by Dr Sanjiv Bharadwaj. The tests revealed severe liver dysfunction and abnormal blood clotting. Medications were prescribed, but during a follow-up visit, Justice J.S. Verma reported bleeding episodes in early April 2013, which were not investigated further. During a visit to Mumbai, he experienced significant gastrointestinal bleeding and was admitted to Fortis Escorts Heart Institute upon his return to Delhi. Dr Sanjiv Bharadwaj treated him and performed an endoscopy, which identified and treated an ulcer causing the bleeding. However, multiple blood and plasma transfusions led to fluid overload in his lungs, resulting in breathing difficulties. Complications like low calcium levels were not effectively managed. On the recommendation of Dr Sanjiv Bharadwaj, along with Dr Yugul Mishra and Dr Arvind Bharadwaj, Justice J.S. Verma was transferred to Medanta Medicity, Gurgaon (“Medanta”). Unfortunately, inadequate management at Medanta failed to address the underlying issues, and he suffered a cardiac arrest, ultimately passing away.

The wife and the children of Justice J.S. Verma (“Complainants”) filed a complaint before the Medical Council of India (MCI) against the doctors for negligence and professional misconduct for not exercising due care while treating Justice J.S. Verma. The same was referred to Delhi Medical Council (DMC) which dismissed on 10.06.2014. The complainants approached the NCDRC with a complaint on 10.04.2015.

Contentions of the Complainants:

The complainants alleged that Dr Piyush Jain of Fortis Hospital failed to prescribe a liver ultrasound despite significant abnormalities in the liver test report. This failure to follow medical protocol delayed the diagnosis of Justice J.S. Verma’s ‘liver cirrhosis’. At Bhardwaj Hospital, Dr. Sanjiv Bhardwaj wrongly prescribed a tablet called ‘Dabigatran’, without thorough analysis of Justice J.S. Verma’s medical reports. The incorrect combination of medications resulted in fatal bleeding and multiple organ failure, leading to his demise. Multiple blood and plasma transfusions at Fortis Escorts Heart Institute caused a fluid overload in his lungs. Moreover, the doctors at Medanta failed to address reversible factors promptly, leading to a cardiac arrest. Despite the evidence, no magnesium dose was prescribed. After Justice Verma’s death, the family faced mental trauma and distress due to breaches of patient privacy and issues with medical ethics by Dr Naresh Trehan, Chairman of Medanta.

Contentions of the Opposite Parties:

In response to the allegations, Dr V.A. Bhardwaj, the owner of Bhardwaj Hospital and family doctor of Justice J.S. Verma, stated that consultation and recommendation were obtained from highly qualified doctors in the United Kingdom before administering the tablet ‘Dabigatran’. Dr Sanjiv Bhardwaj, another doctor at Bhardwaj Clinic, mentioned that the reports of Justice J.S. Verma did not indicate any evidence of specific medical conditions, and appropriate treatment was provided based on the available information. Fortis Hospital stated that Justice J.S. Verma was stable upon admission, and he was transferred to Medanta at the family's request. Dr Naresh Trehan, Chairman of Medanta, argued that the complainants concealed certain facts regarding the medical condition and treatment. The remaining doctors at Medanta denied the allegations and provided justifications for their actions or any omissions during Justice J.S. Verma’s treatment.

Observations by the Commission:

The NCDRC perused the Liver Functions Test (LFT) report of Justice J.S. Verma and observed that there was no evidence suggesting an active liver disease and in the absence of any such indication, the doctors did not recommend an abdominal ultrasound (USG) to Justice J.S. Verma. As a result, the NCDRC absolved Dr Piyush Jain (Opposite Party 5) of Fortis Escorts Hospital (Opposite Party 4), from negligence. Regarding the allegation of wrong administration of the tablet ‘Dabigartan’, the NCDRC referred to the documented literature and the textbooks on Cardiology to observe that as long as there is no severe liver impairment, the tablet can be safely given to Justice J.S. Verma. As the LFT report did not show any gross abnormality, Dr Sunil Bhardwaj (Opposite Party 2) could not be held to be negligent for the administration of ‘Dabigartan’. Further prescription of another tablet ‘Amiodarone’ was also considered to be safe by the NCDRC as the literature established that ‘Amiodarone’ is not known to interact with ‘Dabigartan’ in Justice J.S. Verma’s body and hence, multiple organ failure cannot be attributed to the aforementioned combination of drugs. The NCDRC further referred to the medical record and concluded that during Justice J.S. Verma’s stay in the Fortis Escorts Hospital (Opposite Party 4), there was no sign of fluid overload in the lungs due to multiple transfusions at the hospital and thus, Fortis Escorts Hospital (Opposite Party 4) could not be held liable of negligence.

Regarding the allegation of non-administration of magnesium dose to Justice J.S. Verma at Medanta (Opposite Party 6) by the doctors in charge (Opposite Parties 7-10), the NCDRC observed that as per the lab reports, the Magnesium levels of Justice J.S. Verma were within the normal range and further, other appropriate medication was given to Justice J.S. Verma.

Referring to the opinion of the Delhi Medical Council (DMC) and the Medical Council of India (MCI), the NCDRC reiterated that no negligence can be attributed on the part of the doctors of the Bhardwaj Hospital, Fortis Escorts Hospital and Medanta, in the treatment administered to Justice J.S. Verma. The NCDRC also remarked that the complainants failed to establish ‘dereliction of duty of care’ from the Opposite Parties and any ‘direct (proximate) cause’ to Justice J.S. Verma’s death. Resultantly, the complainants failed to establish the 4 D’s which form the essentials of medical negligence, namely (1) Duty; (2) Dereliction/Deviation; (3) Direct (proximate) Cause; and, (4) Damages. Relying on the Supreme Court’s decision in Achutrao Haribhau Khodwa and others vs the State of Maharashtra and others (1996) 2 SCC 634, the NCDRC held that if the doctor attends a patient with due care skill and diligence, and the patient still does not survive or suffers a permanent ailment, the doctor cannot be held guilty of medical negligence. The bench sympathised with the complainants but held that no ground for liability was established on the part of the doctors and the hospitals. Thus, the complaint was dismissed.

Case: Pushpa Verma and 2 others vs Bhardwaj Nursing and Maternity Home and 9 others

Case No.: Consumer Case No. 257 of 2015

Counsel for the Complainants: Mr. Prashant Bhushan with Mr. Abhimanue Shrestha

Counsels for the Opposite Parties: Mr. Satish Tamta with Mr. Shariq Iqbal (For Opposite Party 1); Mr. Dhruv Tamta (For Opposite Party 3); Mr. Rohit Puri, Mr.Abitya Awasthi and Ms. Sangeeta (For Opposite Parties 2, 4 and 5); Ms. Shyel Trehan and Mr. Raghav Anand (For Opposite Parties 6-10)

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