Medical Negligence Not Established By Mere Assertion Of 'Expected Standard Of Care': Delhi High Court

Justice Sanjeev Narula remarked, “While it is acknowledged that doctors are expected to apply a reasonable level of expertise and exercise due diligence in their practices, their conduct must not be judged against preconceived notions of a specific procedure or outcome. Consequently, the proper criterion for determining medical negligence lies in assessing whether the actions of the doctor fall below the accepted standards of a reasonably competent practitioner within the relevant field.”

The Court was considering the petitioner's case who alleged medical negligence and misconduct against respondent-doctors at Max Super Speciality Hospital, Delhi. The petitioner alleged that the lapses of the doctors resulted in the loss of his wife's life, who was diagnosed with Systemic Lupus Erythematosus/Hematemesis.

The Delhi Medical Council (DMC) conducted a hearing and found two doctors responsible for professional negligence of duty. It issued a warning and directed them to undergo at least one month of training in emergency medicine at a recognised hospital.

The petitioner filed an appeal before the National Medical Commission (NMC) as it did not take action against the respondent-doctors.

However, the NMC through an order concluded that there was no sufficient basis to establish negligence against the respondent-doctors. The petitioner thus challenged the NMC's order.

One of the allegations by the petitioner was that the infusion of 850 mcg of the drug Fentanyl within a short timeframe was reckless, effectively poisoning the patient and leading to her death.

The Court noted that the respondent-doctor's case record provided a detailed explanation regarding the calculation of the dosage of the drug taking into account the patient's specific health condition and weight requirements. It noted that this was duly considered by the NMC during its peer review process.

It remarked that the knowledge of administration and dosage of drugs is only within the expertise of medical professionals and that Court must trust such knowledge of qualified professionals.

“Furthermore, the correct administration and dosage of drugs like FENTANYL is a matter that falls squarely within the expertise of qualified medical professionals. The Court, lacking medical expertise, must trust the domain knowledge of qualified professionals, especially when the decision is the product of a recognized peer-review mechanism. In light of this, the Court, in the exercise of its judicial review, cannot substitute its own judgment for that of specialists and experts [9], whose primary responsibility is to uphold the highest standards of medical practice and professional conduct. Judicial interference here, would be unwarranted.”

The Court was of the view that none of the grounds raised provide any basis to conclude that the orders of the DMC or NMC are tainted by perversity or arbitrariness. It noted that the NMC determined that there was no credible evidence to prove medical negligence after reviewing the medical records and the course of treatment of the petitioner's wife.

The Court stated the findings of medical bodies carry considerable weight and their findings cannot be overturned unless it is perverse or illegal.

It observed that while doctors are expected to apply a reasonable level of due diligence in their practices, their conduct must not be judged against preconceived notions of a specific procedure or outcome.

It stated, “While the Court empathizes with the Petitioner's loss and appreciates the earnestness of his pursuit, it must emphasize that the findings of medical bodies, composed of experts in the field, carry considerable weight. Their determinations, supported by peer review, merit deference unless tainted by palpable perversity or illegality.”

It reiterated that the DMC and NMC's findings indicated that the line of treatment was provided considering the patient's complex medical profile.

The Court thus did not find any illegality in the NMC's order and dismissed the petition.

Title: SHIV KUMAR v. NATIONAL MEDICAL COMMISSION & ORS.

Citation: 2024 LiveLaw (Del) 1394