Doctors Cannot Be Deemed Negligent For Choosing One Acceptable Medical Procedure Over Another, Even If Outcome Is Unfavorable: NCDRC

Brief Facts of the Case

The complainant, who was pregnant, upon admission for delivery to the hospital, she experienced labor pains and was taken to the labor room. During delivery, inexperienced assistants and nurses used inappropriate language and threatened her. After a difficult delivery, a baby boy was born. However, the complainant suffered excessive bleeding and was not moved from the room for two hours. She was later given anesthesia due to ongoing issues. The doctor instructed her relative to arrange three bottles of blood immediately due to the complainant's condition. During delivery, her uterine vein was cut, leading to significant bleeding and extreme pain. The tearing of the uterine vein occurred due to excessive pressure applied by the doctor while attempting delivery by vacuum method. The complainant was admitted to a different hospital then and subsequently spent a month in ICU and 15 days in a general ward before receiving further treatment at another hospital for 1½ months. The complainant alleged negligence on the part of the hospital where she was initially admitted, stating that due to the severed vein and heavy bleeding, she was immediately transferred to a different hospital where she incurred Rs.3,25,834 in expenses. Additionally, she suffered mental agony as her uterus was removed, impacting her ability to conceive again.The complainant approached the District Forum with a complaint and the complaint was allowed. Aggrieved by the District Forum's order, the doctor approached the State Commission. The State Commission allowed the appeal on the grounds that the complainant had failed to prove medical negligence against the doctor. The complainant then filed a revision petition before the National Commission against the State Commission's order.

Contentions of the doctor

The doctor contended that the complainant had been receiving regular treatment at the hospital during her pregnancy. She was admitted to the hospital for delivery with high blood pressure, leg swelling, and low blood levels. The doctor initiated treatment and medication to prevent contractions and facilitate cervical dilation. Labor pains commenced, prompting the complainant's transfer to the delivery room, with her father duly informed of the situation. Following medical protocol, the baby boy was delivered after necessary efforts, with all medications duly recorded in the case papers. Due to the baby's slow heart rate, cesarean delivery was recommended, but the complainant's father declined, leading to the use of a vacuum to expedite delivery. The delivery was successful, with the baby crying after three minutes. After delivery, the complainant experienced bleeding, for which another doctor was summoned to administer anesthesia and medication to control it. She was then transferred to another hospital after a blood transfusion, with advance arrangements made for blood bottles. The doctor asserted that the uterine vein was not severed during delivery. The bleeding was due to the vacuum's inadvertent attachment to the thick uterine wall caused by the complainant's movement and high blood pressure. The doctor emphasized that the complainant received treatment from them and no fees were charged. He emphasized that, despite advising cesarean delivery, they prioritized the safety of both mother and baby by opting for vacuum delivery.

Observations by the Commission

The Commission observed that the primary issue in this case revolved around determining whether there was medical negligence by the doctor in providing treatment to the complainant. Specifically, the key question was whether the actions of the doctor met the standard of care expected, particularly regarding the management of the delivery process and the subsequent treatment of complications experienced by the complainant. The commission highlighted that it was undisputed that the complainant had taken treatment from the doctor from the beginning of the pregnancy until delivery. However, during the delivery, there was excessive bleeding due to the movement of the fetus and the suction procedure. Upon identifying the nature of the bleeding, the hospital immediately arranged for the transfer of the patient to another hospital and facilitated the necessary treatment to address the complications. The Commission relied on the decision of the Hon'ble Supreme Court in Jacob Mathew v. State of Punjab (2005) which followed Bolam's principles and observed that medical professionals often face difficult choices and must choose the option they believe offers the best chance of success, even if it involves higher risk. The decision on which procedure to follow depends on the specific circumstances, and consent from the patient or their representative is usually obtained before proceeding. A doctor cannot be deemed negligent for choosing one acceptable medical procedure over another, even if the outcome is unfavorable. Furthermore, in Achutrao Haribhau Khodwa v. State of Maharashtra (1996), the court stated that the skill of medical practitioners varies, and multiple treatment options might be valid for a patient. Negligence should not be attributed to a doctor if they have performed their duties with care and caution, adhering to acceptable medical practices. Even if there are differing medical opinions, as long as the doctor has acted diligently and in line with medical standards, they should not be held liable for negligence if the patient does not survive or suffers a permanent condition The commission observed that it was evident that the doctor fulfilled his duty of care and provided treatment to the patient in accordance with the reasonable standard of medical practice. The decision to refer the patient to another hospital was necessary and appropriate to safeguard the patient's life and address the complexity of bleeding. Neither the bleeding nor the referral for further management to another hospital could be termed as negligence or deficiency in service.

The commission found no merit in the petition and dismissed it, upholding the State Commission's order.

Case Title: Parulben Shailesbhai Chunara Vs. Dr. Vinaykumar C. Sinh

Case Number: R.P. No. 1943/2017