[Medical Negligence] West Bengal Clinical Establishment Regulatory Commission Cannot Adjudicate Cases Of Medical Negligence: High Court

The Calcutta High Court has recently held that issues of medical negligence cannot be adjudicated by the West Bengal Clinical Establishment Regulatory Commission (WBCERC).

In allowing an appeal by the BM Birla Heart Research Centre, and setting aside an order of a single bench directing the appellant to deposit an amount of Rs 15 lakhs out of a total cost of 20 lakhs imposed on it by the WBCERC for "deficiency in service and negligence in diagnosis", a division bench of Justice Arijit Banerjee & Justice Apurba Sinha Ray held:

The negligence in detection of diseases and the allegation of not giving proper medicines to the patient and further improper diagnosis of the diseases are all matters or issues of medical negligence. Therefore, the said issues cannot be adjudicated by the Commission. There was no sufficient material on record to hold, that delay, if any, was caused only because of the clinical establishment and not from the side of the patient party. There is no material to show how the patient party was misguided by the clinical establishment.

Brief Facts

The complainant had lodged a complaint with the WBCERC upon the death of his mother, alleging “Negligency in detection and causing delay in shifting the patient from the hospital. Not applying proper medication to the patient, improper diagnosis and negligency and misguiding patient party,” on part of the appellant organisation. 

The Commission called for affidavits from the stakeholders of the medical establishment and upon perusing certain reports, came to the conclusion that the appellants were guilty of serious lack and deficiency in patient care service, and directed it to pay Rs 20 lakh to the complainant. 

The aforesaid order was challenged before a single judge, who upheld the findings of the commission, leading to the present challenge. 

Arguments of the Parties

It was argued by the appellants that one of the doctors whose competence was being questioned had conducted an Echocardiogram (ECG) on the deceased and that contrary to the allegations of the complainant, he was qualified to do so, as he had obtained an MBBS degree, whereas the WB Medical Council had stated that even para-medical professionals could conduct an ECG. 

Appellants also challenged the stand taken by the Medical Council of India which had submitted a report before the single-judge stating that the doctor was not entitled to "perform and interpret" the data of an ECG. It was argued:

The basis of an MBBS degree is that a doctor having such degree has knowledge with respect to both medicine as well as surgery. It is completely not understandable that why such an argument was made by the Medical Council of India, who are the custodian of the medical field.

It was also submitted that if the impugned order was not overturned, it would jeopardise the life of the doctor, who was compelled by law to treat any patient who approached him but was being hauled up for not having the right to even interpret an ECG. 

It was further submitted that the Commission had arrived at its findings through an erroneous process and that no expert opinion of any cardiologist was taken to better understand the situation. 

It was submitted that two other doctors who had been implicated had not even been questioned or directed to file affidavits, leading to a violation of the principles of natural justice. 

On the other hand, the respondents submitted that no interference was warranted either in the single-judge order or the commission's findings. 

It was argued that neither the lab technician nor the doctor who conducted the ECG was qualified to do so or interpret the report. 

Respondents questioned the education qualification of the lab technician to show that she did not have a science background and would practise as an ECG technician without any qualifications, leading to an unethical practice.

It was submitted that an MBBS doctor was not supposed to practise as a specialist, and hence the doctor with just an MBBS degree could not enter into the domain of cardiology by interpreting an ECG report. 

It was further submitted that the complainant had made arrangements to shift his mother to CMRI hospital, but that the delay in allowing her discharge by the appellants led to her death. 

Court's Verdict

In hearing all parties, the Bench recalled the facts of the case and noted that the deceased was admitted to the appellant establishment in 2017 with a history of chest pain, shortness of breath and fever for three days and a known patient of hypertension and was having rheumatoid arthritis along with DMARD and suspected to have ACS (N Stemi).

It found that the probable cause of her death was stated as ACS, Sepsis, multi organ failure with background of Rheumatoid arthritis and immuno-compromised state due to DMARD.

Court observed that the patient's condition had begun to deteriorate after her admission and surgery could not be performed due to her fever, which was attended to by a doctor from CMRI hospital. 

It was noted that upon shifting her to CMRI, she was received in a state of shock and she gradually succumbed to her illness.

The Bench noted that the Commission's conclusion that the patient's condition deteriorated due to the failure of the doctor and technician to correctly interpret the ECG report was inappropriate in the realm of medical science given the causes of death. 

In delving into great detail about the conditions being suffered by the patient which may have contributed to her death, the bench observed that ever since she had been admitted to the appellant establishment, the doctors had suspected that she had been suffering from an infection since her fever had not subsided.  It held:

The above factual aspects coupled with medical condition of the patient suggest that the cause of her death may have been sepsis which culminated into septic shock. Therefore, the questions whether or not the doctors or the clinical establishment were at fault in diagnosis, are issues of medical negligence which the Commission could not have adjudicated and the Commission had rightly refused to enter into that arena.

Further in discussing the competencies of the doctor and technician, the court held that a physician could only be declared guilty of misconduct by the concerned medical council after giving them an opportunity for a hearing. 

Accordingly, in finding that the single judge had erred in upholding the order of the commission, the Court set aside its order and the order of the commission directing the appellant to pay 20 lakh to the complainant. 

In other words, the issues of patient care service are dependent upon the competence of the concerned doctor or the ECG technician, and such technical issues which are required to be addressed before the specialised branch, could not be adjudicated by the Hon'ble Commission. The instant fact was also not considered by the Learned Single Judge, it was held. 

Thus the appeal was allowed, but the Bench left it open to the aggrieved persons to agitate all questions of medical negligence before the relevant forum under the National Medical Council Act. 

Citation: 2023 LiveLaw (Cal) 352

Case: B. M. Birla Heart Research Centre v State of West Bengal & Ors

Case No: MAT 1595 of 2019

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