Medical Negligence | 'Egg Shell Skull' Rule Can Be Applied Only When Patient Had Pre-Existing Conditions : Supreme Court

Observing that the compensation was wrongly reduced by applying "Eggshell Skull Rule", the Supreme Court on Tuesday (April 23) enhanced the compensation amount to be paid to a patient from Rs. 2 Lakhs to Rs. 5 Lakhs after recording that she was suffering persistently post-surgery due to deficiency in service by the doctor.

“How could such compensation (Rs. 2 Lakhs) 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 comprising Justices Sanjay Karol and Aravind Kumar said.

The case relates to the claim of compensation from the doctor on the grounds of deficiency of service whereby post-surgery, the appellant/patient suffered continuous pain near the surgical site and was discharged the next day with the assurance that no further pain would be suffered by her.

However, since there was no improvement in her condition, the patient eventually landed up for treatment at the Post Graduate Institute of Medical Science, Chandigarh, where after diagnosis it was found that a 2.5 cm needle was near the surgical site which required immediate removal.

The appellant lodged a consumer complaint for a claim of compensation amounting to Rs. 19,80,000/- whereby the District Forum directed the respondent/Suket Hospital to award compensation of Rs. 5 Lakhs to the patient.

Upon appeal preferred by the Hospital, the State Consumer Dispute Redressal Commission reduced the compensation amount to Rs. 1 Lakhs only.

Ultimately, the National Consumer Dispute Redressal Commission enhanced the compensation amount to Rs. 2 Lakhs from Rs. 1 Lakh.

Aggrieved by the decision of the NCDRC, the patient approached the Supreme Court.

Compensation Amount Was Wrongly Reduced By Applying the Eggshell Skull Rule

At the outset, the Judgment authored by Justice Sanjay Karol questioned the reasoning provided by the State Commission and National Commission in reducing the compensation amount to be payable to the patient by applying the Eggshell Skull Rule.

Eggshell Skull Rule holds the injurer liable for damages that exceed the amount that would normally be expected to occur. It is a common law doctrine that makes a defendant liable for the plaintiff's unforeseeable and uncommon reactions to the defendant's negligent or intentional tort.

However, the court clarified that the Rule would be applied when the condition of the patient falls in either of the four conditions, such as:

“first, when a latent condition of the plaintiff has been unearthed;

second, when the negligence on the part of the wrongdoer re-activates a plaintiff's pre-existing condition that had subsided due to treatment;

third, wrongdoer's actions aggravate known, pre-existing conditions, that have not yet received medical attention; and

fourth, 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.”

The Court explained that for the "egg shell skull rule" to be applied, the person must have a pre-existing condition falling into either of the four categories described above.

The original compensation amount was reduced by the State Commission and National Commission by applying the Eggshell Skull Rule. The reason provided by them was that due to pre-existing vulnerability or medical condition of the patient, he might have suffered 'unusual damage'.

“Therefore, Opposite Party cannot take a plea that; patient took treatment from few other hospitals which might have caused the retention of needle in the abdominal wall. In this context we apply the “Egg Skull Rule” in this case, wherein liability exists for damages stemming from aggravation of prior injuries or conditions. It holds an individual liable for all consequences resulting from their activities leading to an injury, even if the victim suffers unusual damage due to pre-existing vulnerability or medical condition”, holds NCDRC.

Unable to accept the impugned reasoning, the court questioned the decision to reduce the compensation amount on the grounds of the pre-existing condition of the patient by holding that there was no discussion about the pre-existing condition of the patient in the Commission's order while applying the Eggshell Skull Case.

“In regard to the application of the Eggshell-Skull Rule, we may observe that the impugned judgment is silent as to how this rule applies to the present case. 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 court observed.

Based on the above premise, the court set aside the Awards of the NCDRC as also the State Commission and restored the Award as passed by the District Forum, meaning thereby that a sum of Rs.5 lakhs ought to be paid expeditiously by the respondents to the appellant for being medically negligent and providing services deficient in nature.

Counsels For Petitioner(s) Mr. Subhash Chandran K. R., Adv. Ms. Krishna L. R., Adv. Mr. Biju P Raman, AOR (Not Present)

Counsels For Respondent(s) Mr. Mritunjay Kumar Sinha, AOR Mrs. Vimal Sinha, Adv. Mr. J. P. N. Shahi, Adv. Mr. Rameshwar Prasad Goyal, AOR

Case Title: JYOTI DEVI VERSUS SUKET HOSPITAL & ORS.

Citation : 2024 LiveLaw (SC) 320

Click Here To Read/Download The Judgment