No Case Of Medical Negligence If Complications Suffered By Patient Totally Unrelated To Medical Procedure Undergone: Supreme Court

The Supreme Court while deciding a case of medical negligence held that principles of Res Ipsa Locutor get attracted where circumstances strongly suggest partaking in negligent behaviour by the person against whom an accusation of negligence is made. Res ipsa loquitur means “the thing speaks for itself”.

In the context of a legal claim based on negligence, res ipsa loquitur essentially means that the circumstances surrounding the case make it obvious that negligence occurred.

“For applying the principles of Res Ipsa Locutor, it is necessary that a ‘Res’ is present to establish the allegation of negligence. Strong incriminating circumstantial or documentary evidence is required for application of the doctrine.,” a Division Bench of Justices A.S. Bopanna and Prashant Kumar Mishra said.

The present litigation stems from the grievance of appellant (wife of deceased) i.e., the deceased was not attended to by any doctor from neurosurgery team who had operated him after he was shifted into the private room till 11.00 P.M. During the same time, deceased had suffered heart attack and died eventually. It was argued that after such major surgery, instead of shifting to a private room, the deceased should have been shifted to the Intensive Care Unit. Appellant first approached National Consumer Disputes Redressal Commission however, her complaint got rejected. Thus, the present appeal.

In the instant case, the crucial issue to be decided was whether the concerned hospital and doctor have committed negligence in not providing proper postoperative medical care to the patient. Further, whether the Commission has committed any illegality while dismissing the complaint filed by the appellant herein.

Factual Background

The present appeal has been filed by the wife/ appellant of the deceased patient namely, Sankar Rajan, who was 37 years old and died on 06.11.1998 in the Indraprastha Apollo Hospital/ respondent no. 1 while undergoing follow up care and treatment after a major neurosurgery.

It may be noted that the deceased was suffering from Chiari Malformations (Type II) with Hydrocephalous. In this context, the deceased consulted Dr. Ravi Bhatia, present respondent no. 2, and Senior Consultant, Department of Neurosurgery of the hospital, who advised him to get admitted to the same hospital, where the surgery would be performed by him.

Following the advice of Dr. Bhatia, the deceased got himself admitted. After getting operated, the deceased was shifted to private room and at about 04.15 p.m and at about 04.30 p.m, the doctors visiting the deceased were informed about pain in the neck region, which seemed to have transferred downward lower than the region where pain used to occur prior to operation. Subsequently, deceased suffered heart attack around 11.00 p.m. He was declared brain dead on 31.10.1998 and was kept on life support till his death on 06.11.1998.

Contentions of the Parties

Senior Advocate Nikhil Nayyar, appearing for the appellant, submitted that the deceased died due to cardiac arrest, albeit, admittedly, the deceased had no cardiac problems. He further argued that at the time of admission the deceased was informed that after the surgery he would be shifted to the ICU. However, he was shifted from the recovery room directly to a private room and not to the ICU.

Apropos the findings of the impugned order, the counsel herein refuted the same asserting that they are contrary to the facts on record which establishes negligence of the respondents in the post operative care of the deceased.

On the other hand, Senior advocate Meenakshi Arora, appearing for Dr Bhatia/ respondent no. 2, supported the impugned order and submitted that it suffers from no infirmity warranting interference of the Top Court. Inter-alia, she also submitted that that it was explained to the appellant and the deceased that the patient would be examined in the recovery room first and thereafter as per standard practice followed by the hospital, all patients who do not show signs of complications in the Recovery Room and have no pre-operative medical problems are shifted to their ward/room.

Court’s Observations

At the outset, the Court observed that the entire case is about lack of proper post-operative medical care and not about Dr. Bhatia’s negligence while performing the Neurosurgery.

The Court noted that the allegation was that the patient should have been shifted to ICU instead of shifting him to a private room. After examining the relevant material, the Court observed that the same demonstrated that as per the standard practice, all patients who show no signs of complications in the recovery room and have no post or preoperative complications are sent to their rooms.

Addressing the facts of the present case, the Court opined that there is no evidence put forth by the appellant to establish that heart attack suffered by the patient had any connection with the operation in question or that it was on account of negligent post operative care.

The Court also noted that the patient did not have any history of diabetes or hypertension or any cardiac problem. Therefore, it was difficult for treating doctors including the duty doctor or the hospital to assume that the patient may suffer cardiac arrest and moreover, the patient had also not complained of pain in any other part of the body except neck region.

On the issue as to when a medical officer may be held liable for negligence, the Court cited the case of Jacob Mathew v. State of Punjab and another, (2005) 6 SCC 1, wherein it was held that “A professional may be held liable for negligence on one of the two findings: either he was not possessed of the requisite skill which he professed to have possessed, or, he did not exercise, with reasonable competence in the given case, the skill which he did possess.”

Court also placed its reliance upon Bombay Hospital & Medical Research Centre v. Asha Jaiswal and Others, 2021 SCC online SC 1149, wherein the Court has elaborately considered previous judgments on the subject including Martin F. D’Souza v. Mohd. Ishfaq, (2009) 3 SCC 1. In the latter case, it was clearly held that “Simply because a patient has not favourably responded to a treatment given by a doctor or a surgery has failed, the doctor cannot be held straightaway liable for medical negligence by applying the doctrine of res ipsa loquitur.”

Due to the foregoing reasons, the Court concluded there was no mistake in diagnosis or a negligent diagnosis by Respondent no. 2. In the absence of the patient having any history of diabetes, hypertension, or cardiac problem, it is difficult to foresee a possible cardiac problem only because the patient had suffered pain in the neck region, the Court stated.

Therefore, while dismissing the appeal, it recorded that the appellant has failed to establish negligence on the part of Respondents in taking post operative care.

Case Title: Mrs. Kalyani Rajan v. Indraprastha Apollo Hospital & Ors, Civil Appeal No. 10347 Of 2010

Citation : 2023 LiveLaw (SC) 926

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