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Synopsis

The Supreme Court has said a higher threshold limit must be met before a doctor is held liable of medical negligence and a particular line of treatment adopted cannot be discarded due to contesting views.

A bench of Justices Hrishikesh Roy and Manoj Misra has culled out three essential ingredients in determining an act of medical negligence, which are: a duty of care extended to the complainant, breach of that duty of care, and resulting damage, injury or harm caused to the complainant attributable to the said breach of duty. 

"However, a medical practitioner will be held liable for negligence only in circumstances when their conduct falls below the standards of a reasonably competent practitioner," the bench added.

The court said it is natural that there would always be different opinions, including contesting views regarding the chosen line of treatment, or the course of action to be undertaken, due to the unique circumstances and complications that arise in different individual cases, coupled with the constant advancement in the medical field and its practices.

"In such circumstances, just because a doctor opts for a particular line of treatment but does not achieve the desired result, they cannot be held liable for negligence, provided that the said course of action undertaken was recognised as sound and relevant medical practice. This may include a procedure entailing a higher risk element as well, which was opted for after due consideration and deliberation by the doctor. Therefore, a line of treatment undertaken should not be of a discarded or obsolete category in any circumstance," the bench said.

Explaining further, the bench said a medical practitioner should have a higher threshold limit to ensure that these doctors are focused on deciding the best course of treatment as per their assessment rather than being concerned about possible persecution or harassment that they may be subjected to in high-risk medical situations.

"Therefore, to safeguard these medical practitioners and to ensure that they are able to freely discharge their medical duty, a higher proof of burden must be fulfilled by the complainant," it added.

The court said thus, a complainant should be able to prove a breach of duty and the subsequent injury being attributable to it as well, in order to hold a doctor liable for medical negligence, on the other hand, doctors need to establish that they had followed reasonable standards of medical practice. 

Court has enunciated these principles guiding a medical negligence case, while setting aside an order of the National Consumer Disputes Redressal Commission of February 16, 2018.

The consumer panel had directed Nagpur's Suretech Hospital and Research Centre Private Limited, a Hospital, Dr Nirmal Jaiswal, Chief Consultant and Intensive Care Unit In-charge, at Suretech Hospital, Dr Madhusudan Shendre, ENT Surgeon at Suretech Hospital, and Dr M A Biviji, Radiologist jointly and severally pay Rs 6.11 lakh as compensation for medical negligence to Mrs. Sunita Parvate, complainant, with 9 % simple interest from the date of filing of the complaint till the date of actual payment, within six weeks. 

Additionally, the NCDRC directed that Rs 50,000 to be paid to Mrs Sunita as cost towards litigation expenses. Medical negligence was proved on account of the unjustifiable and forceful performance of Nasotracheal Intubation procedure upon Mrs. Sunita on May 13, 2004, at Suretech Hospital. 

The complainant alleged medical negligence resulted in permanent damage to her respiratory tract and permanent voice-loss, altering her life forever. She sought compensation of over Rs 3.58 Cr against loss and injury suffered by her and her family.

Going through the facts of the case, the bench said there was nothing to show that a procedure (Nasotracheal Intubation) conducted on a patient, who met with a serious car accident in May 2004, was poor or outdated.

"Taking into consideration the medical literature on record as well as the expert medical committee report presented by the RML Hospital, it is reasonable to conclude that subglottic stenosis and subsequent trauma in the trachea is not an uncommon phenomenon with respect to a patient that has suffered serious injuries in a road accident. In addition, there tends to be a higher risk element of developing an injury if intubation is done in an emergency situation or multiple times. It could also be a result of being subjected to intubation for a prolonged period," the bench said.

It was further pointed out, in this particular case, the patient was treated and underwent different procedures at multiple hospitals. She underwent the ‘TT’ procedure at Gondia Hospital in an emergency situation. 

Subsequently, she was attended to by multiple medical experts at Suretech Hospital. Therefore, there is a possibility that these medical complications could have arisen at any of these hospitals or places where the patient underwent treatment, the bench said.

Relying upon the RML Hospital Committee Report, the bench said there is no substance to establish the causal link between the ‘NI’ procedure that was undertaken at Suretech Hospital and the subsequent medical complications that arose.

"This is a classic case of human fallibility where the doctors tried to do the best for the patient as per their expertise and emerging situations. However, the desired results could not be achieved. Looking at the line of treatment in the present matter, it cannot be said with certainty that it was a case of medical negligence," the bench said, finding no breach of duty of care at the hospital and doctors.

Case Title: MA Biviji vs. Sunita & Ors.