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Synopsis

The Supreme Court on October 25, 2024 observed that simply for the reason that the patient has not responded favourably to the surgery or the treatment administered by a doctor or that the surgery has failed, the doctor cannot be held liable for medical negligence straightway.

The apex court said that the doctrine of Res Ipsa Loquitor (the thing speaks for itself) can't be applied in such cases, unless it is established that the doctor failed to exercise the due skill possessed by him in discharging his duties.

A bench of Justices P S Narasimha and Pankaj Mithal said when reasonable care, expected of the medical professional, is extended or rendered to the patient unless the contrary is proved, it would not be a case for actionable negligence. 

The court pointed out that it is well recognised that actionable negligence in context of medical profession involves three constituents (i) duty to exercise due care; (ii) breach of duty and (iii) consequential damage. 

"However, a simple lack of care, an error of judgment or an accident is not sufficient proof of negligence on part of the medical professional so long as the doctor follows the acceptable practice of the medical profession in discharge of his duties. He cannot be held liable for negligence merely because a better alternative treatment or course of treatment was available or that more skilled doctors were there who could have administered better treatment," the bench said.

The court also said that a medical professional may be held liable for negligence only when he is not possessed with the requisite qualification or skill or when he fails to exercise reasonable skill which he possesses in giving the treatment. 

Dealing with an appeal by Dr Neeraj Sud and Post Graduate Institute of Medical Education & Research, Chandigarh, and another appeal by one Jaswinder Singh (the complainant) against an order passed by the NCDRC, the bench found none of the two essential conditions for establishing negligence stand satisfied in the case at hand as no evidence was brought on record to prove that the doctor had not exercised due diligence, care or skill which he possessed in operating the patient and giving treatment to him.         

The complaint by Jaswinder Singh (minor) and his father regarding medical negligence against Dr Sud and the PGI was dismissed by the State Commission on May 27, 2005.

On appeal, the NCDRC held Dr. Sud and the PGI jointly and severely liable for payment of compensation of Rs 3,00,000 and Rs 50,000 as costs with 6% interest from the date of the complaint for the negligence in treatment.

Jaswinder Singh aged 6 years was diagnosed with a congenital disorder in his left eye (also known as ‘PTOSIS’ or ‘drooping eyelid’) for which a minor surgery was performed on June 26, 1996, by Dr Sud at PGI. The complainant alleged that there was no other defect in the eyes of the boy and both eyes had normal 6/9 equal vision and the physical deformity diagnosed (PTOSIS, drooping eyelid) could have been cured by a minor operation which required lifting of the left eyelid a little to make it of the same size as the right eye but the said surgery was done in a most negligent manner. Instead of any improvement the condition of the eye further deteriorated post-surgery, he claimed. 

The appellants (doctor and the institute) claimed that Dr. Sud was a qualified post-graduate in ophthalmology. He had three years of experience in eye surgeries including surgery of PTOSIS. During the period 1994-1996 when he was a Senior Resident at PGI, he was associated with about 74 PTOSIS operations. 

They submitted that the complainant was given proper treatment with due care during the operation and that the correction and reoccurrence of PTOSIS is a common complication of congenital ptosis which could have been set right by repeat surgery. The patient was not examined by Dr Sud after January 1997 as he was taken for treatment to Guru Nanak Eye Centre, Delhi and Dr Daljit Singh Hospital, Amritsar, they said.

The court noted that the complainants had not adduced any evidence to establish any negligence in the performance of surgery or treatment on part of Dr Sud or the PGI. They mainly relied upon the medical records of the PGI which were obtained and considered by the State Commission.

"The relief claimed in the appeal by the complainants has been drafted in a very casual and improper manner with no sense of responsibility. We deprecate the manner in which this appeal has been filed, but in the ends of justice, proceed to consider it on merits along with the tagged appeal," the bench said.

In the case, post-surgery, the condition of PTOSIS deteriorated from moderate to severe and the vision of the patient also fell down from 6/9 in both eyes to 6/18. The patient also suffered from double vision post-surgery. Thus, the NCDRC held that the doctor was apparently negligent in not giving proper treatment and was also careless in not performing the repeat surgery.

The bench, however, said, "Deterioration of the condition of the patient post-surgery is not necessarily indicative or suggestive of the fact that the surgery performed or the treatment given to the patient was not proper or inappropriate or that there was some negligence in administering the same. In case of surgery or such treatment it is not necessary that in every case the condition of the patient would improve and the surgery is successful to the satisfaction of the patient". 

The court also opined it was very much possible that in some rare cases, complications of such nature arise but that by itself did not establish any actionable negligence on part of the medical expert.

Having examined the matter, the bench held that the complainant had not adduced any evidence to establish that Dr Sud or the PGI were guilty of not exercising the expertise or the skill possessed by them, so as to hold them liable for negligence. 

"No evidence was produced of any expert body in the medical field to prove that requisite skill possessed by Dr Sood was not exercised by him in discharge of his duties," the bench said.

The bench felt that the NCDRC ought not to have interfered with the findings and the impugned judgment and order of the State Commission so as to hold the doctor of the PGI negligent and to award compensation. 

The court set aside the NCDRC's order of August 24, 2011 and restored the State Commission's order.

"Since the complainants have failed to prove any negligence on part of the doctor or the PGI, they are not entitled to any compensation as such, no question arises for its enhancement," the bench said, dismissing the plea by the complainant.

Case Title: Neeraj Sud And Anr Vs Jaswinder Singh (Minor) And Anr