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Synopsis

The Supreme Court has upheld the National Consumer Disputes Redressal Commission's order which found a doctor negligent in a 2000 surgery to remove gallstones from a woman, resulting in her death from multi-organ failure.

A bench of Justices P.S. Narasimha and Sandeep Mehta dismissed Dr. P.N. Gupta's appeal against the NCDRC's 2012 order directing him to pay Rs 7 lakh in compensation to the woman's husband, Rajinder Singh Dogra, though the interest rate was reduced from 12% to 6% per annum.

Court agreed with the NCDRC's conclusion that the doctor’s actions fell below the standard of ‘reasonable care,’ confirming the negligence finding.

"The parties had filed two different sets of medical records. The medical records filed by the appellant did not contain a detailed record of the surgical process, nor did they contain the standard notings on the closure of wounds. More significantly, the records filed by the appellant did not cite whether the patient’s gall bladder contained any stones, for which the surgery was performed to begin with," the bench said.

The bench opined that the National Commission correctly noted that the results of the first ultrasonography in the records filed by the appellant were similarly doubtful. 

While the report showed the presence of bile in several regions of the patient’s body, the record described the presence to be ‘minimal’, the bench said.

"Furthermore, the appellant failed to supply the results of the second ultrasonography, on the basis of which the second surgery to drain the fluid was conducted. Crucially, nothing was brought to the Commission’s notice which demonstrated that the patient had properly consented to the second surgery," the bench said.

Apart from the medical records filed by the parties, the court also noted that the National Commission had considered the relevant medical literature on the subject and whether the appellant’s conduct was in consonance with standard medical practice. 

The National Commission also considered the report of the Medical Board and concluded that the Board had not examined the medical records carefully, the bench said.

"The National Commission considered the relevant material before itself, and correctly relied on this Court’s decision in Jacob Mathew Vs State of Punjab (2005) to conclude that medical negligence was proved in the facts of the case," the bench said.

The National Commission had allowed the appeal filed by the respondent consumer by setting aside the order passed by the UT Consumer Disputes Redressal Commission, Chandigarh, and had directed payment of compensation quantified at Rs seven lakh.

The deceased suffered from abdominal pain. She went through an ultrasonography test, which showed stones in her gall bladder. The appellant, a doctor, performed surgery for removing the stones on September 11, 2000 on the basis of an ultrasonography. However, the patient developed various problems such as stomach ache, constipation and vomiting, etc. 

The patient re-consulted the appellant, who prescribed medicines for pain and other symptoms. On October 04, 2000, the appellant conducted another surgery to drain the fluid by what is known as “needle aspiration” from the “Pouch of Douglas”.

However, the problems continued to persist. The patient was referred to a liver specialist. On October 16, 2000, the liver specialist conducted an ECRP (Endoscopic Cholangio Pancreatography) test. Despite the test, the patient’s problems were found to continue. In fact, she was found to have developed ‘contracted pancreatitis’. Eventually, due to sepsis and multi-organ failure, the patient passed away on November 04, 2000.

During the proceedings, the National Commission constituted a Medical Board of experienced doctors from the G B Pant Hospital, New Delhi, which concluded that the appellant had taken steps in accordance with the prevailing medical standards on the issue concerned. 

The National Commission, however, found the report to be cryptic as it did not answer the issue convincingly. The National Commission undertook the burden to examine the matter in detail. 

Both parties produced detailed material, including medical literature to establish what the normative standard in such cases ought to be. 

Before the Supreme Court, the appellant argued that the National Commission should not have replaced the opinion of medical experts with its own. He claimed that the patient received reasonable care, citing multiple ultrasonography tests, an X-ray, medical prescriptions, post-operative care, and a second surgery performed free of charge.

Furthermore, the appellant said the cause of death in the patient’s report was not linked with his acts. Throughout the proceedings before the State and the National Commissions, the credentials about my competence were never disproved, he argued.

The respondent submitted that the patient made repeated complaints about subsisting pain in her abdominal area. More specifically, after her discharge on September 12, 2000, she visited the appellant on September 20, 2000, September 25, 2000 and September 30, 2000. However, no diagnosis was conducted by the appellant until the patient visibly developed jaundice. Despite the second ultrasonography report disclosing bile fluid, the cause was not looked into. The delay in referral to the liver-specialist compounded the patient’s problems, and hence, her death has a direct nexus with the appellant’s acts/omissions.

"Having considered the matter in detail, we are of the opinion that the National Commission has not committed any error in reaching its conclusions. The judgment of the National Commission is well-reasoned, and depicts a detailed consideration of all the relevant material, including the opinion of the doctors who have been examined before it," the bench said.

The bench also pointed out the National Commission found the appellant’s submissions to be unreliable.

It is seen that the appellant’s submissions contradicted the liver specialist’s submissions, insofar as the date of postoperative visits was concerned. Another contradiction was that while the appellant denied the patient’s visit on September 28, 2000 before the State Commission, his records showed an entry in the patient’s name for the same date, the court said.

"Significantly, the patient complained to the appellant about stomach pain and constipation on September 25, 2000 and September 28, 2000. However, instead of investigating if a serious problem existed with the patient, the appellant merely gave out prescriptions of medicines to deal with the patient’s symptoms. More importantly, the appellant did not offer any convincing reasons for delaying the referral to a liver-specialist, despite being aware of the medical condition," the bench said.

Case Title: P N Gupta Vs Rajinder Singh Dogra