,
Hemant Gupta, J",
1. The present appeals are directed against an order passed by the National Consumer Disputes Redressal Commission [For short, the",
‘Commission’] on 06.01.2010 against the appellants i.e., Bombay Hospital & Medical Research Centre [For short, the ‘Hospital’] and",
Dr. C. Anand Somaya [For short, the ‘Doctor’], directing to pay a sum of Rs. 14,18,491/- along with interest @ 9% p.a. from the date of filing",
of the complaint till the date of payment.,
2. The complaint was filed before the Commission by the legal heirs [For short, the ‘Complainant’] of the deceased - patient Dinesh Jaiswal",
[For short, the ‘patient’], alleging medical negligence on the part of the Hospital and the Doctor in treating the patient. The patient was admitted",
to the Hospital on 22.04.1998 and breathed his last on 12.06.1998. The Hospital charged a sum of Rs. 4,08,800/- for the treatment of the patient during",
the period of his admission in the Hospital. The said amount is included in and is part of the amount of compensation awarded against the appellants,
herein.,
3. The patient was taking treatment since 1990 for having difficulties in walking due to the pain and discomfort in legs. For his complaint of inability to,
walk, a Colour Doppler Test was conducted on 13.04.1998 at Khemuka X-Ray & Ultrasound Clinic, Nagpur which detected the following:",
“Aneurismal dilatation of the lower abdominal aorta just above bifurcation is seen. The aneurism measures 5.4 x 2.6 in its maximum dimensions.,
Irregular thrombus is seen within the aneurism on colour flow studies.,
Prostate is normal in echo â€" pattern and measures 4 x 3 x 3cms. Prostatic capsule is intact. Urinary bladder is normal in capacity and contour. Post,
void residual urine is not significant.,
Impression: Mild hepatomegaly with aneurism of lower abdominal aorta just above the bifurcation.â€,
4. Dr. K.G. Deshpande Memorial Center, Nagpur was consulted by the patient on 15.04.1998 and Dr. Deshpande diagnosed the following:",
“A case of Abd Aortic Aneurysum,
Involvement on left side,
with Left PVB (Embolism),
H/O Trauma 1983,",
Pain Left LL 1990 S/O Embolism,
Vascular Duplex Seen S/O Large Abd. A. Aneurysum,
6*3*5.1cm,
Adv- Urgent Surgical repair of the aneurysumâ€,
5. After diagnosis, Dr. Deshpande referred the patient to the appellant-Doctor who is a Vascular Surgeon. The patient consulted the appellant-Doctor",
on 21.4.1998. The Doctor ordered the admission of the patient as an urgent case of aorta aneurysum. On 22.4.1998, the Doctor advised urgent",
DSA/CAT Scan [Digital Sub-Traction Angiography and Computerized Axial Tomography] and surgery after noticing the following physical conditions:,
“A 42 years old male with aorta pain left lower limb and right leg below knee. Gradual Claudication BP â€" 100/80,
Ischaemic changes both lower limbs. Seen with impending Gangrene,
Both legs left muscles are tested.,
………………………………….â€,
6. The Doctor after examining the patient recorded that there were ischemic changes in both lower limbs and also noted an impending gangrene.,
Subsequent to the pre-operative preparations, surgery was conducted on 23.04.1998 by a team of surgeons including Dr. Partha and Dr. Bindra, led",
by the appellant-Doctor. The operation notes read as thus:,
“On inspection there was a huge aneurysum on the latral aspect on left side arising infra renal.,
It was densely adherent to the surrounding structure. The aneurysum was directed out. The tape was passed around the left Renal artery/vein for,
retraction. A tape was passed around the aorta just below the renal artery and above the aneurysum. Both the common iliac arteries were exposed.,
Tapes were passed around both the iliac arteries.,
After achieving proper exposure/slinging around all the vessels. The aorta was iron clamped just infra-renally. The aneurysum opened out. The aorta,
transected and both illiacs transected. (A PTFE ‘Y’ Limb Graft) was sutured in place. The short main limb to the aorta using continuous prolure,
and both the limbs of the graft were sutured to the common iliacs end to end anastomosis on right side. After checking the flow in the graft after,
suture the upper end the lower anastomosis were done.,
On the left side, the side of the graft was sutured the end of the common iliac. The limb of the graft further brought down through a tunnel to the",
femoral artery and the end of the graft sutured to the side of the femoral artery.,
After achieving proper haemostasis and checking the pulsation.,
Intra-operatively, the abdomen closed using drainage tubes.",
“34. In all cases of grafting the patient is kept
under close observation to find out whether blood is
flowing normally. In case there is stoppage or lack of
flow immediate action is taken to control the situation
because lack of blood is certain to rupture and deaden
the muscles. The tissues cannot survive without blood
flow. But in this case after the patient was taken to
recovery room he was not examined by any doctor.
The attending nurse observed at 4.30 a.m. on 24.4.98
that lower limbs had become cold and did inform the
doctors. The doctors were called in writing at 8 a.m.
but Dr. Somaya came at 9.30 a.m. This time gap was
enough to rupture the muscles. The process is
irreversible. It cannot be corrected. Timely medical
care could have saved the life of the complainant.","“16. Without prejudice to the above and with
reference to para 34 of the complaint under reply, I deny
the allega(cid:34)ons made therein are false. With further
reference to the said para it is substan(cid:34)ally correct to
state that in all cases of gra(cid:36)ing pa(cid:34)ent is kept under
closer observa(cid:34)ons to find out whether blood is flowing
normally. In case there is stoppage or lack of flow
immediate ac(cid:34)on is taken to control the situa(cid:34)on
because lack of blood is certain to rupture and deaden
the muscles. I say and submit that even while trea(cid:34)ng the
said deceased, utmost care was taken by the opp. party in
post opera(cid:34)ve period. In this connec(cid:34)on I say and submit
that pa(cid:34)ent was kept in Cardio Vascular Incen(cid:34)ve Care
Unit CVICU which isc onsidered to be finest in India. The
pa(cid:34)ent was con(cid:34)nuously monitored by efficient and
trained nursing staff and was also monitored for 24
hours by resident doctor. With further reference to the
said para I deny that at about 4.30 a.m. on 24-4-1998 the
a(cid:51)ending nurse observed that lower limbs had become
cold as alleged or at all. I deny that, doctors were
summoned and that I came to the said unit, only at 9.30
a.m. as alleged or at all. I deny that, because of the so
called delay on my part further complica(cid:34)ons took place
in the case of the said deceased as alleged or at all. I say
and submit that immediately a(cid:36)er I received message
from the resident doctor a(cid:51)ached to the opp. party no.1
a(cid:51)ended the said pa(cid:34)ent at about 9.00 a.m. and not at
9.30 a.m. as sought to be suggested by the complainant.
35. That in spite of the cri(cid:34)cal condi(cid:34)on of the
complainant on 24.4.98, he was made to stand in queue
for DSA test for more than 3 hours. This delay further
worsened the condi(cid:34)on of the complaint it appears that
Bombay Hospital had no medical ethics.","Â 17. With reference to paras 35 and 36 of the complaint
under reply, I deny that in spite of cri(cid:34)cal condi(cid:34)on of the
complainant on 24.4.1998 he was deliberately made to
stand in queue for DSA test for more than 3 hours. I deny
that the said delay was deliberate and due to the said
delay the condi(cid:34)on of the said pa(cid:34)ent, further worsened
as alleged or at all. I say and submit that to the best to my
knowledge immediately I suggested DSA test on 24.4.1998,
the staff of the opp. party no.1 took the said deceased for
DSA test but unfortunately during the relevant (cid:34)me the
equipment was not func(cid:34)oning properly and as soon as
the defects were located the said test was conducted to
enable the opp par(cid:34)es to give further treatment to the
said deceased. I say and submit that on perusal of the
case papers on record, it is crystal clear that the best
possible treatment and due care was given to the said
deceased under circumstances. I say and submit that
during the relevant (cid:34)me the condi(cid:34)on of the said
deceased was cri(cid:34)cal and therefore it was not possible to
shi(cid:36) the said pa(cid:34)ent to any other hospital in nearby
vicinity for any test including DSA. It is also significant, to
note here that during the relevant (cid:34)me DSA test machinery
was available only in Jaslok Hospital, Hinduja Hospital
and Breach Candy Hospital. However, it was not possible
to shi(cid:36) the said pa(cid:34)ent for the said test considering the
pa(cid:34)ent condi(cid:34)on. In any event I dispute the allega(cid:34)ons
made by the complainant as the complainant’s failed
to substan(cid:34)ate the said allega(cid:34)ons by producing any
independent material on that behalf. Besides this the said
allegations are not based or supported on the basis of the
independent expert’s opinion.
36. The situa(cid:34)on turned darker because a(cid:36)er wai(cid:34)ng for
3 hours the complainant was informed that the machine
was dis-functional.",
37. That on the same day at 12.30 p.m. (8 hours a(cid:36)er it
was discovered that blood supply has stopped)
angiography was performed. But again the report was
given at 3.30 p.m. a further delay of 3 hours which were
crucial to the life of the complainant.","18. With reference to para 37 of the complaint under
reply, it is substan(cid:34)ally correct to state that on the same
day at about 12.30 p.m. angiography was performed.
However, I deny that report was made available only at
3.30 p.m. as alleged or at all. I deny that further delay of 3
hours which were crucial to the life of the deceased,
contributed towards further complica(cid:34)ons as alleged or
at all.
38. That on receipt of the report the surgeon decided to
reopen the abdomen to make correctness. Again the
opera(cid:34)on could not be done immediately because the
hospital did not have a vacant opera(cid:34)on theatre. The
hospital did not have emergency opera(cid:34)on theatre. The
hospital did not even try to operate the pa(cid:34)ent in an
outside opera(cid:34)on theatre. This caused another delay of 3
hours.
39. The sequence of event shows that for various causes
wholly a(cid:51)ributable to the Bombay Hospital that treatment
was delayed by 12 hours while the muscles cannot
survive lack of blood supply for more than two hours.","19. With reference to paras 38 and 39 of the complaint
under reply, it is substan(cid:34)ally correct to state that the
surgeon decided to reopen abdomen to make correctness
a(cid:36)er perusing the angiography report. However, I deny
that opera(cid:34)on was postponed or delayed as theatre was
not available. I say and submit that the said delay was
not at all deliberate. During the relevant (cid:34)me, the
opera(cid:34)on theatres of opp. party no.1 were occupied as
other patients were under treatment.
20. With further reference to the said para the allega(cid:34)ons
made therein are not only baseless but the same are made
with ulterior mo(cid:34)ve and malafide inten(cid:34)on. I say and
submit that to my personal knowledge and the opp. party
no.1 is one of the most well equipped hospital in Asia. I
say and submit that there are 4 opera(cid:34)on theatres
available for CU surgery only which is a rear phenomenon
in city of Mumbai and therefore the allega(cid:34)ons made by
the complainants that the hospital did not have
emergency operation is totally baseless.
40. There was a finding of impending gangrene in the DSA
report dated 22.4.98 by Dr. Somaya himself but no heed
was paid to it.
41. That Dr. Somaya being the Senior most surgeon of the
team was duty bound to keep the pa(cid:34)ent in constant
observa(cid:34)on, but a(cid:36)er the pa(cid:34)ent was shi(cid:36)ed to recovery
room, he came to examine the pa(cid:34)ent a(cid:36)er nearly 16
hours. Had he seen the pa(cid:34)ent one or two hours a(cid:36)er he
was shi(cid:36)ed, he could have observed that no blood was
flowing through the gra(cid:36). The surgeons negligence caused
the patient his life.","21. With reference to paras 40 and 41 of the complaint
under reply, I deny the allega(cid:34)on made therein as false. I
say and submit that on perusal of the case papers
maintained by the opp. party no.1 it is abundantly clear
that I was constantly monitoring the said deceased
therefore allega(cid:34)ons that I examined the said pa(cid:34)ent
nearly a(cid:36)er 16 hours from the surgery is totally false,
frivolous and vexa(cid:34)ous and the said allega(cid:34)ons appears
to have been made with ulterior mo(cid:34)ve and malafide
inten(cid:34)on to some how make out case of medical
negligence against me with an intention to knock out hand
sum ransom from me and opp. party no.1. I say and
submit that I treated the said pa(cid:34)ent with best of my
ability and with due and diligent care and therefore, I am
pained to hear such allega(cid:34)ons from the family members
of the deceased, that too, a(cid:36)er 18 months from the said
treatment. It is significant to note here that if the
complainants were really convinced about the so called
negligence on the part of the opp. par(cid:34)es, surely the
complainants or other rela(cid:34)ves of the said deceased
would have lodged complaint with local police sta(cid:34)on or
insisted for post-mortem of the said deceased and/or
would have approached the Court against the hospital as
well as against me. The very fact that present complaint
has been filed on 10.7.1999 without sending any proper
no(cid:34)ce thereby railing upon the opp. par(cid:34)es to explain the
so called negligence also supports my case that present
complaint is filed with ulterior mo(cid:34)ve with an inten(cid:34)on
to knock out hand sum ransom from the opp. parties.
42. That leaving the pa(cid:34)ent figh(cid:34)ng for his life in the care
o f inexperienced junior doctors viz. Dr. Partha and
Bindra, Dr. Somaya went abroad for vaca(cid:34)oning. He was
not available even for advice for more than 30 days.","22. With reference to para 42 of the complaint under
reply, I deny that during the relevant (cid:34)me I went abroad
for vaca(cid:34)on thereby leaving the pa(cid:34)ent figh(cid:34)ng for his
life in the care of inexperienced junior doctors viz. Dr.
Partha and Dr. Bindra as alleged or at all. I say and
submit that aforemen(cid:34)oned allega(cid:34)ons are not only false
but the said allega(cid:34)ons are made with an inten(cid:34)on to
cause prejudice in the mind of the Hon’ble Members of
Na(cid:34)onal Commission. In this connec(cid:34)on, I say and
submit that during the relevant (cid:34)me i.e. between 9th May
1998 to 7.6.1998, I had to China, England and USA to
attend medical conferences and both the said conferences
were fixed well in advance. Similarly the allega(cid:34)ons of
the complainants that Dr. Partha and Dr. Bindra are
inexperienced junior doctors is also baseless for the
simple reasons that both the aforemen(cid:34)oned doctors are
postgraduate and experienced in their respec(cid:34)ve field
and both are having adequate experience in the
aforemen(cid:34)oned field. Besides this the said deceased was
being treated by senior specialist at the opp. party no.1
hospital and in case of any emergency opp. party no.1
could have arranged senior experts and therefore merely
because I was away from India that too in connec(cid:34)on
with my professional ac(cid:34)vi(cid:34)es, the complainants should
not be permitted to make capital out of it.
43. That Dr. Kripalani a neurologist when called to
examine the pa(cid:34)ent remarked that “both the legs are
gone and it is a gone case. Your doctor should tell each
and everythingâ€. But Dr. Somaya con(cid:34)nued to conceal
the health prognosis from the complainant and his
rela(cid:34)ves and con(cid:34)nued to delay in taking vital decisions.
Had he taken a decision to amputate the legs at the right
time he could have saved the life of the complainant.","23. With reference to para 43 of the complaint under
reply, I say and submit that Dr. Kripalani is a
Nephrologists. I deny that Dr. Kripalani remarked that
both the legs are gone and it is a gone case. I deny that Dr.
Kripalani further observed that doctors deliberately
suppressed the said fact from you as alleged or at all. I
say and submit that though the said allega(cid:34)ons are made
by the complainant in the name of Dr. Kripalani, the
complainants have miserably failed to substan(cid:34)ate the
said allega(cid:34)on by filing affidavit of Dr. Kripalani. I say
and submit that a(cid:36)er perusing the aforementioned
allega(cid:34)ons I have consulted Dr. Kripalani and Dr.
Kripalani has confirmed that he had no such occasion to
make any such observa(cid:34)ons to the rela(cid:34)ves of the said
complainant. I am filing the affidavit of Dr. Kripalani to
substantiate my contention.
44. It is clear to even a novice medical student that dead
muscles invite sep(cid:34)cemia and gangrene. So what was
required was a (cid:34)mely ac(cid:34)on to prevent further damage.
But Dr. Somaya refrained from adop(cid:34)ng the requisite
procedure. The pa(cid:34)ent’s legs were amputated only
when all the consultants opined that it was the only
procedure for saving life. Yet his negligence in taking
(cid:34)mely ac(cid:34)on killed the only chance which the pa(cid:34)ent
had.
45. That it is apparent from the series of events that there
has been lack of diligence and an established case of
negligence on the part of opposite party in providing
services to the complainants as a result of which the
complainant died on 12.6.1998 at 9.30 p.m.â€","24. With reference to paras 44 and 45 of the complaint
under reply, I deny the allega(cid:34)ons made therein as false
save and except the factual posi(cid:34)on that the said
deceased died on 12.6.1998 at 9.30 p.m. I say and submit
that though it is unfortunate that the said deceased died
prematurely at the age of 43, even then the complainants
have no right of whatsoever nature to make allega(cid:34)ons
against the opp. par(cid:34)es. I say and submit that my
sympathies are with the complainant and other family
members and rela(cid:34)ves of the said deceased. I say and
submit that the said deceased died due to medical,
mishap and not due to any negligence either on my part or
on the part of the staff of the opp. party no.1.â€
was thought to be the best possible test and was thus conducted. The Hospital had specialized staff in all branches of medicine and the medical,
assistance as was required from time to time including nephrology, orthopedics etc. was provided to the patient. It was argued that the professional",
competence of Doctor has not been doubted even by the Commission but two factors have been taken against the Doctor for holding him negligent;,
first, that he did not visit the patient soon after the surgery till 9/9.30 a.m. on the next day to verify the blood flow after the surgery, and second, he did",
not visit the patient from 29.4.1998 to 9.5.1998 when he was in Mumbai and from 9.5.1998 to 7.6.1998 when he went abroad for attending medical,
conferences.,
17. We do not find that the basis of finding the Doctor negligent in 16 providing medical care is sustainable as there are both legal and factual errors in,
the findings recorded by the Commission.,
18. Dr. K.G. Deshpande had referred the patient to the Doctor on 15.4.1998 with advice of urgent surgical repair of Aneurysum. The patient had,
taken another six days to consult Doctor at Mumbai and it was only on 21.4.1998 that the patient was examined by the Doctor and was advised,
immediate Aneurysmectomy in view of the impending gangrene. Therefore, gangrene was not found to be impending after few days of admission to",
the Hospital but even before the patient was admitted. The patient was in critical condition when the Doctor was consulted on 21.4.1998 and surgery,
was thereafter performed within two days.,
19. Further, the non-working of the DSA machine and consequent delay in performing the test cannot be said to be negligence on the part of the",
Doctor or the Hospital. The DSA machine is a large, expensive and complicated machine which unfortunately developed certain technical problem at",
the time when patient had to be tested. Any machine can become non-functional because of innumerable factors beyond the human control as the,
machines involve various mechanical, electrical and electronic components. The DSA test was conducted in the Hospital on 22.4.1998 and hence",
DSA machine cannot be said to be dysfunctional for a long time. The alternative process to determine the blood flow was carried out by angiography,
and the decision for re-exploration was taken at 12.30 p.m. No fault can be attached to the Hospital if the operation theatres were occupied when the,
patient was taken for surgery. Operation theatres cannot be presumed to be available at all times. Therefore, non-availability of an emergency",
operation theatre during the period when surgeries were being performed on other patients is not a valid ground to hold the Hospital negligent in any,
manner.,
20. The re-exploration of operative notes dated 24.4.1998 shows that a fresh graft was sutured in place after establishing the flow. The patient was,
then put on ventilator and shifted to recovery room. On 25.4.1998, a note by Dr. Bindra indicated that the patient was seen by Dr. Shruti. It was noted",
that there was no movement in both the legs but had pin prick sensation and below mid-thigh, sensation was present on the lower limbs. Further, legs",
were warm till the ankles and the feet were cold. On 27.4.1998, Dr. H.S. Bindra had sought consultation from Dr. Khadilkar giving case history that",
limbs were warm and that the patient had pain in the lumber region and was also feeling tightness in both the lower limbs. Dr. Khadilkar noted his,
impressions that it was very likely lower spinal cord/conus syndrome and thereafter advised MRI of the lower cervical spine and till then to continue,
with the medicine pentosiflin and lomodex and for muscle ischemia â€" high CK and Myoglobulin. Dr. Khadilkar suggested the same treatment to,
continue on 28.4.98. On 29.4.1998, Dr. Khadilkar had reported the sensory level dropped to upper 1/3rd of the thigh and that there was no power in",
limbs. No changes were however seen in the MRI report. It was also reported that probably myonecrosis was playing more significant role in the,
weakness. The patient was put on dialysis thereafter.,
21. The patient was examined by Dr. Kripalani or his unit from 1.5.1998 and thereafter for many days till 23.5.1998. The dialysis was being conducted,
in the meantime as well. The patient was being monitored by Dr. Bindra throughout. Subsequently, the patient was referred to Dr. Amarapurkar on",
12.5.1998 when it was noted that Ischemic Injury to liver needed no treatment on 13.5.1998. The patient was then referred to Dr. Amin for enternal,
nuirisim on 16.5.1998.,
22. It was further noted on 18.05.1998 from Colour Flow Imaging of limb arteries that both common femoral, superficial femoral and popliteal arteries",
were patent. The flow in both posterior tibial arteries was of low velocity and of venous type, suggesting refilled flow. Dr. Pachore also examined the",
patient on 27.5.1998 and observed that the patient had wet gangrene below knee and was thus advised amputation. On 29.5.1998, the patient was",
operated for amputation below the knee at the level of tibial tuberosity for treatment of wet gangrene and the Bilateral Guillatine Amputation was,
carried out. On 30.05.1998, it was noted that the acute renal failure was improving. Further septicemia was diagnosed on 30.05.1998. Later, on",
12.06.1998, the patient was put on ventilator and he subsequently passed away at 9.30 pm due to septicemic shock.",
23. It is to be noted that it is not the case of the complainant that Doctor was not possessed of requisite skill in carrying out the operation. In fact, the",
patient was referred to him by Dr. Deshpande keeping in view the expertise of the Doctor in vascular surgery. There is no proof that there was any,
negligence in performing the surgery on 23.4.1998 or in the process of re-exploration on 24.4.1998. The allegation is of failure of the Doctor to take,
the follow-up action after surgery on 23.4.1998, a delayed decision to amputate the leg subsequent to re-exploration on 24.4.1998, and the alleged",
undue foreign visit of the Doctor.,
24. In respect to such contention of the Doctor being on a foreign visit, it is well known a medical professional has to upgrade himself with the latest",
development in his field which may require him to attend conferences held both in and outside the country. Mere fact that the Doctor had gone abroad,
cannot lead to an inference of medical negligence as the patient was admitted in a hospital having specialists in multi-faculties. Two doctors from the,
unit of the Doctor namely Dr. Bindra and Dr. Partha, both post graduates, were present to attend to the patient. Moreover, as per the stand of the",
Hospital and the Doctor, the patient was kept in Cardio Vascular Intensive Care Unit after the surgery and was continuously being monitored by",
qualified post-graduate doctors including Dr. Nemish Shah, Head of Cardio Vascular Surgery. The patient was even attended by other specialist",
doctors as well which is evident from the brief summary of treatment given to the patient. The experts in the other fields have been consulted from,
time to time and the treatment was modulated accordingly. In spite of the treatment, if the patient had not survived, the doctors cannot be blamed as",
even the doctors with the best of their abilities cannot prevent the inevitable.,
25. The blood was flowing properly soon after the surgery but later the formation of clot was confirmed after the angiography test was conducted at,
12.30 p.m. An immediate decision was taken for re-exploration at 3.30 p.m. The allegation of delay in treatment after the surgery seems to be,
baseless as the patient was being administered antibiotics like Metrogyl 400 and Piperacillin Injection which are used for treatment in gangrene. Dr.,
Kripalani in his affidavit denied the allegation leveled by the complainant. Dr. Kripalani had treated patient continuously including carrying out the,
dialysis. In respect of the allegation that doctors failed to amputate legs on time, efforts were being made to save the limbs as amputation is considered",
as the last resort. The amputation was done as per the advice of Dr. Pachore. In the present era of super-specialization, one doctor is not a solution",
for all problems of a patient. Each problem is dealt with by an expert in the concerned field and that is what is apparent from the medical record. The,
stand of the complainant is that since surgery was performed by a doctor, he alone would be responsible for different aspects of the treatment",
required and given to the patient. However, it is an incorrect assumption to be made.",
26. It is a case where the patient was in serious condition impending gangrene even before admission to the Hospital but even after surgery and re-,
exploration, if the patient does not survive, the fault cannot be fastened on the doctors as a case of medical negligence. It is too much to expect from a",
doctor to remain on the bed side of the patient throughout his stay in the hospital which was being expected by the complainant here. A doctor is,
expected to provide reasonable care which is not proved to be lacking in any manner in the present case.,
27. The sole basis of finding of negligence against the Hospital is of res ipsa loquitor. It is to be noted that res ipsa loquitor is a rule of evidence. This,
Court in a judgment reported as Syad Akbar v. State of Karnataka (1980) 1 SCC 30 explained the principle in a criminal trial as under:,
“19. As a rule, mere proof that an event has happened or an accident has occurred, the cause of which is unknown, is not evidence of negligence.",
But the peculiar circumstances con-stituting the event or accident, in a particular case, may themselves proclaim in concordant, clear and unambiguous",
voices the negligence of somebody as the cause of the event or accident. It is to such cases that the maxim res ipsa lo-quitur may apply, if the cause",
of the accident is unknown and no reasonable explanation as to the cause is coming forth from the defendant. To emphasise the point, it may be reiter-",
ated that in such cases, the event or accident must be of a kind which does not happen in the ordinary course of things if those who have the",
management and control use due care. But, according to some decisions, satisfaction of this condi-tion alone is not sufficient for res ipsa to come into",
play and it has to be further satisfied that the event which caused the accident was within the defendant's control. The reason for this second,
requirement is that where the defendant has con-trol of the thing which caused the injury, he is in a better po-sition than the plaintiff to explain how the",
accident occurred. Instances of such special kind of accidents which “tell their own story†of being offsprings of negligence, are furnished by",
cases, such as where a motor vehicle mounts or projects over a pavement and hurts somebody there or travelling in the ve-hicle; one car ramming",
another from behind, or even a head-on collision on the wrong side of the road. (See per Lord Nor-mand in Barkway v. South Wales Transport Co.",
[(1950) 1 All ER 392, 399] ; Cream v. Smith [(1961) 8 AER 349] ;Rich-ley v. Faull [(1965) 1 WLR 1454 : (1965) 3 All ER 109])",
20. Thus, for the application of the maxim res ipsa loquitur “no less important a requirement is that the res must not only bespeak negligence, but",
pin it on the defendantâ€.,
xxx xxx xxx,
26. From the above conspectus, two lines of approach in re-gard to the application and effect of the maxim res ipsa lo-quitur are discernible.",
According to the first, where the maxim applies, it operates as an exception to the general rule that the burden of proof of the alleged negligence is, in",
the first instance, on the plaintiff. In this view, if the nature of an accident is such that the mere happening of it is evidence of negligence, such as,",
where a motor vehicle without appar-ent cause leaves the highway, or overturns or in fair visibility runs into an obstacle; or brushes the branches of an",
over-hanging tree, resulting in injury, or where there is a duty on the defendant to exercise care, and the circumstances in which the injury complained",
of happened are such that with the exercise of the requisite care no risk would in the ordinary course ensue, the burden shifts or is in the first instance",
on the defendant to disprove his liability. Such shifting or casting of the burden on the defendant is on account of a presump-tion of law and fact,
arising against the defendant from the constituent circumstances of the accident itself, which be-speak negligence of the defendant. This is the view",
taken in several decisions of English courts. [For instance, see Burke v. Manchester, Sheffield & Lincolnshire Rail Co. [(1870) 22 LJ 442] ; Moore",
v.R. Fox & Sons [(1956) 1 QB 596 : (1956) 1 All ER 182] . Also see paras 70, 79 and 80 of Halsbury's Laws of England, Third Edn., Vol. 28, and the",
rulings mentioned in the footnotes thereunder.],
27. According to the other line of approach, res ipsa loquitur is not a special rule of substantive law; that functionally, it is only an aid in the evaluation",
of evidence, “an application of the general method of inferring one or more facts in issue from circumstances proved in evidenceâ€. In this view,",
the maxim res ipsa loquitur does not require the raising of any presumption of law which must shift the onus on the defen-dant. It only, when applied",
appropriately, allows the drawing of a permissive inference of fact, as distinguished from a mandatory presumption properly so-called, having regard to",
the totality of the circumstances and probabilities of the case. Res ipsa is only a means of estimating logical probabil-ity from the circumstances of the,
accident. Looked at from this angle, the phrase (as Lord Justice Kennedy put it [Rus-sel v. London & South Western Railway Co, (1908) 24 TLR",
548] ) only means, “that there is, in the circumstances of the particular case, some evidence which, viewed not as a matter of conjecture, but of",
reasonable argument, makes it more probable that there was some negligence, upon the facts as shown and undisputed, than that the occurrence took",
place without negligence .... It means that the circumstances are, so to speak, eloquent of the negligence of somebody who brought about the state of",
things which is complained of.â€,
28. Recently, a three Judge Bench in a judgment reported as Iffco Tokio General Insurance Company Limited v. Pearl Beverages Lim-ited (2021) 7",
SCC 704 approved the aforesaid judgment in a case of medical negli-gence being examined by the consumer fora. It was held as under:,
“86. Thus, it is used in cases of tort and where the facts with-out anything more clearly and unerringly point to negligence. The principle of res ipsa",
loquitur, as such, appears to be inap-posite, when, what is in question, is whether driver was under the influence of alcohol. It may be another matter",
that though the principle as such is inapplicable, the manner in which the accident occurred may along with other circum-stances point to the driver",
being under the influence of alco-hol.â€,
29. In Martin F. D'Souza v. Mohd. Ishfaq (2009) 3 SCC 1, this court observed that the doctor cannot be held liable for medical negligence by applying",
the doctrine of res ipsa loquitur for the reason that a patient has not favourably responded to a treatment given by a doctor or a surgery has failed.,
There is a tendency to blame the doctor when a patient dies or suffers some mishap. This is an intolerant conduct of the family members to not accept,
the death in such cases. The in-creased cases of manhandling of medical professionals who worked day and night without their comfort has been very,
well seen in this pandemic. This Court held as under:-,
“40. 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 . No sensible professional would intentionally commit an act or,
omission which would result in harm or injury to the patient since the professional reputation of the professional would be at stake. A single failure,
may cost him dear in his lapse.,
xxx xxx xxx,
42. When a patient dies or suffers some mishap, there is a tendency to blame the doctor for this. Things have gone wrong and, therefore, somebody",
must be punished for it. However, it is well known that even the best professionals, what to say of the average professional, sometimes have failures.",
A lawyer cannot win every case in his professional career but surely he cannot be penalised for losing a case provided he appeared in it and made his,
submissions.â€,
30. In case of medical negligence, this Court in a celebrated judgment reported as Jacob Mathew v. State of Punjab and Anr. (2005) 6 SCC 1 held",
that simple lack of care, an error of judgment or an accident, is not a proof of negligence on the part of a medical professional. The Court held as",
under:,
“48. We sum up our conclusions as under:,
(1) Negligence is the breach of a duty caused by omission to do something which a reasonable man guided by those considerations which ordinarily,
regulate the conduct of hu-man affairs would do, or doing something which a prudent and reasonable man would not do. The definition of negli-gence",
as given in Law of Torts , Ratanlal & Dhirajlal (edited by Justice G.P. Singh), referred to hereinabove, holds good. Negligence becomes actionable on",
account of injury resulting from the act or omission amounting to negligence at-tributable to the person sued. The essential components of negligence,
are three: “dutyâ€, “breach†and “resulting dam-ageâ€.",
(2) Negligence in the context of the medical profession nec-essarily calls for a treatment with a difference. To infer rash-ness or negligence on the,
part of a professional, in particu-lar a doctor, additional considerations apply. A case of occu-pational negligence is different from one of professional",
negligence. A simple lack of care, an error of judgment or an accident, is not proof of negligence on the part of a med-ical professional. So long as a",
doctor follows a practice ac-ceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alter-native",
course or method of treatment was also available or simply because a more skilled doctor would not have cho-sen to follow or resort to that practice,
or procedure which the accused followed. When it comes to the failure of taking precautions, what has to be seen is whether those precau-tions were",
taken which the ordinary experience of men has found to be sufficient; a failure to use special or extraordi-nary precautions which might have,
prevented the particular happening cannot be the standard for judging the alleged negligence. So also, the standard of care, while assessing the",
practice as adopted, is judged in the light of knowledge available at the time of the incident, and not at the date of trial. Similarly, when the charge of",
negligence arises out of failure to use some particular equipment, the charge would fail if the equipment was not generally available at that par-ticular",
time (that is, the time of the incident) at which it is suggested it should have been used.",
xxx xxx xxx,
(4) The test for determining medical negligence as laid down in Bolam case [(1957) 1 WLR 582 : (1957) 2 All ER 118 (QBD)] , WLR at p. 586 [",
[Ed.: Also at All ER p. 121 D-F and set out in para 19, p. 19 herein.]] holds good in its ap-plicability in India.",
xxx xxx xxx,
(8) Res ipsa loquitur is only a rule of evidence and operates in the domain of civil law, specially in cases of torts and helps in determining the onus of",
proof in actions relating to negligence. It cannot be pressed in service for determin-ing per se the liability for negligence within the domain of criminal,
law. Res ipsa loquitur has, if at all, a limited applica-tion in trial on a charge of criminal negligence.â€",
31. In another judgment reported as Arun Kumar Manglik v. Chirayu Health and Medicare Private Limited and Anr. (2019) 7 SCC 401, this Court",
held that the standard of care as enunciated in Bolam case must evolve in consonance with its subsequent interpretation by English and Indian Courts.,
The threshold to prove unreasonableness is set with due regard to the risks associated with medical treatment and the conditions under which medical,
professionals’ function. The Court held as under:,
“45. In the practice of medicine, there could be varying approaches to treatment. There can be a genuine difference of opinion. However, while",
adopting a course of treatment, the medical professional must ensure that it is not unreasonable. The threshold to prove unreasonableness is set with",
due regard to the risks associated with medical treatment and the conditions under which medical professionals function. This is to avoid a situation,
where doctors resort to “defensive medicine†to avoid claims of negligence, often to the detriment of the patient. Hence, in a specific case where",
unreasonableness in professional conduct has been proven with regard to the circumstances of that case, a professional cannot escape liability for",
medical evidence merely by relying on a body of professional opinion.â€,
32. In C.P. Sreekumar (Dr.), MS (Ortho) v. S. Ramanujam (2009) 7 SCC 130, this Court held that the Commission ought not to presume that the alle-",
gations in the complaint are inviolable truth even though they re-mained unsupported by any evidence. This Court held as under:,
“37. We find from a reading of the order of the Commission that it proceeded on the basis that whatever had been al-leged in the complaint by the,
respondent was in fact the in-violable truth even though it remained unsupported by any evidence. As already observed in Jacob Mathew case [(2005),
6 SCC 1 : 2005 SCC (Cri) 1369] the onus to prove medical negligence lies largely on the claimant and that this onus can be discharged by leading,
cogent evidence. A mere aver-ment in a complaint which is denied by the other side can, by no stretch of imagination, be said to be evidence by which",
the case of the complainant can be said to be proved. It is the obligation of the complainant to provide the facta probanda as well as the facta,
probantia.â€,
33. In another judgment reported as Kusum Sharma and Others v. Batra Hospital and Medical Research Centre and Others (2010) 3 SCC 480, a",
complaint was filed attributing medical negligence to a doctor who performed the surgery but while performing surgery, the tumour was found to be",
malignant. The patient died later on after prolonged treatment in different hospitals. This Court held as under:,
“47. Medical science has conferred great benefits on mankind, but these benefits are attended by considerable risks. Every surgical operation is",
attended by risks. We cannot take the benefits without taking risks. Every advancement in technique is also attended by risks.,
xxx xxx xxx,
72. The ratio of Bolam case [(1957) 1 WLR 582 : (1957) 2 All ER 118] is that it is enough for the defendant to show that the standard of care and the,
skill attained was that of the ordinary competent medical practitioner exercising an ordinary degree of professional skill. The fact that the respondent,
charged with negligence acted in accordance with the general and approved practice is enough to clear him of the charge. Two things are pertinent to,
be noted. Firstly, the standard of care, when assessing the practice as adopted, is judged in the light of knowledge available at the time (of the",
incident), and not at the date of trial. Secondly, when the charge of negligence arises out of failure to use some particular equipment, the charge would",
fail if the equipment was not generally available at that point of time on which it is suggested as should have been used.,
xxx xxx xxx,
78. It is a matter of common knowledge that after happening of some unfortunate event, there is a marked tendency to look for a human factor to",
blame for an untoward event, a tendency which is closely linked with the desire to punish. Things have gone wrong and, therefore, somebody must be",
found to answer for it. A professional deserves total protec-tion. The Penal Code, 1860 has taken care to ensure that people who act in good faith",
should not be punished. Sec-tions 88, 92 and 370 of the Penal Code give adequate protec-tion to the professionals and particularly medical profession-",
als.â€,
34. Recently, this Court in a judgment reported as Dr. Harish Kumar Khurana v. Joginder Singh & Others (2021) SCC Online SC 673 held that",
hospital and the doctors are required to exercise sufficient care in treating the pa-tient in all circumstances. However, in an unfortunate case, death",
may occur. It is necessary that sufficient material or medical evi-dence should be available before the adjudicating authority to arrive at the conclusion,
that death is due to medical negligence. Every death of a patient cannot on the face of it be considered to be medi-cal negligence. The Court held as,
under:,
“11. …….. Ordinarily an accident means an unintended and unforeseen injurious occurrence, something that does not occur in the usual course of",
events or that could not be rea-sonably anticipated. The learned counsel has also referred to the decision in Martin F.D'Souza v. Mohd. Ishfaq, (2009)",
3 SCC 1 wherein it is stated that simply because the patient has not favourably responded to a treatment given by doc-tor or a surgery has failed, the",
doctor cannot be held straight away liable for medical negligence by applying the doctrine of Res Ipsa Loquitor. It is further observed therein that,
sometimes despite best efforts the treatment of a doc-tor fails and the same does not mean that the doctor or the surgeon must be held guilty of,
medical negligence unless there is some strong evidence to suggest that the doctor is negligent.,
xxx xxx xxx,
14. Having noted the decisions relied upon by the learned counsel for the parties, it is clear that in every case where the treatment is not successful or",
the patient dies during surgery, it cannot be automatically assumed that the medi-cal professional was negligent. To indicate negligence there should be",
material available on record or else appropriate medical evidence should be tendered. The negligence al-leged should be so glaring, in which event the",
principle of res ipsa loquitur could be made applicable and not based on perception. In the instant case, apart from the allegations made by the",
claimants before the NCDRC both in the com-plaint and in the affidavit filed in the proceedings, there is no other medical evidence tendered by the",
complainant to indicate negligence on the part of the doctors who, on their own behalf had explained their position relating to the medi-cal process in",
their affidavit to explain there was no negli-gence. ………………â€,
35. It may be mentioned here that the complainant had led no evidence of experts to prove the alleged medical negligence except their own affidavits.,
The experts could have proved if any of the doctors in the Hospital providing treatment to the patient were deficient or negligent in service. A perusal,
of the medical record produced does not show any omission in the manner of treatment. The experts of different specialities and super-specialities of,
medicine were available to treat and guide the course of treatment of the patient. The doctors are expected to take reasonable care but none of the,
professionals can assure that the patient would overcome the surgical procedures. Dr. Kripalani has been attributed to have informed the complainant,
that the patient’s legs were not working but Dr. Kripalani denied all the averments by filing of an affidavit.,
36. As discussed above, the sole basis of finding the appellants negligent was res ipsa loquitor which would not be applicable herein keeping in view",
the treatment record produced by the Hospital and/or the Doctor. There was never a stage when the patient was left unattended. The patient was in a,
critical condition and if he could not survive even after surgery, the blame cannot be passed on to the Hospital and the Doctor who provided all",
possible treatment within their means and capacity. The DSA test was conducted by the Hospital itself on 22.4.1998. However, since it became",
dysfunctional on 24.4.1998 and considering the critical condition of the patient, an alternative angiography test was advised and conducted and the re-",
exploration was thus planned. It is only a matter of chance that all the four operation theatres of the Hospital were occupied when the patient was to,
undergo surgery. We do not find that the expectation of the patient to have an emergency operation theatre is reasonable as the hospital can provide,
only as many operation theatres as the patient load warrants. If the operation theatres were occupied at the time when the operation of the patient,
was contemplated, it cannot be said that there is a negligence on the part of the Hospital. A team of specialist doctors was available and also have",
attended to the patient but unfortunately nature had the last word and the patient breathed his last. The family may not have coped with the loss of,
their loved one, but the Hospital and the Doctor cannot be blamed as they provided the requisite care at all given times. No doctor can assure life to",
his patient but can only attempt to treat his patient to the best of his ability which was being done in the present case as well.,
37. Therefore, we find that the findings recorded by the Commission holding the Hospital and the Doctor guilty of medical negligence are not",
sustainable in law. Consequently, the present appeals are allowed. The order passed by the Commission is set aside and the complaint is dismissed.",
38. By virtue of an interim order passed by this Court on 8.3.2010, a sum of Rs. 5 lakhs was disbursed to the complainant. The said amount is ordered",
to be treated as ex gratia payment to the complainant and not to be recovered back by either the Hospital or the Doctor.,
