Absence of Specialists not grounds for Medical Negligence: Court absolves Max Hospital, Overturns Rs 10 Lakh Compensation Order

Subhash Chandra, Presiding Member and Dr Sadhna Shankar, Member ruled in favour of the hospital, stating that no case of medical negligence was established. The Commission clarified that the patient was already under the care of a multi-disciplinary ICU team, and the absence of specific specialists does not imply improper treatment or a breach of medical duty.

The case involved the patient who was admitted to Max Super Specialty Hospital, Bathinda, on December 31, 2014, with symptoms of drowsiness, bradycardia (slow heart rate), and dyspnea (shortness of breath). She was placed under the care of Dr Sharad Gupta and a team of doctors. According to the complainant- her husband, the hospital failed to provide specialized treatment for her kidney and lung ailments, leading to a deterioration in her condition.

She was discharged from the hospital on January 12, 2015, under a "Left Against Medical Advice" (LAMA) status and was later treated at DMC & H Ludhiana and Medicity Hospital, Gurgaon. However, she passed away on February 7, 2015. The cause of death was documented as "Septicaemic Shock, Acute Respiratory Distress Syndrome, Multi-Organ Dysfunction Syndrome, Acute Kidney Injury, and Chronic Obstructive Pulmonary Disease."

Complaint and State Commission’s Ruling

The complainant filed a case in 2017 before the Punjab State Consumer Disputes Redressal Commission, seeking Rs 25 lakh as compensation for the loss of his wife, Rs 15 lakh for mental agony and deficiency in service, refund of Rs 2,57,066 spent on medical treatment, and Rs 1 lakh for litigation costs.

The State Commission ruled in favour of the complainant and held Max Hospital liable for medical negligence, stating;

“For not giving treatment to kidney and lungs problem, had deteriorated the condition of the patient, which ultimately led to her death. Therefore, we are of the considered opinion that there is medical negligence or deficiency in service on the part of OP for not giving the treatment to kidney and lungs problem of the patient which deteriorated the condition of the patient and ultimate death of the patient.”

The hospital was ordered to pay Rs 10 lakh in compensation within 45 days, failing which an 8% annual interest would apply from the date of the complaint.

Max Hospital’s Appeal and NCDRC's Ruling

Challenging the order, Max Hospital filed an appeal with the NCDRC, arguing that the patient had a pre-existing condition of diabetes, hypertension, and coronary artery disease, which contributed to her deteriorating health. The hospital provided multi-disciplinary treatment, including oxygen support, dialysis, and antibiotic therapy, which was in line with medical protocol. Additionally, the patient's family opted for discharge under LAMA, and she sought treatment at other hospitals afterwards. The burden of proof was on the complainant, who failed to provide medical records from subsequent hospitals to establish a link between the hospital's treatment and the patient’s death.

Upon reviewing the case, the NCDRC ruled in favour of Max Hospital, setting aside the State Commission’s decision. The court noted that;

“Merely because specialists from certain medical disciplines did not attend on the patient who was in the care of a multi-disciplinary team in the ICU, cannot be a ground to allege that there was medical negligence.”

"There is no allegation that the doctor treating the patient committed any breach of the duty of care in treatment. The admission to the ICU in the absence of a nephrologist and pulmonologist is the only allegation. The death of the patient occurred after 25 days of having left the Petitioner hospital. Details of treatment in the two hospitals consulted have not been brought on record."

Subsequently, the Commission allowed Max Hospital’s appeal and overturned the State Commission’s ruling. It held;

"In light of the aforesaid reasons and discussion it is apparent that the patient/Respondent’s late wife had been provided medical care as per the prescribed medical standards of care and protocol for patients in that medical condition. There was no breach of duty of care while she was admitted in the Appellant hospital by either the hospital or the attendant doctors who provided the reasonable standard of care expected in attending to the issues of heart, kidney and lungs through investigative tests and diagnostic means (blood tests, Xrays, CT scan, ECG and ECHO) and through interventions such as intubation, use of oxygen mask, dialysis and injections such as Lasix apart from the administering of antibiotics. The Respondent has not established through cogent evidence the basis for alleging deficiency in service in treating kidney and lung related issues in the appellant hospital. Its case for negligence in service has not been buttressed through any evidence of treatment in the other hospital she was taken to after a voluntary discharge was taken from the appellant hospital against medical advice.

The onus of proving negligence has therefore not been discharged by the Respondent. In view of the clear position of law as per the Bolam Test and the principles laid down by the Hon’ble Supreme Court in Jacob Mathew, no case of medical negligence and deficiency in service is made out by the respondents, much less a case of res ipsa loquitur. The finding of the State Commission that“ For not giving treatment to kidney and lungs problem, had deteriorated the condition of the patient, which ultimately led to her death. Therefore, we are of the considered opinion that there is medical negligence or deficiency in service on the part of OP for not giving the treatment to kidney and lungs problem of the patient which deteriorated the condition of the patient and ultimate death of the patient” is not based on a complete appreciation of the facts on record which include intubation for oxygen and dialysis."

"The State Commission has clearly fallen into error while adjudicating the issue and has failed to appreciate the settled position of law on medical negligence with regard to the line of treatment which is adopted unless it is contrary to the standard protocol or the standard of care required. As per record, the line of treatment indicates that these issues were addressed by the hospital. No records from the subsequent hospitals which were approached by the patient/her attendants(Respondent) indicates that there was any diagnosis relating to incorrect treatment or improper diagnosis with regard to these ailments by the petitioner hospital. The only allegation of the Respondent in this case was that there was no treatment provided for the lung and kidney related ailments to the patient in view of there not being any specialists in the hospital in this discipline. We are not convinced that there was any cogent basis to conclude medical negligence on part of the Appellant hospital."

"The Appeal is, therefore, found to have merits and is accordingly allowed. The impugned order of the State Commission is set aside. However, there shall be no order as to costs."

The compensation order against Max Super Specialty Hospital was set aside, providing relief to the hospital.

To view the original order, click on the link below: