Dissatisfaction with EXPECTED Standard of Care Does not Constitute Medical Negligence: Delhi HC relief to Max Hospital

New Delhi: While dismissing the medical negligence claims against Max Super Speciality hospital doctors, the Delhi High Court recently observed that mere dissatisfaction or the assertion of an "expected" standard of care does not establish medical negligence.

Relying on the landmark judgment in the case of Bolam V. Friern Hospital Management Committee, the Court opined that the yardstick of medical negligence is whether the doctor's conduct and opinion fell below that of a reasonably competent practitioner in similar circumstances.

"While it is acknowledged that doctors are expected to apply a reasonable level of expertise and exercise due diligence in their practices, their conduct must not be judged against preconceived notions of a specific procedure or outcome. Consequently, the proper criterion for determining medical negligence lies in assessing whether the actions of the doctor fall below the accepted standards of a reasonably competent practitioner within the relevant field. Therefore, a doctor cannot be deemed negligent provided they discharge their duties with reasonable skill and competence," observed the HC bench comprising Justice Sanjeev Narula.

After losing his wife, who died while undergoing treatment at the hospital, the petitioner approached the High Court challenging the Delhi Medical Council (DMC) and National Medical Commission's (NMC) order exonerating the treating doctor.

However, the HC bench concluded that none of the grounds raised provided any basis to conclude that the DMC or NMC orders were tained by perversity or arbitrariness.

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"While the Court empathizes with the Petitioner’s loss and appreciates the earnestness of his pursuit, it must emphasize that the findings of medical bodies, composed of experts in the field, carry considerable weight. Their determinations, supported by peer review, merit deference unless tainted by palpable perversity or illegality. The Court finds no such grounds for interference. The consistent view of both the DMC and NMC points toward the line of treatment provided considering the patient’s complex medical profile, rather than by professional misconduct," observed the HC bench.

The case goes back to 2016 when the petitioner's wife was suffering from severe diarrhoea and was consequently diagnosed with Systemic Lupus Erythematosus/Hematemesis. Even though she was initially taken to other hospitals, due to her urgent requirement for Intensive Care Unit (ICU) support, she was taken to Max Hospital.

Allegedly, despite assuring the petitioner of ICU availability, when the patient was taken to the hospital, they learned that no ICU bed was actually available. Accordingly, having no alternative, the patient was admitted to the Emergency Department, where she was allegedly not attended by any doctors for more than two hours.

There were allegations against the treating doctors not attending the patient, conducting required tests much later etc. The petitioner claimed that the palpable negligence and the callousness on the part of the treating doctor resulted in the deterioration of the patient's health. Consequently, the patient suffered cardiac arrest and was later put on ventilator.

Further submitting the details of the treatment, the patient also alleged that the patient was given a total of 850 much of Fentanyl, arguing that the excessive dosage acted as a "diluted poison", severely deteriorating his wife's already critical stage, and ultimately contributing to her death.

Observing that the patient had developed bradycardia (a dangerously low heart rate) and lost a palpable pulse, the doctors supervised another attempt at resuscitation. They informed the Petitioner that his wife was in a critical condition, with negligible chances of survival, and advised him to take her home. Following this, the petitioner decided to get her discharged from the hospital under LAMA. Finally, the petitioner's wife returned home with ventilator support, effectively brain-dead and passed away roughly three hours after discharge.

Alleging medical and professional negligence of the treating doctors, the petitioner had filed a complaint before DMC, which after conducting a hearing, passed an order dated 5th June, 2018 holding Dr Chitransh and Dr Snehy responsible for professional negligence of duty. They were issued a warned and were directed to undergo at least one month of training in emergency medicine at a recognised hospital. However, DMC did not take any action against other three doctors involved.

Dissatisfied with the DMC order, the petitioner filed an appeal before the erstwhile Medical Council of India (MCI), now NMC. However, NMC, through an order dated 23rd December, 2019, concluded that there was no sufficient basis to establish negligence against the doctors named in the appeal. Therefore, the petitioner challenged the NMC order before the HC bench.

While considering the matter, the HC bench, after perusing the medical record, opined that "notwithstanding the availability of the ICU bed, the Petitioner’s wife was provided with necessary medical interventions, including the administration of medicines and injections, ventilator support, and was resuscitated twice following instances of cardiac arrest in the Crash Room."

"As for the confirmation given to the Petitioner regarding the availability of an ICU bed, it is well understood that ICU admissions are highly dynamic and subject to rapid change. It is entirely plausible that the availability of the bed could have changed by the time the Petitioner arrived at the Respondent Hospital. Therefore, the Court does not find this to be a valid ground for concluding negligence on the part of the Respondent Hospital," noted the HC bench.

Regarding the allegation of an excessive dosage of FENTANYL, the HC bench reviewed the case record and noted that this grievance was also raised before NMC and in this regard, a detailed explanation regarding the calculation of the dosage of Fentanyl administered to the patient was given. "This explanation was duly considered by the NMC during its peer review process, following which a reasoned order was passed," noted the HC bench.

The Court opined that "...the correct administration and dosage of drugs like FENTANYL is a matter that falls squarely within the expertise of qualified medical professionals. The Court, lacking medical expertise, must trust the domain knowledge of qualified professionals, especially when the decision is the product of a recognized peer-review mechanism. In light of this, the Court, in the exercise of its judicial review, cannot substitute its own judgment for that of specialists and experts, whose primary responsibility is to uphold the highest standards of medical practice and professional conduct. Judicial interference here, would be unwarranted."

"In addition, the Petitioner’s assertion that FENTANYL alone caused his wife’s death is not substantiated by reliable evidence. The Respondents have clarified in the counter-affidavits that the patient’s death cannot be solely attributed to the allegedly excessive dosage FENTANYL, but rather was the culmination of multiple underlying medical conditions, which contributed to her overall deterioration," it observed.

After going through the allegations raised by the petitioner in detail, the Court observed that the DMC's order dated 5th June, 2017 indicated that the Disciplinary Committee conducted a proper hearing, examined the evidence, and determined some shortcomings on part of the treating doctors and remedied this by prescribing training and recommending enhanced emergency protocols.

Again, the court noted that NMC, acting as an appellate authority, deliberated afresh over the petitioner's grievances. NMC duly noted that the Petitioner’s wife was suffering from multiple clinical conditions, for which she was advised ventilator support at LNJP Hospital. They observed that after being transferred to the Respondent Hospital, the Petitioner’s wife suffered a cardiac arrest shortly after admission, was resuscitated, placed on life support, and treated by critical care, cardiac, Internal medicine and GE team and advised treatment, which was appropriately carried out. Following a review of the medical records and the course of the treatment, the NMC determined that there was no credible evidence to support the claim of medical negligence against the doctors involved. The treatment provided by the doctors was found to be appropriate.

Accordingly, the Court held that "The Court is of the view that none of the grounds raised provide any basis to conclude that the orders of the DMC or NMC are tainted by perversity or arbitrariness."

With this observation, the Court dismissed the petition.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/delhi-hc-shiv-kumar-vs-nmc-266892.pdf

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