Doctors cannot be held Negligent because they could not save the patient: Supreme Court

New Delhi: While upholding the NCDRC order of exonerating a team of expert doctors from allegations of negligence in providing post-operative care, the Supreme Court today clarified that merely because the doctors fail to save the patient, medical negligence cannot be attributed to them.

The top court bench comprising of Justices Ajay Rastogi and Abhay S Oka was dealing with a case where the patient had died after undergoing an operation of kidney transplant.

Exonerating the team of doctors, the top court bench noted, "The doctors can provide their best medical assistance available at their command but merely because they could not save the patient, that could not be considered to be a case of post operative medical negligence."

Further referring to legal precedence set by earlier judgements, the bench observed, "It clearly emerges from the exposition of law that a medical practitioner is not to be held liable simply because things went wrong from mischance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference to another. In the practice of medicine, there could be varying approaches of treatment. There could be a genuine difference of opinion. However, while adopting a course of treatment, the duty cast upon the medical practitioner is that he must ensure that the medical protocol being followed by him is to the best of his skill and with competence at his command. At the given time, medical practitioner would be liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field."

"The term "negligence" has no defined boundaries and if any medical negligence is there, whether it is pre or post-operative medical care or in the follow-up care, at any point of time by the treating doctors or anyone else, it is always open to be considered by the Courts/Commission taking note of the exposition of law laid down by this Court of which a detailed reference has been made and each case has to be examined on its own merits in accordance with law," further noted the Supreme Court bench.

The history of the case goes back to 22 years ago when the husband of the complainant was undergoing treatment under a nephrologist. Consequenlty, the doctor advised renal transplantation of the patient and dialysis until then.

Following this, the patient and his family approached a reputed Nephrologist Dr. M. A. Muthusethupathi. This doctor along with his team of 12 expert doctors conducted the kidney transplantation surgery on the patient at Aswini Soundra Nursing Home.

However, despite all kinds of treatment after operation, the patient didn't survive and he died only few months after the operation.

Providing details of the treatment after the operation, the complainant alleged there was post-operative negligence on the part of the doctors and nurses in treating the patient and for this she claimed special damages/ general damages for a total sum of Rs.95,16,174.33 before the NCDRC.

However, the doctors and the staff of the hospital denied all kinds of allegations of negligence and they submitted that the operation was successful and all kinds of medical protocols had been followed during the treatment of the patient. They also submitted before the Commission their version of the details regarding the treatment procedure.

After taking note of the submissions, the top court bench also perused the expert opinions as evidence. Dr. Ashok Chopra, an expert had opined that even though the operation was successful, there was negligence in providing post-operative care, which led to septicemia in the patient. Another expert, Dr. Sophia also expressed similar opinions and attributed post operative negligence to the treating doctors.

On the other hand, the expert opinions submitted by the doctors who opined that medical science is not like mathematics and while treating patients the experience of the doctor counts more. They opined that there was no medical negligence during the treatment.

The NCDRC bench dismissed the complaint and exonerated the doctors in an order dated 21.07.2009 as it opined that the patient had received proper treatment from the expert team of doctors.

When the matter came for consideration before the Supreme Court, the bench noted that the complainants had not denied the success in the operation and their main allegation was regarding the lack of post-operative care at the hospital. 

After taking note of all the submissions by both the parties along with their versions of the medical treatment, the top court bench noted, "The doctors can provide their best medical assistance available at their command but merely because they could not save the patient, that could not be considered to be a case of post operative medical negligence despite the fact that medical protocol administered by them was duly supported by the two medical experts of the field who appeared on behalf of the respondents, Dr. S. Sundar and Dr. Arun Kumar, and nothing elicits from the cross-examination made by the appellants. In the given circumstances, the findings which has been returned by the Commission needs no further interference by this Court."

Referring to the Apex Court's judgement in the case of Jacob Mathew v. State of Punjab and Another and bench observed, "Thus, any individual approaching such a skilled person would have a reasonable expectation under the duty of care and caution but there could be no assurance of the result. No doctor would assure a full recovery in every case. At the relevant time, only assurance given by implication is that he possessed the requisite skills in the branch of the profession and while undertaking the performance of his task, he would exercise his skills to the best of his ability and with reasonable competence. Thus, the liability would only come if (a) either a person (doctor) did not possess the requisite skills which he professed to have possessed; or (b) he did not exercise with reasonable competence in given case the skill which he did possess. It was held to be necessary for every professional to possess the highest level of expertise in that branch in which he practices. It was held that simple lack of care, an error of judgment or an accident, is not proof of negligence on the part of the medical professional."

At this outset, the bench also referred to judgments in the case of Kusum Sharma and Others v. Batra Hospital and Medical Research Centre and Others and the recent judgement in the case of Dr. Harish Kumar Khurana v. Joginder Singh and Others.