MCI punishments cannot be an indicator to decide any fault, imperfection, shortcoming, or inadequacy of doctors: Delhi HC

New Delhi: The Delhi High Court has recently observed that the MCI (now National Medical Commission- NMC) award of punishment cannot be an indicator to decide any fault, imperfection, shortcoming, or inadequacy of a medical professional under various laws.

With this observation, the HC bench comprising Justice Subramonium Prasad directed the consumer and criminal courts to continue the proceedings against two Delhi orthopaedicians under various laws, disregarding the decision taken by the MCI and the quantum of punishment awarded to the doctors for alleged medical negligence.

Disposing of the plea filed by the complainant challenging the MCI Order, the Delhi HC observed, "...the award of punishment by the MCI cannot be an indicator to decide on any fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance which is required to be maintained by or under any law for the time being in force or has been undertaken to be performed by a person in pursuance of a contract or otherwise in relation to any service which is required to be maintained under law."

"The competent Courts are directed to proceed ahead with the case on facts without being influenced by the quantum of punishment awarded to the Doctors herein by the MCI," directed the HC bench.

Case History: 

The history of the case goes back to 2016 when the petitioner slipped from the stairs and sustained injuries in his right foot. He was taken to Fortis Hospital for treatment under the supervision of two orthopedics Dr. Maichand and Dr. Kakran. 

A diagnostic X-ray was conducted, on that very day, on the right foot of the patient Mr. Rai. The patient was informed that he had suffered a fracture on his right foot, and he was advised to get a CT scan done of his right foot. Post the diagnostics, Mr. Rai was informed that he had suffered a "comminuted" fracture on his right foot and since his condition was serious, he would have to undergo surgery which would involve fixation of screws on the right foot followed by a plaster-of-paris cast. As far as the patient's left leg and spine were concerned, it was suggested to him that he should undertake physiotherapy.

Also Read: Fortis Wrong Foot Surgery: Doctor accused of negligence declared innocent by MCI

The petitioner stated that the record (X-ray), however, showed that though Mr. Rai had fractured his spine, information on this aspect was not given to him. The Anaesthetist and the patient's physiotherapist also stated that they were not aware of the fracture in the spine. Further, making a blunder, during the surgery, the treating doctor put multiple screws inside the left foot despite the right foot being marked with a marker.

Immediately, the Delhi Medical Council took suo motu cognizance of the Media reports concerning the incident and after inquiry, the disciplinary panel of DMC recommended removal of the names of the two orthopaedicians from DMC's State Medical Register for 180 days.

It was observed by DMC panel that the doctors had also failed to detect the fracture in the patient's spine, despite it being visible in the X-ray. The panel held that the doctors wrongly put the patient on anesthesia and this could have impacted him in the long term.

Further, the DMC Panel held that the patient, attendants, or anaesthetists were never informed of any plan of surgery on the left foot, and no consent was taken for the same. "It is observed that the surgeons also failed to covey the suspicion of spine fracture to the anaesthetist before administration of spinal anaesthesia. It should have been avoided especially when the patient had suspicion of spine fracture," the DMC panel said.

The DMC order was challenged before the Medical Council of India (MCI), the erstwhile apex medical body in India. MCI in its order dated 23.08.2017 exonerated Dr. Maichand completely on the ground that he was absent on the day of the surgery due to personal reasons and therefore he was not present in the OT when the surgery was performed on the patient. Further noting that he was only involved in the planning of the operation in the right leg, the Council observed that whatever led to the operation of the left foot did not have his involvement.

However, MCI sustained the view of DMC regarding the involvement of the other orthopaedician Dr. Kakran, principally, on the ground that he had taken a decision to operate Mr. Rai’s left leg without either taking his or his attendants' consent. The conclusion reached was that Dr. Kakran had not exercised reasonable care while deciding to change course and thereby, performed surgery on Mr. Rai’s left foot as against what was planned earlier.

Challenging the MCI decision, the patient reached Delhi HC, which earlier held that MCI was wrong in exonerating the first orthopaedician completely as he was a senior doctor, under whose care and supervision, the patient had been admitted for treatment. In fact, the concerned doctor had also seen the initial diagnostic test report of the patient.

Apart from directing MCI to hear the matter afresh, the Court had also directed the apex medical regulator to formulate a sentencing policy in place for the guidance of its Committees which are tasked with the job of returning recommendations both, on the guilt and punishment to be accorded to a delinquent doctor.

On remand, the Ethics Committee of MCI once again examined the facts of the case and held that Dr. Maichand had not communicated the fact that he would not be performing the surgery on the patient. Therefore, the Ethics Committee of MCI gave a warning to the doctor for not communicating properly to the patients and their relatives as well as for not keeping records properly.

Following the MCI order, the petitioner patient once again approached the Delhi HC bench praying for an enhancement of punishment awarded to those two doctors.

While considering the matter, the bench clarified that "It is well settled that Courts, while exercising their jurisdiction under Article 226 of the Constitution of India, should not interfere with the decision arrived at by the experts unless it is arbitrary and illegal. Therefore, this Court cannot substitute its conclusion to the one arrived at by an expert Committee on the question of quantum of punishment awarded to the Doctors unless it is so perverse that it shocks the conscience of this Court."

The bench clarified that MCI cannot dilute a finding given by the HC bench in its writ jurisdiction. Further noting that MCI was only considering the facts limited to the award of punishment to both the doctors under the erstwhile MCI Act, the bench observed that "...and this cannot be an indicator to decide the deficiency of service, if any, which has to be evaluated by the competent forums in deciding the issue on deficiency in service."

Meanwhile, the counsel for the petitioner informed the bench that the proceedings under the Consumer Protection Act, 2019 have been initiated against the doctors, and the final report regarding the criminal proceedings, which were initiated, has been filed by the Police and the Court of competent jurisdiction is proceeding ahead with the matter.

Therefore, the bench observed that the award of punishment by the MCI cannot be an indicator to decide on any fault, imperfection, shortcoming, or inadequacy in the quality, nature, and manner of performance of a doctor under various laws.

Finally, disposing of the petition, the HC bench directed the competent Courts to proceed ahead with the case on facts without being influenced by quantum of punishment awarded to the Doctors herein by the MCI.

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

https://medicaldialogues.in/pdf_upload/delhi-hc-wrong-foot-surgery-225175.pdf

Also Read: Formulate sentencing policy for delinquent doctors: Court Tells Medical council of India