SC Relief to Padma Shri Awardee Cardiologist, sets aside adverse observations by Consumer Court in medical negligence case

A bench consisting of Justices AS Bopanna and Prashant Kumar Mishra was handling an appeal against the NCDRC's ruling. The NCDRC had upheld the state commission's verdict that the doctor could not be held responsible, but the hospital had displayed administrative negligence due to a delay in accessing the bypass machine.

When the matter came to be considered before the Supreme Court, the top court bench of Justices AS Bopanna and Justice Prashant Kumar Mishra observed that, even though NCDRC did not accept the allegations against the doctor, the observation of the Commission in regard to the PTCA report for contradicting the version of the doctor gave an impression that adverse observations were made against the concerned doctor.

The incident had occurred in 1994. Justice Bopanna, expounding on the case's backdrop, detailed that the respondent, had approached the state commission, alleging medical negligence on the part of the appellants (the cardiologist and the hospital). The complaint pertained to an angiography procedure conducted by the appellant doctor, which the respondent claimed was devoid of proper medical care, leading to death.

The state commission concluded that the doctor was not at fault, but the hospital was negligent due to the unavailability of the PCPS machine. The NCDRC upheld this finding on appeal.

At the beginning of the proceeding, Advocate Prashant Bhushan, representing Dr Kaul, acknowledged the patient's unfortunate demise and emphasized that such incidents were rare. He pointed out that while a compensation of 2 lakhs had been awarded and paid, the key concern was the allegation of negligence.

Bhushan highlighted Dr Kaul's remarkable contributions to cardiology, including over 11,000 successful angioplasties, and the potential negative impact of the NCDRC's remarks on his career and AIIMS' reputation.

He underscored that the NCDRC had mistakenly conflated the bypass machine with the ventilator. In this case, the ventilator had been promptly employed, and the pacemaker had been swiftly installed as per the established Standard Operating Procedure for cardiac arrest.

Referring to the American Journal of Cardiology (1994), Bhushan argued that the bypass machine took approximately 30 minutes to prime before use.

The central point of contention revolved around the assertion that the bypass machine had not been deployed within a 4-minute timeframe, which was the basis for the NCDRC's negligence finding. Bhushan argued that meeting this timeframe was implausible and contrary to accepted medical practice.

He cited the case of Jacob Matthews, which established that the standard for assessing negligence should be that of an ordinary skilled person in the profession.

Justice Mishra intervened to question whether the NCDRC's order had specifically found medical negligence by the doctor. Bhushan responded that there were observations in the NCDRC order to that effect.

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The primary issue highlighted by the Court was the use of the ventilator support system and the bypass machine (PCPS) after the angioplasty. The NCDRC had suggested a discrepancy between Dr Kaul's statement and the PTCA report, but the Supreme Court agreed with the appellant's argument that the NCDRC had confused the ventilator system with the bypass machine. The Court clarified that the ventilator had indeed been connected promptly as per procedure.

The Supreme Court noted that while the NCDRC had upheld the hospital's negligence finding, it seemed to have made observations that could be interpreted as adverse comments against Dr. Kaul. The Court disagreed with this and emphasized that the NCDRC's reference to the PTCA report to challenge the doctor's version was misleading.

It observed;

“NCDRC upheld the judgment of the state commission which would in effect mean that the finding as against hospital alone was upheld and allegation against doctor has not been accepted by NCDRC. But, the Observation by NCDRC to refer PTCA report to contradict the version of the appellant doctor would give an impression as if certain adverse observations have been made against the doctor.”

The Court also pointed out that the respondent had failed to provide evidence demonstrating a deviation from established medical norms. It noted that apart from the allegations in the complaint, there was no independent medical testimony indicating that the procedure was inappropriate.

The court said;

“It is evident that except for allegations made in the complaint, the respondent has not given evidence of any independent doctor that the manner and procedure as followed was not the appropriate procedure.”

The Court concluded that the NCDRC's assertion that there was a delay in connecting the ventilator was unjustified. Therefore, the allegations against both the doctor and the hospital were dismissed. As the state commission had already ordered a payment of 2 lakhs, which had been paid, the matter was closed.

LiveLaw reports that the Court held;

“The observation made by NCDRC that the ventilator was connected belatedly is not justified. Therefore, the finding that there was a delay that led to negligence would not hold true. The adverse observations against the appellant doctor and hospital are set aside. Having taken note that the state commission had directed payment of 2 lakhs and since the said amount has already been paid, the matter is disposed of.”