When can doctors be held liable for medical negligence? Supreme Court clarifies

New Delhi: The Supreme Court recently stated that a medical professional may be held liable for medical negligence only when he lacks the requisite qualification or skill or fails to exercise the reasonable skill that he possesses while treating the patient.

"A medical professional may be held liable for negligence only when he is not possessed with the requisite qualification or skill or when he fails to exercise reasonable skill which he possesses in giving the treatment," observed the Apex Court bench comprising Justice Pankaj Mithal.

Pointing out that actionable medical negligence involves three constituents (i) duty to exercise due care; (ii) breach of duty and (iii) consequential damage, the top court bench clarified that a simple lack of care or an error of judgment or an accident is not sufficient proof of negligence on the part of the medical professional as long as he/she follows the acceptable practice of the medical profession in discharge of his/her duties.

With this observation, the top court bench exonerated the Post Graduate Institute of Medical Education and Research (PGIMER) and its doctor from charges of medical negligence while providing treatment to a minor boy suffering from PTOSIS.

The Apex Court opined that none of the two essential conditions for establishing negligence were satisfied against the doctor and the hospital as no evidence was brought on record to prove that the doctor had not exercised due diligence, care, or skill which he possessed in operating the patient and giving treatment to him. 

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Back in 1996, the complainant's 6-year-old son was diagnosed with a congenital disorder in his left eye, also known as 'PTOSIS' or 'Dropping eyelid' and for this, a minor surgery was performed by the treating doctor- Dr Sud at PGI Chandigarh. The complainant alleged that there was no other defect in his son's eye and both eyes had normal 6/9 equal vision.

Further, the complainant claimed that the physical deformity diagnosed as PTOSIS i.e. drooping eyelid could have been cured by a minor operation which required lifting of the left eyelid a little to make it of the same size as the right eye. However, allegedly, the said surgery was done in a most negligent manner and due to this, the eye's condition further deteriorated after the surgery, instead of getting any better.

 Therefore, the complainant filed a consumer complaint before the State Commission and claimed a compensation of Rs 15,00,000 for the sufferings due to the doctor's alleged negligence and further a sum of Rs 4,55,000 towards the cost of the treatment, loss of studies etc. 

On the other hand, the doctor and PGI claimed that the complainant was given proper treatment with due care during the operation and further submitted that the correction and reoccurrence of PTOSIS is a common complication of congenital PTOSIS which could have been set right by repeat surgery.

It was further submitted that the patient was not examined by Dr. Sud after January 1997 as he was taken for treatment to Guru Nanak Eye Centre, Delhi and Dr. Daljit Singh Hospital, Amritsar.

While considering the matter, the State Commission, after examining the records, concluded that the complainants failed to establish any negligence or carelessness on the part of the patient. It had noted that Dr. Sud was a duly qualified doctor possessing requisite professional skill and competence to perform the surgery and therefore, neither Dr. Sud nor the PGI could be held responsible for any negligence in the treatment.

However, the NCDRC partly reversed the findings of the State Commission based on the re-examination of the record of PGI which showed that before the surgery, the patient had a proper 6/9 vision in both the eyes and was suffering from a moderate PTOSIS with no history of double vision. However, post-surgery, the condition of PTOSIS deteriorated from moderate to severe and the patient's vision also fell down from 6/9 in both eyes to 6/18. The patient also suffered from double vision post-surgery. Thus, the NCDRC held that the doctor was negligent in not giving proper treatment and careless in not performing the repeat surgery.

Accordingly, the NCDRC had held Dr. Sud and PGIMER jointly and severely liable for payment of compensation of Rs 3 lakh and Rs 50,000 as costs with 6% interest from the date of the complaint for the negligence in treatment. Challenging the NCDRC order, the doctor and the hospital approached the Supreme Court bench.

Taking note of the proceedings of the matter before the State Commission and the Apex Consumer Court, the Supreme Court bench noted that, "Deterioration of the condition of the patient post-surgery is not necessarily indicative or suggestive of the fact that the surgery performed or the treatment given to the patient was not proper or inappropriate or that there was some negligence in administering the same. In case of surgery or such treatment it is not necessary that in every case the condition of the patient would improve and the surgery is successful to the satisfaction of the patient."

"It is very much possible that in some rare cases complications of such nature arise but that by itself does not establish any actionable negligence on part of the medical expert," the bench further noted.

The Supreme Court bench observed that the NCDRC itself acknowledged that Dr. Sud had the necessary professional qualification and expertise to treat the patient but it granted the compensation only for the reason that he did not bring the requisite skill and care in the patient's treatment.

Referring to this, the top court bench noted,

"The said finding is based on no evidence insofar as the complainants have not adduced any evidence to prove any negligence on part of the doctor rather have relied upon the medical records produced by the PGI. The said records merely demonstrate that post-surgery the condition of the patient had not improved but has deteriorated which as stated earlier may not be indicative of the negligence in the treatment of the patient."

It further observed that actionable negligence in the context of medical profession involves three constituents (i) duty to exercise due care; (ii) breach of duty and (iii) consequential damage.

"However, a simple lack of care, an error of judgment or an accident is not sufficient proof of negligence on part of the medical professional so long as the doctor follows the acceptable practice of the medical profession in discharge of his duties. He cannot be held liable for negligence merely because a better alternative treatment or course of treatment was available or that more skilled doctors were there who could have administered better treatment," it noted.

"When reasonable care, expected of the medical professional, is extended or rendered to the patient unless contrary is proved, it would not be a case for actionable negligence," it clarified.

Further referring to the judgment in the case of Bolam v. Friern Hospital Management Committee and the Supreme Court order in the case of Jacob Mathews v. State of Punjab and Another, the bench noted, "The complainant has not adduced any evidence to establish that Dr. ***Sud or the PGI were guilty of not exercising the expertise or the skill possessed by them, so as to hold them liable for negligence. No evidence was produced of any expert body in the medical field to prove that requisite skill possessed by Dr. ***was not exercised by him in discharge of his duties."

"In other words, simply for the reason that the patient has not responded favourably to the surgery or the treatment administered by a doctor or that the surgery has failed, the doctor cannot be held liable for medical negligence straightway by applying the doctrine of Res Ipsa Loquitor unless it is established by evidence that the doctor failed to exercise the due skill possessed by him in discharging of his duties," it further noted.

Opining that NCDRC not to have interfered with the findings and the impugned judgment and order of the State Commission so as to hold the doctor of the PGI negligent and to award compensation, the top court set aside the NCDRC order dated 24.08.2011 and restored the order of the State Commission.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/dr-neeraj-sud-vs-jaswinder-singh-258361.pdf

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