Doctors not liable for patient's condition if they fail to follow up: Commission absolves Delhi Hospital in medical negligence case

In its order issued in September 2023, Justice Sangita Dhingra Sehgal, President; Pinki, Member (Judicial); J.P. Agrawal, Member (General) dismissed the appeal challenging the order of the District Commission clarifying that the patient cannot be allowed to pin his own careless conduct on the hospital, adding that no adverse inference can be drawn against the hospital in the absence of any cogent material on record to establish medical negligence.

The case concerned a patient Mandeep Singh, who was admitted to the hospital on April 11, 2005, due to severe abdominal pain. Subsequent medical tests and treatments were advised by the doctors at the establishment. The complainant was diagnosed with B/L Renal Calculi, and an operation was recommended. The operation, including Lt URS Plus Stenting, was conducted on April 12, 2005, followed by ESWL the next day, although it should have been performed on the day of the operation. The patient was then discharged on April 13, 2005. However, the DT stent, meant to be removed after some time, was allegedly not taken out despite the patient's multiple visits to the hospital. Further, the patient claimed that he was not provided with the calculi (stone) or the x-ray reports post-operation. The patient, a Restaurant Manager at Nirula's Corner House Pvt. Ltd., had to quit his job due to persistent pain.

Thereafter, in 2006, he experienced severe abdominal pain and hematuria. Consequently, he visited Sanjeevani Diagnostic Centre for tests and a urine examination report. He was examined by doctors at AIIMS, New Delhi, and was admitted to emergency care. Several tests were advised, revealing the stent placed by the doctors at the hospital was causing harm and continuous pain.

The doctors at AIIMS, New Delhi, confirmed that the stent placed by the opposite party was causing harm to the complainant, constituting medical negligence and service deficiency. Hence, the patient filed a complaint with the consumer court seeking directions for the hospital to pay Rs 19,20,000 in compensation.

The complainant sought a total compensation of Rs. 19,20,000, which included Rs. 4,00,000 for deficiency in service, Rs. 12,00,000 for pain, mental agony, and torture, Rs. 2,00,000 for treatment and medicine expenses, Rs. 1,00,000 for transportation costs, and Rs. 20,000 for legal expenses, along with 18% interest per annum from the date of cause of action until realization.

Before the District Commission, the complainant argued that, after the operation and being discharged, he visited the hospital but the DT Stent was not removed. However, the hospital stated that the complainant didn't follow up for stent removal after April 13, 2005, proving the complainant's visits to the hospital for follow-up and stent removal was crucial, but there was no strong evidence supporting these visits.

On request of the complainant medical report was called from from RML Hospital, New Delhi, that clearly concluded that there was no medical negligence from the doctors at the said hospital. The report emphasized that the complainant didn't follow medical advice to visit for DT Stent removal.

Considering the medical board's treatment, the District Commission dismissed the complaint noting that, " The complainant failed to prove that there is any medical negligence on the part of the doctors of the opposite parties. Whereas the complainant himself is negligence in taking treatment as advised. Therefore, there is no merit in the complaint. So, the complaint is dismissed."

Dissatisfied with the District Commission's order, the complainant moved the State Commission and argued that the District Commission overlooked a crucial fact: the DT stent, placed during surgery, should have been removed in due time. The complainant blamed the doctors at the hospital for negligence, resulting in the stent being left inside. The complainant highlighted that reports from Mukul Diagnostic Clinic and AIIMS, New Delhi, confirmed the stent's presence and its adverse effects. They opined in their report that the stent placed by the treating doctors at the hospital was lying in the body of the patient and had become unworthy, causing harm and pain on account of the non-removal of the stent and the calculi. The complainant further claimed the hospital didn't share critical post-surgery information. The appeal, subsequently, urged the reversal of the District Commission's order based on these grounds.

Meanwhile, the hospital responded to the appeal, contending that the complainant did not follow the suggested post-operation treatment after 7 days, absolving them of any negligence. They also alleged that the complainant fabricated a false story to illicitly demand money from the hospital, considering the complainant never reported pain or discomfort for a year. The hospital strongly urged the dismissal of the present appeal based on these arguments.

After perusing the material on record and hearing from all parties involved, the State Commission raised its primary concern as whether the District Commission erred in dismissing the case.

To resolve this issue, the Commission deemed it appropriate to refer to the Discharge Slip issued by the hospital. On examining the discharge slip it was found that the patient was recommended to attend a follow-up treatment 7 days after the surgery, specified under "Advice at Discharge."

Accordingly, the Commission emphasized that the responsibility of proving the patient's visit to the hospital rested significantly on the patient. However, after reviewing the records, there is a lack of substantial evidence to demonstrate that the patient visited the hospital for follow-up treatment and DT stent removal after being discharged in 2005. It observed;

"Again, it may be mentioned here that the Appellant (patient/complainant) has led no evidence of experts to prove the alleged medical negligence except his own affidavit. The experts could have proved if any of the doctors in the Respondent No.1-hospital providing treatment to the Appellant were deficient or negligent in service. However, on the contrary the expert opinion from the Medical Superintendent, RML Hospital, New Delhi establishes that no negligence can be carved out on part of the treating doctors of Respondent No.1-Hospital hereunder as: "From the report of the medical board it is clear that there is no medical negligence on the part of doctors of the opposite parties. Whereas the complainant himself did not act on the advice of the doctors. He did not visit the opposite parties for removal of DT Stent.”

The Commission further asserted;

"We deem it pertinent to remark that in a catena of judgments, the Hon’ble National Commission and the Apex Court have held that a doctor is supposed to exercise reasonable care while providing treatment to the patient. Keeping in view the facts and circumstances of the present case, the Appellant cannot be allowed to pin his own careless conduct on the Respondent No.1-hospital. A doctor is only supposed to exercise reasonable care and if the patient doesn’t visit the doctor for follow-up, by no stretch of imagination the liability for the patient’s condition can be affixed on the treating doctor. Therefore, we opine that no adverse inference can be drawn against the Respondent No.1-Hospital in the absence of any cogent material on record to establish medical negligence."

In context of the complainant's argument that after the surgery, the Hospital didn't display the stone removed during the surgery or provide X-ray reports to the complainant, the Commission clarified that the patient was treated with Shock Wave Lithotripsy, further stating that the patient himself placed on record the X-ray report. It noted;

"From the reading of medical literature, it has come to our knowledge that Shock Wave Lithotripsy uses shock waves to break stones in the kidney and ureter into small fragments. Therefore, it is clear that the due to the modality of treatment adopted, the calculi could not be shown to the Appellant. Furthermore, it is to be noted that the Appellant has himself placed on record the X-ray report and in view of the same, it cannot be said that the Respondent No.1-hospital did not provide the X-ray reports to the Appellant."

Subsequently, the Commission dismissed the appeal and upheld the District Commission's order. It held;

"We are of the view that there exists no negligence on part of the Respondent No.1-Hospital and find no reason to interfere with the order dated 16.03.2017 passed by the District Consumer Disputes Redressal Commission (West), 150-151, Community Centre, C-Block, Janakpuri, NewDelhi-110058. Consequently, the Appeal stands dismissed, with no order as to costs."

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