Medical Negligence: Power to grant compensation distinct from state medical council's authority to adjudicate cases- SC

New Delhi: In a recent order, the Supreme Court clarified that the power of the Commission established by the West Bengal Clinical Establishments (Registration, Regulation and Transparency) Act, to grant compensation is separate and distinct from the power of the State Medical Council to examine the presence or absence of medical negligence on the part of a medical professional.

"The power to grant compensation as is given under this Act, is separate and distinct from the power of the State Medical Council to examine the presence or absence of medical negligence on the part of a professional, and it nowhere interferes with the power of the State Medical Council to adjudicate the complaints of medical negligence," the Apex Court two-Judge bench comprising Justices Sanjay Karol and Manoj Misra observed.

The Apex Court made this observation while considering a Civil Appeal preferred against the Calcutta High Court Judgement, where it was held that the Commission did not have the jurisdiction to adjudicate the issues of negligence and alleged deficiency in practice.

When the matter reached the Supreme Court, the two-judge bench of the top court concluded that "...in our considered view, the Commission was well within its jurisdiction in giving the findings that were challenged in the writ appeal before the High Court. The High Court gave too wide a berth to the State Medical Council leaving almost no room for the Commission to function."

"If the findings of the Division Bench are accepted that deficiency in patient care service and medical negligence, in certain cases, are so enmeshed in one another that they cannot be separated, in quite a few cases the functionality of the Commission would be rendered impossible defeating the legislative intent behind this Act," observed the top court bench.

The matter concerned the treatment of the appellant's mother at B.M. Birla Heart Research Centre. As per the case details, after being treated for five days, when the patient's situation did not improve, she was referred to the Calcutta Medical Research Institute in May 2017. After such a recommendation of transfer made by the primary consultant, the discharge summary was prepared by another doctor, who described the patient as being in 'stable condition'.

Consequently, the patient was shifted to the second hospital in the early hours of the morning, and approximately 16 hours later, she passed away. Following this, the patient's son filed a complaint against the first treating hospital, alleging medical negligence, including delays in transferring the patient from the hospital, failure to administer proper medication, and improper diagnosis among others.

Taking note of the complaint, the Commission, established under the WBCE Act, issued notice, and over time, various documents were submitted, including correspondence with and from the West Bengal Medical Council. In February 2018, the Commission ordered the hospital to pay Rs 20 lakh compensation to the patient's son, after noting that for the patient, who was suffering from Acute Coronary Syndrome, the most important procedures- Echocardiogram and Echoscreening, were done by an unqualified doctor and a person claiming to be an Echocardiography Technician. Later, the Single Judge-bench of the Calcutta High Court observed that the Commission had the authority to adjudicate the complaint of the Appellant.

However, this was challenged before the Division Bench of the High Court, which held that the Commission did not have the jurisdiction to adjudicate issues of negligence and alleged deficiency in practice. Following this, the matter reached the Supreme Court for examination of the correctness of the view taken by the Division Bench.

Observations by the Supreme Court:

"Section 36, which provides for the establishment of the Commission, uses the word supervision, the phrase ensuring accountability and transparency by the establishment in providing patient care services. Supervision would, in our view, necessarily include ensuring that all personnel within a clinical establishment are entitled by way of their education and certification to be employed there. Transparency necessarily implies that the concerned doctor should inform the family/attendants of the patient about the true picture of the condition of the patient. This was not done. Making a simple statement that the mother of the appellant had erroneously been described as ‘stable’ cannot and should not absolve the concerned doctor of responsibility. It is quite possible that if the doctor preparing the discharge paper had indicated to the appellant the precarious condition of his mother at the time when discharge was being carried out, he could have taken an alternate decision and possibly she would have lived to fight for her life for another day," observed the Supreme Court.

It further noted that "Section 38 categorically provides that medical negligence complaints would be dealt with by the State Medical Councils. The Division Bench held that the Commission was not entitled to give any finding in this regard. The Commission in its judgment expressly states that they are not entering into the question of negligence. We find that the Commission indeed had not. What it had done was consider a complaint of deficiency in patient care service and in order to ascertain whether there was a deficiency or not looked into the credentials of persons providing the service. The same is expressly permitted by this Section."

It was observed by the Apex Court that making a simple statement that the mother of the Appellant had erroneously been 'stable' cannot and should not absolve the concerned doctor of responsibility.

At this outset, the top court bench observed, "It is quite possible that if the doctor preparing the discharge paper had indicated to the appellant the precarious condition of his mother at the time when discharge was being carried out, he could have taken an alternate decision and possibly she would have lived to fight for her life for another day."

Further, the bench observed that Section 38 of the Act categorically provides that medical negligence complaints would be dealt with by the State Medical Councils.

"The Division Bench held that the Commission was not entitled to give any finding in this regard. The Commission in its judgment expressly states that they are not entering into the question of negligence. We find that the Commission indeed had not. What it had done was consider a complaint of deficiency in patient care service and in order to ascertain whether there was a deficiency or not looked into the credentials of persons providing the service. The same is expressly permitted by this Section," the top court bench noted.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/kousik-pal-vs-b-m-birla-heart-research-centre-316229.pdf

Also Read: WBCERC has no authority to adjudicate medical negligence cases: Calcutta HC