NCDRC relief to Medanta, dismisses Rs 10 crore medical negligence case filed by family of Former CJI

The bench of Dr S M Kantikar (presiding member), Justice (Retd) Ram Surat Ram Maurya (judicial member), and Dr Inder Jit Singh (technical member) observed that the patient’s family failed to prove “all the 4 Ds – Duty, Dereliction, Direct Cause and Damages” which are required to gain successful claim in the case of medical negligence.

The Case:

Justice Verma, the 27th CJI who served from March 25, 1997 until his retirement on January 18, 1998, died in April 2013 due to multiple organ failure. He was diagnosed with coronary artery disease in 1993. In 2012, he suffered from abnormal liver function test results and developed swelling in his left leg. He was diagnosed with atrial fibrillation while seeking treatment at Bhardwaj Nursing & Maternity Home (“Bhardwaj Hospital”). Reports revealed severe liver dysfunction and abnormal blood clotting.

In 2013, Verma reported bleeding episodes. He was admitted to Fortis Escorts Heart Institute after experiencing significant gastrointestinal bleeding. An endoscopy was performed, which identified an ulcer causing the bleeding. The same was treated. However, multiple blood and plasma transfusions led to fluid overload in his lungs, resulting in breathing difficulties.

On recommendation of the doctors, he was transferred to Medanta Medicity, Gurgaon (“Medanta”). However, alleged inadequate management at Medanta failed to address the underlying issues, and he suffered a cardiac arrest, and eventually passed away.

Thereafter, Verma's spouse and the children filed a complaint before the Medical Council of India (MCI) against the doctors for negligence and professional misconduct for not exercising due care while treating the patient. The same was referred to Delhi Medical Council (DMC), and the Medical Council of India (now National Medical Commission (NMC)). However, DMC and MCI considered all the aspects on two occasions and found that there was no negligence on the part of the treating doctors at any stage as alleged.

In 2015, the complainants approached the NCDRC alleging incidence of negligence during hospitalisation to Fortis in 2013 till his shifting to Medanta Hospital. Firstly, the complainants claimed that there were poor attempts to correct the hypocalcemia; another allegation was the failure to intubate on arrival.

It was alleged that doctor at Fortis failed to prescribe a liver ultrasound despite significant abnormalities in the liver test report. This failure to follow medical protocol delayed the diagnosis of the patient’s ‘liver cirrhosis’. At Bhardwaj Hospital, the doctor wrongly prescribed a tablet called ‘Dabigatran’ with combination of Clopidogrel and Amiodarone and other medicines, without thorough analysis of the patient’s medical reports. The incorrect combination of medications resulted in fatal bleeding and multiple organ failure, leading to his demise.

Multiple blood and plasma transfusions at Fortis allegedly caused a fluid overload in his lungs. Moreover, the doctors at Medanta failed to address reversible factors promptly, leading to a cardiac arrest. Despite the evidence, no magnesium dose was prescribed. After Justice Verma’s death, the family was subjected to severe mental trauma and distress due to breach of patient privacy and confidentiality and issue concerning compliance with Medical Ethics by Dr Naresh Trehan.

On the other hand, the owner of Bhardwaj Hospital and family doctor of late Justice Verma, stated that consultation and recommendation were obtained from highly qualified doctors in the United Kingdom before administering the tablet ‘Dabigatran’. The hospital and the doctors further submitted that the reports of the patient did not indicate any evidence of specific medical conditions, and appropriate treatment was provided based on the available information. Moreover, the patient was stable upon admission, and he was transferred to Medanta at the family's request.

The allegations were denied by the concerned doctors, while Dr Trehan argued that the complainants concealed certain facts regarding the medical condition and treatment.

The Conclusion

The Commission referred to relevant literature, medical records, reports, opinion of the Medical Council of India (MCI) observed that there was no evidence suggesting an active liver disease and in the absence of any such indication, the doctors did not recommend an abdominal ultrasound (USG).

NCDRC further clarified, while from the documented literature and the text books on Cardiology, Internal Medicines and Pharmacology, that the drug Dabigartan is metabolized in Kidney, therefore as far as there is no severe liver impairment, it can be given in full dose. As the LFT report did not show any gross abnormality, the doctor could not be held to be negligent for the administration of ‘Dabigartan’. It observed;

"In the instant case, Justice J. S. Verma was Class-I indication for Dabigartan because he suffered atrial fibrillation and he was at a very high risk of stroke because of his multiple co-morbidity HT, DM, bleeding piles, carotid artery disease. Moreover, Dabigartan was given in the lowest dose of 110 mg BD as recommended and the patient had only marginally raised transaminases and PTTK was within normal range. No interaction of Dabigartan with Amiodarone and clopidogrel. Therefore, in our view, the bleeding occurred was not due to Dabigartan, but it was due to chronic liver disease (asymptomatic) and grade 3 esophageal varices and caused active bleeding. Subsequently, the patient developed multiple organ failure."

Underlining the ‘four Ds’ of medical negligence- duty, dereliction/deviation, direct (proximate) cause and damages- the commission said that in the present case, the complainants had failed to prove the dereliction of duty of care from the opposite parties and the same was not a “proximate cause of death”.

It also said the Delhi Medical Council (DMC) and the Medical Council of India (MCI) had considered all the aspects twice and found there was no negligence on the part of the treating doctors at any stage.

Citing a 2021 judgment of the Supreme Court, according to which a medical practitioner is not to be held liable simply because things went wrong from mischance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference to another, the Commission concluded that there was no medical negligence and dismissed the complaint. It held;

"In the instant case, the standard medical protocols being followed by the all opposite parties, it was neither failure of duty of care nor any deficiency from the OPs. Prescribing Dabigartan was not wrong decision (refer para- 23), it was in the interest of the patient to save him from the cerebral stroke. Justice J.S.Verma, who was elderly (80 yrs) with multiple co-morbidities including Chronic Liver Dysfunction and mid-range ejection fraction (40- 45%), Grade III esophageal varices; all these factors contributed to mortality. The death of Justice J.S.Verma was not attributable to the act of OPs. We have deep sympathies with the death of Justice J S Verma, but it cannot be ground for liability."

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