No medical negligence or mistake in diagnosis: SC dismisses plea against Indraprastha Apollo hospital, neurosurgeon

A Division Bench of Justices A.S. Bopanna and Prashant Kumar Mishra said that there was no mistake in diagnosis or a negligent diagnosis by the neurosurgeon, adding that in the absence of the patient having any history of diabetes, hypertension, or cardiac problem, it is difficult to foresee a possible cardiac problem only because the patient had suffered pain in the neck region.

The Case:

The case involving allegations of medical negligence was filed under Section 2(c)(iii) of the Consumer Protection Act, 1986 against Indraprastha Apollo Hospital and others following the death of the complainant's husband. The deceased had undergone a major neurosurgery performed by the doctor (a Senior Consultant, Department of Neurosurgery) at the hospital but subsequently passed away while receiving follow-up care.

Rajan suffered from Chiari Malformations (Type II) with Hydrocephalous and had consulted the neurosurgeon in the year 1998, who advised surgery. The procedure was performed, and the patient was then shifted to a private room. However, he began experiencing severe neck pain and other symptoms, which allegedly led to his death.

The complainant's primary grievance was that no doctor from the neurosurgery team who had conducted the operation attended the patient after he was moved to the private room. The complainant argued that, after such a major surgery, the patient should have been placed in the Intensive Care Unit (ICU).

NCDRC's Conclusion:

The instant appeal was filed against the order of the Commission issued in 2010 that rejected the complainant's allegation.

The Commission had dismissed the complaint, stating that the appellant failed to establish a connection between the patient's cardiac arrest and the surgery or post-operative care. This decision was supported by an affidavit from Prof. Gulshan Kumar Ahuja, a professor of neurosurgery at AIIMS and a senior consultant at the hospital, who stated that the complications suffered by the patient were unrelated to the surgery. He further stated that pain in the neck accompanied by symptoms of profuse sweating and nausea cannot be a symptom of cardiac respiratory arrest.

Furthermore, the medical records confirm the deceased had no prior history of diabetes, hypertension, or heart issues, and the neck pain was linked to the cervical surgery without evidence of pain in other body regions. The Commission, considering the facts, found no conclusive proof of medical negligence, and the care leading up to the cardiac arrest was not deemed inadequate, precluding liability for the hospital or the doctor. The legal principle of "Res Ipsa Loquitur" isn't relevant in this case's particulars, the Commission had added.

The Contentions:

The appellant, represented by Shri Nikhil Nayyar, raised several points alleging medical negligence by the hospital and the neurosurgeon. It was contended that the hospital's practice of transferring patients to private rooms after surgery was not followed in patient's case. They further raised concerns about the lack of care after the patient complained of pain in his neck and other symptoms as a normal post-operative symptom. Furthermore, the failure to address Ventricular Tachycardia (VT) appropriately was highlighted, along with concerns about the accuracy of the findings in the disputed order. The appellant asserted that the case demonstrated negligence due to a lack of care, underlining the absence of senior doctors or specialists during a critical period and the failure to investigate the source of the pain.

On the other hand, the hospital's counsel countered these arguments, emphasizing that the hospital was well-equipped with advanced medical facilities and that the patient received care from the doctor, an internationally renowned expert who formerly headed the Neurosurgery department. The neurosurgeon was assisted by Dr Brahm Prakash, a senior Neurosurgeon. It was emphasized that the patient recovered excellently after neurosurgery with no post-operative complications, which is why he was transferred to the recovery and later private room.

The counsel highlighted the patient's pre and post-operative medical records to argue that neither the hospital nor the treating doctors were negligent. They also pointed out that his symptoms did not suggest cardiac arrest and that it would have been impossible for the doctors to predict this outcome. They further reference the Commission's findings and a precedent, Bombay Hospital & Medical Research Centre v. Asha Jaiswal and Others, to support the dismissal of the present appeal.

Meanwhile, Meenakshi Arora, the senior counsel for the neurosurgeon, aligned her arguments with those made on behalf of the hospital and reiterated the Commission's findings and the precedent set by Bombay Hospital v. Asha Jaiswal. Furthermore, the neurosurgeon explained that it was standard practice to examine patients in the recovery room first, and only those showing complications or with pre-operative medical problems were transferred to the Neurology Intensive Care Unit. The patient had regained consciousness when moved from the Operation Theatre to the Recovery Room, and this was in line with the procedure as most neurosurgical patients were similarly treated. Dr. Brahm Prakash and Dr. Tyagi examined the patient around 5 p.m., and the patient only complained of mild neck pain, considered normal after cervical surgery. The neurosurgeon emphasized that they had received no calls or messages about the patient's condition from the time they left the hospital around 5:30 p.m. until the call from the appellant at about 11:15 p.m. Senior counsel firmly denies the appellant's claims, asserting that the impugned order has no defects warranting intervention from the court and should be dismissed.

Court's Analysis and Findings:

The Supreme Court analyzed the evidence presented and relevant legal principles. It considered the critical issue at hand as whether the respondents were negligent in providing proper post-operative medical care to the patient, and whether the Commission erred in dismissing the appellant's complaint.

Initially, the Court underscored that the crux of this case revolved around the absence of appropriate post-operative medical care, rather than focusing on any negligence by the doctor during the Neurosurgery.

The Court took note of the allegation that the patient should have been transferred to the ICU instead of a private room. After a thorough review of the pertinent evidence, it was observed that standard practice dictated that patients with no signs of complications in the recovery room and lacking pre or post-operative issues were typically sent to their rooms. It said;

"The patient would have been shifted to the ICU immediately, if serious complications would have arisen after the surgery, therefore, in the absence of complications in the surgery or soon thereafter, the patient was not required to be shifted to ICU and there is no negligence on this count by either of the respondents."

In addressing the specific facts of this case, the Court concluded that the appellant had failed to present any evidence establishing a link between the patient's heart attack and the surgical procedure or negligent post-operative care. It observed;

"There is no evidence put forth by the complainant to establish that heart attack suffered by the patient had any connection with the operation in question or that it was on account of negligent post operative care."

The Court also acknowledged that the patient had no history of diabetes, hypertension, or cardiac problems. Thus, it was challenging for the medical staff, including the duty doctor and the hospital, to anticipate a cardiac arrest, especially since the patient had not complained of pain in any other body part except the neck region. It noted;

"It is significant to notice that the patient did not have any history of diabetes or hypertension or any cardiac problem. Therefore, it was difficult for treating doctors including the duty doctor or the hospital to assume that the patient may suffer cardiac arrest and moreover, the patient had also not complained of pain in any other part of the body except neck region."

Regarding the circumstances under which a medical practitioner may be held liable for negligence, the Court referenced the case of Jacob Mathew v. State of Punjab and another, (2005) 6 SCC 1, which outlined two key criteria: either the professional lacked the necessary skills they claimed to possess, or they failed to exercise the skills they did have competently.

The Court also drew upon Bombay Hospital & Medical Research Centre v. Asha Jaiswal and Others, 2021 SCC online SC 1149, which discussed earlier judgments, including Martin F. D’Souza v. Mohd. Ishfaq, (2009) 3 SCC 1. In the latter case, it was emphasized that mere treatment failure or an unsuccessful surgery does not automatically imply medical negligence using the doctrine of res ipsa loquitur. It said;

"In so far as the applicability of principles of Res Ipsa Locutor, in the fact and circumstances of the case, it is to bear in mind that the principles get attracted where circumstances strongly suggest partaking in negligent behaviour by the person against whom an accusation of negligence is made. For applying the principles of Res Ipsa Locutor, it is necessary that a ‘Res’ is present to establish the allegation of negligence. Strong incriminating circumstantial or documentary evidence is required for application of the doctrine."

Subsequently, the Court concluded that there was neither an erroneous diagnosis nor a negligent one by the Neurosurgeon. Given the patient's lack of any history of diabetes, hypertension, or cardiac problems, it was unreasonable to foresee a cardiac issue solely based on the patient's neck pain. Therefore, the Court held that the appellant had not substantiated claims of negligence on the part of the hospital and the doctor in their post-operative care. The appeal was subsequently dismissed.

It held;

"The case in hand stands on a better footing, in as much as there was no mistake in diagnosis or a negligent diagnosis by Respondent no. 2(Neurosurgeon). In the absence of the patient having any history of diabetes, hypertension, or cardiac problem, it is difficult to foresee a possible cardiac problem only because the patient had suffered pain in the neck region."

"For the foregoing, this Court is of the considered view that the appellant has failed to establish negligence on the part of Respondents (hospital and the neurosurgeon) in taking post operative care and the findings in this regard recorded by the Commission does not suffer from any illegality or perversity. The appeal sans substance and is, accordingly, dismissed."

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