Summary
A 47-year-old teacher underwent laparoscopic cholecystectomy on 28.07.2004 in Punjab. She developed pain, distension, bilious drain discharge and breathlessness; the surgeon blamed pancreatitis, refused a second opinion for two days and then referred her to a Ludhiana hospital 100 km away, where a CT scan showed free intra-abdominal air, a laparotomy on 03.08.2004 revealed colon and bile duct injuries, and she died of septicaemia and multi-organ failure on 11.08.2004. The State Commission held the surgeon and his hospital negligent and awarded Rs. 15.44 lakhs; the Medical Council of India's Ethics Committee, on expert opinions from AIIMS and KGMC, found he had failed to exercise adequate competence; but the NCDRC reversed, finding no negligence. The Supreme Court restored the finding of negligence against the surgeon and his hospital and awarded Rs. 25 lakhs with 6% interest.
Issues
- Whether the operating surgeon and his hospital were guilty of medical negligence amounting to deficiency in service in causing iatrogenic injuries during laparoscopic cholecystectomy and in failing to suspect and act on post-operative warning signs of bowel perforation and bile leak.
- Whether the NCDRC erred in reversing the State Commission's finding by relying on general precedents on medical negligence without examining the evidence on record, including the findings of the Medical Council of India.
Provisions considered
- Deficiency in service (Section 2(1)(g)) in medical treatment; compensation, Consumer Protection Act, 1986The surgeon's failure to exercise adequate competence during the procedure and to detect obvious post-operative complications — admitted in cross-examination when he said the possibility of intra-operative injury 'did not occur to my mind' — amounted to negligence and deficiency in service; the question of intention does not arise in a claim for damages for professional negligence. Compensation of Rs. 25 lakhs with 6% interest from the State Commission's order awarded against the surgeon and hospital. (¶¶ 29, 36, 37, 38, 40)
Held
- The NCDRC devoted itself to judicial precedents and to the allegations against the Ludhiana surgeon, who had been exonerated, without meeting the specific allegations against the operating surgeon; there was sufficient material indicative of large bowel perforation after the laparoscopy and sufficient indicators for a diligent professional to detect it and take immediate restitutive steps. Rejecting a plea of res ipsa loquitur on the footing that no sensible professional would intentionally injure a patient misses the point — intention is irrelevant to professional negligence — and the NCDRC did not even refer to the MCI report, which alone would have sufficed. (¶¶ 28, 29, 36)
- The findings of the Medical Council of India, a statutory regulator, on the professional conduct of the doctor have great relevance in a claim for compensation for medical negligence: its Ethics Committee, on the opinions of the Professors and Heads of Surgery at AIIMS and KGMC, found generalised peritonitis from bowel perforation, significant delay in diagnosis and intervention, a large bowel perforation that could have been prevented with care during the procedure, and failure to suspect complications despite the patient not recovering, deteriorating and showing strong indications of a complication — leading to avoidable delay and the unfavourable outcome. (¶¶ 30, 31, 32, 33, 34, 35)
- The MCI findings, fortified by the surgeon's admissions in cross-examination that the possibility of intra-operative injury never occurred to him and that he saw no need to consult another surgeon, establish medical negligence and deficiency in service by the operating surgeon and his hospital; the Ludhiana doctor and hospital, found not negligent by both Commissions and the MCI, are not liable. (¶¶ 36, 37, 38, 39)
Result
Appeals allowed; the NCDRC's judgment of 05.06.2020 in Appeal Nos. 108 and 120 of 2008 set aside; the operating surgeon and his hospital (respondents 1 and 2) held liable for medical negligence and directed to pay the complainants Rs. 25,00,000 with interest at 6% per annum from the date of the State Commission's order, adjusting amounts already paid, within six months, failing which interest at 9%; claim against the Ludhiana doctor and hospital rejected. Parties to bear their own costs.