Summary
A patient died of atonic post-partum haemorrhage hours after delivery at the appellants' nursing home and her newborn also died; the State Commission found the obstetrician and nursing home negligent in post-delivery care and the NCDRC, while holding there was no negligence in the labour, delivery and post-delivery management and exonerating the nursing home, fastened liability on the doctor for deficient antenatal care. The Court set both orders aside: the complaint never alleged deficient antenatal care, the NCDRC could not build a new case beyond the pleadings, and five Medical Boards constituted at the complainant's own instance had found no negligence.
Issues
- Whether a special leave petition under Article 136 lies against an appellate order of the NCDRC, and whether the appellants should be relegated to Article 226 after the matter had remained pending for over twelve years.
- Whether the NCDRC could affirm the award of compensation on a ground (deficient antenatal care) never pleaded in the complaint, after finding that the pleaded case of post-delivery negligence was not made out.
- Whether a finding of medical negligence could be sustained when successive Medical Boards of experts had found no negligence on the part of the treating doctor.
Provisions considered
- Articles 136 and 226, Constitution of IndiaFollowing Universal Sompo General Insurance Co. Ltd. v. Suresh Chand Jain, a special leave petition under Article 136 is not the proper remedy against an appellate order of the NCDRC; but since the matter had been entertained and had been pending for over twelve years, the Court declined to relegate the appellants to the alternative remedy under Article 226 before the High Court. (¶ 4)
Held
- Although a special leave petition under Article 136 is not the proper remedy against an appellate order of the NCDRC (Universal Sompo), where the matter had been entertained and had been pending for over twelve years it was not proper to relegate the appellants at that late stage to the remedy under Article 226 before the jurisdictional High Court. (¶ 4)
- All five Medical Boards and Committees, constituted at the behest of the complainant himself on his complaints to various authorities, found no medical negligence in the management of the patient (one left open, for want of data, whether pre-existing anaemia or cardiac conditions had made the haemorrhage catastrophic). Since every failure in treatment does not automatically lead to an assumption of negligence, the opinions of these experts tilted the balance in favour of the doctor, and the complainant could not fight shy of the conclusions of bodies he had himself set in motion. (¶¶ 17, 18, 19, 20, 21, 22)
- A doctor cannot be held liable per se because a patient did not respond to treatment or a procedure failed (Jacob Mathew; Martin F. D'Souza); courts and consumer fora are not experts in medical science and must not substitute their views for those of specialists; and unless the complainant establishes a specific course of conduct showing lack of due care, the court cannot second-guess the line of treatment, as every death in a hospital does not amount to negligence on a hypothetical assumption (Devarakonda Surya Sesha Mani). (¶¶ 23, 24)
- The NCDRC visualised itself in the role of a medical professional and, while recording that no tortious negligence was made out in handling the labour, delivery, the baby's problem and the post-delivery management, held the doctor negligent only in antenatal care for not insisting on haematological and cardiological investigations. This reversed the State Commission's finding and turned the complainants' own case on its head: the complaint alleged only that the nursing home was ill-equipped for post-delivery emergencies, that there was delay in arranging blood and in shifting the patient, and that the mother was informed of the child's death; it made no allegation about antenatal care and, on the contrary, asserted that all prescribed tests were undergone. (¶¶ 15, 16, 25, 26, 27)
- Once the case as pleaded and projected by the complainant was not made out, the NCDRC erred in building up a new case on his behalf and pinning liability on the doctor for antenatal management, which was never the subject matter of the complaint; in doing so it overstepped its jurisdiction, since a decision cannot rest on grounds outside the pleadings and no party may travel beyond its pleadings (A.V.G.P. Chettiar & Sons; Venkataraman Krishnamurthy; Rama Kt. Barman; Trojan & Co.; Ram Sarup Gupta). (¶¶ 28, 29, 30)
- The NCDRC's finding that there was no negligence in the delivery and post-delivery treatment attained finality as the complainants preferred no appeal; its order confirming the State Commission's award on the new grounds it had itself made out could not be sustained. (¶ 30)
Result
Appeal allowed; NCDRC order dated 09.05.2012 in First Appeal Nos. 158 and 193 of 2007 and the SCDRC judgment dated 31.01.2007 in Complaint Case No. 56 of 2006 set aside and the complaint dismissed. Respondent No. 1 to refund the Rs. 10,00,000 received under orders in the litigation in monthly instalments of Rs. 1,00,000: the first three instalments (Rs. 3,00,000) to New India Assurance Co. Ltd. and the balance Rs. 7,00,000 to Dr. Kanwarjit Kochhar and Dr. GS Kochhar under acknowledgement, the nursing home no longer being in existence; parties to bear their own costs.