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2010 Supreme(SC) 201

Supreme Court of India
THE HONOURABLE MR. JUSTICE G.S. SINGHVI & THE HONOURABLE MR. JUSTICE ASOK KUMAR GANGULY
V. Kishan Rao
Versus
Nikhil Super Specialty Hospital & Another
CIVIL APPEAL NO.2641_ OF 2010 (Arising out of SLP(C) No.15084/2009)
Decided on : 08-03-2010

Advocates appeared:
For the Appellants:N.S. Gahlot, R.K. Singh, Sanjeev Malhotra, Advocates. For the Respondents:K. Maruthi Rao, Advocate.

Headnote:A) CONSTITUTION OF INDIA : Art.21 CONSUMER PROTECTION ACT : S.2(1)(o) HUMAN RIGHTS ACT : Art.2 INDIAN PENAL CODE : S.304(A):- This was a case of a medical negligence in which the Doctor had treated the deceased patient for typhoid where she was alleged to have been suffering from Malaria. While District Forum rejecting the claim for expert evidence in summary trial allowed the compensation of Rs. 2 lakhs apart from cost of Rs.2000/- and refund of fees of Rs.10,000/- The State Commission also held that there is no necessity for expert evidence but held that complainant had failed to prove that there is any case of negligence on the part of the doctor. The same was confirmed by the National Commission against which this SLP was filed. After a prolonged discussion on medical negligence as laid down by this court from time to time, it was held that consumer forum can on its own decide the cases of medical negligence without referring to expert evidence or driving the complainants to file civil case. The decision of this court in Martin F. Dsouza v. Mohd. Ishfaq, reported in 2009 (3) SCC 1, in so far as it mandates consumer forums, to refer all medical negligence to a Government doctor of the concerned branch and obtain his impartial opinion before proceedings on cases of medical negligence, was held to be per incurium and not binding consumer forums. In light of this observation the decisions if National Commission and State Commission. Appeal was allowed and the judgment and order of district consumer forum was restored.

       

       

Judgement Key Points

Key Points: - The District Forum can decide medical negligence cases without expert evidence in appropriate cases. (!) (!) - Larger Benches (Indian Medical Association, Dr. J. J. Merchant) establish that expert evidence is required only in complicated cases; otherwise, civil redress can be provided on affidavits. (!) (!) (!) - D'Souza (supra) directions mandating expert evidence in all medical negligence cases are not binding precedent and are confined to its facts. (!) (!) - The Act preserves a consumer’s right to approach civil court in complicated cases requiring expert testimony. (!) (!) - In uncomplicated cases, consumer fora may adjudicate based on summaries and not require expert evidence. (!) (!) - The judgment emphasizes res ipsa loquitur in appropriate medical negligence cases and cautions against over-reliance on expert opinion where not necessary. (!) (!) - The larger bench decisions distinguish between civil liability under the Act and criminal negligence, requiring mens rea for criminal prosecutions. (!) (!) - The judgment directs that expert evidence should be sought only if necessary and that fora should exercise discretion based on case facts. (!) (!) - This decision overridden State/National Commission conclusions that required expert evidence uniformly. (!)

Question 1?

What is the standard for expert evidence in medical negligence cases under the Consumer Protection Act as clarified by this judgment?

Question 2?

What are the permissible circumstances under which consumer fora can or cannot rely on expert evidence in medical negligence disputes?

Question 3?

What is the relationship and distinction between civil liability under the Consumer Protection Act and criminal negligence standards in medical practice as discussed in this judgment?


Judgment :

GANGULY, J.

1. Leave granted.

2. This appeal has been filed challenging the judgment and order dated 19.02.2009 of the National Consumer Disputes Redressal Commission, New Delhi (hereinafter, `National Commission') which upheld the finding of the State Consumer Forum. The order of the National Commission runs as follows:

"Heard. The State Commission after elaborate discussion has come to the conclusion that there was no negligence on the part of the respondent doctor. All possible care was taken by the respondent in treating the petitioner. The State Commission has also recorded a finding that no expert opinion was produced by the petitioner to prove that the line of treatment adopted by the respondent hospital was wrong or was due to negligence of respondent doctor. Dismissed".

3. The appellant, who happens to be the original complainant, is an officer in the Malaria department and he got his wife admitted in the Respondent No. 1 hospital on 20.07.02 as his wife was suffering from fever which was intermittent in nature and was complaining of chill.

4. In the complaint, the appellant further alleged that his wife was subjected to certain tests by the respondent No.1 but the test did not show that she was suffering from malaria. It was also alleged that his wife was not responding to the medicine given by the opposite party No.1 and on 22nd July, 2002 while she was kept admitted by respondent No.1. Saline was given to her and the complainant had seen some particles in the saline bottle. This was brought to the notice of the authorities of the respondent No.1 but to no effect. Then on 23rd July 2002 complainant's wife was complaining of respiratory trouble and the complainant also brought it to the notice of the authorities of the respondent No.1 who gave artificial oxygen to the patient. According to the complainant at that stage artificial oxygen was not necessary but without ascertaining the actual necessity of the patient, the same was given. According to the complainant his wife was not responding to the medicines and thus her condition was deteriorating day by day. The patient was finally shifted to Yashoda Hospital from the respondent No.1.

5. At the time of admission in Yashoda Hospital the following conditions were noticed:

"INVESTIGATIONS

Smear for MP-Positive-ring forms &

Gametocytes of P. Falciparam seen

Positive index-2-3/100RBCS LFT-TB-1.5 DB-1.0 IB-0.5 WIDAL test-Negative HIV & HBsAG-Negative PT-TEST-22 sec CONTROL-13 sec APTT-TEST-92 sec CONTROL-38 sec CBP-HB-3.8% gms TLC-30.900/cumm RBC-1.2/cumm HRP II-Positive B urea-38 mg/dl S Creatinine-1.3 mb/dl S Electrolytes-NA/K/CL-148/5.2/103 mEq/L C X R - s/o ARDS CASE DISCUSSION

45 yrs old of patient admitted in AMC with H/o fever-8 days admitted 5 days back in NIKHIL HOSPITAL & given INJ MONOCEF, INJ CIFRAN, INJ CHOLROQUINE because of dysnoea today suddenly shifted to Y.S.S.H. for further management. Upon arrival in AMC, patient unconscious, no pulse, no BP, pupils dilated. Immediately patient intubated & ambu bagging AMC & connected to ventilator. Inj. Atropine, inj. Adhenoline, inj. Sodabicarb given, DC shock also given. Rhyth restored at 1.35 PM At 10.45 pm, patient developed brady cardia & inspite of repeated Altropine & Adhenolin. HR-`O' DC shock given. External Cardiac massage given. In spite of all the resuscitative measure patient could not be revived & declared dead at 11.30pm on 24.7.2002".

6. In the affidavit, which was filed by one Dr. Venkateswar Rao who is a Medical Practitioner and the Managing Director of the respondent No.1 before the District Forum, it was admitted that patient was removed from respondent No.1 to the Yashoda Hospital being accompanied by the doctor of the respondent No.1. From the particulars noted at the time of admission of the patient in Yashoda Hospital it is clear that the patient was sent to Yashoda Hospital in a very precarious condition and was virtually, clinically dead.

7. On the complaint of the appellant that hi




















































































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