Judicial Analysis Court Copy Headnote Facts Arguments Court observation

2019 Supreme(SC) 311

SUPREME COURT OF INDIA
DHANANJAYA Y. CHANDRACHUD, HEMANT GUPTA, JJ.
ARUN KUMAR MANGLIK - Appellant
VERSUS
CHIRAYU HEALTH AND MEDICARE PRIVATE LTD. & ANR. - Respondent
CIVIL APPEAL NOS. 227-228 OF 2019 (@SLP (C) Nos. 30119-30120 of 2016) WITH CIVIL APPEAL NO. 229 OF 2019 (@ SLP(C) No. 865 OF 2019) @ Diary No. 44846 OF 2018
Decided on : 09-01-2019.

Advocates:
Advocate Appeared:
For the Appellant : Mr. Brijender Chahar, Mr. Birendra Kumar Mishra, Mr. Shashi Bhushan, Ms. Poonam Atey, Adv.
For the Respondent: Mr. Ankur Mittal, Mr. U.C. Mittal, Ms. Nidhi Mittal, Adv.

IMPORTANT POINTS
Course adopted by medical professional is required to be consistent with “general and approved practice”.
Contribution made by a non-working spouse to the welfare of the family has an economic equivalent.

Headnote:(a) Medical negligence – Patient having a prior medical history including catheter ablation and paroxysmal supra ventricular tachycardia suggestive of cardiac complications – Fell in the Group B (patients that require in-hospital management) under WHO guidelines – Required to closely monitor her condition – Respondents failing to do so – Held, not meeting standard of reasonable care expected of medical services – ‘Bolam test’ – Course adopted by medical professional required to be consistent with “general and approved practice” – Instantly, critical parameters of patient not evaluated for 12 hours – Contravention of WHO guidelines as well as the guidelines prescribed by the Directorate of National Vector Borne Diseases Control Programme – Held, while treating doctor is guilty of medical negligence, the Director of the hospital cannot be held so. (Para 27, 30, 41, 44, 48)
       (2010) 3 SCC 480; AIR 1969 SC 128; (2005) 6 SCC 1; (1995) 6 SCC 651; (2005) 7 SCC 1; (2009) 6 SCC 1; (2010) 5 SCC 513; (2009) 3 SCC 1 – Relied upon
       [1957] 1 WLR 582; 1985 (1) All ER 635; (1968) 118 New LJ 469; (1996) 4 All ER 771 – Referred
       (b) Medical negligence – Patient a house wife dying at 56 years of age – Contribution made by a non-working spouse to the welfare of the family has an economic equivalent – Living spouse entitled to compensation – Compensation enhanced to Rs. 15 lakhs with interest at the rate of 9 per cent per annum. (Para 51, 55, 56)
       (2001) 8 SCC 197; (2009) 3 SCC 663; (2017) 13 SCALE 12 – Relied upon
       Facts of the case:
       The spouse of the appellant, Madhu Manglik, was about 56 years of age, when on 14 November, 2009, she was diagnosed with dengue fever.
       The patient was admitted to Chirayu Health & Medicare hospital at Bhopal at about 7 am on 15 November 2009.
       By 6 pm, on the date of admission the patient was sinking, her blood pressure was non-recordable, extremities were cold and the pulse was non-palpable.
       At 8 pm, the patient had a cardiac arrest. She was declared dead at 8.50 pm.
       The SCDRC came to the conclusion that a case of medical negligence was established. An amount of Rs. 6 lakhs was awarded to the appellant by way of compensation, together with interest at the rate of 9 per cent per annum.
       In appeal, these findings have been reversed by the NCDRC and in consequence, the claim stands dismissed.
       Finding of the Court:
       The impugned judgment is not sustainable.
       Result: Appeal allowed.

JUDGMENT :

Dr Dhananjaya Y. Chandrachud, J.

1. Delay condoned.

2. Leave granted.

3. The National Consumer Disputes Redressal Commission [NCDRC] has set aside an order of the MP State Consumer Disputes Redressal Commission [SCDRC] holding the respondents guilty of medical negligence in the treatment of the spouse of the appellant which eventually led to her death on 15 November 2009. In consequence, the award of compensation of Rs. 6,00,000 awarded, together with interest, has been reversed.

4. The spouse of the appellant, Madhu Manglik, was about 56 years of age, when on 14 November, 2009, she was diagnosed with dengue fever. The report of the pathological laboratory, Glaze Pathology, reported the following state of health:

“RBC- 4.21 Million/cmm

Hb-12,1 gm/d/ TLC-1900/Cmm

Platelet Count 1.79 lakh/cmm

Dengue Ns 1 Antigen - Positive”

The patient was admitted to Chirayu Health & Medicare hospital at Bhopal at about 7 am on 15 November 2009. She was immediately admitted to the Intensive Care Unit. Though she was afebrile, she reported accompanying signs of dengue fever including headache, body ache and a general sense of restlessness. The patient had a prior medical history which included catheter ablation and paroxysmal supra ventricular tachycardia suggestive of cardiac complications.

5. Upon admission at about 7.30 am, basic investigations were carried out. The blood report, together with the accompanying clinical examination indicated the following position:

“Hb 13.4

TLC 3000/Cumm,

Platelet count 97000/cumim,

PS for MP no malarial parasite seen

Blood urea 21 mg%

Serum bilirubin img%

SGPT 521 U/L,

SGOT 105Mg/dl

ELECTROLYTE Sodium 140 meq/L

Potasium 4.0 meq/L Ex R4

Urine test normal Ex R6

10.00 am - Pulse-88/min,

Bp. 130/88 mm Hg

Temp. A febrile c/o Pain in abdomen

At 2.00 pm - p-128/min, mildly febrile

BP - 110/70 mm Hg”

Since the patient was complaining of abdominal discomfort, an ultrasonography of the abdomen was carried out.

6. By 6 pm, on the date of admission the patient was sinking, her blood pressure was non-recordable, extremities were cold and the pulse was non-palpable. In the meantime, the patient was placed on a regime of administering intravenous fluids. The administration of 2500ml of fluids was planned over the course of 24 hours. Between 7 am and 6 pm, she was administered about 1200 ml of fluids. The patient developed bradycardia and cardiac arrest. Faced with this situation, the treating doctors administered about 1.5 litres of extra fluids. Fluids and colloids were administered for increasing the blood pressure.

7. Since the blood pressure of the patient did not improve, she was administered ionotropes (dopamine & non adrenaline). At 6.45 pm, the patient suffered a cardiac arrest. Her cardiac levels were monitored. At 6.55 pm she was examined by Dr C C Chaubey.

8. Belatedly, at 7.15 pm, another blood sample was taken, which indicated the following results:-

“Hb - 8.1/d/

TLC-7,400/Cumm

Platelet count 19000/cmm Ex R 10

Total protein- 3.9 gms%

A/G Ratio - 2

SGOT 169 IU/L”

9. At 8 pm, the patient had a cardiac arrest. She was declared dead at 8.50 pm.

10. A complaint of medical negligence was instituted before the Medical Council of India.

11. The Ethics Committee of the Medical Council of India came to the conclusion on 20 February 2015 that though the treating doctors had administered treatment to the patient in accordance with the established medical guidelines, the treatment was not timely. The Ethics Committee, prima facie, found that there was professional misconduct on the part of both the Director of the Hospital Dr Ajay Goenka (respondent No. 2) and Dr Abhay Tyagi. The Ethics Committee observed thus:

“…..After perusing the statements given by both the parties and documents on record in the case, the Ethics Committee discussed the matter in detailed and noted that the patient admitted in Chirayu Health & Medicare Pvt. Ltd., Malipura, Bhopal on the advice of Dr. A. Goenka but he never visited in hospital to see the patient. The committee furthe

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2019 Supreme(SC) 311

IMPORTANT POINTSCourse adopted by medical professional is required to be consistent with “general and approved practice”.Contribution made by a non-working spouse to the welfare of the family has an economic equivalent.

Cases Referred (11)

IMPORTANT POINTS
Course adopted by medical professional is required to be consistent with “general and approved practice”.
Contribution made by a non-working spouse to the welfare of the family has an economic equivalent.