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SUPREME COURT OF INDIA
A.S. Bopanna, Prashant Kumar Mishra, JJ.
Mrs. Kalyani Rajan - Appellant
Versus
Indraprastha Apollo Hospital & Ors. – Respondents
Civil Appeal No. 10347 of 2010
Decided On : 17-10-2023
Consumer Protection Act, 1986 – Section 2 (c)(iii)[Consumer Protection Act, 2019 – Section 51] – Medical services – Medical negligence – Death of patient after major neurosurgery – Complainant has never questioned diagnosis and recommended surgical treatment given to him by Doctor – Patient did not have any history of diabetes or hypertension or any cardiac problem – Since, deceased did not have any known or identifiable heart ailments, it was impossible for respondents to have prior knowledge that patient may develop cardiac problem after few hours of successful surgery – Patient was not required to be shifted to ICU and there is no negligence on this count by either of respondents – No evidence put forth by complainant to establish that heart attack suffered by patient had any connection with operation in question or that it was on account of negligent post operative care – Principle of Res Ipsa Loquitur get attracted where circumstances strongly suggest partaking in negligent behaviour by person against whom accusation of negligence is made – For applying principles of Res Ipsa Loquitur, it is necessary that a ‘Res’ is present to establish allegation of negligence – Strong incriminating circumstantial or documentary evidence is required for application of doctrine – Appellant has failed to establish negligence on part of Respondents – Appeal dismissed. (Paras 23, 25, 27, 29, 31, 32 and 33)
Facts of the case:
Present appeal is directed against order passed by National Consumer Disputes Redressal Commission dated 03.08.2010 whereby complaint filed by the appellant and proforma respondent No. 3 under Section 2 (c)(iii) of Consumer Protection Act, 1986 was rejected. Crucial issue to be decided is whether respondents have committed negligence in not providing proper postoperative medical care to patient and, accordingly, whether Commission has committed any illegality while dismissing complaint filed by appellant herein.
Findings of Court:
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. In absence of 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.
Result : Appeal dismissed.
Key Points: - The court held that Res Ipsa Loquitur does not apply given the lack of a ‘Res’ and the absence of strong incriminating evidence linking post-operative care to the cardiac arrest (!) (!) . - The evidence shows no prior heart problems or diabetes/hypertension; standard practice permitted sending patients to wards rather than ICU if no complications, and no negligence was proven in post-operative care (!) (!) (!) . - Expert opinions (e.g., Prof. Ahuja) concluded the complications were unrelated to the surgery and not indicative of cardiac arrest symptoms, supporting dismissal of negligence claims (!) (!) . - The respondent hospital and doctors were found not liable for medical negligence; standard of care judged against ordinary competent practice at the relevant time (!) (!) . - The Tribunal noted that negligence cannot be presumed from a poor outcome; there must be clear medical evidence of negligence or a glaring lapse, which was not established here (!) (!) . - The appeal was dismissed, affirming that post-operative care did not breach the standard of care and that no causal link to the death was proven (!) .
JUDGMENT :
PRASHANT KUMAR MISHRA, J.
The present appeal is directed against the order passed by the National Consumer Disputes Redressal Commission1[(for short, ‘the Commission’)] dated 03.08.2010 whereby the complaint filed by the appellant and proforma respondent No. 3 under Section 2 (c)(iii) of the Consumer Protection Act, 19862[(for short, ‘the Act’)] was rejected.
2. The complainant-appellant is the wife of the deceased patient namely, Sankar Rajan3[(for short, ‘the deceased’)], who was 37 years old and died on 06.11.1998 in the hospital-respondent no. 1 herein while undergoing follow up care and treatment after a major neurosurgery in the care of respondent nos. 1 and 2. The deceased was under the employment of proforma respondent no. 3 and was earning handsome annual package at the time of his demise.
3. The deceased was suffering from Chiari Malformations (Type II) with Hydrocephalous. The deceased consulted Dr. Ravi Bhatia – respondent no. 2, Senior Consultant, Department of Neurosurgery of respondent no. 1-hospital on 21.10.1998, who advised him to get admitted to respondent no. 1-hospital where the surgery would be performed by him. As per the advice of respondent no. 2, the deceased got himself admitted to respondent no. 1 on 29.10.1998. After performing preoperative medical examinations, respondent no. 2 conducted the operation of the deceased. The deceased was thereafter shifted to private room at about 04.15 p.m and at about 04.30 p.m, the doctors visiting the deceased were informed about pain in the neck region, which seemed to have transferred downward lower than the region where pain used to occur prior to operation. At about 06.30 p.m. the deceased was given pain reliever intravenously, but the pain increased along with severe sweat spells. At about 09.15 p.m, the deceased started suffering from severe unbearable pain. The complainant-appellant called respondent no. 2 at his residential phone but he was not available. At about 09.30 p.m. another pain killer was intravenously given. At about 11.00 p.m. complainant-appellant talked to respondent no. 2 at his residence. The deceased had suffered heart attack around 11.00 p.m. The deceased was declared brain dead on 31.10.1998. He was kept on life support till his death on 06.11.1998.
4. The grievance of complainant-appellant is that the deceased was not attended to by any doctor from neurosurgery team who had operated the deceased after he was shifted into the private room till 11.00 P.M. After such major surgery, instead of shifting to a private room, the deceased should have been shifted to the Intensive Care Unit,4[(for short, ‘ICU’)].
Findings of Commission (Impugned Order)
5. The allegation in the complaint is mainly apropos lack of medical care from the time he was shifted to the Private room till he suffered a cardiac arrest at around 11:00 PM. However, the appellant herein has not been able to establish by any cogent evidence or material on record that the heart attack suffered by the deceased had any connection with the operation in question or on account of lack of post-operative care.
6. The said finding has been supported by an affidavit of Prof. Gulshan Kumar Ahuja who was professor of neurosurgery in AIIMS & Senior Consultant at R-1/hospital at that time and he has opined that complications suffered by the deceased were totally unrelated to the surgery conducted by R-2. He has further stated that pain in the neck accompanied by symptoms of profuse sweating and nausea cannot be a symptom of cardiac respiratory arrest.
7. The deceased did not have any history of diabetes or hypertension as has been stated by R-2 herein in his evidence neither did he have any heart problem. The said pain in the neck was on account of cervical operation. No material on record to show that the deceased was in pain in any other region of his body. The appellant’s contention apropos the deceased sweating is not met out with in the medical records except for once at 9PM.
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