The judgment establishes the legal principle that in cases of emergency surgery, the burden of proof to show want of consent lies with the medical practitioner, and failure to perform necessary emergency procedures may lead to liability for negligence and adverse outcomes.

1. Devaluation of standards in professional ethics is a dangerous trend. Its proliferation in medical profession is more calamitous than in other professional or occupational areas. "There can be few, if any, professions other than that of medicine about which it is possible to fashion a television series entitled 'Your Life in Their Hands' (Mason and McCall Smith Law and Medical Ethics). Failure to make a proper diagnosis sometimes may be the consequence of human error. But when diagnosis is correctly made, the imperative duty of the medical man to take adequate and prompt curative steps need not be over-emphasised, for, any inertia on his side is at his risk as to all costs and consequences. If the allegations in this case are true, this would fall within the amplitude of the above proposition.

2. The facts: The second plaintiff's husband was admitted in the General Hospital, Ernakulam as an inpatient at about 3.30 P. M. on 11-3-1974 for complaints of severe abdominal pain. It was diagnosed as a case of acute appendicitis. Dr. T. T. Thomas, the appellant, who was one of the civil surgeons of the General Hospital during the relevant time, examined the patient and confirmed the diagnosis, pursuant to which the patient was removed from the Casualty Ward to the Surgical Ward. No surgery was performed on the patient on the day of his admission in the hospital. On the next day his condition deteriorated fast and surgery could not have been performed on him. He breathed his last by about 8.30 A. M. on 13-3-1974. His death was due to "perforated appendix". These are the broad facts over which there is no serious dispute between the parties.

3. The mother, the widow and the children of the deceased are the plaintiffs who filed this suit for damages, limiting their claim to half a lakh of rupees. The claim was made against the appellant as the person primarily liable for damages and against the State of Kerala as vicariously liable for the same.

4. The further allegations in the plaint, relevant for this appeal, are that when the patient was examined by the duty doctor, he found that it was a case which required immediate operation to save the life of the patient, and that the appellant also examined the patient on the same day, but the patient was removed to the surgical ward only on 12-3-1974 where he was prepared for operation, that medicines and catgut were bought by the 2nd plaintiff from outside as prescribed by the doctors, and that the appellant did not care to attend the patient after the first day's examination though the patient was writhing in pain during day and night. The further allegations are that the 2nd plaintiff paid a sum of Rs. 25/- to the appellant as she came to know that the appellant might not turn up to operate without money being paid to him in private, that the appellant did not turn up at any time after 8.45 A. M. on 12-3-1974 since the appellant had gone to an outside private nursing home to conduct operations on other patients, and that the appellant came back only after the death of the patient.

5. In the written statement, the appellant admitted that he examined the patient on the 11th itself and diagnosed his disease as "perforated appendix with peritonitis" and that he advised immediate operation. But the main contention of the appellant, in his written statement, is that no surgery was done on the patient on 11-3-1974 because of the reluctance of the patient to undergo a surgery saying that "he had similar attacks before and he used to get relief with injections and other medicines." So, according to the appellant, other measures were taken to ameliorate the condition of the patient which grew worse on the next day when he was not in an operable condition, though the patient was then willing to be operated upon. The appellant denied having received any amount from the plaintiffs. He also denied that he was absent in the hospital and that he went to the General Hospital only after the death