2009 Supreme(Raj) 725
2009(2) CCR 705 (SC)
(Supreme Court)
Nizam Institute of Med.Sc. Vs. P.S. Dhananka & Ors. (Bedi, J.)
HON'BLE B.N. AGRAWAL, J.
HON'BLE HARJIT SINGH BEDI, J.
HON'BLE G.S. SINGHVI, J.
Nizam Institute of Medical Sciences
Versus
Prasanth S. Dhananka & Ors.
Civil Appeal Nos. 4119 of 1999 With 3126 of 2000, decided on 14.05.2009
Headnote:(a) Consumer Protection Act, 1986, Sec. 2 and 21 — Medical negligence — Deficiency in service — Twenty year old Engineering student — Operation conducted on — Resulting in acute paraplegia with complete loss of control over the lower limbs — Complaint filed alleging negligence before, during and after the operation — Consumer Commission holding that there was negligence and deficiency of service before, during and after the operation — Held — Attending doctors were remiss in their conduct at pre-operative and at operative stage — Case of negligence at post operative stage not made out — Once initial burden has been discharged by the complainant by making out a case of negligence, the onus shifts onto the hospital or attending doctors to prove lack of negligence — Court has to strike a balance between inflated and unreasonable demands of victim and the claim of opposite party negating its liability in its entirety — Use of multiplier method of determining compensation in such cases is not proper. (Paras 37 to 40)
¼d½ miHkksDrk laj{k.k vf/kfu;e] 1986] /kkjk 2 ,oa 21 & fpfdRlh; mis{kk & lsok esa deh & chl o"khZ; baftfu;fjax fo|kFkhZ & dk vkWijsku fd;k & fupys vaxksa ij fu;a=.k dh iw.kZ {kfr ds lkFk tfVy i{kk?kkr esa ifj.kfr & vkWijsku ds iwoZ] nkSjku vkSj mlds ipkr~ ykijokgh dk vfHkdFku djrs gq, ifjokn nk;j fd;k & jkT; vk;ksx us ;g vfHkfu/kkZfjr fd;k fd vkWijsku ls iwoZ] nkSjku vkSj mlds ipkr~ mis{kk vkSj lsok esa deh jgh & vfHkfu/kkZfjr & mifLFkr fpfdRld vkWijsku iwoZ vkSj vkWijsku dh voLFkk esa vius vkpj.k esa fkfFky Fks & vkWijsku iwoZ voLFkk esa mis{kk dk ekeyk ugha curk & ,d ckj tc ifjoknh }kjk mis{kk dk ekeyk cuus ds vkjfHHkd Hkkj dk fuoZgu dj fn;k x;k gks rks mis{kk dk vHkko lkfcr djus gsrq Hkkj mifLFkr fpfdRldksa ;k vLirky ij vk tkrk gS & U;k;ky; dks ihfM+r dh mUer vkSj vrdZlaxr ekaxksa rFkk izfri{k }kjk vius nkf;Ro dks iw.kZ :i ls udkjus ds nkos ds e/; lUrqyu cuk;s j[kuk gksrk gS & ,sls ekeyksa esa izfrdj vo/kkj.k ds xq.kd fof/k dk iz;ksx mfpr ugha gSA ¼in la[;k 37 ls 40½
(b) Consumer Protection Act, 1986, Sec. 2 and 21 — Medical negligence — Consent — Consent given by complainant for the excision biopsy cannot, by inference, be taken as an implied consent — Held — With holding of material documents raises presumption against the Institute and the attending Doctors.
(Paras 17 to 19)
¼[k½ miHkksDrk laj{k.k vf/kfu;e] 1986] /kkjk 2 vkSj 21 & fpfdRlk lEcU/kh mis{kk & lgefr & ifjoknh }kjk ^,Dlhtu ckW;ksilh* gsrq nh xbZ lgefr dks vuqeku ls ,d foof{kr lgefr ds :i esa ugha fy;k tk ldrk & vfHkfu/kkZfjr & rkfRod nLrkostksa dks jksdus ls laLFkku vkSj mifLFkr fpfdRldksa ds fo:) mi/kkj.kk mRiUu gksrh gSA ¼in la[;k 17 ls 19½
vihy fuLrkfjr dhA
2. The respondent Prasant S. Dhananka (hereinafter called the “complainant”), then 20 years of age and a student of Engineering, complaining of recurring fever was examined in the hospital run by the Bharat Heavy Electricals Limited as his father was employed with that Organisation. As the cause of the fever could not be identified, he visited the appellant – Nizam Institute of Medical Sciences (NIMS) on 9th September, 1990 in the evening OPD. He was examined by one Dr. Ashish Boghani, a Chest and Tuberculosis Specialist and was advised to undergo on ultrasound guided biopsy for Neurofibroma, an innocent tumour, after an X-ray revealed a mass in the left hemithorax with posterior mediastinal erosion of the left 2nd, 3rd and 4th ribs. As several attempts at Fine Needle Aspiration Cytology (FNAC) under ultra sound guidance did not give any conclusive evidence as to the nature of the mass detected in the X-ray examination, the complainant was referred (on 5th October, 1990) for further examination to Dr. U.N. Das, who suggested another attempt at the same procedure but under C.T. guidance. This test too did not show any lesion on which Dr. U.N. Das suggested that he undergo an excision biopsy and referred him to Dr. P.V. Satyanarayana, a Cardio Thoracic Surgeon, who further advised him to report at the hospital on 16th October, 1990 for allotment of a room. The complainant was admitted to the hospital on 19th October, 1990 and the operation was performed on 23rd October, 1990 and the tumour was excised. It appears that immediately after the surgery, the complainant developed acute paraplegia with a complete loss of control over the lower limbs, and some other related complications, which led to prolonged hospitalization and he was ultimately discharged from the hospital on 19th May, 1991 completely paralyzed with no change in his sensory deficit. The discharge record also shows that the patient required continuous physiotherapy and nursing care on account of infection of the urinary tract and the development of bed-sores etc. It is the case of the complainant that after his discharge from NIMS, he visited several other hospitals seeking relief, but to no avail. On 11th May, 1991 the complainant’s father requested NIMS for a detailed report so that his son’s case could be discussed with experts from other developed countries` so as to improve his quality of life. No reply was, however, forthcoming despite a reminder. Another letter dated 12th November 1991 also drew no response. Completely frustrated, the complainant filed a complaint before the National Consumer Redressal Commission (hereinafter referred to as the “Commission”) on 5th April, 1993 alleging utter and complete negligence on the part of Dr. P.V. Satyanarayana and the other attending doctors and also making NIMS vicariously liable and the State of Andhra Pradesh statutorily liable for the negligence of the doctors concerned. Allegations was primarily levelled against Dr. P.V. Satyanarayana for negligence before, during and after the operation. It was alleged that the medical record did not indicate any immediate danger to the complainant’s life and health and that his father had pleaded with the doctors that the operation be postponed till such time he could complete his engineering degree course. It was further alleged that the doctors had not carried out the required pre-operative tests which were available in NIMS itself and that the complications which could possibly flow as the result of an excision biopsy had not been spelt out to the complainant prior to the procedure. It was also submitted that operating on a neurofibroma or a schwannoma which had neurological implications as well, warranted the involvement of a Neuro surgeon but no such opinion was sought before the surgery. It