Recently, the division bench compring, Justices Hrishikesh Roy and Manoj Misra of Supreme Court held that, to hold a medical practitioner liable for negligence, a higher threshold limit must be met.
The Court was hearing a set of appeals pertaining to the medical negligence matter.
The primary objective is to guarantee that these healthcare professionals concentrate on determining the most suitable treatment based on their clinical judgment, rather than being preoccupied with apprehensions about potential prosecution or harassment they might face in demanding medical scenarios.
“Therefore, to safeguard these medical practitioners and to ensure that they are able to freely discharge their medical duty, a higher proof of burden must be fulfilled by the complainant. The complainant should be able to prove a breach of duty and the subsequent injury being attributable to the aforesaid breach as well, in order to hold a doctor liable for medical negligence.,”
Case Brief -
The Bench was hearing the appeals filed under the Consumer Protection Act, 1986, (Act) assailing the impugned decision passed on February 16, 2018, by the National Consumer Disputes Redressal Commission (NCDRC) in a Consumer Case filed by Mrs. Sunita Parvate. In the same she had alleged that medical negligence in her treatment at Suretech Hospital which resulted in permanent damage to her respiratory tract and permanent voice-loss.
According to the complaint, the primary allegation of negligence revolved around the unnecessary and forcefully performed Nasotracheal Intubation (‘NI’) procedure, which was the sole cause of her voice loss and permanent respiratory tract deformity. This 'NI' procedure was executed even after multiple unsuccessful attempts to remove the 'TT' (likely tracheostomy tube). It's important to mention that the 'NI' procedure involves the insertion of an endotracheal tube through the patient's nasal passage to aid in breathing.
The NCDRC directed Suretech Hospital and Research Centre Private Limited, a Hospital in Nagpur, Dr. Nirmal Jaiswal, Chief Consultant and Intensive Care Unit In-charge, at Suretech Hospital, Dr. Madhusudan Shendre, ENT Surgeon at Suretech Hospital, and Dr. M. A. Biviji, Radiologist at Suretech Hospital to jointly and severally pay Rs. 6,11,638/- .
The medical negligence was proved on account of the unjustifiable and forceful performance of ‘NI’ procedure on Mrs. Sunita on May 13, 2004, at Suretech Hospital.In a series of three appeals, the first appeal was submitted by Dr. M.A. Biviji, who contested any involvement in the purported medical negligence during Mrs. Sunita's treatment at Suretech Hospital. The second appeal was lodged by Suretech Hospital and other doctors, vehemently denying any wrongdoing during the course of Mrs. Sunita's treatment at the hospital. The final appeal was filed by Mrs. Sunita herself, seeking an increase in the compensation awarded for the medical negligence that occurred during her treatment.
Among other points, the Court noted that the medical team at Suretech Hospital was able to demonstrate that they had thoroughly assessed the medical situation before deciding to proceed with the 'NI' procedure. Consequently, the Court concluded that there was no negligence involved in the choice and execution of the mentioned procedure.
Addressing the impugned judgment, the Court observed that though it held that the ‘NI’ procedure undertaken amounted to negligence, however, it failed to point towards the specific breach of responsibility. There is nothing in the NCDRC judgment to indicate who performed the said procedure.
Following an in-depth examination of the facts, circumstances, and a careful review of the expert medical report from RML Hospital, the Court expressed its view that, given the challenges encountered during the 'TT' decannulation process and the identification of a stridor, the decision to consider the 'NI' procedure as an alternative treatment for improving respiration could be medically justified. The Court's observation was as follows:
“As an accepted medical course of action, it was expected that the procedure would aid with recovery and lead to the desired results which did not happen. However, that cannot be said to be a breach of duty amounting to negligence either. As was rightly observed in the Jacob Mathew case and Kusum Sharma case, adopting an alternative medical course of action would not amount to medical negligence.”
While penning down the conclusion of the judgment, the Court quoted renowned author and surgeon Dr. Atul Gawande on medical treatment:
“We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.”
Considering these factors, the Court, while granting approval to the first two appeals, determined that this situation exemplifies human fallibility. In this scenario, the doctors made genuine efforts to provide the best care for the patient in accordance with their professional judgment, adapting to evolving circumstances. Nevertheless, the anticipated outcomes were not attained. Evaluating the treatment course in this particular case, it cannot be definitively established as a case of medical negligence.
Case Title: M.A Biviji v. Sunita & Ors.
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