Supreme Court clarifies medical negligence standards in surgery: Dr. S.K. Jhunjhunwala vs. Mrs. Dhanwanti Kaur (2018)

Date of the Judgment: October 01, 2018
Citation: Not Available
Judges: Abhay Manohar Sapre, J., Vineet Saran, J.
Can a doctor be held liable for negligence if a surgery doesn’t go as planned, even if they are qualified and take necessary precautions? The Supreme Court of India addressed this critical question in a case involving a surgeon and a patient who experienced complications after a gall bladder surgery. This judgment clarifies the standards for determining medical negligence and protects doctors from unwarranted claims. The bench comprised of Justice Abhay Manohar Sapre and Justice Vineet Saran. Justice Abhay Manohar Sapre authored the judgment.

Case Background

In June 1996, Mrs. Dhanwanti Kaur (Respondent No. 1) experienced abdominal pain and consulted Dr. Lakshmi Basu, who, after conducting medical tests, diagnosed gall bladder stones. Dr. Basu recommended laparoscopic surgery and suggested the name of Dr. S.K. Jhunjhunwala (Appellant), a surgeon.

On August 7, 1996, Mrs. Kaur was admitted to Life Line Diagnostic Center and Nursing Home (Respondent No. 2). The next day, Dr. Jhunjhunwala began with laparoscopic surgery, but due to complications such as swelling and inflammation, he switched to open surgery to remove the gall bladder.

In December 1997, Mrs. Kaur filed a complaint under Section 10 of the Consumer Protection Act, 1986, alleging negligence on the part of Dr. Jhunjhunwala. She claimed that she had only consented to laparoscopic surgery, not open surgery, and that the surgery was not successful, leading to further health issues and another surgery in June 1997.

Timeline

Course of Proceedings

The State Consumer Disputes Redressal Commission dismissed Mrs. Kaur’s complaint, finding no merit in her claims of negligence. Mrs. Kaur then appealed to the National Consumer Disputes Redressal Commission, which overturned the State Commission’s decision and awarded her ₹2 lakhs in compensation, citing negligence on the part of Dr. Jhunjhunwala. Aggrieved by this decision, Dr. Jhunjhunwala appealed to the Supreme Court.

Legal Framework

The case primarily revolves around the interpretation of medical negligence and the standard of care expected from medical professionals. The Supreme Court refers to the established “Bolam Test,” derived from the English case Bolam vs. Friern Hospital Management Committee [1957] 1 WLR 582, which defines the standard of care for professionals.

The Court also cites Eckersley vs. Binnie (1988) 18 Con LR 1 to further elaborate on the expected professional standards.

The Consumer Protection Act, 1986, under which the initial complaint was filed, is also relevant as it provides a framework for addressing consumer grievances, including those related to medical services.

The court also refers to Section 10 of the Consumer Protection Act, 1986, which deals with the procedure for filing complaints with the consumer forum.

Arguments

Respondent No. 1 (Mrs. Dhanwanti Kaur)’s Arguments:

• She argued that she had only consented to laparoscopic surgery and not to open surgery.
• She contended that the surgery performed by the appellant was not successful, leading to further health issues and a second surgery.
• She claimed that the appellant was negligent in performing the surgery, which resulted in her suffering.

Appellant (Dr. S.K. Jhunjhunwala)’s Arguments:

• He stated that he had obtained consent for laparoscopic surgery, but due to complications discovered during the procedure, he had to switch to open surgery.
• He argued that clause 4 of the consent form allowed for additional procedures if necessary.
• He contended that he had informed Mrs. Kaur’s husband about the complications and obtained his consent before switching to open surgery.
• He maintained that he had taken all necessary precautions and was not negligent in performing the surgery.

Issues Framed by the Supreme Court

The Supreme Court framed the following issue for consideration:

1. Whether the National Commission was justified in holding the appellant negligent in performing the surgery of the Gall Bladder of respondent No.1 and, in consequence thereof, was justified in awarding Rs.2 lakhs by way of compensation to respondent No.1.

Treatment of the Issue by the Court

The following table demonstrates as to how the Court decided the issues

Authorities

The Supreme Court relied on the following authorities:

Judgment

The Supreme Court allowed the appeal, setting aside the National Commission’s order and restoring the State Commission’s order. The Court held that Dr. Jhunjhunwala was not negligent in performing the surgery.

How each authority was viewed by the Court?

• The Court applied the principle laid down in Bolam vs. Friern Hospital Management Committee [1957] 1 WLR 582, stating that a doctor is not negligent if they have acted in accordance with a practice accepted as proper by a responsible body of medical professionals.
• The Court used Eckersley vs. Binnie (1988) 18 Con LR 1 to explain that a professional should possess the knowledge of an ordinary member of their profession and should not lag behind in new advances.
• The Court relied on Jacob Mathew vs. State of Punjab [(2005) 6 SCC 1] to reiterate the Bolam Test and to clarify the standard of care required by medical professionals in India.
• The Court cited Hucks vs. Cole (1968) 118 New LJ 469 to emphasize that a medical practitioner is not liable for errors in judgment if they acted reasonably.
• The Court referred to Samira Kohli vs. Dr. Prabha Manchanda & Anr. (2008) 2 SCC 1 to highlight the exception to the rule of consent, where additional procedures are necessary to save a patient’s life or health.

What weighed in the mind of the Court?

The Supreme Court’s decision was primarily influenced by the following factors:

• Professional Competence: The Court acknowledged that Dr. Jhunjhunwala was a qualified and experienced surgeon.
• Consent: The Court noted that the consent form allowed for additional procedures and that Dr. Jhunjhunwala had also obtained consent from Mrs. Kaur’s husband.
• Lack of Evidence of Negligence: The Court found that there was no specific medical evidence to prove that Dr. Jhunjhunwala was negligent in performing the surgery.
• Application of the Bolam Test: The Court applied the Bolam Test, which states that a doctor is not negligent if they have acted in accordance with a practice accepted as proper by a responsible body of medical professionals.

The Court’s reasoning is based on a combination of factual analysis and legal principles. The factual analysis included the doctor’s qualifications, the consent obtained, and the lack of specific evidence of negligence. The legal principles included the Bolam Test and the standard of care expected from medical professionals.

The Court considered the argument that the patient had only consented to laparoscopic surgery but rejected it based on the consent form and the additional consent obtained from the patient’s husband, and the fact that the doctor had to switch to open surgery to save the life of the patient, which is an exception carved out in the Samira Kohli vs. Dr. Prabha Manchanda & Anr. (2008) 2 SCC 1. The Court concluded that the doctor had acted reasonably and within the bounds of his professional competence.

The decision was reached by applying the Bolam Test, which is a well-established legal principle for determining medical negligence. The Court also considered the specific facts of the case, including the qualifications of the doctor, the consent obtained, and the lack of specific evidence of negligence.

The Court stated, “The only assurance which such a professional can give or can be understood to have given by implication is that he is possessed of the requisite skill in that branch of profession which he is practicing and while undertaking the performance of the task entrusted to him he would be exercising his skill with reasonable competence.”

The Court also quoted Lord Denning, “a medical practitioner was not be held liable simply because things went wrong from mischance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference of another. A medical practitioner would be held liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field.”

The Court further observed, “To prove the case of negligence of a doctor, the medical evidence of experts in field to prove the latter is required. Simply proving the former is not sufficient.”

Key Takeaways

• A doctor is not negligent if they have acted in accordance with a practice accepted as proper by a responsible body of medical professionals (Bolam Test).
• Consent for a surgery can include the possibility of switching to a different procedure if necessary, especially in emergency situations.
• Patients must provide specific evidence of negligence to hold a doctor liable for complications after surgery.
• Medical professionals are not expected to be perfect but must exercise reasonable competence and skill.

Directions

No specific directions were given by the Supreme Court in this case.

Development of Law

The ratio decidendi of this case is that a medical professional cannot be held liable for negligence if they have acted in accordance with a practice accepted as proper by a responsible body of medical professionals and have obtained consent for the surgery, including the possibility of switching to a different procedure if necessary. This case reinforces the Bolam Test as the standard for determining medical negligence in India and also carves out an exception to the rule of consent as provided in Samira Kohli vs. Dr. Prabha Manchanda & Anr. (2008) 2 SCC 1 where the additional procedure is necessary to save a patient’s life or health.

Conclusion

The Supreme Court’s judgment in Dr. S.K. Jhunjhunwala vs. Mrs. Dhanwanti Kaur clarifies the standards for determining medical negligence, emphasizing that doctors are not liable for complications if they have acted as reasonably competent practitioners and have obtained proper consent. This case provides a balanced approach, protecting both patients and medical professionals from unwarranted claims.