Supreme Court Holds Doctor Negligent in Post-Operative Care: Bherulal Bhimaji Oswal vs. Madhusudan N. Kumbhare (2024)

Date of the Judgment: 19 December 2024
Citation: 2024 INSC 1035
Judges: Justice Vikram Nath and Justice Prasanna B. Varale
Can a doctor be held liable for negligence if a patient develops complications after surgery? The Supreme Court of India recently addressed this critical question in a case concerning a cataract surgery that resulted in the patient losing his vision. The Court examined whether the doctor’s post-operative care was negligent, leading to the patient’s condition. The judgment was delivered by a two-judge bench comprising Justice Vikram Nath and Justice Prasanna B. Varale, with Justice Vikram Nath authoring the opinion.

Case Background

The appellant, Bherulal Bhimaji Oswal, a resident of Lonavala, underwent cataract surgery on his right eye on 19 January 1999, performed by the respondent, Dr. Madhusudan N. Kumbhare, at his clinic in Pune. The surgery was conducted at 8:00 PM, and the patient was discharged the same night. The following day, 20 January 1999, the appellant visited the respondent with complaints of severe pain and headache. The respondent changed the bandage, prescribed medicines, and provided black glasses. On 23 January 1999, the appellant returned with intense pain and a sticky fluid oozing from his eye. The respondent reassured him, prescribed painkillers and eye drops, and scheduled another check-up for 25 January 1999.

On 25 January 1999, the appellant again visited the respondent due to worsening pain. The respondent prescribed more medication. On 26 January 1999, the appellant, along with his family, visited the respondent again, who, after checking the eye, stated that it was in good condition. On 27 January 1999, after cleaning the eye, the respondent reassured the appellant that his vision would return. It was on this day that the respondent first advised a blood sugar level test, which came back normal. Due to unbearable pain, the appellant sought a second opinion from Dr. Tasliwal, who referred him to Dr. Chitra Khare. Dr. Khare opined that the operated eye was severely damaged and needed to be removed to prevent further damage. The appellant then consulted Dr. Nitin Prabhudesai, who confirmed a septic infection requiring removal of the eye. The appellant was admitted to the Military Hospital on 29 January 1999, where he was diagnosed with endophthalmitis and underwent surgery to remove the infected lens, resulting in complete vision loss in the right eye. The appellant sought compensation for medical negligence and loss of vision.

Timeline:

Course of Proceedings

The District Consumer Forum, Pune, dismissed the appellant’s complaint on 19 October 2005, stating that the appellant failed to provide expert evidence to prove the respondent’s negligence. The appellant appealed to the State Consumer Commission of Maharashtra, which partly allowed the appeal on 26 November 2015. The State Commission noted that the respondent filed case papers only at the appellate stage and that there were contradictions between the written version and the case papers. The State Commission concluded that the respondent failed to treat the complainant post-operatively and was negligent. The respondent was directed to pay compensation of Rs. 3,50,000/-.

The respondent filed a revision petition before the National Consumer Disputes Redressal Commission (NCDRC), and the appellant filed a revision petition seeking enhanced damages. The NCDRC, on 20 November 2018, allowed the respondent’s revision petition and dismissed the appellant’s complaint. The NCDRC concluded that the appellant had changed his bandage, causing a traumatic injury that led to endophthalmitis, and thus, the respondent was not negligent. The appellant then appealed to the Supreme Court.

Legal Framework

The case revolves around the principles of medical negligence and the rights of consumers under the Consumer Protection Act. The core issue is whether the respondent, as a medical professional, failed to provide the necessary standard of care to the appellant, resulting in harm. The concept of res ipsa loquitur, meaning “the thing speaks for itself,” is also relevant, suggesting that negligence can be inferred from the very nature of the injury when it is of a kind that would not ordinarily occur in the absence of negligence. The State Commission relied on medical literature from reference book “Basic Ophthalmology’ to conclude that the respondent had failed to treat the complainant post-operatively.

Arguments

Appellant’s Submissions:

• The appellant argued that he made five visits to the respondent, and on each visit, he was reassured that the operation was successful.
• The appellant contended that the opinions of other eye specialists confirmed that he suffered from endophthalmitis, an infection caused by contaminated instruments.
• The appellant submitted that the principle of res ipsa loquitur applies, as the negligence was evident, and no expert evidence was required.
• The appellant highlighted that the NCDRC erroneously held that medical negligence was not visible, ignoring the fact that the records submitted by the respondent were ante-dated.
• The appellant asserted that the State Commission was correct in finding that he developed an infection and abscess after the cataract operation, which the respondent failed to diagnose and treat.

Respondent’s Submissions:

• The respondent contended that the appellant failed to follow post-operative care instructions.
• The respondent claimed that on 23 January 1999, the appellant visited him with a new dressing and pad not applied by him, and the appellant failed to explain where it came from.
• The respondent argued that the new dressing caused trauma, leading to the infection, and therefore, he is not liable.
• The respondent’s reply before the District Forum did not include case papers or prescription details. These were produced only at the appellate stage before the State Commission.

Issues Framed by the Supreme Court

The Supreme Court did not explicitly frame issues in a separate section. However, the main issue before the court was:

• Whether the NCDRC was correct in holding that there was no medical negligence on the part of the respondent and whether the State Commission’s order was correct in holding the respondent negligent in post-operative care.

Treatment of the Issue by the Court

Authorities

The Supreme Court considered the following authorities:

Medical Opinion:

• Opinion of Dr. Bivash Kumar Das, an ophthalmologist, stating that oozing of pus after operation is not usual and indicates infection requiring aggressive treatment.

Medical Literature:

• Reference book “Basic Ophthalmology’ was relied upon by the State Commission to conclude that the respondent had failed to treat the complainant post-operatively.

Judgment

How each submission made by the Parties was treated by the Court?

How each authority was viewed by the Court?

• The medical opinion of Dr. Bivash Kumar Das* was used to highlight that the symptoms of the appellant were indicative of infection, which the respondent failed to address.
• The reference book “Basic Ophthalmology” was relied upon to conclude that the respondent had failed to treat the complainant post-operatively.

What weighed in the mind of the Court?

The Supreme Court’s decision was heavily influenced by the factual evidence presented, particularly the timeline of events and the medical opinions. The Court emphasized that the respondent failed to diagnose the infection despite the appellant’s repeated complaints, which indicated a clear case of medical negligence. The Court also noted the lack of credible evidence from the respondent, which further weighed against him. The Court relied on the medical opinion of Dr. Bivash Kumar Das and the reference book “Basic Ophthalmology” to support its conclusion. The court also considered the fact that the respondent’s medical records were produced at the appellate stage and there were discrepancies in the same.

Logical Reasoning:

The Court considered the respondent’s argument that the appellant’s actions caused the trauma but rejected it due to the lack of evidence. The Court also considered the NCDRC’s view that the appellant changed his bandage, causing the infection, but found this view to be erroneous. The Court’s final decision was based on the overwhelming evidence of the respondent’s negligence in post-operative care. The Supreme Court restored the State Commission’s order, finding that the respondent’s negligence led to the appellant’s loss of vision. The court noted, “Given the medical opinion reproduced above and the fact that the appellant made five visits to the respondent -doctor in a week’s period while consistently complaining of immense pain in the operated eye, headache and lack of vision while the respondent kept reassuring him that the operation was successful and he would recover his vision eventually, whereas all the three other doctors who the appellant visited on 27.01.1999 opined that the appellant was suffering from endophthalmitis which has led to complete damage of the eye, it becomes evident that the respondent -doctor was negligent in his diagnosing the respondent’s eye.” The Court further observed, “It becomes clear that the respondent failed to detect the infection and clear the same in time despite several complaints by the appellant.” The Court concluded, “It was a blatant result of medical negligence by the respondent in post -operative care wherein corrective steps could have been taken, if the most reasonable and basic skills which were expected from the respondent -doctor, were applied.”

Key Takeaways

• Doctors must provide diligent post-operative care and promptly address patient complaints.
• Medical records must be maintained accurately and produced in a timely manner.
• The principle of res ipsa loquitur can be applied in cases of obvious medical negligence.
• Patients have the right to seek compensation for medical negligence that results in harm.

This judgment reinforces the importance of proper post-operative care and holds doctors accountable for negligence. It also highlights the need for accurate record-keeping and timely production of medical records. The decision is likely to have an impact on future medical negligence cases, particularly those involving post-operative complications.

Directions

The Supreme Court directed the respondent to pay compensation of Rs. 3,50,000/- to the appellant within two months, failing which the amount will carry an interest of 12% per annum from the date of the judgment until its realization.

Specific Amendments Analysis

There were no specific amendments discussed in the judgment.

Development of Law

The ratio decidendi of this case is that a doctor can be held liable for medical negligence in post-operative care if they fail to diagnose and treat a post-operative infection despite the patient’s repeated complaints. The judgment reinforces the principle that doctors must exercise reasonable care and skill in treating their patients, and they cannot shift the blame to the patient without credible evidence. This case also clarifies that the principle of res ipsa loquitur can be applied in cases of obvious medical negligence. There is no change in the previous position of law, rather the court has reiterated the existing law.

Conclusion

The Supreme Court allowed the appeal, setting aside the NCDRC’s order and restoring the State Commission’s order. The Court held that the respondent was negligent in post-operative care, leading to the appellant’s loss of vision. The respondent was directed to pay compensation of Rs. 3,50,000/- to the appellant. This judgment emphasizes the importance of diligent post-operative care and holds doctors accountable for medical negligence.