Supreme Court overturns medical negligence ruling in Bombay Hospital case: Bombay Hospital & Medical Research Centre vs. Asha Jaiswal & Ors. (30 November 2021)

Introduction

Date of the Judgment: 30 November 2021

Citation: Not Available

Judges: Hemant Gupta, J. and V. Ramasubramanian, J.

Can a hospital and doctor be held liable for medical negligence simply because a patient’s condition worsens or they die despite medical intervention? The Supreme Court of India recently addressed this critical question, overturning a ruling that had found a hospital and a doctor negligent. The court clarified that not every adverse outcome in medical treatment constitutes negligence. This judgment underscores the importance of proving actual negligence rather than relying solely on the principle of *res ipsa loquitur* (the thing speaks for itself) in medical malpractice cases. The bench comprised of Justice Hemant Gupta and Justice V. Ramasubramanian.

Case Background

Dinesh Jaiswal, the patient, had been experiencing difficulty walking due to leg pain since 1990. In April 1998, a Colour Doppler Test revealed an aneurysm in his lower abdominal aorta. On April 15, 1998, Dr. Deshpande diagnosed an abdominal aortic aneurysm and advised urgent surgical repair. The patient consulted Dr. C. Anand Somaya, a vascular surgeon at Bombay Hospital, on April 21, 1998. Dr. Somaya noted ischemic changes in both lower limbs and impending gangrene. The patient was admitted to Bombay Hospital on April 22, 1998.

Surgery was performed on April 23, 1998, to repair the aneurysm. The next day, April 24, 1998, the patient’s condition deteriorated, with feeble pulsation and cold lower limbs. A second surgery was performed after a delay due to non-availability of operation theatre. Despite these efforts, the patient’s condition continued to worsen, and he passed away on June 12, 1998. The patient’s legal heirs filed a complaint alleging medical negligence against the hospital and Dr. Somaya, seeking compensation for the loss of life and medical expenses incurred.

Timeline:

Arguments

The complainant argued that the hospital and Dr. Somaya were negligent in several ways:

• The doctor did not examine the patient closely after the initial surgery.
• The patient was made to wait for a DSA test, and the machine was found to be non-functional.
• Angiography was performed after an 8-hour delay after discovering blood supply had stopped.
• The hospital delayed treatment by 12 hours due to the unavailability of an operation theatre.
• The doctor left the patient under the care of inexperienced doctors and went abroad.
• The doctor failed to amputate the legs on time despite the presence of gangrene.

The doctor and the hospital countered these arguments by stating:

• The patient was under constant observation by qualified medical professionals.
• The DSA machine malfunctioned due to unforeseen technical issues.
• Angiography was promptly performed as an alternative.
• The delay in the second surgery was due to the operation theatres being occupied.
• The doctor’s foreign visit was for medical conferences and did not constitute negligence, as other qualified doctors were available.
• Amputation was considered as the last resort and was performed after consultation with Dr. Pachore.

Issues Framed by the Supreme Court:

The Supreme Court framed the following issues:

1. Whether the National Consumer Disputes Redressal Commission (NCDRC) was correct in holding the Hospital and the Doctor guilty of medical negligence?
2. Whether the principle of *res ipsa loquitur* was correctly applied in this case to establish medical negligence?

Treatment of the Issue by the Court:

Authorities

The Supreme Court considered the following authorities:

Judgment

How each authority was viewed by the Court:

• Syad Akbar v. State of Karnataka [CITATION]: The Court relied on this case to explain the principle of *res ipsa loquitur* and its limitations.
• Iffco Tokio General Insurance Company Limited v. Pearl Beverages Limited [CITATION]: This case was used to reinforce the understanding of *res ipsa loquitur* in negligence cases.
• Martin F. D’Souza v. Mohd. Ishfaq [CITATION]: The Court cited this case to highlight that a doctor cannot be held liable for medical negligence simply because a treatment or surgery failed.
• Jacob Mathew v. State of Punjab and Anr. [CITATION]: This judgment was crucial in defining negligence in the medical profession and the required standard of care.
• Arun Kumar Manglik v. Chirayu Health and Medicare Private Limited and Anr. [CITATION]: The Court used this case to emphasize that the standard of care must be reasonable, considering the risks and conditions of medical professionals.
• C.P. Sreekumar (Dr.), MS (Ortho) v. S. Ramanujam [CITATION]: This case was cited to highlight that the Commission should not presume allegations in a complaint as truth without evidence.
• Kusum Sharma and Others v. Batra Hospital and Medical Research Centre and Others [CITATION]: The Court used this case to explain the standard of care and skill required of medical practitioners.
• Dr. Harish Kumar Khurana v. Joginder Singh & Others [CITATION]: This recent judgment was cited to state that every death of a patient cannot be considered medical negligence without sufficient evidence.
• Whitehouse v. Jordan and Anr. [CITATION]: The Court did not endorse the application of *res ipsa loquitur* based on this case, as used by the Commission.
• Article “Repair of Infraneral Abdominal Aortic Aneurysms (AAAs): Introduction”: The Court did not find this article relevant to establish negligence.
• Textbook by Robert B. Rutherford: The Court did not find this textbook relevant to establish negligence.

What weighed in the mind of the Court?

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

• The lack of expert evidence to prove medical negligence.
• The continuous monitoring of the patient by qualified medical professionals.
• The unforeseen technical issues with the DSA machine.
• The prompt administration of alternative tests and treatments.
• The doctor’s foreign visit for medical conferences was not considered negligence.
• The proper and timely consultation with other specialists.
• The incorrect application of the principle of *res ipsa loquitur*.

The Court emphasized that the facts of the case did not support a finding of negligence, and the legal principles were misapplied by the Commission.

Logical Reasoning

Issue 1: Whether the NCDRC was correct in holding the Hospital and the Doctor guilty of medical negligence?

Issue 2: Whether the principle of *res ipsa loquitur* was correctly applied in this case to establish medical negligence?

Key Takeaways:

• The principle of *res ipsa loquitur* cannot be the sole basis for establishing medical negligence.
• Medical negligence must be proven with cogent evidence, including expert testimony.
• Doctors are expected to provide reasonable care, but they cannot assure a positive outcome for every patient.
• Hospitals and doctors are not liable for unforeseen technical issues with equipment or delays due to circumstances beyond their control.
• Medical professionals are entitled to upgrade their knowledge by attending conferences.
• The standard of care is judged in light of the knowledge available at the time of the incident, not at the date of trial.

Directions:

The Supreme Court directed that the sum of Rs. 5 lakhs, which was disbursed to the complainant as an interim measure, should be treated as an ex gratia payment and not be recovered by the hospital or the doctor.

Specific Amendments Analysis:

Not Applicable

Development of Law:

The ratio decidendi of this case is that the principle of *res ipsa loquitur* cannot be the sole basis for establishing medical negligence. The judgment reinforces the need for cogent evidence, including expert testimony, to prove negligence. It also clarifies that doctors are expected to provide reasonable care but are not liable for unforeseen outcomes or technical issues. This judgment clarifies the legal position on medical negligence and sets a higher bar for proving negligence in medical malpractice cases. There is no change in the previous position of law but a reiteration of the same.

Conclusion:

The Supreme Court allowed the appeals filed by Bombay Hospital and Dr. C. Anand Somaya, setting aside the order of the National Consumer Disputes Redressal Commission (NCDRC). The court held that the NCDRC had incorrectly applied the principle of *res ipsa loquitur* and that there was no evidence of medical negligence on the part of the hospital or the doctor. The court emphasized that medical professionals are expected to provide reasonable care but cannot be held liable for every adverse outcome. The court also directed that the interim payment of Rs. 5 lakhs to the complainant should be treated as an ex gratia payment.