Supreme Court overturns NCDRC order in medical negligence case: Neeraj Sud vs. Jaswinder Singh (2024) INSC 825 (25 October 2024)

Introduction

Date of the Judgment: 25 October 2024
Citation: 2024 INSC 825
Judges: Pamidighantam Sri Narasimha, J., Pankaj Mithal, J.

Can a doctor be held liable for medical negligence simply because a patient’s condition worsens after a surgery, even if the doctor is qualified and followed standard medical procedures? The Supreme Court of India recently addressed this critical question in a case involving a minor who experienced a deterioration in his eye condition after undergoing surgery for a drooping eyelid. This judgment clarifies the burden of proof in medical negligence cases and emphasizes the importance of establishing a breach of duty of care rather than merely showing an unsuccessful outcome. The bench comprised Justices Pamidighantam Sri Narasimha and Pankaj Mithal, with the majority opinion authored by Justice Pankaj Mithal.

Case Background

In 1996, a minor, Jaswinder Singh, aged about 6 years, was diagnosed with a congenital disorder in his left eye known as ‘PTOSIS’ (drooping eyelid). He had normal 6/9 vision in both eyes. On 26th June 1996, Dr. Neeraj Sud performed a minor surgery at the Post Graduate Institute of Medical Education & Research (PGI), Chandigarh, to correct the condition. The complainants, the minor’s father and the minor, alleged that the surgery was performed negligently, leading to a deterioration in the minor’s eye condition. Post-surgery, the minor’s PTOSIS worsened from moderate to severe, his vision deteriorated to 6/18 in both eyes, and he developed double vision. The complainants sought compensation of Rs. 15,00,000 for suffering and Rs. 4,55,000 for treatment costs and loss of studies. Dr. Neeraj Sud and PGI defended their actions, stating that Dr. Sud was a qualified ophthalmologist with experience in PTOSIS surgeries and that the deterioration was a common complication.

Timeline:

Course of Proceedings

The State Commission dismissed the complaint on 27.05.2005, concluding that the complainants failed to establish any negligence or carelessness on the part of the doctor. The State Commission held that Dr. Neeraj Sud was a qualified doctor with the necessary skills and competence to perform the surgery and had not adopted any unacceptable medical practice. Aggrieved by this decision, the complainants appealed to the National Consumer Disputes Redressal Commission (NCDRC). After a remand, the NCDRC partly allowed the complaint, setting aside the State Commission’s order. The NCDRC held Dr. Neeraj Sud and PGI jointly and severally liable for compensation of Rs. 3,00,000 and costs of Rs. 50,000 with 6% interest from the date of the complaint, citing negligence in treatment.

Legal Framework

The Supreme Court highlighted that actionable negligence in the medical profession requires three key elements: (i) a duty to exercise due care; (ii) a breach of that duty; and (iii) consequential damage. The court clarified that a simple lack of care, an error of judgment, or an accident is not enough to prove negligence. A medical professional is only liable if they do not possess the required qualifications or skill, or if they fail to exercise reasonable skill in providing treatment. The court referred to the “Bolam test,” established in the English case of Bolam v. Friern Hospital Management Committee, which states that a doctor is not negligent if they act in accordance with accepted medical practices, unless there is evidence that those practices were not followed. This test was approved by the Supreme Court in Jacob Mathews v. State of Punjab and Another.

Arguments

The complainants argued that Dr. Neeraj Sud was negligent because the minor’s condition deteriorated post-surgery. They relied on the medical records from PGI, which showed that the minor had 6/9 vision in both eyes before the surgery, but after the surgery, his vision deteriorated to 6/18, and he suffered from double vision. The complainants contended that the surgery was not performed with due care and that the doctor was negligent in not performing a repeat surgery.

Dr. Neeraj Sud and PGI argued that Dr. Sud was a qualified ophthalmologist with three years of experience in eye surgeries, including PTOSIS surgeries. They stated that during his residency at PGI, Dr. Sud had been associated with about 74 PTOSIS operations. They contended that the surgery was performed with due care and that the deterioration of the patient’s condition was a common complication of congenital ptosis, which could have been corrected by repeat surgery. They also argued that the patient was not examined by Dr. Sud after January 1997 as the patient was taken for treatment elsewhere.

Issues Framed by the Supreme Court

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

• Whether the NCDRC was correct in holding Dr. Neeraj Sud and PGI liable for medical negligence based solely on the deterioration of the patient’s condition post-surgery, despite the doctor being qualified and having followed accepted medical practices.

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 overturned the NCDRC’s decision, reinstating the State Commission’s order. The court emphasized that the complainants failed to prove any negligence on the part of Dr. Neeraj Sud or PGI.

What weighed in the mind of the Court?

The Supreme Court emphasized that medical negligence cannot be presumed simply because a surgery was unsuccessful or a patient’s condition deteriorated. The court focused on the lack of evidence presented by the complainants to establish that Dr. Neeraj Sud failed to exercise the due skill and care expected of a medical professional. The court’s reasoning was heavily influenced by the principle that a doctor cannot be held liable for negligence unless it is proven that they did not possess the required skills or did not exercise them with reasonable competence. The court also stressed the importance of following accepted medical practices, as outlined in the Bolam test.

The court considered alternative interpretations, such as the possibility that the doctor had been negligent, but rejected them due to the lack of evidence. The court emphasized that the burden of proof lies with the complainant to demonstrate negligence, and that simply showing an unsuccessful outcome is not enough. The court’s final decision was based on the principle that a doctor cannot be held liable for negligence unless it is proven that they did not possess the required skills or did not exercise them with reasonable competence.

The court’s reasoning is summarized as follows:

• The deterioration of the patient’s condition post-surgery is not sufficient to prove negligence.
• The complainants failed to provide evidence that the doctor did not possess the required skills or did not exercise them with reasonable competence.
• The doctor followed accepted medical practices.
• The Bolam test was applicable, and the doctor’s actions were in accordance with accepted medical norms.

The court quoted the following from the judgment:

“Deterioration of the condition of the patient post -surgery is not necessarily indicative or suggestive of the fact that the surgery performed or the treatment given to the patient was not proper or inappropriate or that there was some negligence in administering the same.”

“A medical professional may be held liable for negligence only when he is not possessed with the requisite qualification or skill or when he fails to exercise reasonable skill which he possesses in giving the treatment.”

“In other words, simply for the reason that the patient has not responded favourably to the surgery or the treatment administered by a doctor or that the surgery has failed, the doctor cannot be held liable for medical negligence straightway by applying the doctrine of Res Ipsa Loquitor unless it is established by evidence that the doctor failed to exercise the due skill possessed by him in discharging of his duties.”

Key Takeaways

• A doctor cannot be held liable for medical negligence simply because a patient’s condition worsens after surgery.
• The burden of proof lies with the complainant to demonstrate that the doctor did not possess the required skills or did not exercise them with reasonable competence.
• Medical professionals are not liable for errors in judgment or unsuccessful outcomes if they follow accepted medical practices.
• The Bolam test is applicable in India, and adherence to accepted medical norms is a key factor in determining negligence.

Directions

The Supreme Court did not give any specific directions, apart from setting aside the NCDRC order and restoring the State Commission’s order.

Development of Law

The ratio decidendi of this case is that a medical professional cannot be held liable for negligence solely based on the deterioration of a patient’s condition post-surgery. The court reaffirmed the application of the Bolam test and clarified that the burden of proof lies with the complainant to establish a breach of duty of care or lack of skill. This judgment reinforces the existing legal position on medical negligence and provides clarity on the standard of proof required in such cases. There is no change in the previous positions of law.

Conclusion

The Supreme Court’s judgment in Neeraj Sud and Anr. vs. Jaswinder Singh (Minor) and Anr. clarifies that a doctor cannot be held liable for medical negligence merely because a patient’s condition worsens after surgery. The court emphasized the importance of proving a breach of duty of care or lack of skill, rather than relying solely on an unsuccessful outcome. This decision reinforces the legal principle that medical professionals are not liable for errors in judgment or complications if they adhere to accepted medical practices and possess the necessary qualifications.