IndianJUrol.2009JulSep25(3):361371.

PMCID:PMC2779962
doi:10.4103/09701591.56205

Medicalnegligenceliabilityundertheconsumerprotectionact:Areviewof
judicialperspective
S.V.JogaRao
FormerlyAdditionalProfessorofLaw,NationalLawSchoolofIndiaUniversity,Bangalore,India
Forcorrespondence:S.V.JogaRao,M/s.Legalexcel,SRIPADA,BhagawathiVekkaliammaTempleStreet,Ullal,BangaloreUniversityPost,
Bangalore560056,India.Email:spvjrau@gmail.com

CopyrightIndianJournalofUrology

ThisisanopenaccessarticledistributedunderthetermsoftheCreativeCommonsAttributionLicense,whichpermitsunrestricteduse,
distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.

Abstract
Itisimportanttoknowwhatconstitutesmedicalnegligence.Adoctorowescertaindutiestothepatientwho
consultshimforillness.Adeficiencyinthisdutyresultsinnegligence.Abasicknowledgeofhowmedical
negligenceisadjudicatedinthevariousjudicialcourtsofIndiawillhelpadoctortopracticehisprofession
withoutundueworryaboutfacinglitigationforallegedmedicalnegligence.

Keywords:Cconsumerprotectionact,negligence,reasonablecare

INTRODUCTION
Lately,Indiansocietyisexperiencingagrowingawarenessregardingpatient'srights.Thistrendisclearly
discerniblefromtherecentspurtinlitigationconcerningmedicalprofessionalorestablishmentliability,
claimingredressalforthesufferingcausedduetomedicalnegligence,vitiatedconsent,andbreachof
confidentialityarisingoutofthedoctorpatientrelationship.Thepatientcenteredinitiativeofrightsprotection
isrequiredtobeappreciatedintheeconomiccontextoftherapiddeclineofStatespendingandmassive
privateinvestmentinthesphereofthehealthcaresystemandtheIndianSupremeCourt'spainstakingefforts
toConstitutionalizearighttohealthasafundamentalright.Asofnow,theadjudicatingprocesswithregard
tomedicalprofessionalliability,beitinaconsumerforumoraregularcivilorcriminalcourt,considers
commonlawprinciplesrelatingtonegligence,vitiatedconsent,andbreachofconfidentiality.However,itis
equallyessentialtonotethattheprotectionofpatient'srightshallnotbeatthecostofprofessionalintegrity
andautonomy.Thereisdefinitelyaneedforstrikingadelicatebalance.Otherwise,theconsequenceswould
beinexplicable.

Inthecontextofobtainingprocesses,thereisadeservingneedforatwoprongedapproach.Ononehand,
thedesirabledirectionpointstowardsidentificationofminimumreasonablestandardsinlightofthesocial,
economical,andculturalcontextthatwouldfacilitatetheadjudicatorstodecideissuesofprofessionalliability
onanobjectivebasis.Ontheotherhand,suchidentificationenablesthemedicalprofessionalstointernalize
suchstandardsintheirdaytodaydischargeofprofessionalduties,whichwouldhopefullypreventtoalarge
extentthescenarioofprotectionofpatient'srightsinalitigativeatmosphere.Inthelongrun,thepresent
adversarialplacementofdoctorandthepatientwouldundergoatransformationtotheadvantageofthe
patient,doctor,andsocietyatlarge.

WHATAMEDICALDOCTORSHOULDKNOWABOUTCOPRA?

Whocanfileacomplaint?

Aconsumeroranyrecognizedconsumerassociation,i.e.,voluntaryconsumerassociationregisteredunder
theCompaniesAct,1956oranyotherlawforthetimebeinginforce,whethertheconsumerisamemberof
suchassociationornot,orthecentralorstategovernment.
Whoisaconsumer?

Aconsumerisapersonwhohiresoravailsofanyservicesforaconsiderationthathasbeenpaidorpromised
orpartlypaidandpartlypromisedorunderanysystemofdeferredpaymentandincludesanybeneficiaryof
suchservicesotherthanthepersonhiresoravailsoftheservicesforconsiderationpaidorpromised,orunder
anysystemofdeferredpayment,whensuchservicesareavailedofwiththeapprovalofthefirstmentioned
person.Thisdefinitioniswideenoughtoincludeapatientwhomerelypromisestopay.

Whatisacomplaint?

AcomplaintisanallegationinwritingmadebyaComplainant,i.e.,aconsumerthatheorshehassuffered
lossordamageasaresultofanydeficiencyofservice.

Whatisdeficiencyofservice?

Deficiencyofservicemeansanyfault,imperfection,shortcoming,orinadequacyinthequality,nature,or
mannerofperformancethatisrequiredtobemaintainedbyorunderanylawforthetimebeinginforceor
hasbeenundertakentobeperformedbyapersoninpursuanceofacontractorotherwiseinrelationtoany
service.

Whereisacomplaintfiled?

Acomplaintcanbefiledin1)theDistrictForumifthevalueofservicesandcompensationclaimedisless
than20lakhrupees,2)beforetheStateCommission,ifthevalueofthegoodsorservicesandthe
compensationclaimeddoesnotexceedmorethan1crorerupees,or3)intheNationalCommission,ifthe
valueofthegoodsorservicesandthecompensationexceedsmorethan1crorerupees.

Whatisthecostinvolvedinfilingacomplaint?

Thereisaminimalfeeforfilingacomplaintbeforethedistrictconsumerredressalforums.

Isthereanyprovisionforappeal?

AnappealagainstthedecisionoftheDistrictForumcanbefiledbeforetheStateCommission.Anappeal
willthengofromtheStateCommissiontotheNationalCommissionandfromtheNationalCommissionto
theSupremeCourt.Thetimelimitwithinwhichtheappealshouldbefiledis30daysfromthedateofthe
decisioninallcases.

Whatarethepowersoftheconsumerredressalforums?

Theforumshaveavarietyofpowers.Theyare1)thesummoningandenforcingoftheattendanceofany
defendantorwitnessandexaminingthewitnessunderoath,2)thediscoveryandproductionofany
documentorothermaterialobjectproducibleasevidence,3)thereceptionofevidenceonaffidavits,4)the
summoningofanyexpertevidenceortestimony,5)therequisitioningofthereportoftheconcernedanalysis
ortestfromtheappropriatelaboratoryorfromanyotherrelevantsource,6)issuingofanycommissionfor
theexaminationofanywitness,and7)anyothermatterwhichmaybeprescribed.

Howdoesadjudicationofliabilitytakeplace?

Theprocessbeforethecompetentforumwillbesetinmotioninthefollowingmanner.Whenthe
Complainantfilesawrittencomplaint,theforum,afteradmittingthecomplaint,sendsawrittennoticetothe
oppositepartyaskingforawrittenversiontobesubmittedwithin30days.Thereafter,subsequenttoproper
scrutiny,theforumwouldaskforeitherfilingofanaffidavitorproductionofevidenceintheformof
interrogatories,expertevidence,medicalliterature,andjudicialdecisions.

MEDICALNEGLIGENCEDEFINITIONALASPECTS
Negligenceissimplythefailuretoexerciseduecare.Thethreeingredientsofnegligenceareasfollows:

1.Thedefendantowesadutyofcaretotheplaintiff.
2.Thedefendanthasbreachedthisdutyofcare.
3.Theplaintiffhassufferedaninjuryduetothisbreach.
Medicalnegligenceisnodifferent.Itisonlythatinamedicalnegligencecase,mostoften,thedoctoristhe
defendant.

Whendoesadutyarise?

Itiswellknownthatadoctorowesadutyofcaretohispatient.Thisdutycaneitherbeacontractualdutyor
adutyarisingoutoftortlaw.Insomecases,however,thoughadoctorpatientrelationshipisnotestablished,
thecourtshaveimposedadutyuponthedoctor.InthewordsoftheSupremeCourteverydoctor,atthe
governmentalhospitalorelsewhere,hasaprofessionalobligationtoextendhisserviceswithdueexpertise
forprotectinglife(ParmanandKatariavs.UnionofIndia[1]).Thesecasesarehowever,clearlyrestrictedto
situationswherethereisdangertothelifeoftheperson.Impliedly,therefore,inothercircumstancesthe
doctordoesnotoweaduty.

Whatisthedutyowed?

Thedutyowedbyadoctortowardshispatient,inthewordsoftheSupremeCourtistobringtohistaska
reasonabledegreeofskillandknowledgeandtoexerciseareasonabledegreeofcare(Laxmanvs.
Trimback[2]).Thedoctor,inotherwords,doesnothavetoadheretothehighestorsinktothelowestdegree
ofcareandcompetenceinthelightofthecircumstance.Adoctor,therefore,doesnothavetoensurethat
everypatientwhocomestohimiscured.Hehastoonlyensurethatheconfersareasonabledegreeofcare
andcompetence.

Reasonabledegreeofcare

Reasonabledegreeofcareandskillmeansthatthedegreeofcareandcompetencethatanordinary
competentmemberoftheprofessionwhoprofessestohavethoseskillswouldexerciseinthecircumstancein
question.Atthisstage,itmaybenecessarytonotethedistinctionbetweenthestandardofcareandthe
degreeofcare.Thestandardofcareisaconstantandremainsthesameinallcases.Itistherequirementthat
theconductofthedoctorbereasonableandneednotnecessarilyconformtothehighestdegreeofcareorthe
lowestdegreeofcarepossible.Thedegreeofcareisavariableanddependsonthecircumstance.Itisusedto
refertowhatactuallyamountstoreasonablenessinagivensituation.

Thus,thoughthesamestandardofcareisexpectedfromageneralistandaspecialist,thedegreeofcare
wouldbedifferent.Inotherwords,bothareexpectedtotakereasonablecarebutwhatamountstoreasonable
carewithregardtothespecialistdiffersfromwhatamountofreasonablecareisstandardforthegeneralist.In
fact,thelawexpectsthespecialisttoexercisetheordinaryskillofthisspecialityandnotofanyordinary
doctor.Thoughthecourtshaveacceptedtheneedtoimposeahigherdegreeofdutyonaspecialist,they
haverefusedtoloweritinthecaseofanovice.

Anotherquestionthatarisesiswithregardtotheknowledgethatisexpectedfromadoctor.Shoulditinclude
thelatestdevelopmentsinthefield,hencerequireconstantupdatingorisitenoughtofollowwhathasbeen
traditionallyfollowed?Ithasbeenrecognizedbythecourtsthatwhatamountstoreasonablenesschanges
withtime.Thestandard,asstatedclearlyhereinbeforerequiresthatthedoctorpossessreasonable
knowledge.Hence,wecanconcludethatadoctorhastoconstantlyupdatehisknowledgetomeetthe
standardexpectedofhim.Furthermore,sinceonlyreasonableknowledgeisrequired,itmaynotbenecessary
forhimtobeawareofallthedevelopmentsthathavetakenplace.

Wehave,untilnow,examinedthedutyofadoctorinsofarastreatingapatientisconcernedorin
diagnosingtheailment.Doctorsare,however,imposedwithadutytotaketheconsentofaperson/patient
beforeperformingactslikesurgicaloperationsandinsomecasestreatmentaswell.Tosummarize,anyact
thatrequirescontactwiththepatienthastobeconsentedbythepatient.Adutyofcareisimposedonthe
doctorsintakingthepatient'sconsent.Naturally,aquestionarisesastowhatisthisdutyofcare.Asperthe
judicialpronouncements,thisdutyistodiscloseallsuchinformationaswouldberelevantornecessaryfor
thepatienttomakeadecision.Therefore,thedutydoesnotextendtodisclosingallpossibleinformationin
thisregard.Furthermore,thisdutydoesnotextendtowarningapatientofallthenormalattendantrisksofan
operation.Thestandardofcarerequiredofadoctorwhileobtainingconsentisagainthatofareasonable
doctor,asinothercases.

Whendoestheliabilityarise?
Theliabilityofadoctorarisesnotwhenthepatienthassufferedanyinjury,butwhentheinjuryhasresulted
duetotheconductofthedoctor,whichhasfallenbelowthatofreasonablecare.Inotherwords,thedoctoris
notliableforeveryinjurysufferedbyapatient.Heisliableforonlythosethatareaconsequenceofabreach
ofhisduty.Hence,oncetheexistenceofadutyhasbeenestablished,theplaintiffmuststillprovethebreach
ofdutyandthecausation.Incasethereisnobreachorthebreachdidnotcausethedamage,thedoctorwill
notbeliable.Inordertoshowthebreachofduty,theburdenontheplaintiffwouldbetofirstshowwhatis
consideredasreasonableunderthosecircumstancesandthenthattheconductofthedoctorwasbelowthis
degree.Itmustbenotedthatitisnotsufficienttoproveabreach,tomerelyshowthatthereexistsabodyof
opinionwhichgoesagainstthepractice/conductofthedoctor.

Withregardtocausation,thecourthasheldthatitmustbeshownthatofallthepossiblereasonsforthe
injury,thebreachofdutyofthedoctorwasthemostprobablecause.Itisnotsufficienttoshowthatthe
breachofdutyismerelyoneoftheprobablecauses.Hence,ifthepossiblecausesofaninjuryarethe
negligenceofathirdparty,anaccident,orabreachofdutycareofthedoctor,thenitmustbeestablishedthat
thebreachofdutyofcareofthedoctorwasthemostprobablecauseoftheinjurytodischargetheburdenof
proofontheplaintiff.

Normally,theliabilityarisesonlywhentheplaintiffisabletodischargetheburdenonhimofproving
negligence.However,insomecaseslikeaswableftovertheabdomenofapatientorthelegamputated
insteadofbeingputinacasttotreatthefracture,theprincipleofresipsaloquitur(meaningtherebythe
thingspeaksforitself)mightcomeintoplay.Thefollowingarethenecessaryconditionsofthisprinciple.

1.Completecontrolrestswiththedoctor.
2.Itisthegeneralexperienceofmankindthattheaccidentinquestiondoesnothappenwithout
negligence.Thisprincipleisoftenmisunderstoodasaruleofevidence,whichitisnot.Itisaprinciple
inthelawoftorts.Whenthisprincipleisapplied,theburdenisonthedoctor/defendanttoexplainhow
theincidentcouldhaveoccurredwithoutnegligence.Intheabsenceofanysuchexplanation,liability
ofthedoctorarises.

Normally,adoctorisheldliableforonlyhisacts(otherthancasesofvicariousliability).However,insome
cases,adoctorcanbeheldliablefortheactsofanotherpersonwhichinjuresthepatient.Theneedforsucha
liabilitymayarisewhenthepersoncommittingtheactmaynotoweadutyofcareatalltothepatientorthat
incommittingtheacthehasnotbreachedanyduty.Atypicalexampleofacasewheresuchasituationmay
ariseisinthecaseofasurgery.Ifajuniordoctorisinvolvedaspartoftheteam,thenhisduty,asfarasthe
exerciseofthespecialistskillisconcerned,istoseektheadviceorhelpofaseniordoctor.Hewillhave
dischargedhisdutyoncehedoesthisandwillnotbeliableevenifheactuallycommitstheactwhichcauses
theinjury.Insuchacase,itisthedutyoftheseniordoctortohaveadvisedhimproperly.Ifhedidnotdoso,
thenhewouldbetheoneresponsiblefortheinjurycausedtothepatient,thoughhedidnotcommittheact.

Whenthereisnoliability

Adoctorisnotnecessarilyliableinallcaseswhereapatienthassufferedaninjury.Thismayeitherbedueto
thefactthathehasavaliddefenseorthathehasnotbreachedthedutyofcare.Errorofjudgmentcaneither
beamereerrorofjudgmentorerrorofjudgmentduetonegligence.Onlyinthecaseoftheformer,ithas
beenrecognizedbythecourtsasnotbeingabreachofthedutyofcare.Itcanbedescribedastherecognition
inlawofthehumanfallibilityinallspheresoflife.Amereerrorofjudgmentoccurswhenadoctormakesa
decisionthatturnsouttobewrong.Itissituationinwhichonlyinretrospectcanwesaytherewasanerror.
Atthetimewhenthedecisionwasmade,itdidnotseemwrong.If,however,dueconsiderationofallthe
factorswasnottaken,thenitwouldamounttoanerrorofjudgmentduetonegligence.

JUDICIALINTERPRETATIONOFMEDICALNEGLIGENCELIABILITY
Byandlargethefollowinglegalissueshavebeenaddressedandrespondedtobydifferentforumsand
CourtsinIndia.

ChargeofMedicalNegligenceagainstProfessionalDoctors

FromthetimeofLordDenninguntilnowithasbeenheldinseveraljudgmentsthatachargeofprofessional
negligenceagainstthemedicalprofessionalstoodonadifferentfootingfromachargeofnegligenceagainst
thedriverofamotorcar.Theburdenofproofiscorrespondinglygreateronthepersonwhoalleges
negligenceagainstadoctor.Itisaknownfactthatwiththebestskillintheworld,thingssometimeswent
wronginmedicaltreatmentorsurgicaloperation.Adoctorwasnottobeheldnegligentsimplybecause
somethingwentwrong.TheNationalCommissionaswellastheApexCourtincatenaofdecisionshasheld
thatthedoctorisnotliablefornegligencebecauseofsomeoneelseofbetterskillorknowledgewouldhave
prescribedadifferenttreatmentoroperatedinadifferentway.Heisnotguiltyofnegligenceifhehasacted
inaccordancewiththepracticeacceptedasproperbyareasonablebodyofmedicalprofessionals.The
Hon'bleSupremeCourtinthecaseofDr.LaxmanBalkrishnavs.Dr.Trimbak,AIR1969SC128,hasheld
theaboveviewthatisstillconsideredtobealandmarkjudgmentfordecidingacaseofnegligence.Inthe
caseofIndianMedicalAssociationvs.Santha,theApexCourthasdecidedthattheskillofamedical
practitionerdiffersfromdoctortodoctoranditisincumbentupontheComplainanttoprovethatadoctor
wasnegligentinthelineoftreatmentthatresultedinthelifeofthepatient.Therefore,aJudgecanfinda
doctorguiltyonlywhenitisprovedthathehasfallenshortofthestandardofreasonablemedicalcare.The
principleofResIpsaLoquiturhasnotbeengenerallyfollowedbytheConsumerCourtsinIndiaincluding
theNationalCommissionorevenbytheApexCourtindecidingthecaseunderthisAct.Incatenaof
decisions,ithasbeenheldthatitisfortheComplainanttoprovethenegligenceordeficiencyinserviceby
adducingexpertevidenceoropinionandthisfactistobeprovedbeyondallreasonabledoubts.Mere
allegationofnegligencewillbeofnohelptotheComplainant.[3]

WhatConstitutesMedicalNegligence?

Failureofanoperationandsideeffectsarenotnegligence.Thetermnegligenceisdefinedastheabsenceor
lackofcarethatareasonablepersonshouldhavetakeninthecircumstancesofthecase.Intheallegationof
negligenceinacaseofwristdrop,thefollowingobservationsweremade.Nothinghasbeenmentionedin
thecomplaintorinthegroundsofappealaboutthetypeofcaredesiredfromthedoctorinwhichhefailed.It
isnotsaidanywherewhattypeofnegligencewasdoneduringthecourseoftheoperation.Nervesmaybe
cutdownatthetimeofoperationandmerecuttingofanervedoesnotamounttonegligence.Itisnotsaid
thatithasbeendeliberatelydone.Tothecontraryitisalsonotsaidthatthenerveswerecutintheoperation
anditwasnotcutatthetimeoftheaccident.Noexpertevidencewhatsoeverhasbeenproduced.Onlythe
reportoftheChiefMedicalOfficerofHaridwarhasbeenproducedwhereinitsaidthatthepatientisacase
ofposttraumaticwristdrop.Itisnotsaidthatitisduetoanyoperationorthenegligenceofthedoctor.The
mereallegationwillnotmakeoutacaseofnegligence,unlessitisprovedbyreliableevidenceandis
supportedbyexpertevidence.Itistruethattheoperationhasbeenperformed.Itisalsotruethatthe
Complainanthasmanyexpensesbutunlessthenegligenceofthedoctorisproved,sheisnotentitledtoany
compensation.[4]

WhatistheStandardofCare?

Itisnowasettledprincipleoflawthatamedicalpractitionerwillbringtohistaskareasonabledegreeofskill
andknowledgeandmustexerciseareasonabledegreeofcare.Neithertheveryhighestnortheverylowest
degreeofcareandcompetencejudgedinthelightofcircumstancesineachcaseiswhatthelawrequires.
Judgedfromthisyardstick,postoperativeinfectionorshorteningofthelegwasnotduetoanynegligenceor
deficiencyinserviceonthepartoftheoppositepartyAppellant.Deficiencyinservicethuscannotbe
fastenedontheoppositeparty.[5]

Inacasethatledtovisualimpairmentasasideeffect,thefollowingobservationsweremade.Theliterature
withregardtolariagoclearlymentionedthatthesideeffectofthismedicineiftakenforalongerdurationcan
effecteyesightbutthisisnotafactinthiscase.Besides,thereisnoexpertevidenceonrecordtoshowthat
useofthismedicinecauseddamagetothepatient'seyesight.Evenforargument'ssake,ifitisacceptedthat
thismedicinecauseddamagetothepatient'seyesight,iftheRespondentdoctorisonewhohasadvisedhis
patienttousethismedicineafteranexaminationinwhichhefoundthepatienttobesufferingfrommalaria,
inthatcaseaswellthedoctorRespondentcannotbeheldguiltyofnegligenceordeficientinhisservice.
However,asstatedaboveinthiscasethemedicinehasbeenusedbythepatientinlowdosesforafewdays
andthereisnoexpertevidencetoshowthattheuseofmedicinehasaffectedhiseyesight.Therefore,the
ComplainantAppellanthasfailedtoprovethattheRespondentwasnegligentanddeficientinhisdutyasa
doctor.[6]
ProofofMedicalNegligence

IthasbeenheldindifferentjudgmentsbytheNationalCommissionandbytheHon'bleSupremeCourtthat
achargeofprofessionalnegligenceagainstadoctorstoodonadifferentfootingfromachargeofnegligence
againstadriverofavehicle.Theburdenofproofiscorrespondinglygreateronthepersonwhoalleges
negligenceagainstadoctor.Itisaknownfactthatevenwithadoctorwiththebestskills,thingssometimes
gowrongduringmedicaltreatmentorinasurgery.Adoctorisnottobeheldnegligentsimplybecause
somethingwentwrong.ItisanadmittedfactthattheComplainant'seyesightwasnotrestoredafterthe
operationwasconductedbytheAppellantbutonthisgroundaloneadoctorcannotbeheldnegligent
becauseevenafteradoptingallnecessaryprecautionsandcaretheresultoftheoperationmaynotbe
satisfactorysinceitdependsonvariousotherfactors.ThecontentionoftheAppellantwasthatthepatient
wassufferingfromdiabetesandbloodpressureandinmanysuchcaseseyesightisnotrestoredafterthe
operationhowevercarefullyitisdone.Inthiscase,thereisnothingonrecordtoshowthatsomethingwent
wrongduetoanactoftheAppellantdoctor.Thereisnoevidencetocometotheconclusionthatthe
Appellantfellbelowthestandardofareasonablycompetentpractitionerintheirfield,somuchsothattheir
conductmightbedeservingofcensure.TheAppellantcannotbeliablefornegligencebecausesomeoneelse
ofbetterskillorknowledgewouldhaveprescribedadifferentmethodofoperationindifferentway.The
evidencesuggeststhattheAppellanthasperformedtheoperationandactedinaccordancewiththepractice
regularlyacceptedandadoptedbyhiminthishospitalandseveralpatientsareregularlytreatedfortheireye
problems.TheHon'bleSupremeCourtinthecaseofDr.LaxmanBalkrishnavs.Dr.Triambak,AIR1969
SupremeCourtpage128hasheldtheaboveviewandthisviewhasbeenfurtherconfirmedinthecaseofthe
IndianMedicalAssociationvs.Santha.TheApexCourtandtheNationalCommissionhasheldthattheskill
ofamedicalpractitionerdiffersfromdoctortodoctoranditisanincumbentupontheComplainanttoprove
thattheAppellantwasnegligentinthelineoftreatmentthatresultedinthelossofeyesight.AJudgecanfind
adoctorguiltyonlywhenitisprovedthathehasfallenshortofastandardofreasonablemedicalcare.The
factandcircumstancesofthecasebeforeusshowthattheAppellanthasattendedtothepatientwithdue
care,skill,anddiligence.Simplybecausethepatient'seyesightwasnotrestoredsatisfactorily,thisaccount
aloneisnotgroundsforholdingthedoctorguiltyofnegligenceanddeficientinhisduty.Itissettledlawthat
itisfortheComplainanttoprovethenegligenceordeficiencyinservicebyadducingexpertevidenceor
opinionandthisfactistobeprovedbeyondallreasonabledoubt.Mereallegationofnegligencewillbeofno
helptotheComplainant.[7]

Thefollowingcasesofallegedmedicalnegligenceprovideaninsightintohowthefinaldecisionisreached
bythejudicialbodies.Allmedicalnegligencecasesconcernvariousquestionsoffact,whenwesayburden
ofprovingnegligenceliesontheComplainant,itmeanshehasthetaskofconvincingthecourtthathis
versionofthefactsisthecorrectone.NoexpertopinionhasbeenproducedbytheComplainantto
contradictthereportoftheBoardofDoctors.TheappealoftheComplainantwasdismissedwithcostsas
Noexpertopinionhasbeenproducedbyhim.[8]Inacaseofanimproperunionofthepatella,noexpert
hasbeenproducedbytheComplainanttoprovenegligenceoftheoppositeparty.Thus,itcannotbesaid
withexactnessthattreatmentoftheComplainantbytheoppositepartywasagainstthenormsprescribed
underthemedicaljurisprudenceorthattheoppositepartyinanywaywasnegligentordeficientinthe
performanceofhisduties.[8]

Allegationofmedicalnegligenceisaseriousissueanditisforthepersonwhosetsupthecasetoprove
negligencebasedonmaterialonrecordorbywayofevidence.Thecomplaintofmedicalnegligencewas
dismissedbecausetheapplicantfailedtoestablishandproveanyinstanceofmedicalnegligence.[9]Merely
becausetheoperationdidnotsucceed,thedoctorcannotbesaidtobenegligentandtheappealofthedoctor
wasallowed.[10]Amereallegationwillnotmakeacaseofnegligenceunlessitisprovedbyreliable
evidenceandissupportedbyexpertevidenceandtheappealwasdismissed.[4]Thecommissioncannot
constituteitselfintoanexpertbodyandcontradictthestatementofthedoctorunlessthereissomething
contraryontherecordbywayofanexpertopinionorthereisanymedicaltreatiseonwhichreliancecould
bebasedandtheRevisionpetitionofthedoctorwasallowed.[1]Inanothercase,anXrayreportindicated
asmallopacitythatsimilartoanopaqueshadowthatbecomesvisibleformanycausesotherthanacalculus.
Itcouldnotbeassumedthatstillstoneexistedintherightkidneythathadnotbeenoperatedupon.Underthe
circumstances,wedonotthinkthatanycaseofnegligencehasbeenmadebytheComplainant.Thispetition
is,therefore,allowed.[11]
TheNeedforExpertEvidenceinMedicalNegligenceCases

TheCommissioncannotconstituteitselfintoanexpertbodyandcontradictthestatementofthedoctorunless
thereissomethingcontraryontherecordbywayofanexpertopinionorthereisanymedicaltreatiseon
whichreliancecouldbebased.[12]Inthiscasetherewasafalseallegationofurinarystonenotbeing
removedasshownbyashadowinthexrayTheburdenofprovingthenegligentactorwrongdiagnosis
wasontheComplainantandtheappealwasdismissedinanothercaseofallegedmedicalnegligenceasno
expertevidencewasproduced.[13]Thecasediscussedbelowisnotacaseofapparentnegligenceonthepart
ofthesurgeoninconductingtheoperation,butaboutthequalityoftheplateusedforfixingthebone.Inthe
presentcase,theComplainanthasnotproducedanyexpertwitnessestoprovethattherewasanyfaultinthe
performanceoftheoperations.Fixationofthebonesbyusingplatesisoneoftherecognizedmodesof
treatmentinthecaseoffractureofthebones.Iftheoppositepartyhasadoptedtheaforesaidmethod,though
subsequentlytheplatebroke,negligencecannotbeattributedtothedoctor.Thisisnotacasewherethe
woundsoftheoperationwereinfectedoranyothercomplicationarose.Breakingoftheplateapproximately
6monthsafteritwasplacedcannotbeattributedtowardsanegligentactofthedoctorinperformingthe
operation.TheDistrictForumrightlyheldthattheComplainanthadfailedtoprovehiscase.[14]Thereis
nothingontherecordtosuggestthattherehasbeenanynegligenceand/ordeficiencyinserviceonthepart
oftheAppellantexcepttheoralsubmissionoftheRespondent/Complainant.Insuchcases,beforecomingto
apositivefinding,theremustbeexpertevidenceonrecordashasbeenheldbothbytheNational
CommissionaswellastheApexCourt.[15]Asperthesettledlaw,theonustoprovethattherewas
negligencedeficiencyinserviceonthepartoftheoppositeparties,whilediagnosingandtreatingthe
Complainant,layheavilyontheComplainant.Inthegivenfacts,theComplainanthasfailedtodischargethe
onusthatwasonhim.ThecomplaintwasdismissedastheComplainantfailedtodischargetheonustoprove
negligenceordeficiencyinservice.[16]

Inmedicalnegligencecases,itisforthepatienttoestablishhiscaseagainstthemedicalprofessionalandnot
forthemedicalprofessionaltoprovethatheactedwithsufficientcareandskill.Refertothedecisionofthe
MadhyaPradeshHighCourtinthecaseofSmt.SudhaGuptaandOrs.vs.StateofM.P.andOrs.,1999(2)
MPLJ259.TheNationalcommissionhasalsotakenthesameviewobservingthatamishapduringoperation
cannotbesaidtobedeficiencyornegligenceinmedicalservices.Negligencehastobeestablishedand
cannotbepresumed.RefertothedecisionoftheNationalCommissioninthecaseofKanhiyaKumarSingh
vs.ParkMedicareandResearchCentre,III(1999)CPJ9(NC)(2000)NCJ(NC)12.Asimilarviewhas
beentakenbytheMRTPCommissioninthecaseofP.K.Pandeyvs.SufaiNursingHome,I(1999)CPJ65
(MRTP)2000NCJ(MRTP)268.Followedbythis,refertotheCommissioninVaqarMohammedKhan
andAnr.vs.Dr.S.K.Tandon,II(2000)CPJ169.[17]BoththelowerForahaveheldthatthereisno
evidencebroughtonrecordbytheComplainanttoshowthattherewasanynegligencebytheRespondent
whileimplantingthelensintheeyeoftheComplainantresultinginapersistentprobleminthelefteye.[18]

TheComplainantdoesnotexamineanyexpertonthesubjecttoestablishhisallegationofnegligenceonthe
partofthedoctor.Unfortunatethoughtheincidentis,theComplainantneedstoestablishnegligenceonthe
partofthedoctortosucceedinacaselikethis.Wemayobservethatthereishardlyanycogentmaterialto
substantiatetheallegationcontainedinthepetitionofComplainant.Underthecircumstances,wecannotbut
holdthattheComplainanthasfailedtoprovetheallegationsagainsttheoppositeparties.[19]Asheldbythe
NationalCommissioninSethuramanSubramaniamIyervs.TriveniNursingHomeandanr.,1998CTJ7,in
theabsenceofsuchevidenceregardingthecauseofdeathandabsenceofanyexpertmedicalevidence,the
Complainantshavefailedtoprovenegligenceonthepartoftheoppositeparties.[20]

Inordertodecidewhethernegligenceisestablishedinanyparticularcase,theallegedact,omission,or
courseofconductthatisthesubjectofthecomplaintmustbejudgednotbyidealstandardsnorinthe
abstractbutagainstthebackgroundofthecircumstancesinwhichthetreatmentinquestionwasgiven.The
truetestforestablishingnegligenceonthepartofadoctorisastowhetherhehasbeenprovenguiltyofsuch
failureasnodoctorwithordinaryskillswouldbeguiltyofifactingwithreasonablecare.Merelybecausea
medicalprocedurefails,itcannotbestatedthatthemedicalpractitionerisguiltyofnegligenceunlessitis
provedthatthemedicalpractitionerdidnotactwithsufficientcareandskillandtheburdenofprovingthis
restsuponthepersonwhoassertsit.Thedutyofamedicalpractitionerarisesfromthefactthathedoes
somethingtoahumanbeingthatislikelytocausephysicaldamageunlessitisnotdonewithpropercareand
skill.Thereisnoquestionofwarranty,undertaking,orprofessionofaskill.Thestandardofcareandskillto
satisfythedutyintortisthatoftheordinarycompetentmedicalpractitionerexercisinganordinarydegreeof
professionalskill.Asperthelaw,adefendantchargedwithnegligencecanclearhimselfifheshowsthathe
actedinaccordancewiththegeneralandapprovedpractice.Itisnotrequiredinthedischargeofhisdutyof
carethatheshouldusethehighestdegreeofskill,sincethismayneverbeacquired.Evenadeviationfrom
normalprofessionalpracticeisnotnecessaryinallcasesevidentofnegligence.[21]

RECENTSUPREMECOURT'SJUDGMENT
TherecentjudgmentpronouncedinMartinF.D'SouzaV.Mohd.Ishfaq[22]bytheHon'bleSupremeCourt
ofIndiaquiteexplicitlyaddressestheconcernsofmedicalprofessionalsregardingtheadjudicatoryprocess
thatistobeadoptedbyCourtsandForumsincasesofallegedmedicalnegligencefiledagainstDoctors.

InMarch1991,theRespondentwhowassufferingfromchronicrenalfailurewasreferredbytheDirectorof
HealthServicestotheNanavatiHospitalinMumbaiforthepurposeofakidneytransplant.Atthatstage,the
Respondentwasundergoinghemodialysistwiceaweekandwasawaitingasuitablekidneydonor.OnMay
20,1991,theRespondentapproachedtheAppellantdoctorwithahighfever,butherefusedhospitalization
despitetheadviceoftheAppellant.OnMay29,1991theRespondentwhostillhadahighfeverfinally
agreedtogetadmittedintothehospitalduetohisseriouscondition.OnJune3,1991,thereportsoftheurine
cultureandsensitivityshowedasevereurinarytractinfectionduetoKlebsiellaspecies(1lac/ml)sensitive
onlytoAmikacinandMethenamineMandelate.MethnamineMandelatecannotbeusedinpatientssuffering
fromrenalfailure.SincetheurinaryinfectionwassensitiveonlytoAmikacin,aninjectionofAmikacinwas
administeredtotheRespondentfor3days(fromJune5,1991toJune7,1991).Upontreatment,the
temperatureoftheRespondentrapidlysubsided.OnJune11,1991,theRespondentwhopresentedtothe
hemodialysisunitcomplainedtotheAppellantthathehadslighttinnitus(ringingintheear).TheAppellant
hasallegedthatheimmediatelytoldtheRespondenttostoptakingtheAmikacinandAugmentinandscored
outthetreatmentonthedischargecard.However,despiteexpressinstructionsfromtheAppellant,the
RespondentcontinuedtakingAmikacinuntilJune17,1991.Thereafter,theRespondentwasnotunderthe
treatmentoftheAppellant.OnJune14,1991,June18,1991,andJune20,1991theRespondentreceived
hemodialysisatNanavatiHospitalandallegedlydidnotcomplainofdeafnessduringthisperiod.OnJune
25,1991,theRespondent,onhisownaccord,wasadmittedtoPrinceAlyKhanHospital.TheComplainant
allegedlydidnotcomplainofdeafnessduringthisperiodandconversedwithdoctorsnormally,asisproved
fromtheirevidence.OnJuly30,1991,theRespondentwasoperateduponforatransplantandonAugust
13,1991,theRespondentwasdischargedfromPrinceAlyKhanHospitalafterhistransplant.The
RespondentreturnedtoDelhionAugust14,991afterhisdischarge.

OnJuly7,1992,theRespondentfiledacomplaintbeforetheNationalConsumerDisputesRedressal
Commission,NewDelhiclaimingcompensationofanamountofRs.12,00,000/ashishearinghadbeen
affected.TheAppellantfiledhisreplystating,interalia,thattherewasnomaterialbroughtonrecordbythe
Respondenttoshowanycorelationshipbetweenthedrugsprescribedandthestateofhishealth.The
NationalConsumerDisputesRedressalCommissionpassedanorderonOctober6,1993directingthe
nominationofanexpertfromtheAllIndiaInstituteofMedicalSciences,NewDelhi(AIIMS)toexaminethe
complaintandgiveanunbiasedandneutralopinion.AIIMSnominatedDr.P.Ghoshwhowasoftheopinion
thatthedrugAmikacinwasadministeredbytheAppellantasalifesavingmeasureandwasrightlyused.Itis
submittedbytheAppellantthatthesaidreportfurthermakesitclearthattherehasbeennonegligenceonthe
partoftheAppellant.However,theNationalCommissionhascometotheconclusionthattheDoctorwas
negligent.

SupremeCourt'sAppreciationwithRegardtoMedicalNegligenceLiability

AccordingtotheSupremeCourt,casesbothcivilandcriminalaswellasinConsumerFora,areoftenfiled
againstmedicalpractitionersandhospitalscomplainingofmedicalnegligenceagainstdoctors,hospitals,or
nursinghomes,hencethelatterwouldnaturallyliketoknowabouttheirliability.Thegeneralprincipleson
thissubjecthavebeenlucidlyandelaboratelyexplainedinthethreeJudgeBenchdecisionsofthisCourtin
JacobMathewvs.StateofPunjabandAnr.(2005)6SCC1.However,difficultiesariseintheapplicationof
thosegeneralprinciplestospecificcases.Forinstance,inparagraph41ofthedecision,itwasobservedthat:
Thepractitionermustbringtohistaskareasonabledegreeofskillandknowledgeandmustexercisea
reasonabledegreeofcare.Neithertheveryhighestnoraverylowdegreeofcareandcompetenceiswhatthe
lawrequires.Nowwhatisreasonableandwhatisunreasonableisamatteronwhichevenexpertsmay
disagree.Also,theymaydisagreeonwhatisahighlevelofcareandwhatisalowlevelofcare.Togive
anotherexample,inparagraphs12to16ofJacobMathew'scase(Supra),ithasbeenstatedthatsimple
negligencemayresultonlyincivilliability,butgrossnegligenceorrecklessnessmayresultincriminal
liabilityaswell.Forcivilliabilityonly,damagescanbeimposedbytheCourtbutforcriminalliabilitythe
Doctorcanalsobesenttojail(apartfromdamagesthatmaybeimposedonhiminacivilsuitorbythe
ConsumerFora).However,whatissimplenegligenceandwhatisgrossnegligencemaybeamatterof
disputeevenamongexperts.

Thelaw,likemedicine,isaninexactscience.Onecannotpredictwithcertaintyanoutcomeinmanycases.It
dependsontheparticularfactsandcircumstancesofthecase,andalsothepersonalnotionsoftheJudgewho
ishearingthecase.However,thebroadandgenerallegalprinciplesrelatingtomedicalnegligenceneedtobe
understood.Beforedealingwiththeseprinciplestwothingshavetobekeptinmind:

1.Judgesarenotexpertsinmedicalscience,rathertheyarelaymen.Thisitselfoftenmakesitsomewhat
difficultforthemtodecidecasesrelatingtomedicalnegligence.Moreover,Judgesusuallyhavetorely
onthetestimoniesofotherdoctors,whichmaynotbeobjectiveinallcases.Sincelikeinall
professionsandservices,doctorstoosometimeshaveatendencytosupporttheirowncolleagueswho
arechargedwithmedicalnegligence.ThetestimonymayalsobedifficulttounderstandforaJudge,
particularlyincomplicatedmedicalmattersand
2.abalancehastobestruckinsuchcases.Whiledoctorswhocausedeathoragonyduetomedical
negligenceshouldcertainlybepenalized,itmustalsoberememberedthatlikeallprofessionalsdoctors
toocanmakeerrorsofjudgmentbutiftheyarepunishedforthisnodoctorcanpracticehisvocation
withequanimity.Indiscriminateproceedingsanddecisionsagainstdoctorsarecounterproductiveand
arenogoodforsociety.Theyinhibitthefreeexerciseofjudgmentbyaprofessionalinaparticular
situation.

Thereasoninganddecision

InthewordsoftheSupremeCourt,thefactsofthecaserevealthattheRespondentwassufferingfrom
chronicrenalfailureandwasundergoinghemodialysistwiceaweekastreatment.Hewassufferingfroma
highfeverbutherefusedtogetadmittedintothehospitaldespitetheadviceoftheAppellant.The
RespondentwasalsosufferingfromasevereurinarytractinfectionthatcouldonlybetreatedbyAmikacin
orMethenamineMandelate.SinceMethenamineMandelatecannotbeusedforpatientssufferingfromrenal
failure,aninjectionofAmikacinwasadministered.AperusalofthecomplaintfiledbytheRespondent
beforetheNationalCommissionshowsthathismainallegationwasthathesufferedfromahearing
impairmentduetothenegligenceoftheAppellantwhoallegedlyprescribedanoverdoseofAmikacin
injectionswithnoregardforthecriticalconditionoftheRespondentwhodidnotwarrantsuchheavy
dosage.

ThecaseoftheAppellant,however,isthattheComplainantwasreferredtotheAppellantbyDr.F.P.
Soonawalla,therenownedUrologistofBombay.Dr.Soonawallaisaneminentdoctorofinternationalrepute
andhewouldnothaveordinarilyreferredapatienttoanincompetentdoctor.Thisisonefactorthatgoesin
favoroftheAppellant,thoughofcourseitisnotconclusive.AfterexaminingtheComplainant,theAppellant
foundthattheComplainantwasapatientofchronicrenalfailureduetobilateralpolycystickidneysandthe
Appellantadvisedhemodialysistwiceaweekasanoutpatient.TheComplainantwasalsoinvestigatedto
findasuitablekidneydonor.TheAppellanthasallegedinhiswrittenstatementfiledbeforetheNational
CommissionthattheComplainantwasinahurrytohaveaquickkidneytransplantandhewasvery
obstinate,stubborn,andshorttempered.

TheAppellantwasoftheviewthattheRespondent'sinfectioncouldonlybetreatedbyaninjectionof
Amikacin,asMethenamineMandelatecouldnotbeusedduetohischronicrenalfailure.TheRespondent's
reportalsoestablishedhisresistancetoallotherantibiotics.Inouropinion,itisclearthattheRespondent
alreadyhadrenalfailurebeforetheinjectionofAmikacin.Amikacinwasadministeredafteratestdosage
onlyfromJune5,1991andatthisstagehedidnotcomplainofanysideeffectsandhistemperaturesubsided
rapidly.OnJune11,1991,theRespondentcomplainedtotheAppellantofslighttinnitusorringinginthe
ear.TheAppellantimmediatelyreviewedthetreatmentonthedischargecardinpossessionofthe
Respondentandalsoaskedhisattendanti.e.,hiswife,tostoptheinjectionofAmikacinandCap.
AugmantineverballyandalsomarkedanXonthedischargecardinhisownhandwritingonJune11,1991
i.e.,3daysafterdischarge.Hence,asperthedirectionoftheAppellant,theRespondentshouldhavestopped
receivinginjectionsofAmikacinafterJune10,1991,butonhisownhekepttakingAmikacininjections.On
perusalofthecopiesofthepapersfromtheCashMemosuppliedbytheRespondentasperannexure4,itis
inouropinionevidentthattheRespondentcontinuedtotakethemedicineagainsttheadviceofthe
Appellant,andhadunilaterallybeengettinginjectedaslateasJune17,1991,i.e.,7daysafterhehadbeen
instructedverballyandinwritinginthepresenceofhisattendanti.e.,hiswifeandstaffmembersofthe
hospitaltostopinjectionsofAmikacin/Cap.AugmantinebecauseoftinnitusasearlyasJune11,1991.From
theabovefacts,itisevidentthattheAppellantwasnottoblameinanywayanditwasthenoncooperative
attitudeoftheRespondentandhiscontinuingwiththeAmikacininjectionsevenafterJune11,1991thatwas
thecauseofhisailment,i.e.,theimpairmentofhishearing.Apatientwhodoesnotlistentohisdoctor's
adviceoftenhastofaceadverseconsequences.ItisevidentfromthefactthattheRespondentwasalready
seriouslyillbeforehemettheAppellant.ThereisnothingtoshowfromtheevidencethattheAppellantwas
inanywaynegligent,ratheritappearsthattheAppellantdidhisbesttogivegoodtreatmenttothe
RespondenttosavehislifebuttheRespondenthimselfdidnotcooperate.

SeveraldoctorshavebeenexaminedbytheNationalCommissionandwehavereadtheirevidence,whichis
onrecord.Apartfromthat,thereisalsotheopinionofProf.P.GhoshoftheAllIndiaInstituteofMedical
ScienceswhohadbeennominatedbyAIIMSasrequestedbytheCommission,whichisalsoonrecord.The
opinionofDr.Ghoshwasthatthereweremanyfactorsinthecaseofrenaldiseasesthatcausehearingloss
anditisimpossibletoforetellthesensitivityofapatienttoadrug,therebymakingitdifficulttoassessthe
contributionstowardstoxicitybytheotherfactorsinvolved.HehasalsoopinedthattheAmikacindoseof
500mgtwiceadayfor14daysprescribedbythedoctorwasalifesavingmeasureandtheAppellantdidnot
haveanyoptionbuttotakethisstep.Lifeismoreimportantthansavingthefunctionoftheear.ProfGhosh
wasoftheviewthatantibioticswererightlygivenonthereportofthesensitivitytestthatshowedthe
organismsweresensitivetoAmikacin.Hence,theantibioticwasnotblindlyusedonspeculationorasa
clinicalexperiment.InviewoftheopinionofProfGhosh,whoisanexpertoftheAllIndiaInstituteof
MedicalSciences,weareclearlyoftheviewthattheAppellantwasnotguiltyofmedicalnegligencebut
ratherwantedtosavethelifeoftheRespondent.TheAppellantwasfacedwithasituationwherenotonly
wastherekidneyfailureofthepatient,butalsourinarytractinfectionandbloodinfection.Inthisgrave
situation,whichthreatenedthelifeofthepatient,theAppellanthadtotakedrasticsteps.Evenifhe
prescribedAmikacinforalongerperiodthanisnormallydone,heobviouslydidittosavethelifeofthe
Respondent.Wehavealsoseentheevidencefromotherdoctorsaswellastheaffidavitsfiledbeforethe
NationalCommission.Nodoubtsomeofthedoctorswhohavedeposedinthiscasehavegivendifferent
opinions,butincasesrelatingtoallegationsofmedicalnegligence,thisCourthastoexercisegreatcaution.
FromthesedepositionsandaffidavitsitcannotbesaidthattheAppellantwasnegligent.Infact,mostofthe
doctorswhohavedeposedorgiventheiraffidavitsbeforetheCommissionhavestatedthattheAppellant
wasnotnegligent.

WeseenoreasontodisbelievetheaboveallegationsoftheAppellantthatonJune11,1991hehadaskedthe
RespondenttostoptakingAmikacininjections,andinfactthisversioniscorroboratedbythetestimonyof
theSeniorSisterMuktaKolekar.Hence,itwastheRespondenthimselfwhoistoblameforhaving
continuedAmikacinafterJune11,1991againsttheadviceoftheAppellant.Moreover,inthestatementof
Dr.GhoshbeforetheNationalConsumerDisputeRedressalCommissionithasbeenstatedthatitisbyno
meansestablishedthatAmikacinalonecancausedeafness.Dr.Ghoshstatedthatthereare8factorsthatcan
causelossofhearing.Moreover,thereareconflictingversionsaboutthedeafnessoftheRespondent.While
theRespondentstatedthathebecamedeafinJune1991,mostoftheDoctorswhofiledaffidavitsbeforethe
Commissionhavestatedthattheyfreelyconversedwithhiminseveralmeetingsmuchafter21stJuneandin
factuptothemiddleofAugust1991.

TheNationalCommissionhadsoughttheassistanceofAIIMStogiveareportabouttheallegationsof
medicalnegligenceagainsttheAppellant.AIIMShadappointedDr.Ghoshtoinvestigatethecaseand
submitareportandDr.GhoshsubmittedareportinfavoroftheAppellant.Surprisingly,theCommissionhas
notplacedmuchrelianceonthereportofDr.Ghosh,althoughheisanoutstandingENTspecialistof
internationalrepute.WehavecarefullyperusedthejudgmentoftheNationalCommissionandweregretthat
weareunabletoconcurwiththeviewsexpressedtherein.TheCommission,whichconsistsoflaymeninthe
fieldofmedicine,hassoughttosubstituteitsownviewsoverthatofmedicalexperts,andhaspractically
actedassuperspecialistsinmedicine.Moreover,ithaspracticallybrushedasidetheevidenceofDr.Ghosh,
whoseopinionwassoughtonitsowndirection,aswellastheaffidavitsofseveralotherdoctors(referredto
above)whohavestatedthattheAppellantactedcorrectlyinthesituationhewasfaced.TheCommission
shouldhaverealizedthatdifferentdoctorshavedifferentapproaches,forinstance,somehavemoreradical
approacheswhilesomehavemoreconservativeapproaches.Alldoctorscannotbefitintoastraightjacketed
formulaandcannotbepenalizedfordepartingfromthatformula.

WhilethisCourthasnosympathyfordoctorswhoarenegligent,itmustalsobesaidthatfrivolous
complaintsagainstdoctorshaveincreasedbyleapsandboundsinourcountryparticularlyafterthemedical
professionwasplacedwithinthepurviewoftheConsumerProtectionAct.Togiveanexample,earlierwhen
apatientwhohadasymptomofhavingaheartattackwouldcometoadoctor,thedoctorwouldimmediately
injecthimwithMorphiaorPethidineinjectionbeforesendinghimtotheCardiacCareUnit(CCU)because
incasesofheartattacktimeistheessenceofthematter.However,insomecasesthepatientdiedbeforehe
reachedthehospital.AfterthemedicalprofessionwasbroughtundertheConsumerProtectionActvide
IndianMedicalAssociationvs.V.P.Shantha1995(6)SCC651doctorswhoadministertheMorphiaor
Pethidineinjectionareoftenblamedandcasesofmedicalnegligencearefiledagainstthem.Theresultisthat
manydoctorshavestoppedgiving(evenasfamilyphysicians)MorphiaorPethidineinjectionsevenin
emergenciesdespitethefactthatfromthesymptomsthedoctorhonestlythoughtthepatientwashavinga
heartattack.Thiswasoutoffearthatifthepatientdiedthedoctorwouldhavetofacelegalproceedings.
Similarly,incasesofheadinjuries(whichareverycommoninroadsideaccidentsinDelhiandothercities)
earlierthedoctorwhowasfirstapproachedwouldstartedgivingfirstaidandapplystitchestostopthe
bleeding.However,nowwhatisoftenseenisthatdoctorsoutoffearoffacinglegalproceedingsdonotgive
firstaidtothepatient,andinsteadtellhimtoproceedtothehospitalbywhichtimethepatientmaydevelop
othercomplications.

Hence,CourtsandConsumerForashouldkeeptheabovefactorsinmindwhendecidingcasesrelatedto
medicalnegligence,andnottakeaviewthatwouldbeinfactadisservicetothepublic.Thedecisionofthis
CourtinIndianMedicalAssociationvs.V.P.Shantha(Supra)shouldnotbeunderstoodtomeanthatdoctors
shouldbeharassedmerelybecausetheirtreatmentwasunsuccessfulorcausedsomemishapwhichwasnot
necessarilyduetonegligence.Infact,intheaforementioneddecision,ithasbeenobservedthat(videpara
22):Inthematterofprofessionalliabilityprofessionsdifferfromotheroccupationsforthereasonthat
professionsoperateinsphereswheresuccesscannotbeachievedineverycaseandveryoftensuccessor
failuredependsuponfactorsbeyondtheprofessionalman'scontrol.

ItmaybementionedthattheAllIndiaInstituteofScienceshasbeendoingoutstandingresearchinStemCell
Therapyforthelast8yearsfortreatingpatientssufferingfromparalysis,terminalcardiaccondition,
parkinsonism,etc.,thoughnotyetwithverynotablesuccess.ThisdoesnotmeanthattheworkofStemCell
Therapyshouldstop,otherwisesciencecannotprogress.

We,therefore,directthatwheneveracomplaintisreceivedagainstadoctororhospitalbytheConsumer
Fora(whetherDistrict,State,orNational)orbytheCriminalCourt,beforeissuingnoticetothedoctoror
hospitalagainstwhomthecomplaintwasmadetheConsumerForumorCriminalCourtshouldfirstreferthe
mattertoacompetentdoctororcommitteeofdoctorsspecializedinthefieldrelatingtowhichthemedical
negligenceisattributed.Onlyafterthatdoctororcommitteereportsthatthereisaprimafaciecaseofmedical
negligenceshouldanoticebeissuedtotheconcerneddoctor/hospital.Thisisnecessarytoavoidharassment
todoctorswhomaynotbeultimatelyfoundtobenegligent.Wefurtherwarnthepoliceofficialsnottoarrest
orharassdoctorsunlessthefactsclearlycomewithintheparameterslaiddowninJacobMathew'scase
(supra),otherwisethepolicemenwillthemselveshavetofacelegalaction.

Inthepresentcase,theAppellantwasfacedwithanextremelyserioussituation.HadtheAppellantbeen
onlysufferingfromrenalfailure,itispossiblethataviewcouldbetakenthatthedoseprescribedforthe
Appellantwasexcessive.However,theRespondentwasnotonlysufferingfromrenalfailurebuthewasalso
sufferingfromurinarytractinfectionandbloodinfectioni.e.,septicemia,whichisbloodpoisoningcausedby
bacteriaoratoxin.Healsohadextremelyhighurea.Inthisextremelyserioussituation,theAppellant
naturallyhadtotakeadrasticmeasuretoattempttosavethelifeoftheRespondent.Thesituationwas
aggravatedbythenoncooperationoftheRespondentwhoseemstobeofanassertivenatureasdeposedby
thewitnesses.Extraordinarysituationsrequireextraordinaryremedies.Evenassumingthatsuchahighdose
ofAmikacinwouldordinarilyleadtohearingimpairment,theAppellantwasfacedwithasituationbetween
thedevilandthedeepsea.Ifhechosetosavethelifeofthepatientratherthanhishearingsurelyhecannot
befaulted.TheallegationagainsttheAppellantisthathegaveanoverdoseoftheantibiotic.Inthis
connectionitmaybementionedthatantibioticsareusuallygivenforaminimumof5days,butthereisno
upperlimittothenumberofdaysforwhichtheyshouldcontinueanditalldependsontheconditionofthe
patient.Givingalowerdoseoftheantibioticmaycreateothercomplicationsbecauseitcancauseresistance
inthebacteriatothedrug,andthenitwillbemoredifficulttotreat.Withregardtotheimpairmentofhearing
oftheRespondent,itmaybementionedthatthereisnoknownantibioticdrugwithoutsideeffects.Hence,
merelybecausetherewasimpairmentinthehearingoftheRespondentthatdoesnotmeanthattheAppellant
wasnegligent.TheAppellantwasdesperatelytryingtosavethelifeoftheRespondent,whichhesucceeded
indoing.Lifeissurelymoreimportantthansideeffects.

Forexamplemanyantituberculardrugs(e.g.,Streptomycin)cancauseimpairmentofhearing.Doesthis
meanthatTBpatientsshouldbeallowedtodieandnotbegiventheantituberculardrugbecauseitimpairs
hearing?Surelytheanswerwillbenegative.

ThecourtsandConsumerForaarenotexpertsinmedicalscienceandmustnotsubstitutetheirownviews
overthatofspecialists.Itistruethatthemedicalprofessionhastoanextentbecomecommercializedand
therearemanydoctorswhodepartfromtheirHippocraticoathfortheirselfishendsofmakingmoney.
However,theentiremedicalfraternitycannotbeblamedorbrandedaslackinginintegrityorcompetencejust
becauseofsomebadapples.Itmustberememberedthatsometimesdespitetheirbesteffortsthetreatmentof
adoctorfails.Forinstance,sometimesdespitethebesteffortofasurgeon,thepatientdies.Thatdoesnot
meanthatthedoctororthesurgeonmustbeheldtobeguiltyofmedicalnegligence,unlessthereissome
strongevidencetosuggestthatheis.Onthefactsofthisparticularcase,weareoftheopinionthatthe
Appellantwasnotguiltyofmedicalnegligence.

CONCLUSION
TheHon'bleMr.JusticeMarkendeyaKatjuhasdoneyeomanserviceforsocietybyrenderingthisjudgment.
Ononehand,itsetsatrestthespeculativenatureofourjudicialadjudicationofmedicalnegligenceliability
andontheother,itabundantlyclarifiesthatunlessthereisprimafacieevidenceindicatingmedical
negligence,noticeeithertoadoctororhospitalcannotbeissued.Atthesametime,thecoreessenceofthe
judgmentmakesitveryclearthattherecannotbeanassumptionthatdoctorscannotbenegligentwhile
renderingcareandtreatment.Ithinkthistimelyinterventionshouldbedisseminatedatapopularlevelsothat
themandatedSupremeCourt'sprescriptionwillbeobservedmoreinpracticethaninbreach.

Footnotes
SourceofSupport:Nil

ConflictofInterest:Nonedeclared.

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