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Rajmal v. State Of Rajasthan And Another

Rajasthan High Court

Nov 3, 1995

Judgment

CaseIQ

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Factual and Procedural Background

The present order disposes an application for compliance of this Court's earlier order dated 22-9-1989 in S.B. Civil Writ Petition No. 3967/1989 filed by the applicant-petitioner. The writ petition arose from the death of the petitioner's wife, Smt. Lalitabai, who died while undergoing a laparoscopic tubectomy on 2 April 1989 at the Primary Health Center, Gangapurcity, District Sawaimadhopur. In its order dated 22-9-1989 the Court had directed the State Government to conduct a thorough and high-level inquiry into the circumstances surrounding the death and to fix responsibility for any negligence; the Court further directed that if the death resulted from carelessness or negligence by the doctor, the State Government should pay appropriate compensation to the petitioner within two months of that order.

Pursuant to that direction, the State Government constituted an Enquiry Committee which submitted a report to the State Government on 15-7-1992. The Committee's conclusions attributed the death to neurogenic shock (resulting in cardiac arrest) caused by insertion of the pneumo-peritoneal needle, and it did not find evidence of wilful negligence by the operating doctor (Dr. C.P. Gupta). The Committee also recommended that substantial compensation be awarded to the petitioner and recommended mandatory availability of trained anesthetists and resuscitative equipment for laparoscopic tubectomy operations.

Legal Issues Presented

Whether the State (through its Department of Health Services) is liable to pay compensation to the petitioner for the death of his wife occurring during a State-employed doctor's discharge of official duties (i.e., whether vicarious liability attaches to the State in the circumstances).
Whether any responsibility for negligence should be fixed on the operating doctor, in light of the Enquiry Committee's findings and recommendations.
Whether directions should be issued mandating the availability of specific resuscitative equipment and a trained anaesthetist for laparoscopic tubectomy operations (including in camps), to prevent recurrence.

Arguments of the Parties

The opinion does not contain a detailed account of the parties' legal arguments.

Table of Precedents Cited

No precedents were cited in the provided opinion.

Court's Reasoning and Analysis

The Court's analysis proceeded primarily from the Enquiry Committee's report and supplementary input from Dr. P.L. Bansal, Additional Director, Medical and Health Services, Rajasthan, who confirmed the Committee's findings and endorsed its recommendations.

The Enquiry Committee concluded that death was caused by neurogenic shock resulting in cardiac arrest due to insertion of the pneumo-peritoneal needle; it observed that while such an outcome is rare, it is not unknown. The Committee also found no evidence of intoxication or wilful negligence by Dr. C.P. Gupta, and it observed that he appeared competent based on his experience.
The Committee recommended substantial compensation to the husband because of the loss of a young, income-earning spouse (noting the petitioner had three small children and limited income), and emphasized that the life could possibly have been saved if adequate resuscitative facilities (endotracheal anaesthesia, defibrillator, cardiac monitoring) and a trained anaesthetist were available at the time of operation.
The Court accepted the Committee's conclusions that, apart from the lack of resuscitative equipment and trained anaesthetist, there was no evidence to impugn the doctor's competence or integrity. The Court recorded that the death might have been avoidable had the safeguards recommended by the Committee been available.
On the legal basis, the Court relied on the principle of vicarious liability and the doctrine it referred to as "res ipsa liquitor" (as stated in the opinion) to conclude that the Department of Health Services, Gangapurcity — being an instrumentality of the State and the employer of the operating doctor — could not escape responsibility for the incident that occurred in the discharge of the doctor's official duties.
Consequently, while the Court declined to fix responsibility on the individual doctor (exonerating him given the Committee's findings), it held that the State must answer for the lack of necessary equipment and safeguards and therefore be liable to compensate the petitioner.
The Court then calculated an appropriate amount of compensation taking into account: the petitioner's meagre income, the deceased wife's earning of Rs. 500 per month from tailoring, the presence of three minor children, and the Committee's recommendation for substantial compensation. The Court fixed Rs. 1,00,000 as the compensation award, directed interest at 12% per annum from the due date (22-9-1989) until actual payment, and ordered specific modalities for payment and custody of the sum for the benefit of the minor children.
Administrative and preventive directions were issued: a trained anaesthetist with an M.S. degree in anaesthesiology and adequate resuscitative facilities (endotracheal anaesthesia, defibrillator, cardiac monitoring equipment) must be made compulsorily available at every laparoscopic tubectomy operation in State hospitals or in camps; if such equipment cannot be provided in camps, operations should not be performed there and patients should be advised to undergo the operation only in hospitals where such equipment and trained staff are available.

Holding and Implications

Core Ruling: The application is allowed. The State Government is directed to pay the petitioner a sum of Rs. 1,00,000 by way of compensation, with interest at 12% per annum from 22-9-1989 until payment; the individual doctor (Dr. C.P. Gupta) is exonerated and no responsibility is to be fixed on him by the department.

Implications and direct effects:

The State (Department of Health Services) is held vicariously liable for the death and must pay Rs. 1,00,000 plus interest; Rs. 10,000 already paid as interim relief by the Collector, Sawaimadhopur shall not be deducted from the awarded amount.
The awarded amount is to be deposited in a fixed deposit joint account of the petitioner and the petitioner's three minor children in a nationalised bank, initially for two years and renewed for successive two-year periods until the children attain majority. Interest on the deposit is to be used exclusively for the welfare of the minor children until majority.
The State is directed to ensure, by issuing instructions to the Chief Secretary and the Director of Health and Family Welfare, that all State hospitals (and camps where such operations are conducted) provide the necessary medical equipment and trained staff for laparoscopic tubectomy operations to prevent recurrence of similar events.
No costs were ordered. The State was given four months from the date of the order to make the payment, as agreed between counsel.
The Court did not record or establish a new binding legal precedent in the sense of citing prior case law; its decision applies to these facts and imposes administrative and compensatory obligations on the State in the circumstances described.

Application allowed.

Show all summary ...

1. This order will dispose of the above application for compliance of order, dated 22-9-1989 passed by this Court in S.B Civil Writ Petition No. 3967/1989 filed by the applicant-petitioner. This Court while disposing of the writ petition allowed the same in terms of its order, dated 22-9-1989 with the direction to the State Government for conducting thorough inquiry into the matter and the circumstances resulting in the death of the petitioner's wife Smt. Lalitabai while she was being operated for Laproscopic Tubectomy on 2nd April, 1989 at Primary Health Center, Gangapurcity, District Sawaimadhopur. This Court had also directed vide the said order that a high level inquiry to be initiated into the matter so as to ascertain the cause of death of Smt. Lalitabai and to fix the responsibility for negligence, if any, on the concerned Doctor. It was further directed that if the circumstances leading to the death of the petitioner's wife were accidental on account of carelessness and negligence on the part of the Doctor then appropriate compensation shall be paid by the State Government to the petitioner within two months from the said date.

2. Pursuant to the above directions of this Court an inquiry was conducted into the matter by the Enquiry Committee constituted by the State Government. The said Enquiry Committee submitted its report to the State Government on 15-7-1992. The conclusions as well as the recommendations of the said Committee mentioned in the inquiry report are self-explanatory containing startling revelations which are as under:—

“CONCLUSIONS:

1. Death was caused by neurogenic shock resulting in cardiac arrest, caused by insertion of pneumo peritoneal needle. This, while rare, is not unknown.

2. Dr. C.P Gupta does not appear to have been intoxicated while operating,

3. Without proof, to the contrary, we are inclined to accept the doctor's statement that he did not leave the hospital after giving premedication injections,

4. While the death of the patient was extremely unfortunate, there does not appear to be any wilful negligence on the part of Dr. C.P Gupta who besides being M.S in Gynaecology, appears competent and has performed 10-12 thousand laproscopic sterlizations in the past, according to his statement.”

“RECOMMENDATIONS:

1. We are given to understand that only 64 deaths have occurred since 1980 while laproscopic tubectomy operations numbering approximately 2 lacs are being done every year.

This does not appear to be an unreasonable number. Since the number of deaths is only 64, and since the nature of the operation is extremely sensitive, one feels that substantial compensation should be given to the husband of deceased Smt. Lalita Bai, who has three small children to support and has lost his life-partner, who was a substantial income earner.

2. While cardiac arrest due to pneumo peritoneal needle insertion is rare but not unknown, we feel that the life of the patient could have been saved if adequate resuscitative facilities e.g Endotracheal anaesthesic, defibrillator and cardiac monitoring equipment had been available. Since every human life is equal, we feel that whenever laproscopic tubectomy is being done whether in a major hospital or in smaller hospitals or in a laproscopic tubectomy Camp, a trained anaesthetist with M.S degree in anaesthesiology, and the above mentioned equipment should be available. This should be mandatory for every laproscopic tubectomy operation, in view of the sensitive nature of the operation and the fact that the patient is young, disease free and healthy.

Other than the lack of the above mentioned resuscitative equipment and trained anaesthetist, we find no evidence to doubt the competence or integrity or efforts made by Dr. C.P Gupta.”

3. A perusal of the inquiry report itself reveals that if the adequate safeguards by making necessary equipments as suggested by the Committee were made available to the concerned Doctor who had conducted the laproscopic tubectomy operations were adopted, the death of the patient could have been possibly avoided. I have also heard Dr. P.L Bansal, Addl. Director, Medical and Health Services Rajasthan, Jaipur in this connection who, while confirming the report of the Enquiry Committee, has suggested that in view of the sensitive nature of the laproscopic tubectomy operation, whenever such operations are conducted whether in the hospitals or the camps organised for such purposes, necessary medical equipments such as endotrachial anaesthesia, defibrillator and cardiac monitroing equipments should compulsorily be made available to the concerned Doctor conducting such operations besides providing necessary trained staff for the assistance of the said Doctor at the time of operation. If it is not possible to provide such equipments in the camps organised for such purposes, then no risk should be taken to conduct the operations in the camps and the patient should be advised to undergo such operation only in the hospitals where such equipments are available. I am further of the opinion that it was the responsibility of the State Government (Department of Health Services) to have taken adequate care and precaution that all above referred medical equipments were made available to the concerned Doctor who had conducted the operation on the petitioner's wife. I am of the considered opinion that on the principle of vicarious liability and the doctrine of ‘res ipsa liquitor’ the department of Health Services, Gangapurcity, which is an instrumentality of the State cannot escape responsibility, since the concerned Doctor who conducted the laproscopic tubectomy operation was an employee of the State Government rendering his services at primary health centre, Gangapurcity District Sawaimadhopur and the incident occurred in the discharge of his official duty towards the employer i.e, the State Government of Rajasthan. Hence the said department is vicariously liable for the acts of its employee.

4. A perusal of the report of the Enquiry Committee further reveals that other than the lack of the above mentioned resuscitative equipment and trained anaesthetist, there is no evidence on the record to doubt the competence or the integrity of efforts made by the concerned Doctor who had conducted the operation of the petitioner's wife.

5. Keeping in view of the facts and circumstances of this case and the recommendations of the Committee itself that substantial compensation be given to the husband of the deceased Smt. Lalitabai who is applicant-petitioner herein and who has three minor children to support and lost his life partner who was about 30 years of age at the time of her death and was earning Rs. 500/- p.m from tailoring business and also the fact that the petitioner is having only a meagre income of Rs. 300/-, 400/- p.m as per the record, I am of the considered opinion that it will be just and appropriate that a sum of Rupees 1,00,000/- be awarded to the petitioner by the State Government by way of compensation which has been claimed by the petitioner in the writ petition itself.

6. The application is accordingly allowed and disposed of with direction that since the Enquiry Committee in terms of its recommendations in inquiry report dated 15-7-95 has exonerated the concerned Doctor and since he has not been found negligent in conducting operation, no responsibility be fixed on him by the department. It is further directed that henceforth whenever laproscopic tubectomy operation is conducted whether in major hospitals or similar hospitals of the State Government or in the camps organised for such purposes, a trained Anaesthetist with M.S degree in Anaesthesiology and adequate rescuscitative facilities e.g endotrachial anaesthesia, defibrillator and cardiac monitoring equipment should be compulsorily made available at the time of such operation. This should be mandatory for every laproscopic tubectomy operation, in view of the sensitive nature of the operation with a view to avoid risk and also with a view to avoid recurrence of such happenings in future. Keeping in view the facts and circumstances of the case and the recommendations of the Committee itself that substantial compensation be awarded to the husband of the deceased Lalitabai, who is applicant-petitioner herein and who has three minor children to support and also keeping in view the fact that the petitioner has lost his life partner who was quite young about 30 years of age at the time of death and contributing Rs. 500/- p.m from tailoring business for maintenance and up-keep of the family and also the fact that the petitioner is only having a meagre income of Rs. 400/-, 500/- p.m as per the record, I am of the considered opinion that it will be just and appropriate that a sum of Rs. 1,00,000/- be provided to the petitioner by way of compensation by the State Government. This amount shall carry interest @ 12% per annum from the due date, i.e, 22-9-1989 till the date of actual payment. The amount of Rs. 10,000/- which was paid to the petitioner by the Collector, Sawaimadhopur on the spot as interim relief shall not be deducted from the amount of compensation.

7. It is directed that the amount of Rs. 1,00,000/- shall be deposited by the petitioner in fixed deposit joint account of the petitioner and three minor children in any nationalised bank. The said fixed deposit shall be made initially for a period of two years and shall be renewed thereafter for a further period of two years each till the minor children of the petitioner attain the age of majority. The income derived from the principal amount by way of interest shall be utilised by the petitioner exclusively for the welfare of the minor children till they attain the age of majority.

8. It is further directed that the above amount of Rs. 1,00,000/- with interest @ 12% per annum from due date shall be paid to the petitioner by the State Government within a period of four months from today as agreed between learned counsel for the parties. There will be no order as to cost. A copy of this order shall be sent by the registry of this Court to the Chief Secretary, Government of Rajasthan and the Director, Health and Family Welfare, Government of Rajasthan, Jaipur for immediate compliance with a direction that the said functionaries of the State shall issue necessary instructions for future guidance in public interest to all the hospitals of the State for providing necessary medical equipments to the hospitals run by the State Government where such operations are conducted or the camps organised for such purposes in order to avoid recurrence of such happenings in future.