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J.N. SHORI MULTI SPECIALITY HOSPITAL & ANR. v. KRISHAN LAL & ANR.
Factual and Procedural Background
The revision petition was filed against the State Consumer Disputes Redressal Commission, Haryana's order dated 06.04.2012, which dismissed the appeal filed by the petitioners (OPs-1 and 2). The underlying dispute arose from the death of Smt. Kiran, wife of the complainant, who was admitted to Kalka Nursing Home and later referred to J.N. Shori Multi Specialty Hospital where she underwent a caesarean section performed by Dr. Talwar under spinal anesthesia. Post-operation, the patient developed complications, was referred to PGI Chandigarh without a medical attendant, and died en route. The complainant alleged medical negligence against the hospital and Dr. Sangeeta Shori (OP-2), leading to a consumer complaint before the District Forum, Kalka, which awarded compensation of Rs. 5,00,000/- jointly and severally against OPs-1 and 2. The Insurance Company (OP-3) was absolved of liability by the State Commission, but the appeal filed by OPs-1 and 2 was dismissed. The present revision petition challenges that dismissal.
Legal Issues Presented
- Whether the medical practitioners (OPs-1 and 2) were negligent in the treatment and management of the patient leading to her death.
- Whether the failure to refer the patient to PGIMS with a medical attendant constituted negligence.
- Whether the decisions taken during emergency medical treatment were in accordance with accepted medical standards.
Arguments of the Parties
Complainant's Arguments
- The death of the patient was caused by spinal shock due to excessive anesthesia or mismanagement during anesthesia application.
- Excessive bleeding during delivery was not controlled by OP-2, contributing to the patient's death.
Opposite Parties' Arguments
- The patient was admitted in a serious condition with high fever, anemia, and signs of septicemia.
- An emergency caesarean section was performed after informed consent to save the patient and fetus.
- Dr. Talwar performed the surgery under spinal anesthesia; OP-2 was an anesthetist and did not perform the operation.
- Post-operative complications were managed promptly, including hypotension and convulsions.
- The patient was shifted to PGIMS with medical attendants and equipment for further treatment.
- Failure to refer the patient earlier from Kalka Nursing Home was noted, but once in the hospital, treatment was according to reasonable medical practice.
Table of Precedents Cited
| Precedent | Rule or Principle Cited For | Application by the Court |
|---|---|---|
| Jacob Mathew v State of Punjab (2005) 6 SCC 1 | In emergency medical situations, a medical practitioner is expected to act reasonably and not be held negligent for errors of judgment if the chosen procedure is accepted medical practice. | The court relied on this precedent to hold that the OP-2's decision to perform an emergency caesarean section was appropriate and not negligent despite the unfortunate outcome. |
| Achutrao Haribhau Khodwa vs. State of Maharashtra & Ors (1996) 2 SCC 634 | Negligence cannot be attributed to a doctor performing duties with due care and caution; multiple acceptable treatment options exist and choice among them does not constitute negligence. | The court applied this principle to affirm that the treatment course chosen by the doctors was within acceptable medical standards and did not amount to negligence. |
Court's Reasoning and Analysis
The court analyzed the medical records and evidence, noting that the patient was admitted in advanced labour with septicemia and anemia. The decision to perform an emergency caesarean section was considered medically appropriate. The court clarified that OP-2 was an anesthetist and did not perform the surgery; Dr. Talwar conducted the operation. The court emphasized that medical practitioners in emergencies must make decisions between difficult choices, and mere errors of judgment or adverse outcomes do not amount to negligence if the chosen procedure is accepted by medical science.
The court also found that the delay in referral from Kalka Nursing Home to PGIMS was a lapse, but once the patient reached OP-1 hospital, treatment was administered in accordance with reasonable medical practice. The failure to refer the patient to PGIMS with a medical attendant was not negligence on OP-2's part as the patient was shifted with appropriate medical support.
Relying on established Supreme Court precedents, the court held that the findings of negligence by the lower fora were unsustainable because they erred in holding OPs liable solely for not referring the patient to PGIMS earlier. The court set aside the orders of the District Forum and State Commission and allowed the revision petition.
Holding and Implications
The revision petition is allowed and the complaint is dismissed.
The direct effect of this decision is that the petitioners (OPs-1 and 2) are absolved of liability for medical negligence in the death of the patient. The orders of the District Forum and State Commission holding them liable are set aside. The court did not establish any new precedent but reaffirmed existing principles regarding medical negligence in emergency situations and the standard of care expected from medical practitioners.
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
REVISION PETITION NO. 2988 OF 2012
(Against the Order dated 06/04/2012 in Appeal No. 2160/2007 of the State Commission Haryana)
1. J.N. SHORI MULTI SPECIALITY HOSPITAL & ANR. Nalagarh Road, Through its Director Dr Sangeeta Shori Pinjore
2. Dr Sangeeta Shori,Director J.N Shori Multi Speciality Hospital, Nalagarh Road Pinjore ...........Petitioner(s)
Versus
1. KRISHAN LAL & ANR. S/o Sh Rama Nand, R/o Village Tibbi, Post Office Mallah,Tehsil kalka
Panchkula
Haryana
2. National Insurence Co Ltd., Regional Office-II SCO No-337,340 Sector-35-B Through its Duly Constituted Attorney
Chandiagarh
Chandiagarh ...........Respondent(s)
BEFORE:
HON'BLE DR. S.M. KANTIKAR,PRESIDING MEMBER For the Petitioner :
For the Respondent :
Dated : 23 Jul 2021
ORDER
Appeared at the time of arguments through video conferencing For Petitioners : Mr. Abhineet Taneja, Advocate For Respondent No. 1 : Mr. Bharat Swaroop Sharma, Advocate For Respondent No. 2 : Dr. Sushil Kumar Gupta, Advocate
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Pronounced on: 23rd July 2021
ORDER
1. The present Revision Petition was filed against the impugned Order dated 06.04.2012 of the State Consumer Disputes Redressal Commission, Haryana (for short "State Commission" ) whereby the appeal (Appeal No. 2160/2007) filed by the appellants was dismissed.
2. Brief facts are that Smt. Kiran, (hereinafter referred to as the 'Patient') the wife of the Complainant was under regular observation in Civil Hospital, Kalka during her pregnancy. On 15.07.2006, for labour pains she was admitted in Kalka Nursing Home at 9:00 a.m. and remained under observation of Dr. Nitasha upto 2.30 p.m. and then the patient was referred to the OP-1 - J.N. Shori Multi Specialty Hospital at 3:00 p.m. The OP-2 Dr. Sangeeta Shori performed caesarean section and a female baby was delivered at 5.30 pm. According to the complainant after the operation, the patient developed pain and she became critical and unconscious; therefore the OP-2 referred the patient to PGI Chandigarh without providing any medical attendant. The patient died on the way and she was brought back to the OP-1 hospital. The Death Certificate issued by the OP-2 stated the cause of death as septicemia with labour pains. Alleging medical negligence on the part of the OP-1 and OP-2 causing death of Complainant's wife, a Consumer Complaint was filed by the Complainant before the District Forum, Kalka.
3. The OPs-1 & 2 filed their reply and denied negligence during delivery. It was submitted that the patient was brought to OP-1 hospital in serious condition on 15.07.2006 having 50% effaced cervix, fever 1020F, pulse rate was high- 106 per minute and high respiratory rate - 28 per minute. It was diagnosed as septicemia and the treatment was started immediately to save the patient as well as the baby. The patient's hemoglobin was 6.2g%, OP-2 sent the ambulance to collect the blood two units from Rotary and Blood Societies Resources Centre, Chandigarh. At 5.30 p.m., after taking informed consent of her husband Krishan Lal, the Caesarian operation was performed. After the operation during closure of operative wound the patient suffered hypotension and convulsion. The Patient was revived, but again she developed hypotension, which did not improve further despite treatment; therefore for further management, the patient was shifted to PGIMS in their ambulance alongwith the nurse and Ambubag with O2 and IV lines. However, the patient was brought back at 9.40 P.M. with unrecordable BP and pulse. Despite resuscitative efforts, the patient could not be revived and declared dead at 10.00 P.M.
4. After hearing the parties and appraisal of evidence, the District Forum allowed the Complaint and ordered the OPs to pay jointly and severally a lump sum compensation of Rs. 5,00,000/- failing which the complainant would be entitled to 10 % interest on the amount of compensation till actual realization.
5. Being aggrieved by the order of the District Forum, the Opposite Parties preferred two first appeals before the State Commission. The OPs-1 and 2 filed an Appeal No. 2160 of 2007, and Ins. Co (OP-3) filed an Appeal No. 2098 of 2007.
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6. The State Commission accepted Appeal No. 2098/ 2007 and the relief against the Insurance co. (OP-3) was set aside. The Appeal No. 2160/2007 filed by OPs-1 and 2 was dismissed and directed the OPs-1 and 2 to pay the entire amount as awarded by the District Forum.
7. Being aggrieved the Opposite Parties 1 and 2 have filed this revision petition.
8. Heard the arguments from both the sides and perused the material on record inter-alia the medical treatment record of Kalka Nursing Home, J.N. Shori Multi Specialty Hospital and given the thoughtful consideration.
9. The main allegation of the Complainant was that the cause of death of his wife was either due to spinal shock because of excessive anesthesia or mismanagement, while applying anesthesia or excessive bleeding at the time of delivery which the OP-2 failed to control.
10. From the prescription issued by Kalka Nursing Home, it is evident that the patient remained in Kalka Hospital from 9.30 A.M. and then was taken to OP-1 hospital at about 4:30 P.M. At the time of admission she was suffering from high grade fever and anemia. The labour pains were increasing and there was acute foetal distress, therefore after informed consent emergency caesarean delivery was performed by the OP-2.
11. Secondly, the record shows the OP-2 was an anesthetist and she had not performed Caesarian operation. On perusal of the Operation theatre (OT) register, it is evident that Dr. Talwar- a Surgeon was regularly performing surgeries in the OP-1 hospital. The operative notes revealed that Dr. Talwar performed the Caesarian operation under spinal anesthesia and a female baby was delivered at 5.37 p.m. After delivery injection Methergin 2cc IV was given and Oxytocin drip was started (10 unit). It was recorded that approximately 350ml blood was lost. After closure of the uterus, the patient suddenly developed hypotension (BP 60/30 mm of Hg). The treating doctors immediately started Dopamine drip. In the meantime, the patient developed generalized convulsion and it was managed with inj. Midazolam and the patient showed some improvement, BP became 110/60 mm of Hg. The patient was then shifted to ICU at 6.15 P.M. The patient again developed hypotension which was treated with medicines and sent to PGIMS, Chandigarh for further management.
12. I would like to rely upon the judgment of Hon'ble Supreme Court in the case of Jacob Mathew v State of Punjab (2005) 6 SCC 1. It is known that in a critical and emergent situation, the medical practitioner is always left between the devil and the deep sea where the decision to be taken then and there. The medical practitioner faced with such an emergency always tries his best to redeem the patient out of his suffering. No sensible professional would intentionally commit an act or omission which would result in loss or injury to the patient.
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between the devil and the deep sea and he has to choose the lesser evil. The medical professional is often called upon to adopt a procedure which involves higher element of risk, but which he honestly believes as providing greater chances of success for the patient rather than a procedure involving lesser risk but higher chances of failure. Which course is more appropriate to follow, would depend on the facts and circumstances of a given case. It further observed that so long as it can be found that the procedure which was in fact adopted was one which was acceptable to medical science as on that date, the medical practitioner cannot be held negligent merely because he chose to follow one procedure and not another and the result was a failure.
14. In my view, in the instant case the patient was in advanced stage of labour and it was an emergency. The decision of OP-2 was correct to perform emergency Caesarian operation to save the life of patient and the foetus. Therefore, not referring the patient to PGIMS was neither act of omission nor negligence of OP-2.
15. It is pertinent to note that the patient was initially admitted at 9.30 am in Kalka Nursing Home at Kalka for delivery. She was under observation of Dr. Nitasha from 9 am to
2.30 pm. It was diagnosed that the patient was in labour with signs of septicemia. However, Dr. Nitasha was monitoring the progress of labour and then referred the patient at 2.30 pm. In my opinion the patient could have been referred in the morning itself to PGIMS from the Kalka Nursing Home; but the crucial time was wasted till 2.30 pm. Unfortunately, at 4.30 pm, the patient reached the OP-1 Hospital in advanced labour with deteriorated condition. It was an emergency managed by the OP-2 doctor as per the standard reasonable practice. The duty of treating doctor is to decide the method of treatment depending upon the condition of the patients and the circumstances of each case, thus it cannot be construed as medical negligence.
16. The Hon'ble Supreme Court in the case of Achutrao Haribhau Khodwa vs. State of Maharashtra & Ors., (1996) 2 SCC 634, observed that in the very nature of medical profession, skills differ from doctor to doctor and more than one alternative course of treatment are available, all admissible. Negligence cannot be attributed to a doctor so long as he is performing his duties to the best of his ability and with due care and caution. Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him was acceptable to the medical profession.
17. Both the fora did not observe any negligence while performing the operation, but erred and held OPs liable because the patient was not referred to PGIMS from the OP-1 Hospital. Based on the foregoing discussion, the findings of both the fora are not sustainable in the eyes of law. The Orders of both the lower fora are set aside. The Revision Petition is allowed. Consequently, the Complaint is dismissed.
......................
DR. S.M. KANTIKAR
PRESIDING MEMBER
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