2010 (2) TMI 1257 - SC - Indian Laws

Doctor's surgical choice of hemiarthroplasty over internal fixation for fracture not medical negligence

Kusum Sharma and Ors. Versus Batra Hospital and Medical Research Centre and Ors.

SC dismissed appeal against doctor for medical negligence. Patient complained about surgeon's choice of hemiarthroplasty over internal fixation for ... Deficiency in services and medical negligence in the treatment of the deceased - Complaint under Section 21 of the Consumer Protection Act, 1986 - claim for compensation - Post-operative care and follow-up - Appropriateness of surgical approach and procedure - definition of 'Negligence' - principles emerge in dealing with the cases of medical negligence - HELD THAT:- To prosecute a medical professional for negligence under criminal law it must be shown that the accused did something or failed to do something which in the given facts and circumstances no medical professional in his ordinary senses and prudence would have done or failed to do. The hazard taken by the accused doctor should be of such a nature that the injury which resulted was most likely imminent. Pre-operative evaluation was made and the appellant Dr. Sreekumar, on considering the various options available, decided to perform a hemiarthroplasty instead of going in for the internal fixation procedure. The respondent consented for the choice of surgery after the various options have been explained to him. The surgery was performed the next day. The respondent filed a complaint against the appellant for medical negligence for not opting internal fixation procedure. This Court held that the appellant's decision for choosing hemiarthroplasty with respect to a patient of 42 years of age was not so palpably erroneous or unacceptable as to dub it as a case of professional negligence. In our considered view, the principles emerge in dealing with the cases of medical negligence must be kept in view while deciding the cases of medical negligence. We should not be understood to have held that doctors can never be prosecuted for medical negligence. As long as the doctors have performed their duties and exercised an ordinary degree of professional skill and competence, they cannot be held guilty of medical negligence. It is imperative that the doctors must be able to perform their professional duties with free mind. When we apply well settled principles enumerated in the preceding paragraphs in dealing with cases of medical negligence, the conclusion becomes irresistible that the appellants have failed to make out any case of medical negligence against the respondents. The National Commission was justified in dismissing the complaint of the appellants. No interference is called for. The appeal being devoid of any merit is dismissed. Issues Involved:1. Deficiency in services and medical negligence.2. Informed consent and communication of risks.3. Appropriateness of surgical approach and procedure.4. Post-operative care and follow-up.5. Legal principles governing medical negligence.Issue-wise Detailed Analysis:1. Deficiency in Services and Medical Negligence:The appellants claimed compensation of Rs. 45 lakhs under Section 21 of the Consumer Protection Act, 1986, attributing deficiency in services and medical negligence in the treatment of the deceased. The National Commission examined the case in light of established legal principles and found no merit in the allegations. The respondents argued that medicine is not an exact science and every surgical operation involves uncalculated risks. The Court reiterated that a medical practitioner is not expected to achieve success in every case but must exercise reasonable skill and care.2. Informed Consent and Communication of Risks:The appellants alleged that informed consent was lacking and they were not informed about the possible complications of the operation. The respondents countered that the risks were explained to the patient and his family, and consent was given after due consultation. The Court emphasized that the duty of care includes informing the patient about the risks involved, but it does not require the practitioner to guarantee success.3. Appropriateness of Surgical Approach and Procedure:The appellants contended that the anterior approach for adrenalectomy was not appropriate and that the posterior approach should have been adopted. The respondents, supported by medical texts and expert opinions, justified the anterior approach, particularly in cases of suspected malignancy. The Court found that the choice of surgical approach was within the acceptable standards of medical practice and did not constitute negligence.4. Post-operative Care and Follow-up:The appellants criticized the post-operative care and follow-up, alleging that the deceased was not properly monitored and that complications were not adequately addressed. The respondents maintained that the patient was advised regular follow-up, which he did not adhere to. The Court noted that the patient's non-compliance with follow-up instructions contributed to the adverse outcome and did not find the respondents negligent in this regard.5. Legal Principles Governing Medical Negligence:The judgment extensively discussed the legal principles governing medical negligence, citing landmark cases such as Bolam v. Friern Hospital Management Committee and Jacob Mathew v. State of Punjab. The Court reiterated that negligence involves a breach of duty to exercise reasonable care and skill. It emphasized that a medical practitioner would not be held liable for negligence if they acted in accordance with a practice accepted as proper by a responsible body of medical professionals.Conclusion:The Supreme Court upheld the National Commission's decision, dismissing the appeal and finding no merit in the allegations of medical negligence. The Court underscored the importance of protecting medical professionals from undue harassment while ensuring they perform their duties with reasonable skill and care. The appeal was dismissed with parties bearing their own costs.