Ins. Malhotra Vs. A.
Kirplani & Ors.  INSC 604 (24 March 2009)
JURISDICTION CIVIL APPEAL NO. 1386 OF 2001 Ms. Ins. Malhotra ..... Appellant
Versus Dr. A. Kriplani & Ors. ..... Respondents
1] This appeal arises
out of order dated 15.09.2000 of the National Consumer Disputes Redressal
Commission (hereinafter referred as the "Commission") in Original
Petition No. 265 of 1992, whereby a complaint filed by Ms. Ins.
Malhotra-complainant has been dismissed.
2] Brief facts
leading to the filing of this appeal are as follows:
complainant-appellant herein is the sister of Priya Malhotra who died on
24.08.1989 in Bombay Hospital- respondent no. 7 herein. In May, 1989 Priya
Malhotra 2 complained of burning sensation in stomach, vomiting and diarrhea.
On 13.07.1989, her family doctor Dr. P. H. Joshi advised to get the patient
admitted to Bombay Hospital for investigation and treatment under the care of
Dr. Ramamoorthy. On 14.07.1989, Priya Malhotra was admitted to the Bombay
Hospital, but on that day Dr. Ramamoorthy was out of station and in his absence
Dr. Chaubal examined Priya Malhotra and prescribed to undergo several tests.
Priya Malhotra was diagnosed as having Koch's of abdomen.
16/17.07.1989, Dr. Jain suspecting kidney problem referred Priya Malhotra to
Dr. A.Kriplani, a Nephrologist. On 18.07.1989, Dr. A. Kriplani informed
appellant that Priya Malhotra had kidney failure and chronic renal failure. The
appellant consented for immediate Haemodialysis as was recommended by the
doctor to save Priya Malhotra's life. In spite of Heamodialysis, Priya Malhotra
continued to have vomiting and diarrhea and the same went out of control.
Dr. A. Kriplani
directed performance of Ba-meal and Ba- enema tests suspecting Koch's of
abdomen and the two tests 3 conformed dilated loops of small intestine. Dr.
Vasant S. Sheth carried out ascetic tapping. On 22.07.1989, Dr. A. Kriplani
advised Peritoneoscopy for confirming Koch's of abdomen. On the same day, on
the recommendation of Dr. Vasant S. Sheth and Dr. A. Kriplani, ultrasonography
of upper abdomen was performed on Priya Malhotra for confirmation of Koch's of
abdomen. On 31.07.1989, Dr. Vasant S. Sheth performed ascetic tapping on Priya
Malhotra and the diagnosis made from Histopathologist was confirmation of
Koch's abdomen (anti malignant). Dr. A. Kriplani prescribed Streptomycin
injection with other medicines. The two reports of M.D. (Pathologist) and Dr.
Arun Chitale dated 01.08.1989 would show no T.B. organism in Peritoneal Fluid.
On 03.08.1989, Dr. A. Kriplani advised CT scan for confirmation of T.B. lower
abdomen. Priya Malhotra vomited and could not be controlled even by giving
I.V.C.C Perinorm injection. On 06.08.1989, chest X-ray taken by X-ray
Department of the Bombay Hospital showed lung and pleura normal.
2.3] on 08.08.1989,
Dr. Vasant S. Sheth and Dr. [Mrs.] S. R. Jahagirdar examined Priya Malhotra and
4 The operation was
to be performed by Dr. [Mrs.] S. R. Jahagirdar on 09.08.1989. Four bottles of
blood were given to Priya Malhotra during diagnosis. Liver profile and renal
profile tests were performed. Liver profile showed `Australia Antigen' positive
and renal profile showed low serum sodium and serum potassium. On 09.08.1989,
Dr. Pramod came at about 3:00 a.m. and removed Femoral Cath. On that day, Priya
Malhotra was having high fever. On the same day, Dr. [Mrs.] S. R. Jahagirdar,
could not attend the hospital and in her absence Dr. Pratima Prasad performed
Laparoscopy when Dr. A. Kriplani, Dr. Vasant S. Sheth and Dr. S. Gupta were
also present in the O.T.
2.4) After the
operation, Priya Malhotra was removed to the recovery room where she allegedly
told the appellant by gestures that she was having severe pain in the chest and
she was speechless and having breathing difficulty.
Dr. A. Kriplani
observed that there was no need to worry and Priya Malhotra would be kept in
I.C.U for two days under observation. On 12.08.1989, Priya Malhotra was shifted
to 3rd floor of the hospital. According to the appellant, Priya 5 Malhotra
started becoming semi-conscious and erratic in behaviour. On 20.08.1989, Priya
Malhotra developed intestinal fistula leading to her throwing out liquid from
her body and she developed serious infections septicemia.
On 22.08.1989, Priya
Malhotra became deep unconscious and she passed no urine and her face was
On 23.08.1989, Dr. A.
Kriplani advised Haemodialysis and Pneumothorax. Unfortunately, on 24.08.1989
at about 9:15 a.m., Priya Malhotra expired. On the same day, post- mortem upon
the dead body of Priya Malhotra was conducted at J.J. Hospital, Bombay. The
post-mortem report revealed the cause of death was due to Peritonitis with
2.5) The appellant
filed police complaint against the doctors of Bombay Hospital in Azad Maidan
Police Station, Bombay.
In the year 1990,
complaint was also filed before the Maharashtra Medical Council.
2.6) On 02.07.1992,
written complaint was sent by post to the National Consumer Disputes Redressal
Commission, which was registered as Complaint No. 265 of 1992 against Dr. A.
Kriplani, Dr. [Mrs.] Pratima Prasad, Dr. S. Gupte, 6 Dr. Singhania, Dr. [Mrs.]
S. R. Jahagirdar and Dr. Sachdeva.
On notice, the
respondents entered appearance and filed their separate written statements. The
Bombay Hospital initially was not a party in the complaint. An application for
impleadment of Bombay Hospital as party respondent no. 7 was allowed by the
Commission in the year 1996.
3) During the course
of the proceedings before the Commission, the appellant was granted opportunity
to produce written opinion of expert doctors in support of her allegations made
in the complaint against the named doctors and Bombay Hospital for their medical
negligence or lack of proper medical treatment to deceased Priya Malhotra. The
appellant could not lead the evidence of any expert doctor in support of her
complaint and she pleaded before the Commission that no expert doctor was
willing to give an opinion against the doctors of Bombay Hospital though,
according to her, unofficially some doctors had expressed an opinion that
injustice had been done to deceased Priya Malhotra. The appellant was issued
notice to appear on 09.07.2000 for recording of her cross-examination. The 7
counsel for the respondents stated before the Commission that they did not
intend to cross-examine the appellant. None of the respondent had appeared as
witness in support of his or her defence, as pleaded in the written statement.
3.1) On consideration
of the entire material on record, the Commission vide its order dated
15.09.2000 dismissed the complaint of the appellant holding that the
complainant has not been able to establish a case of medical negligence against
4) Being aggrieved
thereby, the appellant has filed this appeal under Section 23 of the Consumer
Disputes Redressal Commission Act, 1986 (hereinafter referred to as the
5) We have heard
learned counsel for the parties, who have taken us through the order of the
Commission and other relevant materials brought on record.
6) The learned
counsel appearing for the appellant contended that the order of the Commission
is bad on facts and in law as the same is passed without proper appreciation of
the evidence of the appellant made in examination-in-chief before the
Commission which has gone unrebutted and 8 uncontroverted as she has not been
cross-examined by the respondents. He next contended that none of the
respondents have appeared for cross-examination before the Commission nor any
one of them has filed evidence on affidavit as prescribed under Section 13 (4)
(iii) of the Consumer Protection Act, 1986 which prescribed procedure on
admission of complaint before the District Forum. The learned counsel also
contended that the appellant, despite her sincere efforts, could not get the
assistance of expert doctors in support of her complaint and to dislodge the
claim of the respondents, the Commission in the interest of the appellant could
have on its own summoned expert doctors from some Government institutions at
Delhi to ascertain whether proper and necessary medical treatment was given by
the doctors to Priya Malhotra or the doctors of Bombay Hospital in discharge
and performance of their duties were, in any manner, negligent and careless.
6.1) In support of
his submission reliance is placed upon a decision of this Court in Civil Appeal
No. 3541 of 2002 titled Martin F. D'Souza v. Mohd. Ishfaq decided on
9 In the said case,
the Division Bench of this Court has passed some directions, which read as
under:- "We, therefore, direct that whenever a complaint is received
against a doctor or hospital by the Consumer Forum (whether District, State or
National) or by the Criminal Court then before issuing notice to the doctor or
hospital against whom the complaint was made the Consumer Forum or Criminal
Court should first refer the matter to a competent doctor or committee of
doctors, specialized in the field relating to which the medical negligence is
attributed, and only after that doctor or committee reports that there is a
prima facie case of medical negligence should notice be then issued to the
concerned doctor/hospital. This is necessary to avoid harassment to doctors who
may not be ultimately found to be negligent. We further warn the police
officials not to arrest or harass doctors unless the facts clearly come within
the parameters laid down in Jacob Mathew's case (supra), otherwise the
policemen will themselves have to face legal action."
7) Mr. Shyam Diwan,
Senior Advocate appearing on behalf of Dr. Kriplani, has canvassed correctness
of the views taken by the Commission in the impugned order. He submitted that
the approach of the Commission in appreciating the consequences of the complaint
and the defence of the doctors taken in their written statements can never be
He then contended
that the evidence of the appellant in examination-in-chief does not establish
that Dr. A. Kriplani was ever negligent in performing his duties in his
He contended that the
treatment which was adopted by the doctors was inconformity with the advice and
opinion of Dr. P.H Joshi and Dr. Ramamoorthy and the appellant has not proved
on record that there was any kind of disagreement or divergence of opinion
between Dr. A. Kriplani on the one hand and Dr. P.H. Joshi on the other hand.
The learned counsel for other respondents has adopted the arguments advanced by
Mr. Shyam Diwan, Senior Advocate appearing for Dr. A. Kriplani.
8) In order to
appreciate the rival contentions of the learned counsel for the parties, we
have examined the impugned order of the Commission and the evidence led by the
parties. The Commission in its order has noticed the decision of Maharashtra
Medical Council dated 13.05.1999, whereby the Registrar of the Council conveyed
that the Maharashtra Medical Council after discussion on the merits and
demerits of the case unanimously resolved that `there is no negligence on the
part of medical practitioners and they have managed the 11 case to the best of
their ability, therefore, it was unanimously resolved to drop the said inquiry
and the medical practitioners be exonerated.' 9) The order of the Commission
would reveal that Dr. P.H Joshi had made noting on 26.07.1989 which reads
"Laparoscopy SOS shall review later" while referring the case of
Priya Malhotra to Dr. S.R. Jahagirdar who at the relevant time was in-charge of
Department of Obstetries and Gynaecology of the Bombay Hospital. The appellant
had no complaint to make against Dr. P.H. Joshi, rather she had got full faith
in him. As noticed above, Dr. S.R. Jahagirdar was out of town on the day when
the patient was to be operated upon and in her absence Priya Malhotra was
examined by Dr. Pratima Prasad and she has filed written statement before the
Commission in which it has categorically been stated that on perusal of the
case papers, she noticed that the patient was referred to her because of
suspected "Tubercular Peritonitis" of the lower abdomen and
"renal failure". On examination of Priya Malhotra, Dr. Pratima Prasad
noticed that the patient was not getting menstruation for the last three
months 12 although before that period, her menstruation periods were stated to
be normal. After clinical examination, Dr. Pratima Prasad advised
Ultrasonograph of the pelvis and laparoscopy to confirm the existence of
tuberculosis of the gynaecological parts. Dr. Pratima Prasad stated that
laparoscopy was considered necessary for confirmation of the diagnosis of
tuberculosis of the abdomen and to get the histopathological report. She stated
that in the presence of Dr. Vasant V. Sheth laparoscopy was done. The
laparoscopy was not contra- indicated from the various investigation reports
and check- ups carried out on the patient prior to 09.08.1989. The Commission
has in its order extracted the necessary averments made by Dr. Pratima Prasad
in her written statement in regard to the procedure and method of conducting
laparoscopy which, in our view, are not necessary to be repeated in this
judgment for unnecessarily burdening the record. The record produced before the
Commission would show that in the operation theatre, the patient was jointly
examined by Dr. A. Kriplani and Dr. S.R. Gupte, Hon.
they had taken conscious decision that the laparoscopy was not contra-indicated
in any way.
Dr. Pratima Prasad
felt that an attempt to conduct laparoscopy had to be abandoned and it became
necessary to perform the laparotomy to get tissue for biopsy which was the main
and only objective of the investigation. In the process, the perforations
caused during laparoscopy were duly sutured. On opening the abdomen, it was
noticed that the patient had active military tuberculosis. Peritoneum and all
the abdominal structures were adhered together. It was also noticed that the
intestines were perforated due to introduction of laparoscopy trocar and
cannula. It was stated by Dr. Pratima Prasad that Dr. Vasant V. Sheth performed
the peritoneal biopsy and sutured six intestinal perforations. The laparotomy
was performed with complete success and did not create any complication to the
patient. Dr. Pratima Prasad also submitted in her statement that it was
conclusively proved by the post-mortem examination that the sutured intestines
had healed and had not developed any leak.
10) Dr. Pratima
Prasad has strongly refuted the allegation made by the appellant that
Tubercular Peritonitis had 14 developed due to laparoscopy. She stated that
Tubercular Peritonitis is a chronic disease which could not suddenly develop.
It was already present when laparoscopy was conducted. Dr. Pratima Prasad also
stated in the written statement that the allegations of the appellant that
there was a departure from the line of action taken by Dr. P.H. Joshi and Dr.
Ramamoorthy, were wholly untrue. She stated that in fact, a perusal of the case
papers would show that Dr. P.H. Joshi had himself suggested laparoscopy on the
patient. It was her statement that medical opinion was clear that tuberculosis
of intestines could be detected best and easily by performing laparoscopy. The
allegations of the appellant that the right lung of Priya Malhotra was
collapsed due to the laparoscopy has empathetically been denied by her.
Dr. Pratima Prasad
pleaded that during laparoscopy the direction of the trocar and cannula were
towards pelvis (downward direction) eliminating any chance of causing
pneumothorax or collapse of the lung. The appellant could not lead evidence of
any expert doctor to counter or rebut the 15 statement made by Dr. Pratima
Prasad in her written statement.
11) In the light of
the unrebutted and uncontroverted statement of Dr. Pratima Prasad, the
Commission, in our view, has rightly come to the conclusion that the appellant
has failed to establish that Dr. Pratima Prasad, in any manner, was negligent
or careless in performing laparoscopy upon the deceased.
12) The appellant
also alleged that Dr. A. Kriplani and his team of doctors had discarded the
line of treatment being pursued by Dr. Ramamoorthy and Dr. P.H. Joshi, which
had resulted in the death of Priya Malhotra. The appellant could not even
remotely substantiate this allegation made against Dr. A. Kriplani. There is
not an iota of evidence on record to prove that Dr. A. Kriplani had ever
departed from the line of treatment being taken and adopted by Dr. Ramamoorthy
and Dr. P.H. Joshi. The appellant has clearly and unequivocally stated that she
had no complaint against the line of treatment being advised by Dr. P.H. Joshi.
It was categorically stated by Dr. Pratima Prasad and Dr. A. Kriplani in their
respective 16 written statements that it was Dr. P.H. Joshi who had in writing
recommended laparoscopy and the said recommendation was placed on record of the
Commission by Dr. Pratima Prasad in support of her written statement. The
doctors-respondents who were involved in the treatment of deceased Priya
Malhotra have established on record that the course of treatment pursued by
them in the Bombay Hospital was in no way contradictory or against the treatment
given by Dr. Ramamoorthy. In fact, Dr. Ramamoorthy had examined the patient and
carried the investigation as a result thereof it was found that the patient was
suffering from chronic renal failure. Dr. Ramamoorthy requested Dr. A.
Kriplani- respondent no.1 for an opinion recorded as "Unit Note"
dated 16.07.1989, a copy thereof has been produced before the Commission duly
signed by Dr. Ramamoorthy. The contents of the "Unit Note" are
extracted by the Commission in its order.
13) Dr. Vasant S.
Sheth of Bombay Hospital for the first time examined Priya Malhotra on
24.07.1989 and found the patient suffering from kidney failure. Dr. Vasant S.
Sheth was 17 informed that the patient had been undergoing haemodialysis since
about 18.07.1989. On 21.07.1989, on clinical examination and going through the
reports of the investigation conducted till that day, it was found that the
patient was suffering from end-stage renal failure and would require kidney
transplant for her survival. When various tests were carried out, Dr. A.
Kriplani suspected the patient to be suffering from abdominal tuberculosis. In
view of the suffering from abdominal tuberculosis and also of the
gastrointestinal problems which had gone out of proportion to the Uremia, the
expert doctors-respondents had decided not to carry out any operation for
kidney transplant. Dr. A. Kriplani and Dr. Vasant S. Sheth both had agreed that
it would not be advisable to carry out kidney transplant, having regard to the
state of health of the patient. The position of the patient was fully explained
by Dr. Vasant S. Sheth to the patient and the appellant and both of them were
informed that renal failure cases stood surgery bodily and were likely to
develop complications following minor surgery and might even result in death.
On 31.07.1989, Dr. Vasant S. Sheth 18 performed diagnostic peritoneal tap for
ascetic fluid examination and also to judge whether laparoscopy would be safe
or not. Having regard to the various problems of the patient and also the
pathological and other reports of the patient, Dr. A. Kriplani and his
colleagues came to the conclusion that there was no better method available for
the patient than to perform laparoscopy. Dr. Ramamoorthy also examined patient
on 04.08.1989 and approved the decision of Dr. A. Kriplani to start
anti-tuberculosis drugs and advised administration of rifampicin/pyrazinamide.
Dr. Ramamoorthy had also insisted upon decision to do histopathological tissue
diagnosis to confirm existence of tuberculosis.
14) Dr. [Mrs.] S.R.
Jahagirdar-respondent stated that Priya Malhotra was admitted to Bombay
Hospital under the observation of Dr. Ramamoorthy and was later being treated
by Dr. A. Kriplani who referred the patient to her for laparoscopy. It was Dr.
Vasant S. Sheth who on or about 08.09.1989 contacted her on telephone and gave
her the details of the complications of Priya Malhotra. Dr. S. R. Jahagirdar
stated that Dr. [Mrs.] Pratima Prasad who had special training to perform
tissue biopsy by laparoscopy was assigned the job. Dr. A. Kriplani is a
Nephrologist, who at the relevant time was the In-charge of the Nephrology Unit
of the Bombay Hospital. Dr. Vasant S. Sheth is the General Surgeon, who is
specialized in kidney transplant surgery.
Dr. Vasant S. Sheth
had to do laparotomy on Priya Malhotra after having supervised laparoscopy
conducted by Dr. [Mrs.] Pratima Prasad. On 21.07.1989, the patient was referred
by Dr. Ramamoorthy to Dr. A. Kriplani and Dr. Vasant S. Sheth.
On detailed clinical
examination and going through the records of the investigation done upto
21.07.1989, Dr. Vasant S. Sheth came to the conclusion that patient was at the
end- stage of renal failure and as such she needed kidney transplant for her
survival as after multiple sessions of haemodialysis the abdomen did not settle
down and also because of occurrence of recurrent features of intestinal
obstruction, it was decided not to have surgical intervention in the case of
the patient. Dr. Vasant S. Sheth agreed to the opinion given by two doctors
namely, Dr. A. Kriplani and Dr. Ramamoorthy that the issue of kidney
transplantation did 20 not arise till abdominal tuberculosis would get healed
15) On re-examination
and re-appraisal of the entire material on record, we find that there was
absolutely no difference or divergence of opinion between a team of specialists
and experts consisting of Dr. Ramamoothy, Dr. P.H. Joshi and Dr. A. Kriplani at
any stage about the method and mode of treatment adopted by doctors-respondents
in this case.
Doctors had informed
the patient and her relatives well in time that condition of Priya Malhotra was
critical and kidney transplantation could not be done nearly for one year and
also the consequence of the renal failure suffered by the patient.
Dr. Vasant S. Sheth
had opined that attempt to do laparoscopy had failed in spite of two attempts
and it became all the more important to perform laparotomy to get tissue for
biopsy and to avoid any further injury that might have occurred due to the attempt
at laparoscopy. On opening abdomen of the patient it became clear that the
patient had extensive chronic peritonitis plastering the whole intestinal tract
and intestines were perforated due to introduction of 21 laparoscopic pressure
and cannula. Dr. Vasant S. Sheth performed peritoneal biopsy and sutured six
intestinal perforations to start with. The patient was put in I.C.U and at the
initial stages she was doing well but unfortunately on 17.08.1989 i.e. eight
days after the operation she developed jaundice probably due to
anti-tuberculosis drugs which had to be stopped. The material on record would
show that on 20.08.1989, the patient developed a fluid leak from the abdomen
due to the leakage of ascites or beginning of fecal fistula. The condition of Priya
Malhotra started deteriorating day by day despite best care and attention of
specialists in I.C.U. The appellant was kept fully informed about the
deteriorating condition of the patient, but the appellant abruptly instructed
the doctors to stop haemodialysis treatment to the patient. Because of the
persisting demand of the appellant, haemodialysis was stopped which according
to the respondents resulted in the untimely death of Priya Malhotra. Exhibit-C
which was part of the continuation sheet of treatment of Medical Research
Centre of Bombay Hospital placed on record of the Commission would reveal that
on 22 23.08.1989 at 9.00 p.m., the patient was examined and it was also
recorded thereon "discussed with relatives and explained the consequences
of not draining of pneumothorax and not doing haemodialysis". The
appellant did not permit such treatment and gave in writing "I refused
Haemodialysis and Pneumothorax on my risk".
16) In the facts and
circumstances noticed hereinabove, the fact remains that when Priya Malhotra
was brought to Bombay Hospital for treatment her health was in very bad
condition. Renal failure had already taken place. In the post mortem report
conducted at J.J. Hospital, Bombay, it finds recorded that "patient was
sick since four months by loose motion, vomiting and she was admitted in Bombay
Hospital since 14.07.1989. She was operated on 09.08.1989 and died on
24.08.1989. The cause of death was due to peritonitis with renal failure".
17) In the backdrop
of the factual situation of the present case, we have examined the principles
of law laid down by this Court in the decisions cited by the learned counsel.
23 18) A three Judge
Bench of this Court in the case of Jacob Mathew v. State of Punjab and Another
[(2005) 6 SSC 1] had the occasion to deal with and decide the liability of
doctors in a death case arising due to criminal medical negligence for an
offence under Section 304-A of the Indian Penal Code, 1860. In the case of
professional negligence, it was observed that in the law of negligence,
professionals such as lawyers, doctors, architects and others are included in
the category of persons professing some special skill or as skilled persons
generally. Any task which is required to be performed with a special skill
would generally be admitted or undertaken to be performed only if the person
possesses the requisite skill for performing that task. Any reasonable man
entering into a profession which requires a particular level of learning to be
called a professional of that branch, impliedly assures the person dealing with
him that the skill which he professes to possess shall be exercised with
reasonable degree of care and caution. He does not assure his client of the
result. A physician would not assure the patient of full recovery in every
case. A surgeon cannot and does not guarantee that the result 24 of surgery
would invariably be beneficial, much less to the extent of 100% for the person
operated on. The only assurance which such a professional can give or can be
understood to have given by implication is that he is possessed of the
requisite skill in that branch of profession which he is practising and while
undertaking the performance of the task entrusted to him he would be exercising
his skill with reasonable competence. This is all what the person approaching
the professional can expect. Judged by this standard, the professional may be
held liable for negligence on one of two findings: either he was not possessed
of the requisite skill which he professed to have possessed, or, he did not
exercise, with reasonable competence in the given case, the skill which he did
possess. The standard to be applied for judging, whether the person charged has
been negligent or not, would be that of an ordinary competent person exercising
ordinary skill in that profession. It is not possible for every professional to
possess the highest level of expertise or skills in that branch which he
practices. A highly skilled professional may be possessed of better qualities,
but that cannot be made the basis or the yardstick for judging the performance
of the professional proceeded against on indictment of negligence. [Paras 18
and 48(3)] 18.1) In the case of medical negligence, it has been held that the
subject of negligence in the context of medical profession necessarily calls
for treatment with a difference. There is a marked tendency to look for a human
actor to blame for an untoward event, a tendency which is closely linked with
the desire to punish. Things have gone wrong and, therefore, somebody must be
found to answer for it. An empirical study would reveal that the background to
a mishap is frequently far more complex than may generally be assumed. It can
be demonstrated that actual blame for the outcome has to be attributed with
great caution. For a medical accident or failure, the responsibility may lie
with the medical practitioner, and equally it may not. The inadequacies of the
system, the specific circumstances of the case, the nature of human psychology
itself and sheer chance may have combined to produce a result in which the
doctor's contribution is either relatively or completely blameless. The human
body and its working is nothing less than a highly complex machine. Coupled
with the complexities of medical science, the scope for misimpressions,
misgivings and misplaced allegations against the operator, i.e. the doctor,
cannot be ruled out. One may have notions of best or ideal practice which are
different from the reality of how medical practice is carried on or how the
doctor functions in real life.
The factors of
pressing need and limited resources cannot be ruled out from consideration.
Dealing with a case of medical negligence needs a deeper understanding of the
practical side of medicine. The purpose of holding a professional liable for
his act or omission, if negligent, is to make life safer and to eliminate the
possibility of recurrence of negligence in future.
The human body and
medical science, both are too complex to be easily understood. To hold in
favour of existence of negligence, associated with the action or inaction of a
medical professional, requires an in-depth understanding of the working of a
professional as also the nature of the job and of errors committed by chance,
which do not necessarily involve the element of culpability.
27 18.2) Negligence
in the context of the medical profession necessarily calls for a treatment with
a difference. To infer rashness or negligence on the part of a professional, in
particular a doctor, additional considerations apply. A case of occupational
negligence is different from one of professional negligence. A simple lack of
care, an error of judgment or an accident, is not proof of negligence on the
part of a medical professional. So long as a doctor follows a practice acceptable
to the medical profession of that day, he cannot be held liable for negligence
merely because a better alternative course or method of treatment was also
available or simply because a more skilled doctor would not have chosen to
follow or resort to that practice or procedure which the accused followed. The
classical statement of law in Bolam's case, (1957) 2 AII ER 118, at p. 121 D-F
[set out in para 19 herein] has been widely accepted as decisive of the
standard of care required both of professional men generally and medical
practitioners in particular, and holds good in its applicability in India. In
tort, it is enough for the defendant to show that the standard of care and the
skill attained was that of the ordinary competent medical practitioner exercising
an ordinary degree of professional skill. The fact that a defendant charged
with negligence acted in accord with the general and approved practice is
enough to clear him of the charge. It is not necessary for every professional
to possess the highest level of expertise in that branch which he practices.
Three things are pertinent to be noted. Firstly, the standard of care, when
assessing the practice as adopted, is judged in the light of knowledge
available at the time (of the incident), and not at the date of trial.
Secondly, when the charge of negligence arises out of failure to use some
particular equipment, the charge would fail if the equipment was not generally
available at that point of time (that is, the time of the incident) on which it
is suggested as should have been used. Thirdly, when it comes to the failure of
taking precautions, what has to be seen is whether those precautions were taken
which the ordinary experience of men has found to be sufficient; a failure to
use special or extraordinary precautions which might have prevented the
particular happening cannot be the standard for 29 judging the alleged
negligence. [Paras 48 (2), 48 (4), 19 and 24] 18.3) Again, it has been held
that indiscriminate prosecution of medical professionals for criminal medical
negligence is counter-productive and does no service or good to the society.
practitioner faced with an emergency ordinarily tries his best to redeem the
patient out of his suffering. He does not gain anything by acting with
negligence or by omitting to do an act. Obviously, therefore, it will be for
the complainant to clearly make out a case of negligence before a medical
practitioner is charged with or proceeded against criminally. A surgeon with
shaky hands under fear of legal action cannot perform a successful operation
and a quivering physician cannot administer the end-dose of medicine to his
patient. If the hands be trembling with the dangling fear of facing a criminal
prosecution in the event of failure for whatever reason--whether attributable
to himself or not, neither can a surgeon successfully wield his life-saving
scalpel to perform an essential surgery, nor can a physician successfully
administer the life-saving dose of medicine. Discretion being 30 the better part
of valour, a medical professional would feel better advised to leave a terminal
patient to his own fate in the case of emergency where the chance of success
may be 10% (or so), rather than taking the risk of making a last ditch effort
towards saving the subject and facing a criminal prosecution if his effort
fails. Such timidity forced upon a doctor would be a disservice to the society.
[See paras 28, 29 and 47] 18.4) In the case of State of Punjab v. Shiv Ram and
Others  7 SCC 1, a three Judge Bench of this Court while dealing with the
case of medical negligence by the doctor in conducting sterilisation
operations, reiterated and reaffirmed that unless negligence of doctor is
established, the primary liability cannot be fastened on the medical practitioner.
In paragraph 6 of the judgment it is said: (page no. 7) "Very recently,
this Court has dealt with the issues of medical negligence and laid down
principles on which the liability of a medical professional is determined
generally and in the field of criminal law in particular. Reference may be had
to Jacob Mathew v. State of Punjab (2005) 6 SCC 1. The Court has approved the
test as laid down in Bolam v. Friern Hospital Management Committee (1957) 1 WLR
582: (1957) 2 AII ER 118 (QBD) popularly known as Bolam's test, in its
applicability to India".
19. In the light of
the propositions of law settled in the above cited judgments of this Court, we
are of the view that both on facts and in law no case is made out by the
appellant against the respondents. The allegations made in the complaint do not
make out a case of negligence or deficiency in service on the part of the
respondents. It is not the case of the appellant that the doctors named in the
complaint are not qualified doctors and specialized in their respective fields
to treat the patient whom they agreed to treat. All the doctors who treated the
patient are skilled and duly qualified specialists in their respective fields
and they have tried their best to save the life of Priya Malhotra by joining
their hands and heads together and performed their professional duties as a
team work. The appellant has not challenged the post mortem report dated
25.08.1989 submitted by J.J. Hospital wherein it has been stated that before
Priya Malhotra was admitted to Bombay Hospital, she was sick since four months
by loose motion and vomiting. A copy of post mortem report of deceased Priya Malhotra
placed on record of the Commission by Dr. A. Kriplani with his evidence on
affidavit would read as under:
III] Microscopy - 1)
Kidneys (same histology in sections from the two bits) reveal advanced kidney
disease in the end stage. Most of the glomeruli are sclerosed/hyalinised and
Some of the few
glomeruli not effected by advanced sclerosis reveal hypercellularity indicating
that the end stage is the result of chronic progressive diffuse proliferative
glomerulinephritis. The end stage lesion is extensive, irreversible and can
cause intractable chronic renal failure. Interstitial fibrosis and inflammation
Finally, it was
opined by doctors that the death of Priya Malhotra was due to peritonitis with
20) On our
independent examination of the order of the Commission and other entire
material on record discussed hereinabove, we find that the Commission has
properly and rightly appreciated the entire factual and legal aspects of the
matter and there is no infirmity or perversity in the findings recorded by the
Commission which warrants any interference in this appeal.
33 21) No other
point has been raised by the appellant. We, thus, find no merit and substance
in any of the submissions made on behalf of the appellant.
22) In the result for
the above-stated reasons there is no merit in this appeal and it is, accordingly,
23) The parties are
left to bear their own costs.
(Lokeshwar Singh Panta)
(B. Sudershan Reddy)