Date of Order:
14th May, 2009
Bench:
Hon’ble Justice B.N. Agrawal, Harjit Singh Bedi and G.S. Singhvi
Parties:
Petitioner: Nizam Institute of Medical Science (NIMS)
Respondent: Prasanth S. Dhananka
IMPORTANT PROVISIONS:
Consumer Protection Act,2019:
Under section 42(11)- the practitioner concerning medical negligence will be considered a "deficiency".
Section 2(42)- "medical services" falls under the scope of services.
OVERVIEW:
- 9th of September: A 20-year-old engineering student who is the complainant-respondent went to the "Nizam Institute of Medical Science (NIMS)" for a checkup after noticing mild fever.
- He underwent a chest and tuberculosis specialist's examination there, and following an X-ray, a specific "innocent tumor" called a Neurofibroma and some rib erosion in the area were discovered.
- After multiple failed attempts, the complaint was directed to Dr. P.V. Satyanarayana, a "Cardio Thoracic Surgeon," who would do an excision biopsy of the tumour, as the specialist had advised for the "ultrasound-guided biopsy" of the tumour.
- On October 19, the plaintiff was admitted to the hospital, and four days later, the operation to remove the tumor was completed. After learning that the complainant had "acute paraplegia," which resulted in the loss of all lower limbs and various other disabilities, the complainant was released from the hospital on May 19, 1991, paralyzed.
- Due to a urinary tract infection and other consequences, the complainant's condition required ongoing nursing care as well as physiotherapy.
- The complainant's parents applied persistent pressure to NIMS to acquire a thorough report but to no avail.
- On April 5, 1993, the complainant filed a complaint with the "National Consumer Redressal Commission" (NCRC) after making numerous attempts and not receiving a response.
- The complaint accused P.V. Satyanarayana of medical negligence and placed NIMS under vicarious liability as well as the state of Andhra Pradesh under statutory liability.
ISSUES RAISED:
- Whether the doctors were "negligent"
- Whether the liability imposed on the doctors be dissolved if the consent of the patient is given
- Whether sufficient compensation was granted to the patient/complainant.
ARGUMENTS ADVANCED BY THE APPELLANT:
- Learned counsel contented that there was Negligence in the pre-operative stage as well as in the operative stage.
- Additionally, it was claimed that the complainant was not made aware of the postoperative complications, that the consent was only obtained for a "exploratory procedure," but that the fourth rib was completely removed, several "intercostal blood vessels" were "sacrificed," and that this resulted in the patient becoming paralyzed.
- Due to the fact that the "neurofibroma excision" also had a number of neurological ramifications, the participation of a neurosurgeon was also very important. Moreover, there was a lack of post-operative care that resulted in pressure ulcers and excruciating dis-comfort.
ARGUMENTS ADVANCED BY THE RESPONDENT:
- It was further argued that since the cardiothoracic surgeon was already present, the attendance of a neurosurgeon was not necessary.
- Additionally, it was argued that all required medical testing had been carried out honestly and responsibly, demonstrating that there had been no pre-operative negligence. Also, the respondent paid close attention to the complainant during the post-operative period, therefore there was no violation of the "duty of care" during that time.
- It was also contended that the presence of a neurosurgeon was not required since the cardiothoracic surgeon was already present. It was also pleaded that there was no negligence in pre-operative as all the requisite medical tests had been performed sincerely and responsibly. And also, there was no breach of "duty of care" during the post-operative stage as considerable attention was given to the complainant by the respondent.
JUDGEMENT ANALYSIS:
- The NCRC reached its decision based on these main facts. The Commission's order, dated 16 February 1999, came to the conclusion that the defendants in this instance were negligent. The CT surgeon said that he had been aware of the tumor's extension into the vertebrae during the pre-operative phase, which automatically justified the requirement for a neurosurgeon. The neurosurgeon was not consulted prior to the surgery or even during it, as the evidence supports.
- The Commission imposed compensation in of Rs. 15.5 lakhs after taking into account these factors, the family's mental anguish, the current and upcoming costs, the family's damages, and the shortened life expectancy. It is important to note that the commission acknowledged the existence of "implied permission" by the parents and rejected the complainant's contention that no consent was given.
- Following this judgement, Appeals were filed both by the complainant and the respondent in the Hon’be Supreme court of India.
- According to the court, although Dr. Satyanarayana claimed that the extension of the tumour into the vertebral column was discovered only after surgery, the discharge record made mention of a "mass lesion in the upper chest."
- This quotation casts doubt on the doctor's assertion, and it also suggests that, had a proper MRI test been performed, it would have been possible to determine whether the tumour had extended into the spinal cord. The bench did, however, provide some credence to the doctor's reasoning while giving the complainant's claim greater weight. It is notable that while the complaint did not provide "informed permission" for the "excision operation," implied consent existed for the "excision biopsy".
- The plaintiff had argued for 4.61 crores in compensation before the commission, but was ultimately awarded a total of somewhere about 15 lakhs. The court had to find a middle ground, and after lengthy deliberation and thorough analysis of all the evidence, it awarded the complaint compensation in the amount of roughly 1 crore rupees.
CONCLUSION:
- In this case, the court properly noted that empathy for the patient should not obstruct the delivery of sound judgment and that rational intelligence must serve as the only foundation for evaluation. Close family members experience stress as a result of the severely disabled person's daily need for assistance and mental support.
- The bench correctly took note of the complainant's and his family's feelings of concern and uncertainty as they invested money in the legal process. A few additional tests, such as an MRI, and consultation with a neurosurgeon, together with significant attention in handling medical difficulties, might have likely spared complainant from paralysis, embarrassment, and distress. This example serves as a benchmark for medical hospitals and practitioners. On the other hand, NIMS would have avoided paying out Rs. 1 crore in compensation.
