Case title:

M.A. Biviji & Ors.  v. Sunita Parvate & Ors.

Date of Order:

19 October 2023

Bench: 

Hon’ble Mr. Justice Hrishikesh Roy

Hon’ble Mr. Justice Manoj Misra

Parties: 

Appellant(s): M.A. Biviji & Ors.

Respondent(s): Sunita Parvate & Ors.

SUBJECT:

The Hon’ble Supreme Court of India (hereinafter referred to as ‘the Supreme Court’ or ‘the Court’) in the case arising of out the impugned order of the National Consumer Disputes Redressal Commission (NCDRC) dealt with the case of specific breach of responsibility in a case of medical negligence and held that while the hospital has to prove the absence of breach of duty in a case of negligence, the higher burden of proof is on the complainant.

IMPORTANT PROVISIONS:

Consumer Protection Act 1986 (Act):

• Section 12
• Section 21
• Section 23

OVERVIEW:

• Mrs. Sunita Parvate (Respondent) was in a road accident on 05.05.2004 and was taken to Gondia Hospital. She was shifted to Suretech Hospital and Research Centre Pvt. Ltd.(SHRC), Nagpur, in the ICU under Dr. Nirmal Jaiswal’s supervision. Followed by procedures by Dr. Madhusudan Shendre, ENT surgeon, and Dr. M.A. Biviji, Radiologist.
• Respondent accused the doctors of medical negligence stating that they performed unnecessary procedures and replaced her existing Tracheostomy Tube (TT) with a Nasotracheal Intubation (NI) despite being able to breathe through normal air-passageway, to facilitate her breathing.
• Respondent claimed that she was unwillingly administered 2 glasses of Barium Sulphate as part of the Barium Swallow Test (BST) despite asphyxia risks to check abnormalities of her digestive tract in Dr. Biviji’s (Appellant) presence.
• Dissatisfied, the respondent sought discharge from SHRC and consulted several other doctors and had to undergo several procedures and ended up having a shortened windpipe, disfiguration of the respiratory tract, and permanent voice loss.
• She filed a case in the NCDRC in Consumer case number 48 against the hospital and the above-mentioned doctors for negligence.
•  The NCDRC ordered the hospital and the doctors to pay the complainant Rs. 6,11,638 jointly and severally as compensation at 9% simple interest from the date of filing of the complaint till the date of actual payment, within six weeks and an additional Rs.50,000 as litigation costs.
• The impugned judgment is under appeal at the Supreme Court.

ISSUES RAISED:

• Whether the act of conducting NI procedure to replace the existing TT after Bronchoscopy revealed normalcy in respiratory airways amount to negligence?
• Whether subsequent medical complications can be directly attributed to the said negligence?

ARGUMENTS ADVANCED BY THE APPELLANT:

• Appellant no.1 (M.A. Biviji) had no role in conducting the respondent's Bronchoscopy or NI procedure. Dr. Rajesh Swarnakar had conducted both procedures.
• Respondent had not impleaded necessary parties- Dr. Swarnakar, who conducted the Bronchoscopy and NI procedure. Ophthalmologists Dr. Ambade Dr. Arti Wanare, and Dr. Vinay Saoji, plastic surgeon.
• The Barium swallow test was essential to determine the cause of liquid feed leakage. The Barium Sulphate was non-toxic and did not pose any danger even in case of being aspirated.
• Appellant No. 1 was present during the test as the test cannot be conducted without a radiologist being present.
• The complaint had been filed at the behest of Dr. Kalidas Parshuramkar (a relative of the respondent) who was a third party apart from being a PG diploma student in Gynecology. It was stated that he lacked the expertise to understand the treatment yet constantly kept interfering and misinforming the patient about BST thereby causing panic.
• As per the medical board, there was no commission of negligent act by the doctors and they had performed with due diligence.
• Appellant No. 1 only had one charge against him, i.e., the BST which was not proven. 
• Although the respondent’s bill had amounted to Rs.95,260/-, the NCDRC awarded her with Rs.6,11,638/- as medical expenses with an additional Rs.50,000/- for litigation costs.

ARGUMENTS ADVANCED BY THE RESPONDENT:

• The compensation amount should be enhanced with a higher rate of interest.
• NCDRC erred in holding that there is no direct link attributable to the said act of negligence leading to prolonged medical complications, permanent respiratory damage & voice loss.
• SHRC’s discharge summary had no mention of the NI, which is indicative of an attempt to hide an act of commission of negligence.

JUDGEMENT ANALYSIS:

• The Court upheld the NCDRC’s judgment of negligence charges with respect to blurred vision, platelet count being low, and BST not being proven.
• Observed the expert committee’s observation that the hospital appropriately managed Mrs. Sunita’s septicemia and thrombocytopenia.
• The line of treatment undertaken by medical practitioners should not be of a discarded or obsolete category in any circumstances.
• A higher proof of burden must be fulfilled by the complainant.
• NCDRC’s judgment failed to point towards a specific breach of responsibility.
• There is no mention of Ni in the discharge summary but the medical bills mention Dr. Swarnakar as the undertaker of both procedures, therefore duty of care could only be attributed to him.
• As observed in the case of Jacob Mathew v. State of Punjab, adopting an alternative medical course does not amount to negligence.
• No medical negligence committed as discharge of due care was proven by the hospital but the respondent failed to provide any substantiative evidence.
• there was no breach of duty of care. In view of such a conclusion, it is not necessary to look at a possible causal link between the subsequent medical complications and voice loss as well as the permanent respiratory tract deformity.
• As the main charge of negligence regarding the aforesaid ‘NI’ procedure is found to be unsubstantiated, the issue of not impleading Dr. Rajesh Swarnakar in the context becomes irrelevant.
• The Hospital and doctors’ plea of rejection of the respondent’s consumer case was not accepted as the charges in that case are factual in nature.
• No causal link was established between the ‘NI’ procedure and the subsequent medical complications such as voice-loss and permanent respiratory tract deformity.

CONCLUSION:

The Supreme Court observed that the Appellants had proven to have performed due diligence before performing NI procedure, therefore the was no negligence on the part of the Appellants. Under such unique circumstances, just because a doctor opts for a particular line of treatment but does not achieve the desired result, they cannot be held liable for negligence, provided that the said course of action undertaken was recognized as sound and relevant medical practice.  The impugned order of the NCDRC was thus set aside, and the appeal filed by appellants were found not proven while the appeal filed by Mrs. Sunita was dismissed. The parties are to bear their own costs.