Holding a medical practitioner liable for medical negligence entails a higher threshold limit

In the matter of M.A Biviji v. Sunita & Ors. (Civil Appeal No. 3975/2018) decided by the Hon’ble Supreme Court on 19.10.2023

FACTS: The present Civil Appeal was filed under Section 23 of The Consumer Protection Act, 1986, (hereinafter referred to as the ‘Act, 1986’) assailing the impugned decision passed on 16.02.2018 by the National Consumer Disputes Redressal Commission (hereinafter, ‘NCDRC’) wherein the NCDRC directed Dr. M. A. Biviji, Radiologist at Suretech Hospital alongwith others to jointly and severally pay Rs. 6,11,638/- as compensation for medical negligence to Complainant with 9 % simple interest. on account of being medically negligent by performing the unjustifiable and forceful performance of Nasotracheal Intubation (hereinafter, ‘NI’) procedure on Complainant on 13.05.2004. The ‘NI’ procedure entails inserting an endotracheal tube through the patient’s nose, to assist in breathing.

The Complainant alleged that that on 13.05.2004, doctors performed Bronchoscopy to check Complainant’s airways and for evaluating her Larynx and Trachea. The complainant further claimed that even though the Bronchoscopy showed a normal air-passageway, indicating her ability to breathe normally through the existing ‘TT’, treating doctors removed the ‘TT’ and forcefully performed ‘Nasotracheal Intubation which led to further severe complications.

ISSUE: Whether while removing the existing ‘TT’ after the Bronchoscopy report indicated normalcy in Complainant’s airways and subsequent act of conducting ‘NI’, amounted to medical negligence or not by the doctors of Suretech Hospital

OBSERVATIONS: While relying on the landmark judgments in the case of Jacob Mathew vs. State of Punjab, (2005) 6 SCC 1 and Kusum Sharma vs. Batra Hospital (2010) 3 SCC 480, wherein the Hon’ble Supreme Court laid down the following three essential ingredients in determining an act of medical negligence:

(1) a duty of care extended to the complainant,

(2) breach of that duty of care, and

(3) resulting damage, injury or harm caused to the complainant attributable to the said breach of duty.

It was also observed that a Medical Professional is expected to bring a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the circumstances of each case is what the law requires. However, a medical practitioner will be held liable for negligence only in circumstances when their conduct falls below the standards of a reasonably competent practitioner.

The Hon’ble Court observed further that with the constant advancement in the medical field and practices it would be natural that there would be difference of opinions between the doctors. In such 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. This may include a procedure entailing a higher risk element as well, which was opted for after due consideration and deliberation by the doctor. Therefore, a line of treatment undertaken should not be of a discarded or obsolete category in any circumstance.

Adverting to facts of the present case, the Hon’ble Supreme Court observed that the existing ‘TT’ was removed after the bronchoscopy showed normalcy in the airways & trachea of the patient. It was expected that the patient would be able to breathe normally without any support after ‘TT’ decannulation. However, a stridor was observed in the airways of the patient, after the said decannulation took place. Considering the same, an alternative course of treatment in the form of an ‘NI’ procedure was opted for as a temporary measure and there was nothing to show that that the said procedure conducted was outdated or poor medical practice.

In view of the same, the Hon’ble Court while allowing the appeal held that this was a classic case of human fallibility where the doctors tried to do the best for the patient as per their expertise and emerging situations however, the desired results could not be achieved. Hence, it was held that the  treatment in the present matter cannot be said to be a case of medical negligence.