Kalyani Rajan Vs. Indraprastha Apollo Hospital & Ors. – Bhargavjyoti Saharia 

Court – The Supreme Court of India 

Bench – Justice A S Bopanna and Justice Prashant Kumar Mishra 

by 

Bhargavjyoti Saharia 

5^th semester, 

LLB hons. (Business Law) 

NEF Law College, Guwahati.

FACTS 

1. The complainant-appellant is the wife of the deceased patient namely, Sankar Rajan, who  was 37 years old and died on 06.11.1998 in the hospital 

Respondent no. 1 herein while undergoing follow up care and treatment after a major  neurosurgery in the care of respondent nos. 1 and 2. The deceased was under the  employment of proforma respondent no. 3 and was earning handsome annual package at  the time of his demise. 

2. The deceased was suffering from Chiari Malformations (Type II) with hydrocephalous.  The deceased consulted Dr. Ravi Bhatia – respondent no. 2, on 21.10.1998, who advised  him to get admitted to respondent no. 1- Hospital where the surgery would be performed  by him. As per the advice of respondent no. 2, the deceased got himself admitted to  respondent no. 1 on 29.10.1998.  

3. After performing pre- operative medical examinations, respondent no. 2 conducted the  operation of the deceased. The deceased was thereafter shifted to private room at about  04.15 p.m. and at about 04.30 p.m., the doctors visiting the deceased were informed about  pain in the neck region, which seemed to have transferred downward lower than the region  where pain used to occur prior to operation. At about 06.30 p.m. the deceased was given  pain reliever intravenously, but the pain increased along with severe sweat spells. At about  09.15 p.m, the deceased started suffering from severe unbearable pain. 

4. The complainant- appellant called respondent no. 2 at his residential phone but he was not  available. At about 09.30 p.m. another pain killer was intravenously given. At about 11.00  p.m. complainant- appellant talked to Respondent no. 2 at his residence. The deceased had  suffered heart attack around 11.00 p.m. The deceased was declared brain dead on  31.10.1998. He was kept on life support till his death on 06.11.1998. 

5. The grievance of complainant-appellant is that the deceased was not attended to by any  doctor from neurosurgery team who had operated the deceased after he was shifted into the  private room till 11.00 P.M. After such major surgery, instead of shifting to a private room,  the deceased should have been shifted to the Intensive Care Unit.

6. NCDRC said that the appellant has not been able to establish by any cogent evidence or  material on record that the heart attack suffered by the deceased had any connection with  the operation in question or on account of lack of post-operative care. No case of medical  negligence has been proved nor can it be said that the aftercare treatment of the deceased  till he suffered a cardiac arrest was inadequate so as to hold the respondents liable for  medical negligence. 

 ISSUE 

Whether the respondents have committed negligence in not providing proper post operative medical care to the patient and, accordingly, whether the Commission has  committed any illegality while dismissing the complaint filed by the appellant? 

LAW APPLIED  

In this case, the complainant (the appellant) alleges that the respondents (doctors and the  hospital) committed medical negligence in the postoperative care of the deceased patient.  To assess this issue, several legal principles and laws related to medical negligence and  patient rights need to be considered. Here’s an overview of the relevant legal framework  and issues that would be applicable in this situation: 

LEGAL FRAMEWORK AND ISSUES. 

1. Medical Negligence 

– Duty of Care: Medical professionals have a duty of care to their patients. This means they  must provide a standard of care that a reasonably competent professional in the same field  would provide. 

– Breach of Duty : To prove negligence, it must be shown that there was a breach of duty,  i.e., the medical professionals failed to provide the expected standard of care. – Causation : There must be a direct link between the breach of duty and the harm suffered  by the patient. The complainant must establish that the lack of proper postoperative care  led to the heart attack and subsequent death. 

– Damages : The complainant must show that the patient suffered harm or injury as a result  of the breach of duty.

2. Consumer Protection Act, 1986 (Now replaced by the Consumer Protection Act, 2019) : 

 – Under the Consumer Protection Act, patients are considered consumers, and healthcare  services are considered services. A complaint can be filed for any deficiency in service,  including medical negligence. 

3. Evidence : 

 – The complainant must provide sufficient evidence to prove that the medical  professionals were negligent. This may include medical records, expert testimony, and  other relevant documentation. 

4. Expert Testimony : 

 – In medical negligence cases, expert testimony is often crucial in establishing the  standard of care and whether it was breached. The testimony of medical experts can help  determine whether the care provided was inadequate. 

5. Postoperative Care Guidelines : 

 – Medical guidelines and protocols for postoperative care must be adhered to. Deviations  from these guidelines may indicate negligence if they result in harm to the patient. 

6. Informed Consent : 

 – Patients have the right to be informed about their treatment, including the risks and  benefits. Lack of informed consent can also be a ground for negligence claims. 

Application to the Case 

In the context of this case, the complainant argues that the deceased was not given proper  postoperative care, which led to his death. Key points to consider include: 

– Whether the hospital and doctors met the standard of care expected in such a medical  scenario. 

– Whether the decision to place the patient in a private room instead of the Intensive Care  Unit (ICU) was appropriate given the circumstances. 

– Whether the lack of immediate attention from the neurosurgery team contributed to the  patient’s deterioration. 

– Whether there was sufficient evidence presented to establish a causal link between the  alleged negligence and the patient’s death. 

ANALYSIS .

1. The Supreme Court observed that the entire case of the complainant was about lack of  proper post-operative medical care. After perusing the material available on the record,  it said that per the standard practice, all patients who show no signs of complications  in the recovery room and have no post or pre-operative complications are sent to their  rooms. The symptoms, which emerged after the deceased was discharged from the operation Theatre, were not the symptoms which typically precede a cardiac arrest.  

2. The Supreme added that since the deceased did not have any known or identifiable  heart ailments, it was impossible for the respondents to have prior knowledge that the  patient may develop cardiac problems after a few hours of successful surgery. The  symptoms, including dizziness, sweating, and pain in the neck area, experienced by the  deceased post-surgery, could not be treated as post-surgery reactions. Therefore, in the  absence of complications in the surgery or soon thereafter, the patient was not required  to be shifted to ICU and there is no negligence on this count by either of the  respondents. 

3. The Top Court referred the case of Jacob Mathew v. State of Punjab, in which it was  observed that a professional may be held liable for negligence on one of the 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. 

4. The Supreme Court regarding the applicability of principles of Res Ipsa locutor, said  that the principles get attracted where circumstances strongly suggest partaking in  negligent behaviour by the person against whom an accusation of negligence is made.  For applying the principles of Res Ipsa locutor, it is necessary that a ‘Res’ is present to  establish the allegation of negligence. Strong incriminating circumstantial or  documentary evidence is required for application of the doctrine. 

CONCLUSION/ JUDGEMENT. 

1. The Supreme Court bench of Justice A S Bopanna and Justice Prashant Kumar Mishra  held that there was no mistake in diagnosis or a negligent diagnosis by Respondent no.  2. In the absence of the patient having any history of diabetes, hypertension, or cardiac  problem, it is difficult to foresee a possible cardiac problem only because the patient  had suffered pain in the neck region. 

2. The Supreme Court further said that the appellant has failed to establish negligence on  the part of Respondents in taking post operative care and the findings in this regard  recorded by the Commission does not suffer from any illegality or perversity.

The NCDRC (National Consumer Disputes Redressal Commission) dismissed the  complaint on the grounds that there was insufficient evidence to prove medical  negligence. The complainant would need to address these evidentiary gaps, potentially  by presenting additional expert testimony or documentation, to successfully appeal or  challenge the decision.  

In summary, to argue a case of medical negligence successfully, the complainant must  clearly establish that the standard of care was breached, leading directly to harm or  injury, supported by substantial evidence and expert testimony.