Medical negligence: A hypocritical oath?

By Vivek Vashi and Shreya Gupta, Bharucha & Partners
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True to the maxim “justice must not only be done, it must also appear to be done” the Supreme Court of India, in a landmark judgment on 24 October, boldly awarded a record sum of ₹60.8 million (US$965,000) to Dr Kunal Saha in a medical negligence claim. In awarding such a large amount the court has departed from its previous view in favour of medical professionals in the hope that it will have a deterring effect on negligent doctors.

In Dr Balram Prasad v Dr Kunal Saha and Ors, Dr Saha brought a case against Advanced Medicare & Research Institute (AMRI), a Kolkata-based hospital, and three doctors for compensation to the tune of ₹970.7 million for deficiency in medical services provided by them which ultimately led to the untimely demise of his wife.

Brief facts

Dr Saha and his wife, residents of the US, visited India in March 1998. Mrs Saha developed acute pain, fever and rashes and was later diagnosed with toxic epidermal necrolysis. She was initially treated at the Nightingale Diagnostic Centre, Kolkata, and when her condition did not improve, she was admitted to AMRI. Several lapses on the part of the doctors involved – failure to prescribe intravenous fluid and nutritional support, failure to maintain acceptable standards of hygiene, inconsistent monitoring of her condition, etc. – caused her condition to deteriorate rapidly and she died on 28 May 1998.

Vivek Vashi
Vivek Vashi

Soon after the demise of his wife, Dr Saha initiated proceedings before the National Consumer Disputes Redressal Commission (NCDRC) against AMRI and as many as 26 doctors who were involved with his wife’s treatment, claiming compensation to the tune of ₹770.7 million, which was later amended to ₹970.7 million. The NCDRC found that AMRI and the doctors had been grossly negligent but awarded compensation of only ₹17 million.

At this point, cross-appeals were filed by each of Dr Saha (seeking enhancement of the compensation awarded), the doctors (asking for the award to be set aside) and AMRI (questioning the quantum of compensation awarded), which were heard and decided by the Supreme Court.

Court’s findings

The court first considered whether Dr Saha’s application to amend his claim for compensation at a belated stage was permissible by law, and decided in the affirmative. In arriving at this conclusion, the court relied on its decision in Malay Kumar Ganguly v Dr Sukumar Mukherjee, which held that damages must be fixed in keeping with the principle of restituto in integrum, i.e. the claimant must be restored to the position he would have been in had it not been for the wrong. On this basis, the court stressed that where the claimant was resident abroad, factors such as inflation and quality of life needed to be taken into consideration.

The court went further to say that it was duty-bound to award just and reasonable compensation even if not specifically sought. The court also upheld the maxim “justice delayed is justice denied”, in its finding that Dr Saha ought to be compensated for the wait of 15 years between the filing and the adjudication of the claim, along with annual interest at 6%.

The court observed that compensation should include “loss of earning of profit up to the date of trial”, which may include “loss already suffered or likely to be suffered in future”, and not purely computed by applying the “multiplier method” prescribed under the second schedule to section 163-A of the Motor Vehicles Act, 1988.

Shreya Gupta
Shreya Gupta

The court dismissed the appeal preferred by AMRI on the ground that every hospital is responsible for the acts of its doctors, irrespective of the nuances of their appointment. Further, the hospital would be vicariously liable for any claim of medical negligence as it would be in the best position to disclose what care and treatment was meted out to a patient, as already held in the case of Savita Garg v National Heart Institute.

The court also dismissed the appeals filed by the appellant doctors – noting that each of these doctors attempted to shirk their responsibility by pointing a finger at others when their respective negligent acts were glaring on the face of the record – and directed the doctors to compensate Dr Saha in the hope that they would shed their callous attitude towards the lives of their patients and uphold the integrity of the profession.

Conclusion

It is noteworthy that in the concluding portion of the judgment, the court called for legislative action and urged the Medical Council of India to tighten the regulatory and supervisory strings. Seeing the negligence which is writ large across the acts of the doctors, we too hope that this judgment reminds the doctors of the oath they once took, the Hippocratic Oath they so revere.

Vivek Vashi is the mainstay of the litigation team at Bharucha & Partners, where Shreya Gupta is an associate.

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