Author: Seleena Saju, a student at Symbiosis Law School, Hyderabad
Abstract
In Bombay Hospital & Medical Research Centre vs. Asha Jaiswal, the death of a patient, Mr. Dinesh Jaiswal, during his treatment, gives rise to allegations of medical negligence. The Supreme Court of India sets aside the decision of the National Consumer Disputes Redressal Commission, which had held the hospital and the attending doctor liable. The Court held that the evidence does not warrant claims of negligence, the Supreme Court held that adverse outcomes by themselves do not point towards any sort of medical malpractice.
Introduction
Mr. Jaiswal had been suffering with pain and discomfort in his leg since 1990. In April 1998, a Colour Doppler Test showed him to have an aneurysm in the lower abdominal aorta. He was referred to Bombay Hospital, where he was admitted on April 22, 1998, under the care of Dr. C. Anand Somaya. Surgery was done to treat the aneurysm, but post-operative complications arose, such as coldness in the lower limbs and a drop in pulse. Further interventions did not improve Mr. Jaiswal’s condition, and he had to undergo amputation of both legs due to gangrene. He died on June 12, 1998.
The Supreme Court’s analysis on key issues:
Non-availability of the Digital Subtraction Angiography (DSA) Machine:
The malfunctioning of the DSA machine during a critical juncture in the treatment of Mr. Dinesh Jaiswal was one of the key issues raised by the patient’s family. The DSA machine is a sophisticated piece of medical equipment used for detailed imaging of blood vessels, critical in diagnosing and planning surgical interventions for vascular conditions.
Its malfunctioning put the doctors to facing a challenge where they had to switch to an alternative; the Supreme Court has noticed that advanced medical devices, such as the DSA machine, may have gadgetry defects that could surface at any time even with regular servicing. Such failures are typically out of, and beyond, human management, and can rarely be linked directly to negligence, except in cases of neglecting issues of possible malfunction and those arising out of lack of maintenance. The hospital here, in this case, made available a different mode of performing the angiograph test in time and did not make the patient wait for an unduly long period.
The Court emphasized that negligence in medical care is established only when there is a breach of duty to provide a reasonable standard of care. Here, the hospital’s swift response to arrange for an alternative test demonstrated its commitment to ensuring continuous care despite unforeseen technical difficulties.
In addition, the alternative angiography changed the subsequent course of treatment which strongly suggests that the medical team did respond correctly to this adverse incident. This dimension of the case strongly points to the necessity of examining alleged medical negligence in a context. Technical failures in equipment, though unpleasant, do not per se become the stepping stone for negligence. The determining factor is the response to such failure. By quickly scheduling alternative diagnostics and proceeding with the treatment plan, the hospital showed reasonable care and diligence.
Delay Due to Occupied Operation Theatres
The second allegation concerned the unavailability of an emergency operation theatre (OT) when it was deemed necessary. The patient’s family argued that this delay contributed to the worsening of Mr. Jaiswal’s condition. The Supreme Court, however, took a pragmatic view, recognizing the operational realities of hospitals, especially large, multi-specialty ones like Bombay Hospital.
The Court observed that operating theatres cannot be kept ready round the clock for emergencies, as the theatres are usually kept busy with scheduled and other essential operations. Hospitals have to work in an environment of scarcity and limited by demand and resources, therefore, it is unfeasible for the operating rooms to be on standby continuously. It is the hospital’s duty to manage its resources and give priority to surgery according to the medical urgency of the case, the Court opined.
The surgery was done as quickly as possible, which shows the responsiveness of the hospital in Mr. Jaiswal’s condition. The Court did not discover any material that would accept the proposition that the delay in these cases was both unreasonable and avoidable. Besides, the prioritizing of surgeries usually gets performed based on the severity and urgency of each case. This judgment is usually in the prerogative of the people in the medical profession.
Absence of the Primary Doctor Due to a Foreign Visit
Dr. C. Anand Somaya, the primary surgeon overseeing Mr. Jaiswal’s care, was abroad during a critical phase of the treatment. The family alleged that his absence led to inadequate care. The Supreme Court, however, rejected this argument, emphasizing the collaborative nature of care in a multi-specialty hospital.
In this respect, hospitals like Bombay Hospital, where Dr. Somaya worked, have a panel of specialist doctors who can offer all-round treatment. The absence of one will not make the treatment bad, especially when other specialists like Dr. Somaya are around. The Court noticed nothing that could prove that the specialists who were giving treatment to Mr. Jaiswal in the absence of Dr. Somaya were incompetent or deprived of necessary care.
The Court also acknowledged that doctors are like any other professionals who have commitments that may require travel. What matters is whether the patient’s care is adequately managed in their absence. In this case, the treatment records indicated that a team of specialists monitored Mr. Jaiswal and took necessary steps to address his condition. This decision further contends that the standard of care indicated by the evidentiary model is one of a team effort and not that of individual doctors, which is another reason why there is no proven negligence.
Application of the Doctrine of Res Ipsa Loquitur
The doctrine of res Ipsa loquitur, allows negligence to be inferred from the nature of an accident when direct evidence is unavailable. The NCDRC applied this doctrine to infer negligence in Mr. Jaiswal’s treatment. However, the Supreme Court disagreed, finding the doctrine inapplicable in this scenario.
The Court put heavy stress on three conditions of this doctrine:
- that it is an incident of a kind which ordinarily does not occur in the absence of negligence,
- that it is caused by an agency or instrumentality within the exclusive control of the defendant, and
- that the plaintiffs have not contributed to the cause. In this case, the complications that set in after treating Mr. Jaiswal were keeping in tune with the risk that his pre-existing condition exposed him to.
The treatment records demonstrated that the medical team took all reasonable steps to address Mr. Jaiswal’s condition, adapting to challenges as they arose. The complications, including gangrene and the subsequent amputations, were unfortunate outcomes of his severe medical condition rather than evidence of negligence.
This aspect of the judgment underscores the importance of scrutinizing the evidence before applying res Ipsa loquitur. Adverse outcomes in medical care do not automatically imply negligence, particularly when the risks are inherent to the patient’s condition and the medical professionals act within the standard of care.
Relation to and Comparison with Other Case Laws
In Martin F. D’Souza v. Mohd. Ishfaq (2009), the Supreme Court observed that a doctor is not liable for medical negligence merely because the treatment has failed or the surgery has not resulted in the desired effect. This principle does maintain consonance with the present case and, indeed, upholds that bad outcomes do not necessarily portray negligence.
In the case of Jacob Mathew v. State of Punjab (2005), it was stated that a medical professional does not commit negligence per se if they act in accordance with a practice accepted as proper by a responsible body of medical professionals. The bench reiterated that an error of judgment does not constitute negligence. The Bolam test, as applied below, says that a doctor is not negligent if his actions were in accordance with a practice accepted by a responsible body of medical opinion.
In the following years, in the case of Vinod Jain v. Santokba Durlabhji Memorial Hospital (2019), the Supreme Court reiterated the position that a doctor cannot be held liable for negligence only because there existed some better alternative treatment. The court held that a treatment that is acceptable in the medical profession is not considered negligent.
In 2019 case of Dr. S.K. Jhunjhunwala v. Dhanwanti Kumar the Court observed that going by the provisions, no medical practitioner can be held guilty of such negligence and that things went wrong either because of the mischance or misadventure or an error of judgment in choosing one reasonable course of treatment over another. An action lies only when the conduct falls below the standards of a reasonably competent practitioner.
Succeeding Case Laws
Jyoti Devi v. Suket Hospital (2022): the Supreme Court referred back to the principles laid down in the Bombay Hospital case bringing out that all adverse outcomes do not by themselves amount to medical negligence. The court reaffirmed that, in order to prove negligence, there should be a breach of duty causing harm, and the standard of care should be judged against contemporary standards of medicine.
Neeraj Sud v. Jaswinder Singh, (2022): In this judgment, the Court placed reliance on the case of Bombay Hospital to emphasize that medical negligence cannot be attributed except on the failure of a medical professional to exercise reasonable skill and care. It was emphasized that an error of judgment is not negligence if the course of action taken is acceptable and is adopted with deliberation.
Conclusion
The case of Bombay Hospital & Medical Research Centre v. Asha Jaiswal highlights some crucial principles of medical negligence law. The overturning of the NCDRC finding of liability by the Supreme Court holds significance for the legal as well as the medical fraternity. The Court affirmed that an adverse outcome in medical treatment cannot, in and of itself, establish negligence. There has to be clear evidence of a failure in the standard of care as would be expected from a reasonably competent medical practitioner. The Court dealt with the issues regarding negligence against the hospital and its medical staff in a very elaborate and well-structured manner.
With regard to the malfunction of the DSA machine, the Court explained that technical breakdowns usually fall outside human control and cannot be made the basis for negligence in the absence of any evidence of improper maintenance or foreseeable failure.
The Court had also correctly opined on the issue regarding Dr. C. Anand Somaya having gone out of the station during part of the treatment, that in modern multi-specialty hospitals, health delivery is through teams of qualified professionals. Absence of one would not qualify as negligence so long as alternative arrangements maintain continuity and quality. This aspect of judgment holds the collaborative nature of modern medical practice strong.
The Court said that from such organization and urgent replacement of newspaper diagnostic procedures by the hospital, it was clear that everything was done to do justice to the patient care; thus, there was no negligence. Not to forget, the fact that there was no availability of the operation theatre was understood, looking at the hospital’s practicality in its operation. The Court accepted that limitation of resources and high requests in multi-specialty hospitals are inevitable facts of life. The only aspect of significance is whether the hospital really operated them prioritized and managed them responsibly, which the facts projected.
In the reasoning, centrally, the rejection of the doctrine of res ipsa loquitur took place. The doctrine, which applies to cases where adverse results are most probably explained by negligence, was found inapplicable in court since evidence showed that Mr. Jaiswal’s complications emanated from a severe pre-existing condition, not from any omission or error by the medical professionals.
Suggestions
- Stringent maintenance and quality control are other processes in hospitals that involve extensive documentation for repairs, ongoing service, and methods for accident recovery to eliminate scenarios of equipment failure.
- Hospitals can optimize resource allocation under such situations, especially in emergencies, by having dedicated emergency operating rooms and taking timely schedules and changes to decrease delays for critical surgeries.
- Transparency, as far as treatment decisions, available resources, and unforeseen complications are concerned, should build rapport and reduce litigation possibilities. Hospitals must maintain patient liaison officers who will act as the link between the medical staff and the families.
- Medical practitioners must supplement their medical knowledge with risk management and legal compliance training so that they can better navigate complex medical and legal scenarios. General awareness concerning the legal implications of negligence claims will help them take preventive measures and maintain good documentation of their actions.
- Litigation can be a process that prolongs and becomes stressful for others too. Hospitals should promote mediation and alternative dispute resolution mechanisms to remedy grievances on an immediate basis and amicably.
- Hospitals and medical associations should facilitate campaigns to educate the public about realistic expectations of medical procedures.
- Regular audits and external accreditation by independent bodies should help the hospitals to conform to the healthcare standards. Such measures would lend credibility to institutions and minimize negligence actions.
By these recommendations, it ensures that the health providers generate a culture of accountability and excellence, curtailing instances of negligence claims while ensuring better care for the patients.
FAQ’s
- What is the legal doctrine of res ipsa loquitur, and when is it applied?
The doctrine of res ipsa loquitur allows negligence to be inferred when the circumstances suggest that the injury is one which normally would not occur without negligence, is exclusively within the control of the defendant, and that the plaintiff did not contribute to the injury in any way.
- Can a hospital be responsible for equipment malfunction?
There are circumstances under which the hospital may be liable for malfunctioning equipment, mainly when it is shown that faults occurred because of poor maintenance or because preventive measures against known dangers were ignored. An unforeseeable defect does not mean automatic negligence, if the hospital acted reasonably to keep the equipment in good working order.
- Can a patient’s pre-existing conditions affect claims of negligence?
A patient’s pre-existing medical complications might provide an explanation for the poor outcome. If the defendant hospital or medical practitioners follow the standard medical procedures considering those conditions, in acts or omissions contributing to injuries, they might have a better chance of successfully fighting against claims of negligence.
- Can adverse medical outcomes alone lead to a finding of negligence?
Reasonable systemic variations do not always lead to a case of negligence. Inherent risks in a given procedure mean that an unfavourable outcome can occur, despite proper care. A claim of negligence should, therefore, establish that the medical service provider failed to meet the appropriate standards of care.