Dr. Harish Kumar Khurana Vs. Joginder Singh [2021]

CITATION	LL 2021 SC 425
DATE OF JUDGEMENT	7th   September 2021
COURT	The Supreme Court of India
APPELLANT	Dr. Harish Kumar Khurana
RESPONDENT	Joginder Singh and Ors
BENCH	Justice Hemant Gupta and Justice AS Bopanna

INTRODUCTION

Negligence is simply failing to take necessary care. Medical negligence happens when a doctor fails to meet the norms of his or her profession. Medical negligence claims are among the most complex conflicts in the legal system. These issues are at the crossroads of law and medicine, necessitating a delicate balance between preserving patients’ rights and acknowledging the inherent risks and uncertainties in medical treatment. The following analysis looks at a landmark Supreme Court decision that provides important insights into how medical negligence standards are interpreted and used in India. The case involves charges of negligence against a doctor and a hospital after a patient died during a second kidney surgery. It highlights several key issues in medical negligence law, such as the standard of care expected of medical professionals, the significance of informed consent, the role of medical evidence in proving negligence, and the application of legal principles like res ipsa loquitur in medical contexts.

FACTS OF THE CASE

1. Jasbeer Kaur was admitted to Sun Flag Hospital, Faridabad, for surgery. 
2. She was diagnosed with hydronephrosis, her right kidney was seriously injured, and her left kidney had a stone. 
3. After being certified fit for surgery, it was determined that both kidneys could not be operated on at the same time, and that the less affected, i.e. left kidney, would be operated first. 
4. Both the woman and her husband provided informed consent for high-risk surgery. 
5. The surgery on the left kidney was successful, and the patient’s condition improved. Following that, the patient was taken in for a second surgery. 
6. Dr. Harish Kumar Khurana administered Pentothal Sodium and Scolin in accordance with medical practice. An endotracheal tube was placed into the trachea to administer nitrous oxide and oxygen. 
7. This normal method was also used during the initial surgery, but this time the patient’s health deteriorated, her blood pressure dropped and her pulse became faint, cardiac respiratory arrest was detected, and she was placed on Boyle’s machine and an automated ventilator. 
8. Regardless, the patient died. The patient’s spouse and children filed a complaint with the National Consumer Disputes Redressal Commission (“NCDRC”), citing medical negligence. 
9. The NCDRC judged Dr Khurana and the institution guilty and ordered compensation of Rs 17 lakh. Dr. Khurana and the hospital took their grievance to the Supreme Court. 

ISSUES RAISED

1. Whether there was medical negligence on part of the appellant?
2. Whether the death of patient during surgery assumed to be medical negligence?

CONTENTIONS OF APPELLANT

The appellant,Harish Kumar Khurana, contented that: 

1. The high risk involved in the second operation was made known to the patient and the cardiac arrest which occurred in the present case is likely to occur in certain cases for which appropriate care had been taken by the doctors. 
2. The observation relating to poor tolerance to anaesthesia was explained as not being a major issue because the earlier operation was successful and was not eventful though anaesthesia had been administered in the same manner for the first surgery.
3. The learned counsel for the appellants made detailed reference to the history of the patient and the patient’s sheet maintained by the hospital. In that regard it is pointed out that on 13.12.1996 the doctor had recorded that the surgical recovery which related to the first operation conducted on 09.12.1996, to be excellent. On 14.12.1996, the observation recorded also indicated that the patient is insisting for surgery of the other side. 
4. The patient’s husband provided informed consent, which included verification of risk factors. 
5. The appellants contend that every unfortunate incidence cannot be classified as medical negligence. 
6. The hospital claims that it had adequate facilities and that the doctors provided appropriate care. 
7. The appellants deny that the observation on 14.12.1996 concerning the patient’s insistence on surgery constituted an insertion. 
8. They dispute the assertions about the lack of a ventilator, claiming that the Boyle equipment was adequate, and that the anaesthetist’s claim of manual operation is plausible. 
9.  The appellants dispute the claim that the hospital lacked a public address system or paging service, which purportedly caused a delay in locating a physician to resuscitate the patient.

CONTENTIONS OF RESPONDENT

The respondent, Joginder Singh, contends that:

1. The appellant doctor and hospital failed to deliver the necessary care in treating the patient. 
2.  Dr. Majumdar, who performed the initial procedure on 09.12.1996, noted on the case sheet that the patient had a low tolerance for anaesthesia. 
3.  The patient was allegedly compelled to have a second procedure in a short period of time, which had negative implications. 
4. Despite the observation of poor anaesthetic tolerance, proper care was not provided, and necessary medical equipment, particularly a ventilator, was not maintained available. 
5. The patient’s consent was not acquired for the second surgery. 
6. Following the patient’s cardiac arrest, adequate care was not provided to assure the presence of a cardiologist or neurologist. 
7. The physician who attended the patient need some time to change and attend to the patient, resulting in a delay.
8. The patient died as a result of medical negligence

JUDGEMENT

The Supreme Court ruled that NCDRC’s ruling could not be upheld. The appeal was accordingly granted. In the current case, the Supreme Court ruled that simply failing to treat a patient or dying during operation cannot be construed as medical negligence on the part of the physicians. 

ANALYSIS

The Supreme Court’s decision in a medical negligence case emphasizes numerous critical criteria of evaluating medical negligence. The Court underlines that ineffective treatments or patient fatalities during surgery may not always constitute carelessness, highlighting the importance of sufficient evidence or expert medical testimony in establishing such claims. In this case, the Court determined that the National Consumer Disputes Redressal Commission’s (NCDRC) conclusion lacked medical evidence and was unduly reliant on assumptions and non-expert questions. The decision examines critical issues such as the notation of “poor tolerance to anaesthesia,” the timing of the second surgery, and the informed consent procedure. The Court dismisses the NCDRC’s interpretation of these elements, stating that such conclusions are untenable in the absence of proper medical evidence.

The principle of res ipsa loquitur is discussed, with the Court holding that it only applies in circumstances of blatant negligence, which was not the case here given the successful first operation. The Court also considers the significance of a magisterial inquiry and criminal case observations but finds them lacking as medical evidence. Importantly, the decision emphasizes the importance of expert medical testimony in complex medical issues, challenging the NCDRC’s reliance on legal principles and generic criteria that lack sufficient medical context. The Court’s approach extends to the issue of informed consent, finding that getting consent from the patient’s spouse for the second surgery was reasonable under the circumstances. Overall, the Supreme Court’s ruling underlines the necessity of comprehensive, expert-based review in medical negligence cases, particularly when dealing with highly technical medical issues, and cautions against making assumptions of negligence without proper evidence.

CONCLUSION

This decision by the Supreme Court of India adds substantial clarity and guidance to the adjudication of medical negligence cases. The Court established a threshold for proving medical negligence claims by highlighting the vital relevance of expert medical evidence. The Supreme Court observed that a medical professional cannot be held negligent if he or she performs a surgery which is unsuccessful, merely because of failure of the treatment. This ruling achieves a balance between protecting patients’ rights and acknowledging the inherent difficulties and risks of medical practice. It establishes a structure that allows for responsibility in cases of true carelessness while protecting medical practitioners from baseless allegations. 

REFERENCE

1. https://indiankanoon.org/doc/96761433/
2. https://www.scconline.com/blog/post/2021/09/13/medical-negligence-3/

Written by Chukki Anagha C an intern under legal Vidhiya.

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