Jaswindher Singh and Anr. v. Santokh Nursing Home and Ors. Etc, (2012) 12 SCC 550

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INTRODUCTION

The case revolves around the order that was passed by the National Consumer Disputes Redressal Commission in the matter of the death of the wife of the appellant owing to the medical negligence performed by the doctor. The case talks about the main issue of the credibility of the order that was passed by the National Consumer Disputes Redressal Commission in the reduction in the amount of the compensation that was determined by the State Commission.

Another issue on which the court decided in the matter was whether medical negligence resulting in a patient’s death could subject a nursing home to liability. The case had certain legal implications on the other matters which are related to a similar nature as it talks about the holding of liability of nursing homes in case they fail the adequate medical standards or they do not practise a standard amount of care which is to be ensured by every person who is in the medical profession.

FACTS OF THE CASE

• The appellants are upset by the ruling in Santokh Nursing Home v. Jaswinder Singh, First Appeal No. 506 of 2005 order dated 7-7-2009 (NC) of the National Consumer Disputes Redressal Commission (also known as “the National Commission”), which partially allowed the appeals filed by Respondents 1, 2, and 3 as well as the insurance company. The award from the State Consumer Disputes Redressal Commission, Union Territory, Chandigarh (also known as “the State Commission”) was cut from Rs. 12,34,414.50 to Rs. 8,00,000.
• The appellants filed a complaint under Section 17 of the Consumer Protection Act, 1986, claiming that the respondents’ medical negligence and deficiency in service caused Smt. Ravinder Kaur to pass away. After receiving a total hysterectomy and having a fibroid removed from her uterus, Smt. Ravinder Kaur was admitted to Santokh Nursing Home (Respondent 1) on August 6, 2004. Dr. Rashmi Jain (respondent 3) performed the surgery, and on September 13, 2004, she was released from the facility. An ultrasound of her abdomen was performed on a follow-up visit, during which it was found that two measuring 13 X 9 gauges were left in her abdominal cavity.
• Following that, Respondent 2 (Dr. Kuldip Singh) conducted an intestinal colostomy. Smt. Ravinder Kaur was admitted to PGI, Chandigarh on June 9, 2004, due to the removal of gauges and mops. She was brought to Fortis Heart Care and Multi-Speciality Hospital in Mohali on October 13, 2004, and a month later, septicemia in her belly claimed her life. The appellants sought Rs. 50,000,000 in total compensation. 
• The State Commission found that Respondent 3 had engaged in gross negligence and was therefore obligated to pay the appellants based on the facts presented by the parties and their pleadings. Moreover, respondents 1 and 2 were found vicariously accountable. As a result, the insurance company, Respondents 1, 2, and 3, and the appellants’ complaint was accepted, and it was mandated that they pay compensation of Rs. 12,34,414.50, together with interest at the rate of 6% annually from the date of the complaint to the actual payment and cost of Rs. 10,000. 
• The national Commission then thought about whether the State Commission’s award of compensation was too high. It took note of the claim made in front of it that the deceased was only a homemaker and was not earning any money from any profession, so it lowered the amount of compensation to Rs. 8,00,000/-. 

ISSUE

• Whether the National Commission committed an error by reducing the amount of compensation determined by the State Commission?
• Whether the nursing home was liable for medical negligence?

CONTENTIONS OF THE APPELLANT

• The appellants’ learned counsel, Shri Himanshu Gupta, contended that the National Commission should be held liable for the impugned order in Santokh Nursing Home v. Jaswinder Singh, First Appeal No. 506 of 2005, dated 7-7-2009 (NC), as it lacks convincing justification for the compensation reduction of Rs. 4,34,414.50. The knowledgeable attorney argued that the State Commission’s award of pay could not be reduced based on the specific opinion held by the National Commission members regarding the worth of the services provided by housewives.
• The appellant argued that his wife died as a result of receiving inadequate medical care from the respondent nursing home, in violation of the Consumer Protection Act. He maintained that the nursing facility had violated their Act-mandated duties and that his wife, as a consumer, had a right to demand appropriate medical treatment.
• Additionally, the appellant claimed that his wife’s death was caused by the respondent nursing home’s negligence in providing her with medical care. He maintained that the nursing home’s failure to promptly diagnose her illness and administer the necessary care for her resulted in her death.
• The appellant argued that the respondent nursing home had broken their contract with him by neglecting to give his wife the necessary medical attention, which resulted to her death. He contended that his wife’s health was declining because the nursing home had promised to give her specialized medical care, but they had neglected to do so.
• The appellant contended that the hospital was insured and, according to the knowledgeable counsel the insurance company has already paid a total of Rs. 5,00,000/-..

CONTENTIONS OF THE RESPONDENT

• The National Commission did not err in lowering the amount of compensation, according to respondent 3’s experienced counsel, Shri Rajiv Kataria, because the appellants failed to provide any proof that the deceased had a profitable employment. He added that by using the multiplier of 13, the State Commission made a severe mistake by failing to take into account the fact that the deceased was fifty years old at the time of the procedure and his death.
• The respondent contended that the appellants had engaged in laches by unnecessarily delaying the commencement of judicial proceedings against them. The respondent argued that although the appellants didn’t bring a case until 2010, they were aware of the alleged fault since 2004. The respondent based its case on the ruling in Bharat Coals Ltd. V. Bhushan Steel Ltd., (2002) 4 SCC 337.
• Additionally, the respondent argued that because the appellants’ claim was made more than three years after their cause of action accrued, it was prohibited by prescription. Citing Section 11 of the Limitation Act, 1963, the respondent contended that the appellant’s child’s hospital discharge in 2004 gave rise to the cause of action.
• The respondent asserted that they had given the appellant’s child the appropriate medical attention while denying any fault on their part. The reply stated that they had attempted every effort to preserve the child’s life and that her condition was severe.

JUDGEMENT

• The court sed aside the order of the State Commission and directed the appellants to pay the balance amount of compensation with 6 percent of interest which will be per annum from the date of filing the complaint.

• The court in this judgment held the performing surgeon liable and concluded that Dr. Rashmi Jain has not denied the fact that pieces of swab or mop were left inside the deceased patient’s abdomen during the surgical procedure to remove the uterine fibroid, based on the respective pleas and the vacillating stance she took throughout the complaint. Even in the absence of this, there is sufficient evidence—the ultrasound report and the treatment/surgery the patient underwent—to demonstrate that, during the deceased’s surgery with Dr. Rashmi Jain, a foreign object, similar to a mop, was left inside the abdomen. Additional doctors indeed help the surgeon during such a surgical procedure. 
• The court also held that Despite receiving the greatest care available in an improved hospital, the patient’s death was caused by an infection and septicemia from the fragments of mop/swab that remained within her abdomen. Therefore, the State Commissioner’s decision to find the nursing home and Dr. Rashmi Jain guilty of negligence and deficiency in service for providing the deceased with medical treatment was entirely justifiable. The aforementioned conclusion, which asks for no intervention from this panel, is based on an accurate assessment of the information and evidence that has been put on file.
• The court determined that the nursing home and its physicians had engaged in medical negligence by neglecting to give the patient the necessary attention and care during childbirth. In addition, the Court determined that the nursing facility was further liable for having broken various requirements of the Indian Medical Council (IMC) Act and Rules.
• The plaintiff was given compensation by the court, which covered future medical costs, loss of consortium, and damages for pain and suffering. The defendants’ inability to provide appropriate medical treatment and their violations of the IMC Act and Rules were further penalized by the court with costs.
• The court further held that Quantifying the value of the services a woman or mother provides to her family—her husband and children—is not attainable. However, a financial estimate of the housewife’s/mother’s services must be produced to give compensation to the dependants. In that situation, it is necessary to interpret the term “services” broadly and to consider the loss of the deceased’s care and attention to her husband as a wife and her children as a mother. To make up for the loss of the deceased’s selfless services, they are entitled to fair compensation. The sum owed to the debtor.

ANALYSIS

The Supreme Court used the judgment that was given in the case of Arun Kumar in deciding that the National Commission committed a very grave mistake by reducing the amount of compensation that was given by the State Commission.  The Court also made it clear that vicarious liability is conditional and not absolute. The hospital and the healthcare provider needed to have an employment relationship, according to the court, and the negligent act needed to have been carried out while the employee was on the job. The Court also made it clear that actions of egregious negligence or deliberate misconduct committed by healthcare professionals are not covered by vicarious responsibility since they fall outside the purview of their employment. The Court made it clear that private hospitals are required to make sure the physicians and other healthcare professionals they employ have the necessary training and expertise. The Court stressed the need for private hospitals to keep accurate records of the training and experience of their physicians since these data could be used as proof in lawsuits alleging medical malpractice.

CONCLUSION

The case serves as the best example where the Court restated that the nature of a medical institution’s relationship with its contractors will determine its liability for medical negligence committed by the latter and that the establishment of an agency relationship is a prerequisite to the institution’s vicarious liability. To reduce potential liability for medical negligence, the Court further stressed that institutions must take appropriate steps to guarantee that their contractors adhere to the necessary standard of care. The Court made it clear that an agency connection is not always established by simply giving the contractor access to facilities, equipment, and infrastructure. The Court further stressed that a medical facility should guarantee that its contractors uphold the same standard of care as it does, and that the facility should demand no less from its contractors.

SUBMITTED BY JASLEEN KAUR BAHRI

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