KALYANI RAJAN V/S INDRAPRASTHA HOSPITAL, 2023

INTRODUCTION

The case of “Kalyani Rajan v. Indraprastha Hospital, 2023” revolves around a critical legal dispute concerning medical negligence. The case begins when Sankar Rajan undergoes neurosurgery in the respondent’s hospital and thereafter suffers from cardiac arrest resulting in death. The case discusses the issue of lack of proper post operative care on part of the respondents and the legality of the order passed by the NCDRC. This case asks critical questions regarding issues of medical negligence and the duty of medical professionals in exercising their skills with due care. The judgement underscores the requisites of proving medical negligence and interprets the principle of Res Ipsa Locutor in reference to this case. 

FACTS OF THE CASE

1. Sankar Rajan, aged 37 years old, was suffering from Chiari Malformations (Type II) with Hydrocephalous.
2. Sankar Rajan consulted Dr. Ravi Bhati – Senior Consultant, Department of Neurosurgery of Indraprastha Hospital – on 21^st October 1998 who advised him to get admitted to the hospital where the surgery would be performed by him. 
3. As per this advice, Sankar got admitted in the hospital on 29^th Oct 1998. After performing pre-operative medical examinations, Dr. Bhatia conducted the surgery. Thereafter, the patient was shifted to a private room. Fifteen minutes later, the doctors were informed about pain in the neck region, which seemed to have descended lower than the region where pain used to occur before the operation.
4. At 6:30 pm the patient was given pain reliever but the pain increased along with severe sweat spells. At about 9:15 pm, the patient started suffering from severe unbearable pain. The complainant-appellant tried to call Dr. Bhatia at his home phone but he was not available. At 9:30 pm another pain killer was intravenously administered. 
5. At about 11 pm, complainant-appellant talked to Dr. Bhatia at his residence. The patient, Sankar Rajan, had suffered from a heart attack around 11 pm. He was declared brain dead on 31^st October 1998.  He was kept on life support till he died on 6^th November 1998. 
6. The complainant-appellant alleges that the deceased was not attended to by any doctor from the neurosurgery team who had performed the operation on the deceased post which he was shifted into the private room till 11.00 pm. Following a significant surgery, the patient ought to have been transferred to the Intensive Care Unit rather than a private room.

ISSUES RAISED

1. Whether there was negligence on part of the respondents in providing proper postoperative care to the patient?
2. Whether the Commission has committed any illegality while dismissing the complaint filed by the appellant herein?

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION FINDINGS

1. The main allegation of the complainant is with regard to the lack of medical care from the time he was shifted to the private room till he suffered from a heart attack at around 11 pm. The complainant here fails to provide any cogent evidence or 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. 
2. The findings have been supported by an affidavit of Prof. Gulshan Kumar Ahuja Professor of Neurosurgery in AIIMS & Senior Consultant at Indraprastha hospital at that time. He expressed the view that the complications experienced by the deceased were entirely independent of the surgery performed by Dr. Bhatia. Additionally, he affirmed that symptoms such as neck pain, along with profuse sweating and nausea, cannot be indicative of a cardiac or respiratory arrest.
3. The deceased had no prior record of diabetes, hypertension, or heart issues, as indicated by Dr. Bhatia in his testimony. The neck pain experienced was a result of the cervical operation, and there is no evidence on record indicating pain in any other part of the deceased’s body. 
4. The appellant’s contention with regard to the deceased sweating is not met out with in the medical records except for once at 9 pm. Here, the appellant drew attention to the observation made in Martin F. D’Souza v. Mohd. Ishfaq that no prescription should ordinarily be given without actual examination and the tendency to prescription over the phone except in acute emergency should be avoided. These remarks are not relevant to the current case, as the deceased had reported neck pain for which a surgical procedure had been performed, and the medication provided by Dr. Tyagi over the phone was specifically for neck pain.
5. Considering the facts and conditions, there is no evidence establishing medical negligence, and it cannot be asserted that the care provided to the deceased until he experienced a cardiac arrest was insufficient in order to hold the respondents responsible for medical negligence. The Res Ipsa Loquitur principle is not applicable in this situation.

CONTENTIONS OF APPELLANT

1. The senior counsel for the appellant admitted that the deceased died due to cardiac arrest, albeit, he had no cardiac problems. At the time of admission, the deceased was informed that he would be shifted to the ICU after surgery. Yet, he was shifted from the recovery room to a private room. 
2. In respect of lack of care, appellant counsel submits that Dr. Brahm Prakash and Dr. S. Tyagi visited the room around 4:30 pm when the deceased complained of pain in the neck region which was dismissed by the doctors as post operative symptom. This was the only visit by Dr. Bhatia and other specialists to the room till the deceased lost consciousness.
3. When the pain didn’t reduce, the Duty Doctor spoke to Dr. Tyagi over call around 7:15 pm and Dr. Tyagi prescribed Nimulid. When he later had a telephonic conversation with the deceased, it was admitted that Nimulid did provide some relief. On this basis, Dr. Tyagi concluded that the symptoms of pain were clearly normal post-op reaction. 
4. The deceased had an episode of Ventricular Tachycardia (‘VT’) and Dr. Bhatia admitted that VT is not his area of expertise and the patient should’ve been referred to the appropriate doctor. However, this was not done and no specialist with relevant expertise was available to the deceased.
5. With regard to the findings of NCDRC order, the appellant refutes the same and submits that they are contrary to the facts on record which establishes negligence of the respondents in the post operative care of the deceased. The Senior Counsel additionally asserts that the Commission failed to recognize that the current case represents a distinct instance of negligence resulting from a lack of care. To support this claim, he asserts that: i) there was a total lack of a senior doctor, surgeon, or specialist to address the patient’s distress call from the moment the patient was moved to the room/ward until he lost consciousness, and; ii) there was a failure to investigate the pain to determine its cause..

CONTENTIONS OF REPONDENT

1. The counsel for the respondent no. 1, Indraprastha Hospital, submits that the hospital is one of the best hospitals equipped with the latest medical equipments. The patient was looked after by Dr. Ravi Bhatia who is an internationally acclaimed neurosurgeon. The patient experienced a successful recovery following neurosurgery, and as there were no complications after the operation, he was transferred to the recovery room and subsequently to a private room.
2. Drawing attention to the pre and post operative history of the patient, the learned counsel submits that there is no negligence on the part of the hospital or the treating doctors. The counsel refutes the contentions of the appellant and submits that in view of the findings of the Commission and the dicta of the Supreme Court in Bombay Hospital & Medical Research Centre v. Asha Jaiswal, the present appeal is liable to be dismissed. 
3. The learned senior counsel for respondent no.2, Dr. Ravi Bhatia, adopts the submissions advanced on behalf of respondent no.1 and well as the findings of the Commission as well as the dicta of the Supreme Court in Bombay Hospital case. 
4. Furthermore, respondent no.2 contends that before the procedure, the appellant and the deceased were informed that the patient would undergo an examination in the recovery room first. Subsequently, in accordance with the hospital’s standard practice, patients without signs of complications in the recovery room and without pre-operative medical issues are transferred to their respective ward or room. In case the patient develops any complications, they would be transferred to the neurology ICU. To substantiate this claim, he has provided data from respondent no. 1/hospital concerning the neurosurgeries performed and the count of patients subsequently transferred to the Neuro ICU. The deceased had gained full consciousness when he had been moved from the Operation Theatre to the recovery room. 
5. The counsel for respondent no.2 also submits that Dr. Brahm Prakash met the deceased and no complaint was made at that time. Around 5 pm, he, along with Dr. Tyagi, met with the deceased and conducted an examination. At that time, the deceased complained of only mild neck pain which is normal after an operation on the cervical (neck) region. Thereafter, he left the premises and submits that between then and till he received a phone call from the appellant at 11:15 pm about the deceased’s condition, he did not receive any calls on either his mobile phone or landline, and there were no messages left for him at his residence. The learned senior counsel refutes the contentions of the appellant and submits that the impugned order suffers from no infirmity warranting interference by this Court and is liable to be accordingly dismissed. 

JUDGEMENT

The complainant had never questioned the diagnosis and the recommended treatment given to him by Dr. Bhatia hence the entire case of the complaint is about lack of proper postoperative care. It is alleged that there was negligence in not shifting the patient to the ICU after the surgery and instead moving him to a private room. As submitted by the respondents, the material available shows that on no signs of complications, patients were shifted first to a private room and only when there were complications they were taken to the ICU. Standard procedure had been followed. The symptoms shown by the deceased were not those of a typical cardiac arrest and could not be treated as post-surgery reactions. Since there were no complications during the surgery or shortly afterward, it was unnecessary to transfer the patient to the ICU, and neither of the respondents can be deemed negligent in this regard.

The next part of the allegation is that the deceased was not attended to by any doctor from the neurosurgery team after he was shifted into the private room till he suffered cardiac arrest. The information presented to this court, including the hospital records, indicates that Dr. Brahm Prakash, Dr. Ravi Bhatia, and Dr. Tyagi examined the patient after being moved to the private room. The complainant has not provided any evidence to demonstrate a connection between the patient’s heart attack and the surgery or to suggest it resulted from negligent postoperative care.

It is important to highlight that the patient had no prior history of diabetes, hypertension, or cardiac issues. Consequently, the medical professionals, including the duty doctor and the hospital staff, faced challenges in anticipating a cardiac arrest. Additionally, the patient had not reported pain in any other part of the body, except in the neck region.

After acknowledging the legal precedents referenced by the counsels, it is evident that in instances where medical treatment is unsuccessful or a patient dies during surgery, automatically assuming medical negligence is unwarranted. Demonstrable evidence or appropriate medical proof should be available to establish negligence. The alleged negligence must be glaring, and in such cases, the principle of res ipsa loquitur could be applied, not merely based on perception. In the current case, besides the assertions presented by the claimants to the NCDRC in both the complaint and the affidavit during the proceedings, there is a lack of additional medical evidence put forward by the complainant to indicate negligence by the doctors. The doctors, in their own affidavits, have explained their position regarding the medical procedures, asserting that there was no negligence.

The Supreme Court ruled that the appellant had failed to establish negligence on the part of the 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 appeal, accordingly, was dismissed. 

ANALYSIS

1. Medical Negligence – In the case of medical negligence, it is necessary to prove two conditions: the medical professional did not possess the requisite skills that he claimed to have possessed or when he did not exercise these skills with reasonable competence. In this case, the doctor’s diagnosis or surgical skills were not challenged. As the symptoms shown by the patient were not indicative of cardiac arrest and he did not have a history of heart problems, the doctors took reasonable care of the patient in administering treatment.
2. Res Ipsa Locutor – Res Ipsa Locutor means ‘things speak for themselves’. In the legal sense, it refers to a situation where it is not necessary that misconduct had taken place for the consequences of the action would not be such had there been no misconduct. This case failed to apply the principle of Res Ipsa Locutor as the patient was not left unattended and was duly monitored and treated by doctors regularly. 

CONCLUSION

In summary, the “Kalyani Rajan v. Indraprastha Hospital, 2023” case focused on alleged medical negligence in postoperative care following a neurosurgery that resulted in the patient’s cardiac arrest and death. The court, including the National Consumer Disputes Redressal Commission and the Supreme Court, found no evidence linking the patient’s demise to the surgery or negligent care. Standard procedures were followed, and the absence of specific symptoms or a medical history of cardiac issues supported the respondents’ position. The court emphasized the need for concrete evidence in medical negligence cases and rejected the application of the Res Ipsa Locutor principle. The appeal was ultimately dismissed, reinforcing the importance of proving negligence through tangible evidence in medical malpractice claims.

REFERENCES

1. https://indiankanoon.org/doc/125669903/
2. https://vlex.in/vid/martin-f-d-souza-572018310

This Article is written by Astha Samal student of National Law University Odisha; Intern at Legal Vidhiya.

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