It Is Not An Error Of Judgment But Breach In Duty Of Care From Doctors, Who Treated The Patient; NCDRC Awards Compensation

Commission stated that, the State Commission erred to observe the duty of doctors and merely holding it as an 'error of judgment', dismissed the Complaint. Thus, it is not an "Error of Judgment" but the breach in duty of care from the doctors, who treated the patient.

In this case, three persons suffered injuries in a major road accident and they were brought to K.V.M Hospital ('Opposite Party No. 1'). One Dr. Sudha ('patient') was examined by the doctors. Her face and neck were swollen, she suffered maxillo facial injuries. The C.T. scan of her head revealed no significant intra-cranial injury. Patient's X-ray of the neck and chest were done, but the fracture of the 6th cervical vertebra was not seen. However, it was informed that her condition was not serious. Dr. Ravindran Narain ('Opposite Party No. 7') performed the wiring procedure with the help of the Opposite Parties Nos. 3 to 6 for the fractured maxilla. During the procedure, there was a sudden spurt of bleeding, which caused airway obstruction and the patient died due to oxygen insufficiency. The doctors failed to secure patient's airway; prior to the wiring and they rather performed tracheostomy or Intubation. Alleging medical negligence by improper clinical evaluation and wrong treatment from the Opposite Parties, the minor sons of the deceased, through their uncle Dr. Satish, filed a complaint before the State Commission seeking compensation of Rs. 20,00,000/- with 12% interest. The State Commission dismissed the Complaint by merely holding it as an 'error of judgment.'

The State Commission observed that, "if there was an error of judgment in not resorting to tracheostomy earlier, the same cannot be treated as negligence on part of the opposite party doctors."

Aggrieved by the decision of State Commission Kerala the Minor Sons, represented by Dr. Satish B, (Uncle) filed an appeal before the National Commission under Section 19 of the Consumer Protection Act, 1986.

Before the National Commission, the Complainants (Minor Sons, represented by Dr. Satish B, Uncle) argued that, the death would not have occurred if the basic precautions were undertaken by the Opposite Parties. It was further argued that the treating doctors have not examined the patient properly and failed to do complete investigations. They acted casually and failed to do proper airway assessment and active steps to protect the airway prior to the major surgical procedure. It was submitted that the maxillo-facial surgery was absolutely not necessary, but the doctors told it was to control the bleeding from the oral cavity, but in fact, there was no active bleeding.

The respondents (Doctors and Hospital), submitted that, the doctors never felt any need and the condition of the patient did not warrant for intubation or tracheostomy as the air entry was fair and equal on both sides and she had no difficulties in breathing before or during the first aid procedure. At the end of the First Aid procedure, the patient complained of breathlessness and immediate steps were taken as per medical protocol including tracheostomy.

Analysis:

The issue for consideration before the National Commission was whether the doctors and hospital are liable for the medical negligence or not.

From the clinical notes, Commission found that, the patient was fully conscious and well oriented and answered all the questions regarding previous history. The condition of the patient was stable. On examination, the airway was patent and the patient did not experience any difficulty in breathing. Moreover, at the time when the patient was taken to the operation theatre, the bleeding was not active.

After carefully looking into Medical Literature on 'ABC' Trauma Management, Commission stated that, From the literature, it is evident that the treating doctors failed to do the basic of ABC protocol for high velocity trauma management, thus it was their failure in the duty of care. In our view, the State Commission erred to observe the duty of doctors therein and merely holding it as an 'error of judgment', dismissed the Complaint. Thus, it is not an "Error of Judgment" but the breach in duty of care from the doctors, who treated the patient. Resultantly, the patient died.

Commission noted that, the treating doctors failed in their duties to act with reasonable degree of skill and knowledge. They have not exercised a reasonable degree of care to handle the emergency by adopting basics of ABC of trauma.

Commission relied upon the case of Dr. Laxman Balkrishan Joshi Vs Dr. Trimbak Bapu Godbole and Anr. where it was observed that, the duties which a doctor owes to his patient are clear. A person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties, viz., a duty of care in deciding whether to undertake the case, a duty of care in deciding whether treatment to give or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient.

Commission observed that, no doubt that interdental wiring is used to treat fractures of the mandible, and this is not a comment on choice of procedure. But it is clear that the procedure was undertaken without proper assessment of airway, risks to patient from Cervical spine injury and without even allowing stabilization of the patient and seems to be taken up with undue haste. Harm was certainly caused due to overenthusiastic interventions which should have been postponed to a suitable time. There is absence of effective medical notes to show if an Anaesthesiologist was available or even present at the time of the procedure. Thus, it was not a case of Error of Judgment, but a negligence.

The bench stated that, the act of omission is evident as the doctors working in KVM Hospital did not follow the basics of ABC of trauma by which one doctor lost her life. Therefore, the Hospital (Opposite Party No. 1) and Dr. Ravindran Nair (Opposite Party No. 7) are liable for breach in the duty of care.

National Commission set aside the order of the State Commission and stated that the Complainants have prayed compensation of Rs. 20 lakhs before the State Commission in the year 2001. We are now in 2022, thus lump-sum compensation of Rs. 30 lakh is just and proper.

Commission directed the opposite parties ((Doctors and Hospital) to pay Rs 30 Lakhs within 3 months.

Case Name: Abhishek V.S. & Ors. v. K.V.M. Hospital & Ors.

Case No.: FIRST APPEAL NO. 501 OF 2008

Corum: Justice R.K. Agrawal, President and Dr. S.M. Kantikar, Member

Decided on: 1^st June, 2022

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