Medical Negligence | Supreme Court Sets Aside Adverse Observations By NCDRC Against Top Cardiologist Dr Upendra Kaul

The Supreme Court on Wednesday(16 August ) set aside the aside adverse observations made by the National Consumer Disputes Redressal Commission (NCDRC) against top cardiologist and Padma Shri Awardee Dr Upendra Kaul in relation to a patient who had died after an angioplasty procedure conducted in AIIMS following a cardiac arrest. The case related to an incident in 1994.

A bench of Justices AS Bopanna and Justice Prashant Kumar Mishra was hearing an appeal against the NCDRC decision which upheld the state commission’s finding that while the appellant doctor could not be held guilty, the hospital was culpable of administrative negligence since the bypass machine was not available readily. 

The Supreme Court observed :  “NCDRC upheld the judgment of the state commission which would in effect mean that the finding as against hospital alone was upheld and allegation against doctor has not been accepted by NCDRC. But, the Observation by NCDRC to refer PTCA report to contradict the version of the appellant doctor would give an impression as if certain adverse observations have been made against the doctor.”

The Court also pointed out the respondent’s failure to present evidence that the procedure deviated from established norms. It observed, “It is evident that except for allegations made in the complaint, the respondent has not given evidence of any independent doctor that the manner and procedure as followed was not the appropriate procedure.”

The major issue identified by the Court was the ventilator support system post-angioplasty and the bypass machine, PCPS being put to use. In that regard, NCDRC had noted that “though Dr Kaul had stated that ventilator system was immediately connected when angioplasty conducted and PCPS(bypass machine) was connected within 30 minutes, the NCDRC observed that such a statement is in fact contradicted by PTCA report.”

However, the Apex Court agreed with the contention made by the appellant that NCDRC committed an error in confusing the ventilator system with the bypass machine. The ventilator was connected immediately as per the procedure.

The court held that “the observation made by NCDRC that the ventilator was connected belatedly is not justified. Therefore, the finding that there was a delay that led to negligence would not hold true. The adverse observations against the appellant doctor and hospital are set aside. Having taken note that the state commission had directed payment of 2 lakhs and since the said amount has already been paid, the matter is disposed of.”

At the outset of the proceeding, Advocate Prashant Bhushan appearing on behalf of the appellant submitted that there was a mishap and the patient died. It happens in 1-2% of cases.

He highlighted that while the consumer forum had awarded a compensation of 2 lakhs, which was duly paid to the heirs, the core issue remaining was the finding of negligence.

He submitted that in the present case, the National and District forum had held the doctor negligent.

Advocate Prashant Bhushan, representing Dr. Kaul, highlighted the exceptional contributions of the distinguished cardiologist, who has conducted over 11,000 successful angioplasties. Bhushan underscored the potential impact of the NCDRC's observations on Dr. Kaul's illustrious career and AIIMS' esteemed reputation.

He emphasized that NCDRC confused the bypass machine with the ventilator. In this specific case, a ventilator had been promptly deployed and the pacemaker was swiftly installed in accordance with the established Standard Operating Procedure (SOP) for cardiac arrest.

Citing the American Journal of Cardiology(1994), he contended that the bypass took 30 minutes since it has to be primed before it can be used.

The heart of the matter hinged on the claim that the bypass machine was not deployed within a 4-minute window, which formed the basis for the NCDRC's negligence finding. However, Adv. Bhushan argued that such deployment within the specified timeframe was implausible and contrary to established medical practice.

He cited Jacob Matthews's case which held that “The standard to be applied for judging, whether the person charged has been negligent or not, would be that of an ordinary competent person exercising ordinary skill in that profession.”

At this stage, Justice Mishra intervened and pointed out” But there's no specific finding as to medical negligence by the doctor in NCDRC order”?

Adv Bhushan responded that “there are observations in NCDRC order to that effect”.

Justice Bopanna, expounding on the case's backdrop, detailed that the respondent had approached the state commission, alleging medical negligence on the part of the appellants.

The complaint pertained to an angiography procedure conducted by the appellant doctor, which the respondent claimed was devoid of proper medical care, leading to death. The state commission, after a thorough assessment, concluded that while the appellant doctor could not be held guilty, the hospital was culpable of administrative negligence since the PCPS machine was not available handily. In appeal, NCDRC upheld the finding by the state commission.

Case title: Upendra Kaul v. S.C. Mathur(Dead) Thr Lrs.

Citation: 2023 LiveLaw (SC) 676

Click here to read the judgment