Medical Negligence & Res Ipsa Loquitur | Where Negligence Is Evident, Burden Of Proof Shifts To Hospital: Supreme Court

In a significant judgment delivered on September 26, the Supreme Court affirmed the applicability of the principle of res ipsa loquitur in the context of medical negligence cases, emphasizing its applicability in cases where negligence is evident and shifts the burden of proof onto the hospital or medical practitioners. Res ipsa loquitur means "the thing speaks for itself”.

The Court affirmed this principle while awarding Rs 1.5 crore compensation to an ex-Indian Air Force official who contracted HIV during a blood transfusion at a military hospital.

It observed that “the condition in which the appellant found himself, was the direct consequence of the two hospital establishments and their breach of the standards of care, resulting in the transfusion of the HIV-positive infected blood into the appellant, which was the causative factor. The necessary foundational facts, to hold that the application of res ipsa loquitur was warranted, were proved in all detail. The respondents failed to discharge the onus that fell upon them, to establish that due care was in fact exercised and all necessary care standards, applicable at the time, were complied with. As a result, it is held that the respondents are liable to compensate the appellant for the injuries suffered by him.”

The Court held both the Indian Army and the Indian Air Force jointly and severally liable for medical negligence

The bench comprising Justices S Ravindra Bhat and Justice Dipankar Datta was hearing an appeal against a judgment of the National Consumer Disputes Redressal Commission(NCDRC) which denied the compensation claimed by the Air Veteran.

The Court began by citing Charlesworth & Percy on Negligence(14th Ed. 2018) to define this principle as a case that "calls for some answer from the defendant and will arise upon proof of:

(1) the happening of some unexplained occurrence;

(2) which would not have happened in the ordinary course of things without negligence on the part of somebody other than the claimant; and

(3) the circumstances point to the negligence in question being that of the defendant, rather than that of any other person."

The Court referred to several previous judgments, including V. Kishan Rao v Nikhil Super Speciality Hospital (2010) 5 S.C.R. 1 which emphasized that when negligence is evident, "the principle of res ipsa loquitur operates, and the complainant does not have to prove anything as the thing proves itself." In such cases, it becomes the responsibility of the respondent to demonstrate that they have taken due care and fulfilled their duty to refute the charge of negligence.

The Court further highlighted the importance of applying the principle of res ipsa loquitur in medical negligence cases. It cited the Nizam Institute of Medical Sciences case (2009) 6 S.C.C. 1, stating that once the initial burden is discharged by the complainant by demonstrating negligence on the part of the hospital or doctors, the onus shifts to the hospital or attending doctors to prove the absence of negligence.

The Court had observed, “In a case involving medical negligence, once the initial burden has been discharged by the complainant by making out a case of negligence on the part of the hospital or the doctor concerned, the onus then shifts on to the hospital or to the attending doctors and it is for the hospital to satisfy the Court that there was no lack of care or diligence.”

Additionally, the Court referred to the Savita Garg case (2004) SUPP. 5 S.C.R. 359, which established that once evidence is presented indicating that a patient suffered due to a lack of care, the burden shifts to the hospital to justify the absence of negligence.

It observed that “once the complainant or aggrieved party had adduced some evidence that the patient suffered (or died, as in that case) due to lack of care (or as in this case, suffered irremediable injury due to want of diligence) then the burden lies on the hospital to justify that there was no negligence on the part of the treating doctor or hospital. Therefore, in any case, the hospital is in a better position to disclose what care was taken”

However, the Court also cautioned against relying solely on res ipsa loquitur to assign liability as highlighted in the cases of Martin F. D’Souza (2009) 3 SCC 1 and Bombay Hospital and Medical Research Centre v Asha Jaiswal 2021 (10) SCR 1118. In Aisha Jaiswal’s case, the court observed that “ the maxim res ipsa loquitur does not require the raising of any presumption of law which must shift the onus on the defendant. It only, when applied appropriately, allows the drawing of a permissive inference of fact, as distinguished from a mandatory presumption properly so-called, having regard to the totality of the circumstances and probabilities of the case. Res Ipsa is only a means of estimating logical probability from the circumstances of the accident.”

In light of the above, the court ordered “As a result, it is held that the respondents are liable to compensate the appellant for the injuries suffered by him, that are to be reckoned in monetary terms.”

Also from the judgment - 'Army & Air Force Liable' : Supreme Court Awards Rs 1.5 Crore Compensation To Air Veteran Who Contracted HIV During Blood Transfusion

Prioritise Cases Of HIV Positive Persons : Supreme Court Directs All Courts; Issues Directions To Centre & States To Enforce HIV Act

Case Number: C.A. No. 7175/2021

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