The Supreme Court while deciding a case of medical negligence held that principles of Res Ipsa Locutor get attracted where circumstances strongly suggest partaking in negligent behaviour by the person against whom an accusation of negligence is made. Res ipsa loquitur means “the thing speaks for itself”.

In the context of a legal claim based on negligence, res ipsa loquitur essentially means that the circumstances surrounding the case make it obvious that negligence occurred. “For applying the principles of Res Ipsa Locutor, it is necessary that a ‘Res’ is present to establish the allegation of negligence. Strong incriminating circumstantial or documentary evidence is required for application of the doctrine.,” a Division Bench of Justices A.S. Bopanna and Prashant Kumar Mishra said.

The grievance of the dead’s widow, the appellant, is the basis for the current case. She claims that after the deceased was moved into a private room, no doctor from the neurosurgery team saw him until 11:00 P.M. The dead had experienced a heart attack at the same moment and had finally passed away. There was a contention that following such extensive surgery, the deceased ought to have been moved to the Intensive Care Unit rather than being placed in a private room. The appellant initially filed a case with the National Consumer Disputes Redressal Commission, but it was denied. Hence, the current appeal.

In the instant case, the crucial issue to be decided was whether the concerned hospital and doctor have committed negligence in not providing proper postoperative medical care to the patient. Further, whether the Commission has committed any illegality while dismissing the complaint filed by the appellant herein.

Factual Background

The wife of the dead patient, Sankar Rajan, who was 37 years old when he passed away on November 6, 1998, at the Indraprastha Apollo Hospital (respondent no. 1) while receiving follow-up care and therapy following a major neurosurgery, has filed the current appeal.

It should be mentioned that the deceased had hydrocephalous Chiari malformations (Type II). The deceased in this case sought the advice of Dr. Ravi Bhatia, current respondent no. 2, a senior consultant in the hospital’s department of neurosurgery, who suggested that he be admitted to the same facility so that he may undergo the surgery there.

Taking Dr. Bhatia’s recommendation, the dead checked himself into a hospital. Following the procedure, the patient was moved into a private room. Between 04.15 and 04.30 p.m., the attending physicians were notified of pain in the neck area, which appeared to have moved to a lower location than it had before the procedure. The deceased then experienced a heart attack at approximately 11:00 p.m. After being placed on life support on October 31, 1998, and certified brain dead, he passed away on November 6, 1998.

Contentions of the Parties

While acknowledging that the dead had no cardiac issues, Senior Advocate Nikhil Nayyar argued on behalf of the appellant that the deceased passed away from cardiac arrest. He further claimed that the deceased was told upon admission that he would be sent to the intensive care unit following surgery. He wasn’t moved to the ICU, though; instead, he was moved from the recovery area to a private room.

 Regarding the conclusions of the contested order, the involved counsel disputed it, claiming that it contradicts the evidence in the file that shows the respondents’ negligence in the deceased’s post-operative treatment.

However, senior attorney Meenakshi Arora, representing Dr. Bhatia/respondent no. 2, defended the contested ruling, arguing that it had no flaws that call for the Top Court to get involved. She further claimed, among other things, that the deceased and the appellant were informed that the patient would be examined in the recovery room first and that, in accordance with hospital protocol, all patients who do not exhibit complications in the recovery room and do not have any pre-operative medical issues are then moved to their ward or room.

Court’s Observations

The Court stated from the beginning that Dr. Bhatia’s carelessness during the neurosurgery is not the main issue in this case; rather, it is about inadequate postoperative medical treatment.

The patient was allegedly supposed to have been moved to the intensive care unit rather than a private room, according to the court. The Court noted after reviewing the pertinent documentation that it showed how, in accordance with regular procedure, all patients who exhibit no difficulties in the recovery area and who have no postoperative or preoperative complications are sent to their rooms.

Addressing the facts of the present case, the Court opined that there is no evidence put forth by the appellant to establish that heart attack suffered by the patient had any connection with the operation in question or that it was on account of negligent post operative care. The Court also noted that the patient did not have any history of diabetes or hypertension or any cardiac problem. Therefore, it was difficult for treating doctors including the duty doctor or the hospital to assume that the patient may suffer cardiac arrest and moreover, the patient had also not complained of pain in any other part of the body except neck region.

On the issue as to when a medical officer may be held liable for negligence, the Court cited the case of Jacob Mathew v. State of Punjab and another, (2005) 6 SCC 1, wherein it was held that “A professional may be held liable for negligence on one of the two findings: either he was not possessed of the requisite skill which he professed to have possessed, or, he did not exercise, with reasonable competence in the given case, the skill which he did possess.” Court also placed its reliance upon Bombay Hospital & Medical Research Centre v. Asha Jaiswal and Others, 2021 SCC online SC 1149, wherein the Court has elaborately considered previous judgments on the subject including Martin F. D’Souza v. Mohd. Ishfaq, (2009) 3 SCC 1. In the latter case, it was clearly held that“Simply because a patient has not favourably responded to a treatment given by a doctor or a surgery has failed, the doctor cannot be held straightaway liable for medical negligence by applying the doctrine of res ipsa loquitur.”

Due to the foregoing reasons, the Court concluded there was no mistake in diagnosis or a negligent diagnosis by Respondent no. 2. In the absence of the patient having any history of diabetes, hypertension, or cardiac problem, it is difficult to foresee a possible cardiac problem only because the patient had suffered pain in the neck region, the Court stated. Therefore, while dismissing the appeal, it recorded that the appellant has failed to establish negligence on the part of Respondents in taking post operative care.

Case Title: Mrs. Kalyani Rajan v. Indraprastha Apollo Hospital & Ors, Civil Appeal No. 10347 Of 2010