2019 (1) TMI 1992 - SC - Indian Laws

Reversal of award of compensation awarded, together with interest - guilty of medical negligence in the treatment of the spouse of the Appellant which eventually led to her death - real bone of contention in the present case is not the decision which was taken by the doctors to place the patient on a regime of intravenous fluids which, for the purposes of the present appeals, the Court ought to proceed as being on the basis of an established protocol. HELD THAT - The patient had a prior medical history which included catheter ablation and paroxysmal supra ventricular tachycardia suggestive of cardiac complications and thus fell in the group of patients that require in-hospital management (Group B) under WHO guidelines. The patient was evidently suffering from abdominal discomfort and hospital authorities were required to closely monitor her condition. In failing to do so in a timely manner, the Respondents were unable to meet the standard of reasonable care expected of medical services - The issue is not whether the patient had already entered a situation involving haemorrhagic fever or a dengue shock syndrome when she was admitted on the morning of 15 November 2009. The real charge of medical negligence stems from the failure of the hospital to regularly monitor the blood parameters of the patient during the course of the day. Had this been done, there can be no manner of doubt that the hospital would have been alive to a situation that there was a decline progressively in the patient's condition which eventually led to cardiac arrest. In the present case, the record which stares in the face of the adjudicating authority establishes that between 7.30 am and 7 pm, the critical parameters of the patient were not evaluated. The simple expedient of monitoring blood parameters was not undergone. This was in contravention of WHO guidelines as well as the guidelines prescribed by the Directorate of National Vector Borne Diseases Control Programme. It was the finding of the Medical Council of India that while treatment was administered to the patient according to these guidelines, the patient did not receive timely treatment - To say that the patient or her family would have resisted a blood test, as is urged by the Respondents, is merely a conjecture. Since no test was done, such an explanation cannot be accepted. That leads the Court to the question of damages. Finding the hospital and its Director guilty of medical negligence, the SCDRC directed compensation in the amount of Rs. 6 lakhs together with interest at 9 per cent - While quantifying the compensation, the SCDRC was in error in holding that since the son and daughter of the Appellant are highly educated and working and had not joined as complainants, the complainant himself would be entitled to receive compensation only in the amount of Rs. 6 lakhs. In computing compensation payable on the death of a home-maker spouse who is not employed, the Court must bear in mind that the contribution is significant and capable of being measured in monetary terms - the interests of justice would be met, if the amount of compensation is enhanced. The Appellant shall be entitled to receive an amount of Rs. 15 lakhs by way of compensation from the first Respondent - The compensation, as awarded, shall carry interest at the rate of 9 per cent per annum from the date of the institution of the complaint before the SCDRC until payment or realisation. Payment should be effected within two months. Appeal allowed.

Summary

Issues Involved:
1. Medical negligence in the treatment of the Appellant's spouse.
2. Reversal of compensation by the NCDRC.
3. Timeliness and adequacy of medical treatment.
4. Standard of care expected from medical professionals.
5. Quantum of compensation awarded.

Issue-wise Detailed Analysis:

1. Medical Negligence in the Treatment of the Appellant's Spouse:
The National Consumer Disputes Redressal Commission (NCDRC) set aside the order of the MP State Consumer Disputes Redressal Commission (SCDRC) which had held the Respondents guilty of medical negligence. The SCDRC found that the treating doctors failed to follow established protocols for treating dengue fever, which led to the patient's death. The patient was admitted with dengue fever and had a significant decline in platelet count, which was not adequately monitored. The treating doctors did not perform timely blood tests to monitor critical parameters, leading to a failure in detecting the progression of the disease. The Supreme Court noted that the hospital failed to provide timely treatment as per the guidelines of the World Health Organization (WHO) and the Directorate of National Vector Borne Diseases Control Programme.

2. Reversal of Compensation by the NCDRC:
The SCDRC awarded Rs. 6 lakhs as compensation to the Appellant, which was reversed by the NCDRC. The Supreme Court found that the NCDRC's reversal lacked cogent reasoning and was unsustainable. The NCDRC had placed undue reliance on the fact that the patient was on aspirin and did not adequately consider the failure of the hospital to monitor the patient's condition.

3. Timeliness and Adequacy of Medical Treatment:
The Supreme Court emphasized the importance of timely and adequate medical treatment. It was found that the hospital did not monitor the patient's blood parameters between 7:30 am and 7 pm, which was a critical failure. The WHO guidelines and the National Vector Borne Diseases Control Programme guidelines require close monitoring of dengue patients, especially those with warning signs or co-existing conditions. The hospital's failure to conduct timely blood tests and monitor the patient's condition was a breach of the standard of care expected.

4. Standard of Care Expected from Medical Professionals:
The Supreme Court reiterated the standard of care expected from medical professionals, referencing the Bolam test and subsequent interpretations. The Bolam test requires that a medical professional's conduct be judged by the standards of a reasonably competent practitioner. The Court noted that the hospital's failure to monitor the patient's condition was not consistent with the standard of reasonable care. The judgment highlighted that medical professionals must ensure their treatment is in line with established and approved medical practices.

5. Quantum of Compensation Awarded:
The Supreme Court found that the SCDRC erred in awarding only Rs. 6 lakhs as compensation, considering the significant contribution of a non-working spouse to the family. The Court referred to previous judgments which recognized the economic value of a homemaker's contribution. The compensation was enhanced to Rs. 15 lakhs, with interest at 9 percent per annum from the date of the institution of the complaint until payment or realization. The Court directed that the payment be made within two months.

Conclusion:
The Supreme Court allowed the appeal, setting aside the NCDRC's judgment and reinstating the finding of medical negligence by the SCDRC. The compensation was enhanced to Rs. 15 lakhs with interest, and the hospital was held liable for the negligence, but not the Director of the hospital personally. The judgment emphasized the importance of adhering to established medical guidelines and the need for timely and adequate treatment.