‘Complications not negligence’: National consumer body backs Medanta doctors in Rs 1 crore claim

Failure to discharge burden of proof

• It is established on record that the doctors of the hospital had carried out all procedures during surgery and post-surgery with due diligence and in accordance with the prevailing medical standards.
• The appellant/present appellants have failed to discharge the burden of establishing negligence or deficiency in service on the part of the respondents.
• There is no reason to interfere in the order passed by the state consumer commission which is reasonably well articulated.
• The state consumer commission has considered the relevant issues raised on behalf of the contesting parties.
• We have also considered grounds taken by the appellant in the present appeal to challenge the state commission’s order, but none of the grounds is sustainable under the facts and circumstances of the case.

The commission noted that the complainant sought treatment from multiple hospitals, yet no adverse opinion was recorded against the treating doctors.

Knee replacement, complications

• The case traces back to 2010, when the complainant, suffering from rheumatoid arthritis and severe knee deformity, underwent bilateral total knee replacement (TKR) surgery at Medanta, Gurugram.
• The patient later developed complications, including discharge from the surgical site, infection, and multiple follow-up procedures, including debridement and revision surgeries.
• The complainant alleged improper treatment, negligent post-operative care, and even unnecessary administration of anti-tubercular drugs without a confirmed diagnosis.
• The complaint sought over Rs 1.08 crore in compensation for alleged medical negligence, mental agony, and financial losses.

Medical evidence favours doctors

• It is not always necessary that in every case the condition of the patient would improve and the surgery is successful to the satisfaction of the patient.
• It is not the case of the appellant that the doctor did not possess the requisite qualification or skill for the treatment.
• The patient was a high-risk case due to rheumatoid arthritis.
• Infections and complications were medically recognised risks of total knee replacement procedures.
• Treatment, including the use of antibiotics like Rifampicin, aligned with standard protocols.
• Multiple procedures, such as debridement and revision surgery, were medically justified.
• The commission also noted that the complainant sought treatment from multiple hospitals, yet no adverse opinion against the treating doctors was recorded.

Doctrine of ‘res ipsa loquitur’

• Rejecting the argument that negligence was apparent, the consumer commission held that the doctrine of res ipsa loquitur (the thing speaks for itself) does not automatically apply in complex medical cases.
• It observed that complications arising after surgery, even serious ones, cannot by themselves establish negligence without clear proof of breach of duty.

State commission’s findings upheld

• The Haryana State Consumer Commission had dismissed the complaint on January 27, 2017, noting absence of expert evidence and holding that known surgical risks and complications cannot automatically imply negligence.
• Affirming this, the NCDRC reiterated that the complainant failed to produce expert testimony to substantiate allegations.
• The commission noted that the treatment followed established medical protocols and that post-surgical infection is a known risk, especially in patients with rheumatoid arthritis.

Negligence must be proven, not presumed

• In a significant observation, the commission underscored, “A doctor is under an obligation to provide high-quality, ethical medical care… However, medical negligence should not be inferred in a casual manner; it must be established with cogent, rational and convincing evidence.”
• The bench emphasised that merely because a treatment did not yield the desired outcome does not amount to negligence.

Supreme Court precedents

• The commission relied heavily on established Supreme Court jurisprudence, including Jacob Mathew vs State of Punjab and Kusum Sharma vs Batra Hospital, reiterating the Bolam test that a doctor is not negligent if their conduct aligns with that of a reasonably competent practitioner.
• A professional is liable only when their conduct falls below accepted standards of care.
• A mere error of judgment or adverse outcome does not constitute negligence.

Final verdict: Appeal dismissed

• Concluding that no deficiency in service or negligence was established, the national consumer body dismissed the appeal and upheld the state consumer commission’s findings.
• “There is no evidence that the respondent failed to exercise due skill, care or diligence. The outcome was a result of complications, not negligence,” the commission said.