Chapter: 4.1.3 Brief facts of the case

Brief facts of the case were as follows:

A minor child, Harjot Ahluwalia was admitted by his parents to a nursing home, M/ s SPRING MEDOWS HOSPITAL, as he was suffering from fever. The Senior Consultant Pediatrician, Dr. Promila Bhutani, examined the patient and on the advice of the said doctor, the patient was admitted as an inpatient in the hospital. The doctor made the diagnosis that the patient was suffering from typhoid and intimated to the parents that medicines had been prescribed for treatment of typhoid fever.

On 30-12-93 at 9 a.m., Miss Bina Mathew, a nurse at the hospital asked the father of the minor patient to get an injection - inj. lariago to be administered intravenously to the minor patient. The father of the child purchased the medicine and gave it to the nurse, whereupon the nurse administered it to the minor patient. The patient immediately collapsed in the lap of his mother. The parents immediately called for help. Dr. Dhananjay told the parents that the child had suffered a cardiac arrest. Manual respiration was attempted using an oxygen cylinder. Though the child was kept alive on manual ventilator, the condition of the child showed no improvement. As in the course of treatment, the minor's platelet count fell, a blood transfusion was given, but still no improvement could be seen. Dr. Mehta (anaesthetist) advised that as the hospital did not have necessary facilities to manage the child, he should be shifted to an ICU equipped with an Auto Respirator. Accordingly, the child was admitted to the pediatric ICU of AIIMS on 3-1-94. Doctors in AIIMS examined the minor child thoroughly and informed the parents that the child was critical and even if he survived he would live only in a vegetable state as irreparable damage had been caused to his brain and there was no chance of reviving the damaged parts. The minor child was again admitted to the Appellant hospital but there was no improvement in the condition of the child.

Evidence: Oral and documentary evidence was produced.

Dr. J. S. Nanra and Dr. A. S. Ahluwalia were also examined before National Commission apart from other witnesses. The doctors testified that the child suffered a cardiac arrest on account of the medicine having been injected which led to brain damage. The National Commission came to the following conclusion that cause of such cardiac arrest was intravenous injection of Lariago of such high dose.

Dr. Dhananjay was negligent in performing his duty because instead of administering the injection himself as advised by Dr. Bhutani; he permitted the nurse to give injection.

There was clear dereliction of duty on the part of the nurse who was not even a qualified nurse and was not registered with any nursing council of any state. She stated that as the patient was earlier advised Lariago by Dr. Bhutani and so when the injection was advised she thought lariago injection should be given and accordingly asked father of child to get lariago injection and administered the same to the child. Thus the child suffered on account of negligence, error and omission on the part of nurse as well as Dr. Dhananjay in performing their professional duties and the hospital is responsible for the negligence of employees and is liable for the consequences.

There was considerable delay in reviving the heart of the minor child and on account of such delay, the brain of the minor child was damaged.

Following are the important observations of the Apex Court:

1. What kind of mistakes cannot be pardoned?
Very often in a claim of compensation arising out of medical negligence, a plea is taken that it is a case of bonafide mistake which under certain circumstances may be excusable, but a mistake which would be tantamount to negligence cannot be pardoned.:

2. Whether a child and its parents are consumers under the Act?
Held: In the present case we are concerned with clause 9(ii) of sec. 2(1) (d). In the said clause a consumer means a person who hires or avails any service or induces any beneficiary of such services other than the person who hires or avails of the services. When a young child is taken into hospital by his parents and the doctor treats a child, the parents would come within the definition of a consumer having hired the services. The definition clause is wide enough to include not only the person who hires the services but also the beneficiary of such services even if the beneficiary is other than the person who hires the services. The conclusion is irresistible that both the parents of the child as well as the child would be consumers within the meaning of Section 2(1) (d) (iii) of the Act and as such can claim compensation under the Act.

3. Whether delegation of responsibility by a doctor to his junior is negligence?
Held: Gross medical mistakes will always result in a finding of negligence. Use of wrong drugs or wrong gases during the course of anesthesia will frequently lead to the imposition of liability and in some situations even the principle of res ipsa loquitor can be applied. Even delegation of responsibility to another may amount to negligence in certain circumstances. A consultant could be negligent when he delegates his responsibility to his junior with the knowledge that the junior was incapable of performing his duties properly.

Comments of the National Commission on different schools of thought in medicine:
The observations of the National Commission in Dr. Subramanyam & Anr v/s Dr.. B. Krishna Rao & Anr. II (1996) CPJ 233 (NC) on the question of medical negligence are most illuminating as it involved a complaint by a well qualified doctor against a fellow professional who treated his wife by performing an endoscopic sclerotherapy. It is relevant to note that in this case the complainant doctor alleged that the moment the patient was admitted to the Nursing Home, there was total mismanagement to the extent of virtually throwing her into the jaws of death solely because of negligence and improper care rather than wrong treatment given to her by the first opposite party Dr. Rao. The complainant submitted that the slipshod, callous and negligent way in which the patient was treated led to her death.