Negligence – Medical Negligence – The NCDRC concluded that the negligence charge regarding the unjustifiable ‘NI’ procedure was proved – The act of replacing the existing Tracheostomy Tube (TT), with ‘NI’ was held to have been an avoidable course of action that was other than what should have ordinarily been done in that situation – The NCDRC awarded complainant a compensation of Rs.6,11,638/- @ 9% p.a. for the medical expenses she incurred at Hospital – Propriety:

Held: (1) Taking into consideration the medical literature on record as well as the expert medical committee report presented by the RML Hospital, it is reasonable to conclude that subglottic stenosis & subsequent trauma in the trachea is not an uncommon phenomenon with respect to a patient that has suffered serious injuries in a road accident – In addition, there tends to be a higher risk element of developing an injury if intubation is done in an emergency situation or multiple times – It could also be a result of being subjected to intubation for a prolonged period; (2) In the instant case, the patient was treated and underwent different procedures at multiple hospitals – Therefore, there is a possibility that these medical complications could have arisen at any of these hospitals or places where the patient underwent treatment; (3) The medical report available in this case i.e., the RML Hospital Committee Report did not attribute any negligence to Hospital in question or the doctors with respect to any of the charges levelled against them – If the ‘NI’ procedure had been conducted in a negligent manner or was a poor medical decision, it is likely that the RML Hospital Committee Report would have mentioned the same – However, no such observation was made either; (4) The medical team at Hospital in question was able to show that the ‘NI’ procedure was carried out only after due consideration – The existing ‘TT’ was removed after the bronchoscopy showed normalcy in the airways & trachea of the patient – It was expected that the patient would be able to breathe normally without any support after ‘TT’ decannulation – However, a stridor was observed in the airways of the patient, after the said decannulation took place – In light of the same, an alternative course of treatment in the form of an ‘NI’ procedure was opted for as a temporary measure – There is nothing to show that the procedure conducted was outdated or poor medical practice – Resultantly, there was no breach of duty of care at Hospital in question or on part of the doctors – The charge of negligence is, therefore, not proved – Impugned judgment set aside. [Paras 50, 51, 52, 53, 56]

Negligence – Medical Negligence – Essential ingredients for determination:

Held: The three essential ingredients in determining an act of medical negligence are: (1) a duty of care extended to the complainant, (2) breach of that duty of care, and (3) resulting damage, injury or harm caused to the complainant attributable to the said breach of duty – However, a medical practitioner will be held liable for negligence only in circumstances when their conduct falls below the standards of a reasonably competent practitioner. [Para 36]

Negligence – Medical Negligence – A line of treatment undertaken should not be of a discarded or obsolete category in any circumstance:

Held: Due to the unique circumstances and complications that arise in different individual cases, coupled with the constant advancement in the medical field and its practices, it is natural that there shall always be different opinions, including contesting views regarding the chosen line of treatment, or the course of action to be undertaken – In such circumstances, just because a doctor opts for a particular line of treatment but does not achieve the desired result, they cannot be held liable for negligence, provided that the said course of action undertaken was recognized as sound and relevant medical practice – This may include a procedure entailing a higher risk element as well, which was opted for after due consideration and deliberation by the doctor – Therefore, a line of treatment undertaken should not be of a discarded or obsolete category in any circumstance. [Para 37]

Negligence – Medical Negligence – A higher threshold limit must be met to hold a medical practitioner liable for negligence:

Held: To hold a medical practitioner liable for negligence, a higher threshold limit must be met – This is to ensure that these doctors are focused on deciding the best course of treatment as per their assessment rather than being concerned about possible persecution or harassment that they may be subjected to in high-risk medical situations – Therefore, to safeguard these medical practitioners and to ensure that they are able to freely discharge their medical duty, a higher proof of burden must be fulfilled by the complainant – The complainant should be able to prove a breach of duty and the subsequent injury being attributable to the aforesaid breach as well, in order to hold a doctor liable for medical negligence – On the other hand, doctors need to establish that they had followed reasonable standards of medical practice. [Para 38]