Arun Kumar Manglik vs Chirayu Health and Medicare Private Ltd. & Anr.

Compensation for the death of home-maker spouse who is not employed – Held: Contribution made by a non-working spouse to the welfare of the family has an economic equivalence – Therefore, for computing compensation payable for the death of a home-maker, the Court must bear in mind that the contribution is significant and capable of being measured in monetary terms.

Allowing the appeals, the Court

HELD: 1.1 The standard of care which is expected of a medical professional is the treatment which is expected of one with a reasonable degree of skill and knowledge. A medical practitioner would be liable only where the conduct falls below the standards of a reasonably competent practitioner in the field. [Para 29] [296-G]

Kusum Sharma v Batra Hospital and Medical Research Centre (2010) 3 SCC 480 : [2010] 2 SCR 685

– relied on.

1.2 Medical negligence jurisprudence in India is characterized by a reliance on the *‘Bolam test’. The *‘Bolam test’ has been the subject of academic debate and evaluation in India and other jurisdictions. Among scholars, the *‘Bolam test’ has been criticized on the ground that it fails to make the distinction between the ordinary skilled doctor and the reasonably competent doctor. The former places emphasis on the standards adopted by the profession, while the latter denotes that negligence is concerned with departures from what ought to have been done in the circumstances and may be measured by reference to the hypothetical “reasonable doctor”. The Court must determine what the reasonable doctor would have done and not the profession. Law must take into account advances in medical science and ensure that a patient-centric approach is adopted. The standard of care as enunciated in the *Bolam case must evolve in consonance with its subsequent interpretation by English and Indian Courts. Significantly, the standard adopted by the three-judge bench of this Court in **Jacob Matthew case includes the requirement that the course adopted by the medical professional be consistent with “general and approved practice” and the Court is bound by this decision. [Paras 30, 36 and 41] [296-H; 302-D-E; 306-C-D]

Dr Laxman Balkrishna Joshi v. Dr Trimbak Bapu Godbole AIR 1969 SC 128 : [1969] 1 SCR 206 ;

**Jacob Mathew v. State of Punjab (2005) 6 SCC 1 : [2005] 2 Suppl. SCR 307 ; Indian Medical Association v. V P Shantha (1995) 6 SCC 651 : [1995] 5 Suppl. SCR 110 ; State of Punjab v. Shiv Ram (2005) 7 SCC 1 : [2005] 2 Suppl. SCR 991 ; Nizam’s Institute of Medical Sciences v. Prasanth S Dhananka (2009) 6 SCC 1 : [2009] 9 SCR 313 – relied on.

V Kishan Rao v. Nikhil Super Speciality Hospital (2010) 5 SCC 513 : [2010] 5 SCR 1 – referred to. *Bolam v. Friern Hospital Management Committee [1957] 1 WLR 582 –Maynard v. West Midlands

Regional Health Authority [1985] 1 All ER 635 ; Hucks v. Cole (1968) 118 New LJ 469 ; Bolitho v. City and Hackney Health Authority (1996) 4 All ER 771 – referred to.

Medical Negligence, Sweet and Maxwell, Fifth Edition (2017) by Michael Jones – referred to.

1.3 In adopting a standard of care, Indian courts must be conscious of the fact that a large number of hospitals and medical units in the country, especially in rural areas, do not have access to latest technology and medical equipment. [Para 42] [306-E] Martin F D’Souza v. Mohd. Ishfaq (2009) 3 SCC 1 : [2009] 3 SCR 273 – relied on.

1.4 In the practice of medicine, there could be varying approaches to treatment. There can be a genuine difference of opinion. However, while adopting a course of treatment, the medical professional must ensure that it is not unreasonable. The threshold to prove unreasonableness is set with due regard to the risks associated with medical treatment and the conditions under which medical professionals function. This is to avoid a situation where doctors resort to ‘defensive medicine’ to avoid claims of negligence, often to the detriment of the patient. Hence, in a specific case where unreasonableness in professional conduct has been proven with regard to the circumstances of that case, a professional cannot escape liability for medical evidence merely by relying on a body of professional opinion. [Para 43] [306-G-H; 307-A]

1.5 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. In failing to provide medical treatment in accordance with medical guidelines, the respondents failed to satisfy the standard of reasonable care as laid down in the Bolam case and adopted by Indian Courts. To say that the patient or her family would have resisted a blood test, is merely a conjecture. Since no test was done, such an explanation cannot be accepted. [Para 44] [307-B-D]

1.6 The NCDRC had before it a well-considered judgment of the SCDRC based on the evidence on the record. While the jurisdiction of an adjudicatory authority in a first appeal is coextensive with that of the original authority, the NCDRC has displaced the findings of fact which have been arrived at by the SCDRC without any cogent reasoning. There was no basis or justification to reverse the finding of medical negligence which was arrived at by the SCDRC. [Para 45 and 47] [307-E, G]

2. However, there is no basis for recording a finding of medical negligence against the Director of the hospital. The Director of the hospital was not the treating doctor or the referring doctor. Hence, while the finding of medical negligence against the hospital would stand confirmed, the second respondent would not be personally liable. [Para 48] [308-A]

3.1 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. The complainant has lost his spouse, who was 56 years of age. Though she was not employed, contribution made by a non-working spouse to the welfare of the family has an economic equivalence. Thus, 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. [Paras 49, 50, 51 and 53] [308-B-D; 309-B]

3.2 The interests of justice would be met, if the amount of compensation is enhanced. Accordingly, it is directed that 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. [Paras 55 and 56] [309-C, D]

Lata Wadhwa v. State of Bihar (2001) 8 SCC 197 : [2001] 1 Suppl. SCR 578 ; Malay Kumar Ganguly v. Sukumar Mukherjee (2009) 3 SCC 663 ; National Insurance Company Ltd. v Pranay Sethi 2017 (13) SCALE 12 – relied on.