Source: Supreme Court

Why in News?

The Supreme Court (SC), has confirmed that the relevance of the res ipsa loquitur (Things Speak for Itself) principle in medical negligence cases and stressed upon the fact that when negligence is clear, the burden of proof transfers to the hospital or healthcare professionals.

What is the Background of the CPL Ashish Kumar Chauhan (Retd.) V. Commanding Officer & Ors Case?

• While on duty working in the Indian Air Force (IAF) the appellant complained of weakness, anorexia and other symptoms consequent to which he was admitted to the military hospital facility (171 MH Samba) for treatment and was advised to undergo a blood transfusion and one unit of blood was transfused to him in 2002.
  • The said medical facility did not have a license for a blood bank but has been termed by the Indian Army as an “ad-hoc blood bank”.
• The appellant again fell ill in 2014 and was admitted to Station Medicare Centre, Gandhinagar, Gujarat where he was checked for Human Immunodeficiency Virus (HIV) and his report came as negative.
  • He suffered complications while being admitted in Gandhinagar and was further transferred to medical facilities in Ahmedabad and thereafter Mumbai where it was revealed that the appellant was suffering from HIV.
• The appellant endeavored to trace the source of the virus and realized that the transfusion of virus infected blood at 171 MH Samba in 2002 was the cause of his condition.
• After detection of HIV, first medical board was constituted and as per its findings the infection with HIV was “non-attributable to service”.
• On being dissatisfied with the decision he further demanded copies of the record and found that – The case sheet prepared while he was undergoing treatment shows that though in 2002, one unit of blood was transfused to him, but whether Enzyme Linked Immunosorbent Assay (ELISA) test was conducted before infusing the blood in the appellant’s body was conspicuously absent from that medical case sheet.
• Further, Medical Boards constituted in 2014 and 2015 proceeded to state that the appellant’s disability was attributable to service owing transfusion of one unit of blood at 171 Military Hospital on 10th July 2002. His disability and the disability qualifying elements for the purpose of disability pension were also assessed by the medical board at 30% for two years.
• The appellant was denied extension of services and was discharged from service, without the due proceedings of the Release Medical Board. The appellant wrote a letter to obtain his disability certificate disability and his medical reports.
  • Pension was sanctioned in addition to his service pension, but he was denied the reports as to his blood transfusion.
• Aggrieved by the denial of medical reports as to his blood transfusion, the appellant preferred an RTI application.
• Dissatisfied with the information provided, he appealed to the First Appellate Authority which by its order rejected the appeal and observed that best efforts were made by the respondent authorities to trace the appellant’s medical document.
• Meanwhile, proceedings of the Court of Inquiry (CoI) were held to investigate circumstances under which the appellant was transfused blood at the 171 Military Hospital and the CoI concluded by its findings that blood provided to the appellant was duly screened for the HIV and other markers.
• Thereafter, the appellant filed a complaint before the National Consumer Disputes Redressal Commission seeking compensation plus litigation expenses and suitable pecuniary punishment to the delinquent officers.
• The Commission dismissed the appellant’s complaint, the appellant has hence preferred an appeal before SC.

What were the Court’s Observations?

• The two-judge bench of SC comprising of Justices S Ravindra Bhat and Justice Dipankar Datta relied on following judgements:
  • In favour of the concept of res ipsa loquitor:
    • V. Kishan Rao v. Nikhil Super Speciality Hospital (2010) Case: SC emphasized that when negligence is evident, "the principle of res ipsa loquitur operates, and the complainant does not have to prove anything as the thing proves itself.
    • Nizam Institute of Medical Sciences case (2009) Case: SC stated that once the initial burden is discharged by the complainant by demonstrating negligence on the part of the hospital or doctors, the onus shifts to the hospital or attending doctors to prove the absence of negligence.
    • Smt. Savita Garg v. The Director, National Heart Institute (2004) Case: SC established that when evidence is presented suggesting that a patient suffered as a result of inadequate care, the hospital is then tasked with justifying the absence of negligence.
• Against relying solely on res ipsa loquitur:
  • Bombay Hospital and Medical Research Centre v. Asha Jaiswal (2021), SC observed that “maxim res ipsa loquitur does not require the raising of any presumption of law which must shift the onus on the defendant. It only, when applied appropriately, allows the drawing of a permissive inference of fact, as distinguished from a mandatory presumption properly so-called, having regard to the totality of the circumstances and probabilities of the case. Res Ipsa is only a means of estimating logical probability from the circumstances of the accident.”
• The SC in light of above pronouncements affirmed the principle while awarding Rs 1.5 crore compensation to an ex-Indian Air Force official who contracted HIV during a blood transfusion at a military hospital.

What is the Principle of Res Ipsa Loquitor?

• This maxim has a Latin origin, and it is believed that this phrase was used first by Cicero in his defense speech Pro Milone.
• It translates to things speak for itself; it suggests that the mere occurrence of the event implies negligence on the part of the defendant.
• It is a doctrine in tort law that allows for an inference or assumption that a defendant was negligent in an accident causing harm to the plaintiff, based on circumstantial evidence, if the accident is the type that typically doesn't happen without negligence.
• In an English case Morgan v. Sim, (1857), Lord Wensleydale observed that the party aiming to obtain compensation for damages must demonstrate that the party they are accusing was at fault. The burden of proof is on them, and they must establish that the loss can be attributed to the negligence of the opposing party.

What is Medical Negligence?

• About:
  • Medical negligence pertains to professional misconduct by a healthcare provider who does not adhere to the expected standards of their profession leading to loss suffered by the seeking medical intervention.
    • The loss suffered can be financial consequences, adverse health effects, worsening the patient's condition, inflicting emotional trauma, and leaving the patient in a permanent and irreparable state for the remainder of their life.
• Essentials to prove Medical Negligence:
  • Duty of Care: It must be established that a healthcare provider owed a duty of care to the patient. This duty of care arises when a doctor-patient relationship exists.
  • Breach of Duty: It must be shown that the healthcare provider breached the duty of care owed to the patient. This breach typically involves failing to meet the accepted standard of care that other competent medical professionals would have provided in similar circumstances.
  • Injury: It is necessary to demonstrate that a doctor had a responsibility to provide care to the patient and that the doctor's failure to fulfill this duty resulted in injury or death to the patient.
• Landmark Cases:
  • Bolam v. Friern Hospital Management Committee (1957): In this English case This case established the principle that a medical professional is not necessarily negligent if their actions align with the practice accepted by a responsible body of medical opinion within their field, even if other experts may disagree.
  • Bolitho v. City and Hackney Health Authority (1996): In this case, the House of Lords held that it is not sufficient for a medical professional to rely solely on established medical practice as a defense against negligence claims. Instead, the professional must also demonstrate that the practice has a logical and defensible basis, known as the "Bolitho test."
  • Kusum Sharma & Ors v. Batra Hospital & Medical Research (2010): In this case, SC defined negligence as “Negligence is the breach of a duty exercised by omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable man would not do”.