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Suffering of ailment by the patient after surgery does not simply mean medical negligence

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Morning MEDtalks with Dr KK Aggarwal 4th October 2018

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Suffering of ailment by the patient after surgery does not simply mean medical negligence. In the matter titled as “Dr. S. K. Jhunjhunwala versus Mrs. Dhanwanti Kumar & Anr., the Hon’ble Supreme Court of India vide judgement dated 01.10.2018 has held that simply proving the suffering of ailment by the patient after the surgery does not amount to medical negligence. The doctor can be held for medical negligence only if the suffering of any such ailment is because of improper performance of the surgery and that too with the degree of negligence on the part of the doctor.

Facts of the case: Mrs. Dhanwanti Kumar (patient) had filed the consumer complaint case claiming compensation for the loss, mental suffering and pain suffered by her throughout after the surgery on account of negligence of the appellant in performing the surgery of her Gall Bladder on 08.08.1996.

She complained that firstly she had never given her consent for performing general Surgery of her Gall Bladder rather she had given consent for performing laparoscopy Surgery only but the doctor performed general surgery of her Gall Bladder which resulted in putting several stitches and scars on her body.

Secondly, even the surgery performed was not successful inasmuch as the patient thereafter suffered for several days with various ailments, such as dysentery, loss of appetite, reduction of weight, jaundice etc.,

Thirdly, in June 1997, she was, therefore, required to undergo another Surgery in Ganga Ram Hospital, Delhi for removal of stones which had slipped in CBD. It was alleged that all these ailments were incurred due to the negligence of the doctor, who did not perform the surgery properly and rather performed the surgery carelessly leaving behind for the patient only mental agony, pain, harassment and money loss and hence she filed a complaint to claim the reasonable amount of compensation under various heads as mentioned above.

Doctor filed his reply and stated in his reply that he, after examining the patient No.1, advised her to go for surgery of Gall Bladder, which may even include removal of Gall Bladder. It was stated that consent of patient for performing the laparoscopic cholecystectomy was duly obtained before performing the surgery.

Doctor stated that after starting laparoscopic surgery, he noticed swelling, inflammation and adhesion on her Gall Bladder and, therefore, he came out of the Operation Theater and disclosed these facts to patients husband and told him that in such a situation it would not be possible to perform laparoscopic surgery and only conventional procedure of surgery is the option to remove the malady. The husband of patient agreed for the option suggested by the doctor and the doctor accordingly performed conventional surgery. The patient was discharged after spending few days in the Hospital for postoperative care.

Doctor, therefore, denied any kind of negligence or carelessness or inefficiency on his part in performing the surgery on the patient and stated that all kinds of precautions to the best of his ability and capacity, which were necessary to perform the surgery were taken by him and by the team of doctors that worked with him in all such operational cases.

Judgment of the Court

44. In our opinion, there has to be a direct nexus with these two factors to sue a doctor for his negligence. Suffering of ailment by the patient after surgery is one thing. It may be due to myriad reasons known in medical jurisprudence. Whereas suffering of any such ailment as a result of improper performance of the surgery and that too with the degree of negligence on the part of Doctor is another thing. To prove the case of negligence of a doctor, the medical evidence of experts in field to prove the latter is required. Simply proving the former is not sufficient.

45. In our considered opinion, respondent No. 1 was not able to prove that the ailments which she suffered after she returned home from the Hospital on 08.08.1996 were as a result of faulty surgery performed by the appellant.

48. In the light of the detailed discussion made above on the issues arising in the case including the issue of grant of consent, we are unable to accept the aforesaid submissions of learned counsel for respondent No.1.

49. It is apt to remember the words of the then Chief Justice of India when he said in Jacob Mathew’s case (supra) which reads as under:

“The subject of negligence in the context of medical profession necessarily calls for treatment with a difference. There is a marked tendency to look for a human actor to blame for an untoward event, a tendency that is closely linked with a desire to punish. Things have gone wrong and therefore somebody must be found to answer for it. An empirical study reveals that background to a mishap is frequently far more complex than may generally be assumed. It can be demonstrated that actual blame for the outcome has to be attributed with great caution. For a medical accident or failure, the responsibility may lie with the medical practitioner, and equally it may not. The inadequacies of the system, the specific circumstances of the case, the nature of human psychology itself and sheer chance may have combined to produce a result in which the doctor’s contribution is either relatively or completely blameless. The human body and its working is nothing less than a highly complex machine. Coupled with the complexities of medical science, the scope for misimpressions, misgivings and misplaced allegations against eh operator i.e. the doctor, cannot be ruled out. One may have notions of best or ideal practice which are different from the reality of how medical practice is carried on or how the doctor functions in real life. The factors of pressing need and limited resources cannot be ruled out from consideration. Dealing with a case of medical negligence needs a deeper understanding of the practical side of medicine. The purpose of holding a professional liable for his act or omission, if negligent, is to make life safer and to eliminate the possibility of recurrence of negligence in future. The human body and medical science, both are too complex to be easily understood. To hold in favour of existence of negligence, associated with the action or inaction of a medical professional, requires an indepth understanding of the working of a professional as also the nature of the job and of errors committed by chance, which do not necessarily involve the element of culpability.”

The National Gandhi Museum has made available the “recreated heartbeat” of the father of the nation. The museum also houses Gandhi’s health data, ranging from his diet charts to blood pressure records. They gathered the electrocardiography (ECG) details from different stages of Gandhi ji’s life and recreated his heartbeat on the digital medium.

Juul launches campaign aimed to keep minors off nicotine-filled products. Juul itself launched a new campaign and you may hear this new strategy on the radio. The ads are for radio and print publications and say their products are designed to be an alternative to smoking for adults—not kids—even though it has become popular amongst teens in recent months.

Three online articles on #Diabetes in South Asia" in @TheLancet. A three article series, comprehensively covering all aspects of diabetes in this region, under leadership of Andrew Hills (Australia) and Dr Anoop Misra. These papers have been written by a consortium of international experts, toiling over a period of three years. This is a unique event, 3 article appearing simultaneously in one of the highest impact journal in the World.

  1. Epidemiology and determinants of type 2 diabetes in south Asia. Andrew P Hills, Ross Arena, Kamlesh Khunti, Chittaranjan Sakerlal Yajnik, Ranil Jayawardena, Christiani Jeyakumar Henry, Steven J Street, Mario J Soares, Anoop Misra. Published online: October 1, 2018The Lancet Diabetes & Endocrinology: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30204-3/fulltext
  2. Public health and health systems: implications for the prevention and management of type 2 diabetes in south Asia. Andrew P Hills, Anoop Misra, Jason MR Gill, Nuala M Byrne, Mario J Soares, Ambady Ramachandran, Latha Palaniappan, Steven J Street, Ranil Jayawardena, Kamlesh Khunti, Ross Arena. Published online: October 1, 2018: The Lancet Diabetes & Endocrinology: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30203-1/fulltext
  3. Clinical management of type 2 diabetes in south Asia. Anoop Misra, Naveed Sattar, Nikhil Tandon, Usha Shrivastava, Naval K Vikram, Kamlesh Khunti, Andrew P Hills. Published online: October 1, 2018. The Lancet Diabetes & Endocrinology:   https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30199-2/fulltext

Swachha Campus Ranking 2018 of Educational Institutions in the country in the category of technical institutions and Universities by the Ministry of Human Resource Development, Government of India. Out of ten many are medical institutions:  

  1. Amrita Vishwa Vidyapeetham, Coimbatore
  2. Indian Institute of Technology, Guwahati
  3. Siksha ‘O’ Anusandhan University, Bhubaneswar
  4. Indraprastha Institute of Information Technology, Delhi
  5. Krishna Institute of Medical Sciences Deemed University, Karad
  6. NIIT University, Neemrana
  7. Kalasalingam Academy of Research & Higher Education, Srivilliputhrur
  8. Indian Institute of Technology, Chennai
  9. Atal Behari Vajpayee Indian Institute of Information Technology & Management, Gwalior
  10. National Institute of Technology, Tiruchirapalli

A record number of US patients died from flu last year, with 80000 deaths recorded in 2017-18, says the director of the Centers for Disease Control and Prevention (CDC), Robert Redfield. He gave the 80 000 estimate during an interview with the Associated Press in New York. It has not yet been published in official data, which is expected within weeks, but the CDC said that the published figure would not be lower. It means that the 2017-18 period will have had the highest number of deaths from flu, by some margin, since tracking began in 1976. The previous record was 56 000 in 2012-13.

Early diagnosis of masked HT with 24-hour ABPM and home BP measurements is important: An updated systematic review and meta-analysis published in the journal Integrated Blood Pressure Control concluded that prompt screening of high-risk individuals with home BP measurements and ambulatory BP measurements (ABPM), the diagnosis of masked hypertension, and the initiation of treatment, may mitigate the adverse cardiovascular effects of masked HT.

Individuals with masked HT had significantly increased rates of cardiovascular events and all-cause mortality than normotensives and white-coat HT and had lower rates of cardiovascular events than those with sustained HT (odds ratio 0.61, 95% confidence interval 0.42–0.89; P=0.010; I2=84%). Among patients on antihypertensive treatment, masked HT was associated with higher rates of cardiovascular events than in those with normotension and white-coat HT and similar rates of cardiovascular events in those with treated sustained HT.

Dr KK Aggarwal

Padma Shri Awardee

President Elect CMAAO

President Heart Care Foundation of India

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