Delhi High Court: In a writ petition alleging serious medical negligence and misconduct against doctors at Max Super Speciality Hospital (‘Max Hospital’), Pratapganj, Delhi which resulted in the death of the petitioner’s wife, a Single Judge Bench of Sanjeev Narula, J. examined the petitioner’s allegations in light of the findings by the Delhi Medical Council (‘DMC’) as well as the National Medical Commission (‘NMC’) and held that none of the grounds that were raised provided any basis to conclude that the orders of the DMC and NMC were tainted by perversity or arbitrariness.
Background
The petitioner’s wife began suffering from severe diarrhea and was admitted in Dr. Hedgewar Arogya Sansthan, Karkardooma on 11-10-2016. The following day she was diagnosed with Systemic Lupus Erythematosus/Hematemesis and was transferred to Lok Nayak Jai Prakash Hospital (‘LNJP Hospital’). Upon LNJP Hospital’s incapacity to provide intensive care, the wife was discharged on 13-10-2016 under ‘leave against medical advice’.
Seeking a suitable ICU, the petitioner contacted Max Hospital, which assured him of ICU availability and upon his arrival he learned that no ICU bed was actually available. With no alternative, he admitted his wife to the emergency department where she remained without attention of the senior doctors/consultants for over two hours. Even though a junior doctor had prescribed several injections, they remained unadministered throughout the night.
At around 10:30 PM, the wife’s condition deteriorated sharply, and she was hurriedly shifted to the Crash room of the emergency department where a junior doctor in neurology, acting under the instructions of respondent 4, took charge and ordered an urgent MRI of her brain. However, the same was not performed until the following day, causing a delay of around 10 hours from the time that she was admitted. The EEG, blood tests, and chest X-Rays were also not carried out in a timely manner.
The petitioner informed the Court that around 11:30 PM, a junior doctor attended to the wife on the instructions of respondent 4 as she suffered a cardiac arrest. Thereafter, the wife needed an artificial ventilation tube to alleviate her breathing distress but the same was delayed until 5:30 AM on 14-10-2016.
On 14-10-2016, the wife was placed on ventilator support and the emergency doctor informed the petitioner that the MRI would take approximately 20-25 minutes. However, owing to the risk associated with keeping his wife off the ventilator for that long, the petitioner declined to sign the consent form for the MRI.
The wife was repeatedly prescribed injections of NORAD by the ER team of Max Hospital as well as by respondent 2 to restore her blood pressure. Despite the prescriptions, she was administered an insufficient dosage of the drug. On the same day, respondent 3 as well as another doctor attended to the petitioner’s wife and prescribed the administration of ‘Fentanyl’ at a dosage of 50 mcg per hour. Later, respondent 2 advised a higher dosage of the same. Consequently, 850 mcg of said medicine was injected between 6:40 AM to 11:35 AM. The petitioner argued that the excessive dosage acted as ‘diluted poison’ which contributed to her death.
After the wife had developed a dangerously low heart rate, the doctors supervised another attempt at resuscitation and advised the petitioner to take her home as she had negligible chances of survival. At home, the wife was under ventilator support, effectively brain-dead and passed away within three hours of discharge.
Having pursued remedies before the DMC as well as the NMC and being dissatisfied with their conclusions, the petitioner filed this petition to invoke the jurisdiction of this Court under Article 226 of the Constitution.
Analysis and Decision
The Court stated that its jurisdiction under Article 226 is not an avenue for reassessing the substantive conclusions of expert bodies in matters such as allegations of medical negligence. It was also stated that the Court’s interference is warranted only when the impugned decisions are arbitrary, perverse, or manifestly unreasonable.
Thus, the Court said that its inquiry would be limited to determining whether the decision of the NMC was tainted by any significant procedural irregularity, evident arbitrariness, or irrationality, thereby justifying judicial intervention.
The Court opined that notwithstanding the availability of an ICU bed, the petitioner’s wife was provided with necessary medical interventions and was resuscitated twice following instances of cardiac arrest in the crash room. It was further said that it was entirely plausible that the availability of the bed could have changed by the time the petitioner arrived at Max Hospital and therefore, the Court said that it did not find this a valid ground for concluding negligence on part of Max Hospital.
The Court perused the petitioner’s complaint dated 16-06-2017 filed before the DMC and said that he had merely recounted the events that led to his wife’s death without assigning specific responsibility to any particular doctor. It was further stated given the petitioner had failed to identify respondent 2 in the complaint, the DMC could not be faulted for not having summoned her at the initial stage as the DMC had conducted thorough disciplinary proceedings by examining 11 doctors including respondents 3 and 4.
Further, the Court stated that the procedural deficiencies raised by the petitioner were rectified during the appellate proceedings before the NMC issued its final decision in the proceedings. The Court also said that as respondent 2 was a junior doctor who was working in collaboration with experienced colleagues and was not solely in charge of the wife’s treatment, her alleged lack of experience could not be a ground for attributing negligence.
The Court said that a review of the case record had revealed that the petitioner had raised the grievance regarding excessive dosage of fentanyl before the NMC who had considered the same during its peer review process and following the review, a reasoned order was passed. Further, it was said that while exercising judicial review, the Court cannot substitute its own judgment for that of specialists and experts who have a primary responsibility to uphold the highest standards of medical practice and professional conduct.
The Court stated that since the primary condition upon admission of the petitioner’s wife was gastrointestinal, it did not find any infirmity in the initial allocation of the petitioner’s wife to a gastroenterologist as necessary cardiological intervention was provided once respiratory complications became apparent.
The Court noted that the petitioner himself had refused to sign the consent form for MRI and prioritized ventilator support for his wife. Thus, the Court opined that the petitioner’s expectation regarding the timeline for conducting tests or administering medication could not override the professional judgment of the attending doctors.
Further, the Court said that the petitioner’s grievance regarding the unavailability of a senior doctor had been duly addressed and adjudicated upon by the DMC as it had acknowledged the lapse in referring the case to a more experienced senior doctor on part of the respondent doctors and directed them to undergo one month of training in emergency medicine at a recognized institution. Additionally, Max Hospital was directed to ensure availability of an emergency physician on a 24-hour basis, capable of providing immediate guidance to resident medical officers.
The Court stated that the unavailability of respondent 4, the only senior doctor among the respondent doctors, due to his leave, could not serve as a sufficient basis for attributing medical negligence to him. In light of the circumstances, the Court found no merit in the petitioner’s demand to hold the respondent doctors personally culpable for the absence of a senior doctor.
The Court stated that negligence could not be attributed to the respondent doctors regarding the discharge of the petitioner’s wife as the petitioner had carried out the discharge voluntarily and with full awareness of the risks involved.
Further, the Court stated that none of the grounds raised in the petition provided any basis to conclude that the orders of the DMC or the NMC were tainted by perversity or arbitrariness and said that it is paramount to remember that medical negligence is not established by mere dissatisfaction or assertion of an ‘expected’ standard of care.
Lastly, the Court dismissed the petition by saying that it found no grounds for interference as the consistent view of both the DMC and NMC pointed towards the line of treatment that was provided considering the petitioner’s wife’s complex medical profile, rather than by professional misconduct.
[Shiv Kumar v. National Medical Commission, W.P.(C) 4828 of 2021, Decided on 20-12-2024]
Judgment by Justice Sanjeev Narula
Advocates who appeared in this case :
For Petitioner — Advocate Vinay Rathi, Advocate Pratham Sharma, Advocate Ashima Jayal
For Respondents — Advocate T. Singhdev, Advocate Anum Hussain, Advocate Abhijit Chakravarty, Advocate Tanishq Srivastava, Advocate Ramanpreet Kaur, Advocate Praveen Khattar
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