Burden To Establish Breach Of Duty, Injury, Causation Lies On Claimant In Medical Negligence Cases, NCDRC Allows Fortis Hospital’s Appeal

Brief Facts:

The Complainant was admitted to Fortis Hospital (“Hospital”) for a total knee replacement. After the surgery was performed, the Complainant started experiencing severe backache and numbness in one leg. Her attendants informed the same to the Orthopedic Surgeon, who assured them that the problem was a result of anaesthesia and pain killers, and that the Complainant would be okay in a day or two. The Complainant also started experiencing numbness in the other leg. However, the doctors gave the same reaction. On consistent complaints, the doctors finally referred the Complainant to a neurosurgeon. The neurosurgeon conducted an MRI Spine Lumber which suggested a spinal ‘subdural/epidural hematoma’ due to the collection of bacteria. The neurosurgeon performed the surgery again and transfused some units of blood. Due to delay in taking corrective measures, the Complainant’s lower limbs got paralyzed.

Feeling aggrieved, the Complainants filed a consumer complaint before the State Consumer Disputes Redressal Commission, Punjab (“State Commission”). The Complainant contended that the anaesthesia given by the Anesthetist was improper and the neurosurgeon performed a delayed corrective surgery.

In response, the Hospital and the neurosurgeon contended that the Complainant failed to provide evidence or expert opinion to prove medical negligence. Further, the Complainant was 78 years old and was already suffering from osteoarthritis for the past 2-3 years. She was also known to experience hypertension, coronary artery disease and cardiac dysfunction. They also contended that the chances of clot formation in the veins of the calf muscles are very high after a knee replacement surgery. To avoid clot formation, the Complainant was given a dose of ‘Clexane’ injection. For pain reduction and vomiting, a voveran gel and anti-vomiting drugs were also injected. When the Complainant was not able to move her limbs, the neurosurgeon was informed, who immediately advised her to stop all blood thinners and conducted a de-compressive surgery. The anesthesia was given as per standard protocols and there was no negligence on the part of the doctors or the Hospital.

On the other hand, the Orthopedic Surgeon contended that the Complainant was not a ‘consumer’ under the Consumer Protection Act, 2019 and the complaint was barred by period of limitation. Further, the Complainant was given necessary pre and post operative treatment including proper antibiotics. The Complainant also failed to produce any expert evidence to prove negligence. Additionally, the Anesthetist contended that he had no privity of contract with the Complainant as he was just working as an employee of the Hospital.

The State Commission allowed the complaint and directed the Hospital, the Neurosurgeon, the Orthopedic Surgeon and the Anesthetist (collectively referred to as “Doctors”) to pay a lump sum amount of Rs. 15 Lakh to the Complainant. Aggrieved by the order of the State Commission, the Hospital and the Doctors filed an appeal before the National Consumer Disputes Redressal Commission (“NCDRC”).

Observations of the NCDRC:

At the outset, the NCDRC observed that the Complainant linked her disability certificate to the surgery. It was held that her disability cannot be attributed to the surgery based on a presumption. The NCDRC referred to PGIMER Chandigarh vs Jaspal Singh [(2009) 7 SCC 330], in which the Supreme Court held that the burden of proof to establish breach of duty, injury and causation lies on the claimant in medical negligence cases. The injury must also be sufficiently proximate to the doctor’s breach of duty. Causation can be inferred even if any positive or scientific report is lacking if there is no evidence produced by the opposite party.

The NCDRC further observed that the Complainant was 78 years old when she was admitted and had multiple co-morbidities. The main contention of the Complainant was based on the doctors’ ignorance of her leg’s numbness after the first surgery and the delay in performing corrective surgery. On the contrary, the Hospital and the doctors contended that the Complainant complained of numbness after 2 days of the surgery and then, a corrective surgery was conducted immediately.

The NCDRC perused the prescription issued by the neurosurgeon, which mentioned that the Complainant was walking with support. Therefore, the Complainant’s allegation, that she became paraplegic due to the corrective surgery, was dismissed. The Complainant also relied on a certificate issued by the Medical Officer of Jalandhar Civil Hospital. However, it was mentioned in this certificate that it was not valid for medico-legal or court cases.

The NCDRC further observed that the Complainant failed to produce any valid expert evidence to show linkage between her paraparesis and the surgery. Further, just because the Hospital gave a discount on the bill, it could not be said that there was an admission of negligence. As a result, it was held that the Complainant failed to prove any medical negligence in the course of the surgery or post-operative care by the Hospital or the doctors. The NCDRC allowed the appeal and set aside the order of the State Commission.

Case Title: Smt. Mohinder Kaur vs Fortis Hospital and Ors.

Case No.: First Appeal No. 698 of 2017

Advocate for the Appellant (Smt. Mohinder Kaur): Mr R.C. Gupta

Advocate for the Respondents: Mr Rohit Puri, Mrs Kanchan Bahl and Mr Aditya Awasthi (for Fortis Hospital and Dr Sandeep Khurana); Ms Anshima Sawhney (for Dr Manuj Wadhwa)

Date of Pronouncement: 6th June 2025

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