Background of the Case: This revision petition is from a decision of State Commission, Bihar, which allowed an appeal filed by the doctor – OP and dismissed the complaint. The decision of the District Forum, Bhojpur about alleged medical negligence during cataract surgery of the left eye was set aside. [Para 1]

Postpartum hysterectomy refers to hysterectomy done either after vaginal delivery or caesarean delivery. It is a major operation in modern obstetric practice, being associated with a high rate of morbidity and mortality. Risk factors for emergency postpartum hysterectomy include placenta previa; placenta accreta, increta, and percreta; and uterine rupture. Postpartum hysterectomies are largely unplanned and often done on an emergent basis for obstetric haemorrhage or undiagnosed abnormal placentation. For some women, due to obstetric emergency during childbirth which results in doctors needing to perform a hysterectomy. In many cases this is because doctors are unable to stop the bleeding (haemorrhage) and in few cases it is because the womb is the site of infection (e.g. septicaemia/blood poisoning) and antibiotics are not being effective.

Issues Discussed: • Issue of Allegations • Observations of NCDRC on Chronology of Events • Issue of Cause of Action and Doctrine of Limitation • Issue of Pecuniary Jurisdiction • Purpose of Pecuniary Jurisdiction • Issue of Referral • Unethical Practices • Issue of Medical Negligence • Issue of Medical Literature • Issue of Hospital administration and management • Issue of Medical Record • Issue of Professor & Head in O.P. No. 4 hospital not seeing the patient personally: Unit System • Issue of Investigations • Issue of Cause of Action and Doctrine of Limitation • Issue of Pecuniary Jurisdiction • Purpose of Pecuniary Jurisdiction • Issue of LAMA.(Leave Against Medical Advise) Issue of Medical Literature: Questions for consideration: i) Whether the Complainants fall within the definition of ‘Consumer’ within the meaning of Section 2(1)(d) of the Act 1986? ii) Whether blood tests were actually done at O.P. No. 2 hospital before referring her to O.P. No. 3 hospital? iii) What can help a Doctor/Hospital in a Medical Negligence Case? Qualification, Experience, Expert Opinion, Medical Literature, Protocol Compensation Claimed: • more than One Crore (sought total compensation of Rs.11120000/- with interest @ 9% per annum from the date of death of the patient)

Questions for Consideration: 1. Whether there was any negligence on behalf of the Appellants in treating the Patient and the same has to be tested on the touch stone of the ‘duty of care’ and ‘standard of care’ which ought to be exhibited by the treating doctors as laid down by the Hon’ble Supreme Court in a catena of judgments? 2. Whether there was negligence or deficiency in service on the part of the opposite parties in treating the complainant? 3. If the answer is in the affirmative what is the quantum of compensation the complainant is entitled to realise? That the Medical Board had clearly revealed that there was no negligence, but the State Commission has only placed reliance on the last sentence wherein it was stated by the Board that ‘a chest X-ray and cardiac evaluation could have been sought for earlier’. [Para 8] Case Law on Patient Centric Approach: In Arun Kumar Manglik vs. Chirayu Health and Medicare Private Limited & Anr., (2019) 7 SCC 401, the Hon’ble Supreme Court, has laid down that ‘our law must take into account advances in medical science and ensure that a patient-centric approach is adopted’. [Para 11]

Questions for Consideration: • Without issuing any referral letter, advised the patient to consult another doctor: A Case of Medical Negligence? • Whether failure to remove GBD Stone by a Surgeon is a case of medical negligence?

Facts of the Case: Late Shri Gyan Mishra, husband of the complainant Rupa Mishra and father of the other complainants visited O.P. No.2, Dr. Sandeep Agarwal, who is a Neurologist, for the first time on 02.5.2011 in Sahara Hospital, Lucknow. The said visit was followed by subsequent visits for consultation with Dr. Sandeep Agarwal. He was admitted in Sahara Hospital in Lucknow on 24.9.2012 and was discharged from there on 25.09.2012. During his stay in the said hospital, his pathology tests were done on 24.09.2012 and his serum creatinine was found to be 3.43 as against the range of 0.7 – 1.2. No further investigations or treatment for monitoring and management of the high serum creatinine which was indication of a kidney disease was advised to him at the time of his discharge from Sahara Hospital, nor was he advised to consult a Nephrologist for the said purpose. He was again admitted to Sahara Hospital on 09.12.2013 and was seen by Dr. Sandeep Agarwal as well as by O.P.No.3 Dr. Muffazal Ahmed, who is a Nephrologist. O.P.No.3 informed him and his family members that the complainant was suffering from end stage renal disease and required dialysis. He was discharged from the hospital on 19.12.2013. Alleged Medical Negligence: The complainant was allegedly given iron injection during his stay in the hospital though, such injection, according to the complainant is contra indicated in the case of a person suffering from a kidney disease. This is also the case of the complainant that he was prescribed iron injection on 18.3.2014 and 26.6.2014 namely Encicarb, without checking his ferritin level. [Para 1] Another grievance of the complainant is that the medicine Metformin was advised to him, which was contra indicated in his case and his cardiovascular examination was not done in Sahara Hospital. [Para 2] Yet another grievance of the complainant is that a medicine namely Liofen was prescribed to him which was contra indicated in his case. [Para 3]

Issues discussed: • Applicability of Bolam Test vs. Bolitho Test • Informed Consent in Orthopedics case Questions for Consideration: • Whether the Complainant was explained about the risks and complications prior to the surgery? • Whether there was negligence on the part of the Treating Doctor in not taking informed consent and in not explaining the risks and complications to the patient? We are of the considered view that the Treating Doctors (Respondents No. 2, 3 and 4) cannot be held to be liable for any ‘blanks’ which have been left in the Consent Form as we have held that there was no negligence per se in the very conduction of the surgery. At the cost of repetition only negligence is with respect to not explaining the known complications of the Complainant, for which Act, we held Hospital alone liable. [Para 18] Bolam Test a nuanced doctrine pertaining to the standard of care. A doctor has a legal duty to take care of his patient. Whenever a patient visits a doctor for treatment there is a contract by implication that the doctor will take reasonable care to treat him. If there is a breach of that duty and if it results in injury or damage, the doctor will be held liable. The doctor must exercise a reasonable degree of care and skill in his treatment; but at the same time he does not and cannot guarantee cure.

Facts of the Case: According to the petitioner-complainant: 1. On 25th June, 1996, his wife was hospitalized due to fever, which was not becoming normal, and hence she was brought to the hospital of respondent nos. 2 and 3. In consultation with one another, these accused gave her treatment on 26th June, 1996. 2. The condition of health of petitioner's wife deteriorated and became serious. 3. His wife was given some medicines, the doses whereof were not properly administered and she ultimately died due to rash and negligent acts of the respondents in the line of treatment. [Para 3 of Bombay High Court Judgment Dated: 24.09.2008] By the imputation of negligence described in paragraph no.11, it is alleged that: 1. The dose of the medicine prescribed and administered to the wife of the petitioner was wrong. 2. The medicine was selected without taking care to make sure the diagnosis after blood examination. 3. The manner in which the medicine was administered was negligent. 4. Need of Circulatory stimulant drug/medicine in case of fall in blood pressure is a known medical contingency than an unpredicted emergency. Said drug/medicine ought to have been procured well in advance as a procurement on provision basis, which was not done, and the accused have thereby acted with negligence and without due care in failing to keep said medicine. 5. No special care was taken, which was necessary in view of the pregnancy of the wife of the complainant, which amounts to negligence. 6. The sum effect of sub-paras of paragraph 11 is description of criminal negligence. [Para 26 of Bombay High Court Judgment Dated: 24.09.2008] Questions for Consideration: • Whether death could occur due to improper administration of medicines? • Whether evidence brought on record by the complainant before charge, remain as it is? • Whether accused can be convicted on that basis if remain unchallenger?

Questions for Consideration: 1. Whether such infection would be possible through any medicine? 2. Whether viscera report was shown to medical board or not? 3. Whether infected needle was shown to Medical Board or not? 4. Which chemical caused death? 5. Whether opinion regarding cause of death was given based on the history given by the IO?

Issues Discussed: • How a medical board should function? • What should be the basis of medical opinion? • Objectivity of Opinion / Reasoned Order • Issue of condonation of Delay: • What Medical Board should not do? • Delay in submitting Opinion: • What Medical Board should have not done? • Types of Medical Opinion