Why Hospitals are Vicariously Responsible in cases of Medical Negligence: What Supreme Court said
Meera Emmanuel December 18 2019
The Supreme Court recently reiterated that a hospital is also vicariously responsible for the medical negligence committed by the medical professionals employed or retained by it. As noted in a judgment passed earlier this week by a Bench of Justices UU Lalit and Indu Malhotra,
"It is well established that a hospital is vicariously liable for the acts of negligence committed by the doctors engaged or empanelled to provide medical care."
The Court goes on to explain,
"It is common experience that when a patient goes to a hospital, he/she goes there on account of the reputation of the hospital, and with the hope that due and proper care will be taken by the hospital authorities. If the hospital fails to discharge their duties through their doctors, being employed on job basis or employed on contract basis, it is the hospital which has to justify the acts of commission or omission on behalf of their doctors."
The case prompting these observations concerned an infant who had gone permanently blind after a medical condition associated with premature birth, Retinopathy of Prematurity (ROP), went undiagnosed until it reached the irreversible stage of Stage 5.
As per an AIIMS report that eventually became part of the case records, babies born at 32 weeks’ gestation or less face the risk of ROP, which if left untreated may lead to severe vision loss and even blindness. Therefore, it is generally expected that such a premature child is examined to detect the condition. Guidelines also prescribe regular follow-up examinations of the child.
The child in this case was born prematurely at 32 weeks’ gestation, with a weight of 1.49 kg at the time of birth, at a super speciality hospital, Maharaja Agrasen Hospital. The child was discharged 27 days after birth. Neither at this point, nor during two follow-up visits to the hospital, was the single mother of the child advised of any ROP vulnerability that the child may have.
Later, the child was diagnosed with ROP after a visit to another hospital, the Shroff Charity Eye Hospital, at which point the condition had already progressed to stage 5 i.e. total retinal detachment.
In the meanwhile, the Maharaja Agrasen Hospital failed to provide in-patient medical records of the baby for over two years, even though a legal notice for the same was eventually issued to them. It was only following a complaint with the Delhi Medical Council, that the hospital finally disposed the medical records in 2007.
In these records, the child's mother noticed that the Hospital mentioned an ROP checkup having been conducted by a doctor. Perplexed, the mother wrote to the Medical Superintendent, querying how this was so recorded when neither was such a check-up mentioned in the discharge summary, nor did she recollect any such examination having been conducted. The Superintendent responded by simply stating that the ROP had been conducted.
In turn, the mother filed a complaint on behalf of her child before the National Consumer Disputes Redressal Commission in November 2007 against the Hospital and the doctors concerned, citing medical negligence and deficiency of service. In 2016, the Forum ruled against the Hospital and directed the payment of Rs 64 lakhs as compensation.
An appeal was filed before the Supreme Court, with the hospital reasserting that it had performed the check up for ROP. However, on a review of the medical records available, the Bench was unconvinced by the Hospital's submissions. The Court observed,
"We find that the ROP was neither advised, nor carried out at all by the Appellant No.1-Hospital, or Appellant No.4-Dr. S.N. Jha, the Senior Ophthalmologist, throughout the period of hospitalisation of the baby, or even after discharge."
A report to the contrary, submitted by AIIMS to the National Consumer Forum was also found to have been prepared on a flawed basis and therefore, misconceived and unreliable. Rather, the Supreme Court found that the doctors had failed in discharging the duty of care owed by them to the child and his parents, and that the hospital was vicariously responsible for medical negligence.
Justice UU Lalit (L) and Justice Indu Malhotra (R)
The Court also castigated the Hospital for having withheld the medical records of the child for over two years, observing that
"... withholding the medical records of Respondent No.1, who was a premature baby, for a period of over 2 years, would constitute grave professional misconduct … apart from being a gross deficiency in service on the part of the Appellant No.1-Hospital and its management."
Accordingly, the Bench dismissed the appeal filed by the Hospital and the doctors concerned, finding that,
"Appellant Nos.1 to 3 are liable for medical negligence since at no stage were the parents of Complainant No.1 either advised or guided about the possibility of occurrence of ROP in a premature baby, nor was the baby examined by Appellant No.4, the Ophthalmologist as per standard protocol. The doctors ought to have been fully aware of the high chances of occurrence of ROP in a pre-term baby. The lack of care constitutes a gross deficiency in service.
... we hold Appellant No.1-Hospital to be vicariously liable for the acts of omission and commission committed by Appellant Nos. 2 to 4. We hold all the Appellants as being jointly and severally liable to pay compensation to the Complainants.'
While upholding the National Consumer Forum order, the Bench also enhanced the compensation payable by Rs 12 lakhs, taking into consideration additional factors of such as the long pendency of the case and monthly medical bills.
Meera Emmanuel December 18 2019
The Supreme Court recently reiterated that a hospital is also vicariously responsible for the medical negligence committed by the medical professionals employed or retained by it. As noted in a judgment passed earlier this week by a Bench of Justices UU Lalit and Indu Malhotra,
"It is well established that a hospital is vicariously liable for the acts of negligence committed by the doctors engaged or empanelled to provide medical care."
The Court goes on to explain,
"It is common experience that when a patient goes to a hospital, he/she goes there on account of the reputation of the hospital, and with the hope that due and proper care will be taken by the hospital authorities. If the hospital fails to discharge their duties through their doctors, being employed on job basis or employed on contract basis, it is the hospital which has to justify the acts of commission or omission on behalf of their doctors."
The case prompting these observations concerned an infant who had gone permanently blind after a medical condition associated with premature birth, Retinopathy of Prematurity (ROP), went undiagnosed until it reached the irreversible stage of Stage 5.
As per an AIIMS report that eventually became part of the case records, babies born at 32 weeks’ gestation or less face the risk of ROP, which if left untreated may lead to severe vision loss and even blindness. Therefore, it is generally expected that such a premature child is examined to detect the condition. Guidelines also prescribe regular follow-up examinations of the child.
The child in this case was born prematurely at 32 weeks’ gestation, with a weight of 1.49 kg at the time of birth, at a super speciality hospital, Maharaja Agrasen Hospital. The child was discharged 27 days after birth. Neither at this point, nor during two follow-up visits to the hospital, was the single mother of the child advised of any ROP vulnerability that the child may have.
Later, the child was diagnosed with ROP after a visit to another hospital, the Shroff Charity Eye Hospital, at which point the condition had already progressed to stage 5 i.e. total retinal detachment.
In the meanwhile, the Maharaja Agrasen Hospital failed to provide in-patient medical records of the baby for over two years, even though a legal notice for the same was eventually issued to them. It was only following a complaint with the Delhi Medical Council, that the hospital finally disposed the medical records in 2007.
In these records, the child's mother noticed that the Hospital mentioned an ROP checkup having been conducted by a doctor. Perplexed, the mother wrote to the Medical Superintendent, querying how this was so recorded when neither was such a check-up mentioned in the discharge summary, nor did she recollect any such examination having been conducted. The Superintendent responded by simply stating that the ROP had been conducted.
In turn, the mother filed a complaint on behalf of her child before the National Consumer Disputes Redressal Commission in November 2007 against the Hospital and the doctors concerned, citing medical negligence and deficiency of service. In 2016, the Forum ruled against the Hospital and directed the payment of Rs 64 lakhs as compensation.
An appeal was filed before the Supreme Court, with the hospital reasserting that it had performed the check up for ROP. However, on a review of the medical records available, the Bench was unconvinced by the Hospital's submissions. The Court observed,
"We find that the ROP was neither advised, nor carried out at all by the Appellant No.1-Hospital, or Appellant No.4-Dr. S.N. Jha, the Senior Ophthalmologist, throughout the period of hospitalisation of the baby, or even after discharge."
A report to the contrary, submitted by AIIMS to the National Consumer Forum was also found to have been prepared on a flawed basis and therefore, misconceived and unreliable. Rather, the Supreme Court found that the doctors had failed in discharging the duty of care owed by them to the child and his parents, and that the hospital was vicariously responsible for medical negligence.
Justice UU Lalit (L) and Justice Indu Malhotra (R)
The Court also castigated the Hospital for having withheld the medical records of the child for over two years, observing that
"... withholding the medical records of Respondent No.1, who was a premature baby, for a period of over 2 years, would constitute grave professional misconduct … apart from being a gross deficiency in service on the part of the Appellant No.1-Hospital and its management."
Accordingly, the Bench dismissed the appeal filed by the Hospital and the doctors concerned, finding that,
"Appellant Nos.1 to 3 are liable for medical negligence since at no stage were the parents of Complainant No.1 either advised or guided about the possibility of occurrence of ROP in a premature baby, nor was the baby examined by Appellant No.4, the Ophthalmologist as per standard protocol. The doctors ought to have been fully aware of the high chances of occurrence of ROP in a pre-term baby. The lack of care constitutes a gross deficiency in service.
... we hold Appellant No.1-Hospital to be vicariously liable for the acts of omission and commission committed by Appellant Nos. 2 to 4. We hold all the Appellants as being jointly and severally liable to pay compensation to the Complainants.'
While upholding the National Consumer Forum order, the Bench also enhanced the compensation payable by Rs 12 lakhs, taking into consideration additional factors of such as the long pendency of the case and monthly medical bills.
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