Calcutta High Court: In an appeal revolving around allegations of medical negligence that resulted in the patient’s demise, the competence of medical practitioners, and the jurisdiction of the Commission in dealing with medical issues, a division bench comprising of Arijit Banerjee and Apurba Sinha Ray,* JJ., set aside the judgment of the learned Single Judge and the order of the State Medical Council, finding palpable wrongs in the adjudication process. The court allowed the appeal, permitting the complainant to pursue issues of medical negligence before the appropriate forum under the National Medical Commission Act.
Factual Matrix
The instant matter stems from a complaint filed by a son before the West Bengal Clinical Establishment Regulatory Commission (the Commission) alleging the untimely death of his mother due to negligence in detection, delay in shifting the patient, improper medication, improper diagnosis, and misleading the patient party. After hearing the service provider, BM Birla Heart Research Centre (BMBHRC), and considering affidavits and reports from medical professionals and councils, the Commission found deficiencies in patient care services and directed BMBHRC to pay compensation of Rs. 20,00,000 to the bereaved family.
BMBHRC challenged the Commission’s decision in a writ proceeding, but the Single Judge upheld the decision, leading to the present appeal. BMBHRC contended that the Single Judge erred in considering medical negligence issues, which fall outside the Commission’s jurisdiction under the West Bengal Clinical Establishment (Registration, Regulation, and Transparency) Act, 2017 (the Act).
Appellant (BMBHRC)’s Contentions
The appellant contended that the Commission violated Section 38(iii) of the Act, by adjudicating medical negligence issues. The appellant challenged the competence of Dr. Giri to conduct and interpret echocardiograms, emphasizing discrepancies in reports from the Medical Council of India (MCI) and West Bengal Medical Council. The appellant contended that M.B.B.S graduates, like Dr. Giri, are qualified to perform echocardiograms. It was argued that the Commission’s decision jeopardizes Dr. Giri’s career and causes confusion in the medical profession.
Regarding the report from MCI, the appellant questioned the competence of the author, highlighting inconsistencies and arguing that the report’s conclusions are based on personal opinions rather than established laws. The appellant also challenged the Commission’s decision-making process, alleging errors, lack of expert opinions, and failure to call relevant witnesses, including Dr. Shuvo Dutta, a qualified cardiologist.
Respondent 4’s Contentions
Respondent 4 argued against the need for the Court’s intervention, citing the Commission’s statutory authority and the Single Judge’s upheld decision. It was contended that a wrong order can be quashed only for fundamental flaws, gross miscarriage of justice, absence of legal evidence, or serious errors of law, which are absent in this case. It was emphasised that the Commission had jurisdiction to address issues related to Dr. Giri’s claimed specialization. The respondent challenged Dr. Giri’s qualifications, asserting that neither he nor Ms. Chaitali Kundu were eligible to conduct echocardiography. It was argued that a medical practitioner with only an MBBS degree should not practice as a specialist, as evidenced by the lack of additional qualifications commensurate with the claimed specialty.
Respondent 4 disputed the appellant’s version of events leading to the patient’s death, alleging unreasonable delays and negligence in the discharge process. It was asserted that the discharge summary was concocted, pointing out contradictory statements and questioning the Commission’s failure to call Dr. Tanmoy Chakraborty for further clarification. The respondent highlighted the patient’s deteriorating condition due to delays in transferring her to a multispecialty hospital and disputed the appellant’s account of events leading up to her admission to CMRI Hospital.
National Medical Commission’s Contentions
The National Medical Commission supported the Single Judge’s observations on a specialist’s status and qualifications, emphasising that certain procedures should only be performed by practitioners with specialized qualifications.
Court’s Assessment
The Court acknowledged the irreparable loss due to the untimely demise of a person and highlighted the difficulty in diagnosing internal conditions. The Court examined patient’s medical history, emphasising her admission with symptoms of infection, fever, and elevated cardiac enzymes.
The Court considered the Commission’s conclusion that the cause of death was the incompetence of Dr. Giri and Ms. Kundu in diagnosing a cardiac problem through ECG. The Court clarified that medical science complexities make it inappropriate to attribute the death solely to the failure in ECG interpretation. The Court delved into medical definitions, explaining ACS, Sepsis, and immuno-compromised state due to DMARD. The Court concluded that the cause of death may have been sepsis leading to septic shock, considering symptoms like hypotension and worsening organ function. The Court criticised the Commission’s unequivocal link between ECG interpretation and patient’s death, emphasising the intricate nature of medical diagnoses.
The Court referred to medical regulations, noting that professional misconduct claims must be adjudicated by the Medical Council. The Court highlighted that the Commission lacks authority to declare a medical practitioner unqualified; such matters fall under the purview of Medical Councils. The Court stressed that the alleged incompetence of Dr. Giri should be assessed by the State Medical Council or National Medical Commission. The Court criticised the Commission for prematurely holding BM Birla Heart Research Institute responsible for deficient patient care without awaiting the Medical Council’s decision on Dr. Giri’s qualifications.
The Court noted that the Medical Council of India, through a letter dated 31-08-2017, did not specify the minimum qualifications for performing echocardiography. A subsequent document, a letter dated 25-06-2019 issued by the Law Officer, Board of Governor superseding the Medical Council of India, stated that a Medical Graduate or a para-medic (with training) could conduct an echocardiogram test. The letter emphasised that individuals with super-specialist qualifications like MD or DM are better suited to clinically interprete the data of an eco-cardiogram.
While considering whether the benchmark for assessing negligence in the medical field is the ‘reasonable standard’ or the lowest standard of skill and competence a professional is expected to possess, the Court made reference to legal principles, including the observation in Bolam v. Frien Hospital Management Committee, (1957) 1 WLR 582, emphasising that the standard is that of an ordinary skilled person exercising and professing to have special skills. The Court accepted the English view that the competence of a professional is judged by the lowest standard considered acceptable in cases where a profession embraces a range of views on acceptable conduct. The Court also observed that the syllabus of medical courses supports that the medical graduates, including Dr. Giri, are taught ECG interpretation.
The Court found that the doctor has at least the minimum standard of competence until proven otherwise by the State Medical Council or the National Medical Commission. The Court dismissed the allegations against a commerce graduate who assisted in conducting an ECG, citing the 2019 letter that allowed paramedics (with training) to perform ECG tests. The Court acknowledged a mistake by Dr. Tanmoy Chakraborty in describing the patient’s condition but emphasised that it is a serious lapse on his part alone. The Court dismissed the failure to submit a utilization report for IV fluids as not a serious lacuna, considering the nature of the patient’s disease.
The Court found that the issues of medical negligence and deficient patient care services are intertwined, and technical matters related to the competence of the doctor or ECG technician should be addressed by specialized branches rather than the Commission. The Court criticised the Commission for discrepancies, lack of proper procedure, and insufficient opportunities given to Dr. Giri to refute allegations. The Court held that Dr. Giri, holding an MBBS equivalent degree, demonstrated a minimum standard of competence in conducting and interpreting ECG until proven otherwise by appropriate disciplinary proceedings. Ms. Chaitali Kundu, a commerce graduate assisting Dr. Giri, was not considered to have conducted ECG unauthorizedly.
Court’s Decision
While noting palpable wrongs in the Commission’s order and the Single Judge’s failure to consider crucial factors, the Court set aside the judgment and order of the Single Judge and the Commission, and allowed the appeal. The complainant is granted the liberty to pursue issues of medical negligence and deficient patient care services under the National Medical Commission Act. The appellant may withdraw the deposited sum of Rs. 15,00,000 after the appeal period expires. No costs are imposed.
[B.M. Birla Heart Research Centre v. State of W.B., 2023 SCC OnLine Cal 5068, order dated 15-12-2023]
*Judgment by Justice Apurba Sinha Ray
Advocates who appeared in this case :
Mr. Aniruddha Chatterjee, Mr. Shibaji Kumar Das, Ms. Rupsa Sreemani, Mr. R. Ahmed Khan, Counsel for the Appellant
Mr. Sirsanya Bandopadhyay, Jr. Standing Counsel, Mr. Arka K. Nag, Counsel for the State
Mr. Avik Ghatak, Counsel for the Respondent 2
Mr. Biswaroop Bhattacharya, Mr. Vivekananda Bose, Ms. M. Ghosh, Mr. R. Pal, Counsel for the Respondent 4
Mr. Indranil Roy, Mr. S. Kr. Roy, Counsel for the National Medical Commission
