The National Consumer Disputes Redressal Commission has set aside a State Commission order awarding Rs. 38.25 lakh compensation against a hospital and two doctors, reaffirming that medical professionals cannot be held liable for negligence merely because a patient subsequently dies or because an alternative course of treatment might have yielded better results. The Commission applied the Bolam test and Jacob Mathew principles to hold that the doctors exercised reasonable skill and competence, and the expert opinion supported their clinical decision-making.
Background & Facts
The Dispute
The complainants, Mrs. Shubhada Dhawde (wife) and Ms. Sakshi Dhawde (daughter) of the deceased Dhananjaya Shankar Dhawde, filed a consumer complaint before the Andhra Pradesh State Consumer Disputes Redressal Commission, Vijayawada, alleging medical negligence by Guntur City Hospital (OP-1), Dr. M. Nagendra Prasad (OP-2), and Dr. Srikanth (OP-3), Consultant Cardiologist. They claimed compensation of Rs. 50,00,000 with litigation costs, alleging that the deceased was wrongly diagnosed with GERD (Gastroesophageal Reflux Disease) with URTI (Upper Respiratory Tract Infection) when he actually suffered from a cardiac condition that led to his death.
Key Facts
- 24.04.2012 (10:00 PM): Deceased Dhananjaya Shankar Dhawde, aged 54 years, Chief Manager at Union Bank of India, admitted to Guntur City Hospital with complaints of difficulty in breathing, dyspepsia, and constipation
- 24.04.2012: Patient attended by Duty Doctor, admitted to ICU, managed with fluids, nebulization, and supportive care; various blood investigations advised
- 25.04.2012: Dr. M. Nagendra Prasad (OP-2) examined patient, suspected cardiac issue, referred to Dr. Srikanth (OP-3), Consultant Cardiologist and Assistant Professor at Government General Hospital, Guntur
- 25.04.2012: Dr. Srikanth examined patient, found mild breathlessness, BP 130/90 mmHg, pulse 80/min, no abnormality in CVS and lungs; patient non-diabetic, non-smoker, non-alcoholic; advised 2D Echocardiography, X-Ray Chest PA view, CT Scan Chest to rule out ILD/COPD, and Ultrasound Abdomen
- 25.04.2012: 2D Echocardiography performed - showed LV dilated, TR mild, RV free wall hypokinesis indicating pulmonary hypertension
- 26.04.2012: Patient discharged with diagnosis of GERD with URTI; vital parameters stable; prescribed antacids
- 27.04.2012: Patient attended bank duties without any episode
- 28.04.2012: Patient visited clinic of OP-2 after experiencing sweating, restlessness, breathlessness; OP-2 unavailable (attending mother's death anniversary); attended by junior doctor
- 29.04.2012 (10:00 AM): Patient expired at hotel in Rajahmundry after developing severe breathlessness, giddiness, profuse sweating
- 03.03.2014: Complaint filed before State Commission (CC No. 58 of 2014)
- 20.12.2019: State Commission allowed complaint in part, awarded Rs. 38,25,953 with 9% interest from 03.03.2014 and Rs. 25,000 litigation costs, payable within eight weeks
Procedural History
- 03.03.2014: Original complaint (CC No. 58/2014) filed before Andhra Pradesh State Consumer Disputes Redressal Commission, Vijayawada
- 20.12.2019: State Commission pronounced order allowing complaint in part, directing payment of Rs. 38,25,953 with 9% interest from date of complaint and Rs. 25,000 litigation costs within eight weeks
- 2020: First Appeal No. 216/2020 filed before NCDRC, New Delhi against State Commission order
- IA/1877/2020: Stay application filed by appellants
- 07.09.2026: NCDRC pronounced judgment allowing appeal, setting aside State Commission order
The Parties' Positions
Appellants (OPs): Contended that patient was properly examined, investigated, and treated according to acceptable medical standards. Dr. Srikanth advised appropriate investigations (2D Echo, X-Ray, CT Scan) but patient did not undergo CT Scan and sought discharge for insurance reimbursement. Patient was stable at discharge and attended work next day. No post-mortem conducted; cause of death based only on cremation receipt. Expert opinion of Dr. Y.V. Subba Reddy supported their conduct.
Respondents (Complainants): Argued that OPs suppressed/misrepresented facts; ECG and Echo reports showed cardiac abnormalities that were negligently overlooked. CT Scan never prescribed; progress sheet subsequently fabricated. OPs adopted callous attitude lacking competence. Diagnosis of GERD with URTI was incorrect.
Relief Sought
Appellants sought setting aside of State Commission order dated 20.12.2019, dismissal of complaint, and release of any deposited amount. Respondents sought dismissal of appeal and confirmation of compensation award.
The Legal Issue
The central question was whether the treatment and diagnosis provided by the appellant doctors from 24.04.2012 to 26.04.2012 fell below the standard of a reasonably competent practitioner in their field, constituting medical negligence under the Consumer Protection Act, particularly where the patient died three days after discharge without any post-mortem examination to establish the exact cause of death.
Arguments Presented
For the Appellants
Learned Senior Counsel Ms. Kanika Agnihotri contended that the State Commission proceeded on assumptions that death resulted from incorrect diagnosis. She argued: (1) Cause of death as heart attack was presumptive, based solely on cremation receipt information without medical corroboration; (2) No FIR registered, no post-mortem conducted, other causes of death not ruled out; (3) Patient treated for GERD with URTI based on history and symptoms, and referred to cardiologist to rule out cardiac issues; (4) Dr. Srikanth independently examined patient, advised 2D Echo, CT Scan, X-Ray to rule out COPD/ILD; (5) State Commission erred in discarding Dr. Srikanth's prescription (Ex.B-1) as subsequently introduced; (6) Patient parameters stable at discharge, attended duties on 27.04.2012; (7) OP-2's absence on 28.04.2012 due to mother's death ceremony cannot support adverse inference; (8) Expert opinion of Dr. Y.V. Subba Reddy wrongly discarded; (9) Relied on Mark Stevan Christianson v. Fortis Hospitals, Mandar Jadhav v. Dr. Riya, C.P. Sreekumar v. S. Ramanujam, and Neeraj Sud v. Jaswinder Singh.
For the Respondents
Dr. Divakar Babu supported State Commission findings, arguing: (1) OPs indulged in suppression and misrepresentation of pivotal facts; (2) ECG and Echocardiography reports showed cardiac abnormalities negligently overlooked; (3) Cross-examination of witnesses supported findings; (4) CT Scan never prescribed by OP-3, document subsequently introduced without patient name/date; (5) OP-1 hospital ought to have CT Scan facility as modern hospital; (6) Diagnosis of GERD with URTI incorrect; deceased suffered heart ailment but not treated for it.
The Court's Analysis
The Commission, through Justice Anoop Kumar Mendiratta, undertook a comprehensive analysis of medical negligence jurisprudence. The Court reproduced extensively from Jacob Mathew v. State of Punjab (2005) 6 SCC 1 and Kusum Sharma v. Batra Hospital (2010) 3 SCC 480, reiterating the Bolam test as the governing standard: a doctor is not negligent if acting in accordance with a practice accepted as proper by a responsible body of medical opinion.
"A medical practitioner would not be held liable simply because things went wrong from mischance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference to another. A medical practitioner would be held liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field."
The Court emphasized three key principles from Jacob Mathew: (1) Negligence requires breach of duty, breach, and resulting damage; (2) For medical professionals, standard is that of an ordinary competent practitioner, not the highest expert skill; (3) Error of judgment or accident is not negligence if the chosen course was acceptable to the medical profession.
Applying these principles to facts, the Court found: (1) Dr. Srikanth's prescription of X-Ray, CT Scan, 2D Echo was correct course to ascertain ailment; (2) All vital parameters normal at discharge; (3) Patient non-diabetic, non-smoker, non-hypertensive; (4) Expert Dr. Y.V. Subba Reddy categorically opined consultants took reasonable care, advised appropriate investigations, and patient discharged without evaluation of advised tests; (5) Cardiologist never called again to review investigations; (6) State Commission's inference that prescription was fabricated because Duty Doctor prescribed similar tests was flawed - specialists independently assess and prescribe; (7) CT Scan facility unavailability in hospital not negligence - outsourcing is common practice; (8) No post-mortem, no medical document establishing cause of death; (9) Onus of proving negligence on complainant - mere averment insufficient.
The Court held that State Commission erred in holding OPs negligent on premise that treatment fell below standard of reasonably competent practitioner. The expert opinion, uncontradicted, established that the course of evaluation adopted was correct and reasonable.
The Verdict
The appeal was allowed. The NCDRC set aside the State Commission order dated 20.12.2019 in CC No. 58/2014. The complaint stood dismissed. No order as to costs. Any amount deposited by appellants to be released to them after thirty days from the date of order (07.09.2026).
What This Means For Similar Cases
Bolam Test Remains the Touchstone
The judgment reaffirms that Bolam v. Friern Hospital Management Committee and Jacob Mathew v. State of Punjab continue to govern medical negligence in India. Practitioners must demonstrate that the doctor's conduct aligned with a practice accepted by a responsible body of medical opinion. The standard is ordinary competent skill, not highest expertise. An error of judgment in choosing between two reasonable courses of treatment does not constitute negligence.
Expert Evidence Carries Decisive Weight
- Uncontradicted expert opinion from a qualified specialist (Dr. Y.V. Subba Reddy, HOD Cardiology, Osmania General Hospital) was given primacy
- The expert's observation that "consultants have taken reasonable care and exercised their knowledge for the diagnosis" was determinative
- Courts should not substitute their own medical judgment for that of qualified experts absent evidence of bias or incompetence
Procedural Lapses Do Not Equal Negligence
- Failure to file progress sheet with written version does not render it fabricated
- Visiting consultants' notes on hospital progress sheets often lack patient name/date/time - this is administrative, not evidentiary
- Absence of CT Scan facility in hospital is not negligence; outsourcing is standard practice
- Patient's failure to undergo advised investigations (CT Scan) and not returning for review breaks causal chain
Burden of Proof Remains on Complainant
- Mere averment in complaint is not proof of negligence
- Complainant must provide facta probanda and facta probantia
- Cremation receipt stating "heart attack" based on family information is not medical evidence of cause of death
- No post-mortem, no FIR, no medical records from final episode = insufficient to establish causation
Practical Takeaways for Practitioners
- For doctors/hospitals: Maintain contemporaneous records; obtain expert opinions early; document referral advice and patient non-compliance
- For complainants: Secure post-mortem examination; obtain independent medical expert opinion; establish causation through medical evidence, not presumptions
- For forums: Apply Bolam test rigorously; do not discard uncontradicted expert evidence on procedural technicalities; distinguish between error of judgment and negligence
