Lakshmi Rajan v/s Malar Hospital

Medical errors are one of the leading causes of death in most of the countries and account for more than 18000 annual deaths in India. Unfortunately, a large number of these errors are the consequence of medical negligence, which happens when healthcare professionals fail to uphold their professional responsibilities. Negligence is defined as failing to act with the same degree of caution that a reasonably sensible person would have shown in the majority of personal injury claims.

However, other professionals-including those in the healthcare industry—are subject to a distinct standard of care. Healthcare providers are required to deliver care that is comparable to what a professional with the same level of training would have provided in the same situation. Medical negligence is the term used to describe carer behaviour that deviates from the recognised medical norm.

One might also classify omissions as medical carelessness. In the event that a physician with comparable training would have taken action in the given situation and the concerned provider chose not to, that might be considered medical negligence.[i]

When it comes to diagnosis and treatment, there is room for sincere disagreements, and it is obvious that a professional doctor is not being irresponsible just because his judgement is different from another professional doctor's. Medical professionals are frequently asked to choose a surgery with a higher degree of risk if, in their honest opinion, it will increase the patient's chances of success rather than a technique with a lower risk but a larger likelihood of failure.

It might not be considered negligence if a professional, aware of the severity of the patient's condition, took a greater risk in an attempt to relieve the patient's suffering even though the outcome was not what was intended. In the judgement of Lakshmi Rajan vs Malar Hospital Ltd., the Supreme Court granted a victim compensation to be paid by the physicians and the private hospital found accountable for the patient's untimely death.

The greatest compensation award in the history of medical negligence lawsuits in India was made in this historic ruling. Because of the potential effects on the country's medical practice in the near future, the procedure of determining compensation for medical negligence has so drawn a lot of attention and discussion.[ii]

Background

• Case Citation: Lakshmi Rajan vs Malar Hospital, 1998 3 CPJ 586
• Petitioners: Lakshmi Rajan
• Respondents: Malar Hospital
• The Supreme Court of India addressed the question of the state government's vicarious responsibility in situations of medical negligence perpetrated by doctors working in government hospitals in the case of Lakshmi Rajan vs Malar Hospital.
• This ruling has had a significant impact on India's medical malpractice laws, highlighting the necessity of accountability and redressal procedures in situations of medical misconduct.

Facts and Issues
Facts
The plaintiff went to the Doctor for diagnosis as she was facing health issues named as Physician Dr. P.K. Srinivasan because she was feeling the lump inside her breast from where she was recommended to the second hospital named as Malar Hospital where after the diagnosis, the Doctor come to know about the development to be "Fibro Adenoma" of the left breast.

She was suggested to undergo a surgery in order to relieve herself from the pain where although abdominal ultrasound was done, it does not suggest any type of abnormalities in the uterus. However, when she was taken for surgery of lump in breast, she found after the surgery that her uterus had been removed. The removal of which was done without any consent or prior information/knowledge to her or any of member of her family.

After the uterus removal, her body pain gets more worsen and she discovered a great amount of pus in her vagina where she again consulted Malar Hospital however, this time he recommended to his wife who is the gynaecologist where she shifted the liability of whole incident towards her husband and she was made again to go to the hospital. After she again went there, Doctor removed the pus without giving her aesthesia which caused severe pain than expected and this further worsen the condition of patient.

She was made to undergo the surgery first without any prior information with respect to her uterus removal and secondly, when she caught problem in vagina she was made to undergo treatment without any aesthesia. The surgery was performed without even Doctor having any knowledge or specialization as he was not gynaecologist.

The state commissioner, which found medical negligence on the parts of the Malar Hospital made Lakshmi Rajan received a payment of Rs 2,00,000. Lakshmi Rajan filed Civil Appeal in National Commission Tribunal to increase the amount of compensation where she was allowed 1000 rupee more in lieu of appeal filled.[iii]

Issues:

• Whether the respondents were negligent?
• Whether there was violation of patient's consent?
• Whether there was violation of bodily integrity (Right to body)?

Arguments Advanced
Arguments by Plaintiff
In the present case, the plaintiff contended that she was not informed by the doctor that uterus treatment was also to be done in surgery and secondly even after the surgery, her condition did not get improved due to which she again visited the Doctor where she was recommended to her wife that caused mental stress due to his negligence and again to himself by her wife, where he removed the pus without giving her aesthesia which caused her suffer much more pain than expected.

Thus, she contended that the Doctor lacks skills and expertise to do uterus surgery as he is not the gynaecologist and secondly, he had not exercised due care because he had not given her aesthesia. The third contention was that Dr P.K. Srivasan had gave her such recommendation which had ultimately led to unauthorized and unrelated surgery of her without her consent violating the Right to own body. This had not only infringed her Right to Life and Liberty but this operation had also led to many future contradictions in her body.

Arguments by Respondent
The first respondent submitted that it has only recommended the party to the Malar Hospital without any employment and it has charged the party only for the services which it provided without any interference in treatment given by 2nd respondent. Thus, it contented that thereby it is not liable for conduct of the 2nd party as no vicarious liability is being established between them and Hospital recommended by them for treatment.

2nd Respondent primary argument against the complainant was that she was recommended to him by their family doctor who in his letter clearly stated that the woman has lump in her breast which is progressively growing and requires an urgent treatment due to excessive pain and the problem in uterus. The Doctor of Malar Hospital also contented that he is the well-known for uterus surgeries and he is also being called by other hospitals for the same thus, he does not lack the skills to do the surgery.

The third point which he contended that the Complainant was well-aware about the problems in her body including the uterus ones also and he had also made her and her husband signed the consent form before undergoing surgery. Thus, he stated that the complainant had both the knowledge and intention to undergo the treatment because he was informed in letter by her family Doctor that she has poor financial condition and cannot afford both the treatments separately due to which he was suggested to treat her with both the problems in single surgery.

Decision
The Tamil Nadu State Consumer Disputes Redressal Commission ruled in favor of Lakshmi Rajan highlighting the importance of consent of the patient whereby court said that treatment must only be done after obtaining consent of the patient. It emphasized that the hospital was enough negligent that it has not obtained the consent of Lakshmi Rajan before undergoing her uterus surgery. Thus, surgery was done without consent of her or her family.

Secondly, there has been negligence on part of doctor because he had not given her anesthesia before treatment which had led to excessive pain and bad condition of Lakshmi Rajan even worse than before treatment. The court also laid attention towards "volentia non fit injuria" especially with respect to medical treatment which means the consent of plaintiff himself. Thus, the court granted compensation to the complainant worth 200000 lakhs and addition 1000 rupee for recovering the cost of appeal.

Analysis
The ruling given by Supreme Court in this case established an example for all the hospitals and physicians whether public or private to beware of the consequences of medical negligence on their part. Tamil Nadu government was ordered by the Consumer Redressal Commission to pay Rs. 2 Lakhs to the lady who suffered pain and weak health by negligence of doctor and had to also undergo surgery of uterus without even her own consent, thus she received lakh of acre in Malar hospital.

The woman in question has permanently lost her uterus and attained various other medical problems due to doctor's default. There is never truly enough money to make up for the sadness in her life. This can have very dangerous outcomes. It is clear at this point in time that she would need assistance, and perhaps in the future, she would have to completely rely on it.

Therefore, it is impossible to believe that she would be able to pursue a conventional profession or even any sexual activity without any obstacles. She could also have a really hard time even working at home. The treatment of her has already cost her husband a great deal of money.

Therefore, it follows that, while taking inflationary tendencies into consideration, there should be sufficient recompense for the costs already paid, the agony and suffering, the lost income, and any future care that may be required. Without a sure, she would need further medical care in the future, which would mean spending money on medications and even surgery.

The multiplier technique is a straitjacket approach that should be avoided for assessing damages in medical negligence cases, as the Court has correctly cautioned. Restitution in integrum is the legal doctrine that governs the giving of compensation under such circumstances that may be trusted. The aggrieved party should get that amount of money as a practical implementation of this concept, placing him in the same situation as if he had not suffered the wrong.

The case served as a reminder of how crucial it is to defend patients' rights and guarantee that they have access to efficient remedies where there has been medical negligence. The verdict sought to protect patients' rights and defend the state's responsibility to ensure that doctors at government hospitals provided high-quality care. The ruling highlighted how important it is to keep government healthcare institutions' standards of care high. It made the state legally obligated to take the required actions to guard against medical malpractice and guarantee that the general public receives quality medical care.

Conclusion
The case of Lakshmi Rajan vs Malar Hospital, covers the legal aspects of medical negligence and deficiency in services performed by doctors and hospitals vicariously. The doctors and the private hospital found to be at fault for the patient's medical condition which made hospital pay the victim compensation totaling Rs. 2 Lakhs in this medical negligence case. Because of the potential effects on the country's medical practice in the near future, the procedure of determining compensation for medical negligence has so drawn a lot of attention and discussion.[iv]

This case also emphasized the importance of precaution and care to be taken in the field of medical science. The case presented a clear picture that how deficiency in services can led to serious consequences in health sector. This case established that, in addition to exercising a fair level of care, the medical practitioner is required to bring a reasonable level of ability and understanding. The law does not mandate either an extremely high or very low level of care and competence determined by the unique facts of each case.

Furthermore, this case also established the principle of restitutio in integrum. According to the aforementioned concept, a person who is entitled to damages should, as far as feasible, get the amount of money that would have placed him in the same situation as he would have been in had he not suffered the wrong. Though in the present case, the situation cannot be brought back in the same situation as before as the eyes of that child could not be brought back, but still in its essence, it is believed that the compensation will be able to provide relief to the child as her needs could be fulfilled using the amount of compensation.

Finally, this case also utilized the principle of vicarious liability, as the hospital was held vicariously liable for negligence of its doctors and the state was held liable for negligence of the hospital. This case forced the institutions and hospitals to realise the importance of reasonable care and precaution in exercising the duties and performing the tasks in such a manner that it does not hurt the other whether physically or mentally.

End Notes:

1. Bieber C, Medical Negligence: Legal Definition & Examples (Forbes Advisor, October 13, 2022) https://www.forbes.com/advisor/legal/medical-malpractice/medical-negligence/
2. Math S and Chandra M, Progress in Medicine: Compensation and Medical Negligence in India: Does the System Need a Quick Fix or an Overhaul? (2016) 19 Annals of Indian Academy of Neurology 21 https://journals.lww.com/annalsofian/fulltext/2016/19001/progress_in_medicine__compensation_and_medical.6.aspx
3. Jain, Megha (2020b). Case Summary: Taj Mahal Hotel vs United India Insurance Company Ltd. & Ors, in: LawLex.Org, https://articles.manupatra.com/pdf/dfdbcaf6-4cd9-45b3-8786-e103c1d3d8c7.pdf
4. Lakshmi Rajan v. Malar Hospitals Ltd. and Another on 13 June 1997 - Judgement - LexTechSuite, https://lextechsuite.com/Lakshmi-Rajan-Versus-Malar-Hospitals-Ltd-and-Another-1997-06-13