The Supreme Court of India has ruled that a failed surgery or post operative complication does not automatically amount to medical negligence. In a landmark judgment, the apex court cleared a doctor and PGI Chandigarh, reaffirming the Bolam test and holding that adverse medical outcomes without expert evidence cannot establish negligence.
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In a crucial judgment that strengthens legal protection for medical professionals, the Supreme Court of India has ruled that a doctor cannot be held negligent merely because a surgery fails or a patient’s condition worsens after treatment. Setting aside the order of the National Consumer Disputes Redressal Commission (NCDRC), the Court restored the findings of the State Commission and held that no medical negligence was proved against the treating doctor or PGI Chandigarh.
The judgment, delivered on October 25, 2024, arose from allegations relating to a corrective eye surgery performed on a minor child nearly three decades ago.
The case involved a father and his minor son, who was around six years old at the time of treatment. The child was diagnosed with a congenital disorder of the eye known as ptosis, or drooping of the eyelid. As recorded by the Court, “the son was a minor aged about 6 years when he was diagnosed of congenital disorder in his left eye (also known as ‘PTOSIS’ or ‘drooping eyelid’).”
The surgery was performed at PGI Chandigarh in June 1996 by Dr Neeraj Sud, an ophthalmologist. The complainants alleged that before surgery the child had normal vision and only a cosmetic defect, but after surgery the condition worsened. The Court noted the allegation that “instead of any improvement the condition of the eye further deteriorated post surgery.”
On the basis of deterioration in vision and development of double vision after surgery, the complainants approached the consumer forum alleging medical negligence. They claimed that the ptosis had worsened from moderate to severe and that vision had reduced significantly. Compensation of more than ₹19 lakh was sought for mental agony, medical expenses, and loss of studies.
While examining the record, the Supreme Court took note of the treating doctor’s credentials. It specifically recorded that “Dr. Neeraj Sud is a qualified post graduate in ophthalmology” and that he had “three years of experience in eye surgeries including surgery of ptosis.” During his tenure at PGI, he had been associated with around 74 ptosis surgeries.
The defence argued that recurrence or worsening of ptosis is a known complication of congenital ptosis surgery and that such outcomes may occur even when surgery is performed with due care. It was also pointed out that repeat surgery is an accepted corrective option.
After examining the medical records, the State Consumer Commission dismissed the complaint. It held that the complainants had failed to prove any lack of care or unacceptable medical practice. As noted by the Supreme Court, the State Commission concluded that “the complainants failed to establish any negligence or carelessness on part of the doctor” and that the doctor “had not adopted any unacceptable medical practice.”
The complainants appealed before the NCDRC, which reversed the State Commission’s findings. The NCDRC relied primarily on medical records showing post surgical deterioration. It noted that before surgery the child had 6/9 vision in both eyes, but after surgery the vision fell to 6/18 and the ptosis worsened. Based on this outcome, compensation was awarded.
The Supreme Court strongly disagreed with this approach. It made it clear that adverse outcomes cannot be equated with negligence. In clear words, the Court observed that “deterioration of the condition of the patient post surgery is not necessarily indicative or suggestive of the fact that the surgery performed or the treatment given to the patient was not proper.”
The Court further explained that “it is not necessary that in every case the condition of the patient would improve and the surgery is successful to the satisfaction of the patient.” Complications, the Court noted, may arise even when reasonable care is exercised.
A key reason for setting aside the NCDRC order was the complete absence of evidence supporting negligence. The Supreme Court noted that “the said finding is based on no evidence insofar as the complainants have not adduced any evidence to prove any negligence on part of the doctor.”
The Court clarified that medical records showing deterioration only establish an outcome, not negligence. Without expert evidence demonstrating breach of accepted medical standards, liability cannot be imposed.
Reiterating settled law, the Supreme Court explained that “actionable negligence in context of medical profession involves three constituents (i) duty to exercise due care (ii) breach of duty and (iii) consequential damage.” It went on to clarify that “a simple lack of care, an error of judgment or an accident is not sufficient proof of negligence.”
The Court also emphasized that doctors cannot be held liable merely because a better alternative treatment existed or because another doctor might have taken a different approach.
Applying the Bolam principle, the Supreme Court reaffirmed that “a doctor is not negligent if he is acting in accordance with the acceptable norms of practice.” In the present case, the Court found that Dr Neeraj Sud was competent, qualified, and followed accepted medical procedures.
It concluded that “there was no material to establish any overt act or omission to prove negligence on his part.”
Rejecting automatic presumption of negligence, the Court ruled that “simply for the reason that the patient has not responded favourably to the surgery or the treatment administered by a doctor, the doctor cannot be held liable for medical negligence straightway.”
The doctrine of res ipsa loquitur, the Court held, cannot be applied unless there is clear proof that due skill and care were not exercised.
After analysing the entire record, the Supreme Court held that the NCDRC should not have interfered with the State Commission’s findings. It categorically ruled that “the judgment and order dated 24.08.2011 of the NCDRC is hereby set aside and that of the State Commission is restored.”
The Court further concluded that “since the complainants have failed to prove any negligence on part of the doctor or the PGI, they are not entitled to any compensation.”
This judgment sends a strong message that medicine is not a guarantee based profession and that courts must avoid hindsight driven conclusions. It reassures doctors that adverse outcomes, by themselves, will not expose them to liability unless supported by credible expert evidence of negligence.
By blending legal clarity with practical understanding of medical science, the Supreme Court has reinforced a critical safeguard for medical professionals. The ruling clearly establishes that failure of treatment is not negligence, and that proof, not presumption, is the foundation of medical liability.
Source: Supreme Court of India, Judgment dated October 25, 2024
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