Pinnamaneni Narasimha Rao v. Gundavarapu Jayaprakasu

This case analysis is written by Sagnik Chatterjee, a student of Symbiosis Law School, Pune.

Case Number

O. S. No.34 of 1969

Equivalent Citation

I (1990) ACC 468, 1990 ACJ 350, AIR 1990 AP 207

Bench

M Rao

Decided on

01 February 1989

Relevant Act/ Section

This case deals with the act of negligence or medical negligence to be specifically performed by the Doctor in a Government hospital which comes under the Tort law. Tort Law is not codified in this country and it is largely based on the precedents of the cases on similar lines.

Brief Facts and Procedural History

The plaintiff was a brilliant young student of 17 years, suffering from chronic nasal discharge, which the ENT surgeon diagnosed as “nasal allergy” and suggested removal of tonsils. After the operation at Guntur (during which the relations of the plaintiff were not allowed to be present), he became unconscious and remained so for three days. Subsequently, he became conscious, but he lost “all the knowledge and learning acquired by him”. His father consulted two eminent doctors, one a neuro-surgeon and the other a psychiatrist and found that the operation had caused the patient cerebral damage and now his intellectual ability was that of a child of five years. The plaintiff claimed damages against the defendants for performing tonsillectomy operation on him carelessly. He sued the Government of Andhra Pradesh (first defendant). the ENT surgeon at the Government General Hospital, Guntur (second defendant) and chief anesthetist of the hospital (third defendant). A suit for damages for Rs. 50,000/- was filed.

Issues before the Court

The issue presented before The High Court of Andhra Pradesh was whether there had been breach of duty of care on the part of the surgeon and anesthetist in government hospital or not.

Ratio of the Case

Defendants put forward the defense that the damage suffered by the plaintiff was “functional” but this was neither believed by the trial judge, nor by the High Court. What actually happened was thus described by the trial judge whose finding was upheld by the High Court was as follows:

“The endo-tracheal tube that was inserted into the endo-trachea of the plaintiff was removed by the third defendant for no valid reasons and that too without taking the minimum precaution of giving a few breaths of pure oxygen to the patient before extubation. There was avoidable delay in inserting the tube again for the second time to give oxygen to the plaintiff when the respiratory arrest occurred. the respiratory arrest that ultimately led to cerebral anoxia was the result of the negligence on the part of the third defendant in adopting faulty techniques of induction and maintenance of anesthesia.”

On these facts, the High Court held that both the second and third defendants had been guilty of negligence as they failed to conduct the surgery with proper standard of care and caused severe harm to the plaintiff. The second defendant (the operating surgeon), although an experienced specialist, did not conform to the standards of conduct expected of an ordinary surgeon. As regards the third defendant (anesthetist). the conclusion of the High Court was as under:

“There has been breach of duty on the pan of the Anesthetist by reason of his failure, an act per se negligence (sic) in the circumstances, to administer respiratory resuscitation by oxygenating the patient with a mask or bag. He exposed the plaintiff to the room temperature for about three minutes and this, coupled with his failure to administer fresh breaths of oxygen before the tube was removed from the mouth of the plaintiff had resulted in respiratory arrest; these are foreseeable factors. There is proximate connection between the Anesthetist’s conduct and the resultant injury—cerebral anoxia.”

With reference to the first defendant (the state government), the court held that it was vicariously liable. It relied on several English cases in this behalf, the last one being Cassidy v. Ministry of Health. Applying the rule laid down in an earlier case, Lord Denning laid down that authorities who run a hospital, whether they are local authorities or government board or any other corporation, are under the self-same duty as the humblest deter to use reasonable care and skill.

“The hospital authorities cannot, of course, do it by themselves; they have no ears to listen through the stethoscope, and no hands to hold the surgeon’s knife. They must do it by the staff which they employ; and if their staff are negligent in giving the treatment, they are just as liable for that negligence as is anyone else who employs others to do his duties for him. What possible difference in law, I ask, can there be between hospital authorities who accept a patient for treatment, and railway or shipping authorities who accept a passenger for carriage? None whatever. Once they undertake the task, they come under a duty to use care in the doing of it, and that is so whether they do it for reward or not.”

On the general question of standard of care. There is a long line of decisions, of both English and Indian, which lays down the requirement of reasonable care and skill. The leading Indian case on the subject is Laxman v. Trimbhak, holding that the doctor is under

(i) a duty of care in deciding whether to undertake the case;

(ii)in deciding what treatment to give;

(iii) in administering the treatment.

In a subsequent case decided by the House of Lords. Whitehouse v. Jordan, Lord Edmund-Davies (with whom Lord Fraser of Tullybelton and Lord Russel of Killowen agreed), in his speech observed:’°

“To say that a surgeon committed an error of clinical judgment is wholly ambiguous, for, while some such errors may be completely consistent with the due exercise of professional skill, other acts or omissions in the course of exercising clinical judgment may be so glaringly below proper standards as to make a finding of negligence inevitable.”

Decision of the Court

The trial court had awarded to the plaintiff Rs. 22000 as damages which the High Court increased to Rs. 50000. In fact, the High Court would have increased it to a much higher amount, but the plaintiff had claimed only Rs. 50000/-. This is what the court says on the subject

“Damages for pain and suffering and loss of amenities are generally given in a single sum. For a grave injury of the nature sustained by the plaintiff. no amount of money would be a perfect compensation. Any amount of money cannot restore to him what he had lost permanently. He is condemned to a perpetual life of misery and agony, during the lucid intervals he is haunted by his brilliant past academic record. His bright future prospects are permanently wiped out The. thrill and joy or life deserted him one and for all. Thinking that a partner in life would give peace and comfort, Iris parents performed his marriage and it appears. that Je marriage came to a tragic end and his wife had deserted him because of his mental deficiency. The tragedy which struck him at the age of 17 in the form of irreversible cerebral anoxia made his life a permanent nightmare. He has no happiness or pleasure for the rest of his life. He is, therefore, entitled to substantial damages under the head ‘loss of amenities’ which in the circumstance, I estimate at Rs. 2 lakhs.”

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