Vijay Irudayaraj v. Medical Council of India, New Delhi
2014-12-02
V.RAMASUBRAMANIAN
body2014
DigiLaw.ai
JUDGMENT V. RAMASUBRAMANIAN, J. 1. The petitioner has come up with the above writ petition, seeking the issue of a writ of Mandamus to direct the Tamil Nadu Medical Council and the State of Tamil Nadu to take necessary action against the fourth respondent on a complaint dated 31.8.2013, filed by him. 2. Heard Ms. Vijayalakshmi K. Rajaratnam, learned counsel for the petitioner, Mr. V.P. Raman, learned counsel appearing for the first respondent, Mr. Veera Kathiravan, learned counsel appearing for the second respondent, Mr. R. Vijayakumar, learned Additional Government Pleader for the third respondent and Mr. P. Shanmuga Sundaram, learned Senior Counsel appearing for the fourth respondent. 3. The petitioner is permanently settled in United States of America. He came down to Chennai for a vacation in February, 2008, when he was 35 years of age. In the morning of 09.3.2008, he was unable to get up from the bed and unable to move his limbs. 4. Therefore, the petitioner was taken to the fourth respondent hospital by his wife's sister. According to the petitioner, there were no doctors or nurses available in the Emergency Ward of the fourth respondent hospital. The petitioner claims that though he was admitted in the fourth respondent hospital in a critical condition at around 10.00 a.m. no doctor attended on him until 3.00 p.m. The petitioner claims that when his father made enquiries, he was informed that they could not reach out to the Chief Doctor and that every minute of delay, was dangerous to his life. 5. The petitioner further claims that since the hospital staff could not even call a Neurologist, his father pleaded with the duty doctor to discharge him, so that he could be admitted to any other hospital. Eventually, after taking Rs. 40,000/- from the petitioner's father, the petitioner was discharged and he was taken to the Apollo Hospital and admitted. The petitioner underwent a neuro surgery at the Apollo Hospital. As a result, the petitioner claims to have become a person with permanent disability, requiring continuous treatment for the past several years, spending a sum of Rs. 50,000/- per month. 6. Therefore, complaining that the doctors at the fourth respondent hospital failed to make an appropriate diagnosis within a couple of hours of his admission, thereby losing the golden hour, the petitioner made complaints to the Tamil Nadu Medical Council and the State Government.
50,000/- per month. 6. Therefore, complaining that the doctors at the fourth respondent hospital failed to make an appropriate diagnosis within a couple of hours of his admission, thereby losing the golden hour, the petitioner made complaints to the Tamil Nadu Medical Council and the State Government. Since these representations did not evoke any response, the petitioner has come up with the above writ petition. 7. The Managing Director of the fourth respondent has filed a counter affidavit. It is contended in the counter affidavit that the writ petition is not maintainable, inasmuch as the petitioner did not avail the alternative remedy of approaching the Consumer Forum under the Consumer Protection Act, 1986, within the period of limitation prescribed under Section 24-A of the Act. It is further contended in the counter affidavit that the petitioner was admitted in a highly critical condition at about 10.30 a.m. on 09.3.2008 to the fourth respondent institution, that immediate emergency medical care was administered to bring down his BP (NTG infusion), reduce cerebral oedema (Injection Manitol, Lasix), prevent seizures (Injection Eptoin) with antibiotics (Injection Levoflox), that the patient was shifted to the ICU for close monitoring, that in the ICU, Dr. Rajan, cardiologist ordered extensive investigations to be done on the patient-blood work, CT brain, ECG etc. that the ICU Anesthetist Dr. Kunthraj identified the patient's increasing drowsy state, intubated him and put him on ventilator support, that the CT brain showed a deep seated hypertensive intra cranial hemorrhage (ICH) in right basal ganglia region, that the patient was examined by the Chief Neuro Surgeon Dr. Srinivasan, who also explained the patient's critical condition to his relatives and took their consent for any further treatment, that in accordance with the standard of practice laid down internationally, Dr. Srinivasan ruled out surgical intervention and advised medical management of the patient's condition. 8. According to the counter affidavit, the petitioner's father got him discharged against medical advice. The fourth respondent has also contended that the surgery performed for the petitioner at the Apollo Hospital was not the norm and that international protocols recommend only medical management of the condition. It is also claimed by the fourth respondent that in the case of a stroke caused by intra cranial bleeding, there is nothing like golden hour. Therefore, the fourth respondent claims that there is no medical negligence. 9.
It is also claimed by the fourth respondent that in the case of a stroke caused by intra cranial bleeding, there is nothing like golden hour. Therefore, the fourth respondent claims that there is no medical negligence. 9. Though the Tamil Nadu Medical Council has not filed a counter affidavit, the learned counsel for the Tamil Nadu Medical Council contended that they are not empowered to enquire into any complaints against the hospital. The Tamil Nadu Medical Council is competent to enquire into the allegations of misconduct against individual doctors, but not into the allegations of medical negligence against hospitals. In addition, the learned counsel for the Tamil Nadu Medical Council also contends that a case of negligence may not fall within the definition of misconduct. 10. However, Ms. Vijayalakshmi K. Rajaratnam, learned counsel for the petitioner relies upon a decision of a Division Bench of this Court in Tamil Nadu Medical Council vs. Dr. Easwaran, 2014 (7) MLJ 220 . In the said case, a Division Bench of this Court held that as per the decisions of the Supreme Court in Dr. P.B. Desai vs. State of Maharashtra, 2013 (4) MLJ (Crl.) 259, the ethical duty of a doctor to treat a patient is covered by Code of Medical Ethics, 1972 and that wherever there is a breach of the aforesaid Code, the aggrieved party can file a petition before the relevant Disciplinary Committee constituted by the concerned State Medical Council. Eventually, the Division Bench directed the Medical Council to look into the complaint both against the hospital as well as the persons who are in the administration of the hospital. The relevant portion of para 14 of the decision of the Division Bench reads as follows:- “Similarly, it is also brought to our notice that in several hospitals, in ICU/Critical Care Units, no experts are available and only unqualified/qualified nurses are put in charge to take care of the critically ill patients. The said conduct of both private and government hospitals as well as the persons, who are in the administration of the hospitals, are bound to be enquired into by the Apex body of the State viz. The Tamil Nadu Medical Council.” 11. I have carefully considered the rival contentions. 12. Let me first to take up the objection of the learned Senior Counsel for the fourth respondent, to the maintainability of the writ petition.
The Tamil Nadu Medical Council.” 11. I have carefully considered the rival contentions. 12. Let me first to take up the objection of the learned Senior Counsel for the fourth respondent, to the maintainability of the writ petition. The objection regarding the maintainability is raised on the ground that there is an alternative remedy available under the Consumer Protection Act, 1986 and that even the period of limitation for approaching the Consumer Forum has now expired. 13. But, the fourth respondent is not correct. What is provided under the Consumer Protection Act, is not an alternative remedy, but only an additional remedy. Section 3 of the Consumer Protection Act, makes it clear that it is in addition to and not in derogation of any other law. Moreover, a person may go to the Consumer Forum seeking compensation for the tortious liability of a professional and the hospital. There is nothing in law which prohibits a person simultaneously filing a criminal complaint of medical negligence as well as a complaint of professional misconduct before a regulatory body, such as the Tamil Nadu Medical Council. The reliefs sought before the Consumer Forum/Civil Court or under the criminal law or before the Medical Council, can be independent of each other and all of them can also happen simultaneously. 14. In any case, it is the contention of the petitioner that he continues to receive treatment from the Apollo Hospital even now and that therefore, the cause of action for approaching the Consumer Forum continues to survive. Therefore, the availability of a remedy under the Consumer Protection Act, 1986, is not a bar for the petitioner to file a complaint before the Tamil Nadu Medical Council. 15. Coming to the contention of the learned counsel for the Tamil Nadu Medical Council, it is true that the Medical Council has no control over hospitals. The Medical Council is only a statutory body, which is entitled to enforce discipline among members who are issued with a license to practice. If persons, whose names are borne on the rolls of the State Medical Council, are found to be guilty of professional misconduct, the Medical Council can either suspend the license for a stipulated period or cancel the certificate of membership. Hospitals do not become members of the Medical Council. This is why some of the hospitals are now owned by industrialists.
Hospitals do not become members of the Medical Council. This is why some of the hospitals are now owned by industrialists. While some Medical professionals have themselves become industrialists in the field of medicine, no industrialist can really become a medical professional. But, the Medical Council does not have any disciplinary control over the hospitals. Their disciplinary control extends only over the individual doctors. 16. Therefore, unless the petitioner names the doctor, who according to him were guilty of professional misconduct, it may not be possible for the Medical Council to proceed. As a matter of fact, any proceeding initiated by the Medical Council, will not really bear any fruit, if persons against whom action is sought are not named. 17. The contention of the learned counsel for the State Medical Council that negligence per se may not amount to a professional misconduct, cannot be accepted, especially in the light of the decision of the Supreme Court in P.B. Desai and the decision of the Division Bench in Tamil Nadu Medical Council stated supra. 18. In exercise of the powers conferred by Section 20A read with Section 33(m) of the Indian Medical Council Act, 1956, the Medical Council of India has framed a set of Regulations known as Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002. Chapter 7 of this Regulations lists certain acts of commission and omission on the part of a physician as constituting professional misconduct, rendering him liable for disciplinary action. Regulation 7.1 states that the violation of any of the Regulations would amount to misconduct. 19. It is interesting to note that under Regulation 7.18, a responsibility is fixed on the physician running a Nursing Home. Regulation 7.18 reads as follows:- “7.18 In the case of running of a nursing home by a physician and employing assistants to help him/her, the ultimate responsibility rests on the physician.” 20. Chapter 2 of the Regulations, indicates the duties of physicians to their patients. Regulation 2.1.1 reads as follows:- “2.1.1 Though a physician is not bound to treat each and every person asking his services, he should not only be ever ready to respond to the calls of the sick and the injured, but should be mindful of the high character of his mission and the responsibility he discharges in the course of his professional duties.
In his treatment, he should never forget that the health and the lives of those entrusted to his care depend on his skill by making his visits at the hour indicated to the patients. A physician advising a patient to seek service of another physician is acceptable, however, in case of emergency a physician must treat the patient. No physician shall arbitrarily refuse treatment to a patient. However for good reason, when a patient is suffering from an ailment which is not within the range of experience of the treating physician, the physician may refuse treatment and refer the patient another physician.” 21. Regulation 2.4 imposes an obligation upon the physician not to neglect a patient. Regulation 2.4 reads as follows:- “2.4 The Patient must not be neglected: A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family. Provisionally or fully registered medical practitioner shall not willfully commit an act of negligence that may deprive his patient or patients from necessary medical care.” 22. Therefore, in the light of Regulations 7.1, 7.18 read with Regulations 2.1.1 and 2.4, the second respondent can look into the complaint of the petitioner. There is also one more reason for my said conclusion. Regulation 8.1 makes it clear that the acts of commission and omission listed in Chapter 7 are not exhaustive. Regulation 8.1 reads as follows:- “8.1 It must be clearly understood that the instances of offences and of Professional misconduct which are given above do not constitute and are not intended to constitute a complete list of the infamous acts which calls for disciplinary action, and that by issuing this notice the Medical Council of India and or State Medical Councils are in no way precluded from considering and dealing with any other form of professional misconduct on the part of a registered practitioner. Circumstances may and do arise from time to time in relation to which there may occur questions of professional misconduct which do not come within any of those categories. Every care should be taken that the code is not violated in letter or spirit.
Circumstances may and do arise from time to time in relation to which there may occur questions of professional misconduct which do not come within any of those categories. Every care should be taken that the code is not violated in letter or spirit. In such instances as in all others, the Medical Council of India and /or State Medical Councils have to consider and decide upon the facts brought before the Medical Council of India and/or State Medical Councils.” 23. Therefore, I do not think that any prejudice will be caused to the fourth respondent by directing the second respondent to consider the complaint of the petitioner. It is true that a period of more than 6 years have passed from the date of the alleged act of negligence on the part of the fourth respondent. This delay is something which the petitioner may have to eventually pay for, in view of the fact that it is impossible for professionals to explain their professional conduct after such a delay of about 6 years. The second respondent themselves can take into account all these factors before taking a decision. 24. In view of the above, the writ petition is disposed of, without expressing any opinion on the merits of the complaint of the petitioner, directing the second respondent to look into the complaint of the petitioner and take a decision one way or the other, within a period of 8 weeks from the date of receipt of a copy of this order. I make it clear that this order is not to be taken as a reflection on the quality of the services rendered by the fourth respondent hospital. No costs. Consequently, connected miscellaneous petition is closed.