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2019 DIGILAW 566 (UTT)

Nisha Mathur v. Medical Council of India

2019-11-06

SUDHANSHU DHULIA

body2019
JUDGMENT : The petitioner before this Court has been a patient of Dr. Tejashvi Kamra who is a surgeon. The allegation against the doctor by the petitioner is that he had committed a medical negligence in her case, while she was under his treatment. The matter was first taken by the petitioner to the Uttarakhand Medical Council and thereafter to the Medical Council of India. Both the bodies have found that there was no medical negligence on the part of the doctor. Aggrieved, the petitioner has filed the present writ petition before this Court. 2. Brief facts of the case are that the petitioner, who was 56 years of age, at the relevant time, complained of lower abdomen swelling and discomfort and approached Dr. Tejashvi Kamra on 22.06.2015 for his advice. Petitioner was advised for an Ultrasound scan and certain tests. The Ultrasound report showed that the petitioner had distended Gall Bladder with a stone of eleven mm size in her gall bladder. At the same time, facial defect of size 2cm was also seen in anterior Abdominal Wall with herniated bowel and fat at the site of palpable lump. In other words, the petitioner was also to be operated for Hernia as well. As per the opinion of the doctor, since both the operations had to be performed i.e. operation of Hernia as well as that of gall bladder, the medical procedures prescribes that the gall bladder operation be done first and hence the petitioner was first operated for gall bladder on 11.07.2015. After the gall bladder operation was successfully performed by Laparoscopy, on 18.07.2015 the second operation for Hernia was performed. While the petitioner was still admitted in the Nursing Home of respondent no. 3 which is Dr. Kamra’s Urinary & Surgical Diseases Centre in Dehradun, she complained of breathlessness on 20.07.2015. The petitioner was thereafter advised to be shifted to another higher multispecialty hospital i.e. Synergy Hospital in Dehradun, where the respondent no. 3 was also a visiting surgeon. 3. On 25.07.2015, the petitioner was found to have a foul smelling discharge from her laparotomy wound with passing of flatus and fecal fluid from the laparotomy wound. She also had a mild abdominal distension. Therefore, the diagnosis which was made by the doctor was that there was a possibility of a leak from her small bowel anastomosis site. 3. On 25.07.2015, the petitioner was found to have a foul smelling discharge from her laparotomy wound with passing of flatus and fecal fluid from the laparotomy wound. She also had a mild abdominal distension. Therefore, the diagnosis which was made by the doctor was that there was a possibility of a leak from her small bowel anastomosis site. In other words, it was the discharge from where the bowels were joined. Immediately an operation was performed. However, as the petitioner was not comfortable, she hence sought discharge from Synergy Hospital from where she was discharged and was later admitted to another hospital i.e. Asian Hospital at Faridabad on 29.07.2015, where according to the petitioner, her CT Scan was done and it was found that there was discharge of pus which had led to a septicemia. Then the necessary operations were performed at Asian Hospital, Faridabad and the petitioner was thereafter cured and discharged from the hospital. The petitioner is now ultimately cured. She then approached the Uttarakhand Medical Council alleging medical negligence against respondent no. 3. Her case was that after the second operation was performed, when she complained for breathlessness, and thereafter when faecal matters were passing from wounds of her bowel, a proper diagnosis was not done at that stage as there was no CT Scan. Had that been done, correct procedures could have been adopted there itself. 4. The case of the doctor before the Uttarakhand Medical Council, on the other hand, was that the petitioner did not need a CT Scan at that stage. On 25.07.2015 there was a foul smell coming out from her laparotomy wound and since he himself had performed the first operation on 11.07.2015 as well as the second operation on 18.07.2015, he knew exactly how bowels were stitched and where the fault lay, therefore he naturally suspected that the discharge was from her small bowel anastomosis site, and hence he performed the necessary operations. This part, however, the petitioner alleges to be a medical negligence was taken before the Uttarakhand Medical Council. The Uttarakhand Medical Council came to the conclusion that there was no medical negligence on the part of the Dr. Tejashvi Kamra and it cannot be said that he has acted against the professional conduct, etiquettes and ethics. 5. This part, however, the petitioner alleges to be a medical negligence was taken before the Uttarakhand Medical Council. The Uttarakhand Medical Council came to the conclusion that there was no medical negligence on the part of the Dr. Tejashvi Kamra and it cannot be said that he has acted against the professional conduct, etiquettes and ethics. 5. Having made this determination, however, the Ethics Committee of the Uttarakhand Medical Council has given a warning to the doctor that whenever he is away from the hospital and not performing his duties in the hospital, this fact should be specifically declared and stated at the conspicuous place in the Clinic. The Uttarakhand Medical Council has also warned respondent no. 4 i.e. Synergy Institute of Medical Sciences that they should be sensitive to the patients. Since the petitioner was not satisfied with these findings of the Uttarakhand Medical Council, she filed an appeal before the Medical Council of India, which was dismissed vide order dated 03.08.2018. 6. The Ethics Committee of the Medical Council of India before whom the matter was referred consisted of 8 members i.e. Dr. Dhruba Jyoti Borah as the Chairperson with other seven members and the Deputy Secretary who was also a doctor. The Ethics Committee had deliberated in its meeting on 18.05.2017 and 19.05.2017 and has heard both the sides. It had also called for an expert report by Dr. Anurag Srivastava, Professor & Head, Department of Surgical Disciplines, AIIMS, New Delhi. The report of Dr. Anurag Srivastava stated as follows:- “Smt. Nisha Mathur was diagnosed with Ventral Hernia of lower Abdomen and Gall bladder Stone disease by Dr. Kamra at his hospital. Putting a prolene mesh for mesh hernioplasty was not possible along with gall bladder surgery as it is a Contaminated Surgery (biliary spillage may cause infection of the mesh). So, Dr. Kamra only mobilized the hernia content during Cholecystectomy. But after three days of discharge patient develop Abdominal Distention and Recurrent Vomiting due to Obstructed Ventral Hernia. She underwent Exploratory Laparotomy and Resection Anastomosis of small bowel. During the hospital stay patient develop abdominal collection leading to Septicemia, which was managed appropriately leading to safe recovery of Smt. Nisha Mathur.” 7. Thereafter, the Ethics Committee considering all the aspects came to the conclusion as follows:- “The Ethics Committee after detailed discussion and deliberation and after considering the opinion of Dr. During the hospital stay patient develop abdominal collection leading to Septicemia, which was managed appropriately leading to safe recovery of Smt. Nisha Mathur.” 7. Thereafter, the Ethics Committee considering all the aspects came to the conclusion as follows:- “The Ethics Committee after detailed discussion and deliberation and after considering the opinion of Dr. Anurag Srivastava noted that the patient Mrs. Nisha Mathur was diagnosed with Ventral Hernia of lower abdomen and Gall bladder Stone disease and was operated upon by Dr. Kamra. Later the patient exhibited S/S of Obstructed Ventral Hernia for which she underwent Exploratory Laparotomy and Resection Anastomosis of small bowel which was managed appropriately. The Committee therefore decided to exonerate Dr. Tejasvi Kamra of Dr. Kamra’s Urinary and Surgical Diseases Centre, Dehradun and Synergy Institute of Medical Sciences, Canal Road, Dehradun, Uttarakhand from the allegation leveled against him in the present matter.” 8. Not satisfied with the order passed by the Medical Council of India, the petitioner has filed the present writ petition before this Court. 9. This Court has heard the learned counsel for the petitioner as well as learned counsels for the respondents at length. Dr. Tejasvi Kamra was also heard in person on 18.10.2019 as well as today. 10. The first and foremost thing which this Court has to examine is whether due process was adopted by the Uttarakhand Medical Council as well as by the Medical Council of India in hearing the complaint of the petitioner or not. 11. Both the Councils gave a detail hearing to both the sides and the Experts of the Uttarakhand Medical Council had come to the conclusion that there was no medical negligence or misconduct on the part of the doctor. The same view has also been taken by the Ethics Committee of the Medical Council of India which consisted of 8 persons who after due deliberations and after considering the expert report also came to the similar conclusion as the Uttarakhand Medical Council. 12. Primarily this Court has to see whether a due process has been adopted or not in giving the petitioner hearing in the matter. This Court is of the view that there has been a complete compliance of due process. To that extent, the petitioner cannot have any complaint. 13. The petitioner, however, also urged the Court to examine independently whether there is a medical negligence against respondent no. 3. This Court is of the view that there has been a complete compliance of due process. To that extent, the petitioner cannot have any complaint. 13. The petitioner, however, also urged the Court to examine independently whether there is a medical negligence against respondent no. 3. Purely in the interest of justice, we shall now examine this aspect. 14. Petitioner was admittedly diagnosed for Hernia as well as Gall Bladder. Petitioner admits that due medical protocol was followed and the Gall Bladder was first removed and thereafter she was operated for Hernia. However, she was not satisfied with the subsequent diagnosis and treatment given to her. 15. The medical negligence actually alleged against respondent no. 3 is when the operation was performed of Ventral Hernia, where stitches were made in the bowel and Resection Anastomosis was performed, which in simple terms would mean that cutting and joining of bowels had been done. When complications occurred on 25.07.2015, the doctor could visibly see that faecal matter was coming out from the wound and therefore he immediately tried to cure that part of the body. Since he had performed the second operation and he knew where exactly the faecal matters were coming from, there was no requirement of a CT Scan at that stage. Even if there was one and it has not been done, it cannot be called a case of medical negligence and same is the finding of the Uttarakhand Medical Council and the Medical Council of India. Therefore, there was no medical negligence on the part of the doctor. 16. There are two leading cases on this, on which reliance has been placed by the learned counsel for respondent no. 3. The reference here would be of Jacob Mathew vs. State of Punjab and another reported in (2005) 6 SCC 1 and Martin F. D’Souza vs. Mohd. Ishfaq reported in 2009 (2) Supreme 40 . 17. Jacob Mathew (supra) is actually a case which arises out of criminal proceedings relating to Section 304-A/34 of the Indian Penal Code i.e. against the person who has caused the death by negligence. 18. The facts of the case were that a patient was admitted in a private ward of CMC Hospital, Ludhiana, who complained of breathlessness. The nurse who was on duty was contacted by the complainant’s elder brother, who in turn called the doctor to attend the patient. 18. The facts of the case were that a patient was admitted in a private ward of CMC Hospital, Ludhiana, who complained of breathlessness. The nurse who was on duty was contacted by the complainant’s elder brother, who in turn called the doctor to attend the patient. No doctor turned up for about 20 to 25 minutes. Then, Dr. Jacob Mathew and Dr. Allen Joseph came to the room of the patient and an oxygen cylinder was connected to the mouth of the patient but the breathing problem increased further. The oxygen cylinder was found to be empty. There was no other gas cylinder available in the room. The complainant’s elder brother went to the adjoining room and brought a gas cylinder, yet there was no arrangement to make the gas cylinder functional and in-between, 5 to 7 minutes were wasted. By this time, another doctor arrived who declared the patient dead. On the above report, a case was registered under Sections 304-A/34 of IPC against the two doctors and subsequently a charge-sheet was filed before the court of Judicial Magistrate First Class, Ludhiana. Thereafter charges were framed against the accused persons under Section 304-A of IPC by the learned Magistrate. Against the framing of charges, a revision was filed by the accused persons before the learned Sessions Judge, which was dismissed and thereafter a C-482 Petition was filed before the High Court for quashing of FIR and all the subsequent proceedings, where the learned Single Judge of the High Court was of the opinion that the plea raised by the applicants was available to be urged in the defence in the trial and therefore case for quashing of FIR and subsequent proceedings is not made out under C-482 Petition and their C-482 Petition was dismissed. Aggrieved, the two doctors ultimately approached the Hon’ble Apex Court where the appeal of the doctors was allowed by the Hon’ble Apex Court vide order dated 05.08.2005 19. The Hon’ble Apex Court while hearing the matter in detail first discussed what is negligence as a tort. The reference was made to the concept of negligence as given in the Law of Torts by Ratanlal & Dhirajlal (24th Edn., 2002, edited by Justice G.P. Singh). The Hon’ble Apex Court while hearing the matter in detail first discussed what is negligence as a tort. The reference was made to the concept of negligence as given in the Law of Torts by Ratanlal & Dhirajlal (24th Edn., 2002, edited by Justice G.P. Singh). It was stated as under :- “Negligence is the breach of a duty caused by the omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs would do, or doing something which a prudent and reasonable man would not do. Actionable negligence consists in the neglect of the use of ordinary care or skill towards a person to whom the defendant owes the duty of observing ordinary care and skill, by which neglect the plaintiff has suffered injury to his person or property. … the definition involves three constituents of negligence: (1) A legal duty to exercise due care on the part of the party complained of towards the party complaining the former’s conduct within the scope of the duty; (2) breach of the said duty; and (3) consequential damage. Cause of action for negligence arises only when damage occurs; for, damage is a necessary ingredient of this tort.” 20. Thereafter reference was given of Charlesworth & Percy on negligence (10th Edn., 2001) and it was said as under:- “11. According to Charlesworth & Percy on Negligence (10th Edn., 2001), in current forensic speech, negligence has three meanings. They are: (i) a state of mind, in which it is opposed to intention; (ii) careless conduct; and (iii) the breach of a duty to take care that is imposed by either common or statute law. All three meanings are applicable in different circumstances but any one of them does not necessarily exclude the other meanings. The essential components of negligence, as recognised, are three: “duty”, “breach” and “resulting damage”, that is to say: (1) the existence of a duty to take care, which is owed by the defendant to the complainant; (2) the failure to attain that standard of care, prescribed by the law, thereby committing a breach of such duty; and (3) damage, which is both causally connected with such breach and recognised by the law, has been suffered by the complainant. If the claimant satisfies the court on the evidence that these three ingredients are made out, the defendant should be held liable in negligence.” 21. Thereafter the Hon’ble Apex Court discussed negligence-as a tort and as a crime in paragraph nos. 12, 13 and 14 of the said judgment, which are reproduced as under:- “12. The term “negligence” is used for the purpose of fastening the defendant with liability under the civil law and, at times, under the criminal law. It is contended on behalf of the respondents that in both the jurisdictions, negligence is negligence, and jurisprudentially no distinction can be drawn between negligence under civil law and negligence under criminal law. The submission so made cannot be countenanced inasmuch as it is based upon a total departure from the established terrain of thought running ever since the beginning of the emergence of the concept of negligence upto the modern times. Generally speaking, it is the amount of damages incurred which is determinative of the extent of liability in tort; but in criminal law it is not the amount of damages but the amount and degree of negligence that is determinative of liability. To fasten liability in criminal law, the degree of negligence has to be higher than that of negligence enough to fasten liability for damages in civil law. The essential ingredient of mens rea cannot be excluded from consideration when the charge in a criminal court consists of criminal negligence. In R. v. Lawrence, (1981) 1 All ER 974, Lord Diplock spoke in a Bench of five and the other Law Lords agreed with him. He reiterated his opinion in R. v. Caldwell (1981) 1 All ER 961 and dealt with the concept of recklessness as constituting mens rea in criminal law. In R. v. Lawrence, (1981) 1 All ER 974, Lord Diplock spoke in a Bench of five and the other Law Lords agreed with him. He reiterated his opinion in R. v. Caldwell (1981) 1 All ER 961 and dealt with the concept of recklessness as constituting mens rea in criminal law. His Lordship warned against adopting the simplistic approach of treating all problems of criminal liability as soluble by classifying the test of liability as being "subjective" or "objective", and said: (All ER p. 982e-f) "Recklessness on the part of the doer of an act does presuppose that there is something in the circumstances that would have drawn the attention of an ordinary prudent individual to the possibility that his act was capable of causing the kind of serious harmful consequences that the section which creates the offence was intended to prevent, and that the risk of those harmful consequences occurring was not so slight that an ordinary prudent individual would feel justified in treating them as negligible. It is only when this is so that the doer of the act is acting 'recklessly' if, before doing the act, he either fails to give any thought to the possibility of there being any such risk or, having recognized that there was such risk, he nevertheless goes on to do it.” 13. The moral culpability of recklessness is not located in a desire to cause harm. It resides in the proximity of the reckless state of mind to the state of mind present when there is an intention to cause harm. There is, in other words, a disregard for the possible consequences. The consequences entailed in the risk may not be wanted, and indeed the actor may hope that they do not occur, but this hope nevertheless fails to inhibit the taking of the risk. Certain types of violation, called optimizing violations, may be motivated by thrill-seeking. These are clearly reckless. 14. In order to hold the existence of criminal rashness or criminal negligence it shall have to be found out that the rashness was of such a degree as to amount to taking a hazard knowing that the hazard was of such a degree that injury was most likely imminent. The element of criminality is introduced by the accused having run the risk of doing such an act with recklessness and indifference to the consequences. The element of criminality is introduced by the accused having run the risk of doing such an act with recklessness and indifference to the consequences. Lord Atkin in his speech in Andrews v. Director of Public Prosecutions, 1937 AC 576 stated: (All ER p.556 C) "Simple lack of care such as will constitute civil liability is not enough. For purposes of the criminal law there are degrees of negligence, and a very high degree of negligence is required to be proved before the felony is established." Thus, a clear distinction exists between "simple lack of care" incurring civil liability and "very high degree of negligence" which is required in criminal cases. In Riddell v. Reid (1942) 2 All ER 161 (AC at p.31) Lord Porter said in his speech- "A higher degree of negligence has always been demanded in order to establish a criminal offence than is sufficient to create civil liability. (Charlesworth & Percy, ibid., Para 1.13).” 22. The Hon’ble Apex Court states further on negligence by professionals in paragraph nos. 18, 19 and 20, which are reproduced as under:- “18. In the law of negligence, professionals such as lawyers, doctors, architects and others are included in the category of persons professing some special skill or skilled persons generally. Any task which is required to be performed with a special skill would generally be admitted or undertaken to be performed only if the person possesses the requisite skill for performing that task. Any reasonable man entering into a profession which requires a particular level of learning to be called a professional of that branch, impliedly assures the person dealing with him that the skill which he professes to possess shall be exercised with reasonable degree of care and caution. He does not assure his client of the result. A lawyer does not tell his client that the client shall win the case in all circumstances. A physician would not assure the patient of full recovery in every case. A surgeon cannot and does not guarantee that the result of surgery would invariably be beneficial, much less to the extent of 100% for the person operated on. A lawyer does not tell his client that the client shall win the case in all circumstances. A physician would not assure the patient of full recovery in every case. A surgeon cannot and does not guarantee that the result of surgery would invariably be beneficial, much less to the extent of 100% for the person operated on. The only assurance which such a professional can give or can be understood to have given by implication is that he is possessed of the requisite skill in that branch of profession which he is practising and while undertaking the performance of the task entrusted to him he would be exercising his skill with reasonable competence. This is all what the person approaching the professional can expect. Judged by this standard, a professional may be held liable for negligence on one of two findings: either he was not possessed of the requisite skill which he professed to have possessed, or, he did not exercise, with reasonable competence in the given case, the skill which he did possess. The standard to be applied for judging, whether the person charged has been negligent or not, would be that of an ordinary competent person exercising ordinary skill in that profession. It is not necessary for every professional to possess the highest level of expertise in that branch which he practices. In Michael Hyde and Associates v. J.D. Williams & Co. Ltd. 8 2001 PNLR 233 (CA) Sedley L.J. said that where a profession embraces a range of views as to what is an acceptable standard of conduct, the competence of the defendant is to be judged by the lowest standard that would be regarded as acceptable. (Charlesworth & Percy, ibid., Para 8.03) 19. An of quoted passage defining negligence by professionals, generally and not necessarily confined to doctors, is to be found in the opinion of McNair, J. in Bolam v. Friern Hospital Management Committee (1957) 1 WLR 582, WLR at p. 586 in the following words: (All ER p. 121 D-F) "Where you get a situation which involves the use of some special skill or competence, then the test as to whether there has been negligence or not is not the test of the man on the top of a Clapham omnibus, because he has not got this special skill. The test is the standard of the ordinary skilled man exercising and professing to have that special skill. A man need not possess the highest expert skill…It is well-established law that it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art.” (Charlesworth & Percy, ibid., para 8.02) 20. The water of Bolam (1957) 1 WLR 582 test has ever since flown and passed under several bridges, having been cited and dealt with in several judicial pronouncements, one after the other and has continued to be well received by every shore it has touched as neat, clean and well-condensed one. After a review of various authorities Bingham L.J. in his speech in Eckersley v. Binnie, (1988) 18 Con LR 1 summarised the Bolam test in the following words:- "From these general statements it follows that a professional man should command the corpus of knowledge which forms part of the professional equipment of the ordinary member of his profession. He should not lag behind other ordinary assiduous and intelligent members of his profession in the knowledge of new advances, discoveries and developments in his field. He should have such an awareness as an ordinarily competent practitioner would have of the deficiencies in his knowledge and the limitations on his skill. He should be alert to the hazards and risks in any professional task he undertakes to the extent that other ordinarily competent members of the profession would be alert. He must bring to any professional task he undertakes no less expertise, skill and care than other ordinarily competent members of his profession would bring, but need bring no more. The standard is that of the reasonable average. The law does not require of a professional man that he be a paragon combining the qualities of polymath and prophet." (Charlesworth & Percy, ibid., para 8.04).” 23. Ultimately after discussing the case at length, the Hon’ble Judges of the Supreme Court were satisfied that no case of criminal rashness or negligence was made out on the part of the accused, though liability was fixed on the hospital and it was said as under:- “It is a case on non-availability of oxygen cylinder either because of the hospital having failed to keep available a gas cylinder or because of the gas cylinder being found empty. Then, probably the hospital may be liable in civil law (or may not be-we express no opinion thereon) but the accused appellant cannot be proceeded against under Section 304-A IPC on the parameters of the Bolam test.” 24. This decision was also relied upon later by the Hon’ble Apex Court in the case of Martin F. D’Souza (supra), where relying upon the said decision, the Hon’ble Apex Court in paragraph nos. 35, 41 and 45 has said as under:- “35. Before dealing with these principles two things have to be kept in mind : (1) Judges are not experts in medical science, rather they are lay men. This itself often makes it somewhat difficult for them to decide cases relating to medical negligence. Moreover, Judges have usually to rely on testimonies of other doctors which may not necessarily in all cases be objective, since like in all professions and services, doctors too sometimes have a tendency to support their own colleagues who are charged with medical negligence. The testimony may also be difficult to understand, particularly in complicated medical matters, for a layman in medical matters like a Judge; and (2) a balance has to be struck in such cases. While doctors who cause death or agony due to medical negligence should certainly be penalized, it must also be remembered that like all professionals doctors too can make errors of judgment but if they are punished for this no doctor can practice his vocation with equanimity. Indiscriminate proceedings and decisions against doctors are counter productive and serve society no good. They inhibit the free exercise of judgment by a professional in a particular situation. 41. A medical practitioner is not liable to be held negligent 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. He would be liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field. For instance, he would be liable if he leaves a surgical gauze inside the patient after an operation vide Achutrao Haribhau Khodwa v. State of Maharashtra, (1996) 2 SCC 634 or operates on the wrong part of the body, and he would be also criminally liable if he operates on someone for removing an organ for illegitimate trade. 45. For instance, he would be liable if he leaves a surgical gauze inside the patient after an operation vide Achutrao Haribhau Khodwa v. State of Maharashtra, (1996) 2 SCC 634 or operates on the wrong part of the body, and he would be also criminally liable if he operates on someone for removing an organ for illegitimate trade. 45. The higher the acuteness in an emergency and the higher the complication, the more are the chances of error of judgment. At times, the professional is confronted with making a choice between the devil and the deep sea and has to choose the lesser evil. The doctor is often called upon to adopt a procedure which involves higher element of risk, but which he honestly believes as providing greater chances of success for the patient rather than a procedure involving lesser risk but higher chances of failure. Which course is more appropriate to follow, would depend on the facts and circumstances of a given case but a doctor cannot be penalized if he adopts the former procedure, even if it results in a failure. The usual practice prevalent nowadays is to obtain the consent of the patient or of the person in-charge of the patient if the patient is not in a position to give consent before adopting a given procedure.” 25. In short the conclusion is that even if the concerned doctor inspite of his best efforts, experience and knowledge has not performed the procedure which he should have performed, it cannot be called a medical negligence. The facts of each case have to be examined independently. In the present case the doctor did whatever was possible for him to do at the relevant time and he did that in his best judgment. It also cannot be specifically pin pointed, and that has also been a finding of the experts here, that the second surgery performed by the doctor cannot be called as an act of medical negligence and at best it was an error of judgment. All the same, in no manner can this be described as medical negligence. 26. In view of the above observations, the writ petition fails and it is hereby dismissed. 27. All the same, in no manner can this be described as medical negligence. 26. In view of the above observations, the writ petition fails and it is hereby dismissed. 27. It is, however, made clear that as far as the warning and the directions given to the doctor by the Uttarakhand Medical Council are concerned, the same shall remain and in fact this Court has been informed that the same are being followed.