This article is the part of our Medical Negligence Series
The case of ‘Laxman Balkrishna Joshi vs Trimbak Bapu Godbole[1], is an important case in medical negligence. In this case, the supreme court made important observation on the duty of the doctor to the patient.
The case reached at supreme court through special leave petition and judgment was delivered Justice Shelat.
Facts of the Case
- A boy, Ananda, met with an accident on the sea beach at Palshet, a village in Ratnagiri District, which resulted in the fracture of the femur of his left leg. Since the sea beach was at a distance of 14′ miles from the place where he and his mother lived at the time it took some time to bring a cot and remove him to the house.
- Dr. Risbud, a local physician, was called at about 8-30 or 8-45 P.m. The only treatment he gave was to tie wooden planks on the boy’s leg with a view to immobilise it and give rest. Next day, he visited the boy and though he found him in good condition, he advised his removal to Poona for treatment.
- On May 8, 1953, Dr. Risbud procured Mae Intyres splints and substituted them for the said wooden planks. A taxi was thereafter called in which the boy Ananda was placed in a reclining position and he, along with respondent 2 and Dr. Risbud, started for Poona at about 1 A.m. They reached the city after a journey of about 200 miles at about 11-30 A.m.
- on May 9, 1953. By that time respondent 1 had come to Poona from Dhond where he was practising as a medical practitioner. They took the boy first to Tarachand Hospital where his injured leg was screened. It was found that he had an overlapping fracture of the femur which required pin traction.
- The respondents thereafter took the boy to the appellant’s hospital where, in his absence, his assistant, Dr. Irani, admitted him at 2-15 P.m. Sometime thereafter the appellant arrived and after a preliminary examination directed Dr. Irani to give two injections of 1/8th grain of morphia and 1/200th grain of Hyoscine H.B. at an hour’s interval. Dr. Irani, however, gave only one injection.
- Ananda was thereafter removed to the X-ray room on the ground floor of the hospital where two X-ray photos of the injured leg were taken. He was then removed to the operation theatre on the upper floor where the injured leg was put into plaster splints. The boy was kept in the operation theatre for a little more than an hour and at about 5-30 P.m., after the treatment was over, he was removed to the room assigned to him.
- On an assurance given to respondent 1 that Ananda would be out of the effect of morphia by 7 P.m., respondent 1 left for Dhond. Respondent 2, however, remained with Ananda in the said room. At about 6-30 P.m. she noticed that he was finding difficulty in breathing and was having cough. Thereupon Dr. Irani called the appellant who, finding that the boy’s condition was deteriorating started giving emergency treatment which continued right until 9 P.m. when the boy expired.
- The appellant thereupon issued a certificate, Ext. 138, stating therein that the cause of death was fat embolism.
Allegations of the Respondent
The case of the respondents, was that the appellant did not perform the essential preliminary examination of the boy before starting his treatment; that without such preliminary examination a morphia injection was given to him; that the boy soon after went ‘under morphia’ that while he was ‘under morphia’ the appellant took him to the X-ray room, took X-ray plates of the injured leg and removed him to the operation theatre.
Their case further was that “While putting the leg in plaster the defendant used manual traction and used excessive force for this purpose, with the help of three men although such traction is never done under morphia alone, but done under proper general anaesthesia. This kind of rough manipulation is calculated to cause conditions favourable for embolism or shock and prove fatal to the patient.
Journey through the Courts
The trial court’s findings
The trial Court came to the conclusion that notwithstanding the denial by the appellant, the appellant had performed reduction of the fracture; that in doing so he applied with the help of three of his attendants excessive force, that such reduction was done without giving anesthetic, that the said treatment resulted in cerebral embolism or shock which was the proximate cause of the boy’s death.
The trial court disbelieved the appellant’s case that be had decided to postpone reduction of the fracture or that his treatment consisted of immobilisation with only light traction with plaster splints. The trial Judge was of the view that this defence was an after-thought and was contrary to the evidence and the circumstances of the case.
On these findings he held the appellant guilty of negligence and wrongful acts which resulted in the death of Ananda and awarded general damages in the sum of Rs. 3,000.
The High Court’s decision
In appeal, the High Court came to the conclusion that though the appellant’s case was that a thorough preliminary examination was made by him before he started the treatment, that did not appear to be true.
The reason for this conclusion was that though Dr. Irani swore that the patient’s temperature, pulse and respiration were taken, the clinical chart, showed only two dots, one indicating that pulse was 90 and the other that respiration was 24. But the chart did not record the temperature. If that was taken, it was hardly likely that it would not be recorded along with pulse and respiration.
As regards the appellant’s case that he had decided to delay the reduction of the fracture and that he would merely immobilise the patient’s leg for the time being with light traction, the High Court agreed with the trial court that case also was not true.
The next conclusion that the High Court reached was that if the appellant had come to a decision to postpone reduction of the fracture on account of the reasons given by him in his evidence, he would have noted in the clinical chart, or the clinical paper, the symptoms which impelled him to that decision.
The High Court agreed that the medical text books produced before it seemed to suggest that where time has elapsed since the occurrence of the fracture and the patient has arrived after a long journey. deferred reduction is advisable.
But the High Court observed, the question was whether the appellant did defer the reduction and performed only immobilisation to give rest to the injured leg.
After analysing the evidence, it came to the conclusion that what the appellant actually did was to reduce the fracture, that in doing so he did not care to give anaesthetic to the patient, that he contented himself with a single morphia injection, that he used excessive force in going through this treatment, using three of his attendants for pulling the injured leg of the patient that he put that leg in plaster of Paris splints, that it was this treatment which resulted in shock causing the patient’s death, and lastly, that the appellant’s case that the boy died of cerebral embolism was merely a cloak used for suppressing the real cause of death, viz., shock.
The supreme court
When the case was reached through SLP to the supreme court and SC looked upon the findings of the trial and high court, the supreme court on well-established practice, did not find any reason to interfere in the conclusion of the below courts.
The observations of the court
After denying to interfere with the findings of the high courts, the supreme court made important observations while concluding the judgment-
“The duties which a doctor owes to his patient are clear. A person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties, viz., a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give or a duty of care in the administration of that treatment. A breach of any of those, duties gives a right of action for negligence to, the patient.
The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law require. The doctor no doubt has a discretion in choosing treatment which he proposes to give to the patient and such discretion is relatively ampler in cases of emergency.
Reference
Laxman Balkrishna Joshi vs Trimbak Bapu Godbole; 1969 AIR 128, 1969 SCR (1) 206
[1] 1969 AIR 128