NCDRC on Doctors Liability: Amputation Is Not Always Negligence

 In an era where medical litigation headlines travel faster than clinical nuance, a recent decision of the National Consumer Disputes Redressal Commission deserves careful reading by the medical fraternity. The apex consumer court has dismissed a claim of Rs 23 crore filed against Apollo Hospitals Secunderabad and two of its specialists, including an orthopaedic surgeon and a consultant neurologist, in a case that culminated in the amputation of a young man’s right leg. For doctors across India, the ruling is a reminder that medicine operates in the realm of probabilities, complications, and clinical judgment, not guaranteed results.

The complaint had alleged gross medical negligence following a knee fracture surgery that was later followed by vascular complications and eventual amputation at another hospital. The parents of the patient argued that timely intervention, better monitoring, and appropriate referral could have saved the limb. They sought substantial compensation, citing mental agony, deficiency in service, and alleged failure in post-operative care. The case raised familiar questions that many doctors confront in their careers: When does a complication become negligence? How should courts interpret adverse outcomes? And what constitutes reasonable care in high-risk trauma cases?

According to the case records placed before the Commission, the patient had sustained a knee injury after falling from a two-wheeler. He was diagnosed with a tibial condyle fracture and underwent surgical fixation at the Secunderabad hospital. During the procedure, an orthopaedic implant with a locking plate and screws was used to stabilise the fracture. Post-operatively, he reportedly complained of reduced sensation and difficulty in moving his right foot. The treating team explained that nerve-related symptoms such as foot drop can occur in high-velocity injuries around the knee joint, often due to swelling or nerve irritation.

He was discharged and subsequently evaluated by a neurologist when symptoms persisted. Medication and observation were advised. Days later, his condition worsened, and he was admitted to another hospital in Hyderabad, where he was diagnosed with irreversible ischemia of the right lower limb along with popliteal artery occlusion. Despite surgical attempts to salvage the limb, including fasciotomy, amputation above the knee was performed after muscle necrosis was identified.

The complainants contended that the initial treating hospital had failed to recognise vascular compromise in time. They argued that earlier referral to a vascular surgeon or extended monitoring might have prevented the progression to limb loss. They also questioned the decision to discharge the patient and alleged that proper warnings regarding surgical risks were not communicated. The hospital management and the concerned doctors firmly denied these allegations. They maintained that the surgery was conducted according to accepted orthopaedic standards and that there were no clinical signs of vascular injury at the time of discharge. They emphasised that distal pulses were palpable, pulse oximeter readings were satisfactory, and the limb was warm and normally coloured during follow-up examination.

In its judgment, the Commission made an observation that resonates deeply with medical practitioners. It stated that negligence cannot be inferred merely because a procedure ended in an adverse outcome. A doctor’s liability arises only when it is demonstrated that reasonable skill and care were not exercised. The bench clarified that an unfortunate result, including amputation, does not automatically establish medical negligence. To succeed in such a claim, the complainant must provide clear, cogent, and credible evidence that the treating professionals acted in a manner inconsistent with accepted medical standards.

Courts in India have repeatedly relied on the doctrine that a practitioner is expected to exercise a degree of skill and care that is reasonable under the circumstances. Medicine is not an exact science. Trauma around the knee, particularly high-impact injuries, can lead to delayed vascular complications. Popliteal artery occlusion is a recognised risk in such fractures, and in some cases, arterial compromise may evolve over time without immediate overt signs.

The defence in the Apollo case argued that a significant percentage of extremity injuries may not show classic symptoms of arterial insufficiency in the early stages. The Commission appears to have accepted that the absence of initial vascular red flags and the presence of normal clinical indicators at discharge weighed against the allegation of negligence. The second hospital’s discharge summary did not explicitly attribute fault to the first treating team. This absence of direct criticism became relevant in evaluating whether there was a breach of duty.

Recording distal pulses, limb temperature, neurological findings, and patient counselling details can later become crucial evidence. In medico-legal disputes, what is documented often carries more weight than recollections. The Commission’s approach signals that well-maintained medical records remain a doctor’s strongest safeguard.

The ruling also touches upon vicarious liability. The complainants sought to hold the hospital management company accountable for the actions of its consultants. In healthcare litigation, hospitals are frequently arrayed as parties on the principle that institutions are responsible for services rendered under their banner. While vicarious liability remains a valid doctrine, it does not dispense with the need to establish primary negligence. Without proof that the treating doctors deviated from accepted standards, the institutional liability argument loses force.

With greater awareness of consumer rights and expanding access to legal recourse, more patients are approaching consumer courts and civil forums alleging deficiency in medical service. This trend has led to heightened anxiety among doctors. Defensive medicine, unnecessary referrals, excessive investigations, and reluctance to take high-risk cases are emerging concerns. When courts reaffirm that negligence must be proved through solid evidence rather than inferred from outcomes, it provides a measure of reassurance to the medical community.

At the same time, the judgment should not be misread as immunity for practitioners. Courts continue to act firmly in cases where deviation from protocol, lack of informed consent, or gross carelessness is established. The standard remains that of reasonable competence. What the Apollo ruling clarifies is that complexity in clinical evolution, particularly in trauma and vascular cases, cannot be oversimplified in hindsight.

The case also highlights the challenge of managing post-operative follow-up. The hospital’s counsel argued that the patient did not return after a particular date and that the treating team was unaware of subsequent deterioration. Continuity of care is central to patient safety, yet it depends on active engagement from both doctor and patient. Ensuring that discharge instructions are clear, written, and emphasise warning signs requiring urgent review can reduce ambiguity later.

This judgment also reinforces the need for structured clinical pathways in trauma care. Protocols for vascular assessment in knee injuries, timely imaging when suspicion arises, and interdisciplinary consultation should be well defined. Standard operating procedures reduce variation and strengthen defence in litigation.

It is worth reflecting on the emotional dimension as well. For the patient and his family, the loss of a limb is life-altering. Anger and grief often seek accountability. For the treating doctors, facing a Rs 23 crore claim can be professionally and personally draining. Litigation stretches over years, affecting morale and reputation. A fair adjudicatory process must weigh evidence without prejudice, acknowledging both patient suffering and the inherent uncertainties of medical science.

The Commission, in its reasoning, referred to the classic understanding of negligence as a breach of duty resulting from omission or commission that a prudent professional would not commit. This formulation has long guided Indian jurisprudence. It draws a line between error of judgment and actionable negligence. In complex surgical scenarios, an adverse result does not equate to breach unless the conduct falls below the standard expected of a reasonably competent practitioner.

India’s healthcare system stands at a crossroads where patient rights and doctor protection must coexist. Consumer courts serve as important forums for redressal. Their credibility depends on balanced decisions grounded in evidence. The dismissal of the high-value claim against Apollo Hospital Secunderabad demonstrates judicial restraint in the absence of convincing proof of negligence.

For the medical profession, the ruling restores confidence that courts can distinguish between unavoidable complications and culpable conduct. It encourages doctors to continue practising evidence-based medicine without paralysing fear of disproportionate liability. It also highlights the responsibility to maintain transparency, ethical standards, and patient-centred care.

In the final analysis, this case is less about one hospital or one amputation and more about the evolving relationship between medicine and law in India. As medical technology advances and patient expectations rise, disputes will occur. The key lies in careful adjudication, rigorous clinical standards, and mutual respect between the healthcare system and the society it serves. When these elements align, justice can be delivered without undermining the noble practice of medicine.

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