M.A BIVIJI versus SUNITA & ORS.

Citation: [2023] 15 S.C.R. 113 · Decided: 19-10-2023 · Supreme Court of India · Bench: HRISHIKESH ROY · Disposal: Disposed off

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Judgment (excerpt)

[2023] 15 S.C.R. 113 : 2023 INSC 938
113
CASE DETAILS
M.A BIVIJI 
v.
SUNITA & ORS. 
(Civil Appeal No. 3975 of 2018)
OCTOBER 19, 2023
[HRISHIKESH ROY AND MANOJ MISRA, JJ.] 
HEADNOTES
Issue for consideration: The complainant alleged negligence on the 
part of a Hospital – The main claim of negligence that the complainant 
attributed was that the forced Nasotracheal Intubation (NI) procedure 
resulted in her developing Grade-IV Subglottic Stenosis (i.e., narrowing 
of upper airway between the vocal folds and lower border of cricoid 
cartilage) in the trachea – Subsequently, the same led to various severe 
complications. 
Negligence – Medical Negligence – The NCDRC concluded that 
the negligence charge regarding the unjustifi able ‘NI’ procedure 
was proved – The act of replacing the existing Tracheostomy Tube 
(TT), with ‘NI’ was held to have been an avoidable course of action 
that was other than what should have ordinarily been done in that 
situation – The NCDRC awarded complainant a compensation of 
Rs. 6,11,638/- @ 9% p.a. for the medical expenses she incurred at 
Hospital – Propriety:
Held: (1) Taking into consideration the medical literature on record 
as well as the expert medical committee report presented by the RML 
Hospital, it is reasonable to conclude that subglottic stenosis & subsequent 
trauma in the trachea is not an uncommon phenomenon with respect to a 
patient that has suff ered serious injuries in a road accident – In addition, 
there tends to be a higher risk element of developing an injury if intubation 
is done in an emergency situation or multiple times – It could also be a 
result of being subjected to intubation for a prolonged period; (2) In the 
instant case, the patient was treated and underwent diff erent procedures 
114 
SUPREME COURT REPORTS 
[2023] 15 S.C.R.
at multiple hospitals – Therefore, there is a possibility that these medical 
complications could have arisen at any of these hospitals or places where the 
patient underwent treatment; (3) The medical report available in this case 
i.e., the RML Hospital Committee Report did not attribute any negligence 
to Hospital in question or the doctors with respect to any of the charges 
levelled against them – If the ‘NI’ procedure had been conducted in a 
negligent manner or was a poor medical decision, it is likely that the RML 
Hospital Committee Report would have mentioned the same – However, 
no such observation was made either; (4) The medical team at Hospital in 
question was able to show that the ‘NI’ procedure was carried out only after 
due consideration – The existing ‘TT’ was removed after the bronchoscopy 
showed normalcy in the airways & trachea of the patient – It was expected 
that the patient would be able to breathe normally without any support after 
‘TT’ decannulation – However, a stridor was observed in the airways of the 
patient, after the said decannulation took place – In light of the same, an 
alternative course of treatment in the form of an ‘NI’ procedure was opted 
for as a temporary measure – There is nothing to show that the procedure 
conducted was outdated or poor medical practice – Resultantly, there was 
no breach of duty of care at Hospital in question or on part of the doctors 
– The charge of negligence is, therefore, not proved – Impugned judgment 
set aside. [Paras 50, 51, 52, 53, 56]
Negligence – Medical Negligence – Essential ingredients for 
determination:
Held: The three essential ingredients in determining an act of medical 
negligence are: (1) a duty of care extended to the complainant, (2) breach 
of that duty of care, and (3) resulting damage, injury or harm caused to the 
complainant attributable to the said breach of duty – However, a medical 
practitioner will be held liable for negligence only in circumstances 
when their conduct falls below the standards of a reasonably competent 
practitioner. [Para 36]
Negligence – Medical Negligence – A line of treatment undertaken 
should not be of a discarded or obsolete category in any circumstance:
Held: Due to the unique circumstances and complications that arise 
in diff erent individual cases, coupled with the constant advancement in the 
medical fi eld and its practices, it is natural that there shall always be diff erent 
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M.A BIVIJI v. SUNITA & ORS.
opinions, including contesting views regarding the chosen line of treatment, 
or the course of action to be undertaken – In such circumstances, just 
because a doctor opts for a particular line of t

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