Citation – 2023 Lawsuit(SC) 948
Appellant – CPL Ashish Kumar Chauhan
Respondent – Commanding Officer
Bench – Dipankar Datta, S. Ravindra Bhat
Facts:
The appellant was a radar technician in the Indian Army force and was serving for the Operation Parakram on India-Pak border in the aftermath of Indian Parliament attack which took place on 13th December, 2001. For some purposes, he got his posting at Pathankot. There he fell ill and suffered symptoms like weakness, anorexia and high colored urine. Thereafter he was thereby admitted to Military Hospital -171 MH, Samba. There, Devika Bhat posted as MO (physician), advised for blood transfusion dated 10th July, 2002, however the hospital didn’t possess any license for blood bank. It was simply referred as Ad-Hoc blood bank. Also, it was alleged that the hospital didn’t tested the blood for ‘markers of blood’ also for Human immunodeficiency viruses (hereafter HIV), due to unavailability of any such facility.
In 2014, the appellant fell ill again and was admitted to Station Medicare Centre, Gandhinagar. He was checked for HIV but his reports came negative but his health was deteriorating and was thereafter shifted to another Military hospital in Ahmedabad, but his health deterioration didn’t stop, so he was shifted to INHS Asvini, Mumbai. He was tested Positive for HIV.
The medical Board upheld that such infection of HIV was Non-attributable to the service. He somehow traced the source of this HIV back to transfusion of virus infected blood back in 2002 to 171 MH, Samba. When he demanded his copy of document related to his blood transfusion at samba, as he wanted to check whether Enzyme Linked Immunosorbent Assay (ELISA) test was conducted before infusing the blood, he was denied the same on ground of ‘Unavailability of that account’. In 2015, a respondent wrote a letter to Indian army on the request of appellant about his 2002 report. It was found that transfusion was certainly done but the test report was absent.
In 2014 & 2015, the medical board held the Appellant disability was attributable to the service the appellant also claims that they were compelled to sign the medical board’s proceedings upon release and were not provided with their medical records, which were crucial for their treatment. Further he alleged, he was denied extension of service, got discharged from service & was mainly denied ‘Ex-Servicemen Contributory Health Scheme’ (hereafter, “ECHS”) card. Additionally, an amount of 15,000 was deducted from his post-retirement dues due to the lack of an ECHS card and for his current medical expenses. He was also not issued his disability certificate.
His Pension was Sanctioned but was not given his medical reports regarding a blood transfusion. In response, he submitted an RTI application. Unhappy with the response, he appealed to the First Appellate Authority, which upheld the decision, noting that efforts were made to locate his medical records. A Court of Inquiry was also conducted at the 171 Military Hospital to examine the blood transfusion process, confirming that the blood had been properly tested for HIV and other markers. Subsequently, the appellant sought compensation and punitive measures against the officers involved through the National Consumer Disputes Redressal Commission, which dismissed his complaint. As a result, he appealed before Supreme Court.
Legal Issues Raised:
Issue I– Was the appellant’s consent obtained prior to the blood transfusion?
Issue II– Was there a violation of the appellant’s fundamental health rights?
Issue III– Was the appellant’s bodily integrity infringed upon
Issue IV– Were the potential risks communicated to the appellant, and did they give their consent to those risks?
Issue V– Is it the responsibility of the state to safeguard the well-being of its military personnel?
Issue VI– Could there have been bias present in the Court of Inquiry’s proceedings?
Issue VII– Did a blood test precede the blood transfusion procedure?
Appellant arguments:
- The petitioner argued that the burden of proof shall be on the respondent to prove that they weren’t negligent during that transfusion of blood conducted by their army hospitals and doctors.
- The petitioner also stated that one of the respondents has said that there was no authorization or any license granted to blood bank.
- The petitioner along with the Amicus curiae (hereby referred as amici), argued that the respondent failed in providing any material evidence to prove that they have followed their Standards of Procedure or SOPs before blood transfusion.
- The amici and appellant referred to RTI filed, by which they stated that any expert to conduct such transfusion and test reports were absent.
- The counsel highlighted that there was no documented consent or signature obtained from the respondent prior to the transfusion. Additionally, the authenticity of the HIV negative result is questionable as it was issued seven days later without following proper procedures. Furthermore, when faced with allegations of concealment, the appellant countered by stating that the report was in the respondent’s custody and access to it was denied to the appellant.
- The petitioner highlighted the consequences he has faced, like losing his job in IAF, losing his job when employed in a food corporation company, becoming a divorcee etc.
- He appealed for the grant of monetary relief on the ground of negligence as no proper care was taken during that process of blood transfusion
- It was debated that the respondent’s conduct towards the appellant did not align with the relevant regulations, undermining his trust, and thus the court should provide appropriate instructions and ensure the continuation of medical care
- It was contended that the appellant’s current state of reliance on assistance is due to being denied access to his medical records and not being asked for consent before his transfusion, which resulted in mental distress warranting compensation.
Respondent Arguments:
- The respondent contended that once the they acknowledged that the appellant’s disability was due to their actions, no further discussion was necessary as per as Section 58 of Indian Evidence act, 1872.
- They argued before the court that that consent is only required for surgical procedures, not for transfusions as per as the IMC Professional Conduct regulations
- The Respondent argued that the appellant suffered from anemia prior to the transfusion, and anemia is a known cause of HIV, suggesting uncertainty about whether HIV was contracted through the transfusion or another source.
- Furthermore, they claimed that they did not tamper with the appellant’s medical reports and were not obligated to retain them beyond three years as per IMC Professional Conduct regulations, especially since the military hospital 171, where the transfusion occurred, was not a permanent facility.
- It was also argued that it is incorrect for the appellant to blame the respondents for his divorce, which was a mutual decision.
- Lastly, the respondent accounted that there is no evidence in the IAF affidavits, indicating that the appellant was discharged from his duties.
Rationale / Judgement:
- The court referred to he “Guidelines for HIV Testing, March 2007” by the National AIDS Control Organization, under the Ministry of Health and Family Welfare. They were cited to stress the significance of obtaining informed consent prior to HIV testing. According to these guidelines, a doctor must inform the patient adequately about why a blood test is necessary and obtain their consent before performing any invasive procedure [2009] 6 S.C.C. 1.
- Also the SC referred to doctrine Of res ipsa loquitur (Things Speak for Itself) principle in medical negligence cases and stressed upon the fact that when negligence is clear, the burden of proof transfers to the hospital or healthcare professionals.
- The court was of the opinion that the appellant has gone through shock and agony due to his HIV condition. Additionally, his denial of such condition was stonewalled by the conduct of the respondents which were denying information to him, holding a Court of Inquiry secretly, found to be actionable. The court reasoned it is not possible to attribute individual blame, the apparent conclusion is one of significant bias against the appellant, despite his exemplary service record in the IAF. His early retirement, compounded by the unfortunate incident of being turned down by the Food Corporation of India (FCI) due to his HIV status—an incident not attributable to the respondents—constitute exacerbating factors. The IAF could have seriously taken active measures to secure alternative employment for the appellant within its ranks or through its rehabilitation programs for veterans and ex-servicemen. The compounded effect led to severe mental distress for the appellant. Hence, the court was of the view that the appellant deserves a compensation of ₹ 50,00,000/- (Rupees fifty lakhs only) for these reasons.
- Further, the court held IAF and Indian army vicariously, severally and jointly liable as it was impossible to pinpoint the individual’s liability and granted the appellant compensation of ₹ 1,54,73,000/- (Rupees one crore fifty-four lakhs seventy-three thousand only) on account of medical negligence. Also, all pending disability pension payments must be given to the appellant within six weeks
- The court directed the central government to issue necessary guidelines within 3 months, in respect to SOPs for HIV and AIDS medical facilities. Specific medical therapies must be available to all the person to detect and diagnose such condition at earliest.
- The court held that central and state governments must ensure that people with HIV or AIDS can easily access welfare schemes.
- Directed that they should also create educational programs about HIV and AIDS that are suitable for all ages, respect both genders, and do not stigmatize or discriminate.
- The Court was of the opinion that the Court proceedings may be held privately to protect the identity of those involved.
- Held that it is forbidden to publicly reveal any information that could identify someone with HIV or AIDS.
Defects of Law
This judgement highlights upon the negligence that can impair the live of an individual. Such medical negligence is result of not following the designated SOPs established for specific task, thus accounts for more accountability and need for following the law religiously. It highlighted the need for maintenance of medical record of a patient, but even though the Medical council of India has provided guideline to secure such record of period of 3 years, yet it is full of lacuna in terms of accountability.
Inferences:
The court as ordered giving direction to both Centre and state government to make down welfare schemes for people with AIDS, HIV highlights the stigma that is still prevalent in our society looking down on such people. The mental agony and pain they suffer is burdensome in nature, yet many deals with such burden every day. This judgement served a commendable effort of judiciary to highlight the plight of such people. Also, as this case dealt with medical negligence, it further highlight the need for more accountability upon the wings of state like Army, as in this case if MH 171, samba would have followed all the required SOPs, the appellant wouldn’t need to go through such mental and physical pain, thus it accounts for a better infrastructure with utmost accountability because people put their faith in services provided by state and if such negligence is to take place, this will lead to erosion of people’s faith in such services especially by soldiers who finds themselves in dire need of treatment, I, as a law student finds this judgement absolutely sound and rational as court has meticulously decided after thoroughly analyzing the facts and evidences presented before it. Therefore, this judgement serves as testament to integrity to judicial system of India.
Author
Jyotirmay Shrivastava
St. Xavier’s University, Kolkata