Supreme Court’s guidelines on application of “Eggshell Skull Rule” in cases of Medical Negligence

Introduction

“Eggshell Skull Rule” or “Thin Skull Rule”, as the name suggests, refers to a doctrine arising from common law legal system which affixes the liability upon the defendant for the uncommon or unforeseeable reactions of the plaintiff to the defendant’s tortious or negligent acts. According to this doctrine, the civil law affixes the liability of injury or losses caused to the plaintiff upon the defendant even though the victim was more susceptible to being injured due to an underlying medical condition or an already – existent injury.

The eggshell rule is applicable to all types of injurious acts caused to a plaintiff including physical or psychological harm and is aimed at ensuring that the defendant does not escape his liability affixed by law for enhancing a pre – existent medical condition of the plaintiff through his/her actions.

Supreme Court’s Observations on Eggshell Skull Rule in cases of Medical Negligence

In a recent judgment of the Hon’ble Supreme Court of India dated 23rd April, 2024, a 2 – judge division bench consisting of Hon’ble Justices Sanjay Karol and Aravind Kumar set aside an order of the National Consumer Disputes Redressal Commission and the State Consumer Disputes Redressal Commission and directed a delinquent medical institution to pay a compensatory amount of Rs. 5,00,000/- to the appellant accompanied with 9% interest rate and Rs. 50,000/- as a cost of litigation.

As per the facts of the case, the appellant/plaintiff was admitted to Suket Hospital for removal of appendicitis through a surgical procedure post which she complained of severe pains in her abdomen. She was again admitted and discharged a day after with an assurance that she would no longer suffer pain. However, her ordeal continued for 4 more years. To obtain a second opinion, she consulted Post Graduate Institute of Medical Science, Chandigarh wherein it was discovered by the medical team that a 2.5 CM foreign needle was present in her abdominal wall which was the primary reason for her pain and had to be removed surgically.

A complaint was filed by the appellant at both State Consumer Disputes Redressal Commission (SCDRC) and the National Consumer Dispute Redressal Commission (NCDRC) wherein both the forums held the defendant liable for the delinquent act and granted compensation for Rs. 2,00,000/-. The present appeal has therefore been filed by the appellant for enhancement of compensation.

Determination of Compensation by the Court

In order to determine the quantum of compensation payable by the hospital for the above act, the court considered the scope of consumer law and medical negligence jurisprudence and referred to the scope of ‘just compensation’ in order to take the receiver of the compensation to such a position where the loss/injury suffered by him had not occurred. In order to determine the scope of egg – shell skull rule, the court considered the following four categories:

• Where the hidden or latent medical conditions of the plaintiff have been triggered.
• Where the pre – existing medical conditions of the plaintiff have been re – triggered due to the medical treatment given by the defendant.
• Where the pre – known medical conditions of the plaintiff that have not yet received medical attention have been re – aggravated due to the actions of the defendant.
• Where the actions of the defendant accelerate the possible loss of life of the plaintiff which would have earlier taken time to complete its natural course of action.

Additionally, the court held that these conditions can only be applied wherein the medical conditions are ‘pre – existent’ for the plaintiff and there is a direct co – relation between the actions of the wrongdoer and the injury caused or aggravated for the plaintiff. Moreover, the State Consumer Commission has rightly noted the delinquency of the medical centre while giving adequate and reasonable care to the patient, which is not only a negligent act but also constitutes a deficiency in service. Therefore, the compensation of merely Rs. 1 Lakh does not suffice the claim of the plaintiff and is not in line with the balance of interests of the parties involved.

Secondly, according to the apex court, the NCDRC which granted a compensatory relief of Rs. 1 Lakh is also at fault since the patient suffered physical pain and ailments for more than five years even when the ‘casual’ treatment given to the plaintiff was apparent from the face of the case. Therefore, the court ruled that there is a need to not only enhance the compensation but also to recognise the principle of “egg – shell rule” in the judgment itself which has nowhere found its mention in the judgements of both the commissions. In light of the above facts and arguments, the Hon’ble Supreme Court has not only enhanced the compensation but also awarded litigation costs to the appellant.

Conclusion

The preset case has rightly discussed in detail about numerous intricacies and aspects of the intersection of consumer laws and medical negligence cases and laid down various parameters required for the subordinate courts to be considered while awarding compensation.

Firstly, the court as rightly noted that the application of the above – mentioned doctrine should find its mention in appropriate cases laid down by the judgment and the computation of compensation should be based upon these broad parameters. Secondly, the courts should also consider the possibility of restitution of the parties to such a position as if the accident had never occurred through the means of compensation.

This judgment is not only an example of the importance of ‘egg – shell skull rule’ for determining the compensation in cases of medical negligence but has also acted as a guiding light for the subsequent cases of this nature.