ASHISH KUMAR MAZUMDARversusAISHI RAM BATRA CHARITABLE HOSPITAL TRUST & ORS.

                       [2014] 5 S.C.R. 519


                 ASHISH KUMAR MAZUMDAR                                     A
                                   v.
  AISHI RAM BATRA CHARITABLE HOSPITAL TRUST &
                          ORS.
            (Civil Appeal No. 4010 of 2010)
                                                                           B
                          APRIL 22, 2014
       [P. SATHASIVAM CJI, RANJAN GOGOi AND
                   N.V. RAMANA, JJ.]

      Medical Negligence - Principle of res ipsa /oquitur -                C
Applicability of - Plaintiff admitted as indoor patient in the
Hospital and suffering with high fever and in delirious state -
Found lying below the window of his hospital room with
multiple fractures and despite treatment became a paraplegic
i.e. 100% disabled below the waist - Suit for damages on the               D
ground that absence of due and reasonable care on the part
of the hospital authorities led to the incident disabling the
plaintiff for rest of his life .:... Courts b.elow applied the principle
of res ipsa loquitur to cast the burden of proving on the
defendant that there was no negligence and thereafter held                 E
that the defendant was liable for negligence and failure to take
due care - Held: There was no error in c/pplication of the
principle of.res ipsa loquitur to the present case - Insofar as
the findings of negligence and absence of due care of the
defendant was concerned, 'such findings being concurrent                   F
findings of fact the same ought not to be reopened in appeal
filed by defendant-hospital u/Art~ 136 of the Constitution - Any
such exercise would be wholly inappropriate to the
extraurdinary and highly discretionary jurisdiction vested in
the Supreme Court by the Constitution - Even otherwise,                    G
nothing inherently improbable or outrageously illogical in the
conclusions reached by the Trial ~udge as affirmed by High
Court - Maxims - Res ipsa /oquitur.

     Medical Negligence - Compen~ation - Damages -
                           .      519      /                       ;
                                                                           H
    520      SUPREME COURT REPORTS                [2014] 5 S.C.R.

A Plaintiff admitted as indoor patient in the Hospital and
    suffering with high fever and in delirious state - Found lying
    below the window of his hospital coom with multiple fractures
    and despite tre-atment became a paraplegic i.e. 100%
    disabled below the waist - Suit for damages on the ground
    that absence of due and reasonable care on the part of the
8
    hospital authorities led to the incident disabling the plaintiff
    for rest of his life - Courts below of the view that duty of a
    hospital is not limited to diagnosis and treatment but extends
    to looking after the safety and security of the patients,
    particularly, those who are sick or under medication and
C   therefore can become delirious and incoherent - Trial judge
    quantified the damages at Rs. 7 lakhs - High Court enhanced
    the amount to Rs. 11 lakhs for loss of future prospects in
    employment, for keeping an attendant and for non-pecuniary
    loss including pain and suffering, loss of limb etc. - Held:
D   Insofar as the quantum of compensation is concerned, the
    three broad heads considered by the High Court for award of
    damages were sufficiently representative of the claim of the
    plaintiff - Precise quantum of compensation that should be
    awarded in any given case cannot and, in fact, need not be
E   determined with mathematical exactitude or arithmetical
    precision - So long the compensation awarded broadly
    represents what could be the entitlement of a claimant in any
    given case the discretion vested in the trial court and the High
    Court ought not to be lightly interfered - On facts, the quantum
F   of damage cannot be said to be either inadequate or
    inappropriate so as to justify. interference.

       The plaintiff-claimant filed suit for damages against
  the defendant hospital trust. The claim of the plaintiff was
G that he was admitted on 27.10.1988 as an indoor patient
  in the defendant-hospital. He was running high fever and
  was in a delirious state. In the night intervening 31.10.1988
  and 01.11.1·988, the plaintiff's sister who was staying with
  him in the room noticed the absence of the plaintiff from
H the room. She promptly informed the staff nurse on duty
 ASHISH KUMAR MAZUMDAR v. AISHI RAM BATRA 521
         CHARITABLE HOSPITAL TRUST
and after search, the plaintiff was found lying on the            A
ground floor and at a distance of 50 yards from a point
immediately below the window of room where he was
lodged. The plaintiff suffered multiple fracture of lumbar
vertebrae with complete dislocation of the spinal cord and
despite treatment he became a paraplegic i.e. 100%                B
disabled below ·the waist.

     According to the plaintiff, it was on account of the
absence of due and reasonable care on the part of the
hospital authorities that the incident occurred disabling C
the plaintiff for the rest of his life. The Trial Judge held that,
having regard to the layout of the room and the location
of the window and also having regard to the precarious
health condition of the plaintiff on the day of the incident
(he was running high fever), it was not possible to accept
the contention of the defendant that the plaintiff had 0
himself jumped out of the window resulting in the injuries
sustained. The Trial Judge came to the conclusion that
the facts established by thlJ evidence on record attracted
the principle of res ipsa /oquitur and, therefore, it was for
the defendant to prove the absence of any negligence E
and due care and attention on its part. The Trial Judge
was also of the view that duty of a hospital is not limited
to diagnosis and treatment but extends to looking after
the safety and security of the patients, particularly, those
who are sick or under medication and therefore can F
become delirious and incoherent. So far as the quantum
of damages is concerned, the Trial Judge quantified the
same at Rs.7 lakhs along with interest at 12% per annum
thereon. The Division Bench upheld the judgment of
single judge and also enhanced the amount to Rs.11 G
lakhs by way of damages for loss of future prospects in
employment, for keeping an attendant and for non-
pecuniary loss including pain and suffering, loss of limb
etc.

    Not satisfied, the plaintiff filed appeal before this Court   H
   522       SUPREME COURT REPORTS           [2014] 5 S.C.R.


A seeking enhancement of damages while cross-appeal
  filed by the defendant challenging the award of damages.

         Dismissing both the appeals, the Court

       Held: 1. The maxim res ipsa loquitur in its classic
B form has been stated as: " ........ where the thing is shown
  to be under the management of the defendant or his
  servants, and the accident is such as in the ordinary
  course of things does not happen if those who have the
  management use proper care, it affords reasonable
C evidence, in the absence of explanation by the
  defendants, that the ac~ident arose from want of care."
  The maxim applies to a case in which certain facts
  proved by the plaintiff, by itself, would call for an
  explanation from the defendant without the plaintiff
D having to allege and prove any specific act or omission
  of the defendant. [Para 8] [527-H; 528-A-C]

       1.2. The principal function of the maxim is to prevent
  injustice which would result if the plaintiff was invariably
E required to prove the precise cause of the accident when
  the relevant facts are unknown to him but are within the
  knowledge of the defendant. The doctrine would apply
  to a situation when the mere happening of the accident
  is more consistent with the negligence of the defendant
F than with other causes. [Para 9] [528-D-E]

       Shyam Sunder an_d Others vs. The State of Rajasthan
   1974 (1) sec 690: 1974 (3) SCR 549 - relied on.

      Scott v. London & St. Katherine Docks, (1865) 3 H & C
G 596, 601 - referred to
      2. The courts below have applied the principle of res
  ipsa /oquitur to the present case to cast the burden of
  proving on the defendant that there was no negligence.
  Thereafter, the Trial Judge as well as the Division Bench
H of the High Court held the defendant was liable for
 ASHISH KUMAR MAZUMDAR v. AISHI RAM BATRA                  523
         CHARITABLE HOSPITAL TRUST
 negligence and failure to take due care of the plaintiff         A
,who was an indoor patient in the hospital. The said
 conclusions reached was on an elaborate consideration
 of the evidence and materials on record and after a
 detailed discussion of the stand of the rival parties. There
 was no error in the application of the principle of res ipsa     B
 loquitur to the present case. In so far as the findings of
 negligence and absence of due care of the defendant
 was concerned, such findings being concurrent findings
 of fact the same ought not to be reopened in the appeal
 filed by th'e defendant-hospital under Article 136 of the        c
 Constitution. Any such exercise would be wholly
 inapprop,ri~e to the extraordinary and highly
 discretion'ary jurisdiction vested in this Court by the
 Constitution. Even otherwise, there is nothing inherently
 improbable or outrageously illogical in the conclusions
                                                                  0
 reached by the Trial Judge as affirmed in appeal. [Para
 10] [528-F-G; 529-A-D]
    3. Insofar as tl:le quantum of compensation is
concerned, the three broad heads considered by the
Diyision Bench for award of damages .are sufficiently             E
representative of the claim of the plaintiff. The precise
quantum of compensation that should be awarded in any
given case cannot and, in fact, need not be determined
with mathematical exactitude or arithmetical precision. So
long the compensation awarded broadly represents what             F
could be the entitlement of a claimant in any given case
the discretion ves'ted in the trial court and the regular first
appellate court ought not to be lightly interfered. The
quantum of damage cannot be said to be either
inadequate or inappropriate so as to justify interference.        G
[Para 11] [529-D-G]
                     Case Law Reference:
     1974 (3) SCR 549         relied on             Para 9
                                                                  H
    524       SUPREME COURT REPORTS                 [2014] 5 S.C.R.

A         (1865) 3 H & C 596        referred to            Para 10

        CIVIL APPELLATE JURISDICTION : Civil Appeal No
    4010 of 2010.

      From the Judgment & Order dated 23.12.2009 of the High
B Court of Delhi at New Delhi RFA (OS) ·No. 7 of 2009.

                                  WITH

    C.A. No. 4011-4012 of 2010

C      S.B. Upadhyay, Tarkeshwar Nath, Saurabh Kumar Tuteja,
    Rameshwar Prasad Goyal for the Appellant.

        S.S. Khanduja, Kalpana, Yash Pal Dhingra for the
    Respondents.
D
          The Judgment of the Court was delivered by

         RANJAN GOGOi, J. 1. Suit No. 3413 of 1991 filed by one
    Ashish Kumar Maz.umdar (hereinafter referred to as 'the
    plaintiff') was decreed by a learned Single Judge of the High
E   Court of Delhi awarding a sum of Rs. 7 la_khs with interest @
    12% per annum on account of damages for injuries suffered
    by the plaintiff while undergoing treatment in the Batra Hospital,
    Delhi. The aforesaid judgment and decree passed on
    02.12.2008 was challenged in appeal before the Division
F   Bench of the High Court by the defendant in the suit i.e. the trust
    managing the hospital (hereinafter referred to as 'the
    defendant'). The plaintiff had also filed a separate appeal
    challenging the quantum of damages awarded and seeking
    enhancement thereof. The Division Bench of the High Court by
G   a common order dated 23.12.2009 dismissed the appeal filed
    by the defendant trust and allowed the appeal filed by the
    plaintiff enhancing the amount of damages awarded from Rs.
    7 lakhs to Rs. 11 lakhs alongwith interest@ 12% per annum.
    Not satisfied, the plaintiff has filed Civil Appeal No.4010 of
H   2010, whereas aggrieved by the dismissal of its appeal, the
   ASHISH KUMAR MAZUMDAR v. AISHI RAM BATRA 525
  CHARITABLE HOSPITAL TRUST [RANJAN GOGOi, J.]
                                                                   -
 defendant trust has-filed -tbg connected appeals (Civil Appeal           A
 Nos. 4011-4012 of 2010).

       2. We· have heard Mr. S.B. Upadhyay, learned senior
 counsel for the plaintiff and Mr. S.S. Khanjuda, learned counsel
 for the defendant.
                                                                          B
        3. According to the plaintiff, he was admitted as an indoor
  patient in the Batra Hospital on 27.10.1988 and was lodged in
  Room No.305 on the third floor of the hospital. He was running
  high fever and was in a delirious state. In the night intervening
  31.10.1988 and 01.11.1988, at about 2.20 a.m., the plaintiff's          C
  sister, one Kajal, who was staying with him in the room had
  noticed the absence of the plaintiff from the room. She promptly
  informed the staff nurse on duty and a search was conducted
  to trace out the plaintiff in the course of which a security guard,
  Hans Raj, found the plaintiff lying on the ground floor in the          D
  oncology gallery of the hospital and at a distance of 50 yards
  from a point immediately below the window of room No. 305.
  The plaintiff suffered multiple fracture of lumbar vertebrae wjth
  complete dislocation of the spinal cord and despite treatment
  he became a paraplegic i.e. 100% disableEl below the waist.             E
  Though the plaint is silent on the circumstances in which the
  injuries were caused or the manner in which the same we're
  sustained, according to the plaintiff, as at the time of the incident
  he was an indoor patient in the hospital it was the duty and
  responsibility of the hospital authorities to take care of th           F
  plaintiff who was suffering from high fever and was in a delirious
  state. The plaintiff had alleged that it is on account ·of the
  absence of due and reasonable care on the part of the hospital
  authorities that the incident could occur disabling the plaintiff
  for the rest of his life. According to the plaintiff though the         G
  injuries suffered by him had not immediately affected his
  employment as a Junior Assistant in Punjab National Bank the
· same had severely affected his service prospects. Accordingly,
  the suit in question was filed seeking damages to the extent of
  Rs. 58 lakhs; the claim, however, was restricted to Rs. 25 lakhs
                                                                          H
    526       SUPREME COURT REPORTS                  [2014] 5 S.C.R.


A on account of the plaintiff's inability to pay the requisite court
  fee on the rest of the amount.

       4. The defendant trust, in its written statement, took the
  stand that the hospital had permitted the plaintiffs sister to stay
  in the room as an attendant and that the plaintiff had himself
8
  jumped out of the window of his room despite the presence of
  his sister leading to the injuries suffered. On the said broad
  facts the defendant denied the allegation of negligence and
  absence of due care on its part as claimed by the plaintiff in
  the suit.
c
         5. On the basis of the pleadings cif the parties, the learned
   Trial Judge framed four issues for trial in the suit. Five witnesses
   including the plaintiff himself (PW-1 ), his sister (PW-2) and his
   brother (PW-3) were examined. One Dr. R.K. Srivastava (PW-
D 5) was also examined to prove the disability certificate showing
   the extent of the disability of the plaintiff. To controvert the case
   of the plaintiff, the defendant had examined one Dr. Arun
   Dewan (DW-1 ). who had treate-d the plaintiff and the seGurity
  ~uard Hans Raj (DW-2) who had found the plaintiff in an injured
E state.

       6. The learned Trial Judge came to the conclusion that,
  having regard to the layout of the room and the location of the
  window and also having regard to the precarious health
  condition of the plaintiff on the day of the incident (he was
F running high fever), it was not possible to accept the contention
  of the defendant that the plaintiff had himself jumped out of the
  window resulting in the injuries sustained. On the contrary the
  learned Trial Judge came to the conclusion that the facts
  established by the evidence on record attracted the principle
G of res ipsa /oquitur and, therefore, it was for the defendant to
  prove the absence of any negligence and due care and
  attention on its part. Proceeding, the learned Trial Judge was
  also of the view that duty of a hospital is not limited to diagnosis
  and treatment but extends to looking after the safety and
H security of the patients, particularly, those who are sick or under
 ASHISH KUMAR MAZUMDAR v. AISHI RAM BATRA 527
CHARITABLE HOSPITAL TRUST [RANJAN GOGOi, J.]
medication and therefore can become delirious and incoherent.         A
Adverting to the facts before him, the learned Judge took the
view that it is evident that in the present case the plaintiff, who
was suffering from high fever, had gone out for a stroll in the
middle of the night being unable to sleep. His absence from
the room on being noticed by his sister (PW-2) a search was           B
organized and the plaintiff was found lying on the ground' floor
in the oncology gallery of the hospital with the injuries in
question. On the said basis, the learned Trial Judge concluded
that, in the present case, the hospital should be held liable for
not maintaining the necessary vigil in the hospital premises to       c
ensure the safety o.f its patients and it is on account of the
absence of such vigil that the plaintiff, despite his poor health,
was able to walk around and in the process had sustained the
injuries in question. So far as the quantum of damages is
concerned, the learned Trial Judge quantified the same at Rs. 7
                                                                      0
lakhs along with interest at 12% per annum thereon.

     7. In appeal, the Division Bench reiterated the findings
recorded by the learned Trial Judge holding the same to be
justified in the totality of the facts proved in the case.
Additionally, the Division Bench was of the view that the plaintiff   E
was entitled to a total amount of Rs.11 lakhs by way of damages
which was quantified in the following manner :

  (i)     For loss of future prospects          Rs. 4,00,000.00
          in employment                                               F
  (ii)    For keeping an attendant              Rs. 4,00,000.00

  (iii)   For non-pecuniary loss including      Rs. 3,00,000.00
          pain and suffering, loss of limb etc.
                                                                      G
     The aforesaid amount of damages was directed to carry
interest @ 12% from the date of filing of the suit i.e. 29.10.1991.
                                                           '--'
     8. The maxim res ipsa loquitur in its classic form has
been stated by Erle C.J.
                                                                      H.
                                                                       '
    528          SUPREME COURT REPORTS                    [2014) 5 S.C.R.

A          (1)    " ........ where the thing is shown to be under
                  the management of the defendant or his
                  servants, and the accident is such as in the
                  ordinary course of things does not happen if
                  those who have the management use proper
B                 care, it affords reasonable evidence, in the
                  absence of explanation by the defendants,
                  that the accident arose from want of care." 1

       The maxim applies to a case in which certain facts proved
C by the plaintiff, by itself, would call for an explanation from the
  defendant without the plaintiff having to allege and prove any
  specific act or omission of the defendant.

          9. In Shyam Sunder and Others vs. The State of
    Rajasthan 2 it has been explained that the principal fUnction of
D the maxim is.. to prevent injustice which would result if the plaintiff
  was invariably required to prove the precise cause of the
  accident when the relevant facts are unknown to him but are
  within the knowledge of the defendant. It was also explained
  that the doctrine would apply to a situation when the mere
E happening of the accident is more consistent with the
  negligence of the defendant than with other causes.

        10. We have considered the case of the respective parties
  and the evidence adduced in support thereof; the judgment
  under appeal as well as the view taken by the learned Trial
F Judge besides the arguments and contentions advanced
  before us. The learned courts have applied the principle of res
  ipsa /oquitur to the present case to cast the burden of proving
  that there was no negligence on the defendant. Thereafter, the
  learned Trial Judge as well as the Division Bench of the High
G Court has held the defendant liable for negligence and failure
  to take due care of· the plaintiff who was an indoor patient in
  the hospital. The aforesaid conclusions reached is on an

    1.   Scott v. London & St. Katherine Docks, (1865) 3 H & C 596, 601.
H   2.   1974 (1) sec 690.
 ASHISH KUMAR MAZUMDAR v. AISHI RAM BATRA 529
CHARITABLE HOSPITAL TRUST [RANJAN GOGOi, J.]

elaborate consideration of the evidence and materials on record          A
and after a detailed discussion of the stand of the rival parties.
On a consideration of the facts of the. present case we do not
find any error in the application of the principle of res ipsa
/oquitur to the present case. In so far as the findings of
negligence and absence of due care of the defendant is                   B
concerned, we are of the view that such findings being
concurrent findings of fact the same ought not to be reopened
by us in the appeal filed by the defendant-hospital under Article
136 of the Constitution. Any such exercise would be wholly
inappropriate to the extraordinary and highly discretionary              c
jurisdiction vested in this Court by the Constitution. Even
otherwise, we do not find.anything inherently improbable or
outrageously illogical in the conclusions reached by th'e learned
Trial Judge as affirmed in appeal. The appeals filed by the
defendant-hospital are, therefore, dismissed.                            0
                                                                     '
      11. Insofar as the quantum of compensation is ~oncemec:t;--
we are of the view that the three broad heads considered by
the Division Bench for awatd of damages are sufficiently
representative of the claim of the plaintiff. The precise quantum
of compensation that should be awarded in any given case E
cannot and, in fact, need not be determined with mathematical
exactitude or arithmetical precision. So long the compensation
awarded broadly represents what could be the entitlement of
a claimant in any given case the discretion vested in the trial
court and the regular first appellate court ought not to be lightly F
interfered. Taking into account the facts before us and having
regard to the basis on which damages have been awarded,
we do not consider the same to be either inadequate or
inappropriate so as to justify interference. Accordingly, the
appeal filed by the plaintiff is also dismissed.                    G

     12. Consequently and in the light of the aforegoing
discussions, both sets of appeals are 'dismissed.

Bibhuti Bhushan Bose                            Appeals dismissed.
                                                                         H