'Eggshell Skull Rule' Can Only Be Applied In Medical Negligence Cases Of Victims Having Pre-Existing Vulnerability Or Medical Condition: SC

The Supreme Court, in a Judgment delivered in a medical negligence case,  explained the applicability of ‘Eggshell Skull Rule’.

It is a common law doctrine that makes a defendant liable for the plaintiff’s unforeseeable and uncommon reactions to the defendant’s negligent or intentional tort.

The Court observed that this Rule can only be applied when the victim had a pre-existing vulnerability or medical condition.

The Court was dealing with an appeal preferred by a woman (claimant) against the hospital seeking enhancement of compensation.

The two-Judge Bench comprising Justice Sanjay Karol and Justice Aravind Kumar observed, “This rule (applied by the NCDRC) holds the injurer liable for damages that exceed the amount that would normally be expected to occur. It is a common law doctrine that makes a defendant liable for the plaintiff's unforeseeable and uncommon reactions to the defendant's negligent or intentional tort. In simple terms, a person who has an eggshell skull is one who would be more severely impacted by an act, which an otherwise “normal person” would be able to withstand. Hence the term eggshell to denote this as an eggshell is by its very nature, brittle. It is otherwise termed as “taking the victim as one finds them” and, therefore, a doer of an act would be liable for the otherwise more severe impact that such an act may have on the victim.”

The Bench said that this rule is well recognized and has often formed the basis of which compensation has been awarded in countries such as the United States of America (USA).

Advocate Subhash Chandran K.R. represented the appellant while AOR Mrityunjay Kumar Sinha represented the respondents.

Brief Facts -

The claimant was admitted to Suket Hospital, Sundernagar, Mandi, Himachal Pradesh in 2005 and had her appendicitis removed by a Senior Surgeon (respondent). Post surgery, she was discharged, however, her ordeal did not end there. She suffered continuous pains near the surgical site, as such she was admitted again but was discharged the next day with the assurance that no further pain would be suffered by her. She was further treated by one doctor on the reference of the respondent surgeon and yet again, there was no end to her suffering. Such process continued for a period of four years and the claimant - appellant eventually landed up for treatment at the Post Graduate Institute of Medical Science, Chandigarh. Upon investigation, it was found that a 2.5 cm foreign body (needle) was present below the anterior abdominal wall in the preveside region just medial to previous abdominal scar (Appendectomy) for which a further surgery had to be performed for its removal. Alleging negligence on the part of the respondent hospital, a claim was brought for the “huge pain and spent money on treatment” totalling to Rs. 19,80,000/-. The District Consumer Disputes Redressal Forum (DCDRF) adjudicated the complaint case vide an award under Section 12 of the Consumer Protection Act, 1986.

On appeal preferred by the respondents, the State Consumer Disputes Redressal Commission (SCDRC), the respondents were held liable to compensate the appellant for the physical pain, mental agony, and expenses incurred by her, to the tune of Rs. 1,00,000/-, thereby partly allowing the respondent’s appeal. The National Consumer Disputes Redressal Commission (NCDRC), in the Revision Petition observed that the post-operative care provided by the respondents was casual and fell short of the standard of medical care. They had failed to investigate the non-healing surgical wound thereby constituting a deficiency in service and the NCDRC refused to accept the argument that since the appellant had received care at other hospitals as well it would be difficult to determine who was responsible for the needle in the abdomen. The egg-skull rule was applied to hold an individual liable for all consequences of their act. The compensation awarded by the State Commission was enhanced to Rs. 2,00,000/-. However, the appellant sought enhancement of compensation before the Apex Court.

The Supreme Court in view of the facts and circumstances of the case noted, “The jurisprudence of the application of this rule, as has developed, (needless to add, in countries other than India) has fit into four categories19 - first, when a latent condition of the plaintiff has been unearthed; second, when the negligence on the part of the wrongdoer re-activates a plaintiff’s pre-existing condition that had subsided due to treatment; third, wrongdoer’s actions aggravate known, pre-existing conditions, that have not yet received medical attention; and fourth, when the wrongdoer’s actions accelerate an inevitable disability or loss of life due to a condition possessed by the plaintiff, even when the eventuality would have occurred with time, in the absence of the wrongdoer’s actions. As these categories and, the name of the rule itself suggest, the persons to whose cases this rule can be applied, are persons who have pre-existing conditions.”

The Court added that for this rule to be appropriately invoked and applied, the person in whose case an adjudicatory authority applies must have a pre-existing condition falling into either of the four categories described above.

The Court also explained the scope of the Consumer Protection Act in the following manner:

i. It is a benevolent, socially orientated legislation, the declared aim of which is aimed at protecting the interests of consumers.

ii. Its goal is to provide inexpensive and prompt remedies for the grievances of consumers against defective goods and deficient services.

iii. For the above-stated objective, keeping in view the accessibility of these grievance redressal bodies to all, to all persons, quasi-judicial bodies have been set up at the district, state, and national levels.

iv. These bodies have been formed to save the aggrieved consumer from the hassle of filing a civil suit, i.e., provide for a prompt remedy in the nature of award or where appropriate, compensation, after having duly complied with the principles of natural justice.

The Court further said that in determining compensation in cases of medical negligence, a balance must be struck between the demands of the person claiming compensation, as also the interests of those being made liable to pay.

“The idea of compensation is based on restitutio in integrum, which means, make good the loss suffered, so far as money is able to do so, or, in other words, take the receiver of such compensation, back to a position, as if the loss/injury suffered by them hadn’t occurred. In Sarla Verma v. DTC this Court observed that compensation doesn’t acquire the quality of being just simply because the Tribunal awarding it believes it to be so. For it to be so, it must be, (i) adequate; (ii) fair; and (iii) equitable, in the facts and circumstances of each case”, it observed.

The Court emphasised that the compensation by its very nature, has to be just and for suffering, no part of which was the claimant-appellant’s own fault, she has been awarded a sum which can, at best, be described as ‘paltry’.

“In regard to the application of the Eggshell-Skull Rule, we may observe that the impugned judgment is silent as to how this rule applies to the present case. Nowhere is it mentioned, as to what criteria had been examined, and then, upon analysis, found to be met by the claimant-appellant for it to be termed that she had an eggshell skull, or for that matter, what sort of pre-existing condition was she afflicted by, making her more susceptible to such a reaction brought on because of surgery for appendicitis”, it noted.

Accordingly, the Apex Court allowed the appeal, set aside the awards of NCDRC and SCDRC, and restored the award of District Forum, meaning thereby that a sum of Rs. 5 lakhs to be paid by the respondents to the appellant.

Cause Title- Jyoti Devi v. Suket Hospital & Ors. (Neutral Citation: 2024 INSC 330)

Appearance:

Appellant: Advocates Subhash Chandran K. R., Krishna L. R., and AOR Biju P Raman.

Respondents: AOR Mritunjay Kumar Sinha, Advocates Vimal Sinha, J. P. N. Shahi, and AOR Rameshwar Prasad Goyal.

Click here to read/download the Judgment