JUDGEMENT ANALYSIS: Pinnamaneni

Narasimha Rao v. Gundavarapu Jayaprakasu

AIR 1990 AP 207

SUBJECT: Moot Court (Clinical)

SUBMITTED TO: Prof. Durgambini Patel

SUBMITTED BY: Group 6

Akansha Pant- F019
Aarushi Agarwal- F046
Mansha Kathuria- F021
Somya Gulati- F001
Ansh Sugandhi- F036
Advika Shrivastava- F054
Shriyansh Gupta- F018
INTRODUCTION
In legal terms, negligence is defined as the failure to exercise the standard of care that a
reasonably prudent person would have exercised in a similar situation. It can be referred to as
culpable carelessness. Negligence which is an outcome of ignorance, thoughtfulness and
forgetfulness being unfortunately also present in workplaces but there are certain professions
such as medicine where exercising and providing reasonable degree of skill and knowledge
becomes more dire. In spite of this there are countless cases in hospitals which arise due to
negligence. Medical negligence can be seen as the doctor’s failure to exercise the degree of
skill and care that a physician or surgeon of the same medical speciality would use in the
same circumstance.
In the case of Pinnamaneni Narasimha Rao v. Gundavarapu Jayaprakasu, the plaintiff was an
intelligent (on the basis of his good academic records) 17-year-old student who suffered from
chronic nasal discharge and due to medical negligence by an ENT surgeon suffered cerebral
damage, reducing his intellectual ability to that of a 5-year-old alongside loss of all prior
knowledge. The plaintiff sought damages from the defendants for executing a reckless
tonsillectomy on him which resulted in harm. The first, second and third defendants in the
case were the government of Andhra Pradesh (as the hospital responsible was government
affiliated), the ENT surgeon and chief anaesthetist of the hospital respectively. A suit for
damages for Rs. 50,000/- was filed.
The issue presented before The High Court of Andhra Pradesh was whether there had been
breach of duty of care on the part of the surgeon and anaesthetist in government hospital or
not.

CASE ANALYSIS
This case deals with a doctor's act of negligence or medical negligence in a government
hospital which falls under Tort law. In this country, tort law is not codified and it is mostly
relied on precedents from previous cases. The issue before the Andhra Pradesh High Court
was whether or not the surgeon and anaesthetist at the government hospital had breached
their duty of care. The complainant was a 17-year-old child who suffered from chronic nasal
discharge, which the ENT surgeon described as nasal allergies and recommended tonsil
removal. He got unconscious and remained unresponsive for three days after the operation in
Guntur during which the plaintiff's family was not permitted to be there. He regained
consciousness thereafter but he lost all of his knowledge and learning which he acquired till
date. His father sought the advice of two renowned doctors, one a neurosurgeon and the other
a psychiatrist who discovered that the procedure had resulted in cerebral damage and the
patient's cognition had deteriorated to that of a five-year-old child.
The plaintiff sought damages from the defendants for executing a negligent tonsillectomy on
him. He filed a lawsuit against the state of Andhra Pradesh (first defendant), the ENT surgeon
(second defendant) and head anaesthetist at the Government General Hospital in Guntur
(third defendant). A lawsuit for Rs. 50,000/- in damages was filed. The defendants claimed
that the plaintiff's damages were ‘functional,’ but neither the trial judge nor the High Court
believed them. The plaintiff suffered substantial suffering as a result of the second and third
defendants' failure to conduct the surgery with adequate level of care, according to the High
Court. Although an experienced expert, the second defendant (the operating surgeon) did not
follow the standards of behaviour expected of an ordinary surgeon.
The plaintiff was granted Rs. 22000 in damages by the trial court which the High Court
raised to Rs. 50000.The plaintiff had only requested Rs. 50,000/-, thus the High Court would
have enhanced it to a far higher amount. This is what the court had to say about it.

FACTS OF THE CASE

 The plaintiff was a bright 17-year-old student who suffered from recurrent nasal
discharge, which Dr. P. Narasimha Rao the ENT surgeon described as nasal allergies
and recommended tonsillectomy.
 He got unconscious and remained comatose for three days after the operation in
Guntur (during which the plaintiff's relatives were not allowed to be there).
 He regained consciousness after that, but he lost "all of the knowledge and wisdom he
had obtained.
 His father Gundavarapu Jayaptrakasu sought the advice of two famous doctors, one a
neurosurgeon and the other a psychiatrist, who discovered that the procedure had
resulted in cerebral damage, and that the patient's cognition had deteriorated to that of
a five-year-old child.
 The plaintiff sought damages from the defendants for executing a reckless
tonsillectomy on him. He filed a lawsuit against the state of Andhra Pradesh (first
defendant).
 The second defendant is the ENT surgeon at the Government General Hospital in
Guntur, and the third defendant is the hospital's head an aesthetist.
 A lawsuit for Rs. 50,000/- in damages was filed.

LEGAL PRECEDENTS
 Laxman v. Trimbhak:
In 1953 Ananda, the plaintiff met with an accident which resulted in a fractured femur on his
left leg. He was transferred to Poona from his village, where he was admitted to a hospital.
The presiding doctor was directed to give the patient 2 injections but the doctor injected him
with only one. Post the surgery the patient suddenly faced difficulty breathing and succumbed
to death.
The court found the accused guilty and stated- “The duties which a doctor owes to his patient
are clear. A person who holds himself out ready to give medical advice and treatment
impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a
person when consulted by a patient owes him certain duties viz., a duty of care in deciding
whether to undertake the case, a duty of care in deciding what treatment to give, or a duty of
care in the administration of that treatment. A breach of any of those duties gives a right of
action for negligence to the patient. The practitioner must bring to his task a reasonable
degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very
highest nor very low degree of care and competence judged in the light of the particular
circumstances of each case is what the law requires”

 Whitehouse vs. Jordan:

In 1981, After a difficult childbirth, the baby suffered a severe brain damage. The doctor had
used forceps to assist the delivery as the mother had been in labour for more than 22 hours.
The plaintiff sued the hospital registrar (who was supervising the delivery). The house of
Lords ruled that the injury was reasonably foreseeable and did not fall below the reasonable
standard of care, Hence the defendant was found guilty.

JUDGEMENT ANALYSIS
The trial court had awarded to the plaintiff Rs. 22000 as damages which the High Court
increased to Rs. 50000 in favour of the plaintiff in damages for performing a careless and
negligent tonsillectomy operation on the plaintiff. Dr. P. Narasimha Rao, the second
defendant, was the E. N. T. Surgeon who performed the tonsillectomy operation on the
plaintiff at the Government General Hospital in Guntur, and Dr. S. Shankar Rao, the third
defendant, was the Hospital's Chief Anaesthetist who administered anaesthetics during the
operation. The first defendant is the Government of Andhra Pradesh, represented by the
District Collector of Guntur, who is vicariously liable for the damages, according to the
plaintiff, because the alleged act of negligence was committed by defendants 2 and 3 while
performing their duties as State Government employees.
The plaintiff, therefore, sought a decree in a sum of Rs. 50,000/- as damages under all the
heads including mental pain, suffering, loss of earning capacity, expenses incurred for
medical treatment etc.
This is what the court says on the subject:
“Damages for pain and suffering and loss of amenities are generally given in a single sum.
For a grave injury of the nature sustained by the plaintiff. no amount of money would be a
perfect compensation. Any amount of money cannot restore to him that he had lost
permanently. He is condemned to a perpetual life of misery and agony, during the lucid
intervals he is haunted by his brilliant past academic record. His bright future prospects are
permanently wiped out The. thrill and joy or life deserted him one and for all. Thinking that a
partner in life would give peace and comfort, Iris parents performed his marriage and it
appears. that Je marriage came to a tragic end and his wife had deserted him because of his
mental deficiency. The tragedy which struck him at the age of 17 in the form of irreversible
cerebral anoxia made his life a permanent nightmare. He has no happiness or pleasure for the
rest of his life. He is, therefore, entitled to substantial damages under the head ‘loss of
amenities’ which in the circumstance, I estimate at Rs. 2 lakhs.”
As the injury sustained by the plaintiff was due to the negligence of defendants 2 and 3 who
at the relevant time were the employees of the first defendant, the Government of Andhra
Pradesh, the latter is vicariously liable. In view of the death of the third defendant the suit
against him had abated. Hence there shall be a decree only against the defendants 1 and 2.

CONCLUSION
Through the judgements it is clear that Pinnamaneni Narasimha Rao vs Gundavarapu
Jayapraksu successfully sets a benchmark for the standard of duty of care required from a
trained medical professional in India.
As seen through the precedents previously mentioned medical negligence is an immense
problem in India and it is through judgements like this that a solution can be found which
both holds medical professionals responsible, thus through the deterrence theory of
punishment makes them more likely to be focused and in case the negligence does occur,
gives relief to the victim.
The trial court had initially awarded to the plaintiff Rs. 22000. However, the High Court
recognised that the loss to the victim was severe and thus deserved a much higher
compensation. Due to the plaintiff having claimed a sum of 50,000, it was awarded as such
but had it been up to the court the relief given would be much higher.