Savita Garg v. National Heart Institute

In this foundational precedent on medical negligence and hospital liability, Justice A.K. Mathur established the principle of vicarious liability of healthcare institutions under the Consumer Protection Act. The Supreme Court held that when a patient is admitted to a hospital, a contract of service comes into existence between the patient and the hospital. Patients pay fees directly to the institution and place their lives in its care, unaware of the internal contractual arrangements between the hospital and its treating consultants. Consequently, the hospital is vicariously responsible for the acts and omissions of all medical professionals practicing under its roof. The National Consumer Commission erred fundamentally in dismissing a wrongful death complaint on the ground that the specific treating doctors were not impleaded as parties. Once a patient demonstrates unexplained death or deterioration following medical intervention, the burden of proof shifts to the hospital to demonstrate that standard medical care was administered.

• Vicarious Liability of Hospitals: Healthcare institutions are legally liable for the negligence of all medical personnel, including visiting and guest doctors.
• Non-Joinder of Doctors Not Fatal: Consumer complaint is fully maintainable against the hospital alone without impleading individual physicians.
• Hospital-Patient Contract of Service: Legal relationship exists primarily with the hospital which charges fees and guarantees professional care.
• Reversal of Evidentiary Burden: Once injury/death occurs during custody of hospital, the hospital must produce medical records and justify treatment.
• Consumer Protection Act Accessibility: Ensured patients and bereaved families are not defeated by procedural technicalities when seeking medical justice.

The appellant's husband, A.K. Garg, was admitted to the National Heart Institute, New Delhi in 1995 for treatment of viral fever and cardiac complications.

During his hospital stay, his condition deteriorated rapidly following invasive procedures and oxygen tube administration, and he died of septicemia.

The widow Savita Garg filed a consumer complaint before the National Consumer Disputes Redressal Commission (NCDRC) claiming Rs. 20 lakhs compensation for medical negligence.

The NCDRC dismissed the complaint at the threshold without examining evidence, holding that the complaint was bad for non-joinder of necessary parties because the individual treating doctors were not arrayed as respondents.

The widow appealed to the Supreme Court.

When a patient is admitted to a hospital, he does not know who are the doctors or consultants who will be attending to him. He goes to the hospital believing that the hospital is a reputed institution which will provide best medical care and facilities. The patient pays the hospital and the hospital provides the doctors. Therefore, the hospital is vicariously liable for the acts of negligence committed by its doctors, nurses and staff, whether they are permanent employees or visiting consultants. The distinction between a contract of service and a contract for services has blurred in modern institutional healthcare. A consumer complaint cannot be dismissed on the technical ground of non-joinder of the treating doctors. The hospital cannot be allowed to hide behind its doctors. Once the complainant has made out a prima facie case that the patient was admitted to the hospital and died due to lack of proper treatment or care, the burden shifts to the hospital to satisfy the court that there was no lack of care or diligence. All hospital records, case sheets, and treatment charts are in the exclusive custody of the hospital. If the hospital fails to produce records and explain the course of treatment, an adverse inference can be drawn against it. The judgment of the NCDRC is set aside and the matter is remitted for trial on merits.

• Maharaja Agrasen Hospital v. Rishabh Sharma (2020) 6 SCC 501: Applied Savita Garg to hold private hospital vicariously liable for retinopathy blindness in a premature baby.
• Balram Prasad v. Kunal Saha (2014) 1 SCC 384: Relied on Savita Garg to award historic compensation of Rs. 11.5 crores against AMRI Hospital for medical negligence.
• V. Kishan Rao v. Nikhil Super Speciality Hospital (2010) 5 SCC 513: Reaffirmed Savita Garg on res ipsa loquitur and hospital accountability.
• Arun Kumar Manglik v. Chirayu Health and Medicare (P) Ltd. (2019) 7 SCC 401: Followed Savita Garg regarding standard of medical diligence in critical care.