* Author
[2024] 4 S.C.R. 757 : 2024 INSC 330
Jyoti Devi
v.
Suket Hospital & Ors.
(Civil Appeal No. 5256 of 2024)
23 April 2024
[Sanjay Karol* and Aravind Kumar, JJ.]
Issue for Consideration
Post surgery of appendicitis at respondent hospital, the claimantappellant suffered continuous pains near the surgical site. Eventually
upon investigation, it was found that a 2.5 cm needle was present
in the abdomen and for removing it another surgery had to be
performed. District Forum passed award directing Rs.5 lakhs to
be paid to the appellant. However, State Commission reduced the
compensation to Rs.1 lakhs. NCDRC applying the eggshell skull
rule enhanced the compensation to Rs.2 lakhs. Appellant sought
enhancement of compensation.
Headnotes
Consumer Protection Act, 1986 – Medical negligence
– Deficiency in service – Determination of quantum of
compensation – Just compensation – Eggshell skull rule –
Inapplicability:
Held: The factum of negligence on the part of the respondent
Hospital as well as respondent No.2 was not doubted across fora –
Although the State Commission differed with the District Forum on
the presence of the needle, the NCDRC found the medical record
to testify the presence of a needle in the abdomen and also found
that the respondent Hospital was found wanting in terms of postoperative care – In determining compensation in cases of medical
negligence, a balance has to be struck between the demands of
the person claiming compensation, as also the interests of those
being made liable to pay – What qualifies as just compensation has
to be considered in the facts of each case – Despite having made
observations regarding the service rendered by the Hospital being
deficient and the continuous pain and suffering on the part of the
appellant, the compensation granted was paltry and unjustified –
Further, eggshell skull rule holds the injurer liable for damages that
exceed the amount that would normally be expected to occur – It
758 [2024] 4 S.C.R.
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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 persons to whose cases this rule
can be applied, are persons who have pre-existing conditions –
Therefore, 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 –
Impugned judgment is silent as to how the Eggshell Skull Rule rule
applied to the present case – Nowhere it mentioned as to what
criteria had been examined, and then, upon analysis, found to be
met by the 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 – Awards of the
NCDRC and State Commission set aside while that of the District
Forum restored – Rs.5 lakhs with 9% simple interest to be paid
by the respondents to the appellant for being medically negligent
and providing services deficient in nature – Cost of litigation @
Rs.50,000/- also imposed. [Paras 11, 12.3.1, 12.3.3, 12.4.1, 16-18]
Doctrine – Common law doctrine – Rule of tort – Eggshell
skull rule – Application of the rule – Jurisprudence:
Held: Jurisprudence of the application of this rule, as developed (in
countries other than India) has fit into four categories – 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 – 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 – The persons to whose cases this rule can be
applied, are persons who have pre-existing conditions– Therefore,
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. [Para 12.4.3]
Compensation – Just compensation:
Held: 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,
[2024] 4 S.C.R. 759
Jyoti Devi v. Suket Hospital & Ors.
back to a position, as if the loss/injury suffered by them hadn’t
occurred – 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 adequate; fair; and equitable, in the facts
and circumstances of each case. [Para 12.3.2]
Consumer Protection Act, 1986 – Scope of – Discussed. [Para
12.1.1]
Case Law Cited
C. Venkatachalam v. Ajitkumar C. Shah and others
[2011] 13 SCR 814 : (2011) 12 SCC 707; J.J. Merchant
(Dr) v. Shrinath Chaturvedi [2002] Supp. 1 SCR 469 :
(2002) 6 SCC 635; Common Cause v. Union of India
[1993] 1 SCR 10 : (1997) 10 SCC 729; M.A Biviji v.
Sunita & Ors. [2023] 15 SCR 113 : (2024) 2 SCC 242;
Jacob Matthew v. State of Punjab [2005] Supp. 2 SCR
307 : (2005) 6 SCC 1; Dr. Mrs. Chanda Rani Akhouri
v. Dr. M.A. Methusethupati [2022] 5 SCR 812 : (2022)
SCC OnLine SC 481; Harish Kumar Khurana v. Joginder
Singh (2021) 10 SCC 291; Nizam’s Institute of Medical
Sciences v. Prasanth S. Dhananka [2009] 9 SCR 313 :
(2009) 6 SCC 1; Sarla Verma v. DTC [2009] 5 SCR
1098 : (2009) 6 SCC 1 – relied on.
Balram Prasad v. Kunal Saha and Ors. [2013] 12 SCR
30 : (2014) 1 SCC 384; V. Krishnakumar v. State of
Tamil Nadu & Ors. [2015] 8 SCR 100 : (2015) 9 SCC
388; Nand Kishore Prasad v. Mohib Hamidi and Ors.
[2019] 7 SCR 1076 : (2019) 6 SCC 512 – referred to.
Vasburg v. Putney 50 N.W 403 (Wis 1891); Dulieu v.
While & Sons (1901) 2 KB 669; White and Others v.
Chief Constable of South Yorkshire and Others; Athey v.
Leonati [1996] 3 SCR 458; James E. Niehus and Denise
Niehus v. Vince Liberio and Frank Vittorio 973 F.2d 526
(7th Cir. 1992); Lancaster v. Norfolk and Western Ry.
Co. 773 F.2d 807, 820 (7th Cir. 1985) – referred to.
Books and Periodicals Cited
Mark A. Geistfeld, Proximate Cause Untangled, 80
Md L. Rev. 420 (2021); Steve P. Calandrillo & Dustin
E. Buelher, Eggshell Economics: A Revolutionary
760 [2024] 4 S.C.R.
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Approach to the Eggshell Plaintiff Rule, 74 Ohio St. L.J
375 (2013); Restatement (Third) of Torts: Liability For
Physical and Emotional Harm, American Law Institute,
2010 – referred to.
List of Acts
Consumer Protection Act, 1986.
List of Keywords
Medical negligence; Deficiency in service; Needle in abdomen;
Continuous pain and suffering post surgery; Post-operative care;
Determination of quantum of compensation; Just compensation;
Eggshell skull rule; Common law doctrine.
Case Arising From
CIVIL APPELLATE JURISDICTION: Civil Appeal No. 5256 of 2024
From the Judgment and Order dated 01.09.2015 of the National
Consumers Disputes Redressal Commission, New Delhi in RP No.
57 of 2015
Appearances for Parties
Subhash Chandran K. R., Ms. Krishna L. R., Biju P Raman, Advs.
for the Appellant.
Mritunjay Kumar Sinha, Mrs. Vimal Sinha, J. P. N. Shahi, Rameshwar
Prasad Goyal, Advs. for the Respondents.
Judgment / Order of the Supreme Court
Judgment
Sanjay Karol, J.
Leave granted.
2. In ordinary circumstances, a procedure concerning appendicitis is
considered to be routine. It did not turn out to be so for Jyoti Devi1
.
She was admitted to Suket Hospital, Sundernagar, Mandi, Himachal
Pradesh on 28th June 2005 and had her appendicitis removed by Dr.
Anil Chauhan, Senior Surgeon, Suket Hospital. Post surgery, she
1 Hereafter, ‘claimant-appellant’
[2024] 4 S.C.R. 761
Jyoti Devi v. Suket Hospital & Ors.
was discharged on 30th June 2005. However, her ordeal did not end
there. She suffered continuous pains near the surgical site, as such
she was admitted again on 26th July 2005 but was discharged the
next day with the assurance that no further pain would be suffered
by her. She was further treated by one Dr. L.D. Vaidya of Mandav
Hospital, Mandi, on the reference of Dr. Anil Chauhan respondent
no.2 herein. Yet again, there was no end to her suffering. This process
continued for a period of four years.
3. 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) “is
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.
4. Alleging negligence on the part of the respondent - Suket Hospital, a
claim was brought for the “huge pain and spent money on treatment”
totalling to Rs.19,80,000/-.
5. The District Consumer Disputes Redressal Forum, Mandi, H.P.2
, while
adjudicating Complaint Case No.262 of 2011 vide award dated 18th
December, 2013 under Section 12 of the Consumer Protection Act,
1986, concluded as under:-
“15. In the case at hand, the complainant has suffered
physical pain for more than five years due to negligence of
opposite parties no. 1 and 2. …we feel that compensation
for Rs.5,00,000/- in lump sum is just and proper to meet
out the injury of the complainant. …Opposite parties no. 3
and 4 have taken plea that they are only liable for bodily
injury as per the contract for death, injury, illness or disease
of or any person. In the present case the complainant
was operated by opposite party no.2 for appendicitis but
after operation, the complainant developed pain and pus
started oozing out from stitches and she was operated
at PGI where needle was extracted by the doctor from
her abdomen. Therefore, the case of the complainant is
covered under injury and illness and opposite parties no.3
2 For short, ‘District Forum’
762 [2024] 4 S.C.R.
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and 4 are liable to pay compensation awarded against
opposite parties no.1 and 2 being the insurers”
6. On appeal preferred by the present respondents (First Appeal No.70 of
2014 dated 23rd September 2014) the H.P. State Consumer Disputes
Redressal Commission, Shimla3
observed that:-
“…needle was not left at the site of surgery, at the Hospital
of the appellants, when the complainant was operated for
removal of appendicitis, yet from an overall reading of the
pleadings and evidence on record, it can be said that surgery
conducted at the clinic of the appellants, was the cause of
pain, which the complainant had been having at-least upto
December, 2008, when the pus was drained out.”
7. The respondents herein 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.
8. The National Consumer Disputes Redressal Commission4
, in the
Revision Petition 57 of 2015 arising out of the order of the State
Commission 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. 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.
9. 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/-.
10. Hence, the claimant-appellant prefers the present appeal, seeking
enhancement of compensation. We may state, for ample clarity,
that, the present dispute arose within the contours of the Consumer
Protection Act, 1986, the predecessor legislation to the current
Consumer Protection Act, 2019.
3 For short, ‘State Commission’
4 For brevity, ‘NCDRC’
[2024] 4 S.C.R. 763
Jyoti Devi v. Suket Hospital & Ors.
11. The factum of negligence on the part of the respondent Hospital as
well as respondent No.2 has not been doubted, across fora. Although
the State Commission had differed with the District Forum on the
presence of the needle, the NCDRC, in para 5 of the impugned
judgment and order, found the medical record to testify to the presence
of a needle in the abdomen and also found that the respondent
Hospital was found wanting in terms of post-operative care.
12. The primary ground alleged, in submitting that the finding of medical
negligence is unjustified, was that there has been a recorded gap
of time where the appellant did not suffer from any pain (1½ years).
However, we notice the NCDRC to have observed her period of
suffering to be more than 5 years, implying thereby that the gap in
suffering aspect has not been accepted. No material has been placed
before us to take a different view therefrom. The respondents are
not the ones who have approached this Court. As such, we are only
required to examine the sufficiency of compensation as awarded by
way thereof. The same, though, cannot be appositely done without
having appreciated pronouncements of this Court on the scope and
purpose of the Consumer Protection Act; medical negligence; and
compensation in such cases as also, the rule of tort law known as
the ‘eggshell skull’ rule.
12.1 Scope of the Consumer Protection Act
12.1.1 An examination of the decisions of this Court in C.
Venkatachalam v. Ajitkumar C. Shah and others5
and J.J. Merchant (Dr) v. Shrinath Chaturvedi6
and
Common Cause v. Union of India7
among a host of other
pronouncements, reveals the following in this regard:-
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;
5 [2011] 13 SCR 814 : (2011) 12 SCC 707
6 [2002] Supp. 1 SCR 469 : (2002) 6 SCC 635
7 [1993] 1 SCR 10 : (1997) 10 SCC 729
764 [2024] 4 S.C.R.
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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;
12.2 The Law on Medical Negligence
12.2.1 Three factors required to prove medical negligence, as
recently observed by this Court in M.A Biviji v. Sunita &
Ors.8
, following the landmark pronouncement in Jacob
Matthew v. State of Punjab9
, are :-
“36.As can be culled out from above, the three
essential ingredients in determining an act of
medical negligence are : (1.) a duty of care
extended to the complainant, (2.) breach of that
duty of care, and (3.) resulting damage, injury
or harm caused to the complainant attributable
to the said breach of duty. However, a medical
practitioner will be held liable for negligence
only in circumstances when their conduct falls
below the standards of a reasonably competent
practitioner.”
12.2.2 To hold a doctor liable, this Court in Dr. Mrs. Chanda
Rani Akhouri v. Dr. M.A. Methusethupati10 observed: -
“…. a medical practitioner is not to be held
liable simply because things went wrong from
mischance or misadventure or through an
error of judgment in choosing one reasonable
course of treatment in preference to another.
8 [2023] 15 SCR 113 : (2024) 2 SCC 242
9 [2005] Supp. 2 SCR 307 : (2005) 6 SCC 1
10 [2022] 5 SCR 812 : 2022 SCC OnLine SC 481
[2024] 4 S.C.R. 765
Jyoti Devi v. Suket Hospital & Ors.
In the practice of medicine, there could be
varying approaches of treatment. There could
be a genuine difference of opinion. However,
while adopting a course of treatment, the duty
cast upon the medical practitioner is that he
must ensure that the medical protocol being
followed by him is to the best of his skill and
with competence at his command. At the
given time, medical practitioner would be
liable only where his conduct fell below that
of the standards of a reasonably competent
practitioner in his field.”
(Emphasis supplied)
12.2.3 Observations in Harish Kumar Khurana v. Joginder
Singh11 are also instructive. Bopanna J., writing for the
Court held:
“…It is necessary that the hospital and the
doctors are required to exercise sufficient care
in treating the patient in all circumstances.
However, in unfortunate cases, though death
may occur and if it is alleged to be due to
medical negligence and a claim in that regard is
made, it is necessary that sufficient material or
medical evidence should be available before the
adjudicating authority to arrive at a conclusion.”
(emphasis supplied)
These observations, although made in the context of a patient
having passed away in the course of, or as a result of treatment,
nonetheless are essential even in cases where the claimant
has suffered an injury.
12.3 Determination of the Quantum of Compensation
12.3.1 This Court has held that in determining compensation
in cases of medical negligence, a balance has to be
struck between the demands of the person claiming
11 (2021) 10 SCC 291
766 [2024] 4 S.C.R.
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compensation, as also the interests of those being made
liable to pay. It was observed in Nizam’s Institute of
Medical Sciences v. Prasanth S. Dhananka12 -
“88. We must emphasise that the court has
to strike a balance between the inflated and
unreasonable demands of a victim and the
equally untenable claim of the opposite party
saying that nothing is payable. Sympathy for
the victim does not, and should not, come in
the way of making a correct assessment, but
if a case is made out, the court must not be
chary of awarding adequate compensation. The
“adequate compensation” that we speak of, must
to some extent, be a rule of thumb measure,
and as a balance has to be struck, it would be
difficult to satisfy all the parties concerned.
89. It must also be borne in mind that life has
its pitfalls and is not smooth sailing all along the
way (as a claimant would have us believe) as
the hiccups that invariably come about cannot
be visualised. Life it is said is akin to a ride on
a roller-coaster where a meteoric rise is often
followed by an equally spectacular fall, and the
distance between the two (as in this very case)
is a minute or a yard.”
In the very same judgment, it was further observed, particularly
in cases of the person being injured:-
“90. At the same time we often find that a person
injured in an accident leaves his family in greater
distress vis-à-vis a family in a case of death. In
the latter case, the initial shock gives way to a
feeling of resignation and acceptance, and in
time, compels the family to move on. The case of
an injured and disabled person is, however, more
pitiable and the feeling of hurt, helplessness,
despair and often destitution enures every
12 [2009] 9 SCR 313 : (2009) 6 SCC 1
[2024] 4 S.C.R. 767
Jyoti Devi v. Suket Hospital & Ors.
day. The support that is needed by a severely
handicapped person comes at an enormous
price, physical, financial and emotional, not only
on the victim but even more so on his family
and attendants and the stress saps their energy
and destroys their equanimity.”
12.3.1 It would also be instructive to refer to the concept of ‘just
compensation’. 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. DTC13 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. This understanding was reiterated in Balram
Prasad v. Kunal Saha and Ors14, V. Krishnakumar
v. State of Tamil Nadu & Ors,
15 and Nand Kishore
Prasad v. Mohib Hamidi and Ors16.
12.3.2 What qualifies as just compensation, as noticed above,
has to be considered in the facts of each case. In Balram
Prasad (supra) it has been observed that this court has
been ‘skeptical about using a straightjacket multiplier
method for determining the quantum of compensation
in medical negligence claims’.
12.3 Eggshell Skull Rule
12.4.1 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
13 [2009] 5 SCR 1098 : (2009) 6 SCC 1
14 [2013] 12 SCR 30 : (2014) 1 SCC 384
15 [2015] 8 SCR 100 : (2015) 9 SCC 388
16 [2019] 7 SCR 1076 : (2019) 6 SCC 512
768 [2024] 4 S.C.R.
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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.
12.4.2 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. So
much so, that a famous treatise records as follows
“Extensive research has failed to identify a single United
States case disavowing the rule”17 Its origins, if not by
that name, have been traced back to 1891 in a decision
of the Washington State Supreme Court- Vasburg v.
Putney18. In this case, arising out of a common childhood
altercation, Putney, a twelve-year-old child had kicked the
fourteen-year-old Vasburg, which aggravated a previous
injury (of which Putney was not aware), leading to his
permanent incapacitation. Putney was held liable. The
Court opined “the wrongdoer is liable for all the injuries
resulting directly from the wrongful act, whether they
could or could not have been foreseen by him”.
12.4.3 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 reactivates 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
17 Mark A. Geistfeld, Proximate Cause Untangled, 80 Md L. Rev. 420 (2021)
18 50 N.W 403 (Wis 1891)
19 Steve P. Calandrillo & Dustin E. Buelher, Eggshell Economics: A Revolutionary Approach to the Eggshell
Plaintiff Rule, 74 Ohio St. L.J 375 (2013)
[2024] 4 S.C.R. 769
Jyoti Devi v. Suket Hospital & Ors.
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 20cases this rule can be applied, are
persons who have pre-existing conditions.21 Therefore,
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.
12.4.4 It would be opportune to refer to a few judgments across
jurisdictions to better discern the application of this rule.
™ The King’s Bench in Dulieu v. While & Sons22 while
speaking in reference to American cases cited at
that Bar where the New York Court had refused to
pay compensation for ‘fright’ to a woman who while
waiting for a tram, was nearly run-over by a horsedrawn cart, and as result of the same fainted, suffer
a miscarriage and subsequent illness; observed:
“It may be admitted that the plaintiff in this
American case would not have suffered
exactly as she did, and probably not to
the same extent as she did, if she had not
been pregnant at the time; and no doubt the
defendants’ horses could not anticipate that
she was in this condition. But what does
that fact matter? If a man is negligently
run over or otherwise negligently injured in
his body, it is no answer to the sufferer’s
claim for damages that he would have
suffered less injury , or no injury at all, if
he had not had an unusually thin skull or
an unusually weak heart.
20 Restatement (Third) of Torts: Liability For Physical and Emotional Harm, American Law Institute, 2010.
21 Geistfeld, 2021 (supra)
22 (1901) 2 KB 669
770 [2024] 4 S.C.R.
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™ Griffiths LJ, in White and Others v. Chief
Constable of South Yorkshire and Others
observed in regards to this rule, as follows-
“…The law expects reasonable fortitude
and robustness of its citizens and will not
impose liability for the exceptional frailty
of certain individuals. This is not to be
confused with the “eggshell skull” situation,
where as a result of a breach of duty the
damage inflicted proves to be more serious
than expected. It is a threshold test of
breach of duty; before a defendant will
be held in breach of duty to a bystander
he must have exposed them to a situation
in which it is reasonably foreseeable that
a person of reasonable robustness and
fortitude would be likely to suffer psychiatric
injury…”
™ The Supreme Court of Canada, in an appeal arising
out of the Court of Appeal for British Colombia,
Athey v. Leonati23 observed that this case in its
own words, is one of “straightforward application
of the thin skull rule.” The application of the rule
as made herein, underscores the existence of
pre-existing conditions. The relevant paragraphs
are as follows:-
43 The findings of the trial judge indicate
that it was necessary to have both the
pre-existing condition and the injuries from
the accidents to cause the disc herniation
in this case. She made a positive finding
that the accidents contributed to the
injury, but that the injuries suffered in the
two accidents were “not the sole cause”
of the herniation. She expressly found
that “the herniation was not unrelated
23 [1996] 3 SCR 458
[2024] 4 S.C.R. 771
Jyoti Devi v. Suket Hospital & Ors.
to the accidents” and that the accidents
“contributed to some degree” to the
subsequent herniation. She concluded
that the injuries in the accidents “played
some causative role, albeit a minor one”.
These findings indicate that it was the
combination of the pre-existing condition
and the injuries sustained in the accidents
which caused the herniation. Although
the accidents played a lesser role than
the pre-existing problems, the accidents
were nevertheless a necessary ingredient
in bringing about the herniation.
44 The trial judge’s conclusion on the
evidence was that “[i]n my view, the plaintiff
has proven, on a balance of probabilities,
that the injuries suffered in the two earlier
accidents contributed to some degree
to the subsequent disc herniation”. She
assessed this contribution at 25 percent.
This falls outside the de minimis range
and is therefore a material contribution:
Bonnington Castings, Ltd. v. Wardlaw,
supra. This finding of material contribution
was sufficient to render the defendant fully
liable for the damages flowing from the
disc herniation.
45 The finding of material contribution was
not unreasonable. Although the plaintiff
had experienced back problems before
the accidents, there was no evidence
of herniation or insult to the disc and no
history of complaints of sciatica. When a
plaintiff has two accidents which both cause
serious back injuries, and shortly thereafter
suffers a disc herniation during a mild
exercise which he frequently performed
prior to the accidents, it seems reasonable
to infer a causal connection.
772 [2024] 4 S.C.R.
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46 The trial judge found that the plaintiff’s
condition was improving when the herniation
occurred, but this also means that the
plaintiff was still to some extent suffering
from the back injuries from the accidents.
The inference of causal link was supported
by medical evidence and was reasonable.
47 This appeal involves a straightforward
application of the thin skull rule. The preexisting disposition may have aggravated
the injuries, but the defendant must take the
plaintiff as he finds him. If the defendant’s
negligence exacerbated the existing
condition and caused it to manifest in a disc
herniation, then the defendant is a cause
of the disc herniation and is fully liable.
™ Let us now turn to, illustratively, the application of
this rule in the USA. Richard Posner J., speaking
for the 7th Circuit Court of Appeals in James E.
Niehus and Denise Niehus v. Vince Liberio and
Frank Vittorio24, noted as hereinbelow:
“Niehus was sufficiently drunk when his car
was struck that he mightn’t have felt the
pain of a broken cheekbone. But at least
according to the defendants’ lawyer he had
(though this seems improbable) sobered
up a lot by the time the altercation in the
station house began several hours later,
yet still he said nothing about a pain in
his cheek until after the fight. The doctors
testified as we said that the break was
consistent with a kick though it could of
course have been caused by Niehus’s
striking his head against the door of the
car in the accident. If the jury believed, as
it had every right to do, that Niehus was
kicked in the left side of his face by the
24 973 F.2d 526 (7th Cir. 1992)
[2024] 4 S.C.R. 773
Jyoti Devi v. Suket Hospital & Ors.
defendants, the fact that the cheekbone
might have been broken already would not
help the defendants. If you kick a person’s
freshly broken cheekbone you are likely
to aggravate the injury substantially, and
the “eggshell skull” or “thin skull” rule,
would make the officers liable for the full
consequences of their kicks even if, had
it not been for a preexisting injury, the
consequences would have been much
less injurious. Oddly, the leading “eggshell
skull” case also involved a kick.”
™ We may also refer to another instance, from the
same Court. In Lancaster v. Norfolk and Western
Ry. Co.25, this rule was applied thus:-
“All that really matters, moreover, is that
Tynan’s misconduct be attributable to
the railroad, as is easily done under a
thoroughly conventional interpretation of
respondent superior. It was he (the jury
could have found) who pushed Lancaster
over the edge. That Lancaster may have
been made especially susceptible to such
misconduct by earlier acts for which the
railroad might or might not be liable would
be no defense. Under the “thin skull,” or
more colorfully the “eggshell skull,” rule,
the railroad would be fully liable for the
consequences of Tynan’s assault. See,
e.g., Vosburg v. Putney, 80 Wis. 523, 50
N.W. 403 (1891); Stoleson v. United States,
708 F.2d 1217, 1221 (7th Cir. 1983).”)
XXXX
The fact that the railroad had weakened
Lancaster by earlier misconduct for which it
could not be held liable would be irrelevant
25 773 F.2d 807, 820 (7th Cir. 1985)
774 [2024] 4 S.C.R.
Digital Supreme Court Reports
to its liability for Tynan’s assault and to
the amount of damages it would have to
pay. The tortfeasor takes his victim as he
finds him (emphatically so if the victim’s
weakened condition is due to earlier, albeit
time-barred, torts of the same tortfeasor);
that is the eggshell-skull rule. The single
act of Tynan made the railroad fully liable
for all the damages that Lancaster sought
and the jury awarded.”
13. Let us now turn our attention back to the facts in presenti. Keeping
in view the afore-noted position of law in regard to the benevolent
purpose of the Consumer Protection Act, the aspects required to
be established to allege medical negligence, the determination of
compensation in a case where a person is injured, we find the manner
in which compensation stood reduced by the State Commission
as also the NCDRC, vis-à-vis the District Forum to be based on
questionable reasoning.
14. The State Commission has recognized that the appellant herein had
not been treated “with the care expected at a medical clinic”; she had
been suffering from persistent pain right from 2005 until December,
2008; and that post-surgical care was deficient which undoubtedly
constitutes a deficiency in service and yet found it appropriate to
reduce the compensation to a mere Rs.1 lakh. This clearly is not in
line with the balance of interests required to be borne in mind while
determining compensation.
15. The NCDRC observed that the claimant-appellant’s treatment at the
respondent-Hospital was ‘casual’; that the excuse of having sought
treatment at other hospitals was not available to the respondents
and that she had suffered pain for more than 5 years apart from
the case having been dragged on for more than a decade, and yet
lumpsum compensation was only Rs.2 lakhs.
16. How could such compensation be justified, after observations
having been made regarding the service rendered by the Hospital,
being deficient, and the continuous pain and suffering on the part
of the claimant-appellant, is something we fail to comprehend.
Compensation by its very nature, has to be just. 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’.
[2024] 4 S.C.R. 775
Jyoti Devi v. Suket Hospital & Ors.
17. 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. All that has been stated is,
“9. Therefore, OP cannot take a plea that; patient took
treatment from few other hospitals which might have
caused the retention of needle in the abdominal wall. In this
context we apply the “Egg Skull Rule” in this case, wherein
liability exists for damages stemming from aggravation of
prior injuries or conditions. It holds an individual liable for
all consequences resulting from their activities leading to
an injury, even if the victim suffers unusual damage due
to pre-existing vulnerability or medical condition”
If we take the rule as exposited by the NCDRC, even then it stands
to reason that the record ought to have been speaking of a preexisting vulnerability or medical condition, because of which the
victim may have suffered ‘unusual damage’. However, none of the
orders - be it District, State Commission or the NCDRC refer to any
such condition.
18. Considering the discussion as aforesaid, we deem it fit to set
aside the Awards of the NCDRC as also the State Commission
and restore the Award as passed by the District Forum, meaning
thereby that a sum of Rs.5 lakhs ought to be paid expeditiously by
the respondents to the appellant for being medically negligent and
providing services deficient in nature. The sum of Rs.5 lakhs shall
be accompanied by interest simple in nature @ 9% from the date
of the award passed by the District Forum. The same be paid within
a period of four weeks from the date of this judgment. Additionally,
a cost of Rs.50,000/- be paid in terms of the cost of litigation. The
appeal is accordingly allowed.
Headnotes prepared by: Divya Pandey Result of the case:
Appeal allowed.
