10 May 1996
Supreme Court


Case number: C.A. No.-008856-008856 / 1994
Diary number: 19174 / 1994
Advocates: P. N. PURI Vs ABHIJAT P. MEDH






DATE OF JUDGMENT:       10/05/1996


CITATION:  1996 AIR 2111            1996 SCC  (4) 332  JT 1996 (5)     1        1996 SCALE  (4)364



JUDGMENT:                       J U D G M E N T S. SAGHIR AHMAD      "Similia Similibus  Curantur" (Like  Cures Like) is the basis  of  a  system  of  therapeutics  known  popularly  as Homoeopathy. It  is based on the premise that most effective way to  treat disease  is to  use drugs or other agents that produce the symptoms of the disease in healthy persons. This theory had  its origin  in or  about 460 B.C. when the Greek physician, Hippocrates,  noted the  similarity  between  the effect of  some drugs  and the symptoms of the diseases they seemed to relieve. It was, however, in the late 18th Cantury that this  theory  was  tested  and  popularised  by  German Physician, Christian  Friedrich Samuel  Hahnemann as  a  new form of  therapeutic treatment after six years test study of scores of  drugs on himself and others. Ultimately, in 1796, he published his findings in a leading Medical journal under the  caption  "On  a  New  Principle  for  Ascertaining  the Curative Power  of Drugs  which set  in motion  a process of continued  research   in  all   directions   including   its Pharmacology with  the result  that  Homoeopathy  is  taught today as  a positive science in various Medical Colleges all over the country. 2.   Respondent  No.   1  pursued   a  4  years’  course  in Homoeopathic Medicine  and Surgery  and after being declared successful in  the Examination conducted by the Homoeopathic Medical College, Anand, Gujarat, he was awarded a Diploma in Homoeopathic Medicine  and Surgery  on the basis of which he was registered as a Medical Practitioner in 1983. Initially, he joined  a private nursing home at Bombay where he worked, as he  claims, as  Chief Medical  Officer from  1983 till he opened his  own private  clinic in  1989 and took up private practice. 3.   Pramod Verma,  husband  of  the  appellant,  was  Sales Manager in  M/s Encore  Marketing P.  Ltd.  where  the  last salary drawn by him is said to be Rs.5,700/- out of which he



maintained his  family comprising  of himself,  his wife and two children besides supporting the aged parents. 4.   On 4th  of July,  1992, Pramod Verma, who complained of fever was  examined at his residence by Respondent No.1 (Dr. Ashwin Patel)  who kept  him on  allopathic drugs  for viral fever up  to 6th  July, 1992  and, thereafter,  for  typhoid fever. When  condition of  Pramod Verma deteriorated, he was shifted to  Sanjeevani Maternity and General Nursing Home of Dr. Rajeev  Warty (Respondent  No.2) as an indoor patient on 12th July,  1992. This  was done on the advice of Respondent No. 1.  Verma received  treatment there  till the evening of 14th July,  1992 when  he was  transferred  to  the  Hinduja Hospital in an unconscious state where, after about four and a half hour of admission, he died. 5.   Appellant,  thereafter,  filed  (on  14.8.92)  Original Petition No.  184  of  1992  before  the  National  Consumer Disputes Redressal  Commission (for short, ’commission’), at New Delhi praying for compensation and damages being awarded to her  by Respondents  1 and  2 for  their  negligence  and carelessness in  treating her husband (Pramod Verma) but the Commission  by   its  judgment  and  order  dated  8.11.1994 dismissed  the  petition.  It  is  this  judgment  which  is challenged in this appeal. 6.   It  appears   that  in  the  claim  lodged  before  the Commission it  was set  out by the appellant that Respondent No. 1  was negligent  in administering strong antibiotics to Pramod Verma  initially for the treatment of Viral Fever and subsequently  for   Typhoid  Fever  without  confirming  the diagnosis by  Blood Test  or Urine  Examination. It was also set out  that Respondent  No. 1  was not  qualified or  even authorised to  practise in Allopathic System of Medicine and prescribe allopathic  drugs  and,  therefore,  his  lack  of expertise  in   the  Allopathic   System  of   Medicine  was responsible for  deficiency in the treatment administered by him. 7.   Negligence imputed  to Respondent  No. 2 is that Pramod Verma, immediately on his admission in the Nursing Home, was put  on   intravenous  Glucose   (Dextrose)   drip   without ascertaining the  level of  Blood Sugar  by a  simple  Blood Test. This was said to be primarily responsible for constant and steady  deterioration of  Pramod Verma’s  condition, but Respondent No.  2 continued  to assure  the  appellant  that Pramod Verma  would soon  recover and  there was  no need to shift him to a better equipped Hospital. It was, however, in the evening  of 14th  July, 1992,  that Pramod Verma who was already in  an unconscious  state, was  shifted  to  Hinduja Hospital on the advice of Respondent No. 2. 8. Both the Respondents filed separate counter-affidavits in which they  denied the allegation of negligence made against them  and   contended  that  they  had  taken  all  due  and reasonable care  to cure Mr. Verma or the ailment from which he suffered.  They contended that there was no deficiency in service nor was there any negligence on their part. 9. The  exact pleas  raised in  defence by  Respondent  No.1 which have  been set  out by  the Commission in its judgment under appeal, are given below:      "It has  been submitted by opposite      party no.  1 that  he has undergone      an integrated  course of  study  in      both the Homeopathic and Allopathic      systems of medicine and was awarded      the  D.H.M.S.   Diploma  after  his      having passed the final examination      at the  end of  a four  year course      conducted   by    the   Homeopathic



    Medical  College,  Anand,  Gujarat.      Exhibit Annexure  R-1 is  a copy of      the said  diploma and it shows that      the said  diploma had  been awarded      after  the   candidate   had   been      examined   inter    alia   in   the      following     subjects:     Anatomy      Physiology,   Pathology,   Forensic      Medicine,  surgery,   Practice   of      Medicine,  Hygiene,  Midwifery  and      Gynaecology. Opposite  party no.  1      has stated in his counter affidavit      that during  the final  year of the      study in  the  Homeopathic  Medical      collage, Anand  he had  been  given      training  in  the  Anand  Municipal      Hospital and  also another  private      nursing home  in Anand for a period      of six months. Opposite party no. I      was  thereafter   enrolled   as   a      Registered Medical  Practitioner in      the   states    of   Gujarat    and      Maharashtra    with    Registration      numbers G649  (Gujarat)  and  10197      (Maharashtra). Opposite party no. 1      has denied  the allegations  of the      complainant   that    he   is   not      qualified, competent and authorised      to practice  the Allopathic  system      of Medicine.  He has submitted that      he used  reasonable degree of skill      and  knowledge   in  treating   the      complainant’s husband and had taken      reasonable degree  of care  of  the      patient  while  he  was  under  his      treatment.      It is further submitted by opposite      party no.  1 in  his  counter  that      after the completion of his studies      and obtaining  the diploma,  he had      worked as  Chief Medical Officer at      a well  known Allopathic  clinic by      name,  Patel   Surgical  &  Nursing      Home, Andheri,  Bombay from 1983 to      1990 and  he had  gained very  good      experience in examining, diagnosing      and  treating   the  patients  with      complaints  of   various  types  of      sickness   and    in    prescribing      necessary Allopathic  medicines. It      is also submitted by opposite party      no. l  that late  Mr. Pramod  Verma      and  his  family  had  been  taking      Allopathic treatment  from him  for      the sickness  of the members of the      family ever  since they  moved into      the colony  about one  and  a  half      years prior  to July,  1992 and  he      had  been   functioning  as   their      family physician.      According to  opposite party no. 1,      Mrs.  Poonam   Verma  came  to  his      clinic on  the evening of 4th July,      1992 and  requested him  to see her      husband at  her home.  Accordingly,



    opposite party  no.1   made a house      visit and examined Mr. Pramod Verma      in the  evening of  4th July,  1992      and  on  such  examination  it  was      found that  Shri Verma  had  fever.      Thereupon he prescribed :      1) cap.  Ampicillin (500  mg.- four      times a day)      2) Tab.  Paracetamol (500  mg. -  3      times a day)      3) Tab. Diavol (2 times a day) and      4) Tab B. Complex (2 times a day)      Opposite party  no.  1  has  stated      that he gave the above treatment as      he felt  it may  be a case of viral      fever  which  was  then  very  much      prevalent in the locality.      Thereafter on  6th July, 1992, Mrs.      Verma called  opposite party  no. 1      again to  see her husband and hence      he went to examine Mr. Verma at his      house on  that day  in the evening.      It was  found that  Shri Verma  had      mild fever  and since the fever had      continued  for   the   third   day,      opposite party no. l states that he      advised   Mr.Verma    to    undergo      pathological tests,  namely,  blood      test & urine examination etc. Since      enteric fever was prevalent at that      time in  the locality  in  question      (Asha   Nager)   and   neighbouring      localities  of   Bombay,   opposite      party no. 1 prescribed Tab. Quintor      (500 mg.  2 times a day for 2 days)      in the place of Cap. Ampicillin. It      is stated  in the counter affidavit      that Quintor  is  a  broad-spectrum      antibiotic which  is active against      the   broad-spectrum,    of    gram      negative and gram positive bacteria      including Enterbacter. According to      opposite party  no.  1,  Mr.  Verma      thereafter came  to his  clinic  on      8th July,  1992  and  on  examining      him, opposite  party  no.  1  found      that the  was not having any fever.      Since there  was no other complaint      also, opposite  party no. 1 advised      Mr.  Verma  to  continue  the  same      treatment  for  another  two  days,      i.e. upto  10th July,  1992. It  is      further  averred   in  the  counter      affidavit that  on 10th  July, 1932      Mr. Pramod  Verma again came to the      clinic of  opposite party no. 1, he      had  no  fever  but  complained  of      back-ache. Thereupon opposite party      no. 1  advised him  to continue the      same treatment  as before and added      a pain  killer Tab.  Ibuflamor MX 2      times a  day for two days . He also      gave him  an injection  Diclonac (3      cc.1 I/M  (Intra-Muscular)  to  the      patient.  Subsequently,   at  about



    10.30 p.m.  on the  night  of  11th      July,   1992,    the    complainant      requested opposite  party no.  1 to      visit  her  residence  to  see  her      husband.  Opposite   party  no.   1      thereupon went  there and  examined      late Mr.  Verma. It  was found that      he had  again developed  mild fever      and was  complaining of pain in the      shoulder. Opposite party no. 1 then      prescribed for  him Tab.  Vovaron 1      twice daily  and Tab.  Neopan  plus      Cap. Becosules  1  twice  daily  in      addition to  Quintor and  Ibuflamor      tablets  which   he   was   already      taking.     The      Intra-Muscular      injection of  Diclonac (3  cc.) was      also given  to the  patient. lt  is      the definite case of Opposite party      no. 1  that he  once again  advised      Mr.   verma    to   get   pathology      investigations   done   for   blood      count, E.S.R.,  urine  routine  and      widal test and told him to meet him      with the investigation reports.      On the  next date  - 12th  of July,      1992 at  about 1  p.m.  Mrs.  Verma      came to  the residence  of opposite      party no.  1 and  requested him  to      see Mr.  Verma at  their residence.      Thereupon  opposite   party  no.  1      visited Mr.  Verma at  his home and      examined    him.     On    clinical      examination it  was found  that  he      had mild  fever and  that his blood      pressure was  90/70 mm.  of Hg.  On      the patient  being asked  about the      reports   of    the    pathological      investigations, opposite  party no.      l was  informed that  Mr. Verma had      not  got   them   done.   Thereupon      opposite party  no. 1  advised  the      complainant  to   get  her  husband      admitted   to    some   physician’s      nursing home  of their  choice  for      examination,           pathological      investigations     and      further      management.  It   is  the  case  of      opposite party  no. 1  that at that      time, Mrs.  Verma herself mentioned      the name  of  Dr.  Warty  (opposite      party   no.    2)   and   suggested      admission of  the patient  into his      Sanjeevani nursing home saying that      she  knew   Dr.  Warty  quite  well      because  she   had   earlier   been      admitted for  her delivery  in  Dr.      (Mrs.)  Warty’s   Maternity   Home.      Opposite party  no. 1 agreed to the      said suggestion  and gave a medical      note setting out the treatment that      he has so far been administering to      the patient  for being shown to Dr.      Warty. The complainant’s allegation      that  opposite   party  no.  1  had



    prescribed    strong    antibiotics      without conducting any pathological      investigations is  strongly refuted      by  opposite   party   no.   1   as      incorrect and  untrue. He submitted      that  on   the  contrary   he   had      specifically advised  the  deceased      Mr. Pramod Verma as early as on 6th      July, 1992  to undergo pathological      tests and on finding that the tests      had not  been got  done  till  then      this advise  was reiterated  on the      night of  11th July, 1992. But, for      reasons best  known to himself, Mr.      Verma ignored  the said  suggestion      also   and    did   not   get   the      investigations done.  When  it  was      found in  the after  noon  of  12th      July. 1992 that the patient was not      cooperating    in    getting    the      investigations done, opposite party      no. 1  advised the  complainant  to      get her  husband admitted  to  some      physician’s   nursing    home   for      pathological   investigation    and      further management  as it  was felt      by opposite  party no.  1  that  it      would not  be prudent or correct to      proceed with  the treatment  of the      patient   without    getting    the      requisite              pathological      investigation done.      Opposite party  no. 1 has submitted      that the  treatment administered by      him  to   late  Pramod   Verma  was      correct in  every respect and there      was no  negligence, carelessness or      deficiency of  any kind on his part      in relation  to the  said treatment      given to  the deceased  Shri  Verma      during the period 4th July, 1992 to      12th July, 1992.      Respondent No.1 was examined on oath by the Commission, which was  keen to know his qualifications and experience in Allopathic System of Medicine. His statement was recorded in question -  answer  form  and  the  relevant  questions  and answers given by Respondent No. 1 are set out below: Mr. Raju Ramacnandran, Advocate for the Opposite Party No.1:    Dr. Patel, can you briefly describe                         your educational qualification, the                         number of years you have put in                         practice, your age? A.                      I passed my DHMS degree i.e.                         Diploma in Homoeopatnic Medicines                         and Surgery in 1983 and thereafter                         I jointed in Bombay one Private                         Nursing Home. Hon’ble President:      This DHMS is conducted by? A.                      This DHMS is conducted by Gujarat                         Homeopathic Medical Council and                         from 1983 to 1989 I was working as                         a Chief Medical Officer there.  Hon’ble Pr.            Where? A.                      In Patel Surgical Nursing Home at



                       Bombay. Hon’ble Pr.             That is your own. A.                      No that is another Patel. He is                         himself is a Surgeon. Mr.Y. Krishnan          Is he an Allopathic Surgeon. A.                      Yes, he is an Allopathic Surgeon.                         Upto 1989 I was there, then I                         started my private practice and                         opened my clinic in 1989 and                         another clinic I opened in 1991. Hon’ble Pr.             Do you practice allopathy or                         homoeopathy? A.                      Both, I am practising. Hon’ble Pr.             Are you registered as Allopathic                         Practitioner? A.                      I am registered with the                         Homeopathic Council. Hon’ble Pr.             How are you entitled to practice                         allopathy? A.                      As and when required in emergency                         cases. Hon’ble Pr.             Are you permitted in the Medical                       Council’s Rules to practice allopathy? A.                      In Gujarat it is allowed. Hon’ble Pr.             Are you allowed in Maharashtra A.                      I have not gone through. Q.                      Your age also for the record. A.                      I am right now running 35. Q.                      Dr. Patel, in the course of your                         Homeopathic Studies were you also                         given instructions in Allopathic                         medicines. A.                      Yes. Q.                      For how many years is the                         Homeopathic course, A.                      Four years. Q.                      And your instructions in                         Allopathic medicines was tor                         now long? A.                      That is upto second year when                         we got the subject of Anatomy. Q.                      When were you working in                         Patel Surgical Nursing Home,                         you have started your career?                         Did you handle Allopathic                         cases? Did you prescribe                         allopathic medicines. A.                      Yes, in the absence of Dr.                         Patel, I have to manage all                         the emergency cases including                         medicines. Q.                      The decision whether to give                         Allopathic medicine or                         Homeopathic medicine is taken                         by you or at the patients                         request. . A.                      No, I was taking the                         decision." 10. The  counter-affidavit and  the statement  of Respondent No.1 recorded by the Commission are self contradictory While in the  couter-affidavit,  he  stated  to  have  studied  an integrated course  in Allopathic  and Homeopathic  System of Medicine, in  his statement on oath, he categorically stated that he  had studied  Homoeopathy only  and instructions  in Allopathic medicines were given only in the second year when



he was  studying Anatomy. Usually, Pharmacology is taught to students after  they have  learned Physiology  and  Anatomy. D.H.M.S.  Diploma   awarded  to   Respondent  No.  1  though indicates  that   he  had   studied   Anatomy,   Physiology, Pathology, Forensic Medicine, Surgery, Practice of Medicine, Hygiene,  Midwifery   and  Gynaecology,   does  not  mention Pharmacology relating  to Allopathic  System of  Medicine to have been  taught to  him. He  appears to  have gained  some experience (if at all it can be said to be experience) while he worked  as Medical  Officer in  the private  nursing home where  he   prescribed  Allopathic  Medicines  also.  It  is admitted by  him that  he was  not registered  as a  Medical Practitioner  in  Allopathy  under  the  relevant  statutory provisions applicable to the State of Maharashtra to which a detailed reference shall be presently made 11.  It will  be seen  that Respondent  No. 1  had all along treated Pramod  Verma under  Allopathic  System  prescribing Allopathic Medicines  though he  himself was  registered  as Medical Practitioner  with the  Gujarat Homeopathic  Medical Council as  he had  studied Homoeopathy  for 4  years in the medical College  at Anand  and had,  thereafter, obtained  a Diploma in  Homeopathic Medicine and Surgery. If, therefore, he had  not  studied  Allopathy  and  had  not  pursued  the prescribed course  in Allopathy  nor  had  he  obtained  any degree or  diploma in  Allopathy from any recognised Medical College,  could   he  prescribe  and  administer  allopathic medicines, is  the question  which is to be answered in this appeal with  the connected question whether this will amount to actionable negligence. 12. The decision of this Court in Indian Medical Association vs. B.P.  Shantha (1995)  6 SCC 651, has settled the dispute regarding applicability  of the  Act to  persons engaged  in medical profession  either as  private practitioners  or  as Government   Doctors   working   in   Hospitals   or   Govt. Dispensaries. It  is also  settled that  a patient  who is a ’consumer within  the meaning  of the  Act has to be awarded compensation for  loss or  injury suffered  by  him  due  to negligence of  the Doctor  by applying the same tests as are applied in an action for damages for negligence. . 13. Negligence  as a  tort is the breach of a duty caused by omission to  do something  which a reasonable man would  do. or doing  something which a prudent and reasonable man would not do. (See : Blyth vs. Birmingham Waterworks Co. (1856) 11 Ex 781; Bridges vs. Directors, etc. of N.L. Be. (1873-74) LR 7 HR 213; Governor-General in Council vs. Mt. Saliman (1948) ILR 27 Pat. 207; Winfield and Jolowicz on Tort). 14. The definition involves the following constituents: (1) a legal duty to exercise due care; (2) breach of the duty; and (3) consequential damages. 15. The breach of duty may be occasioned either by not doing something which  a reasonable  man, under  a  given  set  of circumstances would  do, or,  by  doing  some  act  which  a reasonable prudent man would not do. 16.  So far  as persons  engaged in  Medical Profession  are concerned, it  may be  stated that  every person  who enters into the  profession, undertakes to bring to the exercise of it, a reasonable degree of care and skill. It is true that a Doctor  or  a  Suregon  does  not  undertake  that  he  will positively cure  a patient nor. does he undertake to use the highest possible  degree of  skills as  there may be persons more learned  and skilled  than himself,  but he  definitely undertakes to use a fair, reasonable and competent degree of skill. This  implied undertaking  constitutes the real test, which will  also be  clear from  a study and analysis of the



judgment in  Bolam vs. Friern Hospital Management Committee. (1957) 2  All ER 118, in which, McNair, J., while addressing the jury summed up the law as under :      The test  is the  standard  of  the      ordinary skilled man exercising and      professing  to  have  that  special      skill. A  man need  not possess the      highest expert  skill; it  is  well      established   law    that   it   is      sufficient  if   he  exercises  the      ordinary  skill   of  an   ordinary      competent   man   exercising   that      particular art.  In the  case of  a      medical   man,   negligence   means      failure to  act in  accordance with      the     standards   of   reasonably      competent medical  men at the time.      There may  be one or more perfectly      proper   standards,   and   if   he      conforms with  one of  these proper      standards,   then    he   is    not      negligent. 17. This  decision has  since been  approved by the House of Lords in  Whitehouse vs.  Jordon (1981)  1 All  ER 267 (HL); Maynard vs. West Midlands Regional Health Authority (1985) 1 All ER 635 (HL); Sidaway vs. Bathlem Royal Hospital (1995) 1 All ER 643 (HL); Chin Keo vs. Govt. of Malaysia (1967) 1 WLR 813 (PC). 18. The  test pointed out by McNair, J. covers the liability of a  Doctor in  respect of  his diagnosis, his liability to warn the  patients of the risk inherent in the treatment and his liability in respect of the treatment. 19. This  Court in  Dr. Laxman  Balakrishna  Joshi  vs.  Dr. Trimbak Bapu  Godbole & Anr. AIR 1969 SC 128, laid down that a Doctor  when consulted  by  a  patient  owes  him  certain duties, namely,  (a) a  duty of  care in deciding whether to undertake the  case; (b)  a duty  of care  in deciding  what treatment  to   give;  and   (c)  a  duty  of  care  in  the administration of  that treatment.  A breach of any of these duties gives  a  cause  of  action  for  negligence  to  the patient. 20. The principles were reiterated in A.S.. Mittal vs. State of U.P.  AIR 1989  SC 1570, in which wide extracts from that judgment were made and approved. 21. It is in the light of the above principles that it is to be seen  now whether  there was  a breach of duty of care on the part  of Respondent No. 1 in the process of treatment of Pramod Verma. 22. Respondent  No. l,  at the relevant time, was practicing at Bombay  and admittedly  he was  also registered under the Bombay  Homoeopathic  Practitioners  Act,  1959,  in  which, ’Homoeopathy’ has been defined under Section 2(8) as under :      "Homoeopathy means the Homoeopathic      System of Medicine and includes the      use Of Biochemic remedies." 23. ’Practitioner’  has been  defined in Section 2(12) while ’Registered  Practitioner’  is  defined  in  section  2(16). ’Recognised  Medical  Qualification,  according  to  Section (14A)  means   any  of   the   medical   qualifications   in Homoeopathy, included in the Second or Third Schedule to the Homoeopathy Central Council Act, 1973. 24. Registration  Of Practitioners  is dealt with in Chapter IV of  the Act. Section 20 provides that the Registrar shall prepare   and    maintain   a   register   of   Homoeopathic Practitioners for  the State  of Maharashtra  in  accordance



with the  provisions of  the Act.  The particulars which are required to  be entered  in this  register and  the  persons possessing requisite  qualifications, whose  names would  be entered therein, are indicated in other Sub-sections of this Section. 25. Sub-section 12 (a) of Section 20 provides as under:      "Every   registered    practitioner      shall be  given  a  certificate  of      registration in the form prescribed      by   rules   and   shall   practice      Homoeopathy  only.  The  registered      practitioner  shall   display   the      certificate of  registration, in  a      conspicuous    place     in     his      dispensary,  clinic   or  place  of      practice." 26. On  registration, a  person gets  the right to practice. This Section  also provides that it shall be lawful for such person  to  use,  after  his  name,  the  words  "Registered Homoeopathic Practitioner" in full to indicate that his name has been entered in the register under the Act. 27. Under Section 23. the Maharashtra Council of Homoeopathy has  been  given  the  power  to  remove  the  name  of  any registered  practitioner  if  he  is  found  guilty  of  any misconduct. Explanation  appended to  Section 23(1)  defines misconduct, inter  alia, as any conduct Which is infamous in relation to the profession. 28. The  rights of Registered Practitioners are indicated in Section 28 which is quoted below:      "28.  Notwithstanding  anything  in      any law for the time being in force      -      (i)   the    expression    "legally      qualified medical  practitioner" or      "duly       qualified       medical      practitioner" or any word importing      a person  recognised by  law  as  a      medical practitioner  or member  of      the medical  profession  shall,  in      all Acts  of the Legislature in the      State of  Maharashtra  and  in  all      Central Acts  (in their application      to the  State of  Maharashtra)in so      far as  such  Acts  relate  to  any      matters specified  in  List  II  or      List III in the Seventh Schedule to      the Constitution  of India, include      a  practitioner   whose   name   is      entered in  the resister under this      Act;      (ii) a  certificate required by any      Act from  any medical  practitioner      or medical  officer Shall  be valid      if such certificate has been signed      by a  practitioner  whose  name  is      entered in  the register under this      Act;      (iii) a practitioner- whose name is      entered in  the register  shall  be      eligible to hold any appointment as      physician or  other medical officer      in  any   Homoeopathic  dispensary,      hospital or  infirmary supported by      or receiving a grant from the State      Government  and  treating  patients



    according   to   the   Homoeopathic      system of medicine or in any public      establishment, body  or institution      dealing   with   such   system   of      medicine;      (iv) every  registered practitioner      shall be  exempt, if he so desires,      from serving  on an  inquest  under      the  Code  of  Criminal  Procedure,      1973. 29. The  scheme of  the Act,  therefore,  indicates  that  a person gets  the right  to practice  in Homoeopathy on being registered as  a Medical  Practitioner. The  certificate  of registration issued  to such  practitioner requires  him  to practice in HOMOEOPATHY ONLY as is clear from the words ’AND SHALL PRACTICE  HOMOEOPATHY ONLY’  used in Sub-section 12(a) of Section  20. Apart  from the  right  to  practice,  other rights which  become immediately  available to  a person  on registration of  his name are indicated in Section 28 which, inter alia,  includes right  to treat  patients according to the Homoeopathic System of Medicine. 30.   Right  to practice in Allopathic System of Medicine as also the  right to  practice in Ayurvedic or Unani System of Medicine is  regulated by  separate independent  Central and local Acts.  Indian Medical  Council Act,  1956 deals, inter alia, with  the registration of persons possessing requisite qualifications as  Medical Practitioner in Allopathic System as  also   recognition   of   Medical   Qualifications   and Examinations by  Universities  or  Medical  Institutions  in India.      Section  15  of  this  Act  provides  that  any  person possessing  any  of  the  qualifications  mentioned  in  the Schedule appended to the Act, may apply for the registration of his  name. Sub-sections  2 and 3 of Section 15, which are extremely relevant, are quoted below :      "15(21 Save  as provided in section      25, no  person other than a medical      practitioner enrolled  on  a  State      Medical Register-      (a) shall  hold office as physician      or surgeon  or any other office (by      whatever  designation   called)  in      Government or  in  any  institution      maintained  by  a  local  or  other      authority;      (b) shall  practice medicine in any      State;      (c) shall  be entitled  to sign  or      authenticate a  medical or  fitness      certificate    or     any     other      certificate required  by any law to      be signed  by or authenticated by a      duly       qualified        medical      practitioner;      (d)  shall   be  entitled  to  give      evidence at  any inquest  or in any      court of  law as  an  expert  under      section 45  of Indian Evidence Act,      1872  on  any  matter  relating  to      medicine.      (3)  Any   person   who   acts   in      contravention of  any provision  of      sub-section (2)  shall be  punished      with imprisonment  for a term which      may extend  to one  year,  or  with



    fine  which   may  extend   to  one      thousand rupees, or with both." 31. The impact of the above provisions is that no person can practice medicine  in any  State  unless  he  Possesses  the requisite  qualification   and  is  enrolled  as  a  Medical Practitioner on State Medical Register. The consequences for the breach  of these provisions are indicated in Sub-section 3. If  a person practices medicine without possessing either the requisite  qualification or  enrollment under the Act on any State Medical Register, he becomes liable to be punished with imprisonment or fine or both. 32. Apart from the Central Act mentioned above, there is the Maharashtra Medical  Council Act  7 1965  dealing  with  the registration of  Medical Practitioners  and  recognition  of qualification  and   medical  institutions.  Section  2  (d) defines ’Medical Practitioner’ or ’Practitioner’ as under :      "Medical      Practitioner       or      Practitioner means  a person who is      engaged in  the practice  of modern      scientific medicine  in any  of its      branches  including   surgery   and      obstetrics,   but   not   including      Veterinary medicine  or surgery  or      the Ayurvedic,  Unani, Homoeopathic      or Biochemic system of medicine                      (emphasis supplied) 33. It  will be  seen that  the definition  consists of  two distinct parts;  the  first  part  contains  the  conclusive nature  of   phraseology  and   the  latter   part  is   the exclusionary part  which specifically  excludes Homoeopathic or Biochemic  System of  Medicine.  A  register  of  Medical Practitioners is  to be  maintained in  terms of the mandate contained in Section 16(1) of the Act Under Sub-section (3), a person  possessing requisite  qualification and on payment of requisite  fee can  apply for registration of his name in the aforesaid Register. 34. A  combined reading  of the  aforesaid Acts, namely, the Bombay Homoeopathic  Practitioners  Act,  1959,  the  Indian Medical  Council  Act,  1956  and  the  Maharashtra  Medical Council Act,  1965 indicates that a person who is registered under the  Bombay Homoeopathic  Practitioners Act,  1959 can practice Homoeopathy  only and  that he cannot be registered under the  Indian Medical  Council Act,  1956 or  under  the State Act,  namely, the  Maharashtra Medical  Council,  Act, 1965, because  of the restriction on registration of persons not possessing  the  requisite  qualification.  So  also,  a person  possessing   the  qualification   mentioned  in  the Schedule appended to the Indian Medical Council Act, 1956 or the  Maharashtra   Medical  Counsel   Act,  1965  cannot  be registered  as  a  Medical  Practitioner  under  the  Bombay Homeopathic Practitioners Act, 1959, as he does not possesse any qualification  in Homoeopatnic  System of  Medicine. The significance of mutual exclusion is relevant inasmuch as the right to  practice in  any particular  system of medicine is dependent upon  registration which  is permissible  only  if qualification) and  that too,  recognised qualification,  is possessed by a person in that System. 35. It  is  true  that  in  all  the  aforesaid  Systems  of Medicine, the  patient is  always a  human being. It is also true that  Anatomy and  Physiology of  every human being all over the world, irrespective of the country, the habitat and the region  to which  he may belong, is the same. He has the same faculties and same systems. The Central Nervous System, the Cardio-Vascular  System, the  Digestive and Reproductive systems etc.  are similar  all over  the  world.  Similarly,



Emotions, namely,  anger, sorrow,  happiness, pain  etc. are naturally possessed by every human being. 36. But  merely  because  the  Anatomy  and  Physiology  are similar, it  does not  mean that a person having studied one System of  Medicine can  claim to treat the patient by drugs of another  System which  he might  not have  studied at any stage. No  doubt, study  of Physiology and Anatomy is common in all  Systems   of Medicines and the students belonging to different Systems  of Medicines may be taught physiology and Anatomy together,  but so  far as  the  study  of  drugs  is concerned, the  pharmacology   of all  systems  is  entirely different. 37. an  ailment, if  it  is  not  surgical,  is  treated  by medicines or  drugs. Typhoid  Fever,  for  example,  can  be treated not  only under  Allopathic System  of medicine, but also under  the Ayurvedic, Unani and Homoeopathic Systems of Medicine by  drugs prepared  and manufactured   according to their own  formulate and pharmacopoeia . Therefore, a person having studied  one particular  System  of  Medicine  cannot possibly claim  deep and  complete knowledge about the drugs of the other System of Medicine. 38. The  bane of Allopathic medicine is that it always has a side-effect. A  warning to  this effect  is printed  on  the trade label  for the  use  of  the  person  (Doctor)  having studied that System of Medicine. 39.  Since  the  law,  under  which  Respondent  No.  1  was registered  as  a  Medical  Practitioner,  required  him  to practice in  HOMOEOPATHY ONLY, he was under a statutory duty not to  enter the  field of any other System of Medicine as, admittedly, he  was  not  qualified  in  the  other  system, Allopathy, to  be precise.  He trespassed  into a prohibited field and was liable to be prosecuted under Section 15(3) of the Indian  Medical Council  Act, 1956. His conduct amounted to an actionable negligence particularly as the duty of care indicated by  this Court  in DR. LAXMAN JOSHI’S CASE (SUPRA) WAS BREACHED  BY HIM  ON  ALL  THE  THREE  COUNTS  INDICATED THEREIN. 40. Negligence  has many  manifestations -  it may be active negligence, collateral  negligence, comparative  negligence, concurrent  negligence,   continued   negligence,   criminal negligence, gross  negligence, hazardous  negligence, active and passive  negligence, willful  or reckless  negligence or Negligence  per   se,  which   is  defined  in  Black’s  Law Dictionary as under :      Negligence per se: Conduct, whether      of action or omission, which may be      declared and  treated as negligence      without any argument or proof as to      the     particular      surrounding      circumstances, either because it is      in violation  of a statute or valid      municipal ordinance,  or because it      is  so   palpably  opposed  to  the      dictates of common prudence that it      can be  said without  hesitation or      doubt that  no careful person would      have  been   guilty  of  it.  As  a      general rule,  the violation  of  a      public duty,  enjoined by  law  for      the   protection   of   person   or      property, so constitutes." 41. A  person who  does not  have knowledge  of a particular System of  Medicine but  practices in that System is a Quack and a  mere pretender  to medical  knowledge or skill, or to put it differently, a Charlatan.



42. Where  a person  is guilty  of  Negligence  per  se,  no further  proof  is  needed.  However,  we  may  notice  that Respondent No.1  started treatment of Pramod Verma for Viral Fever as  it was  "very much  prevalent  in  the  locality". Subsequently, he  treated Pramod  Verma  for  Typhoid  Fever since it  was "prevalent  at that  time in  the locality  in question and neighbouring localities of Bombay". On both the occasions, treatment  was given  for fever  which Respondent No.1 thought  was prevalent  in the locality and, therefore, Pramod Verma would also be suffering from that fever. He did not  feel   it  necessary   to  confirm   the  diagnosis  by pathological tests  which would  have positively established whether  Pramod  Verma  was  suffering  from  typhoid  Fever Respondent No.1  has given  out in  his statement  on  oath, recorded by  the Commission,that  he had  advised Blood test and Urine test but Pramod Verma did not get it done. All the prescriptions of  Respondent No.1  have been  filed  by  the appellant but  on none  of them  any advice  was written  by Respondent No.1  for Blood  or Urine  Test. We cannot ignore the usual  practice of almost all the Doctors that when they want pathological  tests to  be done, they advise in writing on a  prescription setting  out  all  the  tests  which  are required to  be done.  Admittedly, Respondent  No.1 had  not done it  in writing.  He says that he had advised it orally. This cannot be believed as this statement is contrary to the usual code of conduct of medical practitioners. 43. The  condition of  Pramod Verma while under treatment of Respondent No.1  deteriorated so  much so  that he had to be shifted to  the private  nursing home of Respondent No.1 and from that  nursing home,  he  was  shifted  to  the  Hinduja Hospital  in   an  unconscious  state  where  he  ultimately breathed his last. 44. On  29th of  November, 1995,  the  following  Order  was passed by us:           "This appeal  is sequel  to  a      complaint filed by Ms.Poonam Verma,      before   the    National   Consumer      Disputes Redressal  Commission, New      Delhi, (the  Commission),  alleging      negligence   and    deficiency   in      service on  the part of two doctors      of Bombay, namely, Ashwin Patel and      Rajeev  M.Warty.   The   Commission      recorded the statements of both the      doctors. Dr.  Ashwin Patel as R.W.1      and Dr.  Rajeev M.Warty  as  R.W.3,      appeared before the Commission. Dr.      Ashwin Patel  produced  an  Expert,      namely,  Dr.Jitender   V.Patel   as      R.W.2 in support of his case before      the Commission           Dr.Ashwin Patel  is admittedly      a Homeopath  Physician. It  is also      admitted   that    he    prescribed      Allopath medicines  to the deceased      husband  of  the  complainant.  Dr.      Rajeev  M.  Warty  is  an  Allopath      Practitioner  running   a  Nursingh      Home in Bombay. Deceased husband of      the complainant was admitted in the      Nursing where  he stayed  for  two-      three days.  Finally  the  deceased      was admitted  in Hinduja  Hospital,      where he  passed away  within  four      hours of  his admission.  No expert



    was  produced  by  the  complainant      before    the    Commission.    The      Commission  finally  dismissed  the      complaint by a speaking order.           We are  of the  view  that  in      order  to   do   complete   justice      between   the    parties,   it   is      necessary  to   have  opinion  from      eminent doctors on the basis of the      material which  is on  the  record.      We, therefore, request the Director      of  the   All  India  Institute  of      Medical  Sciences,   New  Delhi  to      appoint   a   Board   of   doctors/      Specialist in  Medicine  and  other      related branches,  to  examine  the      material  which is being sent along      with  this   order,  regarding  the      correctness,  adequency  and  other      relative aspects  of the  treatment      rendered to the deceased. The Board      shall give  its opinion  within two      weeks of the receipt of this order.      Registry to  send a  copy  of  this      order to  the Director  of the  All      India    Institute    of    Medical      Sciences, New  Delhi, within 2 days      along with the following documents:      (1) Copies of the Statements of Dr.      Ashwin Patel  (R.W.1), Dr. Jitender      V.Patel  (R.W.2)  and  Dr.R.M.Warty      (R.W.3).  These  documents  are  at      pages 141  to  201  of  the  record      received from the Commission.      (2) Copies  of the  documents  from      pages 20  to 48  and 121  to 129 of      the above said record.           The opinion  of the  Board  of      doctors shall be sent to this Court      in sealed cover, with in the period      indicated by us. 45. In pursuance of the above Order, Dr. J.N. Pande, Prof. & Head, Deptt.  of Medicine,  Dr. A.K.  Mukhopadhya,  Prof.  & Head, Deptt.  of Lab.  Medicine, Dr. K. Prasad, Assoc. Prof. of   Neurology,    Dr.   Y.K.   Joshi,   Assoc.   Prof.   of Gastroenterology,  Dr.   Kamal  Kishore,   Assoc.  Prof.  of Pharmacology and  Dr. Shakti  Gupta, Asstt.  Prof. of  Hosp. Admn.  of  the  All  India  Institute  of  Medical  Sciences examined  the   record  of   this  case  including  all  the prescriptions and they gave the following opinion:      "Mr.Parmod  Verma   suffered   from      fever on  the 3rd of July, 1992 and      after a  brief period of illness of      less than 2 weeks he expired on the      15th  of   July,  1992  at  Hinduja      Hospital. It was felt that material      available to  the Medical Board, it      is not  possible  to  arrive  at  a      definitive   conclusive   diagnosis      regarding the  deceased. It appears      most probably  that Mr.Verma had an      infection leading  to    septicemia      possibly   on   a   background   of      hitherto   unrecognized    diabetes      mellitus.    He  probably  suffered



    from       some        intracranial      complications presumably related to      infection and died as a consequence      thereof.  He   received  the  usual      treatment   by   antipyretics   and      commonly used  antibiotics  in  the      initial stages  of his  illness  as      per the  usual practice in patients      suffering from  fever. Mr.  Verma’s      illness    however    followed    a      fulminant   course    with    rapid      deterioration   in    his   general      condition requiring  admission into      a   private    nursing   home   and      subsequently to  a  large  referral      hospital.   From    the   available      information  it  appears  that  the      treatment administered  to Mr.Verma      was  in   keeping  with  the  usual      practice in  the management of such      problems. It  is  unfortunate  that      Mr.  Verma   had  rather  fulminant      course of  his disease  and expired      before  the   definitive  diagnosis      could be established." 46. The  Professors have  not been  able to  give a positive opinion but  they do observe that Pramod Verma died before a positive diagnosis  could be  established. The sad story had its beginning  in the  hands of  a Quack  Allopathic Doctor, namely, Respondent  No.1 who,  having not studied Allopathic System of  Medicine, treated Mr. Pramod Verma in that System and gave  Broad Spectrum  Antibiotics with  antipyretics for Viral Fever  "which was   prevalent"  and then  for  Typhoid Fever "which  was also  prevalent" together  with tablets as also intra-muscular  injections  of  a  sodium  compound  to relieve him  of pain  without ascertaining the cause for the pain. Since  Pramod Verma  had already suffered at the hands of Respondent  No.1 and  his  condition  had  already’  been damaged to  an unascertainable  extent before he was shifted to the  clinic of  Respondent No.2,  we do not, specially in iew of  the report  of the  Professors of AIIMS, consider it proper to proceed against Respondent No.2. 47. But we are of the positive opinion that Respondent No.1, having practised  in Allopathy,  without being  qualified in that system, was guilty of Negligence per se and, therefore, the appeal  against him has to be allowed in consonance with the maxim  Sic Utere  tuo ut alienum non loedas (a person is held liable  at law for the consequences of his negligence), leaving it to repeat to himself the words of Dr.J.C. Lettsom (On Himself) :                 ’When people’s ill, they comes                 to I,                 I physics, bleeds, and sweats                 em;                 Sometimes they live, sometimes                 they die.                 What’s that to I? I lets ’em.’ 48. Pramod  Verma was  35  years  of  age  and  was  getting Rs.5,700/- per  month as salary. He died a young death which has deprived his dependants, namely; the widow, two children and parents, of the monetary benefit they were getting. They are entitled under law to be compensated. 49. For the reasons stated above:                (a) The  appeal as against Respondent No.1 is                allowed and  the judgment  of the Commission,



              to that  extent, is  set aside.  The claim of                the   appellant   is   decreed   as   against                Respondent No.1  for a  sum of  Rs.3,00,000/-                payable to  her  within  three  months  from,                today failing  which it  shall be recoverable                in accordance with law.                (b)  Medical  Council  of  India  constituted                under the Indian Medical Council Act, 1956 as                also the  State  Medical  Council  under  the                Maharashtra Medical Council Act, 1965 to whom                a copy  of this  Judgment shall be sent shall                consider  the   feasibility   of   initiating                appropriate action  against  Respondent  No.1                under Section  15(3) of  the  Indian  Medical                Council Act, 1956 for his having practised in                Allopathic System  of Medicine  without being                registered with  the Medical Council of India                or the  State Medical Council as also without                possessing the requisite qualifications .                (c) The  appellant shall  be entitled  to her                costs which are quantified at Rs . 30, 000/-.