The Supreme Court while granting the Rs 5 lakhs in compensation in a medical compensation case disagrees the application of Egg Shell skull rule in the instant case. The recent decision of the apex court has raises concerns over the misinterpretation of the rule in medical negligence cases.
Background
A woman named Jyoti Devi visited Suket hospital in the Mandi area of Himachal Pradesh in 2005 to have her appendix removed. The operation went according to plan, but her stomach pain persisted. A four-year struggle and multiple hospital visits occurred. Ultimately, the Post Graduate Institute of Medical Science in Chandigarh’s medical staff discovered that she had “a 2.5 cm foreign body (needle)” in her belly that required surgical removal. The hospital in Mandi gave Jyoti Rs 5 lakhs for medical malpractice after she filed a complaint with the district consumer forum. However, the compensation was only increased to Rs 2 lakh by the National Consumer Disputes Redressal Commission (NCDRC) after the hospital filed an appeal against the verdict with the state consumer forum. After the matter came before the SC, it upheld the district forum’s compensation ruling and said that the other two courts had used the eggshell skull rule while nevertheless awarding a “paltry” and “unjust” amount.
Law point under discussion
The “eggshell skull rule,” also known as the “thin skull rule” or the “eggshell plaintiff rule,” is a legal doctrine that states a tortfeasor (someone who commits a tort, i.e., a wrongful act) is held liable for all damages inflicted upon a victim, even if the victim’s pre-existing condition makes them more susceptible to injury than an average person. In essence, the tortfeasor takes the victim as they find them, regardless of their fragility.
However, there are some exceptions and limitations to this rule, including:
Foreseeability: If the harm caused by the tortfeasor was not reasonably foreseeable, they might not be held liable for all the consequences. For instance, if someone with a pre-existing condition is injured in an unforeseeable way, the tortfeasor might not be responsible for exacerbating that condition.
Intervening Causes: If an intervening cause, such as a separate event or medical malpractice, contributes significantly to the harm suffered by the victim, the original tortfeasor might not be held fully responsible.
Contributory Negligence or Assumption of Risk: In some jurisdictions, if the victim’s own negligence contributed to their injuries, the damages awarded may be reduced or eliminated. Similarly, if the victim knowingly assumed the risks associated with an activity, they might not be able to hold others liable for resulting injuries.
Pre-existing Condition Not Connected to Injury: If the victim’s pre-existing condition did not contribute to the injuries caused by the tortfeasor, the eggshell rule might not apply. For example, if someone with a heart condition is injured in a car accident, the eggshell rule would likely still apply because the heart condition was not a factor in the accident itself.
Criminal Acts: In some cases, if the victim’s injury resulted from their own criminal conduct, the tortfeasor may not be held fully liable under the eggshell rule.
Judicial approach towards Egg shell skull rule
While there may not be Indian cases that explicitly mention the “eggshell skull rule” by name, the principle underlying this rule is often applied in cases involving tort law, particularly in the context of causation and foreseeability. Here are a few cases that illustrate this principle:
Municipal Corporation of Delhi v. Subhagwanti, (1966) 3 SCR 649: In this case, the Supreme Court of India held that the defendant, the Municipal Corporation of Delhi, was liable for the death of a pedestrian who fell into a manhole due to the negligence of the Corporation, despite the fact that the deceased suffered from epilepsy. The Court ruled that the Corporation was liable for the consequences of their negligence, even though the victim had a preexisting medical condition.
New India Assurance Co. Ltd. v. Asha Rani, AIR 2003 SC 1173: In this case, the Supreme Court of India held that an insurance company was liable to compensate the insured for injuries sustained in a motor vehicle accident, even though the insured had a preexisting medical condition. The Court emphasized that the insurance company could not escape liability by arguing that the insured was already predisposed to injury due to their medical condition.
Kusum Sharma & Ors. v. Batra Hospital & Medical Research Centre & Ors., (2010) 3 SCC 480: In this case, the Supreme Court of India held that a doctor and a hospital were liable for medical negligence resulting in the death of a patient, even though the patient had preexisting health issues. The Court emphasized that the defendants were responsible for the consequences of their negligent actions, regardless of the patient’s preexisting condition.
Observations made by the court
While dealing with the matter, the Consumer Protection Act and the Medical Negligence Law were also reviewed by bench comprising of Justice Sanjay Karol and Justice Arvind Kumar. When the bench came to determine what constituted “compensation,” it cited the notion of “just compensation” and explained that it is based on restitutio in integrum, which is Latin for “make good the loss suffered, to the extent that money can do so,” or, put another way, “return the recipient of such compensation to a position, as if the loss/injury suffered by them had not occurred.”
According to the Court’s analysis of the Eggshell Skull Rule, it is a common law principle that holds a defendant accountable for the plaintiff’s unusual or unforeseen responses to the defendant’s deliberate or negligent wrongdoing.
The Court established a four-pronged framework for applying the legal principle in question, all centered on the concept of pre-existing conditions and the defendant’s potential role in exacerbating them. These categories encompass situations where:
- A previously unknown (latent) condition of the plaintiff comes to light.
- The defendant’s negligence reignites a pre-existing condition that had previously been successfully treated and subsided.
- The defendant’s actions worsen a known, pre-existing condition that had not yet received medical attention.
- The defendant’s actions expedite the inevitable disability or demise stemming from a pre-existing condition, even if the outcome was likely to occur eventually regardless of the defendant’s involvement.
Egg shell rule in different jurisdictions
United States:
The US generally embraces the eggshell skull rule, with landmark cases like Vosburg v. Putney, 56 N.W. 480 (Wis. 1893) establishing the foundation. Most states recognize the eggshell skull rule. If a defendant’s negligence causes a minor injury that unexpectedly triggers a severe reaction due to a pre-existing, unknown condition, the defendant can be liable for the full extent of the harm. Some states might introduce limitations based on foreseeability. If the defendant couldn’t reasonably anticipate the pre-existing condition and its potential for exacerbation, their liability might be restricted. For instance, a car accident causing a minor whiplash that triggers a rare genetic disorder due to an unknown pre-existing condition might not result in full liability for the defendant
Canada:
Canada follows a similar approach as the US. Cases like Athey v. Leonati, [1996] 3 S.C.R. 458 demonstrate that a defendant is liable for the entirety of the injuries, even if a pre-existing condition makes them worse. Canadian courts generally uphold the eggshell skull rule, ensuring that victims with pre-existing vulnerabilities are not penalized when a defendant’s negligence causes them harm.
United Kingdom:
The UK boasts a long history with the eggshell skull rule, dating back to the influential Walker v. Great Northern Railway Co.(1891) case. British courts continue to emphasize that a defendant takes the victim “as they find them,” ensuring full compensation for injuries regardless of pre-existing conditions. This approach reflects a strong commitment to fairness for victims.
Australia:
Australia aligns with the US and Canada in acknowledging the eggshell skull rule. The case of Jaques v. Commonwealth (1962) exemplifies this principle. Here, a defendant’s negligence causing harm, even if magnified by a pre-existing condition, leads to full liability. This approach ensures that victims in Australia receive fair compensation for their injuries.
Common Law countries:
The eggshell skull rule finds strong footing in common law jurisdictions. However, civil law systems might have a different approach. The emphasis might be on proving the specific fault of the defendant and establishing a direct causal link between their actions and the harm suffered. This could potentially lead to a more limited application of the eggshell skull rule compared to common law systems.
