National Consumer Disputes Redressal
Cosmopolitan Hospitals And Anr. vs Vasantha P. Nair on 21 April, 1992
JUDGMENT Balakrishna Eradi, J.
(1) This appeal has been preferred by M/s Cosmopolitan Hospitals (P) Ltd., Thiruvananthapuram as appellant No. 1 and one Dr. K.Venugopalan Nair, Senior Consultant in Orthopaedics in the said hospital as appellant No. 2 who are figuring as opposite parties in a complaint petition-Complaint No. 123 of 1990 pending on the file of the Kerala State Consumer Disputes Redressal Commission. The said complaint has been preferred against the appellants by the respondent herein, who is the widow of one G.P. Nair, who was a Company Executive in M/s Aluminium Industries Ltd., Thiruvananthapuram. Mr. G.P. Nair was admitted in the appellant hospital on September 7, 1989 with persistent back pain. It is not in dispute that for the admission and treatment of patients in the appellant hospital, charges are collected by the hospital. The ailment of Mr. G.P. Nair was initially diagnosed in the hospital as tuberculosis and treatment was started on that basis. It is alleged that in the course of said treatment, the patient exhibited other symptoms on the basis of which it was later diagnosed to be a case of jaundice and in view thereof he was treated in the hospital for that condition by one Dr. P.P. Joseph from September 15, 1989. It would appeal that the condition of the patient progressively grew worse and hence on September 17,1989 he was referred to the Gastro Enterology Department of the Medical College Hospital, Thiruvanathapuram where better facilities could be had for diagnosis and treatment. The patient was shifted to the Medical College Hospital only on September 18,1989 and while undergoing treatment there, he expired on September 28, 1989. The complaint petition was thereafter filed by the respondent herein-widow of the deceased seeking to recover a compensation of Rs. 5,67,776/ - from the opposite parties on the plea that they were criminally negligent in their diagnosis and treatment of late Mr. G.P. Nair while he was under their care and treatment in the first appellant hospital and had they been careful, his valuable life could have been saved.
(2) The opposite parties filed a joint version before the State Commission wherein they categorically repudiated the charge of negligence and also contended that the complainant had no cause of action against them and is not entitled to initiate proceedings under the Consumer Protection Act, 1986 (hereinafter called the 'Act') since he is not a "consumer" and the treatment rendered in the hospital does not constitute 'service' as defined in the Act. On the above basis it was contended that the State Commission had no jurisdiction to entertain and adjudicate upon the complaint.
(3) The State Commission took up for consideration the questions of locus standi and jurisdiction as preliminary issues and after a detailed discussion of all the relevant aspects, it has recorded the finding that the complainant who is the widow of the deceased patient is a "consumer" entitled to invoke the redressal machinery provided under the Act and that the activity carried on by the appellant hospital of rendering medical treatment for consideration is a 'service' as defined in the Act and hence it is within the jurisdiction of the Redressal Forums constituted under the Act to entertain and adjudicate upon a complaint relating to alleged deficiency in such service. This appeal has been preferred by the appellants against the said decision rendered by the State Commission on the preliminary issue.
(4) The Indian Medical Association, New Delhi through its honorary Secretary filed Miscellaneous Petition Nos. 66 and 67 of 1991 in the appeal praying that the Association should be permitted to intervene in the case and support the contentions of the appellants since the questions involved in the appeal are of grave importance and concern to the members of the Association belonging to the medical profession. First Appeal NO. 94 Of 1991 (5) This appeal also arises out of a similar complaint petition filed against M/s Cosmopolitan Hospitals (P) Ltd., Thiruvanathapuram (Appellant No.l and four senior Consultant docotrs attached thereto (Appellant Nos. 2 to 5) and the challenge is against the order dated April 25, 1991 passed by the State Commission, Kerala at Thiruvananthapuram rejecting the preliminary objection raised by them against the maintainability of the complaint petition-Complaint No. 1 of 1991 - filed against them by the widow and two children (Respondent Nos. 1 to 3 herein) of one Mr. P.S. Bhaskaran who was admitted into the first appellant hospital on July 4, 1990 as a patient. This patient with the history of a fall on the previous day and complaininng of hip pain unfortunately expired following an operation performed upon him on July 6, 1990.
(6) The widow arid two sons of deceased Bhaskaran filed the complaint petition before the State Commission on January 3, 1991 seeking to recover Rs. 3 lakhs from the opposite party by way of compensation on the ground that the death of Mr. Bhaskaran had taken place as a result of "THEimperfection, short coming and inadequacy in quality, nature and manner of performance of the medical service rendered by the 1st counter petitioner and the gross negligence of the counter petitioners 2 to 5 for which the 1st counter petitioner is liable."
(7) The opposite parties in the joint version filed by them denied the allegations of imperfection, negligence etc. attributed to them and have set out in detail the nature and particulars of the surgical operation performed on Mr. Bhaskaran and submitted that his death had taken place as a result of cardiac arrest. While denying their liability they have raised the objection that the complainants are not "consumers" as M/s Cosmopolitan Hospitals & Anr. Vs. Smt. V.P. Santha & Ors. contemplated in the Act and that the services rendered by the opposite parties are 'personal services' and since contracts of personal service are exempted under Section 2(1)(o) of the Act, these respondents are protected from proceedings under the Act. The opposite parties requested the State Commission to hear and decide the question of jurisdiction and the maintainability of the complaint as a preliminary issue.
(8) The State Commission accordingly heard both sides on the preliminary issue raised by the opposite parties and passed the impugned order dated April 25, 1991 following the view already expressed by it on the identical question raised in Complaint No. 123 of 1990 (of which First Appeal No. 48 of 1991 has arisen) and rejecting the objections raised by the opposite parties. The State Commission held that the complainants who are the legal representatives of deceased Mr. Bhaskaran are clothed by operation of law with the rights which late Mr. Bhaskaran had to initiate action against the opposite parties on the ground of alleged deficiency in service and that those rights had not become extinguished by his death but remained enforceable by his legal representatives. It was further held that since Mr. Bhaskaran had a fall from his bed during the previous night he was taken to the hospital by the complainants and thus the services of the hospital had been hired by them for the benefit of Mr. Bhaskaran. On this basis also the State Commission held that the complainants are "consumers" and that no exception could be taken to the institution of the complaint by them.
(9) Dealing with the objection raised that the service rendered by the opposite parties was "personal service", the State Commission held that like the service of a lawyer, the seice rendered by the hospital and its doctors was basically professional service and hence "it will be incorrect, infelicitious and even crude" to call the sophisticated high class professional service as 'personal service'.
(10) The legality and correctness of the reasoning and conclusion recorded by the State Commission on the preliminary issue are under challenge by the appellants in this appeal.
(11) The Qualified Private Medical Practioners' Association, Kerala filed Miscellaneous Petitions Nos. 38 and 39 of 1991 praying that the said Association may also be impleaded in the aforesaid two appeals since the issues raised therein are of grave concern and interest to the members of the Association and the medical profession at large and the Association is therefore desirous of placing before this commission "all relevant aspects in their correct perspective, as a knowledgeable and truly representative body of doctors". By order dated July 12, 1991, the prayer for impleadment was allowed and the Association was granted three weeks' time from that date to file its detailed written submission in the case.
(12) We have heard Counsel appearing for the appellants and the respondents as well as the interveners in the two appeals and have also carefully examined the written arguments submitted by them in supplementaiton of their oral submissions. Having given our anxious consideration to all aspects of the case, we have come to the conclusion that the State Commission was perfectly right in rejecting the preliminary objections raised by the opposite parties in the two complaint petitions before it (appeals herein) and in holding that the complainants are "consumers" entitled to invoke the jurisdiction of the Redressal Forum under the Act and that the activity carried on by the opposite parties constitutes 'service' as defined in the Act and does not fall within the exempted category of service rendered under a "contract of personal service".
(13) Learned Counsel appearing for the appellants as well as for the interveners reiterated before us the contentions which had been urged before the State Commission on behalf of the opposite parties in the two complaint petitions. Reference was made by them to the statement of objects and reasons of the Consumer Protection Bill, 1986 and it was contended that when the objects and reasons set out therein are read along with the speech made in Parliament by the then Hon'ble Minister of Parliamentary Affairs and Food and Civil Supplies while introducing the Bill in Parliament, it would be clear that the only purpose sought to be achieved by the various provisions contained in the Bill was to safeguard and protect the interests of consumers against unscrupulous traders selling defective goods or indulging in unfair trade practices and against deficiency in services relating to "commercial transactions" alone. On this basis it was contended that the services rendered to a patient by a medical practioner which is a professional service has absolutely no connection with the definition of the expression 'service' contained in Section 2 (l)(o) of the Act. According to the appellants and interveners, the expression 'service' in the Act relates only to goods purchased by a consumer. It was further submitted that the legislation that governs the medical practioners is only the Medical Council Act, 1956 and it , only this law, which has been left unamended by the Consumer Protection Act, that governs the field as far as the professional services of medical practioners and those rendered in hospitals are concerned. It was urged by the Counsel for the appellants and the interveners, the expressions 'consumer', 'service', 'hires any service', 'consumer dispute', 'defect' and 'deficiency' have to be understood in a commercial sense only. They submitted that the Consumer Protection Act, 1986 has no application to the medical profession at all or to the services rendered in hospitals whether they are run by Government or by private agencies; and that it is wholly incorrect to say that a patient treated by a doctor in a hospital is a "consumer" coming within the definition of the Act.
(14) Another point urged on behalf of the appellants was that by no stretch of imagination can it be said that the legal representative of a person to whom medical services had been provided would fall within the expression "consumer" within the Act so as to be competent to maintain a complaint petition under the Act.
(15) We are unable to accept any of the aforesaid contentions urged on behalf of the appellants and the interveners.
(16) It is a well established principle of statutory construction that where the words of the statute are clear and unambigous, they have to be given their full effect and their ambit cannot be cut down by reference to the preamble to the Act, the statement of objects and reasons appended to the Bill or to the debates and speeches on the floor of the legislature/parliament. The expression 'service' has been defined in Section M/s Cosmopolitan Hospitals & Anr. Vs. Smt. V.P. Santha & Ors. 2(1)(o) of the Act as meaning "service of any description" which is made available to potential users. The only two categories of service exempted from the purview of the Act under the said definition are "service rendered free of charge" or under a contract of personal service. When Parliament has unambigously defined the expression "service" in such broad language giving it the widest amplitude, we see absoldtely no warrant for cutting down and restricting the scope of the definition to only service relating to "commercial transactions" That such a restriction was not intended by the parliament becomes clear when we turn to the inclusive part of the said definition where facilities in connection with 'insurance' and 'purveying of news or other information' are specifically enumerated as falling within its scope. Life Insurance is basically a welfare measure for ensuring social security and it would not be right to regard it as a purely 'commercial transaction', so too, the purveying of news or Other information need not always partake of a commercial character. Even apart from this, going by the language used by Parliament, service of any kind which is made available to potential users for consideration falls within the scope of the definition unless it is covered by either of the two exempted categories aforementioned. Hence, we see no substance in the arguments advanced on behalf of the appellants and the interveners that service rendered by hospitals and members of medical profession/or consideration will not constitute 'service' as defined in the Act becuase it does , relate to a commercial transaction.
(17) We shall now proceed to consider the next contention raised by the appellants that the service rendered to patients by hospitals and doctors fall within the exempted category of service rendered under a contract of personal service. This Commission had occasion to consider the scope of the expression "contract of personal service" occurring in Section 2 (l)(o) of the Act, in the decision rendered in A. C. Modagi vs. Cross Well Tailor and Anr. (R.P. No 75 of 1990) and reported in 11(1991) Cpj 586 decided on August 9, 1991. We may usefully extract paragraphs 9 to 13 of the order passed in that case where the said question has been elaborately discussed, which run as follows:
"9.Before we proceed further we may mention here that a distinction is to be drawn between a 'contract/or service' and contract of service. "In the one case the master can order or require what is to be done while in the other case he can not only order or require what is to be done but how itself it shall be done" (Per Hilber J" in Collins V. Hertfordshire Country Council, 1947 Kb 598 at page 615) quoted in Dharangadhra Chemicals works Ltd.v. State of Saurashtra and Ors. 1957 S.C. 264 at P. 267.
10. In Oxford Companion to Law (Page 1134) contract for services has been defined as follows: "In Roman Law. Locatio operis faciendi, the contract whereby one party undertakes to render services e.g. professional or technical services, to or for another in the performance of which he is not subject to detailed direction and control but exercises professional or technical skill and uses his own knowledge and discretion. There are two major groups of such services, professional services of M/s Cosmopolitan Hospitals & Anr. Vs. Smt. V.P. Santha & Ors. lawyers, accountants, surgeons and the like and technical services of building and engineering contractors, builders, garages and many more."
INStrouds Judicial Dictionary (Page 540, 5th Edn.) it is mentioned: "A contract to render services is not the same thing as a 'contract of service'; semble, the latter implies some relationship of master and servant and involves an obligation to obey orders in the work to be performed and as to its mode and manner of performance."
(18) We may also quote here the following passage occurring at page 268 of the report of the case of Dharangadhra Chemicals Works Ltd. (supra): "THE principle which emerges from these authorities is that the prima facie test (or the determination of the relationship between master and servant is the existence of the right in the master to supervise and control the work done by the servant not only in the matter of directing what work the servant is to do but also the manner in which he shall do his work". It was further remarked in the above case (page 268 of the report): The correct method of approach, therefore, would be to consider whether having regard to the nature of the work there was due control and suprevision by the employer or to use the words of Flelcher Moulton, L.J., page 549 in Simmons V. Health Laundry Company. 1910 I Kb 543 at pp. 549,550: "In my opinion it is impossible to lay down any rule of law distinguishing the one from the other. It is a question of fact to be decided by all the circumstances of the case. The greater amount of direct control exercised over the person rendering the services by the person contracting for them the stronger the grounds for holding it to be a contract of service, and similarly the greater the degree of independence of such control the greater the probability that the services rendered are of the nature of professional services and that the contract is not one of service". The following passage from the judgment in Executive Committee of Vaish Degree College vs. Laxmi Narain and Ors. will also be useful for further discussions in the case: "It must be noted that all these doctrines of contract of service as personal, non-assignable, unenforceable and so on grew in an age when contract of service was still frequently a 'personal relation' between the owner of a small workshop or trade or business and his servant.' Of course in a narrow sense there is personal element in practically all services such as a servant's or aya's services. However, it will be incorrect and even crude to call the professional or technical service as personal service. 11. From the above authorities it is clear that personal service stems from a master and servant relationship which is totally different from a lawyer client relationship or other professional or technical relationship. The reason for excluding the rendering of service 'under a contract of personal service from the definition of service' under the Act is obvious. Such an employee can be turned out of service by the master at will and, therefore, no occasion can arise for the master to complain about the deficiency in the rendering of service by the employee. 12. Applying the above tests to the present case, it will be clear that the petitioner was not in a position to exercise any sort of control or supervision over the work of the respondent. The respondent was independent of any supervision or control of the petitioner while he (i.e. respondent) was cutting the cloth for stieching the pant or was stitching it.While doing his work the respondent was not bound to obey any direction given by the petitioner except about the design of the pant but not further. Thus the service rendered by the respondent was in the course of his profession and the service was not rendered by him under any contract of personal service"
(19) After having anxiously applied our minds over again to all aspects of the question, we see no reason at all to deviate from the aforesaid conclusion recorded by us in Modagi's case.
(20) We agree with the terse observation of the Stale Commission that while a medical officer's service may loosely be called personal, it will be incorrect, infelicitous and crude to describe it as 'personal service'. A contract of personal service involves a master and servant relationship which is wholly different from a medical doctor-patient relationship and in our opinion it will be totally wrong to call the service rendered by a medical doctor to his patients as 'personal service' coming within the exempted category mentioned in Section 2(l)(o).
(21) In the case of hospitals which provide treatment to patients for payment we are unable to see how there is any element of personal service involved in such an arrangement. When a patient goes to such a hospital and avails himself of the facility of treatment on payment of consideration, he is dealing only with an institution carrying on the activity of providing medical service for payment and no element of 'personal service' does enter into the picture in scuh a case. The hospital may having its own doctors, consultants etc. for treating the patients admilled to its care but ordinarily it is not likely that there will be privity of relationship between the person who gets admitted in the institution and the doctors who may be on the staff of the institution M/s Cosmopolitan Hospitals &Anr. Vs.Smt. V.P.Santha & Ors. or may be visiting consultants there.
(22) In the light of the foregoing discussion, we have no hesitation to uphold the finding of the State Commission that the activity of providing medical assistance for payment carried on by hospitals and members of the medical profession falls within the scope of the expression 'service' as defined in Section 2(l)(o) of the Act and that in the event of any deficiency in the performance of such service the aggrieved party can invoke the remedies provided under the Act by filing a complaint before the Consumer Forum having jurisdiction.
(23) We do not find any merit in the further plea taken by the interveners namely, Indian Medical Association and by the Qualified Private Medical Practioners Association, Kerala that because medical doctors are covered by the Indian Medical Council Act, 1956 "which provides a complete code of conduct" and the said Act has not been superseded by the Consumer Protection Act, the provisions of the latter Act cannot have any application to members of the medical profession.
(24) On an examination of the various provisions contained in the Indian Medical Council Act. 1956, it will be seen that the said Act has been enacted primarily for the reconstitution of the Medical Council of India, and I he maintenance of a Medical Register for India and for providing for incidental matters. The Act provides for the constitution by the Central Government of a Medical Council, the membership of which is to consist partly of persons nominated by the (central Government and partly of persons to be elected by the agencies specified in clauses (b) to (c) of Section 3 in the manner specified therein. The other provisions of the statute deal with the power of the Medical Council to grant recognition of medical qualifications awarded by Universities or Medical Institutions in India and of such qualificalions granted by Medical Institutions in countries with which there is a scheme of reciprocity as well as in countries with which no such scheme of reciprocity exists, the maintenance of a Medical Register in every State enrolment wherein is a pre-requisite for the entitlement of any person to practice medicine and to hold office of physician, surgeon etc. in Government or any local authority etc. The Act also provides for the prescription by the Council of minimum standards of medical education for granting degrees including Post-graduate degrees and confers power on the Council to prescribe standards of professional conduct and etiquette and code of ethics for medical practioners. Section 24 empowers the Council to direct the removal of the name of any person enrolled on a State Medical Register on the ground of professional misconduct. There is a prohibition imposed by the Act against any person other than a medical practitioner enrolled in a State Medical Register practicing medicine in any State and contravention thereof is made punishable with imprisonment for a term which may extend to one year or with fine which may extend to Rs. 1000.00 or with both. Nowherein the Act do we Find any provisions for the protection of the interests of the persons who may have suffered on account of any negligence or deficiency in the service rendered by members of the medical profession and the said topic is not even incidentally touched upon by this Act. This field left unoccupied by the Indian Medical Council Act is covered by the Law of Torts in general and now by the Consumer Prolection Act inparticular. It is worthwhile to remember that the existence on the statute book of the Indian Medical Council Act has not stood in the way of such grievances being agitated before the ordinary Civil Courts by institution of civil suits claiming damages for negligence as against the concerned hospital or medical doctors. What the Consumer Protection Act has done is to provide a speedy and inexpensive alternate remedy in resspect of claims for compensation for loss or injury suffered by a consumer due to deficiency and negligence on the part of the person responsible for providing any service for consideration. This is an additional remedy now made available by Parliament to persons who have hired for consideration services of any kind other than one 'under a contract of personal service'. Inasmuch as we have held that the availing of the service of a hospital or a medical doctor for getting medical treatment will not fall within the expression service rendered "under a contract of personal service", the exemption is not attracted. Hence the provisions of the Act relating to adjudication of consumer disputes and award of reliefs under Section 14 fo the Act fully apply to disputes concerning deficiency in the service rendered by hospitals and the members of the medical profession also.
(25) The next question to be considered is whether the complainants in the two cases who are the legal representatives of the deceased patients are "consumers" under the Act so as to he competent to maintain the complaints. In First Appeal No.94 of 1991 arising out of complaint No. 1 of 1991, there is a clear findig recorded by the State Commission that it was the complainants themselves who took the deceased Mr. Bhaskaran to the first appellant hospital and made the arrangements for his admission and treatment there. Thus they themselves were the persons who had hired the service of the hospital and the deceased Mr. Bhuskaran was only the person for whose benefit the arrangement was made. Hence in this case there cannot be any doubt that the complainants having themselves hired the service, they squarely fall within the definition of the expression "consumer" contained in Section 2 (l)(d) of the Act.
(26) Although there is no similar categorical finding recorded by the Stale Commission in Complaint No. 123 of 1990, out of which First Appeal No, 48 of 1991 has arisen, we are fully in agreement with the view expressed by the State Commission that the complainant who is the widow and legal representative of deceased Mr. G.P. Nair can invoke the remedy under the Act since, in the eye of law, she stands in the shoes of the deceased as his representative to enforce the cause fo action which the deceased had and in respect of which the right to seek legal remedies has survived and become part of his estate. In this connection we may refer with advantage to the following passage from Salmoiid's Jurisprudence (12th Edn.). Page 443, which reads as follows: "THE rights which a dead man thus leave behind him vest in his representative. They pass to some person whom the- dead man, or the law on his behalf, has appointed to represent him in the world of the living. This repH'sciltaliw bears the person of the deceased, and therefore has vested in him all the inheritable rights, and has imposed upon him all the inheritable liabilities of the deceased. Inheritance is in some sort a legal and fictitious continunation of the perssonality of the dead man for the representative is in some sort identified by the law with him whom he represents." It is true that in the definition of the expression "consumer", there are no express words indicating that his legal representative is also included within its scope. But as pointed out by the eminent author in the above passage, by operation of law, the legal representative gets clothed with the rights, status and personality of the deceased for the purpose of enforcing the cause of action which has devolved on him. In our opinion, it is consistent with the object and scheme of the Act and conducive for the achievement and promotion of the legislative purpose underlying the statute to give an extended meaning to the expression "consumer" defined in Section 2(l)(d) of the Act so as to include legal representatives of deceased consumers. Unless such a broad and pragmatic view is taken, the result that would follow is that even a case of gross negligence or deficiency in the performance of service leading to the death of the family of the deceased will be left without any remedy under the Act for the redressal of their grievance arising out of the said deficieny. We cannot believe that such an anomalous situation was intended by Parliament. We have to apply the well established principle of interpretation that the provisions of a social welfare legislation are to be liberally construed so as to suppress the mischief and advance the remedy. We accordingly uphold the finding entered by the State Commission that the complainants arc "consumers" and have full locus standi to maintain the complaint petitions before the Consumer Redressal Forum."
(27) We note that there are some passing observations in the orders passed by the State Commission which indicate an inclination on the part of the State Commission to adopt the view that whenever a patient is admitted into a hospital there is automatically a hiring by him of the service not merely of the hospital but also of every doctor who happens to treat him there. In order that there should be an arrangement of hiring of service, there should be the requisite privity between the person who hires the service and the one whose services are hired. It is a question of fact to be determined on the evidence adduced in each case whether such a privity did exist as between the patient and the individual doctors who might have treated him while he was an in patient in the hospital. The question as to the existence of such privity has to be examined in each case where a complaint is made not only against the hospital but also against doctors who may be on the staff of the hospital and may have attended on the patient in that capacity as well as against any consultants Who might have been called in from outside by the concerned hosptial for seeing and treating the patient. The matter may assume a different complexion in cases where a hospital merely provides paramedical and other infrastruetural facilities and the patient is allowed to be treated by a doctor of his own choice called from outside. Much will therefore depend upon the facts of each case as established by the evidence. We would only observe that the matter requires to he thoroughly examined by the State Commission after the evidence is fully adduced before it. We are sure that in making the preliminary observations in the two orders, the State Commission was only giving expression to its prima facie view and that is would approach the said question with an open mind and investigate it afresh when these two cases go back to it for being dealt with on the merits.
(28) Subject to the above observations, we confirm the orders passed by the State Commission the preliminary issues raised in both these cases and dismiss these (29) The appellants will pay Rs. 2500.00 as costs to the respondents in each case.