Medical Negligence Cannot Be Presumed Solely Based on Post-Operative Complications Lacking Proven Causal Nexus

The Plaintiff (Respondent) underwent a family planning operation (tubal ligation) at a Government hospital on July 1, 1999.

The following day, she developed paralysis in her lower limbs, rendering her bedridden.

She filed a suit for compensation of Rs. 10,00,000 against the State, alleging medical negligence.

The Trial Court decreed the suit in her favor, awarding Rs. 4,00,000 with 9% interest, reasoning that since symptoms appeared immediately post-surgery, a nexus existed.

The State appealed this decree. During the appeal, the High Court referred the Plaintiff to a Medical Board at Civil Hospital, Ahmedabad, to determine the causal link.

1. Whether the Plaintiff established a causal nexus between the family planning operation and the paralysis (paraplegia) suffered by her.

2. Whether the paralysis was caused due to the negligence or lack of due care on the part of the State or its instrumentalities.

The court applied the fundamental principle of medical negligence in tort law, which requires the plaintiff to prove a breach of duty and a direct causal link between the medical procedure and the injury sustained.

It emphasized that sympathy cannot substitute for legal proof of negligence.

The court relied on the evidentiary value of expert medical opinion under the Indian Evidence Act to determine complex medical causation, specifically looking for "acute transverse myelitis" as an independent clinical condition.

The Court analyzed the Medical Board’s report [dated 03/07/2026], which concluded that the Plaintiff’s paraplegia was caused by "Acute Transverse Myelitis" and "epidural collection" at the dorsal spinal cord—conditions unrelated to the tubal ligation.

The Board noted the surgery was performed under local anesthesia, making it medically impossible to cause the specific spinal cord injuries observed.

The Court found that the Trial Court erred by relying on mere presumption (post-surgery timing) rather than interpreting the MRI findings and medical records correctly.

Since the paralysis was an independent medical event (myelitis), the Plaintiff failed to establish the essential element of causation required to hold the State liable for negligence.

The High Court allowed the appeal and set aside the Trial Court’s judgment, dismissing Special Civil Suit No. 89 of 2003.

On humanitarian grounds, since 50% of the decretal amount had already been disbursed, the Court ordered that the Plaintiff be allowed to keep the withdrawn amount plus an additional Rs. 1,39,150 and accrued interest, with the remaining balance refunded to the State.