Holding the cardiologist guilty of medical negligence and the hospital vicariously liable for the deficiency in service in connection with the treatment of a 42-year-old cardiac patient who died days after undergoing pacemaker implantation, the national consumer disputes redressal commission (NCDRC) upheld a ₹32.94 lakh compensation award against Dr Sudheer Saxena and Mohali-based Max Super Specialty Hospital (the appellants).
In an order on 29 July 2026, the NCDRC bench of presiding member Dr Inderjit Singh and member Shashi Nandkeolyar said, "After a thorough reassessment of the entire evidence, we find ourselves in agreement with the conclusion reached by Punjab State Consumer Disputes Redressal Commission, Chandigarh (the state commission) and the High Court. The appellants have failed to provide a cogent and consistent explanation for the contradictions in the medical records and the bill. The X-ray report and nursing note of 20 September 2013 strongly suggest that a procedure beyond the mere implantation of two leads was performed on that day. The bill entry for a 'double chamber pacemaker' stands unrebutted by any credible evidence. The expert opinion of PGIMER, while noted, does not resolve these specific factual inconsistencies. The appellants have, therefore, failed to prove that there was no negligence or deficiency in service on their part."
Rishi Gupta, who was 42 years old and had a serious pre-existing cardiac condition, was admitted to Max Super Specialty Hospital in Mohali, on 17 September 2013, following prolonged chest pain. He had undergone coronary artery bypass graft surgery at the age of 27 and was being treated by Dr Saxena.
Dr Saxena advised implantation of a biventricular, or triple-chamber, pacemaker manufactured by St Jude Medical India Pvt Ltd. According to the case record, a four-day treatment package costing around ₹5.5 lakh had been discussed.
The dispute arose over what happened during the pacemaker procedure on 20th September and 22 September 2013.
Pooja Gupta, the wife of Mr Gupta, alleged that after she deposited ₹3 lakh, her husband was taken for surgery on 20 September 2013. She alleged that Dr Saxena performed the procedure without the complete kit and implanted a cheaper double-chamber pacemaker costing ₹45,000, with the procedure remaining incomplete because the third wire was allegedly unavailable.
A second surgery was performed on 22 September 2013, during which the biventricular pacemaker costing ₹447,869 was implanted. Mr Gupta was discharged on 24th September but suffered a severe heart attack on 27 September 2013 and died after being brought back to the hospital. A daily diary report (DDR) was lodged and a post-mortem examination was conducted. Ms Gupta subsequently sought ₹84.73 lakh in compensation, alleging medical negligence, cheating and unfair trade practice.
Dr Saxena and Max Super Specialty Hospital challenged the state commission's finding, arguing that the pacemaker implantation was deliberately carried out in two stages because of Mr Gupta's fragile condition.
Their case was that two leads were implanted on 20th September and that the third, left ventricular lead, along with the pulse generator, was implanted on 22 September 2013. They maintained that this was an accepted medical practice and that the expert committee from the Postgraduate Institute of Medical Education and Research (PGIMER) had found the procedure to have been performed according to protocol.
They also disputed the interpretation of the hospital bill showing a ₹45,000 entry for a 'double chamber pacemaker'. According to the doctor and hospital, the entry was a billing software error and was actually related to procedure charges rather than the cost of a separate pacemaker.
The appellants further argued that the X-ray reference to 'electric conventional pacemaker (ECPM) with wires' did not establish that a permanent pacemaker had been implanted on 20 September 2013. They said ECPM referred to an external chamber pacemaker and that the permanent pulse generator was implanted only on 22 September 2013.
They also relied on the patient's severe underlying cardiac disease and argued that his death resulted from sudden cardiac death or myocardial infarction associated with his pre-existing condition rather than negligence during the procedure.
NCDRC, however, found that the case turned on contradictions contained in the hospital's own contemporaneous records.
The commission identified three key contradictions which had also formed the basis of the state commission's finding of negligence.
First, the X-ray report dated 20 September 2013, referred to an 'ECPM with wires' being in situ, while Dr Saxena consistently maintained that no pacemaker had been implanted that day.
Second, an internal nursing note dated 20 September 2013 stated: 'Patient CRT done'. The commission noted that CRT, or cardiac resynchronisation therapy, specifically involves a biventricular pacemaker and found it difficult to reconcile with the defence that only two leads had been implanted and that the pacemaker would be installed later.
Third, the hospital bill contained a specific entry for a 'double chamber pacemaker' costing ₹45,000 on 20 September 2013, despite the patient having paid for and consented to a biventricular device. NCDRC rejected the explanation that the ₹45,000 entry was merely a typographical error or a billing software mistake.
The commission observed that hospital billing software was expected to maintain a standard chart of accounts and that if the amount represented procedure charges, it should have been described as such. Instead, the bill specifically described it as a 'double chamber pacemaker'.
The commission held that the entry created a strong presumption that such a device had actually been used and described the finding as one based on documentary evidence rather than a technical medical inference.
Dr Saxena and Max Hospital subsequently produced documents intended to show that the biventricular pacemaker and its leads had been delivered to the hospital on 19th September and 20 September 2013.
NCDRC said those documents did not resolve the central contradictions.
The commission questioned why, if the correct device was available, the bill showed a cheaper and different device, why the medical notes stated 'CRT done' on 20 September 2013, and why the X-ray report showed a pacemaker in situ if, as the appellants maintained, only two leads had been implanted that day.
According to the commission, the documents filed after the state commission's order raised more questions than they answered and did not erase the inconsistencies in the contemporaneous medical records.
A significant part of Dr Saxena and Max Hospital's defence rested on the PGIMER medical board's opinion that the procedure had been carried out in accordance with protocol.
NCDRC acknowledged the importance of the expert opinion but found its value diminished because the medical board had not adequately addressed critical contradictions in the medical record.
The commission referred to the Punjab and Haryana High Court (HC)'s observation that the medical board had not discussed the inconsistencies concerning the X-ray reports of 20th September and 22 September 2013.
NCDRC further held that a blanket opinion that the procedure was 'as per protocol' could not resolve specific contradictions contained in contemporaneous records generated by the hospital itself.
It relied on the principle that a consumer forum is not bound by an expert opinion when the factual record raises issues that the expert opinion does not satisfactorily address.
NCDRC also considered a subsequent judgment of the Punjab and Haryana High Court in CRM-M-3458-2015.
The HC had dismissed the quashing petition filed by the appellants and directed them to face trial for offences under Sections 304-A, 420 and 120-B of the Indian Penal Code.
NCDRC clarified that findings in a criminal proceeding are not binding on a consumer forum. However, it said the HC’s detailed examination of the same medical records and its conclusion that a prima facie case of cheating and gross negligence existed were highly persuasive.
The HC had also noticed the same discrepancies involving the X-ray showing an ECPM, the nursing note stating that CRT had been done and the bill recording a double-chamber pacemaker. The NCDRC said these findings strengthened Ms Gupta's case that the version put forward by Dr Saxena and the hospital was not credible.
NCDRC said the case was not simply one involving an alleged error of judgement during a complex medical procedure.
It observed that the Hospital's own documents indicated the presence of a pacemaker on an X-ray, the medical notes indicated that CRT had been completed and the bill showed a cheaper device, while the doctor maintained that the pacemaker had not been implanted on 20 September 2013.
The commission said the appellants had failed to provide a satisfactory, coherent and consistent explanation for the discrepancies.
It held that their shifting explanations and subsequent attempts to explain away the records did not inspire confidence and that the unexplained contradictions in the hospital's own records were sufficient to draw an adverse inference of deficiency in service.
The commission ultimately agreed with the state commission and the HC’s assessment of the evidence.
NCDRC consequently upheld the state commission's finding that Dr Sudheer Saxena was guilty of medical negligence and deficiency in service and that Max Super Specialty Hospital was vicariously liable for the acts of its consultant doctor.
The state commission had ordered Dr Saxena and Max Super Specialty Hospital to jointly and severally pay ₹32.94 lakh to Ms Gupta, with interest at 9% a year in case of delay.
NCDRC dismissed the first appeal filed by Dr Saxena and Max Hospital and upheld the state commission's order. It also rejected Ms Gupta's appeal seeking enhancement of compensation. The commission said the ₹32.94 lakh award was just and fair, taking into account loss of income, treatment expenses, pain and suffering and litigation costs.
While observing that the loss of a life was invaluable, NCDRC said the compensation awarded was substantial and met the standard of being 'just and proper' in the circumstances.
NCDRC did not impose liability on St Jude Medical India. The commission specifically held that there was no evidence of any defect in the pacemaker supplied by the company and therefore no liability could be fastened on it.
NCDRC thus dismissed both appeals — the appeal filed by Dr Saxena and Max Super Specialty Hospital against the negligence finding and the cross-appeal filed by Ms Gupta seeking higher compensation — bringing the consumer proceedings to a close with the state commission's original award remaining intact.
(First Appeal No1495 of 2017 Date: 29 July 2026)
