Safeguarding Patients and Doctors: Medical Negligence under India’s new criminal law

Under the Bharatiya Nyaya Sanhita, India’s new criminal law, severe penalties are outlined for cases of death resulting from medical negligence. If such negligence occurs during a medical procedure performed by a Registered Medical Practitioner (RMP) under the National Medical Commission Act, the practitioner may face imprisonment of up to two years along with a fine.

However, if the negligence is committed by any other individual, including nurses, healthcare workers, physiotherapists, or Indian medicine practitioners, the penalties are more severe. In such cases, imprisonment for up to five years, in addition to a fine, may be imposed.

A “registered medical practitioner” is defined as someone possessing a medical qualification recognized under the National Medical Commission Act, 2019, and whose name is listed in either the National Medical Register or a State Medical Register under the same Act. This distinction underscores the accountability and legal consequences for medical professionals in ensuring the safety and well-being of patients during medical procedures.

In the medical profession, doctors are bound by a sacred duty to provide treatment to all patients, upheld by legal precedents and constitutional provisions, such as Article 21 of the Indian Constitution. The Supreme Court of India affirmed this in the case of Parmananda Katara v. Union of India (1989).

When a patient engages the services of a medical practitioner, they enter into a contractual relationship imbued with elements akin to tort law. Within this framework, the doctor assumes a duty to wield their medical knowledge and skill to address the patient’s health concerns. Any deviation from this duty constitutes negligence, providing grounds for legal action. Of paramount importance is the obligation for the doctor to secure informed consent from the patient before initiating diagnostic procedures or implementing clinical or surgical interventions.

At the heart of this fiduciary relationship lies the cardinal principle of informed consent, a cornerstone of medical jurisprudence. Judicial pronouncements, notably Dr. Laxman Balkrishna Joshi vs. Dr. Trimbark Babu Godbole and A.S. Mittal v. State of U.P., delineate the trinity of duties owed by physicians: the judicious exercise of discretion in accepting cases, the scrupulous deliberation over treatment modalities, and the conscientious administration of said treatments.

To safeguard patients and doctors alike, hospitals and medical practitioners can implement the following measures:

• Standardized Protocols: Publish and ensure adherence to protocols for clinical management, minimizing the risk of errors and negligence.

• Comprehensive Consent Procedures: Establish various consent modalities (express, implied, surrogate) and ensure patients fully understand their treatment options and associated risks.

• Competent Personnel: Ensure only qualified experts handle patient care, mitigating the risk of substandard treatment.

• Audio-Visual Consent: Utilize audio-visual recording for consent acquisition, enhancing transparency and documentation.

• Data Protection: Implement strict data protection measures to securely store consent data, adhering to privacy regulations.

• Patient Information: Inform patients and bystanders about the hospital’s consent policy, promoting awareness and transparency.

• Role of Data Protection Officer: Appoint a dedicated officer responsible for managing and safeguarding patient data, ensuring compliance with legal requirements.

• Availability of Expertise and Medical Consumables: Clearly communicate the availability of doctors with relevant expertise, avoiding treatment by unqualified personnel.

• Immediate Referral: After providing first aid, promptly refer patients to facilities with the required expertise, ensuring continuity of care.

• Medico-Legal Training: Conduct regular training sessions on medico-legal aspects to equip healthcare professionals with the knowledge and skills to navigate legal complexities.

By adhering to these measures, hospitals and doctors can uphold the principles of medical ethics, foster patient trust, and ensure the delivery of high-quality, patient-centered care while safeguarding themselves against legal liabilities.

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