Beyond The Scalpel: Medical Negligence In India

Posted On - 21 January, 2025 • By - Aravindh

Introduction

Medical negligence is a serious issue which has several legal and ethical implications. In India, medical negligence is dealt with under civil, criminal, and consumer protection laws. Under civil laws, the emphasis is on the existence of a duty of care and its breach that results in damage. The remedy for this is compensation. On the other hand, criminal negligence involves gross carelessness or recklessness with a much higher threshold of fault. Even the Consumer Protection Act, 2019 provides an avenue for consumers to file medical negligence cases to obtain compensation. This is also highlighted by the recent Supreme Court (SC) decision in Bherulal Bhimaji Oswal v. Madhusudan N. Kumbhare.[1]

Medical Negligence under Civil Law

Medical negligence occurs when a healthcare provider fails to meet the standard of care expected in their profession, leading to harm or injury to the patient.

Definition and Core Elements

Claims of medical negligence are based on three elements:

  • Duty of Care: A doctor owes a duty of care to their patient, which starts the moment they undertake the patient’s treatment.
  • Breach of Duty: This occurs when a medical professional fails to meet the standard of care expected of them.
  • Resulting Damage: There must be a direct link between the breach of duty and the harm suffered by the patient.

For a successful claim, all three elements must be proven.

Standard of Care – The Bolam Test

The Bolam v. Friern Hospital Management Committee case laid down a key principle: a medical practitioner is not expected to possess exceptional skills but should act in line with what an ordinarily competent professional in the same field would do.[2]

SC endorsed this test in Jacob Mathew v. State of Punjab.[3] It clarified that negligence is not about errors in judgment but conduct that falls below the accepted standards of the medical profession.

Judicial Interpretations on Duty of Care

The scope of a doctor’s duty was elaborated in Laxman Balkrishna Joshi v. Trimbak Bapu Godbole.[4] According to the SC:

  • A doctor must decide whether to accept a patient’s case.
  • They must choose a suitable treatment method.
  • They must deliver care with reasonable skill and caution.

Causation and Proof

Patients must show that the harm they suffered was directly caused by the breach of duty. Courts often rely on expert testimony to evaluate whether the care provided was adequate.

Following the Wednesbury Principle of reasonableness, only glaring errors, those that no reasonable doctor would commit, are considered negligence.

Damages and Liability

Compensation depends on the harm suffered. Patients may claim damages for physical injury, lost income, or emotional suffering. In India, courts are cautious about holding underpaid government doctors liable for unintended errors, often setting a higher bar for proving negligence in such cases.

Medical Negligence under Criminal Law

Distinction from Civil Negligence

The primary distinction between criminal and civil carelessness is the degree of fault that must be demonstrated. Criminal cases seek to punish the wrongdoer, whereas civil cases focus on providing compensation for the victim.

The “degree and extent” of negligence is where the main distinction can be found. Compared to the norm of ordinary carelessness used in civil liability, criminal negligence requires a higher threshold, which is frequently referred to as gross negligence.

Mens Rea (Mental Element) in Criminal Negligence

Criminal negligence often includes reckless behavior, which includes overlooking a significant risk. Cases such as R. v. Lawrence[5] and R. v. Caldwell[6] have highlighted the importance of recklessness as a key component of mens rea, or guilty mentality, in criminal law. The concept of magna culpa dolus est, i.e., a grave fault is practically equivalent to intent, is also applied in cases of extreme carelessness.

Defining Gross Negligence

The concept of gross negligence does not have a clear definition. Generally, it refers to a degree of negligence that goes beyond ordinary carelessness, where the standard of care is grossly breached. Courts have struggled to draw a clear distinction, especially in medical cases where treatment decisions are subjective and context-driven.

Key Case Law in India

Several landmark judgments have shaped the understanding of criminal medical negligence in India:

  • Kurban Hussein Mohamedalli Rangawalla v. State of Maharashtra: The Court held that for criminal negligence, there must be a direct link between the negligent act and the resulting death.[7]
  • Juggankhan v. State of Madhya Pradesh: The Court stressed the importance of a doctor’s expertise. It held that practicing outside one’s field can result in criminal liability.[8]
  • Achutrao Haribhau Khodwa v. State of Maharashtra: The Court clarified that negligence cannot be assumed just because a doctor chose one legitimate treatment option over another. However, the court also applied the doctrine of res ipsa loquitur in cases where harm was self-evident, such as surgical instruments left inside a patient.[9]

Medical Negligence and Consumer Protection

The CPA protects consumer rights and allows complaints for deficiency in services under Section 2(42). Medical services are included despite the term “healthcare” being omitted in the 2019 version.

Position Before the CPA 2019

In Indian Medical Association v. V.P. Shantha, SC held that medical services fall within the scope of “services” under the Consumer Protection Act, 1986, even without specific mention of “healthcare.”[10]

Position After the CPA 2019

  • Dr. Vijil v. Ambujakshi T.P.: The Kerala High Court held that medical services are covered under CPA, despite the removal of “healthcare” from the draft bill.
  • Medicos Legal Action Group v. Union of India: The Bombay High Court reaffirmed the inclusion of medical services[11], and the Supreme Court declined to interfere with this ruling.
  • Section 2(42): Defines “service,” encompassing medical services.
  • Section 42(11): Medical negligence by a service provider constitutes a violation.
  • Section 69(1): Complaints must be filed within two years of the harm.

If medical services are provided free of charge, they are generally excluded from CPA’s coverage.

Supreme Court’s Recent Decision

In Bherulal Bhimaji Oswal v. Madhusudan N. Kumbhare, the patient underwent cataract surgery.[12] Post the surgery, he developed a serious eye infection. He visited the surgeon multiple times with complaints of pain and discomfort. However, the doctor failed to diagnose the infection and assured the patient that the surgery was successful.

The patient filed a consumer complaint before the District Forum, which dismissed the complaint due to a lack of expert evidence. On appeal, the State Commission held that the doctor was negligent and awarded Rs. 3.5 lakhs in compensation. On a further appeal, the National Consumer Dispute Resolution Commission (NCDRC) overturned this decision and held that the infection was caused by trauma and not the doctor’s negligence. Finally, the patient filed the present appeal before the SC.

The SC held that the doctor was negligent on the basis of the following:

  • The Court held that the doctor failed to recognize the severity of the infection and provide appropriate treatment. This led to irreversible damage to the patient’s eye.
  • The Court highlighted that the doctor failed to give adequate post-operative care and properly monitor the patient’s condition.
  • The Court rejected the doctor’s claim that the infection was caused by the patient’s own actions. It held that there was no evidence to support this assertion.

The Court overturned the NCDRC’s decision and restored the State Commission’s Order. Thus, the patient was awarded Rs. 3.5 lakh in compensation for loss of vision and mental suffering.

Conclusion

Medical negligence is a serious issue, with legal implications that affect both patients and healthcare providers. To succeed in a claim, it is crucial to show that the doctor failed in their duty of care and that this failure directly led to the patient’s harm. The case of Bherulal Bhimaji Oswal highlights how important it is for doctors to provide thorough post-operative care and identify issues early on.

While the CPA offers patients a way to seek compensation, each case is unique and requires careful legal handling. The aim is to ensure patient safety while encouraging a medical practice that is both ethical and accountable.

[1] https://www.livelaw.in/pdf_upload/1281720196150258085judgement19-dec-2024-1-578005.pdf.

[2] Bolam v. Friern Hospital Management Committee, (1957) 1 WLR 582.

[3] Jacob Mathew v. State of Punjab, (2005) 6 SCC 1.

[4] Dr. Laxman Balkrishna Joshi v. Dr. Trimbak Bapu Godhole, AIR 1969 SC 128.

[5] R. v. Lawrence, [1981] 1 All ER 974 (HL).

[6] R. v. Caldwell, [1981] 1 All ER 961 (HL).

[7] Kurban Hussein Mohamedalli Rangawalla v. State of Maharashtra, MANU/SC/0093/1964.

[8] Juggankhan v. State of Madhya Pradesh, AIR 1965 SC 831.

[9] Achutrao Haribhau Khodwa v. State of Maharashtra, 1996 SCC (2) 634.

[10] Indian Medical Association v. V.P. Shantha, 1995 SCC (6) 651.

[11] Medicos Legal Action Group v. Union of India, 2021 SCC OnLine Bom 3696.

[12] https://www.livelaw.in/pdf_upload/1281720196150258085judgement19-dec-2024-1-578005.pdf.

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