Understanding the principles, components, and judicial analysis of medical negligence in India, with a comparative international perspective

The medical profession is considered one of the noblest in the world because it preserves life. A patient often approaches a doctor based on their reputation. For the patient, a doctor is like a god. But in reality, a doctor is human too, and to err is human. Doctors can sometimes make mistakes; they can be negligent, leading to conflicts and legal disputes between doctors and patients. Due to this, many rules and principles have been formed by most countries to deal with such scenarios, which have led to the development of a new branch of jurisprudence, i.e., medical negligence.

Negligence, in simple terms, means the failure to take due care and caution. It is a breach of duty caused by an omission to do something that a reasonable person, guided by those considerations, should have done. It also connotes something that a reasonable person would not have done.

India, as a country, is committed to the rule of law; these matters are taken to court and decided there. However, negligence becomes difficult for judges to determine because they are not trained in medical science. Therefore, “expert opinion” is sought in these matters; reasonableness and prudence become the guiding factors.

In this paper, we will explore these principles in light of some court judgments and try to understand what is expected from a medical professional as a reasonable person and what their duties are towards the patients.

1. Negligence – Meaning:

Black’s Law Dictionary defines negligence as “conduct, whether of action or omission, which may be declared and treated as negligence without any argument on proof as to the particular surrounding circumstances, either because it is in violation of a statute or valid Municipal ordinance or because it is so palpably opposed to the dictates of common prudence that it can be said without hesitation or doubt that no careful person would be guilty of it. As a general rule, the violation of a public duty, enjoined by law for the protection of a person or property, so constitutes.”

Negligence is the breach of a duty caused by the omission to do something which a reasonable person, guided by those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable person would not do. Actionable negligence consists of the neglect of the use of ordinary care or skill towards a person to whom the defendant owes the duty of observing ordinary care and skill, by which neglect the plaintiff has suffered injury to their person or property.

The definition involves three constituents of negligence:

1. A legal duty to exercise due care on the part of the party complained of towards the party complaining within the scope of the duty
2. Breach of the said duty
3. Consequential damage

“When a medical professional or service provider indulges in any inhuman behavior, creating an atmosphere of terror or victimization with medical knowledge or license, it’s not solely negligence; it’s also a medical act of terrorism.”

In Poonam Verma v. Ashwin Patel & Ors., the Apex Court discussed the issue of medical negligence and held that, “Negligence has many manifestations. It may be active negligence, collateral negligence, comparative negligence, concurrent negligence, continued negligence, criminal negligence, gross negligence, hazardous negligence, active and passive negligence, willful or reckless negligence, or Negligence as such.”

In the case of Dr. Laxman Balkrishnan Joshi vs. Dr. Trimbark Babu Godbole, the court laid down that when a doctor is consulted by a patient, the doctor owes their patient certain duties which are:

1. Duty of care in deciding whether to undertake the case;
2. Duty of care in deciding what treatment to give;
3. Duty of care in the administration of that treatment.

A breach of any of the above duties may give rise to a cause of action for negligence, and the patient may, on that basis, recover damages from the doctor.

1. Components of Negligence:

Winfield has propounded three important components in order to constitute medical negligence, which are:

1. Existence of a legal duty: Existence of a legal duty begins from the very first instance when a patient consents to a doctor for their illness. Although the patient does not ordinarily enter into any contract, written or oral, it is implied that any erring attitude will amount to a breach of professional duty on the part of the doctor. So it is incumbent upon doctors to treat patients with an implied assurance of special skill and knowledge.
2. Breach of legal duty: The second important component of negligence is the breach of duty on the part of the doctor. Whatever is expected from a prudent person who has developed the necessary skill after years of experience certainly constitutes their legal duty, and not to deviate from it in ordinary circumstances is the norm. Therefore, a breach of legal duty is perceived whenever the doctor does something not in tune with what an ordinary person or a regular practitioner would have omitted. The test for deciding whether there has been a breach of duty was laid down in *Blyth v. Birmingham Waterworks*. It was said that “negligence is a breach of duty caused by the omission to do something which a reasonable person, guided upon those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable person would not do.”
3. Breach of duty should have caused the damage: Another important ingredient of negligence is that there should be a connection between the breach of duty and the damage. It implies that the plaintiff is required to prove the causal connection between the breach of duty and the damage; it implies that, where some fault has been attributed to the defendant, the plaintiff should prove that the defendant was negligent. However, every act by the doctor shall not render them negligent. In *Laxman v. Trimba*, the court held: “The duties which a doctor owes to their patient are clear. A person who holds himself out as ready to give medical advice and treatment impliedly undertakes that they possess the skill and knowledge for the purpose. Such a person, when consulted by a patient, owes them certain duties, viz., duty of care whether to undertake the case, a duty of care in deciding what treatment to give, or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient. The practitioner must bring to their task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires.”

III. Navigating the Legal Landscape of Medical Negligence in India:

In India, there are various legislations that can be utilized to initiate legal action against erring doctors or other medical staff, such as:

1. Indian Medical Council Act, 1956 and Dentists Act 1984: These two Acts regulate the medical profession in India. Under these Acts, the Medical Council of India and the Dental Council of India are constituted along with state medical and dental councils, which enforce the Acts. These Councils prescribe the standards of professional conduct and a code of ethics to be followed by all medical practitioners, the violation of which is actionable under the Acts. The State Medical Councils are empowered to take disciplinary action against medical practitioners whereby their name could be removed forever, or they may be suspended. Therefore, one consequence of negligence could be in the form of the imposition of penalties pursuant to disciplinary action.
2. Civil Courts: This is one of the remedies available to aggrieved persons. An aggrieved person can initiate proceedings for compensation and damages against a medical practitioner for negligence. This principle of initiating action is based on Tort Law. Under Civil Law, claims can also be made under the provisions of the Fatal Accidents Act, 1855. This Act has been used by the Supreme Court of India to award compensation in many cases.
3. Indian Penal Code (IPC): IPC primarily governs the Criminal Liability in cases of medical negligence in India. Although the term ‘medical negligence’ is not explicitly defined in the IPC, it provides a legal basis for holding a medical professional liable for their omissions or actions. Section 304A of IPC deals with the cases involving the death of a person due to a rash or negligent act. This provision is frequently invoked in cases of medical negligence leading to a patient’s death. Also, other provisions of the IPC, such as Section 337 and Section 338, are also used in cases of medical negligence. In these cases, the difference between civil and criminal liability is hinged on the degree of negligence.
4. Consumer Protection Act: Under the Consumer Protection Act, if the services availed by a consumer suffer from any deficiency, the consumer can initiate proceedings under the Act. After its advent, almost all cases of medical negligence are being initiated under this Act. The Supreme Court, in the case of *Indian Medical Association v. V.P. Shantha*, brought the medical profession under the ambit of the Consumer Protection Act. The Court said that Section 14 (1) (d) of the Consumer Protection Act applies to the medical profession also.
5. Writ Jurisdiction: Each aggrieved person has a constitutional right under Articles 32 and 226 of the Indian Constitution to approach the High Court or Supreme Court for redressing their grievances. The Constitutional Courts can award compensation against erring medical professionals and institutions who fail in their public law duties towards their patients.
6. Medical Negligence: International Perspective

United Kingdom

In the United Kingdom, the National Health Service Litigation Authority (NHSLA) is a special health authority responsible for handling medical negligence cases on behalf of the National Health Service (NHS). This authority manages claims against NHS organizations, aiming to ensure fair compensation for those who have suffered due to negligence while also protecting the NHS from unnecessary legal costs. The NHSLA publishes annual reports detailing the number and nature of claims received. It is noted that claims are settled, on average, within 1.25 years. The UK’s legal framework emphasizes the importance of preventing negligence through stringent professional standards and encouraging the resolution of disputes through mediation before court proceedings.

United States

In the United States, medical negligence is a significant concern and is considered the third leading cause of death, according to the Journal of the American Medical Association (JAMA). The legal system treats these cases as civil torts, emphasizing extensive discovery and negotiation between the parties to avoid going to trial. Damages awarded may include compensation for both economic losses, such as medical expenses and lost wages, and noneconomic losses, such as pain and suffering. The US legal system encourages settlements, but if a case does go to trial, the jury plays a significant role in determining liability and damages. The complexity and costs associated with medical malpractice litigation have led to debates about the need for tort reform to balance the interests of patients and healthcare providers.

Italy

In Italy, the interpretation of medical negligence historically required establishing gross negligence on the part of the treating doctor. Currently, more than 15,000 medical liability actions are filed annually against doctors and hospitals, reflecting a crisis in the patient-physician relationship. The Italian Ministry of Health has addressed this issue by publishing a manual for healthcare employees on the “Safety of Patients and Management of Clinical Risk.” This document provides a comprehensive set of guidelines aimed at improving patient safety and reducing the risk of medical errors, thereby fostering a more transparent and accountable healthcare environment.

Sweden and New Zealand

Both Sweden and New Zealand have adopted a no-fault system for handling medical negligence cases, with Sweden implementing it in 1975. Under this system, compensation is provided to patients who suffer harm due to medical treatment without requiring proof of negligence. A Patient Insurance Fund, financed by county taxes and contributions from private healthcare providers, is used to compensate patients. When a claim is made, the healthcare provider submits a report to a judge, who then investigates and awards compensation as appropriate. This approach aims to reduce the adversarial nature of medical negligence claims and focus on fair compensation and improved patient safety.

1. Judicial Analysis

Dr. Laxman Balkrishna Joshi vs. Dr. Trimbhak Bapu Godbole

The Supreme Court of India established that a doctor owes a duty of care to their patients. This duty encompasses deciding whether to undertake the case, determining the appropriate treatment, and administering that treatment correctly. Breach of any of these duties could lead to medico-legal proceedings against the doctor.

Indian Medical Association vs. V.P. Shantha

This landmark judgment in 1995 brought the medical profession under the purview of the Consumer Protection Act, 1986. It defined the relationship between patients and medical professionals as contractual, allowing patients to seek compensation for injuries resulting from medical negligence under consumer law. This decision significantly increased the accountability of medical practitioners.

Paschim Bengal Khet Mazdoor Samity & Ors. vs. State of Bengal

The court held that the duty of care extends beyond individual doctors to include the medical institution or hospital where treatment is provided, including government hospitals. This ruling emphasized institutional responsibility for patient care.

Jacob Mathew vs. State of Punjab & Anr

In this case, the Supreme Court of India extensively discussed the criteria for establishing medical negligence. The court stated that a private complaint against a doctor would not be entertained without prima facie evidence supported by a competent medical opinion, preferably from a government-employed doctor. This guideline aims to prevent frivolous litigation against medical practitioners.

Balram Prasad vs. Kunal Saha & Ors

The Supreme Court noted the rising trend of medico-legal cases in India and stressed the need for strict guidelines and penalties for negligent medical treatment. The court awarded one of the highest compensation amounts in India for medical negligence, underscoring the need for accountability in the medical profession.

1. Statistics

– A study published in 2022 by the National Library of Medicine reported approximately 5.2 million cases related to medical negligence in India.

– The Indian Journal of Medical Ethics highlighted that only 46% of healthcare providers adhere to ethical guidelines.

– Legal sources indicate a 400% increase in medical negligence litigation in recent years, with Punjab, West Bengal, Maharashtra, and Tamil Nadu leading in cases filed.

– The National Crime Records Bureau (NCRB) reported 626 alleged criminal medical negligence cases under Section 304A of the IPC between 2017 and 2019. North, Central, and South zones accounted for 118 (18.86%), 115 (18.37%), and 128 (20.45%) cases, respectively, while the North-East zone reported the fewest cases at 23 (3.68%).

VII. Conclusion

The judiciary in India has generally shown deference to the medical profession when handling negligence cases, emphasizing the need for doctors to exercise reasonable care and diligence. However, when a medical professional acts in a manner that deviates significantly from accepted standards of practice, it constitutes negligence. Creating a more precise legal framework for medical negligence is essential to protect both patients and healthcare providers. Public awareness and education are crucial in informing people about their rights and the recourse available in cases of medical negligence. Implementing a no-fault liability system in public healthcare, as seen in countries like Sweden and New Zealand, could provide a balanced approach in India, especially considering the disparities in healthcare access and quality between rural and urban areas. Increased government investment in healthcare infrastructure is also necessary to improve overall patient safety and reduce incidents of negligence.

The writer is a final-year law student at the University of Kashmir and an intern at BTG Advaya

By Ibtisam Gani 

[email protected]

Ibtisam Gani