Exploring the balance between patient care and the legal implications of medical errors in contemporary healthcare
The medical profession, universally esteemed as one of the noblest, is entrusted with the preservation of life. Patients often place unwavering trust in doctors, viewing them as lifesavers, (almost divine). However, doctors, like all humans, are fallible. Despite their expertise and dedication, mistakes can happen, sometimes leading to negligence. These unfortunate instances can escalate into legal disputes between patients and medical professionals. To address this growing challenge, many countries have implemented comprehensive regulations, giving rise to a specialized legal domain known as medical negligence law.
Negligence occurs when a person fails to fulfill their duty of care towards another, resulting in harm or damage that could have been avoided. Medical negligence occurs when the doctor fails to provide due care to the patient which results in harm to the patient. The main aim of the introduction of stringent punishments is to reduce acts of negligence. A medical practitioner must take care of the patient and ensure utmost protection. The relationship between doctors and patients often involves an unspoken, unannounced agreement rooted in trust and responsibility. Patients, by seeking care, inherently trust doctors to act in their best interest, providing accurate diagnoses, treatments, and care with compassion. On the other hand, doctors commit themselves to this trust, following ethical guidelines and medical standards, and prioritizing patient well-being.
While no formal contract is signed at every consultation, this mutual understanding forms the basis of medical practice. However, when this trust is broken, whether through negligence or miscommunication, it can lead to disputes, legal challenges, and a breakdown of this implicit agreement. The Apex court also in Dr Laxman Balkrishna Joshi vs. Dr. TrimbhakBapu Godbole 1969 AIR 128, 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. complaints of medical negligence are covered under the provisions of the Consumer Protection Act, 1986 and a patient can seek redressal of grievances from the Consumer Courts. Any aggrieved person can claim damages for medical negligence against a doctor or a hospital. Section 69(1) of the Consumer Protection Act, 2019 lays down the time limit within which a complaint for medical negligence must be filed as 2 years from the date of injury.
Medicine is a science and to set probability is the need of science
Medicine, like all sciences, operates on the principle of probability, reflecting the inherent uncertainty in diagnosing and treating conditions. Science, by nature, seeks patterns and predictions, but no outcome can be guaranteed with absolute certainty, especially in complex biological systems. In medicine, probabilities help in determining the likelihood of diseases, treatment success, or risks associated with interventions. Doctors rely on evidence-based practices, using the most probable outcomes to guide decisions, yet acknowledging that individual variations exist. The Apex Court discussed the issue of medical negligence. In Poonam Verma v. Ashwin Patel &Ors, AIR 1996 SCC (4) 332 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.
Under new law, doctors face two years of imprisonment for death due to negligence
Patients often have the burden of proof of legal cases and a lack of awareness of the laws discourages the enforcement of legal rights available to the aggrieved patients and victims of medical negligence. The patient may suffer financial losses, mental agony, loss of life and trauma. Criminal consequences of medical negligence were governed by Section 304Aof the Indian Penal Code (IPC) which states, Whoever causes death of any person by doing any rash or negligent act amounting to culpable homicide, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.
The three new criminal laws, the “Bharatiya Nyaya Sanhita,” the “Bharatiya Nagarik Suraksha Sanhita,” and the “Bharatiya SakshyaAdhiniyam,” have replaced the Indian Penal Code (IPC), the Code of Criminal Procedure (CrPC), and the Indian Evidence Act respectively, effective from 1 July 2024. Section 106 (1) of the Bharatiya Nyaya Sanhita says: “Whoever causes death of any person by doing any rash or negligent act not amounting to culpable homicide, shall be punished with imprisonment of either description for a term which may extend to five years, and shall also be liable to fine; and if such act is done by a registered medical practitioner while performing medical procedure, he shall be punished with imprisonment of either description for a term which may extend to two years, and shall also be liable to fine. The section was amended to include the clause on medical practitioners.
It further explains that for this sub-section, “registered medical practitioner” means a medical practitioner who possesses any medical qualification recognised under the National Medical Commission Act, 2019 and whose name has been entered in the National Medical Register or a State Medical Register under that Act.in Jacob Mathew v. State of Punjab and Another, AIR 2005 6 SCC 1 Thus medical negligence is the commission or omission of an act by a medical professional or healthcare provider which deviates from the accepted standards or practice of the medical community, leading to an injury of the patient. In the case of Kusum Sharma and others v. Batra Hospital and Medical Research and others (3) SCC 480, while defining and laying down the standards of medical negligence, the court stated that the doctor must have a reasonable degree of skill and knowledge and should exercise care of a reasonable degree neither highest nor very low and a doctor would be liable only when the conduct falls below that of a reasonably competent doctor.
Conclusion
Negligence is not an absolute concept, rather, it is relative and must be assessed in the context of specific circumstances, available resources, and the intentions of the individuals involved. The actions of an expert, particularly in fields like medicine, are influenced by these factors, which determine whether their conduct can be considered negligent. For instance, what might be deemed negligence in a well-equipped urban hospital could be seen differently in a rural setting with limited resources. Medical negligence is a complex legal concept that requires a balance of both objective and subjective evaluation to ensure fair judgment. Objectively, it involves assessing whether the healthcare professional’s actions met the standards of care expected in their field. This comparison with the conduct of a “reasonably competent” doctor helps determine if there was a breach of duty. The objective analysis is based on medical protocols, evidence, and expert opinions. By integrating both objective facts and the subjective intentions of the healthcare provider, the legal evaluation of medical negligence ensures accountability while recognizing the challenges faced by medical professionals. This dual approach is crucial for delivering justice to both patients and doctors, ensuring fairness in every case, and understanding the nuances of medical practice.
The writer is an Assistant Professor at the University Institute of Legal Studies, Chandigarh University
By Dr Ajaz Afzal Lone