Aakarsh Shah, RNPI law school
Editor’s note: Medical negligence is punishable under various laws such as torts, IPC, Indian Contracts Act, Consumer Protection Act, etc. It can be defined as misconduct by a medical practitioner or doctor, and causes many deaths and illnesses each year. This paper covers the legal aspects and consequences of medical negligence, liability of the victim, and aims to spread awareness regarding the same.
Medical negligence is a combination of two words. The second word solely describes the meaning, though the meaning of negligence has not been described in a proper way but it is an act recklessly done by a person resulting in foreseeable damages to the other. Negligence is an offense under tort, IPC, Indian Contracts Act, Consumer Protection Act and many more. Medical Negligence basically is the misconduct by a medical practitioner or doctor by not providing enough care resulting in breach of their duties and harming the patients which are their consumers. A professional is deemed to be an expert in that field at least; a patient getting treated under any doctor surely expects to get healed and at least expects the doctor to be careful while performing his duties. Medical negligence has caused many deaths as well as adverse results to the patient’s health. This article focuses on explaining negligence under various laws, professional negligence, medical negligence and landmark as well as recent cases in India. This provides information on liability that can be incurred by the victim of the medical malpractice. It aims at providing information about the topic to create as much awareness as possible.
“No doctor knows everything. There’s a reason why it’s called “practising” medicine.”
To err is human. Though patients see the doctors as God and believe that their disease will be cured and they will be healed by the treatment but sometimes even the doctors makes mistakes which can cost a lot to the patients in many ways. Sometimes the mistakes are so dangerous that a patient has to suffer immensely. “In my opinion, our health care system has failed when a doctor fails to treat an illness that is treatable.”[i] – Kevin Alan Lee. “Being in such a profession where sick, ill and sufferers are your customers who look upon you as the almighty, an absolute amount of care is expected.” This kind of mistake is called negligence. If an owner of the restaurant can be sued for providing low quality of food then even a doctor can be sued for providing low quality of treatment and care.
Medical negligence also known as medical malpractice is improper, unskilled, or negligent treatment of a patient by a physician, dentist, nurse, pharmacist, or other health care professional.[ii] Medical malpractice occurs when a health-care provider strays from the recognized “standard of care” in the treatment of a patient. The “standard of care” is defined as what a reasonably prudent medical provider would or would not have done under the same or similar circumstances. “The important question isn’t how to keep bad physicians from harming patient; it’s how to keep good physicians from harming patients. – Atul Gawande[iii]. It is unreasonably threatening practice and it is classified as such because first, the actor did or should have foreseen that it would subject another to an adverse risk of harm, and second, the magnitude of the perceivable risk was such that the actor should have acted in a safe manner.[iv]
Mistakes or Negligence in medical profession may lead to minor injuries or some serious kinds of injuries and sometimes these kinds of mistakes may even cause death. Since no man is perfect in this world, it is evident that a person who is skilled and has knowledge over a particular subject can also commit mistakes during his practice. Too err is human but to replicate the same mistake due to one’s carelessness is negligence. The fundamental reason behind medical error or medical negligence is the carelessness of the said doctors or medical professionals it can be observed in various cases where reasonable care is not taken during the diagnosis, during operations, sometimes while injecting anaesthesia etc.
For example, after a severe operation of a patient, he is likely to get infected by many diseases because of certain reason which can include loss of blood, weakness, high dose of medicines. In due course a standard care is expected from the doctor to give premedication regarding certain infectious diseases. If a doctor fails to do so due to which a patient suffers from some infection which can cause a lot of harm or even death in adverse cases, the doctor is said to have committed medical negligence or malpractice.
There are distinct definitions for negligence. It is the omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs, would do or doing something which a prudent and reasonable man would not do. It must be determined in all cases by reference to the situation and knowledge of the parties and all the attendant circumstances.[v] Conduct which is below the standard behaviour established generally for protection of others against unreasonable risk of harm is negligence. As per Winfield, “Negligence as a tort is the breach of a legal duty to the care which results in damage, undesired by the defendant, to the plaintiff.” Negligence doesn’t arise just because of a wrongful conduct by a person; it is essential that that misconduct has caused a foreseeable harm to the other. If there’s no harm, there’s no negligence. In King v. Phillips[vi] it was observed that the question of negligence arises only when there is a direct harm to the plaintiff by the misconduct and the harm should be foreseeable. Damage is an important ingredient to bring negligence under tort.
Negligence as a Tort
A tort is a residuary civil wrong. Duties in tort are fixed by the law and such duties are owed in rem or to the people at large generally. Such wrongs can be remedied by filing for unliquidated damages. There may also be cases where concurrent liability may exist under tort and contract. For instance, if there is a contract existing between a patient and a doctor, then the doctor, for his negligence, will be liable under contract.
Negligence under Contract
A contract may have express or implied terms. There are situations where there is a contract between medical practitioners and patients. Even in the absence of an express stipulation to the effect that the practitioner will exercise reasonable skill and care in treatment of a patient, it is taken as an implied duty arising out of the contract. Breach of this duty thus results in violation of the contract.
Negligence as a Crime
Negligence as a crime has a different yardstick. Negligence under tort is determined on the extent of the loss caused whereas negligence under criminal law is dependent on the degree or amount of negligence. Courts have repeatedly held that the burden of proving criminal negligence rests heavily on the person claiming it. Criminal law requires a guilty mind. If there is a guilty mind, a practitioner will be liable in any case. But if, under the criminal law, rashness and recklessness amount to crime, then also a very high degree of rashness would be required to prove charges of criminal negligence against a medical practitioner. In other words, the element of criminality is introduced not only by a guilty mind, but by the practitioner having run the risk of doing something with recklessness and indifference to the consequences. It should be added that this negligence or rashness or must be ‘gross’ in nature.
Negligence under Consumer Protection Legislations
Ever since professions have been included under the purview of consumer protection laws; medical practitioners too have felt the heat. It is on a footing different from any other kind of negligence. Under consumer protection laws, medical negligence is another form of deficiency in service. It is most akin to the liability under the law of torts. But there is stricter and broader liability in this situation as failure to exercise skill and care as is ordinarily expected of a medical practitioner is the test under consumer protection laws.
Admittedly, doctors have an extremely difficult duty to perform. They are the ones in whose hands a patient places what is most valuable to each human – their lives. It is for this reason that doctors are expected to exercise a very high degree of skill and care, but this is also the precise reason why they should not be inhibited in the exercise of their duty. Therefore the laws imposing liability on medical practitioners have been tailored to accord to practitioners maximum possible protection.
Negligence by professionals
Professionals are persons professing some special skill or job, who are trained to profess in that area specially and bear the responsibility of professing with due care. Such professionals include lawyers, doctors, architects etc. The SC in Jacob Mathew v. State of Punjab,[vii] explained: a professional entering into certain profession is deemed to have knowledge regarding that profession and it is assured impliedly by him that a reasonable amount of care shall be taken to profess his profession. The person can be held liable under negligence if he did not possess the required skills to profess or he failed to take essential amount of care to profess the said profession.
The law nowhere states that a professional shall be held liable if he fails to perform his skills, it states that a professional shall take reasonable amount of care and shall possess knowledge as compared to any practitioner in the same field. The skills of different professionals surely differs from one another even if they are practicing in the same field but what is required is that a professional has knowledge of new advances, discoveries and developments in his field so as to give essential care to the consumers of his profession. The failure to comply with this which any ordinary professional would have done properly amounts to professional negligence liable under the law. This paper discusses the Medical Negligence in detail in the following part.
Doctor’s duty to attend the patient with care
Medicine is such a profession where a practitioner is supposed to have requisite knowledge and skill needed for the purpose and has a duty to exercise reasonable duty of care while dealing with the patient. The standard of the care depends upon the nature of the profession. A surgeon or anaesthetist will be determined by the standard of average practitioner in that field while in case of specialists, a higher skill is needed.[viii]
If the doctor or a specialist doesn’t attend a patient admitted in emergency or under his surveillance and the patient dies or becomes victim of consequences which could have been avoided with due care from the doctor, the doctor can be held liable under medical negligence. This was held in Sishir Rajan Saha v. The state of Tripura[ix] that if a doctor did not pay enough attention to the patients in government hospitals as a result of which the patient suffers, the doctor can be held liable to pay compensation to the patient. Moreover the liability of the doctor cannot be invoked now and then and he can’t be held liable just because something has gone wrong. For fastening the liability, very high degree of such negligence was required to be proved.[x] A doctor or a medical practitioner when attends to his patients, owes him the following duties of care:
- A duty of care in deciding whether to undertake the case
- A duty of care in deciding what treatment to give
- A duty of care in the administration of the treatment
When you go to a doctor, you expect to be seen promptly and attentively, and at a reasonable cost. You expect the doctor to be knowledgeable about the latest advances in his field of specialty, and educate you about your diagnosis and prognosis, and explore the best possible solution to your health issue. In short, you expect to be healed. But for millions of people, what they expect is far from what they receive.
Doctor acting in a negligent manner
It is well accepted that in the cases of gross medical negligence the principle of res ipso loquitur is to be applied[xi]. The principle of res ipso loquitur is said to be essentially an evidential principle and the said principle is intended to assist the claimant.[xii] Res Ipso loquitur means things speaks for itself; while deciding the liability of the doctor it has to be well established that the negligence pointed out should be a breach in due care which an ordinary practitioner would have been able to keep. Latin for “the thing speaks for itself,” a doctrine of law that one is presumed to be negligent if he/she/it had exclusive control of whatever caused the injury even though there is no specific evidence of an act of negligence, and without negligence the accident would not have happened. A doctor is not an insurer for the patient, inability to cure the patient would not amount to negligence but carelessness resulting in adverse condition of the patient would.
In Gian chand v. Vinod kumar Sharma[xiii] it was held that shifting of the patient from one ward to another in spite of requirement of instant treatment to be given to the patient resulting in damage to the patient’s heath then the doctor or administrator of the hospital shall be held liable under negligence. Also in Jagdish Ram v. State of H.P.[xiv], it was held that before performing any surgery the chart revealing information about the amount of anaesthesia ad allergies of the patient should be mentioned so that an anaesthetist can provide ample amount of medicines to the patient. The doctor in above case failed to do so as a result of the overdose of anaesthesia the patient died and the doctor was held liable for the same.
The liability of the person committing the wrong can be of three types depending on the harm or the injury suffered by the injured person they are
- Civil Liability– Civil liability usually includes the claim for damages suffered in the form of compensation. If there is any breach of duty of care while operating or while the patient is under the supervision of the hospital or the medical professional they are held to be vicariously liable for such wrong committed. And are liable to pay damages in the form of compensation. At times the senior doctors are even held vicariously liable for the wrongs committed by the junior doctors. If someone is an employee of a hospital, the hospital is responsible if that employee hurts a patient by acting incompetently. In other words, if the employee is negligent (is not reasonably cautious when treating or dealing with a patient), the hospital is on the hook for any resulting injuries to the patient[xv]. In Mr. M Ramesh Reddy v. State of Andhra Pradesh[xvi], the hospital authorities were held to be negligent, inter alia, for not keeping the bathroom clean, which resulted in the fall of an obstetrics patient in the bathroom leading to her death. A compensation of Rs. 1 Lac was awarded against the hospital[xvii]
- Criminal Liability- There may be an occasion when the patient has died after the treatment and criminal case is filed under Section 304A of the Indian Penal Code for allegedly causing death by rash or negligent act. According to S. 304A of the IPC, whoever causes the death of any person by a rash or negligent act not amounting to culpable homicide shall be punished by imprisonment for up to two years, or by fine, or both[xviii]. Hospitals can be charged with negligence for transmission of infection including HIV, HBsAg, etc. if any patient develops such infection during the course of treatment in the hospital and it is proved that the same has occurred on account of lapse on part of the hospital then the hospital can be held liable for lack of reasonable duty to care. My very own grandmother passed away due to the negligence of the doctors. Due to the carelessness of the doctor that he was in so hurry to rush for his next operation that he forgot to sterilize the equipments and as a result there was this transmission of some infection into her blood which infected her entire system and ultimately resulted in her death.
- Further In Dr. Suresh Gupta’s Case – Supreme Court of India, 2004 – the court held that the legal position was quite clear and well settled that whenever a patient died due to medical negligence, the doctor was liable in civil law for paying the compensation. Only when the negligence was so gross and his act was as reckless as to endanger the life of the patient, criminal law for offence under section 304A of Indian Penal Code, 1860 will apply.[xix] Indian Penal Code 1860 sections 52, 80, 81, 83, 88, 90, 91, 92 304-A, 337 and 338 contain the law of medical malpractice in India.
- The conduct of medical malpractice was brought under the Consumer Protection Act, 1986, due to the landmark case of the Indian Medical Association vs. V. P. Shantha & others[xx], The judgment in this case defined medical care as a “service” that was covered under the Act, and also clarified that a person seeking medical attention may be considered a consumer if certain criteria were met.
-The service provided was not free of charge or for a nominal registration fee;
-If free, the charges were waived because of the patient’s inability to pay;
-The service was at a private hospital that charges all patients; or
-Any service rendered which was paid for by an insurance firm.
This meant that certain categories of patients could now sue errant health care providers for compensation under the Consumer Protection Act, 1986, as a breach of contract. Only facilities and doctors that provided all services free of cost to all clients were not liable under the CPA. However, even patients that do not fall under the category of consumers under the Act can sue for negligence under the law of Torts. The burden to prove negligence, however, is on the patient.
It is not stated that doctors are negligent or irresponsible but while performing the duty which requires a lot of patience and care, often many practitioners fail or breaches their responsibility towards the patient. Medicine which is one of the noblest professions requires setting a realm which can benefit the victims of various diseases. Many doctors even the specialist sometimes neglects small things to be taken care of while practicing which may result in damages to the patients that could have been avoided or sometimes even the death of the patients. This type of professional negligence needs more focus than to include it in other laws or statutes. An independent and unique legislature shall be set up to govern the malpractice. In our country recently in a case Krishna Iyer v. State of Tamilnadu and Others[xxi] the Apex Court awarded a compensation of 1.8 crores on July 1, 2015 as she lost her eyes in 1996. This is highest amount of compensation awarded in the country. Many activists and the victims of medical negligence have been alleging to get redressal against malafied acts of medical practitioners and doctors. Not just for medicine, the law shall be made applicable to all the professionals practicing in different areas which require a requisite amount of skill and duty of care. People in our country are already victims of many diseases and are dying due to same, let’s make efforts to reduce these deaths and focus on improvising the profession so that people do not die in the place where they come to get healed.
Edited by Neerja Gurnani
[ii] The Law Dictionary
[iv] See W. Prosser, Handbook on the Law of Torts 145-49 (4th ed. 1971)
[v] Blythe v. Birmingham Waterworks Co. 11 Evch. 7S4, nitroglycerin case, 15 wall, 536,21 I Ed. 206
[vi] [(1953) 1 QB 429]
[vii] A.I.R. 2005 S.C. 3180
[viii] Dr. P. Narsimha Rao v. G. Jayaprakashu, AIR 1989 A.P. 207, at 215
[ix] A.I.R. 2002 Gauhati 102
[x] A.I.R. 2010 S.C. 1162
[xi] Spring Meadows Hospital v. Harjot Ahluwalia, A.I.R. 1998 S.C. 1801
[xii] Soni Hospital v. Alum Biyer, A.I.R. 2011 Mad. 208 at 214
[xiii] A.I.R. 2008 H.P. 97
[xiv] A.I.R. 2007 (NOC) 2498 (H.P.)
[xvi] [2003 (1) CLD 81 (AP SCDRC)]
[xvii] Sharma J and Bhushan V. Medical Negligence & Compensation. 2 nd Edition. New Delhi: Bharat Publications; 2004.
[xix] Dr. Suresh Gupta vs. Government of N.C.T. of Delhi, August 4, 2004, Supreme Court of India, AIR 2004 SC
[xx] (1995) 6 SCC 651
[xxi] 2015 STPL(Web) 1239 SC