The medical profession, revered in society, sees doctors in both private and hospital settings striving to provide patients with care and diligence. Despite this, claims of medical negligence frequently emerge in consumer, criminal, and civil courts. Notably, this issue is now encompassed within the Consumer Protection Act of 2019.
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Historically, medical negligence was often viewed more as a criminal act rather than a tort. Early legal systems, rooted in local customs, regulated medical professionals' conduct. As per ancient Indian texts, the term 'mithya' depicted negligent medical care, with classical texts like Sushruta Samhita emphasizing penalties for medical malpractice, varying with the patient's status. Similarly, the Yajnavalkya Smriti prescribed fines for medical negligence, depending on the harm caused.
Medical Negligence in India under Tort Law
Negligence as a tort involves failing to perform an action that a reasonable person would, or performing an act that a reasonable person wouldn’t, resulting in harm. Medical negligence in india under tort rest on these definitions
This definition incorporates the following interrelated, yet independent constituents:-
1. A legal duty to exercise reasonable skill, knowledge and care;
2. A breach of that duty; and
3. Consequential damages arising from such breach29
Bolam Test and Medical negligence in India
The test for determining the negligence of a medical professional was first given by McNair J. in Bolam’s case to be ‘the standard of the ordinary skilled man exercising and professing to have that special skill’. In this case, Mr. Justice McNair articulated a standard for assessing professional negligence.
He stated that a doctor is not negligent if they act in accordance with a practice accepted as proper by a reasonable body of medical professionals. This test essentially sets a benchmark where the standard of care in medical negligence cases is determined by reference to the general level of skill and expertise in the medical community.
The standard for assessing a medical professional’s negligence, as established in Bolam’s case and later upheld in Indian case law on Medical Negligence in India.
Application of Bolam Test in Indian Context:
Suresh Gupta v. Govt. of NCT of Delhi: This case initially saw the Indian judiciary accepting the Bolam test. The Supreme Court of India applied the principles of Bolam, suggesting that a medical professional is not negligent if their actions conform to a practice accepted as proper by a reasonably competent body of medical professionals.
Jacob Mathew v. State of Punjab: The case of Suresh Gupta was later referred to a larger bench in the case of Jacob Mathew v. State of Punjab, which further solidified the acceptance of the Bolam test in India. This case is significant because the Supreme Court specifically addressed the issue of criminal liability of doctors in cases of alleged medical negligence.
Shiv Ram v. State of Punjab: This case further affirmed the principles laid down in the Jacob Mathew case. The Supreme Court reiterated the need for establishing a higher degree of negligence for criminal liability, reinforcing the Bolam test’s applicability in assessing medical negligence.
Medical Negligence in India And Consumer Protection Act
Consumer Protection Act revolutionized redressal mechanisms for consumers of various services, including healthcare. The Act’s broad definition of 'service' encompasses medical services, as clarified in the landmark judgment of Indian Medical Association v. Shantha. Key points from this judgment include:
Medical services fall under the Act's service definition.
Free medical services by hospitals or independent doctors are not covered under the Act.
Paid medical services and those paid by a third party are included under the Act.
Hospitals offering both free and paid services are within the Act’s ambit.
In Nihal Kaur v. Director, P.G.I.M.S.R. a patient died a day after surgery and the relatives found a pair of scissors utilized by the surgeon while collecting the last remains. The doctor was held liable and a compensation of Rs. 1.20 lakhs was awarded by the state consumer forum, Chandigarh.
In the significant case of Malay Kumar Ganguly v. Sukumar Mukherjee, the Supreme Court of India thoroughly examined the concept of ‘medical negligence’ and the necessary standard of care expected from medical professionals. The Court established several principles to guide the determination of medical negligence or service deficiency:
No Assurance of Cure by Doctors: The Court recognized that no doctor or surgeon can guarantee the cure of a patient. The inherent uncertainties in medical treatments and individual patient reactions imply that even with optimal care, successful outcomes cannot always be assured.
Required Standard of Skill and Care: The judgment highlighted that doctors are expected to exercise a fair, reasonable, and competent level of skill in their practice. This standard does not necessarily mean the highest level of skill but demands a basic level of competency and knowledge expected of a professional in the field.
Choice of Treatment Methods: When multiple treatment options are available, choosing one of them and administering it with due care and caution does not constitute negligence. This principle acknowledges the often complex decision-making process in medical treatment, where different viable options may be present.
Negligence in Diagnosis and Treatment: A failure to act according to the standard and reasonable degree of care and skill can lead to negligence. Particularly, if a doctor fails to use the necessary skill in diagnosing a condition, resulting in incorrect treatment, this can be deemed as negligence.
Approach in Complex Cases: The Court stated that in cases involving complicated medical issues, it would be cautious in attributing negligence to a doctor, especially if the doctor has performed their duties to the best of their ability and knowledge.
The legal framework for medical negligence, deeply rooted in Tort Law, establishes that criminal liability in medical practice arises only in cases of evident gross negligence.
The judicial interpretations by the Supreme Court offer guiding principles for resolving medical negligence cases, which are often complex and challenging. The Consumer Protection Act offers an accessible, cost-effective avenue for victims of medical negligence to seek justice, particularly benefiting those with limited resources. This legal infrastructure, while still evolving, provides significant protection and recourse to patients against medical malpractice.
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