“When Doctors Fail: Legal Provisions and Punishment For Medical Negligence”

ACCOUNTABILITY VS. WHITE COATS

Addressing medical negligence in India

The future of a nation is completely dependent on the future of its population. When looking into the essential components of development, the health of the population comprising the nation is vital to its economic growth and internal stability.

Indian doctors are widely respected across the globe. Among all the professional groups in the country, without any doubt they form the most privileged class. But when we take a look into the accountability of the people belonging to this profession we can understand that, any kind of negligence from their part will not be taken lightly and will be punished accordingly.

At present, medical negligence is a significant problem in India. Along with this, commercialization of healthcare is also a grave challenge as it creates inequality among the people.

Meaning of Medical Negligence

Negligence can be defined as, neglect of some care which we are bound to exercise towards somebody. It is something less than misconduct.

In the case of medical negligence, it is neglecting some care that has to be taken by the doctor towards his or her patients. Medical negligence is a professional negligence. Under this, the wrongdoer must have a special skill. Medical negligence is not different in law from any other type of negligence. The basis of liability of professional negligence is that of negligence itself as held by the court in the case State of Punjab vs. Shiv Ram, (2005) 7 SCC 5.

Nature of Medical Negligence

Medical Negligence can be broadly classified into two types:

(i) Civil medical negligence

(ii) Criminal medical negligence

This division is based on the liability, that is the necessity that exists between the wrongdoer and the remedy of wrong.

Civil Medical Negligence

It is a case of medical negligence, where there is an infringement of a civil right. Patients whose rights are violated can sue for compensation in consumer forums or civil courts. Injunction is also a remedy provided.

Criminal Medical Negligence

This negligence is more grave than the breach of a civil duty. The negligence must be so great, as it should not come within the purview of compensation. The general ingredients of criminal liability can be understood from the maxim, ‘actus non facit reum nisi mens sit rea’, which means, the act alone does not amount to guilt, it must be accompanied by a guilty mind.

Legislative provisions regarding Medical Negligence in India

The Constitution of India, which is the supreme law of the land, does not expressly safeguard the right to health care. Although, the right to health care and it's protection has been recognized from a very early time. But Preamble, Fundamental Rights and Directive Principles of State Policy have a direct link on enhancing the healthcare of Indian citizens.

Several laws has been enacted, this includes:

●      The Indian Penal Code,1860

●      The Fatal Accidents Act, 1855

●      The Indian Medical Degrees Act, 1916

●      Pharmacy Council of India Regulations, 1952

●      Prevention of Food Adulteration Act, 1954

●      The Transplantation of Human Organs Act, 1994,etc.

The Constitution of India

There is no direct provision on medical negligence in the Constitution. However it is indirectly covered under Article 21 of the Constitution, which guarantees the ‘Right to life and personal liberty’, which includes the right to live with dignity and not only that it also imposes a duty on the state to secure the health of its people. And if this right is violated, one can approach the Supreme Court as mentioned under Article 32 and High Court under Article 226.

The Indian Penal Code, 1860

IPC addresses criminal liability for medical negligence, specifically under Sec. 304A. This section deals with the cases of death caused by negligence which also includes the death caused due to negligent acts of medical practitioners such as Doctors, medical assistants, nurses, etc.

Sec. 304A also provides punishment, that is, imprisonment of either description for a term which may extend to two years or with fine or with both. Under Bharatiya Nyaya Sanhita, 2023 the corresponding section is Sec. 106.

The Contract Act, 1872

Liability of health professionals under the Indian Contract Act, 1872, mainly depends upon the express and implied terms agreed upon by the patient or his representatives and the doctor or hospital's consent for treatment on payment of fees on the part of a patient can be treated as an implied contract with the doctor, who by undertaking treatment on acceptance of fees, promises to exercise proper care and skill.

According to Sec. 74 of Indian Contract Act, 1872, Medical practitioner is liable to pay compensation to the patient as there is a breach of contract, when proper care is not given and is acting negligently.

The Indian Medical Council Act, 1956

This act was enacted with the objective of the reconstitution of the medical council in India. If any registered medical practitioner is found guilty of professional misconduct then his name will be removed from the medical council.

This act has been repealed and replaced by the National Medical Commission (NMC) Act, 2019, which now governs medical education and professional conduct in India.

The Consumer Protection Act, 1986

Under this act, the patients have the right to file a case, if they face medical negligence. But it is to be noted that, medical profession has been brought under Sec. 2(1) (o) of Consumer Protection Act, 1986, only after the Supreme Court judgement in the case Medical association vs. V P Shantha. The burden of proof lies upon the patient or relatives to prove negligence. Res ipsa loquitur is a situation of gross negligence where, thing speaks  for itself and thus it is not required to be proved.

Consumer Forums or Consumer courts are established to adjudicate the disputes arising among the consumers. In India, Consumer Protection Act, establishes three tier grievance redressal mechanisms:

1. National Consumer Disputes Redressal Commission

2. State Consumer Disputes Redressal Commission

3.  District Consumer Disputes Redressal Commission

Some of the important cases cited under medical negligence includes :

1)      In Phillips India Ltd v. Kunju Punnu (AIR 1975 Bom. 306), the plaintiff’s son was wrongly diagnosed by a hospital-employed doctor as having a venereal disease instead of smallpox, leading to incorrect treatment and the boy’s death. However, the Court held that a mere error in diagnosis does not by itself amount to medical negligence. For a doctor to be held liable, the mistake must be so unreasonable that it reflects a clear lack of due care and professional competence. Since this standard was not met, the Court dismissed the negligence claim against the hospital.

2)      In Jasbir Kaur v. State of Punjab (AIR 1995 P&H 278),a newborn baby went missing from his bed in Bahadur Hospital, Amritsar, during the night. Later, the baby was found near a bathroom washbasin, badly bleeding with one eye missing. The hospital claimed a cat had caused the injury, but the Court did not accept this and held the hospital responsible for gross negligence. The parents were awarded ₹1 lakh as compensation.

3)      In Laxman Balkrishna Joshi v. Dr. Trimbak Bapu Godbole (AIR 1969 SC 128), a doctor performed surgery on a patient with a fracture without giving anaesthesia, which led to the patient suffering a nervous shock and eventually dying. The Supreme Court held that the doctor failed in his duty to take proper care and was therefore liable for medical negligence.

Conclusion

In conclusion, the issue of Accountability vs. White coats brings to light the critical balance between the noble profession of medicine and ensuring that medical practitioners are held responsible for their actions. Only those medical negligence is actionable which has three elements, that is, the duty to take care, breach of that duty to take care and consequential damages. As already mentioned, there are various legislative provisions dealing with the cases of medical negligence. But there is no legislation which has direct laws on medical negligence. Strengthening transparency, improving grievance redressal systems and implementation of  provisions mentioned under Consumer Protection Act and other relevant acts are necessary reforms.

Role of state as well as a fair and just system that protects both the patient’s rights and doctor's dignity is vital for restoring trust in the healthcare system.