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Report of the Medical Council cannot be determinative, when it contradicts with the evidentiary findings of Consumer Forum on Medical Negligence: Supreme Court

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Case title – Najrul Seikh vs Dr. Sumit Banerjee & Anr

Case no. – Civil Appeal No(S). OF 2024 [Arising out of SLP (Civil) No(s). 17437 of 2018]

Decision on – February 22, 2024

Quoram – Justice Vikram Nath and Justice Satish Chandra Sharma

Facts of the case

The Appellant is the father of Master Irshad, a 13-year-old boy. The appellant unable to finance the surgery at Disha Eye Hospital approached the Respondent 1 and 2 (Doctor and Megha Eye Centre). After the surgery, by Respondent No. 1, Irshad began experiencing irritation, pain, and blood clotting with no relief in his condition.

Respondent No.1 eventually referred them to the Regional Institute of Ophthalmology (‘RIO’). The Appellant and his son visited the RIO a month later and were informed that it was a case of Retinal detachment leading to permanent loss of vision in the right eye, caused due to the faulty operation conducted by Respondent No. 1.

The Appellant alleged negligent cataract surgery by the Respondents and filed a complaint under Section 12 of the Consumer Protection Act, 1986. The District Consumer Disputes Redressal Commission (DCDRC) relied on the uncontroverted expert evidence provided by Dr. Anindya Gupta and held that there was deficiency in the medical services provided by the Respondents and thereby, directed a payment of INR 9,00,000 as compensation.

However, the order of the DCDRC was set aside by the West Bengal State Consumer Disputes Redressal Commission (‘SCDRC’). The SCDRC relying on the report of the West Bengal Medical Council found contributory negligence on part of the Appellant in visiting the RIO a month later.

Thereafter, a revision petition preferred by the Appellant before the National Consumer Disputes Redressal Commission (the ‘NCDRC’) was also dismissed which was subsequently impugned before this Court.

Submission of the Parties

The Learned Counsel for the Appellant submitted that the NCDRC failed to notice a selective appreciation of evidence by SCDRC and completely ignored the report provided by Dr. Gupta regarding the lapses in pre-operative and post-operative care provided by the Respondents.

The Learned Counsel for the Respondents, on the contrary, submitted that both the NCDRC and the SCDRC have correctly placed reliance on the decision of the Medical Council to arrive at their conclusions regarding the absence of negligence on part of the Respondents.

Court’s Analysis and Judgement

The Court upon perusal of the orders of NCDRC and the SCDRC found merit in the Contention of the Appellants. The Court stated that DCDRC was right in holding the respondent for deficiency in services. Moreover, through the evidence of Dr. Gupta, it noted that a nexus was established between the lapses in post-operative care and the development of loss of vision after the operation, thereby held the expert evidence of Dr. Gupta as valid.

The Court pointed out that despite the presence of evidence regarding the negligence of the Respondents, both the SCDRC and the NCDRC failed to consider it and relied only on the report of the Medical Council. On a perusal of the Medical Council report, the court noted that it did not delve into the nuances of pre-operative and post-operative care.

The Court held that the report of the Medical Council can only be relevant in determining deficiency of service before a consumer forum, but not determinative, especially when it contradicts the evidentiary findings made by a consumer forum.

The Court, with the aforementioned findings, set aside the orders of SCDRC and the NCDRC. It upheld the decision of DCDRC and directed the respondents to comply with the order of the DCDRC within one month from the date of this order.

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Judgement Reviewed by – Keerthi K

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“The issues of patient care service are dependent upon the competence of the concerned doctor or the ECG technician” : State of West Bengal

Title: B.M. Birla Heart Research Centre -Vs.- State of West Bengal & Ors.

Citation: MAT 1595 of 2019

Decided on: 15.12.2023

Coram: Justice Arijit Banerjee & Justice Apurba Sinha Ray

 

 

Introduction

This case highlights the potential consequences of inadequate patient care, even if medical negligence isn’t proven. It also demonstrates the importance of thorough investigations and fair compensation for families impacted by hospital shortcomings.

 

Facts of the case

A writ petition was filed under article 226 of the constitution of India before a single judge of  Calcutta High court by BM Birla Heart Research Centre (BMBHRC) challenging the judgement and order of West Bengal Clinical Establishment Regulatory Commission. The case involved a bereaved son accusing BMBHRC of negligence as the reason for his mother’s death. He cited delays in shifting her, improper medication, diagnosis, and communication.

The Commission investigated, finding no medical negligence but significant deficiencies in patient care. They awarded the family 20 lakh rupees (approximately $26,000) in compensation.

The court, after hearing the parties and taking into consideration the materials on record, dismissed the said writ application holding that the conclusion arrived at by the Commission was correct and justified.

Aggrieved by this judgement and order, BMBHRC challenged the decision, arguing the judge overlooked their arguments and evidence and that he had flawed analysis and findings.

 

Court’s observation and analysis

The Court set aside the impugned judgment passed by the learned Single Judge as well as the order of the Hon’ble Commission. The instant appeal, was thus, allowed but without any order as to costs. In this case the issues of patient care service was dependent upon the competence of the concerned doctor or the ECG technician. The court made reference to the case – State of Punjab Vs. Shiv Ram & Ors.( AIR 2005 SC 3280 ), wherein the Hon’ble Apex Court has been pleased to observe in paragraph 28 that unless primary liability is established, vicarious liability on the state cannot be imposed. The Commission lacked authority to judge doctor misconduct because a specialized body handles such cases under specific regulations. The court wasn’t informed of this. The court made the wrong judgment about the expected level of doctor’s competence due to incomplete guidance. According to the commission had the ECG of the patient been done and interpreted by the BMBHRC’ through a competent doctor and technician, such untimely death of Arati Pal might have been averted. The questions whether or not the doctors or the clinical establishment were at fault in diagnosis, are issues of medical negligence which the Commission could not have BEEN adjudicated and the Commission had rightly refused to enter into that arena. Furthermore, there is no material on record showing that there was any nexus between the ECG report done and the death of the patient Arati Pal. The allegation against the incompetent doctor is such that he has committed professional misconduct under Regulation 7.20 of Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 and for which a specific provision has been made for determining whether he has committed any professional misconduct or not. The Commission has therefore no authority to observe that the doctor  was not qualified to conduct as well as interpret the ECG report.

Furthermore, unless the Medical Council of the West Bengal declares through specific and appropriate disciplinary action that Dr. Giri is an unqualified doctor, the Commissioner has no authority to declare Dr. Giri as unqualified to perform ECG or to interpret the findings thereof.

 

 

 

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Suo Motu Cognizance of the Bombay High Court: A Wake-Up Call for Healthcare

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The Bombay High Court has recently taken suo motu note of the unfortunate deaths of patients in government-run hospitals in the Nanded and Chhatrapati Sambhaji Nagar districts, which has shocked the Maharashtra healthcare system. In a letter, lawyer Mohit Khanna expressed worry about the rising rate of mortality, particularly among infants, and this action is in reaction to his letter. Justice Arif Doctor and Chief Justice Devendra Kumar Upadhyaya’s division bench have intervened to look into the situation and make sure that responsibility is established.

The Unsettling Truth

In his letter to the court, Advocate Mohit Khanna revealed a depressing truth: At the Dr. Shankarrao Chavan Government Medical College and Hospitals (GMCH) in Nanded, 31 people, including infants, perished, while 14 more patients perished tragically at the Chhatrapati Sambhajinagar Government Hospital. These deaths were linked to a lack of basic supplies like beds, medical personnel, and medications—a flagrant violation of the right to life protected by Article 21 of the Constitution.

After receiving Khanna’s letter, the Bombay High Court responded promptly to this serious matter. At first, the court instructed Khanna to submit a thorough petition that included information on the number of open hospital beds, the availability of medications, and government spending on healthcare. But after giving the subject some more thought, the court chose to take suo motu cognizance of it, designating Khanna as the case’s amicus curiae.

The court’s prompt response underscores the seriousness and urgency of the circumstance. It recognises that human lives lost as a result of institutional flaws cannot be allowed and that those accountable must be held in check.

An Invitation to Accountability

The state’s fiscal allocation for healthcare is one of the important factors that the court is concentrating on. Birendra Saraf, the advocate general for Maharashtra, has been given the task of outlining the government’s financial commitment to the healthcare industry. This openness is essential for determining whether the deaths could have been avoided and whether resources were used efficiently to save lives.

The court has also requested an investigation into the dearth of specialised physicians in these facilities. Lack of skilled staff can have disastrous effects because specialised medical care can frequently mean the difference between life and death.

The Next Steps

On October 4, 2023, the National Human Rights Commission of India (NHRC) also took “suo motu cognizance” of the situation. According to the reports, patients in these hospitals have reportedly been dying owing to a lack of doctors and medicine.[1] It is crucial that all parties participate fully and openly in the inquiry as the court gets ready to hear the case on Friday, October 6. Families who have lost loved ones need an explanation, and any carelessness or flaws in the healthcare system must be corrected.

[1] Official NHRC website, https://nhrc.nic.in/media/press-release/nhrc-notice-chief-secretary-government-maharashtra-over-reported-deaths-several

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Medical Negligence Laws in India.

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Abstract:

This article delves into the intricate web of medical negligence laws in India, shedding light on the legal intricacies, consequences, and responsibilities entailed in this multifaceted domain. With a spotlight on the pivotal role of regulatory bodies like the Medical Council of India (MCI) and the establishment of consumer courts, it explores the avenues through which medical negligence cases are addressed. Additionally, it examines the surge in medical malpractice insurance, the emergence of alternative dispute resolution (ADR) mechanisms, and the evolving jurisprudence surrounding medical negligence in India. As India navigates the dynamic landscape of healthcare, this article serves as a valuable resource for healthcare professionals, policymakers, and individuals seeking a deeper understanding of medical negligence laws in the country. With a commitment to balance the rights of patients and healthcare providers, India’s evolving legal framework strives to ensure accountability and uphold the highest standards of medical care.

Introduction:

The realm of medical practice carries profound implications for both healthcare providers and patients, intertwined with intricate legal considerations. In India, the landscape of medical negligence laws has undergone significant evolution, reflecting the nation’s commitment to strike a delicate equilibrium between medical autonomy and patient rights. As the country continues to place a heightened premium on the sanctity of human life and well-being, understanding the contours of medical negligence laws becomes an imperative for healthcare professionals, legal practitioners, policymakers, and individuals alike. Medical negligence, though not explicitly defined in Indian statutes, represents a pivotal aspect of the legal framework governing the healthcare landscape. As such, this article endeavours to provide clarity by outlining the fundamental elements of medical negligence, the duty of care that doctors owe to their patients, and the standards by which their actions are assessed. By drawing from select judicial opinions of India’s higher courts, it elucidates the consequences of medical negligence, categorizing them into criminal liability, monetary liability, and disciplinary action, each with its unique implications. Furthermore, the article delves into the intricate web of informed consent, emphasizing the pivotal role of patient autonomy in healthcare decisions. It explores the boundaries within which medical practitioners must operate, recognizing that while they possess expertise, the ultimate choice should rest with the patient, guided by adequate information and consultation. As the legal landscape surrounding medical negligence in India continues to evolve, this article navigates through advisory guidelines and safeguards, as enunciated by the Supreme Court. It highlights the importance of preserving the sanctity of professional judgments while safeguarding patient interests. Additionally, it discusses the safeguards put in place to protect healthcare providers from frivolous and unjust criminal prosecutions, including the necessity of obtaining independent medical opinions. In a rapidly changing healthcare ecosystem, this article aims to serve as a beacon of clarity, providing insights, guidance, and an understanding of the legal nuances that underpin medical negligence laws in India. It acknowledges the dual responsibility of ensuring accountability for medical professionals and safeguarding the autonomy and well-being of patients. As we embark on this journey through the realm of medical negligence laws in India, we invite readers to explore the evolving landscape where medicine and the law intersect, forging a path toward equitable healthcare for all.

Overview of the Consequences:

Within the intricate framework of medical negligence laws in India, the ramifications of legally cognizable medical negligence can be broadly categorized into three distinct consequences: criminal liability, monetary liability, and disciplinary action. These consequences are a result of breaches of duty or wrongful acts committed by healthcare professionals in the course of their practice, and they play a pivotal role in ensuring accountability and safeguarding patient interests within the healthcare landscape.

Criminal Liability:

Criminal liability in cases of medical negligence is primarily governed by the provisions of the Indian Penal Code, 1860 (IPC). While the IPC does not explicitly define “medical negligence,” it provides a legal basis for holding healthcare professionals criminally liable for their actions or omissions. Notably, Section 304A of the IPC deals with 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 demise and can result in imprisonment for up to two years. Additionally, other general provisions of the IPC, such as Section 337 (causing hurt) and Section 338 (causing grievous hurt), are also utilized in the context of medical negligence cases. The distinction between civil and criminal liability hinges on the degree of negligence, with criminal liability typically requiring a higher threshold of recklessness or gross negligence.

Monetary Liability:

Monetary liability, often in the form of compensation, is another significant consequence of medical negligence. It arises from civil actions initiated by patients or their dependents seeking redress for injuries or harm caused by medical professionals. These actions are typically pursued before civil courts or consumer forums, where claimants must establish that the medical professional breached their duty of care, resulting in harm or injury to the patient. Permanent lok adalats, established under the Legal Services Authority Act, 1987, can also adjudicate on cases related to medical negligence involving “public utility services.” These lok adalats attempt conciliation before making determinations on the merits of the matter. Monetary compensation can be substantial, and the quantum of damages is assessed based on factors such as the severity of harm, medical expenses, loss of income, and other relevant considerations.

Disciplinary Action:

Disciplinary action against medical practitioners is governed by the Indian Medical Council (IMC) (Professional Conduct, Etiquette, and Ethics) Regulations, 2002, formulated under the IMC Act, 1956. The IMC and State Medical Councils have the authority to take disciplinary measures against healthcare professionals for professional misconduct. Such misconduct can encompass a range of actions, including medical negligence. Disciplinary actions may include suspension or the permanent removal of a medical practitioner’s name from the medical register, thereby barring them from practicing medicine. It’s important to note that professional misconduct is a broader concept that may encompass medical negligence, and the specifics of each case determine the disciplinary measures taken. The consequences of medical negligence in India are both multifaceted and far-reaching. They serve the dual purpose of holding healthcare professionals accountable for their actions while providing recourse to patients who have suffered harm or injury due to substandard care. By encompassing criminal, civil, and disciplinary dimensions, the legal framework strives to maintain a delicate balance between ensuring the quality of healthcare and protecting the rights of patients. Consequently, healthcare providers in India operate within a legal landscape that demands a high standard of care, while also recognizing the inherent complexities and uncertainties of medical practice.

Basic Features of Medical Negligence and Standard of Care:

To comprehend the nuances of medical negligence in India, it is crucial to delve into its fundamental features and the yardstick applied to assess the standard of care expected from healthcare professionals. Medical negligence encompasses breaches of duty or wrongful acts by medical practitioners during the provision of medical care to patients. Here, we explore the key elements of medical negligence and the standards of care that guide legal determinations:

Duty of Care:

A paramount element of medical negligence is the duty of care owed by healthcare professionals to their patients. The duty to decide whether to undertake a case or not. It is the duty of a medical officer to determine the appropriate course of treatment with Care and Competence. The duty not to undertake procedures beyond one’s capabilities. Healthcare providers are expected to exercise a reasonable degree of skill, knowledge, and care when discharging these duties.

Breach of Duty:

Negligence, in the context of medical practice, is essentially a breach of the duty of care. It occurs when a healthcare professional fails to meet the standard of care expected of a reasonably skilled and prudent practitioner. The breach of duty can manifest in various forms, including errors in diagnosis, treatment, surgical procedures, prescription of medication, and the failure to obtain informed consent. Notably, errors of judgment alone do not necessarily imply negligence. Gross errors, however, may lead to findings of negligence.

Causation:

A critical aspect of medical negligence is establishing a causal link between the breach of duty and the resultant harm or injury suffered by the patient. The law requires that the breach of duty must be the direct or proximate cause of the harm. In other words, there must be a clear connection between the negligent act or omission and the adverse outcome.

Standard of Care:

The standard of care expected from healthcare professionals is a pivotal aspect of medical negligence cases. It sets the benchmark against which their actions are evaluated. In India, the standard of care is often assessed using the “Bolam test,” which requires healthcare professionals to adhere to the standard of the ordinary skilled person in their field, rather than the highest level of expertise. This test recognizes that the medical field is characterized by varying approaches and opinions, and it evaluates whether the practitioner’s actions align with those of a reasonably skilled peer in similar circumstances.

Errors of Judgment:

It is important to distinguish between errors of judgment and gross negligence. Errors of judgment, arising from complex medical decisions, do not necessarily equate to negligence. Gross mistakes, however, such as administering the wrong drug, operating on the wrong patient, or leaving surgical instruments inside a patient, may constitute gross negligence and warrant legal action.

Shifting Burden of Proof:

In medical negligence cases, the burden of proof initially rests with the party alleging negligence. The claimant must demonstrate a prima facie case of negligence. Once this threshold is met, the burden shifts to the healthcare provider to establish that there was no lack of care or diligence in their actions.

Evolving Standards:

Standards of care are not static and may evolve over time with advances in medical knowledge and technology. The standard of care applied is often influenced by the prevailing medical practices and opinions at the time of the incident. The assessment of medical negligence cases in India is a meticulous process that takes into account the complexities of medical practice and the need to balance accountability with the autonomy of healthcare professionals. While healthcare providers are held to high standards, the law recognizes the inherent uncertainties and variations in medical science, ensuring that judgments are fair and grounded in reasonable expectations of care.

Cases related to Medical Negligence

  • Indian Medical Association v. V.P. Shantha (1996):

This case introduced the concept of ‘informed consent,’ which mandates that patients must be provided with comprehensive information about the potential risks associated with a medical procedure before granting consent. The Supreme Court ruled that a failure to secure informed consent from a patient could constitute an act of medical negligence.

  • Martin F. D’Souza v. Mohd. Ishfaq (2009):

In this case, the Supreme Court delineated the expected standard of care for healthcare professionals. The court emphasized that a medical practitioner must possess the knowledge and skills that are reasonably anticipated from a competent professional in their respective field.

  • Samira Kohli v. Dr. Prabha Manchanda (2008):

Addressing the issue of vicarious liability in instances of medical negligence, this case established that a hospital can be held accountable for the negligence of its staff, even if the hospital itself was not directly responsible for the wrongdoing.

  • Malay Kumar Ganguly v. Dr. Sukumar Mukherjee (2009):

This case revolved around the significance of expert opinions in medical negligence lawsuits. The Supreme Court clarified that expert opinions can serve as evidence in such cases, but they should not be the sole basis for determining whether negligence occurred.

  • Kusum Sharma v. Batra Hospital & Medical Research Centre (2010):

In this case, the Supreme Court affirmed that patients have the right to seek compensation for medical negligence, even in the absence of physical injuries. The court emphasized that mental distress and trauma resulting from medical negligence can also be grounds for compensation.

Advisory to Doctors and Safeguards in Criminal Prosecution by Supreme Court

Recognizing the increasing frequency of criminal prosecutions against doctors, which can be both distressing and disruptive to their professional lives, the Supreme Court of India has laid down certain advisory guidelines to protect medical practitioners from frivolous and unjust prosecutions. These guidelines, until statutory rules or government instructions in consultation with the Medical Council of India (MCI) are issued, provide essential safeguards to doctors facing criminal charges related to medical negligence. Here, we delve into these important safeguards:

Prima Facie Evidence Requirement:

Private complaints alleging medical negligence may not be entertained by the legal system unless the complainant provides prima facie evidence in the court. This evidence should take the form of a credible opinion from another competent doctor.

Independent Medical Opinion:

In cases involving medical negligence allegations, the investigating officer is required to obtain an independent and competent medical opinion. This opinion should ideally be provided by a doctor in government service who is qualified in the relevant medical field. This requirement aims to ensure an impartial and unbiased evaluation of the case, applying the Bolam test to the collected facts during the investigation.

Restriction on Routine Arrests:

Routine arrests of doctors should be avoided unless they are deemed necessary for furthering the investigation or for collecting evidence. Arrests should not be made solely on the assumption that the doctor may attempt to evade legal proceedings. These safeguards are aimed at protecting doctors from the undue burden of criminal prosecutions, particularly when the allegations lack credible evidence or are driven by frivolous motives. By setting these guidelines, the legal system seeks to strike a balance between accountability and the prevention of harassment of medical professionals.

Conclusion:

In conclusion, the realm of medical negligence laws in India is a multifaceted landscape that balances the rights of patients with the professional judgments of healthcare practitioners. This intricate equilibrium is vital to uphold the highest standards of patient care while acknowledging the inherent complexities and uncertainties present in the practice of medicine. The consequences of legally cognizable medical negligence can range from criminal liability and monetary compensation to disciplinary action. The legal system in India has laid out mechanisms to address these consequences while respecting the autonomy of medical professionals and the challenges they face. The concept of medical negligence is underpinned by the duty of healthcare practitioners to exercise care, diligence, and a reasonable degree of skill while making clinical judgments. Errors of judgment, which are not uncommon in the medical field, do not necessarily amount to negligence unless they are gross or reckless. Informed consent is another crucial facet of medical negligence laws, emphasizing patients’ rights and autonomy in making decisions about their treatment. While professional judgments are respected, healthcare providers are required to obtain valid informed consent based on adequate information. The legal system relies on expert opinions from qualified medical professionals to navigate the complexities of medical negligence cases. Courts do not substitute their judgment for that of medical experts but may intervene if medical actions are deemed highly unreasonable. Moreover, safeguards have been put in place to protect doctors from frivolous criminal prosecutions. These safeguards require prima facie evidence, independent medical opinions, and restrict routine arrests in cases of medical negligence allegations. Medical negligence laws in India continue to evolve, and there is a growing recognition of the need to strike a balance between safeguarding patient rights and respecting the autonomy of medical professionals. As the field of medicine advances and new challenges emerge, the legal framework surrounding medical negligence will adapt to ensure that both patients and healthcare providers are treated fairly and justly within the healthcare system.

References:

https://www.lexology.com/library/detail.aspx?g=b271f61b-9bc7-4d12-9e88-4c058fd8951b

https://ssrana.in/articles/medical-negligence-india/

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2354282

https://www.ijlmh.com/medical-negligence-in-india-a-critical-study/

https://asiindia.org/medical-negligence-the-judicial-approach-by-indian-courts/

https://lawrato.com/indian-kanoon/medical-negligence-law/medical-negligence-in-india-laws-and-procedures-2833

https://www.latestlaws.com/articles/all-about-law-on-medical-negligence-in-india-by-gargi

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Article Written By: Jangam Shashidhar.