Medical Negligence

Legal Framework

-Sumukh Sairam S

JULY, 2024
Understanding Medical Negligence
A Comprehensive Overview

Jan 00, 2021

DEFINITION

Medical negligence occurs whenever a doctor’s action or omission fall below

the standard of care, when a healthcare provider such as doctor, nurse or
medical institution fails to provide the appropriate standard of care,
causing harm or injury to the patient
 Components of Medical Negligence:
 Standard of Care: This refers to the level and type of care that a reasonably
competent healthcare provider, with similar training and experience, would
provide under similar circumstances.
 Deviation from Standard of Care: Negligence involves a deviation from the
established standard of care. This can occur through acts or commission or
omission.
 Harm or Injury: The patient must suffer harm or injury as a direct result of the
deviation from the standard of care. This Harm can be physical, emotional or
financial.
 Causation: There must be a clear link between the healthcare provider’s
negligence and the harm suffered by the patient. The harm must be a foreseeable
result of the negligent action or inaction.
TYPES OF MEDICAL NEGLIGENCE

Medical Negligence can occur in various forms, each impacting patient care
and safety differently. Here are some key type:
 Diagnostic Errors: Misdiagnosis, delayed diagnosis, or failure to diagnose a medical
condition correctly. Example: Failing to recognize symptoms of a heart attack,
misinterpreting lab results.
 Treatment Errors: Incorrect treatment, inappropriate treatment, or failure to
provide treatment. Example: Administering the wrong medication, performing
unnecessary surgery.
 Surgical Errors: Mistakes made during surgery, such as operating on the wrong part,
leaving surgical instruments inside the body, or causing unintentional injury to
surrounding tissues.
 Medication Errors: Errors made in prescription, dispensing or administering
medication. Examples: Wrong dosage, wrong medication, failure to check for drug
interactions.
 Aftercare Errors: Inadequate follow-up care, improper monitoring, or failure to
provide necessary post-treatment instructions. Examples: Failing to monitor a
patient’s recovery, not providing instructions for wound care.
PROVING MEDICAL NEGLIGENCE
 Establishing the Duty of Care: Duty of Care refers to the legal obligation a
healthcare provider has towards their patient to provide care that meets
established standards. A Duty of Care is established through the doctor-patient
relationship. This relationship is typically formed when a provider agrees to
diagnose or treat a patient, creating an obligation to adhere to a standard of
care. The proof of relationship can include medical records, appointment
histories, and communication between the patient and provider.
 Demonstrating a Breach of Duty: A breach occurs when the healthcare provider
fails to meet the standard of care expected of a reasonably competent
professional in similar circumstances. Standard of care is established through
expert testimony, which outlines what a competent provider would have done in
the same situation.
 Proving Causation : Causation requires demonstrating that the breach of duty
directly led to the harm suffered by the patient.
 Quantifying the Damages Suffered: Quantifying damages involves assessing the
financial, physical, and emotional harm suffered by the patient due to the
negligence. Evidences like Medical Records, Expert testimony and personal
Testimonies are required to be produced.
By following these steps and gathering appropriate evidence, a claim of medical
negligence can be sustained.
DEFENSES IN MEDICAL NEGLIGENCE CASES
COMMON DEFENSES
 Consent: Consent involves the patient being informed of the risks and benefits of
a proposed treatment and agreeing to proceed.
 Informed Consent: Healthcare providers must disclose relevant
information about the risks, benefits, and alternatives to a patient
before proceeding with a treatment or procedure. Evidence of
informed consent can include signed consent forms and detailed
records of discussions between the healthcare provider and patient.
 Defense Argument: The provider can argue that the patient was fully
informed about the risks involved and the patient voluntarily agreed to
the treatment despite the potential risks.
 CONTRIBUTORY NEGLIGENCE: Contributory negligence occurs when the patient’s
own actions or omissions contribute to the harm they suffered.
 Example: Failure to follow medical advice
 Evidence: Medical records, patient history and testimonies can be used
to show that the patient’s actions or inactions contributed to the harm.
 Defense Argument: The healthcare provider can argue that the
patient’s negligence played a significant role in causing or worsening
the injury.
DEFENSES IN MEDICAL NEGLIGENCE CASES
 ACCEPTED PRACTICE: Accepted practice involves demonstrating that the
healthcare provider followed established medical standards and practices
accepted by the medical community.
 Standard of Care: The defense can argue that the provider’s actions
were in line with what a reasonable healthcare professional would have
done under similar circumstances.
 Expert Testimony: Medical experts can testify that the treatment
provided was consistent with accepted medical practices and
standards. This is critical in proving that the provider’s actions were
within the bounds of acceptable medical practice.
 Defense Argument: The Healthcare provider can argue that the
treatment was appropriate and that any deviation from the standard of
care was not significant enough to constitute negligence.
Demonstrating adherence to widely accepted medical guidelines and
protocols can help counter claims of negligence.
These defenses can be used to challenge allegations of medical negligence by
shifting focus away from the provider’s conduct and highlighting factors that may
mitigate their liabilit
LEGAL FRAMEWORKS OVERVIEW
LEGAL FRAMEWORK

Medical Negligence is governed by a complex legal framework that includes

civil, criminal and consumer protection laws. Understanding these legal
bases helps in comprehending how negligence claims are processed and
adjudicated.
CIVIL LIABILITY
 Tort Law: Medical Negligence is primarily addressed under tort law, where a
breach of duty of care leading to damages constitutes a tortious act. Patients can
file lawsuits seeking compensation for injuries caused due to negligence.
 Contract: A contract may have express or implied terms. There are situations where
there is a contract between medical 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.
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.
LEGAL FRAMEWORK

Criminal Liability
 Indian Penal Code (IPC): Certain Negligent acts can lead to criminal charges under the IPC,
especially when they result in severe harm or death.
 Section 304A IPC: This section addresses causing death by negligence, where a person can be
punished with imprisonment for up to two years, a fine, or both.
 Other Relevant Sections: Section 337: causing hurt by act endangering life or personal safety.
Section 338: Causing grievous hurt by act endangering life or personal safety.
 Proof Requirements: In Criminal Cases, negligence must be proven “Beyond a reasonable
doubt”, a higher standard than in civil cases where it is “on the balance of probabilities.
Consumer Protection
 Consumer Protection Act, 1986: This act recognizes patients as consumers, allowing them to
seek redress for deficiencies in medical services.
 Scope: Patients can file complaints in consumer courts for compensations
related to unacceptable services, including negligence.
 Redressal Mechanism: Consumer courts provide a more accessible and less
expensive forum for patients compare to civil courts. Patients can seek
compensatory and punitive damages, as well as other reliefs like refund or
specific performance.
LEGAL FRAMEWORK: CRIMINAL LIABILITY

GROSS NEGLIGENCE AND RECKLESS BEHAVIOR

Gross negligence involves a severe lack of care that is considered a significant departure from the
standard of care expected in medical practice. Reckless behavior is characterized by a disregard
for the foreseeable risks of harm. This Applies when a healthcare provider’s actions or omissions
rise to the level of gross negligence or recklessness, it can lead to criminal charges in addition to
civil liability.
Indian Penal Code (IPC) Provisions
 Section 304A: Deals with causing hurt by act endangering life or personal safety. This can apply if a
healthcare provider’s actions cause injury or harm to a patient. Punishment is imprisonment upto two years,
a fine or both.
 Section 337: Deals with causing hurt by an act endangering life or personal safety. This can apply if a
healthcare provider’s actions cause injury or harm to a patient. Punishment is imprisonment upto six
months, a fine , or both.
 Section 338: Addresses causing grievous hurt by an act endangering life or personal safety. This can apply in
cases of severe harm due to negligence. Punishment is imprisonment upto two years, a fine, or both.
Criminal liability for Medical Negligence serves as a deterrent to ensure that healthcare providers adhere to high
standards of care and maintain accountability for their actions.
LEGAL FRAMEWORK: CONSUMER PROTECTION ACT,2019

 Section 2 (1) (g) CPA defines ‘deficiency in service ‘ as

any fault , imperfection, shortcoming, or inadequacy in
quality, nature and manner of performance which is
required to be maintained by or under any law for the
time being in force or has been undertaken to be
performed by a person in pursuance of a contract or
otherwise in relation to any service.
• A determination about deficiency in service for the
purpose of Section 2 (1) (g) is to be made by applying
the same test as is applied in an action for damages for
negligence.
 ‘Consumer’ defined under Section 2 (1 ) (d) ii means a
person who hires or avails of any service for a
consideration which has been paid or partly paid and
partly promised , or any beneficiary of such services
with his prior approval but does not include a person
who avails the services for any commercial purpose.
 Complainant under under Section 2 (1)b means a
consumer, any voluntary consumer association,
Central government or State government, one or more
consumers & incase of death of a consumer, his legal
heir or representative
LEGAL FRAMEWORK: CONSUMER PROTECTION ACT,2019

This Act broadens the definition of “services” to encompass healthcare, recognizing medical services
as subject to Consumer Protection Laws. This inclusion ensures that patients can file complaints
for deficiencies in medical services, making healthcare providers accountable for their
performance and conduct.
CONSUMER DISPUTE REDRESSAL COMMISSIONS FOR GRIEVANCE REDRESSAL
 Section 32: Establishes district Consumer Redressal Commissions, which handle complaints related to
medical negligence with claims up to 1 crore Rs.
 Section 34: Establishes the state Consumer Dispute Redressal Commissions, dealing with complaints where
the value is between 1 crore and 10 crore Rs.
 Section 47: Establishes National Consumer Dispute Redressal Commission, which deals with complaints
exceeding 10 Crore Rs. And appeals from State commissions, ensuring uniformity in the adjudication of
severe medical negligence cases.
Compensation for Deficiencies in Medical Services
 Section 38: Outlines the powers of the Commissions to award compensation for harm caused by deficiencies
in medical services, including financial compensation for medical expenses, pain and suffering and other
damages.
 Section 41: Details the process for determining compensation, taking into account the nature of the
negligence and the extent of harm suffered by the patient
LANDMARK JUDGMENTS
Bolam v Friern Hospital Management Committee [1957] 1 WLR 582
 Brief Facts: Mr. Bolam, a voluntary patient at a mental health institution managed by the
Friern Hospital Management Committee, underwent electroconvulsive therapy (ECT).
During the procedure, he was not given muscle relaxants and was not physically restrained.
As a result, he flailed about violently, leading to severe injuries, including fractures of the
acetabula. Mr. Bolam claimed negligence on three grounds: (a) The hospital did not
administer muscle relaxants. (b)He was not restrained during the procedure.(c) He was not
adequately warned about the risks associated with the treatment.
 Judgment: Expert witnesses testified that the use of muscle relaxants was opposed by
much of the medical profession at the time, and manual restraints could sometimes
increase the risk of fractures. Furthermore, it was common practice to not warn patients
about the small risks of the treatment unless specifically asked. The Court held that the
standard of care required for medical professionals is that they must act in accordance with
a responsible body of medical opinion. In this case, the practices followed by the hospital
were in line with accepted medical standards and were supported by a responsible body of
opinion within the profession.
 The court found in favor of the defendant, the Friern Hospital Management Committee.
The hospital was not found negligent as the treatment practices employed were consistent
with the accepted standards of the medical profession at that time.
Kunal Saha vs. Sukumar Mukherjee and Ors. MANU/CF/0065/2006
 Brief Facts: Anuradha consulted Dr. Sukumar Mukherjee in Kolkata on April 25, 1998, for skin rashes. Dr.
Mukherjee did not prescribe any medication but advised rest. As the rashes worsened, Dr. Mukherjee
prescribed Depomedrol injections on May 7, 1998. This treatment was later criticized by specialists.
Anuradha's condition deteriorated, leading to her admission to AMRI Hospital on May 11, 1998, under
Dr. Mukherjee’s supervision. Unable to improve, Anuradha was transferred to Breach Candy Hospital in
Mumbai, where she was diagnosed with Toxic Epidermal Necrolysis (TEN), a rare and severe skin
condition. Anuradha died on May 28, 1998, at Breach Candy Hospital. Saha filed a civil case against Dr.
Mukherjee, AMRI Hospital, and Breach Candy Hospital, alleging gross negligence in Anuradha’s
treatment, leading to her death. Saha initially sought Rs. 77 crore in compensation.The National
Consumer Disputes Redressal Commission (NCDRC) awarded Rs. 1,72,87,500 in compensation. The
compensation was reduced by 10% due to the hospital’s negligence, resulting in a final amount of Rs.
1,55,00,000.Supreme Court Verdict: On October 24, 2013, the Supreme Court of India awarded
approximately Rs. 6.08 crore in compensation for Anuradha’s death, holding the doctors and hospitals
responsible for the gross negligence in her treatment.
 Judgment: The Supreme Court found that the medical professionals involved, including Dr. Sukumar
Mukherjee, and the hospitals (AMRI and Breach Candy), were negligent in their treatment of Anuradha.
The Court held that their actions and omissions contributed significantly to her worsening condition and
ultimate death. The Court increased the compensation amount to Rs. 6.08 crore, reflecting the severity
of the negligence and the impact of the loss on the complainant.
Juggan Khan v. State of Madhya Pradesh,1965 SCR (1)14
 Brief Facts: The appellant, a 55-year-old registered homoeopathic medical practitioner,
treated Deobai, a 20-year-old woman suffering from guinea-worm. He administered
drops, a dhatura leaf, and a solution labeled "stramonium." Deobai became unconscious,
vomited, and showed signs of severe poisoning. Despite efforts to revive her, she passed
away the same day. The appellant had suggested fresh air might help, but she died. The
appellant was charged under Section 302 of the Indian Penal Code (IPC) for murder, with
key issues focusing on whether he administered the poisonous substances, if Deobai’s
death resulted from dhatura poisoning, and the legitimacy of using dhatura in treatment.
 Judgment:The court upheld the conviction of the appellant under Section 302 IPC for the
murder of Deobai. It found that the appellant knowingly administered a lethal substance,
stramonium (dhatura), leading to her death. The treatment was not in line with any
recognized medical system, including homoeopathy, and the appellant acted with
recklessness beyond mere negligence. The appellant was sentenced to life imprisonment,
underscoring the serious legal consequences of deviating from established medical
standards and causing fatal harm.
Mr. M Ramesh Reddy v. State of Andhra Pradesh 2003 (1) CLD 81 (AP SCDRC)

 Brief Facts: An obstetrics patient fell in the

hospital bathroom due to it being unclean. This
fall resulted in severe injuries, leading to the
patient's death. The complainant, Mr. M Ramesh
Reddy, argued that the hospital authorities were
negligent in maintaining a safe and clean
environment for their patients.
 Judgment: The Andhra Pradesh State Consumer
Disputes Redressal Commission held the
hospital authorities negligent for not keeping
the bathroom clean, which directly led to the
patient's fall and subsequent death. The court
emphasized that hospitals have a duty of care to
ensure a clean and safe environment for
patients. Consequently, the hospital was found
liable for the patient's death, and the court
awarded compensation of 1 lakh rupees to the
complainant for the hospital's negligence..
CONCLUSION

Medical Negligence occurs when healthcare providers fail to meet the expected standard of care,
leading to patient harm. In India, the legal framework includes civil, criminal and consumer
protection laws, offering various ways for patients to seek redress. It is essential for healthcare
providers to adhere to medical standards to avoid legal consequences, while patients should
be aware of their rights to ensure proper care. Landmark cases like Bolam Vs Friern Hospital
Management Committee and Mr. M Ramesh Reddy Vs State of Andhra Pradesh illustrates
the judiciary’s role in setting and enforcing care standards. To reduce instances of negligence,
healthcare institutions should implement strict care protocols, provide continuous staff
training, and maintain a safe environment. Patients should be proactive in their healthcare,
seek second opinions, and understand treatment risks. Increasing awareness and education
can improve healthcare outcomes and reduce negligence. Ultimately, understanding and
adhering to legal and medical standards can enhance patient safety and trust in the healthcare
system.