Analysis of Medical Negligence

This article is written by Christina Fernandes of Amity Law School, an intern under Legal Vidhiya

Abstract

Medical negligence, sometimes known as medical malpractice, is a complicated and challenging law that concerns healthcare practitioners failing to fulfill the level of care anticipated in their profession, causing damage or harm to patients. The inability to behave in line with the norms of medical experts who were at that point in time fairly competent is referred to as negligence ^[1]. The avoidance of medical mistakes is important since they are frequently the consequence of carelessness ^[2]. The link between medical errors, medical negligence, and defensive medicine has been studied, and methods, as well as behaviors to avoid mistakes and the practice of defensive medicine, have been advocated ^[3]. Numerous laws, including the torts, Indian Penal Code, Indian Contracts Act, and Consumer Protection Act ^[4], criminalize medical malpractice.

Introduction

Medical negligence, sometimes known as medical malpractice, is a complicated and vital field of law that deals with situations in which healthcare practitioners fail to fulfill the level of care expected of them, causing patients injury. When patients seek medical attention, they have faith that their doctors will treat them competently and appropriately without clouding their judgment or making mistakes. However, medical practitioners may make errors or fail to offer the desired quality of care in some situations, resulting in catastrophic repercussions for patients such as damage, disease, disability, or even death. Medical negligence claims can emerge from a variety of circumstances, such as surgical mistakes, misdiagnosed or delayed diagnosis, pharmaceutical problems, birth traumas, and other issues.

^[5] Types of medical negligence

1. Misdiagnosis or Delayed Diagnosis: This takes place when a medical practitioner fails to accurately identify a patient’s ailment or delays the diagnosis, resulting in a delay in appropriate treatment or worsening of the patient’s condition.
2. Surgical mistakes: Surgical mistakes, including wrong-site surgery, inappropriate incisions, organ damage, or leaving surgical equipment or additional foreign materials within the human body of the patient, can occur during surgery.
3. Prescription errors: include errors in prescribing, administering, or managing drugs, such as prescribing the incorrect prescription or dosage, giving medication to the wrong patient, or neglecting to account for potential drug interactions or allergies.
4. Birth injuries:- Are those that happen during childbirth, such as harm to the mother or child from using the delivery tools incorrectly, from failing to notice fetal discomfort, or by delaying a cesarean section when one is actually called for by a doctor.
5. Dose mistakes:- failure to keep track of the patient’s vital signs, and unfavorable medication responses are all examples of anesthesia mishaps that can happen while the application of anesthesia.
6. Inability to gain Full Assent: This happens when a doctor or other healthcare provider fails to gain sufficient knowledge to obtain permission from a patient before executing a medical operation, such as failing to offer sufficient data regarding the treatment’s downsides, advantages, and alternates
7. Inability to Give Sufficient Follow-Up Care: This might involve failing to administer proper after-surgery or after-treatment care, failing to keep track of the wellness of the patient, or failing to promptly handle issues.
8. Negligence in nursing homes or long-term care facilities:-  It is the failure to provide older or seriously ill patients the appropriate healthcare, prescription drugs, or safety against danger.
9. Issues when communicating:- While communicating between healthcare professionals at times include failures to convey important test findings, misunderstanding of patient information, and disruptions in communications during exchanges or transitions of care.
10. Defects that are devices- or facilities-related:– These may occur as an outcome of malfunctioning or faulty medical equipment, poor facility servicing, or poor infection control procedures, harming patients.

It should be noted that medical negligence cases can be complicated, and deciding whether a healthcare provider’s acts or omissions constitute negligence necessitates a comprehensive examination of the specific facts by legal and medical experts.

Essentials of Medical Negligence

1. Legal obligation to care for the patient must exist for the healthcare professional. The responsibility to deliver treatment that satisfies the standard of care anticipated of a reasonably qualified medical expert in the same area arises from the professional connection between the healthcare provider and the patient ^[6].
2. By failing to offer the level of care demanded of them, the healthcare practitioner must have violated their obligation to provide reasonable care. actions of conduct (doing something badly) or actions of omission (failing to do something) can lead to this. The level of care that would be anticipated of a reasonably competent healthcare professional in the same field under comparable circumstances is used to compare the healthcare provider’s acts or omissions to establish if a duty was broken ^[7].
3. Causation: The violation of duty must have resulted in the patient’s damage or injury. In order to prove a direct causal connection between the patient’s injury and the healthcare provider’s negligence, the patient must show that both occurred. It must be demonstrated that the patient’s injury was caused directly by the medical care vendor’s negligence and would not have happened in any other circumstance.
4. Damages: Due to the medical service provider’s negligence, the patient must have really been harmed or injured. This includes injury to one’s body, emotions, or finances. The patient must be able to prove the type and scope of the losses sustained as an outcome of the negligent actions of the medical professional in question ^[8].
5. Proximate cause: The patient’s injury has to be a reasonably anticipated consequence of the healthcare provider’s breach of duty. In a nutshell, the injury needs to not have been too far away or unconnected to be viewed as the outcome of the breach of duty, but rather an inevitable and probable effect of the healthcare provider’s conduct or omissions ^[9].
6. Statute of restrictions: A medical malpractice claim needs to be submitted within a certain amount of time or the “period of limitation.” The statute of limitations that apply to the claim must be followed, which differs depending on the location ^[10].

What doesn’t constitute medical malpractice?

In some situations wherein a patient has been hurt, medical professionals may not be held accountable. He might successfully argue that he hasn’t violated the duty of care ^[11]. There are a pair of judgment errors:

1. A lapse in judgment – In certain situations, it may have been acknowledged that it does not constitute a duty violation. We can’t hold a doctor accountable for medical malpractice solely because his judgment turned proved to be incorrect.
2. The term “mistake of judgment owing to negligence”- Refers to the failure to take all relevant variables into account prior to making a choice. The result constitutes a duty violation.

When does the liability of medical negligence occur?

Overall, a medical professional becomes liable when a patient is hurt as a result of the doctor’s negligent actions, which fell far short of the reasonable standard of care. Therefore, the patient must prove that there is an accountability that their physician must uphold before proving a breach of that obligation. Liability often only becomes an issue when the complaint is prepared to meet the burden of establishing carelessness. The “res ipsa loquitor” concept, which states that the object argues for itself, may, nonetheless, apply in specific circumstances. Most of the time, a doctor is only accountable for his own conduct, but in certain instances, a doctor may also be held vicariously liable for the actions of another. For instance, if a young physician who performs duties for an older physician makes a mistake, the older physician becomes vicariously accountable for it.

Res Ipsa Loquitor

The Latin phrase res ipsa loquitur translates to “the thing speaks for itself.” There is a notion in the English common law and Roman-Dutch law regimes where, in the lack of tangible proof of how any defendant behaved in the context of a tort, a court might infer carelessness from the very character of an accident or harm ^[12]. When a mishap with an unidentified cause occurs and it would not have occurred ordinarily without the defendant in charge’s carelessness, the doctrine of res ipsa loquitur applies ^[13]. It is a convenient expression used to imply that the evidence speaks for itself ^[14]. Res ipsa loquitur enables the proof of negligence to be established in the context^[15].

It demonstrates that the court has acknowledged that carelessness happened by using the concept. The doctor will subsequently have to deny this, and if he fails to do so, the patient shall be deemed to have succeeded in proving medical malpractice.

How is a res ipsa loquitur case proven?

A tort law theory known as res ipsa loquitur enables plaintiffs to satisfy the burden of proof in negligence lawsuits even when there isn’t any direct evidence of how the damage happened ^[16]. To establish res ipsa loquitur, the plaintiff must demonstrate that the harm was brought about by a circumstance that would not have occurred absent the defendant’s culpable negligence ^[17]. Res ipsa loquitur is a kind of circumstantial proof that makes it possible for an adequate fact-finder to conclude that the defendant’s negligence led to an exceptional incident that led to the plaintiff’s harm ^[18]. For proving res ipsa loquitur, a two-step procedure is outlined in The Restatement (Second) of Torts and 328D. The initial phase is determining whether or not the mishap was the type often brought on by carelessness, and the following phase is determining whether the party responsible possessed exclusive ownership of the instrument that ultimately resulted in the injury ^[19].

Medical negligence provisions in the Indian Penal Code, 1860

There are various clauses pertaining to medical negligence in the Indian Penal Code, of 1860. Sections 52, 80, 81, 83, 88, 90, 91, 92, 304-A, 337, and 338 of the Indian Penal Code are applicable to medical negligence.

In accordance with Section 304-A of the Indian Penal Code, 1860, if somebody conducts a hasty or careless act that results in culpable murder, they may be sentenced to a maximum of two years in jail, a monetary punishment, or both of them.

Section 337 of the Indian Penal Code states that harming others by putting at risk their lives or personal safety: For instance, where someone endangers someone else’s life or personal safety, is covered in this section of the law. This provision allows for charges to be brought against medical personnel who are careless and cause damage or harm to their fellow patients.

Section 338 – Grievous Injury by Endangering Others’ Life or Personal Safety: This section covers situations where someone jeopardizes someone’s life or personal safety in order to inflict great harm. They may be held accountable under this provision if their negligence causes substantial damage or harm to one of their clients.

Medical negligence defenses under the Indian Penal Code, of 1860

Although there are provisions for medical malpractice under the Indian Penal Code, of 1860, there is no separate actual offense for it ^{[20] [21]}. Medical negligence is covered under Sections 52, 80, 81, 83, 88, 90, 91, 92, 304-A, 337, and 338 of the Indian Penal Code of 1860 ^{[22] [23]}. If a patient passes away from the effects of anesthesia during surgery or another type of procedure and it can be established that his or her passing was caused by malice aforethought or egregious carelessness ^[24], a doctor may be prosecuted with criminal negligence. The Indian Penal Code’s Section 304A addresses the crime of negligently causing death ^[25]. No evidence of fault, negligence that contributes, and consent from patients are defenses used in medical negligence proceedings in India. The Consumer Protection Act, the Indian Penal Code, and other Supreme Court and High Courts rulings are the foundation for the legal framework for medical negligence in India ^[26].

How to file a complaint against medical negligence in India?

The initial step in filing a complaint against medical malpractice in India is submitting a complaint to the State Medical Council ^[27]. The patient may be entitled to lodge a complaint with the authorities if they believe the physician or hospital breached their rights ^[28]. The Indian Penal Code, the Consumer Protection Act, and other decisions by the Supreme Court and High Courts are the foundation for the country’s legal system regarding medical negligence ^[29]. To handle charges relating to medical malpractice, the Consumer Protection Act stipulates the formation of consumer courts at the district, state, and federal levels ^[30]. The victim can bring a claim before the consumer court, which will look into it and render a decision ^[31]. Additionally, the person receiving treatment could consult with a lawyer to submit an appeal via a legitimate court ^[32].

Supreme Court’s Judgement on medical negligence cases in India

A few of the significant Supreme Court rulings on medical negligence are presented down below

1. Dr. Kunal Saha Represented By Sri vs. Dr. Sukumar Mukherjee and Ors^[33], also known as the Anuradha Saha Case, is known as the landmark decision in medical negligence claims and the first decision that comes to mind with the greatest amount of compensation awarded to date. In that case, the spouse of the patient had a drug allergy, and the physicians’ negligence in failing to provide the right medications for her finally made her condition worse and caused her death. The doctor in question was found guilty of medical malpractice by the court, and Rs. 6.08 crore in damages were given as punishment.
2. A woman who was to receive medical attention for fever caused by malaria was handled differently in the case of V. Kishan Rao vs. Nikhil Super Speciality Hospitalf^[34]. An officer in the malaria department sued the hospital administration for improperly treating his spouse, who was receiving care for typhoid illness rather than malaria fever. The res Ipsa loquitor concept was used in this instance, and the husband received compensation amounting to Rupees 2 Lakhs.
3. The Supreme Court ruled in Jacob Mathew v. State of Punjab^[35]that in some situations, doctors must make tough decisions. At times circumstances force people to make riskier decisions because they have a better possibility of succeeding. And in certain circumstances, there is less danger and a larger likelihood of failure. Therefore, the choice will rely on specific details and situations.
4. The petitioner was a licensed homeopathic physician in Juggan Khan v. State of Madhya Pradesh^[36]. A woman sought his care for guinea worms after viewing advertising. After consuming the medication he recommended, she began to feel agitated, and even after receiving some countermeasures, she passed away in the evening. According to IPC Section 302, the petitioner was found guilty of murder. The court ruled that prescribing hazardous medications without conducting a thorough investigation and knowing they were harmful constituted negligence.
5. The case of, A.S. Mittal and others v. State of UP and Others^[37], appears to be a legal case that was heard by the Supreme Court of India. From the information provided, it seems that the case involves a mishap that occurred during an ‘Eye Camp’ in Uttar Pradesh, where 108 patients underwent surgeries, including cataract surgery. However, due to the use of normal saline during the operations, 84 patients suffered permanent damage to their eyesight. The Supreme Court held the doctor liable for medical negligence in this case.
6. The case of Poonam Verma v Ashwin Patel and others^[38] is a legal case that was heard by the Supreme Court of India. It appears that the respondent in this case, who had a diploma degree in Homoeopathic Medicine, administered allopathic drugs to a patient who was suffering from high fever. Subsequently, the patient was shifted to a nursing home where he eventually died. The court held the respondent liable for medical negligence as he was registered to provide homeopathic treatment, but not under the allopathy system, and his actions amounted to medical negligence.
7. The case of Spring Meadows Hospital and another v Harjol Ahluwalia^[39] appears to be a legal case that was heard by a court. In this case, a child who was apparently suffering from typhoid was admitted to the appellant’s hospital. However, after receiving an injection from a nurse, the child collapsed. Despite efforts to provide medical care, the child’s condition deteriorated and he was eventually shifted to AIIMS (All India Institute of Medical Sciences), where it was informed to the parents that the child was in critical condition due to an overdose of injection resulting in a cardiac arrest. The court held both The doctor and the nurse are liable to compensate for the negligence. The injection administered by the nurse resulted in an overdose that caused harm to the child, and both the doctor and the nurse were held responsible for this negligence.
8. In the case of Bhalchandra Alias Bapu & Another v. State of Maharashtraf^[40], the Supreme Court of India opined that negligence is the omission to do something that a reasonable person would do or doing something that a reasonable person would never do. Criminal negligence, on the other hand, is the gross neglect to exercise reasonable care and precaution to guard against the public as well as against an individual.

Conclusion

In conclusion, medical negligence is a complex legal concept that involves a breach of the duty of care by a healthcare professional, resulting in harm or injury to a patient. It may arise from actions taken by healthcare providers that fall below the standard of care expected of a reasonably competent practitioner in similar circumstances, or from omissions to act when a duty of care exists. Medical negligence cases often require careful examination of various factors, including the standard of care, evidence of negligence, causation of harm, and the specific facts and circumstances of the case. The analysis of medical negligence involves considering the legal principles, standards of care, and evidence to determine whether there has been a breach of the duty of care and whether the healthcare provider should be held liable for the resulting harm. Different cases may involve different legal standards, such as ordinary negligence or criminal negligence, depending on the level of recklessness or disregard for the safety and well-being of others. It’s important for both healthcare professionals and patients to understand the legal concepts and implications of medical negligence. Patients have the right to expect a certain standard of care from healthcare providers, while healthcare professionals have the responsibility to provide care that meets that standard. In case of suspected medical negligence, it’s advisable to seek professional legal advice to assess the situation thoroughly and determine the appropriate course of action.

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^[1] Medical negligence: Coverage of the profession, duties, ethics, case law, and enlightened defense – A legal perspective by MS Padit and Shobha Pandit. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779963/

^[2] Clinical Errors and Medical Negligence. https://www.karger.com/Article/Abstract/346296

^[3] Medical errors, medical negligence, and defensive medicine: A narrative review by Ivan Dieb Miziara  & Carmen Silvia Molleis Galego Miziara. https://www.elsevier.es/en-revista-clinics-22-articulo-medical-errors-medical-negligence-defensive-S1807593222005026

^[4] Study on medical negligence and implications with special reference to consumer protection act by Suba Yoga S. https://acadpubl.eu/hub/2018-120-5/2/184.pdf

^[5] Medical Negligence in India by Richa Singh FOL AMU. https://blog.ipleaders.in/medical-negligence-india/#Types_of_medical_negligence

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^[7] Medical Negligence and Complaints by Nigel Spencer. https://academic.oup.com/book/25290/chapter-abstract/191490732?redirectedFrom=fulltext

^[8] Clinical Errors and Medical Negligence by Oyebode F. https://www.karger.com/Article/Abstract/346296

^[9] 5 elements of Negligence. https://bencrump.com/faqs/what-are-the-5-elements-of-negligence/

^[10] 5 elements of Negligence. https://bencrump.com/faqs/what-are-the-5-elements-of-negligence/

^[11] What is not considered medical malpractice?. https://www.scottsharrislaw.com/resources/articles/what-not-considered-medical-malpractice/

^[12] Res Ipsa Loquitor. https://en.wikipedia.org/wiki/Res_ipsa_loquitur

^[13] Res Ipsa Loquitor. https://en.wikipedia.org/wiki/Res_ipsa_loquitur

^[14] Res Ipsa Loquitor. https://en.wikipedia.org/wiki/Res_ipsa_loquitur

^[15] Negligence in Tort Law: Res Ipsa Loquitur and Negligence Per Se. https://lawshelf.com/shortvideoscontentview/negligence-in-tort-law-res-ipsa-loquitur-and-negligence-per-se

^[16] https://study.com/learn/lesson/res-ipsa-loquitur.html

^[17] What’s the Meaning of Res Ipsa Loquitur?. https://www.enjuris.com/personal-injury-law/res-ipsa-loquitur/

^[18] Res Ipsa Loquitur and Evidence Law by FinfLawStaff. . https://www.findlaw.com/injury/accident-injury-law/res-ipsa-loquitur.html

^[19] Res Ipsa Loquitor. https://en.wikipedia.org/wiki/Res_ipsa_loquitur

^[20] Medical Negligence in India and in Indian Penal Code, 1860 by Suresh Kumar. https://www.ijmra.us/project%20doc/2018/IJRSS_NOVEMBER2018/IJRSS%20Nov18SureshPr.pdf

^[21] Medical Negligence India by SS Rana & Co. https://www.lexology.com/library/detail.aspx?g=b271f61b-9bc7-4d12-9e88-4c058fd8951b

^[22] Medical Negligence by Ysrao Judge. https://www.legalservicesindia.com/article/1170/Medical-Negligence.html

^[23] Medical Negligence in India and in Indian Penal Code, 1860 by Suresh Kumar. https://www.ijmra.us/project%20doc/2018/IJRSS_NOVEMBER2018/IJRSS%20Nov18SureshPr.pdf

^[24] https://www.medindia.net/indian_health_act/consumer_protection_act_and_medical_profession_indian_penal_code_and_medical_negligence.htm

^[25] Medical Negligence Laws In India by Sanjay KK. https://www.legalserviceindia.com/legal/article-10686-medical-negligence-laws-in-india.html

^[26] Medical Negligence Laws In India by Sanjay KK. https://www.legalserviceindia.com/legal/article-10686-medical-negligence-laws-in-india.html

^[27] Medical negligence in India. https://blog.ipleaders.in/medical-negligence-india/

^[28] How to file a medical negligence case in India? https://vakilsearch.com/blog/file-a-in-india-for-medical-negligence/

^[29] Medical Negligence. https://www.legalservicesindia.com/article/1170/Medical-Negligence.html

^[30] How to file a consumer complain against medical negligence in India? https://www.onlinelegalindia.com/blogs/how-to-file-a-consumer-complaint-against-medical-negligence-in-india

^[31] How to file a consumer complain against medical negligence in India? https://www.onlinelegalindia.com/blogs/how-to-file-a-consumer-complaint-against-medical-negligence-in-india

^[32] How to file a consumer complain against medical negligence in India? https://www.onlinelegalindia.com/blogs/how-to-file-a-consumer-complaint-against-medical-negligence-in-india

^[33] National Consumer Disputes Redressal, Dr Kunal Saha vs Dr Sukumar Mukherjee 21 October, 201. https://indiankanoon.org/doc/22051430/

^[34] Supreme Court of India, V. Kishan Rao vs Nikhil Super Speciality Hospital 8 March 2010. https://indiankanoon.org/doc/1920027/

^[35] Supreme Court of India, Jacob Mathew vs State Of Punjab & Anr on 5 August 2005. https://indiankanoon.org/doc/871062/

^[36] Supreme Court of India Juggankhan vs State Of Madhya Pradesh on 10 August 1964. Equivalent citations: 1965 AIR 831, 1965 SCR (1) 14. https://indiankanoon.org/doc/845354/

^[37] Supreme Court of India A.S. Mittal & Ors vs State Of U.P. & Ors on 12 May 1989. https://indiankanoon.org/doc/338680/

^[38] Supreme Court of India. Poonam Verma vs Ashwin Patel & Ors on 10 May, 1996. Equivalent citations: 1996 AIR 2111, 1996 SCC (4) 332. https://indiankanoon.org/doc/611474/

^[39] Supreme Court of India, M/S. Spring Meadows Hospital & Anr vs Harjol Ahluwalia Through, K.S. on 25 March 1998. https://indiankanoon.org/doc/1715546/

^[40] Supreme Court of India, Bhalchandra Alias Bapu & Anr vs State Of Maharashtra on 11 April 1968

Equivalent citations: 1968 AIR 1319, 1968 SCR (3) 766. https://indiankanoon.org/doc/1748452/