Medical Negligence & Legal Ramifications on Healthcare Providers in India

Cutting Edge

Medical Negligence & Legal Ramifications on Healthcare Providers in India

Ashwini Kavadimatti | April 2024

INTRODUCTION

Medical negligence remains a significant concern in India, with its legal framework primarily based on judicial precedents rather than specific legislation. This article examines the challenges posed due to absence of comprehensive laws governing medical negligence, particularly its civil and criminal aspects. It explores how this ambiguity affects healthcare providers and why reform is imperative.

Medical Negligence As Judgemade Law:
- Absence of statutory framework: Unlike many other jurisdictions, India lacks specific legislation governing medical negligence. Instead, the legal principles surrounding medical negligence have evolved through judicial decisions, leading to varying interpretations and inconsistencies in legal standard
- Forum shopping: The absence of codified laws on medical negligence allows patients to file same complaint or grievance before multiple forums like, Medical Boards, Government Bodies, Consumer Courts, Civil Courts, Criminal Courts etc., seeking compensation, criminal prosecution, disciplinary action against doctors and the hospital or any other redressal. This practice, known as forum shopping, creates confusion and imposes a burden on healthcare providers who must defend themselves against multiple claims in different forums simultaneously on the same grievance. The healthcare providers are subjected to differing legal standards and outcomes based on the chosen forum. It can also lead to forum-specific variations in legal precedents and judgments, creating inconsistencies and uncertainties in the legal landscape surrounding medical negligence.
Civil And Criminal Dimensions Of Medical Negligence:
- Civil liability: Medical negligence primarily entails civil liability, where patients seek compensation for damages or injuries suffered due to healthcare provider’s alleged negligence. Without clear statutory guidelines, determining the standard of care and assessing liability becomes subjective, leading to protracted legal battles and uncertain outcomes.
- Criminal prosecution: In addition to civil liability, medical negligence may also attract criminal liability under provisions of the Indian Penal Code (IPC). Sections such as 304A (causing death by negligence) and 337/338 (causing hurt by negligent or rash acts) allow for criminal prosecution of healthcare providers for alleged gross negligence or recklessness resulting in harm or death of patient while providing medical care. However, the lack of specific criteria or thresholds for criminal liability leads to arbitrary prosecutions and undermines the principles of natural justice.
Challenges Of Healthcare Providers:
- Legal uncertainty: The absence of clear laws defining medical negligence creates legal uncertainty for healthcare providers, making it challenging to ascertain their legal obligations and liabilities.
- Financial burden: Defending against medical negligence claims, whether civil or criminal, imposes a significant financial burden on healthcare providers. Legal fees, court expenses, and potential damages awards can strain hospital budgets, divert resources from patient care, and undermine the sustainability of healthcare services.
- Professional and brand reputation: Allegations of medical negligence tarnish the reputation and credibility of healthcare providers, affecting patient trust and confidence. Even unfounded claims can damage a provider’s reputation irreparably, leading to loss of patients, healthcare networks, and professional standing within the medical community.
- Psychological stress: Dealing with medical negligence allegations affects mental health and well-being of healthcare providers. The stress, anxiety, and emotional strain associated with litigation can lead to depression, and decreased job satisfaction, impacting the quality of care provided.
Need For Legal Reforms:
- Codification of laws: To address the challenges posed by the absence of comprehensive laws on medical negligence, there is a pressing need for legislative intervention. Codifying laws on medical negligence would provide clarity, consistency, and predictability in legal standards, reducing ambiguity and forum shopping.
- Standardization of liability: Legislative reforms should establish clear criteria and standards for determining liability in cases of medical negligence, both civil and criminal. This would ensure that healthcare providers are held accountable for breaches of duty of care while protecting them from arbitrary or unjustified prosecutions. It is prudent to review and amend existing laws to establish clearer standards like, ensuring that criminal charges are to be reserved for cases of gross negligence or willful misconduct rather than honest mistakes or unforeseen complications.
- Alternative dispute resolution: Implementing alternative dispute resolution mechanisms, such as mediation or arbitration, can expedite the resolution of medical negligence disputes, reduce legal costs, and promote amicable settlements. Such mechanisms offer a more patient-centered approach to resolving grievances and addressing harm suffered by patients. It is a need of the hour to introduce mandatory mediation or arbitration processes to resolve medical negligence disputes before criminal charges are pursued, this will encourage improved communication and reconciliation between doctors and patients.
- Professional education and training: Enhancing education and training on medical ethics, risk management, and legal obligations is essential for healthcare providers to mitigate the risks of medical negligence. Continuous professional development programs can improve awareness, adherence to best practices, and ethical conduct among healthcare professionals.
- Support System: To develop support systems for doctors facing allegations of medical negligence, including legal assistance, counseling services, and peer support networks to mitigate the psychological and professional impact of litigation
- Public Awareness Campaigns: There should be frequent public awareness banning violence against healthcare providers by patient or attendants which is clearly an illegal act leading to stringent actions in law with criminal prosecution. Public awareness campaigns must be launched to educate patients about the complexities of medical practice, the risks associated with healthcare interventions, and the importance of realistic expectations and informed consent.
- Restriction on social media: The laws and legal reforms should be made against reporting of false medical negligence cases in any form of media by restricting them from cascading incorrect and concocted information leading to unnecessary media trials, which are far from the reality and which in turn influence the various forums to misinterpret, whereby the healthcare providers become victims of media trials and scrutiny.
- Challenging unfounded medical negligence Claims: To discourage unfounded medical negligence claims, it’s essential to impose consequences. Patients should be held accountable and obligated to legally compensate doctors and healthcare providers when their claims are proven false or baseless. This Promotes fairness, discourages frivolous allegations and upholds he integrity of the healthcare system.

By implementing these measures, the government can strive to strike a balance between ensuring accountability for medical negligence and safeguarding the professional integrity and well-being of Doctors and Healthcare providers.

Conclusion

The absence of comprehensive laws governing medical negligence in India poses significant challenges for healthcare providers, leading to legal uncertainty, financial burden, reputational damage, and psychological stress. The dual dimensions of civil and criminal liability further compound these challenges, creating a complex legal landscape characterized by forum shopping and arbitrary prosecutions. Urgent legislative reforms are needed to codify laws on medical negligence, establish clear standards of liability, and promote alternative dispute resolution mechanisms.

A Few Landmark Judgements In India On Medical Negligence:

The judgements of various courts have played a crucial role in the evolution of medical jurisprudence in India and underscored the importance of accountability, patient rights, doctors’ rights and ethical conduct in healthcare delivery. Below discussed are a few notable cases that have had a significant impact:

Jacob Mathew v. State of Punjab: In this case, the Supreme Court clarified the key legal principles governing medical negligence:

Duty of care: Medical practitioners owe a duty of care towards their patients. This duty requires them to exercise a reasonable degree of skill and care while treating patients. This duty is not absolute but varies depending on the circumstances of each case
Breach of duty: A breach of this duty occurs when a medical professional fails to adhere to the standard of care expected of them. The standard of care is determined by what a reasonable doctor, with the same level of expertise, would do in similar circumstances. If a doctor’s actions fall below this standard, it constitutes a breach of duty.
Breach being direct cause of injury, harm, or death To establish medical negligence, it is not sufficient to prove that there was a breach of duty. It must also be demonstrated that this breach directly caused the injury suffered by the patient. The harm suffered must be a foreseeable. consequence of the doctor’s negligence.

Indian Medical Association v. V.P. Shantha case is a significant legal case in India concerning medical negligence and patient rights. Here are the key principles of the case

Informed consent: The case reaffirmed the importance of informed consent, and ruled that patients have the right to be informed about the risks, benefits, and alternatives of a proposed treatment
Doctor-Patient relationship: It emphasized the fiduciary nature of the doctor-patient relationship, highlighting that doctors have a duty to act in the best interests of their patients.
Standard of care: Like the Jacob Mathew case, it reiterated duty of care.
Liability of Hospitals: The case Also addressed the liability of hospitals for the actions of their staff, including doctors. Hospitals can be held vicariously liable for the negligence of their employees if it occurs in the course of employment.
Scope of Compensation: It Clarified the scope of compensation available to victims of medical negligence, including compensation for physical injuries mental anguish loss of income, and medical expenses.

In this case, the Hon’ble Supreme Court of India ruled that medical professionals and institutions could be held liable for negligence under the Consumer Protection Act, recognizing healthcare services as a form of consumer service

Dr. Laxman Balkrishna Joshi v. Dr. Trimbak Bapuji Thakur: The court held that the surgeon had exercised due care and skill during the operation, and the patient’s complications were unforeseeable. This judgment underlined all inferences of Jacob Mathew case like, Standard of Care, Negligence (detailed above) and an in addition, it also emphasized on the following broad principles:

Res Ipsa Loquitur: The principle of res ipsa loquitur (“the thing speaks for itself”) was applied in this case. It allows the inference of negligence based on the nature of the injury and the circumstances surrounding it, even without direct evidence of negligence.
Expert testimony: Expert witnesses play a crucial role in assessing whether the doctor’s actions or omissions deviated from the accepted standard of care
Causation: There must be link between the doctor’s negligent conduct and the harm suffered by the patient. Negligence must be a direct cause of the injury or damage sustained by the Patient
Burden of proof: The burden of proof lies with the plaintiff (the patient) to establish that the doctor’s negligence caused their injury.

Kunal Saha v. Dr. Sukumar Mukherjee & Ors.: This case involved a medical negligence claim against Kolkata hospital and its doctors following the death of his wife due to medical complications. The Supreme Court awarded substantial compensation recognizing negligence, inappropriate treatment and the lack of proper medical care. However, certain elements were held in favor of the Doctors and Hospital especially it elaborated importance of proper documentation :

Documentation: If the doctor maintained thorough and accurate medical records documenting the patient’s condition, treatment provided, and any relevant discussions or decisions, it could serve as evidence of the doctor’s diligence and professionalism.

Indian Medical Association v. Santha Sonawalla (2002): In this case, the Supreme Court held that medical practitioners cannot be held liable for negligence merely because the treatment they provided was unsuccessful. The court emphasized that the standard of care expected from doctors should be judged based on accepted medical practices at the time of treatment, rather than the outcome alone.

Disclaimer: The content of this article is a culmination of insights from subject matter experts, books, and online reading materials. It represents the work of original authors, drawing upon and crediting the various sources that were relied upon during its creation.

About Author

Ashwini Kavadimatti

Ashwini P. Kavadimatti is currently working as the General Counsel at HealthCare Global Enterprises Ltd.