Introduction

Consumer Protection Act 2019, has been mainly enacted to provide protection for the rights and interests of consumers and for the redressal of consumer disputes. As the medical sciences are advancing and patients awareness regarding the healthcare is increasing it is important to know what constitutes medical negligence. In India, medical negligence is addressed under civil , criminal and consumer protection law making it a multifaceted legal issue.

The Judiciary plays an important role in striking a balance between the rights of patients and the autonomy afforded to doctors. Courts have made landmark rulings to formulate a legal precedent, the scope of the duty of care expected of medical professionals and what circumstances may result in a physician being found liable of their actions. This article will discuss what medical negligence means, the legal standard that a court applies in determining medical negligence, the duties owed to a patient by a doctor, and a review of some of the major case law that has developed this area of law.

Concept of Medical Negligence

Negligence is a form of tort or civil wrong, as well as a criminal and wrong. Consumer law. The Supreme Court in Poonam Vermas case has given us the essential elements of medical negligence. The latter are: (1) A legal obligation to exercise due care (2) violation of the said duty (3) consequential damages. Medical negligence is therefore the violation of the duty of a medical practitioner that does not conform to the accepted standards of medical practice, causing an injury to patient. In Dr. Laxman Balkrishna Joshi v. Dr. Trimbak Babu Godbole, the Supreme Court of India explained that negligence consists of a breach of duty caused by omission to do something which a reasonable man would do or doing something which a prudent man would not do.

Essential Elements Of Medical Negligence

To establish medical negligence , the following elements must be proven;

1. Duty of care

The medical professionals must owe a  a legal duty to the patient. In the case of M. Shobha v. Rajakumari Unnithan, “Negligence” is defined by the Court according to the components of duty of care, breaching that duty of care, and then being liable for any resulting damages to the patient or client to whom you owe a duty of care. The duty of care can be established through contract, but it can also be established without a contract when you take on the treatment of a patient or client. In Philips India case, the Supreme Court has laid down  four main duties of a registered medical practitioner, which include:

• Duty to take reasonable care when deciding whether or not to accept a case

• Duty to take reasonable care on deciding what course of treatment to provide

• Duty to take reasonable care when providing that treatment

• Duty to answer questions posed to them.

2. Breach of Duty

There must be a breach of that duty due to failure to adhere to the standard of care expected from a reasonably competent medical professional. In Mr .X v. Hospital Z,  A complainant who was suffering from HIV claimed compensation from the hospital authorities for breach of confidentiality. In the case of the Indian Medical Association vs. V.P. Shantha, the Supreme Court has reiterated that proof of medical negligence by the physician must come from the presentation of empirical information through qualified expert testimony. As such, this case cannot be resolved through a simple affidavit whereby the accused vendor states that he noticed a problem with vision for his right eye (loss of) and partial loss of vision in his left eye after having had surgery 3 days earlier.

3. Causation

The breach must be the direct cause of injury or harm to the patient. In medical negligence lawsuits, the concept of causation refers to determining whether medical negligence occurred due to an absence or failure of duty owed by a physician, and therefore injury resulted from that failure. The process by which you prove the jurisdiction for establishing causation is referred to as 'establishing causation.' The task of establishing medical negligence in these cases of medical negligence is extremely difficult. To put it another way, proving causation in these cases is very difficult for anyone bringing a claim for medical negligence against another person. When a person is receiving medical treatment, or has undergone any other procedures associated with their medical condition, it is presumed that during the process there may be complications or other effects on the ultimate result of the treatment. Therefore, proving that a breach or not taking proper care of the patient caused the injury requires a party establishing causation through the balance of probabilities, and if there are other causes of the injury sustained, you will have to demonstrate that the injury or item claimed was a direct result of the event of which you are bringing a claim.

4. Damage

The patient must have suffered actual harm, injury, or loss as a result of the breach. Unless all four elements are established, a claim of medical negligence will fail.

Legal Standards In Medical Negligence

The reasonable doctor standard

Medical malpractice does not require doctors to demonstrate the most advanced level of skill or expertise; rather, it requires them to possess an adequate level of competence to treat patients. A Doctor should apply skill and care that meets the reasonable standards that most doctors within their specialty would meet when treating the same medical condition.

The Bolam Test

The Bolam case established medical negligence in the UK as something to be measured by whether or not a medical professional acted within the standard of care accepted by a responsible group of other similar professionals at the time the doctor acted. If the medical professional followed what was considered an acceptable standard of care at the time they acted, they would not be considered negligent. In addition to evaluating how other medical professionals would have acted in similar situations, the Bolam case set a very minimal or ordinary standard of care for assessing doctors as liable for medical negligence.

Medical Negligence under Indian Laws

Under Criminal Law

Criminal conduct requires two important components: actus reus, which is the actual crime (an act that has been committed), and mens rea, which refers to a person’s mental state at the time they committed that act (was that person guilty or criminal-minded when they committed the act). As with any professional relationship, doctors have a professional obligation to act with integrity toward their patients. It should be assumed that doctors do not approach their patients with mens rea, except in very rare and unusual circumstances, and therefore, when evaluating whether a physician’s negligence can amount to a criminal offense pursuant to Section 304A of the Indian Penal Code (currently S. 106(1) of BNS) it must be established that the professional acted with gross negligence.

Section 304A of IPC (S. 106(1) of BNS ) forbids the infliction of death by way of a negligent or reckless act which is not guilty of a sufficiently culpable act to amount to a homicide. Should the offender be convicted of the offense of section 304A the offender can serve a maximum two year prison term or may be fined or both. For medical professionals, “negligently” or “rashly” committed means the fault was of such a nature as to have been “gross negligence” or “grossly rash.” For mere negligence, failure to exercise proper care, or an error of judgement, in treatment cannot be prosecuted criminally.

It is essential to provide proof that a doctor engaged in conduct (or negligently failed to engage in required conduct) similar to actions that an ordinary, capable health care practitioner would engage in under similar circumstances when bringing a criminal prosecution against a physician for negligent actions. Criminal negligence occurs when a physician demonstrates a callous disregard for the safety of patients. To prove that a physician acted with criminal negligence, there must be clear evidence that the potential for injury to a patient due to the physician's negligence was sufficiently certain to result in injury or death.

Although Section 304A of the Indian Penal Code (S. 106 (1) of BNS ) may be invoked, a physician's offence is bailable, and therefore eligible for bail. Furthermore, a doctor can also find sanctuary in terms of Section 80 of the IPC, (S. 18 BNS) that states that an accidental committed crime or a misfortune that was committed without any criminal intentions should not be regarded as an offence. Additionally, Section 88 (S. 26 BNS) protects those individuals who act for the welfare of another person in good faith, and have not intended to do further harm to that individual. These provisions protect medical practitioners from unfounded criminal charges while acknowledging the complex issues involved in a determination of what constitutes a sound medical practice.

Under Consumer Protection Act 2019

The question regarding whether medical services come under the consumer protection act is answered as; Yes. the medical services come under the purview of Consumer Protection Act 2019. Patients are treated as “consumers” as they pay for the medical services. However there is exception to this which includes free treatment in government hospital and charitable healthcare services offered without cost. India has a legal framework that ensures accountability and compensation through medical negligence complaints. This is commenced by getting the necessary evidence that includes; medical records, prescriptions, bills, and where feasible expert medical opinion to prove negligence. The aggrieved patient then has to serve a formal legal notice to the doctor or hospital in question in which they give an account of the grievance and request redress. In case of not being solved the complaint may be made to the relevant consumer forum depending on the amount of claim- District Commission up to claims not exceeding 50 lakh, State Commission up to 50 lakh to 2 crore and the National Commission over and above 2 crore. Proper drafting and proper representation would require legal help of a skilled advocate. New statutes like Jacob Mathew v. State of Punjab made it clear that medical practitioners can only be held liable when they are guilty of gross negligence and not otherwise and V. Kishan Rao v. The Nikhil Super Specialty Hospital,  believed that there are no cases when expert evidence is mandatory. Compensation may be made to victims based on medical costs, loss of revenue, emotional distress, disability or fatality with the most recent decisions granting substantial damages. The willingness of the Courts to award large sums in viable Negligence cases continues to exist as a recent order of 2 crores granted by the Supreme Court of India in 2023 confirms.

Contempary Issues And Judicial Approach

Concerns regarding Doctor Harassment and Defensive Medicine have arisen as a result of the increasing volume of Medical Litigation within India. In adopting a balanced approach, Indian Courts provide Protection of Patient Rights, while preventing the misuse of legal provisions against Physicians.

Judges emphasise that there is no liability for bona fide errors or differences of opinion regarding treatment provided by Physicians, provided that they acted with reasonable competence and in good faith.

Conclusion

Through Medical Negligence, Legal Standards and Regulations provide accountability within Health Care, while also recognising Physician Autonomy and Dignity. Courts use the Bolam Test, and the reasonable care standard (in the context of the Medical Error) as a balance between Patient Safety and Medical Expertise. All of these Medical Negligence Laws have their foundations in Duties such as; Informed Consent, Accurate Diagnosis, and Competent Treatment. Landmark Legal Decisions made by Indian Courts have helped clearly define the liability of physicians for medical errors, and have divided Negligence (i.e., Civil and Criminal). As Technology and Patient Awareness continue to evolve, Medical Negligence Law will also continue to develop in order to Strike a Fair and Equal Balance Between Patient Rights and Physician Independence.

REFERENCES:

• Consumer Protection Act, 2019

• Poonam Verma v. Aswin Patel and Ors 1996 SCC(4) 332

• Dr. Laxman Joshi v. Dr. Trimbak Godbole  (1969) 1 SCR 206

•  Bolam v. Friern Hospital Committee (1957) 1 WLR 582

• Indian Medical Association vs. V.P. Shantha, [1995] 3 CPR 412, AIR 1996 SC 550,[1995]III CPJ 1, [1995] 6 SCC 651

• Philips India Ltd. v. Kunju Punnu, AIR 1975 Bom 306

• V. Kishan Rao v. The Nikhil Super Specialty Hospital 5 SCC 513

• Jacob Mathew v. State of Punjab (2005) 6 SCC 1

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