Medical Negligence and Courts: Law and Case Laws

The Author, Shreya Shreeja, is a 3^rd Year law student at NMIMS School of Law, Bangalore. She is currently interning with LatestLaws.com.

INTRODUCTION

The medical profession is widely regarded as one of the most esteemed and honourable occupations within the Indian professional landscape. From the perspective of a patient, it can be argued that the doctor assumes a role akin to that of a God.

Furthermore, it is a well-established principle that the deity in question possesses the attribute of infallibility. However, it is the subjective belief of the patient. In actuality, it is a well-established principle that medical practitioners are indeed human beings.

So to speak, it is a well-established legal principle that the propensity for human beings to make mistakes is an inherent characteristic of their nature. Medical practitioners have the potential to engage in errors or lapses in judgment. Medical professionals have the potential to engage in acts of negligence. The potential for negligence on the part of the support staff cannot be discounted. The commission of two acts of negligence has the potential to give rise to a significantly more substantial legal predicament.

The potential cause for such an occurrence could potentially be attributed to an act or omission that demonstrates a severe lack of care or disregard for the safety and well-being of others, commonly referred to as gross negligence.

It is arguable that within the realm of legal possibilities, any outcome may conceivably be attainable. In the given scenario, it is imperative to ascertain the party responsible for negligence and the specific circumstances surrounding the incident.

In a jurisdiction dedicated to upholding the principles of legal governance, the aforementioned matters are brought forth before the court, wherein the presiding judges are entrusted with the responsibility of rendering a decision.

Nevertheless, it is imperative to acknowledge that the determination of medical negligence by judges poses a considerable challenge due to their lack of specialized training in the field of medical science.

The determinations rendered are predicated upon the opinions of qualified experts. Judicial officers, commonly referred to as judges, employ the fundamental tenets of jurisprudence in conjunction with the prevailing legal framework to render a verdict. The guiding principles in this context are reasonableness and prudence.

WHAT IS NEGLIGENCE?

The definition of negligence poses considerable challenges, yet it has gained recognition within the field of jurisprudence. Negligence, as defined in legal parlance, refers to the failure to fulfill a duty, either by neglecting to perform an action that a reasonable individual, guided by the customary standards governing human conduct, would undertake, or by engaging in an act that a prudent and reasonable person would abstain from. The concept of actionable negligence arises when an individual fails to exercise the appropriate level of care or skill towards another individual to whom they owe a duty of ordinary care and skill. This failure, commonly referred to as neglect, results in harm or damage to the plaintiff's person or property.

The definition encompasses three essential elements of negligence:

(1) The party being accused has a legal obligation to act with reasonable care towards the party making the complaint, considering the specific responsibilities involved.

(2) The accused party has failed to fulfill this duty.

(3) As a result of this breach, the complaining party has suffered consequential harm or loss.

The fundamental and indispensable elements that are necessary for the proper functioning and operation of a particular subject matter or system

In a cause of action grounded in negligence, it is incumbent upon the plaintiff to establish the following essentials:

• The defendant, as a matter of legal obligation, owed a duty of care to the plaintiff; The defendant, in contravention of said duty, committed a breach thereof;
• The plaintiff, as a direct result of said breach, incurred damages.

DUTY OF CARE OF THE DEFENDANT

It would be patently unreasonable to impose liability upon any individual for each and every negligent act committed, or even for each negligent act resulting in harm. The potential imposition of liability in negligence shall only arise if the individual in question is subject to a legally recognized duty to exercise due care. The distinction between legal duty and moral, religious, or social duty is crucial. Consequently, it is incumbent upon the plaintiff, acting as the consumer, to substantiate that the alleged wrongdoer possessed a distinct legal duty towards them, which was subsequently violated. The imposition of the standard of care is contingent upon the existence of a legal duty or obligation on the part of an individual to exercise caution. Therefore, it can be posited that the term ‘duty’ refers to ‘the legal relationship between individuals wherein one party is obligated by law to act in the best interest of another party.’ In alternative phraseology, the duty can be defined as ‘a legal obligation imposed upon an individual to refrain from engaging in behavior that possesses an unreasonable and foreseeable threat of harm to others.’ The presence of a legal obligation owed to the plaintiff assumes a significant role in determining the imposition of liability upon the wrongdoer.

DUTY DEPENDING ON REASONABLE FORESEEABILITY OF HARM

The determination of whether the defendant bears a legal duty towards the plaintiff hinges upon the application of the doctrine of reasonable foreseeability to the circumstances at hand. In the event that, at the moment of the act or omission, the defendant possessed the capacity to reasonably anticipate the occurrence of harm to the plaintiff, a legal obligation is imposed upon him to take necessary measures to avert said harm. The defendant’s failure to fulfill this duty renders him legally accountable and subject to liability. The duty of care entails refraining from engaging in or neglecting to engage in any action that could reasonably and likely result in harm to others. This duty is owed to individuals who may reasonably and likely suffer injury if the duty is not upheld.

In the case of Booker v. Wenborn[1], it was alleged that the defendant, in a manner contrary to established norms and regulations, embarked upon a moving train while negligently failing to properly secure the door of the carriage, thereby exposing fellow passengers to potential harm and endangering the safe operation of said train. The act of the door opening outwardly resulted in a hazardous condition for individuals situated upon the platform.

The individual initiating the legal action, hereinafter referred to as the plaintiff, employed in the capacity of a porter, was positioned proximate to the periphery of the platform when an impact occurred between the door and the plaintiff, resulting in bodily harm and injury.

The court rendered a decision wherein it was determined that the defendant bore legal responsibility due to the fact that an individual embarking upon a train in motion possessed an obligation to exercise reasonable care towards an individual situated in close proximity on the platform.

In the case of S. Dhanaveni v. State of Tamil Nadu[2], it was alleged that the deceased, under circumstances yet to be fully elucidated, inadvertently descended into a cavity containing accumulated precipitation during the nocturnal hours. The individual in question, in order to prevent an imminent fall, grasped onto a nearby electric pole.

As a result of the presence of an electrical current escaping from the aforementioned pole, the individual in question experienced electrocution. The respondent, in his capacity as the party responsible for the maintenance of the electric pole, was deemed to have acted negligently and consequently found to be legally accountable for the untimely demise of the deceased individual.

In the case of Mata Prasad v. Union of India[3], it was observed that the gates of a railway crossing were found to be in an open position. Upon the driver's attempt to traverse the railway line, the truck in question was subjected to a collision with an oncoming train. The court determined that in the circumstance where the gates of the level crossing were open, the truck driver possessed a reasonable basis to believe that there existed no imminent peril in traversing the railway track. The railway administration, by virtue of their negligence, has been deemed legally responsible and held liable.

In the matter of Orissa Road Transport Co. Ltd. v. Umakant Singh[4], it was determined that the bus driver bore responsibility for the unfortunate demise of two passengers. This liability arose from the driver's attempt to traverse the level crossing, which proved unsuccessful due to a mechanical flaw present in the truck.

The temporal window available for traversing the level crossing was sufficient, and the individual in question possessed knowledge pertaining to the existence of a mechanical malfunction. Therefore, it can be concluded that the individual in question was found to have breached the duty of care owed, thereby establishing a prima facie case of negligence.

BREACH OF DUTY

The second crucial element requisite for establishing liability of the tortfeasor in a negligence claim is not only the existence of a duty of care owed by the defendant to the plaintiff, but also the demonstration of a breach thereof. The legal standard for determining a breach of duty was established in the well-known statement made by Alderson B in the case of Blyth v. Birmingham Waterworks Corporation[5]. According to this dictum, negligence occurs when there is a failure to perform an action that a reasonable person, guided by the usual principles that govern human conduct, would do, or when an action is taken that a prudent and reasonable person would not do. 

 In assessing the defendant's breach of duty, the courts adhere to an objective standard of care, the extent of which may differ depending on the circumstances of each case. It is established that a higher degree of standard of care is required when the magnitude of risk is greater.

Moreover, it is imperative to consider two pivotal factors when assessing the extent of risk, namely:

(i) the severity or gravity of the potential harm that may be incurred; and

(ii) the probability of the actual occurrence of said harm.

In the case of Nirmala v. Tamil Nadu Electricity Board[6], it is alleged that the plaintiff's husband, while engaged in agricultural activities on his farm, suffered an electrocution resulting in instantaneous death. This unfortunate incident occurred when the deceased individual came into contact with a live wire that had become detached.

In the matter of establishing liability in negligence against the defendants, it is crucial to highlight that the court duly observed the defendants' failure to exercise due care in maintaining the relevant premises. This failure ultimately led to the snapping of wires, thereby causing harm. Additionally, it is worth noting that the defendants neglected to furnish a mechanism that would have promptly rendered the snapped wire inactive and devoid of any potential danger.

BREACH OF DUTY

The third and final element indispensable to establish a claim of negligence necessitates the plaintiff to demonstrate the causal nexus between the breach of duty and the resulting harm. In other words, in cases where the defendant is alleged to have committed a fault, the plaintiff bears the burden of proving that the defendant acted negligently. The aforementioned observation can also be discerned in the judicial pronouncement rendered by the Madras High Court in the case of Pandian Roadways Corporation v. Karunanithi[7].

In the present case, it is pertinent to note that three individuals of a tender age were engaged in the act of operating a bicycle. Upon observing a confrontation between canines in close proximity, the individuals in question experienced a loss of equilibrium resulting in their subsequent descent to the ground.

The bus operator, upon witnessing the descent of the boys, failed to expeditiously engage the braking mechanism, thereby causing the bus to traverse over the right upper extremity of one of the aforementioned juveniles. The driver's failure to bring the bus to a halt was deemed to constitute a manifest instance of negligence on his behalf.
In the event that the plaintiff is unable to establish a sufficient evidentiary basis for the defendant's alleged negligence, it follows that the defendant shall not be held legally responsible or liable.

The plaintiff bears the initial burden of proof to establish, at minimum, a prima facie case of negligence against the defendant. Notwithstanding, it is imperative to acknowledge that there exist specific instances wherein the burden of proof is not required of the plaintiff, as the presumption of negligence is derived from the factual assertions put forth by said plaintiff.

The maxim ‘Res Ipsa Loquitor’ establishes a presumption of negligence, wherein the thing in question speaks for itself. In instances where an accident, defect in goods, or deficiency in services can be attributed to a singular cause, it is established that said accident or defect/deficiency would not have transpired had the defendant not acted negligently. Consequently, the legal framework presumes negligence on the part of the defendant.

NEGLIGENCE BY PROFESSIONALS

Under the doctrine of negligence, individuals who possess specialized knowledge or skills, including but not limited to lawyers, doctors, architects, and other professionals, are encompassed within the classification of persons engaged in the practice of a particular expertise or skilled individuals at large. A professional may incur liability for negligence based on either of two findings: first, if they lack the necessary skill they claim to possess; or second, if they fail to exercise reasonable competence in applying the skill they profess to have in a specific case.

MEDICAL NEGLIGENCE

An individual who presents themselves as capable of providing medical advice or treatment implicitly assumes the responsibility of possessing the requisite expertise and understanding for such endeavors.

In the event that an individual, regardless of their status as a medical practitioner, is approached by a patient seeking consultation, they are bound by specific obligations towards said patient. These obligations consist of a duty of care in the assessment of whether or not to accept the case, a duty of care in determining the appropriate course of treatment, and a duty of care in the execution of said treatment. A breach of any of these duties shall give rise to a cause of action for negligence by the patient.

In the case of Jacob Mathew v. State of India[8], the esteemed Supreme Court of India meticulously delved into the intricacies surrounding the definition of negligence as it pertains to medical practitioners.

In the realm of the medical profession, the concept of negligence inherently necessitates a distinct approach to treatment. In the context of imputing recklessness or negligence to a professional, specifically a medical practitioner, it is imperative to take into account supplementary factors.

A distinction can be drawn between a case involving occupational negligence and one involving professional negligence. Merely demonstrating a dearth of attentiveness, an instance of flawed discernment, or an unintended occurrence does not suffice as evidentiary support for the assertion of negligence on the part of a healthcare practitioner.

Provided that a physician adheres to a standard of care deemed acceptable by the contemporary medical community, they shall not be subject to liability for negligence solely on the grounds that a superior alternative course of action or treatment method was available or that a more proficient physician would have refrained from adopting the practice or procedure employed by the accused individual.

In the context of assessing the failure to exercise due precautions, it is imperative to consider whether the precautions taken align with those commonly deemed sufficient based on the ordinary experience of individuals. It is not appropriate to evaluate the alleged negligence based on the failure to employ exceptional or extraordinary precautions that could have potentially averted the specific incident.

Furthermore, it is imperative to consider that the evaluation of the practice adopted necessitates an examination of the standard of care. This standard is to be assessed based on the knowledge that was accessible at the time of the incident, rather than at the date of trial.

In a similar vein, in cases where the allegation of negligence stems from the omission to employ specific equipment, the assertion would be rendered invalid if said equipment was not commonly accessible during the precise moment (namely, the time of the occurrence) when it is contended that it ought to have been utilized.

DEGREE OF MEDICAL NEGLIGENCE

The absence of punitive consequences shall be applicable to any instance of negligence committed by a medical practitioner. Slight neglect, by its very nature, does not warrant punitive measures, as it falls below the threshold of legal culpability. Similarly, ordinary neglect, as its nomenclature implies, does not merit penal consequences.

Upon amalgamating these two elements, we are presented with two distinct classifications: negligence that shall render the doctor accountable, and negligence that shall not render the doctor accountable. In the majority of instances, the demarcation shall be readily discernible; nonetheless, the quandary arises in those particular cases wherein the demarcation is tenuous.

With respect to the matter of medical negligence, the legal stance has been expounded upon in numerous authoritative judicial decisions. Hereinbelow, a non-exhaustive enumeration of certain examples is presented for the purpose of elucidation:

In the matter of Bolam v. Friern Hospital Management Committee[9], the case at hand pertains to a significant legal dispute that transpired within the realm of healthcare. It is imperative to note that the aforementioned case carries substantial weight and has garnered considerable attention within legal circles.

The crux of the John Hector Bolam, hereinafter referred to as the patient, purportedly endured a state of mental distress characterized by depression, thereby necessitating medical intervention. The patient sought treatment at the Friern Hospital during the year 1954, where he was subjected to a therapeutic modality known as electro-convulsive therapy (ECT).

The administration of any relaxant drug was conspicuously absent, notwithstanding the fact that nurses were positioned on both sides of the couch in order to avert any potential mishap involving the individual in question inadvertently descending from said couch. Upon the individual's voluntary consent to undergo medical treatment, it has come to light that the hospital, in its duty to inform, neglected to apprise him of the potential risks associated with said treatment, most notably the administration thereof in the absence of relaxant drugs.

The plaintiff suffered fractures as a direct consequence of the medical intervention and subsequently initiated legal proceedings against the hospital, alleging a breach of duty resulting in negligence, seeking compensation for the resulting damages. According to the opinions of experts, it has been asserted that there exist two accepted practices in the field.

These practices encompass the administration of relaxant drugs as a form of treatment, as well as the alternative approach of treatment without the utilization of relaxant drugs. With respect to the matter of the warning, it is imperative to acknowledge the existence of two prevailing practices. Firstly, it is customary to provide patients with the requisite warning.

Secondly, an alternative approach is observed wherein the warning is exclusively dispensed upon the patients' explicit inquiry regarding the associated risks. The court, in its determination, reached the conclusion that the medical practitioners and the healthcare facility in question did not exhibit any form of negligence.

In the case of Achutrao Haribhau Khodwa v. State of Maharashtra[10], the Honorable Supreme Court opined that there exists a variance in the aptitude of medical practitioners, which may vary from one doctor to another. The inherent essence of the legal vocation is such that there may exist multiple avenues of action that could be deemed appropriate for the purpose of attending to a patient's medical needs.

The courts would, in fact, exhibit a propensity for deliberation when ascribing negligence to a medical practitioner, particularly if said practitioner has discharged their professional obligations with utmost competence, diligence, and circumspection. Divergence of medical opinion may arise concerning the appropriate course of action to be undertaken by a physician in the treatment of a patient.

Nevertheless, as long as the doctor conducts themselves in a manner that is deemed acceptable by the medical community, and the Court determines that they have attended to the patient with the requisite level of care, expertise, and conscientiousness, it would prove arduous to ascribe culpability for negligence upon the doctor, even in the event that the patient's survival is not achieved or they endure a lasting affliction.

Moreover, in the legal case of State of Haryana v. Santra[11], the court affirmed the judgment that granted compensation for medical malpractice. This was due to the fact that the woman in question had experienced the birth of an undesired child as a result of a failed sterilization procedure.

The court's decision was based on the factual finding that the doctor had solely performed the operation on the right fallopian tube, neglecting to address the left fallopian tube. The patient was duly apprised of the successful completion of the surgical procedure and was provided with unequivocal assurance that she would be incapable of conceiving progeny henceforth. In the present matter, a determination of medical negligence has been established, thereby warranting a justifiable decree for compensation in tort.

LIABILITY OF HOSPITALS

The liability of hospitals in relation to medical negligence may manifest as either direct liability or vicarious liability. Direct liability pertains to the inherent inadequacy exhibited by the hospital in fulfilling its duty to furnish a secure and appropriate treatment setting as previously assured. Vicarious liability, as a legal doctrine, pertains to the imposition of liability upon an employer for the negligent acts committed by its employees.

The legal responsibility of an employer extends beyond their own actions, encompassing both intentional and unintentional acts, as well as omissions. Furthermore, an employer bears liability for any negligent conduct exhibited by their employees, provided that such conduct transpires within the parameters of their employment duties and responsibilities.

The aforementioned liability is in accordance with the legal doctrine of ‘respondeat superior,’ which translates to ‘let the master answer.’ Employers, in accordance with the common law doctrine encapsulated by the Latin maxim ‘qui facit per alium facit per se,’ bear legal responsibility.

This principle elucidates that an individual who acts through a representative ultimately acts in their own self-interest. The aforementioned notion bears resemblance to the legal doctrines of vicarious liability and strict liability, wherein an individual is subjected to legal responsibility in the realm of Criminal Law or Tort for the actions or failures of another party.

CONCLUSION

In matters concerning negligence, it is essential to consider two potential scenarios: either the negligence in question stems from the actions of the physician, or it arises from the conduct of the medical staff. There exists a potentiality for negligence, attributable to both the medical practitioner and the personnel. In the majority of instances, it is likely to be a matter of joint and several liability, wherein both the physician and the medical facility shall bear legal responsibility. The apportionment of liability between the parties shall be determined in accordance with the mutual agreement reached between them.

Currently, the existing judgments exhibit a considerable degree of discretion, which may, on certain occasions, be exercised by various individuals, such as medical professionals and members of the judiciary, in a manner that is deemed undesirable. The legal framework pertaining to the aforementioned subject matter necessitates a higher degree of precision and certainty. That will undoubtedly provide a more comprehensive comprehension regarding the concept of the ‘reasonable person.’ It is hereby posited that in light of the apparent settlement of the law pertaining to medical negligence by the esteemed apex court, it becomes imperative to establish a definitive legal stance in other domains.

REFERENCES

1. Daya Shankar Tiwari, 2013, Medical Negligence in India: A Critical Study, published by SSRN, available at: https://dx.doi.org/10.2139/ssrn.2354282
2. M.S. Pandit and Shobha Pandit, 2009, Medical Negligence: Coverage of profession, duties, ethics, case law, and enlightened defense – A legal perspective, published by the Indian Journal of Urology, 25(3), 372-378, available at: https://doi.org/10.4103%2F0970-1591.56206
3. 2023, Guidelines on Medical Negligence under consideration, says Union Health Ministry, published by The Hindu, available at: https://www.thehindu.com/sci-tech/health/guidelines-on-medical-negligence-under-consideration-says-union-health-ministry/article66617921.ece

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