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Law related to Medical Negligence: Impact of Case Laws | Overview
- Landmark Judgements that fortified rights of Patients as Consumers
- Indian Medical Association v. V.P. Shantha & others (1992) 1 Andhra Law Times 713
- Dr Laxman Balkrishna Joshi v. Dr Trimbak Bapu Godbole and Anr (1969 AIR 128)
- National Commission in S.R. Shivaprakash and Ors. v. Wockhardt Hospital Ltd. and Ors (2005)
- Aparna Dutt v. Apollo Hospital Enterprises Ltd (2002 ACJ 954 (Mad. HC))
- Dr. Balram Prasad v. Dr. Kunal Saha & others
Medical Negligence characterises a major part of our medical system today, with increasing reliability on instrumental infrastructure and junior practitioners. The devolution of powers from the doctor to the patients has improvised several of our laws which were limited to the convenience of doctors. A key towards curbing such prejudice would be a Medical Transformation, amounting to a triumph of the nation and the global community as a whole.
It would nurture a sense of safety and trust among citizens and build our sensitivity towards the developments in medical science. The rightful need of a patient is honest care and its proposition by courts, leading to efforts by hospitals in curbing negligence and malpractice, has helped pave the way for more secure treatments and remedies.
All medicine is made to make you better. If it did the opposite, it would be malpractice. – Chael Sonnen
The medical profession, which is considered to be a humanitarian and noble profession compared to the others, prevalent in society, idolizes the duty of doctors, bestowing upon them, such designations as Lifesavers and even God. But, nowadays the credibility of that “God” is being questioned, as not only India but the world is acknowledging the patient’s right and restricting the care giver’s carelessness or medical negligence through stricter parameters of the law.
In India, the Medical Council of India which is a self-regulatory authority usually responds to any unacceptable and wrong treatment towards the patient and calls for disciplinary inquiry against the medical practitioner. Since there are some ambiguities and incapacities in MCI’s disciplinary mechanism which ends up with the patient’s rights being compromised, the Apex Court through its reasoned judgment created guidelines, which will address the concerns of the patient as a consumer and benefit them in the long run.
Judiciary respects the medical fraternity and hardly questions the credibility of a doctor but the same is actively done if a consumer would receive damage because of the negligence, malpractice, and unethical treatment by others.
Landmark Judgements that fortified rights of Patients as Consumers
Our first case in which we are dealing is the Indian Medical Association v. V.P. Shantha & Others, which put the medical facilities under the broad umbrella ambit of “service” under Section 2 (1) (0) of Consumer Protection Act, 1986.
In a landmark judgment of Dr Laxman Balkrishna Joshi v. Dr Trimbak Bapu Godbole and Anr, the court held that the Doctor in his capacity has a duty of care and if such duty of care is being breached resulting in damage, then that will amount to medical negligence. The case will specifically deal with what duty of care is and in what case the breach will end up with damage.
The maintenance of documents of prescription and treatment would also be dealt with as our third case named The National Commission in S.R. Shivaprakash and Ors. v. Wockhardt Hospital Ltd. and Ors. Apart from this breach of duty, there is also a breach on the part of the junior practitioner and other administrative failures which imposed vicarious liability on the medical professional. This area of vicarious liability will be covered under Aparna Dutt v. Apollo Hospital Enterprises Ltd.
At the end of the case timeline, the most important question which is complex in its own way, is the assessment of the compensation specifically addressed in the case of Dr Balram Prasad v. Dr Kunal Saha & Others.
I. Indian Medical Association v. V.P. Shantha & others (1992) 1 Andhra Law Times 713
This case proved to be the first to acknowledge the patient’s right by giving a patient the status of a “service” and protect him from the marketing of medical facilities which implicate threat of life and property. The said case has vigilance over the quality and standard of medical facilities.
The question raised was whether the facilities provided by medical professionals and hospital/nursing homes will fall under the definition of ‘service’ under Section 2(1)(o) of the Consumer Protection Act, 1986. If the answer is in affirmative, then in what circumstances?
The three-judge bench held that service provided by the medical practitioner or hospital/nursing home will fall under “services” under Section 2(1) (o) of this act. The court opined that there is “contract for personal service” and not “contract of service” as there is no master-servant relationship between the doctor and the patient. With regard to the service provided by the doctor and hospital/nursing home, the falling under the “service’’ definition depends on whether they charge any amount from the patient.
In case the doctor or the hospital charge from the patient, then their facility will be considered as “services” and the patient availing those services will be considered as “consumer”. The patient can’t approach the consumer court if he avails those services free of charge but in case the same is exempted for inability to pay, then this will be called “services”.
In deciding this case the Apex court heavily relied on cases like Bolam v. Friern Hospital Management Committee, Dharangdhara Chemical Works Ltd. v. State of Saurashtra, Lucknow Development Authority v. M.K. Gupta, etc.
II. Dr Laxman Balkrishna Joshi v. Dr Trimbak Bapu Godbole and Anr (1969 AIR 128)
Respondent’s son was injured in an accident and sent to the appellant’s hospital where he was operated after detailed X-ray examination and plaster was put around the leg. The doctor prescribed two injections named Morpia and Hyoscine Hydrobromide in an hour’s interval but only one injection was administered.
The patient developed respiratory problems and expired on the same night. The appellant who himself was a medical practitioner had alleged that the doctors had not administered proper anaesthesia and used manual methods to treat his son, which gave him a shock, ending his life.
The question that arose before the court is whether the medical professionals have a special duty of care towards the patient? If yes, then what is the standard of such duty of care?
The Court pronounced that
“a person who held himself out ready to give medical advice and treatment impliedly undertook that he was possessed of the skill and knowledge for the purpose. Such a person owed to his patient certain duties, viz., a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give or (and – sic) a duty of care in the administration of that treatment. A breach of any of these duties gave a right of action for negligence to the patient.
The medical practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence, judged in the light of the particular circumstances of each case was what the law required: (cf. Hal bury’s Law of England, 3rd ed. vol. 26 p. 17). A doctor no doubt had discretion in choosing the treatment that be proposed to give to the patient and such discretion was relatively ampler in cases of emergency.”
III. National Commission in S.R. Shivaprakash and Ors. v. Wockhardt Hospital Ltd. and Ors (2005)
One of the patients got deceased due to the sudden extubation of an endotracheal tube due to sudden violent coughing resulting in the cardiac arrest which was just after 2 days of an hour-long surgery. While doing the surgery the medical team took all the necessary precautions and care, knowing that this might include a high risk of fatality but the practice was not new for the practitioners.
The dispute arose with regard to the poor pre-operative inherent condition belonging to the patient which was a general cause of death. The principle of res Ipsa loquitor was inferred but the court held that the team is not negligent on their part. With regard to the accessibility and availability of the documents, the court held that doctors and hospitals are obliged to supply all records containing treatment given, medicines administered, and the nature of the operation.
IV. Aparna Dutt v. Apollo Hospital Enterprises Ltd (2002 ACJ 954 (Mad. HC))
A woman felt severe pain in her belly and was, further diagnosed with cysts in her uterus. She was operated for the removal of cysts in Apollo Hospital. After the surgery, she felt pain in the abdomen and in a few days, died. When she was cremated, there was found a scissor in the cremation ground, which alarmed relatives and suspected a relative reason for her sudden death.
The family approached the court and the court found that because of the negligent behaviour of the junior medical professionals the scissor was left behind in the abdomen which ultimately, became the cause of death. Hence, the hospital authority will be held vicariously liable to pay compensation to the deceased family.
The principle of vicarious liability has been derived from a Latin maxim “qui facit per alium facit per se” which means that the one who acts through another act in his or her own interest. He who acts through another does the act himself. This case became the first to establish vicarious liability in medical negligence cases.
The least essential demand for the patient is diligence and proper care. If the hospital authority is negligent in fulfilling that least demand, then there is medical negligence on their part or such a practitioner. The borrowed doctors who commit negligence will also be held vicariously liable because they are giving their service on behalf of the hospital authority.
The application of this principle will not be administered in criminal cases as this case imposes personal liability. In the case of a senior anesthesiologist, if he delegates his authority to his junior, to perform the task then any wrong in the part of the junior team will make the senior anesthesiologist vicarious liable irrespective of whether they are permanent or temporary, residential or visiting, full time or part-time. Whoever works on behalf of others, then the work will be considered by the one on whose behalf the work is done. The hospital or doctor may be held vicariously liable even if there is a presence of faulty types of equipment, unskilled staff, or any other mistake.
V. Dr. Balram Prasad v. Dr. Kunal Saha & others
Kolkata based AMRI Hospital came under the scanner, when its three doctors were accused of medical negligence. Anuradha Saha, wife of Dr Kunal Saha was suffering from a drug allergy and the medical practitioner negligently prescribed medicine which ended up with her death.
This case decided that the traditional multiplier formula could not adjust with the time and propounded a new method as the court strongly believed that “ the loss of human life in no-fault motor vehicle accidents and death due to medical negligence are two different matters and must be dealt differently.”
The court further reasoned that
“In today’s India, hospitals, nursing homes and doctors make lakhs and crores of rupees on regular bases. Under such scenario, allowing the multiplier method to be used in determining compensation in medical negligence case would not have any deterrent effect on them for medical negligence but encouraging more incidents of medical negligence in India would bring even greater damage for the society at large.”
After this heavy discussion, the court increased the multiplier to 30 and rejected the traditional practice of multiplier rule discussed in the Sarla Verma case, Trilok Chandra, and Charlie.
By – Prakash Balout
Law graduate from NUJS, Kolkata
 Branny Quotes available at https://www.brainyquote.com/quotes/chael_sonnen_959808?src=t_malpractice
 (1995) 6 SCC 651
 1969 AIR 128
 II (2006) CPJ 123(NC)
 (2002 ACJ 954 (Mad. HC)
 (2014) 1 SCC 384
  1 W.L.R. 582
 AIR 1957 SC 264
 1994 AIR 787
 Supra 3
 Dr Balram Prasad v. Dr Kunal Saha & Others
 2009 Indlaw SC 488
 UP State Transport Corporation v. Trilok Chandra (1994) 2 SCC 176
 New India Assurance Co. Ltd v. Charlie [2005(10) SCC 720]
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