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Medical Negligence: Major Takeaways from the National Medico-Legal Summit 2024

The field of medicine is vast and intricate, defying easy judicial scrutiny or non-professional regulation. A highly trained, qualified, and licensed medical practitioner requires the autonomy to deliver services aligned with their expertise. To achieve this, protection from frivolous, excessive, and harassing litigations, as well as ill-investigated judicial decisions in medical negligence cases, is essential.

Unfortunately, frivolous negligence claims and misguided medical negligence judgments�often based on ill-applied legal fictions without substantial medical evidence�have eroded public trust in the medical profession. To restore this trust, it is crucial to recognize the doctrine of good faith, which relies on robust medico-judicial processes.

Acknowledging the detrimental impact of baseless medical negligence cases on both healthcare providers and patients, the Supreme Court has established laws to curb and prevent the misuse of legal provisions. These laws stem from two landmark judgments: Jacob Mathew and Marin D'Souza. Until the legislature enacts specific provisions, these judgments serve as binding guidelines for all stakeholders in the medical field.

Numerous Supreme Court judgments, including Suresh Gupta vs. Government of NCT, Delhi (2004), Jacob Mathew vs. State of Punjab & Anr (2005), Martin F. D'Souza vs. M. Ishfaq (2009), and M.A. Biviji v. Sunita & others (2018), underscore the pitfalls of adjudicating medical negligence cases through affidavit-based summary trials. These summary trials have significantly burdened doctors and adversely affected the medical profession. Despite established guidelines on how to handle medical negligence cases to prevent such injustices, these guidelines are often overlooked.

Good faith serves as a crucial premise for granting exemptions from liability in various contexts. Just as judicial officers receive immunity based on good faith for their decisions, Sections 88 and 92 of the Indian Penal Code (IPC) provide similar exemptions to medical professionals for their professional acts and decisions. However, it's essential to recognize that good intention alone does not constitute good faith. The relevant sections specify that an act done in good faith must also demonstrate care and attention.

When assessing medical professionals' actions, the patient's medical records play a pivotal role. If a licensed physician's treatment is alleged to be an actionable offense, the complainant must prove that the act was malicious and intended to cause harm.

A patient who receives regular treatment from a qualified and licensed practitioner, as part of a team of medical professionals in a hospital setting, with proper consent, should be excluded from the scope of Section 304A of the Indian Penal Code (IPC). This provision pertains to causing death by negligence.

Medical negligence cases should be adjudicated under Section 88 of the IPC (Bhartiya Nyaya Sanhita Sec 26), along with other related sections that provide exemptions from criminal liability for licensed medical practitioners.

The medical community should actively engage with the Supreme Court and lawmakers to decriminalize and exclude medical negligence from the purview of IPC Section 304A.

As per the statutory exceptions and exemptions outlined in the Bhartiya Nyaya Sanhita:
  1. A duly qualified and licensed physician (demonstrating competence).
  2. Acting in good faith (with honesty and sincerity).
  3. Providing treatment to a patient (with care and attention).
  4. Believing that the treatment would benefit the patient (alleviating their disease and suffering).
  5. With the patient's consent.
Such a physician is exempted from liability for any injury to the patient. It is essential to recognize that the physician has committed no offense.

Judicial scrutiny of medical treatment or management of a disease episode for negligence relies on legal principles, postulates, or fictions developed by legal experts. While these legal fictions are necessary due to the lack of medical expertise, they must always be applied based on medical evidence.

Medical negligence, when defined in terms of various duties assigned to a licensed medical practitioner, is commendable. However, for a medical professional, these abstract principles lack objective and concrete criteria for adherence. Take, for instance, the concept of "duty of care", which appears too abstract and subjective. For a doctor, fulfilling the medical needs of a patient constitutes their duty of care. This can be objectively assessed based on medical records.

While the legal principles have evolved and been applied, they must also be translated into medical terms to allow for objective evaluation. Negligence, in essence, is the failure to meet the diagnostic and therapeutic needs of a patient.

In the context of the Consumer Protection Act (CPA), health care was initially included in Section 2(42) of the 2018 CPA, following the judgment of the Supreme Court in IMA v. V.P. Shantha (1995). However, it was specifically removed from the 2019 CPA due to objections raised by members of Parliament. The intent of Parliament is clear, necessitating a fresh statutory interpretation of the relevant provisions in the CPA 2019.

Furthermore, it is high time that the judgment in the Indian Medical Association vs. V.P. Shantha case is revisited and reviewed.

The dichotomy and divergence between judicial and medical thinking in assigning the cause of death are evident in cases such as Jacob Mathew, Martin D'Souza, and Dr. Suresh Gupta. While judicial reasoning relies on legal principles like proximity of events and their probability to cause death, the medical approach considers known facts of the disease process to identify the underlying cause of death. Instead of attributing the cause of death to a proximate act with a probability of causing death, we should adopt cause of death certification as per WHO guidelines. The medically assigned cause of death should focus on the underlying disease, and clear guidelines need to be established to determine the direct cause of death.

The medical community should engage in active debate regarding medical negligence decisions, particularly those made by lower courts through summary trials. These discussions should focus on medical grounds and highlight instances of manifest judicial ignorance in medical matters.

Written By: Dr.Shri Gopal Kabra, MBBS, LLB,MSc, MS (Anatomy), MS (Surgery)
Email: [email protected] Mobile: 8003516198

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