Medical Negligence & Consumer Law: Expanding Rights of Patients in India
Lately, Indian society is experiencing a growing awareness regarding patient's rights. This trend is clearly discernible from the recent spurt in litigation concerning medical professional or establishment liability, claiming redressal for the suffering caused due to medical negligence, vitiated consent, and breach of confidentiality arising out of the doctor-patient relationship.
As of now, the adjudicating process with regard to medical professional liability, be it in a consumer forum or a regular civil or criminal court, considers common law principles relating to negligence, vitiated consent, and breach of confidentiality. However, it is equally essential to note that the protection of patient's right shall not be at the cost of professional integrity and autonomy. There is definitely a need for striking a delicate balance. Otherwise, the consequences would be inexplicable.
Negligence
Negligence is simply the failure to exercise due care. The three ingredients of negligence are as follows:
- The defendant owes a duty of care to the plaintiff.
- The defendant has breached this duty of care.
- The plaintiff has suffered an injury due to this breach.
Medical negligence is no different. It is only that in a medical negligence case, most often, the doctor is the defendant.
When does a duty arise?
It is well known that a doctor owes a duty of care to his patient. This duty can either be a contractual duty or a duty arising out of tort law. In some cases, however, though a doctor-patient relationship is not established, the courts have imposed a duty upon the doctor.
What is the duty owed?
The duty owed by a doctor towards his patient, in the words of the Supreme Court is to “bring to his task a reasonable degree of skill and knowledge” and to exercise “a reasonable degree of care”. A doctor, therefore, does not have to ensure that every patient who comes to him is cured. He has to only ensure that he confers a reasonable degree of care and competence.
Reasonable degree of care
Reasonable degree of care and skill means that the degree of care and competence that an “ordinary competent member of the profession who professes to have those skills would exercise in the circumstance in question.” At this stage, it may be necessary to note the distinction between the standard of care and the degree of care. The standard of care is a constant and remains the same in all cases. It is the requirement that the conduct of the doctor be reasonable and need not necessarily conform to the highest degree of care or the lowest degree of care possible. The degree of care is a variable and depends on the circumstance. It is used to refer to what actually amounts to reasonableness in a given situation.
Thus, though the same standard of care is expected from a generalist and a specialist, the degree of care would be different.
In other words, both are expected to take reasonable care but what amounts to reasonable care with regard to the specialist differs from what amount of reasonable care is standard for the generalist.
Legal Framework Governing Medical Negligence
- Consumer Protection Act, 2019
Section 2(1)(o): Defines "deficiency in service," which encompasses medical services. This is critical for patients to file complaints against healthcare providers.
Section 12: Details the process for filing complaints. Patients can approach the consumer forum if they believe they have experienced medical negligence .
Section 14: Lists remedies available to the consumer, which can include compensation for damages, replacement of goods, or correction of services.
- Medical Council of India (MCI) Regulations
- Code of Medical Ethics (2018)
This code outlines ethical guidelines and responsibilities for medical practitioners, emphasizing patient welfare, confidentiality, and informed consent .
- Clinical Establishments (Registration and Regulation) Act, 2010
Section 10: Mandates registration of clinical establishments with authorities to ensure accountability.
Section 11: Specifies minimum standards for facilities and services, ensuring quality care.
- The Right to Information Act, 2005
Section 2: Defines "information" broadly, crucial for patients seeking records related to their treatment.
Section 6: Outlines the procedure for requesting information, enabling access to medical records necessary for substantiating claims.
Key Case Laws in Medical Negligence
Jacob Mathew v. State of Punjab (2005)
Facts of the Case-
Jacob Mathew, a doctor, was involved in a medical negligence case after a patient died following a surgical procedure. The patient had undergone surgery for the removal of a stone from the kidney. Post-operative complications arose, and despite the doctor's treatment efforts, the patient passed away.
The family of the deceased alleged that the doctor had acted negligently, leading to the patient’s death.
Issues-
The main issues before the Supreme Court included:
1. Whether the doctor had acted negligently in the treatment of the patient.
2. The standard of care expected from medical practitioners in similar circumstances.
3. How to determine liability in cases of alleged medical negligence.
Judgment-
The Supreme Court of India delivered a significant judgment, focusing on the standard of care expected from medical practitioners.
The Court established the following key principles:
1. Standard of Care:- The Court held that medical professionals are expected to act according to the standards of a reasonably competent practitioner in their field. A doctor is not liable for negligence if they act in accordance with accepted medical practices, even if there is a poor outcome for the patient.
2. Bolam Test: The Court referred to the "Bolam test," which originates from the case Bolam v. Friern Hospital Management Committee. According to this test, a medical practitioner is not negligent if they acted in accordance with the practice accepted as proper by a responsible body of medical men skilled in that particular art22 .
3. Evaluation of Negligence: The Court emphasized that the determination of negligence should be made based on the medical community's standards at the time of the treatment, rather than hindsight. The mere fact that a patient suffered harm does not automatically imply that the doctor was negligent.
4. Onus of Proof: The burden of proof lies on the complainant to establish that the doctor had failed to meet the expected standard of care, and not on the doctor to prove that they acted correctly.
Conclusion
The Supreme Court ruled in favor of Jacob Mathew, concluding that there was no negligence in his actions during the treatment of the patient. The judgment reinforced the principle that medical professionals are to be judged by the standards of their peers and that liability in medical negligence cases requires a clear demonstration of failure to meet the accepted standard of care. This case is landmark in Indian medical jurisprudence as it clarifies the legal standards applicable to medical negligence and the expectations from medical practitioners.
