Medical negligence

Medical Negligence

Medical negligence may be defined as a breach of the duty of care owed by a medical

practitioner to a patient, whereby the practitioner fails to exercise the degree of skill, care,

and diligence expected of a reasonably competent professional in similar circumstances,

resulting in harm, injury, or damage to the patient.

Official definition of Medical Negligence

There is no legislation in India that officially define the word Medical Negligence.

1)World Medical Association related to Medical Practice

Medical malpractice involves the physician’s failure to conform to the standard of care for

treatment of the patient’s condition, or a lack of skill, or negligence in providing care to the

patient, which is the direct cause of an injury to the patient.

2)Medical Negligence defined under Case Laws

A.S. Mittal v. State of U.P

In this case the Supreme Court affirmed that medical professionals owe a

clear duty of care to their patients in the course of treatment. The Court emphasised that this

duty requires doctors to exercise reasonable skill, care, and caution, and any breach or

violation of such duty, resulting in harm to the patient, gives rise to a valid cause of action for

negligence.

Indian Medical Association v. V.P. Shantha

In this case the Supreme Court held that medical services fall within the ambit of “service” under

Section 2(47) of the Consumer Protection Act, 2019.

Consequently, when a doctor or medical professional fails to provide treatment in accordance

with the standard expected of a reasonably competent practitioner, it amounts to a “deficiency

of service” under Section 2(11) of the Act. Such deficiency, when resulting in harm or injury

to the patient, constitutes medical negligence, thereby making the medical professional liable

under consumer law and entitling the patient to seek compensation through the consumer

dispute redressal mechanism.

Jacob Mathew v. State of Punjab

In the landmark case of the Supreme Court of India laid

down important safeguards regarding the prosecution of doctors for medical negligence. The

Court held that a complaint alleging medical negligence should not be entertained unless the

complainant produces prima facie evidence supporting the allegation. It further directed that,

before initiating proceedings, the investigating officer should obtain an independent and

impartial medical opinion from a competent government doctor by applying the Bolam Test.

Additionally, the Court emphasized that a doctor should not be arrested in a routine manner

merely because a complaint has been filed; arrest should be made only when it is necessary

for further investigation or when there is a reasonable apprehension that the doctor may evade

the legal process.

Kumud Lall v. Suresh Chandra Roy

The Supreme Court in clarified that proceedings for

medical negligence do not abate upon the death of a doctor and that the legal heirs of the

deceased doctor may be impleaded in such proceedings. However, their liability is restricted

to the extent of the estate inherited from the deceased. Medical negligence refers to the failure

of a medical practitioner to exercise the reasonable degree of care, skill, and diligence

expected of a competent professional, resulting in injury, harm, or loss to a patient. Such

negligence gives rise to a claim for compensation under the Consumer Protection Act and

other applicable laws.

Medical Negligence under various laws

1)Medical Negligence under Tort Law

A form of actionable negligence in which a medical professional, owing a duty of care to the

patient, breaches that duty by failing to exercise the standard of reasonable skill, care, and

diligence expected of an ordinarily competent practitioner in similar circumstances, and such

breach results in damage or injury to the patient.

2)Medical Negligence under Consumer Protection Act, 2019

Under the Consumer Protection Act, 2019, medical services are included within the scope of

“service.” Therefore, when a doctor, hospital, or healthcare professional fails to exercise the

reasonable degree of care, skill, and diligence expected of a competent medical practitioner,

such conduct may amount to a “deficiency of service” under the Act. If this deficiency results

in injury, harm, or loss to a patient, it constitutes medical negligence and gives rise to a right

to seek compensation through the consumer dispute redressal mechanism.

3)Medical Negligence under Bharatiya Nyaya Sanhita,2023

Section 106 of the Bharatiya Nyaya Sanhita, 2023 recognises medical negligence in the

context of criminal liability . It provides that whoever causes the death of any person by a

rash or negligent act, not amounting to culpable homicide, shall be punished with

imprisonment which may extend to five years along with fine. However, where such an act is

committed by a registered medical practitioner in the course of performing a medical

procedure, the punishment is reduced to imprisonment up to two years with fine. The

Explanation clarifies that a “registered medical practitioner” refers to one possessing

qualifications recognised under the National Medical Commission Act, 2019 and duly

registered in the National or State Medical Register. Thus, when death is caused due to rash

or negligent medical conduct, it amounts to criminal negligence under this provision.

Types of Medical Negligence

There are 12 types of Medical Negligence which are,

1. Active Negligence

Active negligence occurs when a doctor performs a wrongful act that

directly causes harm to a patient. It generally arises from lack of proper skill, knowledge, or

care, such as administering an injection at the wrong site.

2. Passive Negligence

Passive negligence results from the omission or failure to perform a

necessary act. For example, a doctor may fail to obtain a patient’s medical history before

prescribing treatment, leading to adverse consequences.

3. Contributory (Collateral) Negligence

Contributory negligence occurs when the patient

also contributes to the injury by failing to follow medical advice or treatment instructions. In

such cases, the patient’s conduct may reduce or affect the liability of the doctor.

4. Comparative Negligence

Comparative negligence arises when both the doctor and the

patient are partially responsible for the harm caused. Liability is apportioned according to the

degree of fault attributable to each party.

5. Concurrent Negligence

Concurrent negligence occurs when two or more healthcare

professionals independently or jointly contribute to the patient’s injury. Each negligent party

may be held liable for the resulting damage.

6. Continued Negligence

Continued negligence refers to a situation where negligent

conduct persists over a period of time. It may include abandonment of treatment or failure to

correct a known medical error.

7. Criminal Negligence

Criminal negligence involves a grossly careless act or omission that

endangers life or causes death. Such conduct may attract criminal liability under provisions

relating to rash and negligent acts.

8. Gross Negligence

Gross negligence is a severe form of negligence involving a complete

disregard for the safety and well-being of the patient. Examples include leaving surgical

instruments inside a patient’s body after surgery.

9. Hazardous Negligence

Hazardous negligence occurs when medical professionals use

unsafe methods, defective equipment, or unsterilized instruments that expose patients to

unnecessary risks and injuries.

10. Wilful Negligence

Wilful negligence refers to intentional or deliberate disregard of a

patient’s safety or medical needs. The healthcare provider knowingly acts or fails to act

despite being aware of the likely harmful consequences.

11. Reckless Negligence

Reckless negligence occurs when a doctor undertakes a course of

action with conscious disregard for the risks involved. It reflects a serious departure from

accepted standards of medical practice.

12. Negligence Per Se

Negligence per se arises when a doctor violates a statutory provision,

regulation, or professional rule designed to protect patients. The breach itself is treated as

evidence of negligence without requiring further proof of the standard of care.

International Experience

Medical negligence in United States

In the United States, medical negligence is commonly referred to as medical malpractice is

primarily governed by state laws rather than federal law. However, federal legislations such

as the Patient Protection and Affordable Care Act and the Health Care and Education

Reconciliation Act play an important role in regulating the broader healthcare system. While

these federal laws do not directly define malpractice standards, they influence access to

healthcare and the overall framework within which medical services are delivered.

To establish medical negligence, a patient must prove four essential elements. First, there

must be a duty of care owed by the doctor to the patient, arising from a recognized doctor

patient relationship. Second, there must be a breach of that duty, meaning the healthcare

provider failed to meet the accepted standard of medical care. Third, the patient must

establish causation, demonstrating a direct link between the doctor’s breach and the injury

suffered. Finally, there must be actual damage, which refers to the harm or loss experienced

by the patient as a result of the negligence.

Medical malpractice claims are generally filed in state courts, as healthcare regulation largely

falls within state jurisdiction. However, federal courts may have jurisdiction in certain

situations, such as cases involving federal healthcare institutions or disputes between parties

from different states. In practice, many malpractice claims are resolved outside of court

through negotiated compensation settlements, while others proceed to trial and may be

decided by a jury.

Additionally, most physicians in the United States carry malpractice insurance, which

significantly influences how claims are handled and resolved. The presence of such insurance

has also contributed to the practice of “defensive medicine,” where doctors may order

additional tests or procedures primarily to reduce the risk of litigation rather than strictly for

medical necessity.

Deviation from Indian Practice

Medical negligence in the United States and India differs significantly in its legal framework

and application. In the United States, medical malpractice is primarily governed by state

laws, and claims are typically decided through a jury trial system, where the patient must

strictly prove the four essential elements duty, breach, causation, and damage. Compensation

is generally high and structured, and most doctors carry mandatory malpractice insurance,

which has led to the practice of defensive medicine. In contrast, in India, medical negligence

is governed by a combination of tort law, consumer law under the Consumer Protection Act,

2019, and criminal law under the Bharatiya Nyaya Sanhita, 2023. Cases are decided by

judges rather than juries, and patients can seek remedies through civil courts, consumer

forums, or even constitutional remedies for violation of fundamental rights. While

compensation is available, it is often inconsistent and depends on judicial discretion.

Additionally, criminal liability for medical negligence is more explicitly recognised in India,

whereas in the United States it is relatively rare.

Technological Transformation

In India, the integration of technology into the healthcare system has significantly influenced

the standards and determination of medical negligence. With the increasing adoption of

digital tools such as electronic health records (EHRs), telemedicine, and artificial intelligence

(AI), the delivery of healthcare services has become more efficient and accessible. However,

these advancements have also expanded the scope of legal scrutiny, as the standard of care

expected from medical professionals now includes the proper use and understanding of such

technologies.

Electronic health records and hospital management systems have improved documentation

and continuity of care, which are crucial in medical negligence litigation. Proper digital

records can serve as key evidence in determining whether a doctor acted in accordance with

accepted medical standards. At the same time, errors in data entry, system malfunctions, or

failure to maintain accurate records may themselves give rise to liability if they contribute to

patient harm.

Artificial intelligence and advanced diagnostic tools are gradually being introduced in Indian

healthcare, assisting doctors in clinical decision making. While these technologies can reduce

human error, they also raise complex legal questions regarding accountability. In the absence

of a comprehensive statutory framework governing AI in healthcare, liability is generally

determined based on existing principles of negligence, with the primary responsibility

continuing to rest on the medical professional who relies on such tools.

Research that engages with the Term

1)Medical Negligence By Sanjay Sukumar (2023)

The study by Sanjay Sukumar (2023) examines 253 medical negligence cases decided by

the National Consumer Disputes Redressal Commission (NCDRC) between 2015 and 2019

to identify patterns of negligence, compensation trends, and the factors responsible for

adverse medical outcomes. The research moves beyond the traditional legal definition of

medical negligence by analysing how negligence occurs in actual healthcare settings. It

highlights that negligence often results from lack of skill and care, poor maintenance of

medical records, failure to diagnose diseases, delayed treatment, inadequate infrastructure,

and deficient pre-operative or post-operative care. By connecting legal liability with patient

safety and healthcare quality, the study provides a broader understanding of medical

negligence as both a legal and systemic healthcare issue.

However, the study has certain limitations. It is restricted to NCDRC decisions and does not

consider cases from other courts or unreported incidents of negligence. It also focuses mainly

on quantitative analysis and does not include the perspectives of patients, doctors, or

healthcare administrators. The findings overlap with previous national and international

research showing that surgery and obstetrics are high-risk specialties for negligence claims

and that many adverse events are preventable through better communication, documentation,

informed consent, adherence to medical standards, and improved patient safety mechanisms.

Thus, the study strengthens existing literature by providing empirical evidence on the causes

and consequences of medical negligence in India.

2)Medical Negligence by Rajinder Paul Jindal

The article “The Truth About Medical Negligence” by Rajinder Paul Jindal provides a critical

examination of medical negligence by moving beyond statutory definitions and judicial

interpretations to explore the realities of medical practice. The author argues that genuine

medical negligence often arises from inadequate professional knowledge, insufficient

training, lack of supervision, and systemic shortcomings within healthcare institutions rather

than from isolated mistakes such as leaving surgical instruments inside a patient. Through

practical examples from surgical and emergency settings, the study demonstrates how

negligence is frequently rooted in structural and educational deficiencies that remain

unnoticed, thereby expanding the understanding of medical negligence beyond its

conventional legal framework.

The research also identifies significant gaps in the existing approach to negligence claims,

highlighting that many serious instances of negligence go undetected, while numerous cases

brought before consumer courts involve complications, unmet patient expectations, or

allegations difficult to substantiate. The article overlaps with broader literature on medical

negligence by emphasising the importance of professional competence, patient safety,

institutional accountability, and effective healthcare training. However, its primary limitation

lies in its reliance on the author's personal experiences and observations rather than empirical

data or systematic analysis, which may affect the generalisability of its conclusions.

Nevertheless, the study contributes valuable insights into the underlying causes of medical

negligence and the challenges involved in its legal adjudication.

Official Database

The data indicates that cases registered under Deaths due to Medical Negligence remain

extremely low in comparison to overall IPC crimes. A total of 142 cases were reported in the

2021 which slightly decreased to 118 cases in 2022 and then declined to 114 cases in the

2023. Throughout the period, the crime rate remained 0.0 per lakh population, reflecting the

relatively small number of reported incidents at the national level.

The figures also show that deaths resulting from medical negligence constitute a negligible

proportion of total IPC crimes, with a percentage share of 0.0%. While the number of cases

fluctuated marginally over the years, the consistently low crime rate suggests that such

offences are either comparatively rare or significantly underreported. Nevertheless, each

reported case represents a serious allegation involving the loss of human life and highlights

the continuing need for accountability, adherence to professional standards, and effective

legal mechanisms to address medical negligence.

Challenges

The issue of medical negligence in India is compounded by several practical and systemic

challenges that significantly hinder its effective adjudication. A primary concern is the lack of

awareness among patients, particularly in rural areas, regarding their legal rights and

available remedies, which often prevents them from initiating claims. Further, the technical

complexity of medical science places patients at a disadvantage, as they are generally unable

to understand or prove deviations from accepted medical standards, while the burden of proof

rests upon them. Access to crucial evidence is also problematic, as medical records are

controlled by healthcare institutions, leading to difficulties in obtaining them and raising

concerns about possible tampering. In addition, the high cost of legal proceedings and the

prolonged duration of litigation discourage many victims from pursuing justice. Accessibility

issues, such as the distant location of adjudicatory bodies, add to the financial and logistical

burden. There is also the possibility of institutional bias, as medical professionals may have

influence within regulatory bodies, thereby affecting impartial decision-making.

Way Ahead

Addressing the challenges of medical negligence in India requires a combination of legal,

institutional, and technological reforms. There is a need to enhance public awareness

regarding patient rights and available legal remedies through government initiatives and legal

literacy programs, particularly in rural areas. Standardised protocols for maintaining and

providing access to medical records should be strictly implemented, with digitisation

ensuring transparency and preventing tampering. The establishment of specialised medical

tribunals or fast-track courts can help reduce delays and ensure efficient adjudication of

claims. Additionally, reducing litigation costs and providing legal aid to victims would

improve access to justice. Strengthening regulatory oversight and ensuring independence of

medical councils can minimise bias and improve accountability. Training healthcare

professionals on ethical practices and legal responsibilities, along with encouraging the use of

technology for accurate documentation and error reporting, can further reduce instances of

negligence and improve overall patient safety.