Medical malpractice refers to the improper or unskilled treatment by healthcare providers, including nurses, doctors, staff, dentists, hospitals, and hospital employees. It can cause harm, injury, or even death to a person. In recent years, it has become a serious issue in the country. According to the IJME, 5.2 million cases of medical malpractice are experienced annually in India. Even medical professionals are not immune to this kind of negligence. This article aims to provide an in-depth analysis of medical malpractice in India, along with the legal safeguards put in place to help doctors avoid being falsely accused while preventing medical malpractice in the first place.
The rise of medical malpractice claims in India can be partly attributed to increased patient awareness of their legal rights under the Consumer Protection Act. While this empowers patients, it’s important to remember that not all claims are valid. Even doctors are targeted unfairly by false accusations.
To protect doctors from unfair accusations, various provisions have been established. This article will explore both sides of medical malpractice, offering insights on how doctors can protect themselves from such false claims.
Understanding Medical Malpractice in India
In the current scenario, medical professionals and healthcare services are included under the Consumer Protection Act as service providers. The act recognizes a consumer’s right to safety, information, choice, redressal, consumer education, and to be heard.
Doctors and hospitals can be held liable under this act for deficiencies in their services. This was In 1995, when the Supreme Court delivered a historic decision in Indian Medical Association v VP Shantha which brought the medical profession within the ambit of a ‘service’ as defined in Section 2 (1) (o) of the Consumer Protection Act, 1986.
According to the Indian Journal of Medical Ethics, 80% of medical error deaths are due to surgical mistakes, and 70% of emergency fatalities result from mismanagement. Additionally, the study reveals a concerning trend: only 46% of healthcare providers comply with ethical guidelines.
This lack of adherence coincides with some of the highest malpractice rates in the country, particularly in Punjab (24%), West Bengal (17%), Maharashtra (16%), and Tamil Nadu (11%).
These concerning statistics highlight the importance of understanding medical malpractice in India. A few examples of medical negligence include the following:
- Failure to diagnose the correct medical condition
- Improper treatment given to the patient
- Not referring the patient to another physician when needed
- Performing an incorrect operation on a patient
- Administering the wrong medical doses and treatments that further worsen the medical condition of a patient.
- Falsely taking note of an allergic condition
Given the alarming number of medical malpractice cases (5.2 million annually), prioritising adherence to ethical and legal guidelines in healthcare becomes even more critical for ensuring better patient care.
However, the issue isn’t one-sided. Before advocating for stricter legal adherence, let’s explore the other side of the coin. We’ll examine cases where doctors themselves became victims of malpractice and false medical claims.
Medical Negligence Cases in India
According to the Ministry of Health and Family Welfare, India’s doctor-to-patient ratio stands at 1:834, which is better than the World Health Organization’s (WHO) standard of 1:1000. However, despite these seemingly positive statistics, the high number of medical negligence cases paints a worrying picture.
The obstetrics and gynaecology departments face the majority of medical negligence cases, followed by orthopaedics and other specialties. Furthermore, healthcare practitioners face an additional challenge in the form of harassment from patients or their families.
In many instances, doctors are wrongly accused of malpractice, even when a patient’s death was due to a cause beyond doctor’s control. To shed light on this issue, we will explore a few cases where healthcare professionals themselves became victims of medical malpractice and false medical claims.
1. Jacob Mathew versus the State of Punjab
Jeewan Lal, suffering from breathing difficulties, was admitted to CMS Hospital. However, doctors only arrived after a concerning delay of 20–25 minutes. Upon arrival, they provided an empty oxygen cylinder. His son rushed to obtain a replacement, but tragically, his father was declared dead by another doctor before his return.
Believing his father’s death resulted from negligence, the son filed a complaint under Section 304(A) of Indian Penal Code (IPC) for death due to gross negligence and Section 34 of IPC for the intention of criminal liability. The accused doctor countered that Mr. Lal was already in the terminal stages of cancer and had been refused admission by other hospitals for the same reason.
In this landmark judgement, the Supreme Court made it very clear that a doctor accused of rashness or negligence may not be arrested in a routine manner simply because a charge is levied against him. The court ultimately did not entertain the case on the grounds of criminal rashness.
It offered a sense of hope to the medical profession by not granting automatic immunity in such situations. This case became one of the most well-known medical negligence cases in India.
2. Dr. Archana Sharma's Suicide Case
The high number of medical negligence cases in India doesn’t necessarily equate to every case being valid. Not all deaths are the result of medical malpractice. This case exemplifies this issue. Dr. Archana Sharma, facing harassment and threats after a patient’s death due to postpartum haemorrhage (a known complication of caesarean), was booked under Section 304 of IPC, a charge typically used for murder.
This immense pressure tragically led her to take her own life. This incident, from March 2022, is a recent example of a medical negligence case in India. It serves as a serious wake-up call, highlighting how false accusations can destroy a doctor’s career and even lead to their death. The case underscores the lack of protection for doctors, who often face blame even without concrete evidence.
Let’s explore some important aspects of medical ethics and law to mitigate the for medical malpractice claims.
The Legal Framework for Preventing Medical Malpractice in India
Medical professionals play an essential role in society by providing healthcare services to the public. However, medical professionals face numerous legal risks in their practice. There are several provisions under the Indian legal system that may safeguard the doctors and other medical professionals from criminal liability.
This enables the medical fraternity to ensure that they can provide quality care without fear of legal consequences or harassment. Interestingly, the judicial intervention in deciding the criminal liability of healthcare professionals has always been liberal. As it was observed by the Supreme Court in Jacob Mathew versus the State of Punjab :
“A surgeon with shaky hands under fear of legal action cannot perform a successful operation and a quivering physician cannot administer the end-dose of medicine to his patient.”
Let us look into the legal protection of doctors in India in detail.
Indian Penal Code/Bharatiya Nyaya Samhita (BNS) Sections to Strengthen Medical Malpractice Prevention
The IPC/BNS has made several provisions for exempting certain acts from criminal liability. Here it goes:
- Section 80 of the IPC, now Section 18 of the BNS, deals with accidents resulting from a lawful act. It states that nothing is an offence that is done by accident or misfortune and without any criminal intention or knowledge if it is done in a lawful manner by lawful means and by proper care and caution. In general, an act without a guilty mind doesn’t constitute a crime.
- Section 81 of the IPC, now Section 19 of the BNS. Section 81 of the IPC deals with the doctrine of necessity. It is a legal defence that can be used in the Indian Penal Code to justify an act that would otherwise be considered a crime. The doctrine of necessity was invoked in India in the landmark case of Gullapalli Nageswara Rao v. APSRTC (1958).
Furthermore, Section 81 deals with an act that is likely to cause harm without criminal intention in order to prevent other harm. An action isn’t considered a crime just because you know it might cause harm. This applies if you had no intention to cause harm and genuinely believed it was necessary to prevent a worse outcome for someone or something else.
- Section 88 of the IPC is now Section 26 of the BNS. It deals with an action that isn’t considered a crime just because it might cause harm, even if you know it might. This applies as long as:
- You didn’t intend to cause harm.
- You honestly believed you were preventing a worse outcome.
- The person you’re helping either agreed to the risk or benefited from your actions (with or without explicitly saying so).
For instance, imagine you see someone choking. You might give them the Heimlich manoeuvre, even though it could cause some discomfort. Because your intention is to save them from more serious harm (choking to death), your action wouldn’t be considered a crime.
Criminal Procedure Code (CrPC) Provisions to Protect Doctors
- Section 482 CrPC/Section 530 of The Bharatiya Nagarik Suraksha Sanhita, 2023 (BNSS) (Saving of Inherent Power of the High Court):
If a doctor feels that false cases are registered against them in an alleged medical negligence case, they can approach the respective High Court for the same. There are numerous cases, such as the Daljit Singh case, the Dr. Jayshree Ingole case, and the Dr. Mohammad Azam case, where the high court quashed the FIRs and criminal proceedings. Thus, this section can be used as a defence by the medical fraternity if they feel that they are being harassed without any prima facie evidence and/or by breach of guidelines issued thereunder.
- Section 197 CrPC/ Section 218 BNSS (Prosecution of Judges and Public Servants):
A legal provision exists to protect doctors working in government service. The Supreme Court, in reference to public servant prosecution, has ruled that prior approval from the competent authority is mandatory under Section 197(1) of the CrPC. This applies to any legal proceedings against a government doctor for alleged offences directly linked to their official duties.
Constitutional Provision
The Constitution of India provides protection under Article 20(3) and Article 21, which safeguard against self-incrimination and ensure the right to life and liberty.
See Also: Legal Measures For The Prevention Of Violence Against Doctors In India
IMA National Professional Protection Scheme
A concerning trend of doctors delaying treatment due to fear of false malpractice charges can be seen. This creates a precarious situation where both patients and doctors are at risk. Ideally, medical professionals should be protected from insignificant lawsuits and accusations of negligence that arise from unavoidable complications during treatment.
The fear of such false claims can lead doctors to adopt overly cautious practices. They might delay treatment until extensive testing is complete or become overly selective in the patients they choose to treat. This approach, while understandable given the legal climate, can have negative consequences for patient care.
To avoid such calamities and protect the public, the IMA decided to take responsibility for protecting doctors and came up with the National Professional Protection Scheme in 2002. This scheme is only eligible for life members of the Indian Medical Association within the jurisdiction of the Republic of India. It protects the members and helps them in cases of harassment, litigation, etc. that may arise during the course of their professional practice.
The Right to Choose
Doctors can now refuse the treatment of unruly or violent patients under the National Medical Commission Registered Medical Practitioner RMP (Professional Conduct) Regulations, 2023, which have taken the place of the Medical Council of India’s (MCI) Code of Medical Ethics, 2002. These regulations are effective as of August 2023.
The notification states that in cases of abusive, unruly, and violent patients or relatives, the registered medical practitioner can document and report the behaviour and refuse to treat the patient. Additionally, such patients should be referred for further treatment elsewhere. Notably, doctors cannot refuse a patient’s treatment if they are already under their care or are serious.
The patient care section in these regulations also gives doctors the right to choose whom they will serve, except in the case of a life-threatening emergency. Also, doctors can refuse the treatment if agreed-upon fees are not paid in lieu of treatment. However, it does not apply to doctors in government service or emergencies.
Note that any violation of these regulations is bound to attract disciplinary action in the form of a suspension of the licence to practise for a period ranging from 3 months to 3 years.
The Role of Insurance Coverage in Preventing Medical Malpractice
In the landmark judgement of Anuradha Shah, the Supreme Court awarded the highest compensation of Rs. 11 crore. This amount was paid by the doctors and the private hospital deemed responsible for the wrongful death of a patient. Considering the judgement, it becomes crucial to protect yourself from the financial burden of a malpractice lawsuit.
Here, insurance provides financial protection in case of damage or loss sustained by an individual or business. In the case of doctor indemnity insurance, it provides financial protection against false claims related to mistakes or injuries sustained by a patient during medical treatment or procedure.
It can be obtained by an institute or by an individual medical practitioner alone. It covers legal liability, compensatory claims by the patient, medical expenses, and related damages. The people entitled to purchase indemnity insurance for the medical field include physicians, surgeons, and other medical professionals.
The different types of indemnity insurance include:
- Malpractice insurance provides financial safety in cases of medical negligence and malpractice.
- Medical Indemnity Insurance to provide safeguard against wrongful legal claims of medical errors or failures.
- Professional liability insurance provides financial safety against lawsuits alleging professional carelessness or misconduct.
There are various indemnity insurances available on the market, and each of them has several limitations and restrictions. It is important to obtain insurance from authentic companies to prevent fraud. One may use medical societies to reduce the premium cost, as a group of doctors can always negotiate better terms with the insurer than any individual.
There have also been an increasing number of physical assault incidents involving doctors.
An IMA survey indicates that verbal abuse affects 75% of doctors, and physical abuse affects 12% of them. Given this, physicians need to obtain insurance to protect themselves from unintentional harm or disability. Further, to protect the establishment, doctors may go with public liability insurance to cover injuries and property damage at their premises.
A few companies with the best professional indemnity in India are:
- ICICI Lombard General Insurance Company
- Reliance General Insurance
- HDFC Ergo General Insurance Company
- Bajaj Finserv
It is advised to check the coverage and deductibles, as a higher deductible can lower your premium.
Best Practices for Preventing Medical Malpractice
Now that we’ve explored the legal aspects of preventing medical malpractice, let’s shift gears and examine practical strategies you can integrate into your daily practice. By following these best practices, you can not only reduce the risk of medical negligence but also improve patient care and overall practice efficiency. Here are some ways you can lessen the risk of a medical malpractice lawsuit:
- Effective communication is the cornerstone of preventing medical malpractice claims. Regardless of a doctor’s educational background, establishing a clear understanding with patients is crucial. This requires actively listening to their concerns, questions, and medical history. Open and honest communication fosters a strong doctor-patient relationship and builds trust, ultimately minimising the risk of lawsuits.
- Document everything before, during, and after the treatment, and it should include follow-up appointments, medical history, diagnosis, examination done, and medications provided.
- Any procedure done to a patient without informed consent is against the law. Always obtain informed consent.
- It is important to stay updated on the laws and regulations related to medical malpractice. So, keep yourself updated with the current standards.
- Prioritise empathy to build a strong and beneficial doctor-patient relationship.
In conclusion, education plays a crucial role in reducing medical negligence cases in India. Many patients are unaware of their medical rights and may misinterpret an unfortunate medical outcome as malpractice.
To ensure fairness, we must consider all aspects of a situation. Did the healthcare professional exhibit negligence, or was it a genuinely unavoidable event? Remember, just as patients’ families suffer, so do the loved ones of doctors facing false accusations.
By promoting patient education on their rights and fostering a culture of understanding medical realities, we can create a more balanced healthcare environment for everyone.
Sneha Bhonsle
Sneha is a Supreme Court of India advocate specializing in healthcare law and compliance. A US-certified medical coder with home health and HIPAA expertise, she also brings a strong understanding of pharmaceutical and life science regulations across the US, UK, and Asia-Pacific. As an AMR Advocate, Sneha champions responsible antibiotic use.
Sneha Bhonsle
Sneha is a Supreme Court of India advocate specializing in healthcare law and compliance. A US-certified medical coder with home health and HIPAA expertise, she also brings a strong understanding of pharmaceutical and life science regulations across the US, UK, and Asia-Pacific.
