Medical negligence only in case of ‘clear deviation from practice’: SC

The court ruled that doctors can't be deemed negligent solely for poor outcomes, emphasizing the need for clear evidence of deviation from accepted practices.

The Supreme Court has emphasised that medical professionals cannot be held liable for negligence solely because a surgery or treatment does not produce the expected results, asserting that culpability of doctors must stem from clear evidence pointing to a deviation from accepted medical practices.

The Supreme Court stressed that complications, even unexpected ones, do not necessarily imply that a doctor has failed to perform their duties with due diligence and skill. (HT Photo)

In a ruling on Friday that underscored the protection of medical professionals against allegations of negligence, the top court stressed that complications, even unexpected ones, do not necessarily imply that a doctor has failed to perform their duties with due diligence and skill.

“Simply for the reason that the patient has not responded favourably to the surgery or the treatment administered by a doctor or that the surgery has failed, the doctor cannot be held liable for medical negligence straightway by applying the doctrine of ‘Res Ipsa Loquitur’ (a Latin term meaning ‘the thing speaks for itself’) unless it is established by evidence that the doctor failed to exercise the due skill possessed by him in discharging of his duties,” held a bench of justices PS Narasimha and Pankaj Mithal.

The principle of “Res Ipsa Loquitur” implies that negligence is so obvious that it needs no further proof, but the bench maintained that a poor outcome does not necessarily equate to negligence.

Rejecting the assumption that a failed surgery or unsatisfactory medical outcome inherently points to negligence, the court underscored that medical procedures come with inherent risks, and the unpredictability of outcomes should not automatically lead to the conclusion of malpractice.

The case in question revolved around a complaint of medical negligence that had its roots in a minor eye surgery performed on a child diagnosed with congenital ptosis, a condition characterised by the drooping of the upper eyelid. The surgery was carried out by a qualified ophthalmologist at the Post Graduate Institute of Medical Education & Research (PGI) in Chandigarh in June 1996. When the surgery did not bring about the expected improvement and the child’s condition seemed to deteriorate, the patient’s family filed a complaint, seeking compensation for what they alleged as substandard medical care.

Initially, the state consumer commission dismissed the complaint, finding no evidence of negligence. However, the national consumer disputes redressal commission (NCDRC) later reversed this decision, awarding a compensation of ₹3.5 lakh to the complainants and holding the doctor and PGI jointly liable. The case eventually reached the Supreme Court, which took a different stance, ultimately exonerating the doctor and the medical institution.

A key aspect of the Supreme Court’s analysis was its reaffirmation of the Bolam Test, a standard that has long been recognized in medical negligence cases. Originating from the 1957 English case Bolam Vs Friern Hospital Management Committee, this test states that a doctor is not negligent if they act in accordance with a practice accepted by a responsible body of medical professionals. In the Indian context, the Supreme Court had already endorsed the Bolam Test in the case of Jacob Mathews Vs State of Punjab (2005), holding that only if a doctor lacks requisite skills or fails to exercise reasonable competence should liability be imposed.

Dr DK Gupta, founder of Felix Hospital, applauded the Supreme Court’s decision, stressing the importance of understanding the inherent uncertainties in medical care. “We thank the court for recognising the realities of medical practice and supporting an environment where health care providers can perform their duties without fear of baseless legal consequences. We also reaffirm our hospital’s support for our dedicated professionals who prioritise safety, transparency and patient-centered care, ensuring that each patient journey is guided by both skill and compassion,” said Gupta.

In the present case, the Supreme Court applied this well-established benchmark, concluding that the treating doctor had the necessary qualifications and experience to perform the surgery, adding there is no evidence suggesting that the doctor had failed to exercise due care or had deviated from acceptable medical standards. It concluded that the complications observed post-surgery were not indicative of any medical negligence.

The judgment also clarified the three essential components required to establish medical negligence: a breach of that duty owed by the medical professional to the patient; the doctor’s actions falling short of the expected standard; and consequential harm directly linked to the breach.

In the absence of clear evidence of negligence, the apex court held, the failed outcome could not be construed as a failure in duty. It acknowledged that complications could arise even with the best medical practices and that a doctor should not be unfairly penalised for rare or unfortunate outcomes.

“Deterioration of the condition of the patient post-surgery is not necessarily indicative or suggestive of the fact that the surgery performed, or the treatment given to the patient was not proper or inappropriate or that there was some negligence in administering the same. In the case of surgery or such treatment it is not necessary that in every case the condition of the patient would improve, and the surgery is successful to the satisfaction of the patient,” stated the judgment.

When reasonable care is extended or rendered to the patient, the bench said, evidence to the contrary ought to be proved for fastening medical professionals with actionable negligence.

The verdict has significant implications for medical professionals, offering them protection from unwarranted liability if they have followed established medical practices and exercised reasonable care even as it seeks to balance patient rights with safeguarding doctors from undue harassment.