Medical Negligence has nowhere been defined in any law but it refers to the breach of a duty of care by a medical professional, resulting in harm, injury, or death to a patient. It occurs when a healthcare provider fails to exercise the degree of care, skill, or diligence that is expected of a reasonably competent professional in that field, under similar circumstances.

Under the Indian Penal Code (IPC), Section 304A (now, Section 106(1)) specifically addresses the offense of causing death by negligence, which is often invoked in cases of medical negligence leading to fatal outcomes. This section plays a significant role in holding medical professionals accountable when their negligent actions result in the death of a patient.

The section reads as follows

Whoever causes the death of any person by doing any rash or negligent act not amounting to culpable homicide, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.

This provision is designed to criminalize acts of negligence that result in death, provided that the negligence does not rise to the level of culpable homicide (Section 300 IPC), which would indicate intent to cause death.

Section 304A is particularly relevant in cases where a healthcare professional’s negligence or rash behavior directly leads to a patient's death. It applies when a medical practitioner fails to exercise the expected standard of care, resulting in fatal consequences. Common examples include:

• Wrong surgeries or operations carried out incorrectly.

• Incorrect medication or dosage leading to lethal side effects.

• Failure to diagnose life-threatening conditions such as cancer or heart disease that leads to death.

Key Elements of Medical Negligence Under Section 304A

1. Rashness or Negligence: The act that causes death must be negligent or rash, but not intentional. For example, a doctor may inadvertently administer a wrong drug, but this act does not involve an intention to harm.

2. Causation: There must be a direct link between the negligent act and the patient’s death. It must be shown that the medical professional’s breach of duty resulted in the fatal outcome.

3. Not Culpable Homicide: For Section 304A to apply, the death must not be caused by intentional actions (i.e., culpable homicide). The negligence must be a result of a breach of duty rather than an intent to kill.

Punishment Under Section 304A

If convicted under Section 304A, the medical professional can face imprisonment of up to two years, a fine, or both, depending on the severity of the negligence. The penalty reflects the seriousness of causing death due to a negligent or rash act, though it is not as severe as a conviction under charges of culpable homicide.

Examples of Medical Negligence Under Section 304A

1. Incorrect Administration of Drugs: A doctor prescribing the wrong dosage of medication or administering the wrong drug, resulting in the patient’s death.

2. Surgical Mistakes: A surgeon performing a procedure in a negligent manner, such as leaving surgical instruments inside the patient, causing fatal complications.

3. Failure to Diagnose: A doctor failing to diagnose a serious condition, such as cancer, which results in the death of the patient due to the delayed treatment caused by the failure.

Medical Negligence and the Bharatiya Nyaya Sanhita

The Bharatiya Nyaya Sanhita (BNS), 2023 introduces a significant change by specifically addressing medical practitioners in the context of punishment for causing death by negligence. Under the earlier Section 304A of the IPC, doctors were not distinctly recognized; the provision applied generally to all acts of negligence leading to death. While the BNS enhances the punishment for negligent acts causing death to a maximum of 10 years' imprisonment in certain cases, it provides a separate and more lenient treatment for doctors. Section 106(2) of the BNS states that if a registered medical practitioner, while performing a medical procedure, causes death through a negligent act, the punishment shall be imprisonment of up to two years and a fine. Thus, in cases of death caused by medical negligence, doctors face a reduced maximum term of imprisonment, along with the possibility of a monetary penalty. This provision has not been has not been made effective from 1st July, 2024.

The Core Tenet : Jacob Mathew Case

In the landmark case of Jacob Mathew v. State of Punjab [2005 INSC 334], the Supreme Court of India addressed the crucial issue of criminal liability for medical negligence. The case arose when a patient suffering from breathing difficulties died allegedly due to the delay of doctors and the non-availability of a functioning oxygen cylinder. A criminal complaint was filed against Dr. Jacob Mathew under Section 304A IPC for causing death by negligence. The Court laid down important principles, distinguishing between civil and criminal negligence, and held that for a medical professional to be criminally liable, the negligence must be "gross" or of a very high degree. Applying the Bolam Test from English law, the Court observed that a doctor would not be negligent if he acted in accordance with a practice accepted as proper by a responsible body of medical professionals. Importantly, the Court emphasized the need for obtaining an independent and competent medical opinion before initiating criminal proceedings against doctors. Ultimately, it quashed the criminal case against Dr. Mathew, holding that no prima facie case of gross negligence had been established. This case serves as a guiding principle in India for balancing the accountability of medical professionals with protection from frivolous litigation.

The Court issued interim guidelines to protect medical professionals from unwarranted criminal prosecution until formal rules are established by the government. The key points of the guidelines are as follows:

• A private complaint against a doctor should not be entertained unless the complainant presents prima facie evidence, along with a credible opinion from another competent doctor supporting the allegation of rashness or negligence.

• Before initiating any action against a medical professional suspected of negligence, the investigating officer must seek an impartial and competent medical opinion, ideally from a government doctor specializing in the relevant field, and apply the Bolam test to the findings of the investigation.

• Furthermore, a doctor accused of negligence should not be arrested casually. Arrest should only occur if it is necessary for gathering evidence or facilitating the investigation, and not merely because a charge has been filed. If the investigating officer is satisfied that the doctor will cooperate, arrest may be avoided.

Remedies Available Against Medical Negligence

Victims of medical negligence in India have access to several remedies under both civil and criminal law.

Civil remedies: These primarily involve filing a claim for compensation through a suit for damages in civil courts under the law of torts, or by approaching consumer forums under the Consumer Protection Act, 2019, where patients are considered "consumers" (held in Indian Medical Association v. V.P. Shantha [1995 INSC 720]) and healthcare services are treated as "services." Victims can claim compensation for physical injury, mental trauma, loss of income, or additional medical expenses.

Criminal remedies: These are available under the IPC (BNS), particularly Sections 304A [106(1), BNS] (causing death by negligence), 337[125(a), BNS] (causing hurt by an act endangering life), and 338[125(b), BNS] (causing grievous hurt by negligence). In such cases, the doctor can face imprisonment and/or fines. Additionally, patients can approach Medical Councils (such as the Medical Council of India or State Medical Councils) for disciplinary action against negligent practitioners, which can result in suspension or cancellation of the medical license.

Victims may also seek writ remedies under Article 32 or Article 226 of the Constitution in cases involving violation of fundamental rights, particularly the right to life under Article 21.

Here’s a simple table for your reference, summarizing the remedies available against medical negligence:

Medical negligence represents a serious breach of the duty of care owed by healthcare professionals to their patients. It not only undermines trust in the medical system but can also cause irreversible harm. Indian law provides multiple remedies- civil, criminal, and disciplinary, to ensure that victims receive justice and that medical practitioners are held accountable. Landmark judgments such as Jacob Mathew v. State of Punjab [2005 INSC 334] and Indian Medical Association v. V.P. Shantha [1995 INSC 720] have shaped the legal framework by balancing patient rights with protections for doctors against frivolous litigation. With the introduction of the Bharatiya Nyaya Sanhita, 2023, the law continues to evolve, aiming to ensure greater clarity and fairness in dealing with cases of medical negligence.