Q. Indian case law on good faith exemption from medical negligence?

In India, the concept of "good faith" in medical negligence cases is often discussed in the context of whether a doctor can be held liable for unintended outcomes. Here are a few notable cases and legal principles:

1. Dr. A.K. Gupta vs. State of U.P. (2018): This case involved a doctor who was accused of causing a patient's death due to negligence. The court emphasized that if a doctor treats a patient with due care and in accordance with accepted medical practices, they cannot be held liable for negligence simply because the patient did not recover.
    
2. Sabiha Hamid vs. Dr. M Khan Hospital (2021): In this case, the State Consumer Disputes Redressal Commission highlighted that for a doctor to be held liable for negligence, there must be clear evidence of a breach of duty that directly caused harm to the patient.
    
3. Bharatiya Nyaya Sanhita (2023): This new law includes provisions to protect doctors from criminal prosecution if they act in good faith. For example, a surgeon performing an operation with the intention of helping the patient, even if the outcome is not favorable, is protected under this law.

These cases and legal provisions illustrate that Indian courts often consider the intent and adherence to standard medical practices when determining liability in medical negligence cases. If a doctor acts in good faith and follows accepted medical protocols, they are generally exempt from liability.

Q. Indian case law on IPC Sec 88 in defence of medical negligence?

Section 88 of the Indian Penal Code (IPC) provides a defense for acts done in good faith for the benefit of a person, with their consent, even if those acts result in harm. This section is often invoked in medical negligence cases to protect doctors from liability when they act with the patient's best interests in mind.

Here are some notable cases where IPC Section 88 was discussed in the context of medical negligence:

1. Dr. A.K. Gupta vs. State of U.P. (2018): In this case, the Allahabad High Court emphasized that a doctor cannot be held liable for negligence if they acted in good faith and with the patient's consent, even if the outcome was not favorable.
    
2. Kusum Sharma & Ors vs. Batra Hospital & Medical Research Centre (2010): The Supreme Court of India highlighted that acts done in good faith for the benefit of the patient, with or without their consent, are protected under IPC Sections 88 and 92. The court noted that these sections provide immunity to doctors from criminal liability for unintended outcomes.
    
3. Suresh Gupta vs. Govt. of NCT of Delhi (2004): This case involved a surgeon who was accused of causing a patient's death due to negligence. The Supreme Court ruled that if a doctor performs an act in good faith for the patient's benefit, they are protected under Section 88, provided there is no gross negligence.

These cases illustrate how Indian courts interpret and apply IPC Section 88 to protect medical professionals who act in good faith and follow standard medical practices.

Q. Indian Case law on IPC Sec 90 in medical negligence?

Section 90 of the Indian Penal Code (IPC) deals with the concept of consent, specifically when consent is not considered valid. In the context of medical negligence, this section can be relevant when determining whether a patient's consent was obtained properly and whether it was informed.

Here are some notable cases where IPC Section 90 was discussed in relation to medical negligence:

1. Samira Kohli vs. Dr. Prabha Manchanda (2008): This landmark case dealt with the issue of informed consent. The Supreme Court of India held that for consent to be valid, it must be obtained after providing the patient with sufficient information about the procedure, its risks, and alternatives. The court emphasized that consent obtained without proper disclosure of information is not valid under Section 90.
    
2. Nizam Institute of Medical Sciences vs. Prasanth S. Dhananka (2009): In this case, the Supreme Court reiterated the importance of informed consent. The court ruled that failure to obtain proper consent, especially when the patient is not fully informed about the risks involved, can amount to medical negligence.
    
3. Dr. Suresh Gupta vs. Govt. of NCT of Delhi (2004): This case involved a surgeon who was accused of negligence leading to a patient's death. The Supreme Court discussed the importance of obtaining valid consent and noted that if consent is obtained through misrepresentation or without full disclosure, it is not valid under Section 90.

These cases highlight the critical role of informed consent in medical practice and how the lack of valid consent can lead to allegations of medical negligence.

Q. Indain Case laws on IPC 92 in medical negligence in India?

Section 92 of the Indian Penal Code (IPC) provides protection for acts done in good faith for the benefit of a person without their consent, under certain circumstances. This section is particularly relevant in emergency medical situations where obtaining consent is not feasible.

Here are some notable cases where IPC Section 92 was discussed in the context of medical negligence:

1. Dr. A.K. Gupta vs. State of U.P. (2018): This case involved a doctor who performed an emergency procedure without the patient's consent. The court held that the doctor acted in good faith and for the patient's benefit, thus falling under the protection of IPC Section 92.
    
2. Suresh Gupta vs. Govt. of NCT of Delhi (2004): In this case, the Supreme Court discussed the application of IPC Section 92 in situations where immediate medical intervention is necessary to save a patient's life. The court emphasized that doctors are protected under this section when they act in good faith and in the best interest of the patient.
    
3. Aruna Ramachandra Shanbaug vs. Union of India (2011): Although primarily a case on euthanasia, the Supreme Court touched upon the principles of good faith and benefit under IPC Section 92. The court noted that medical professionals are protected when they act without consent in emergency situations, provided their actions are intended to benefit the patient.

These cases illustrate how Indian courts interpret and apply IPC Section 92 to protect medical professionals who act in good faith during emergencies.

Q. 'Good Faith' in Section 3(22) of the General Clauses Act, 1897 - "A thing shall be deemed to be done in good faith where it is in fact done honestly, whether it is done negligently or not." Does it no mean that even if the act was negligent it does not mean it was not in good faith? Case Law?

Yes, under Section 3(22) of the General Clauses Act, 1897, an act is considered to be done in "good faith" if it is done honestly, regardless of whether it is done negligently or not1. This means that even if an act is negligent, it can still be deemed to be done in good faith as long as there was no dishonest intention.

Here are some relevant case laws that illustrate this principle:

1. State of Rajasthan vs. Shantilal (1997): In this case, the Supreme Court of India held that an act done honestly, even if it involves negligence, is protected under the definition of "good faith" as per Section 3(22) of the General Clauses Act.
    
2. Dr. Suresh Gupta vs. Govt. of NCT of Delhi (2004): This case involved a surgeon accused of negligence. The Supreme Court noted that the surgeon's actions, though negligent, were done honestly and without any malicious intent, thus falling under the protection of "good faith".
    
3. Kusum Sharma & Ors vs. Batra Hospital & Medical Research Centre (2010): The court reiterated that acts done honestly, even if negligently, are considered to be in good faith. This case further emphasized the importance of the doctor's intention and adherence to standard medical practices.

These cases highlight that the concept of "good faith" under Section 3(22) can provide a defense in medical negligence cases, as long as the actions were honest and without any fraudulent intent.

Q. Indian evidence act sec 111 requires that the accused has to establish, not prove, that he acted in good faith. The burden of disproving it lies with the complainant. Case law apropos medical negligence?
Section 111 of the Indian Evidence Act, 1872, indeed places the burden on the accused to establish that they acted in good faith in transactions where one party is in a position of active confidence. This principle is particularly relevant in medical negligence cases, where doctors must demonstrate that their actions were in good faith, while the complainant must disprove this claim.

Here are some notable cases that illustrate the application of Section 111 in the context of medical negligence:

1. Dr. A.K. Gupta vs. State of U.P. (2018): In this case, the Allahabad High Court discussed the burden of proof in medical negligence cases. The court emphasized that once the doctor establishes that they acted in good faith, the burden shifts to the complainant to disprove this claim.
    
2. Kusum Sharma & Ors vs. Batra Hospital & Medical Research Centre (2010): The Supreme Court of India highlighted that in cases of medical negligence, the doctor must establish that their actions were in good faith and in accordance with accepted medical practices. The complainant then has the burden to prove otherwise.
    
3. Suresh Gupta vs. Govt. of NCT of Delhi (2004): This case involved a surgeon accused of negligence. The Supreme Court ruled that the surgeon had to establish that his actions were in good faith. Once this was done, the burden shifted to the complainant to disprove the surgeon's claim of good faith.

These cases demonstrate how Indian courts interpret and apply Section 111 of the Indian Evidence Act in medical negligence cases, focusing on the burden of proof and the concept of good faith.

Q. Conflict between good faith under general exemption clauses and IPC Sec 52. Case law apropos medical negligence?

The concept of "good faith" under general exemption clauses and IPC Section 52 can sometimes appear to be in conflict, especially in the context of medical negligence. Section 52 of the IPC defines "good faith" as an act done with due care and attention, while general exemption clauses, such as those in the General Clauses Act, 1897, define "good faith" as an act done honestly, regardless of negligence.

Here are some notable cases that discuss this conflict in the context of medical negligence:

1. Dr. Suresh Gupta vs. Govt. of NCT of Delhi (2004): In this case, the Supreme Court of India discussed the concept of "good faith" under IPC Section 52. The court emphasized that for an act to be considered in good faith, it must be done with due care and attention. The court also noted that negligence, even if honest, does not constitute good faith under IPC Section 52.
    
2. Kusum Sharma & Ors vs. Batra Hospital & Medical Research Centre (2010): This case highlighted the difference between the definitions of "good faith" under the General Clauses Act and IPC Section 52. The Supreme Court reiterated that while the General Clauses Act allows for honest negligence to be considered as good faith, IPC Section 52 requires due care and attention.
    
3. Jacob Mathew vs. State of Punjab (2005): In this landmark case, the Supreme Court clarified that medical professionals must exercise due care and attention to be protected under IPC Section 52. The court held that honest mistakes without due care do not qualify as good faith under this section.

These cases illustrate the nuanced interpretation of "good faith" in medical negligence cases and the importance of due care and attention under IPC Section 52.

Q. This means that once a doctor has demonstrated that he treated the patient with due attention and care, his good faith is established and he is exempted from any liability?

Yes, that's correct. Once a doctor demonstrates that they treated the patient with due attention and care, their actions are considered to be in good faith. This can provide a strong defense against liability in medical negligence cases. The key is that the doctor must show they acted with the necessary due care and attention, as required under IPC Section 52.

For instance, in the Jacob Mathew vs. State of Punjab (2005) case, the Supreme Court emphasized that medical professionals must exercise due care and attention to be protected under IPC Section 52. If they can establish this, their good faith is recognized, and they are generally exempt from liability.

Q. To prove that the physician acted with due attention and care would the case record showing the physician, when approached, noted his complaints, examined him, conducted the required tests and having arrived at a clinical diagnosis, in other words after ascertaining the patient's diagnostic and therapeutic needs, prescribed him a treatment, sufficient proof that he did so with due attention and care?.

Yes, detailed case records can serve as strong evidence that a physician acted with due attention and care.
Here are the key elements that such records should include to demonstrate this:

1. Patient Complaints: Documentation of the patient's initial complaints and symptoms.
2. Examination: Notes on the physical examination conducted by the physician.
3. Diagnostic Tests: Records of any diagnostic tests ordered and their results.
4. Clinical Diagnosis: The physician's clinical diagnosis based on the examination and test results.
5. Treatment Plan: The prescribed treatment plan, including medications, procedures, and follow-up care.
6. Informed Consent: Documentation that the patient was informed about the diagnosis, treatment options, risks, and obtained consent.

These elements collectively show that the physician followed a systematic and thorough approach in diagnosing and treating the patient, which is indicative of due care and attention.

In cases like Kusum Sharma & Ors vs. Batra Hospital & Medical Research Centre (2010), the Supreme Court emphasized the importance of adhering to standard medical practices and maintaining detailed records to demonstrate good faith and due care.

Q. Medical negligence is actionable only when it causes injury i.e. hurt, injury, grievous hurt or homicide. All these are offences under IPC. It has to be proved under IPC before any liability arises or fixed. This holds good even if the complainant seeks only compensation under Tort, or Civil or under CP Act. I can not be denied statutory exemption/protection because the complainant has approached the court for civil liability only. The offence is criminal, the liability optional, civil or criminal.

You raise an important point about the intersection of criminal and civil liability in cases of medical negligence. Under Indian law, medical negligence can indeed lead to both criminal and civil consequences, depending on the nature and severity of the negligence.

• Criminal Liability:
  • Section 304A of the IPC deals with causing death by negligence. It states that "whoever causes the death of any person by doing any rash or negligent act not amounting to culpable homicide shall be punished with imprisonment for a term which may extend to two years, or with fine, or with both".
  • For criminal liability to be established, it must be proven that the healthcare provider's actions were grossly negligent and directly resulted in the patient's death.
     
• Civil Liability:
  • Patients can seek compensation for medical negligence through civil litigation, consumer protection laws, or tort claims. The burden of proof in civil cases is generally lower than in criminal cases.
  • Even if a complainant seeks only civil remedies, the underlying act of negligence must still be established. However, the standards of proof and the nature of the proceedings differ from criminal cases.

Statutory Exemptions/Protections:

• Healthcare providers may claim statutory exemptions or protections Under certain circumstances, such as acting in good faith or within the scope of their professional duties. However, these defenses must be substantiated with evidence.

In summary, while the nature of the liability (civil or criminal) may vary, the foundational requirement is to establish the negligent act and its consequences. The legal framework allows for both criminal prosecution and civil compensation, depending on the specifics of the case.

If you have any specific cases or scenarios in mind, feel free to share, and we can delve deeper into those examples.

Q. BNS 104.

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 seven years, and shall also be liable to fine. 106.

1. Whoever causes 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 five years, and shall also be liable to fine; and if such act is done by a registered medical practitioner while performing medical procedure, he shall be punished with imprisonment of either description for a term which may extend to two years, and shall also be liable to fine.

Explanation: For the purposes of this sub-section, "registered medical practitioner" means a medical practitioner who possesses any medical qualification recognised under the National Medical Commission Act, 2019 and whose name has been entered in the National Medical Register or a State Medical Register under that Act. Having retained IPC 304 A as BNS 104(1) was it not unnecessary, discriminatory and inequitable against a registered medical practitioner to insert a new Sec. BNS 106(1)?

The comparison between the Indian Penal Code (IPC) and the Bharatiya Nyaya Sanhita (BNS) can indeed be insightful, especially for legal professionals navigating both systems.

Let's delve into the relevant sections and explore the differences:

1. IPC Section 304A:
   • This section deals with causing death by negligence. It states that 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 that may extend up to seven years, along with a fine.
      
2. BNS Clause 106(1):
   • The corresponding provision in the BNS addresses the same offense. It states that 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 that may extend up to five years, along with a fine.
   • However, there's an important distinction: If such an act is committed by a registered medical practitioner while performing a medical procedure, the punishment is reduced. In such cases, the medical practitioner may face imprisonment for a term that may extend up to two years, along with a fine.
   • The definition of a "registered medical practitioner" in the BNS aligns with the National Medical Commission Act, 2019, and includes practitioners whose names are entered in the National Medical Register or a State Medical Register.
      
3. Comparison and Considerations:
   • The retention of IPC Section 304A as BNS Clause 104(1) and the introduction of BNS Clause 106(1) raise valid questions.
   • While the BNS aims to modernize and adapt legal provisions to contemporary needs, it's essential to evaluate whether the differentiation based on the status of the offender (registered medical practitioner or not) is equitable.
   • Legal scholars and practitioners may debate the necessity and implications of this distinction. Factors such as professional accountability, medical expertise, and societal expectations come into play.
   • Ultimately, the BNS seeks to strike a balance between accountability and fairness, but discussions around its provisions remain ongoing.
      

Please note that legal interpretations can vary, and seeking professional legal advice is advisable for specific cases.

Conclusion
Medical fraternity must press for and insist on availability of statutory exemptions from liability in medical negligence cases.

Medical fraternity should strive to get BNS 106 (1) declared discriminatory.

Medical fraternity should strive to get the latest judgment of Supreme Court in Bar of Indian Lawyers through its President Jasbir Singh Malik & Ors v. DK Gandhi PS National Institute of Communicable Diseases and Ors as final excluding all professionals including medical professionals, from the purview CPA 2023. Uncertainty of IMA decision for CPA 1986 should be resolved by the Apex Court. Health care should be excluded from CPA.

Written By: Dr Shri Gopal Kabra, MBBS, LLB, MSc, MS(Anatomy), MS(Surgery)
15, Vijay Nagar, D-block, Malviya Nagar, Jaipur-302017
Email: [email protected] Mobile: 8003516198