India:- Medical Negligence, can it be pardoned?

Mediacal profession is viewed as the most devout and mindful calling among others. It is one of the most regarded areas of the general public and there is no forswearing of the way that specialists have been given assignment proportionate to that of the God. In the current occasions additionally, everybody is admiring these experts and hailing them as warriors in white uniform.

Nonetheless, a few occurrences put the specialist customer relationship in an air pocket. Because of some careless clinical experts the whole society is addressed and detested. Indeed, even the smallest carelessness of their part can be lethal for the patient and once the word ‘carelessness’ is appended with any clinical expert it is a major hit to the generosity of that individual.

UNDERSTANDING MEDICAL NEGLIGENCE

What is clinical carelessness?

The Supreme Court in Poonam Verma v. Ashwin Patel and Ors. [(1996) 4 SCC 332] talked about the idea of clinical carelessness and characterized as under:

“Carelessness has numerous signs – it might be dynamic carelessness, insurance carelessness, near carelessness, simultaneous carelessness, proceeded with carelessness, criminal carelessness, net carelessness, perilous carelessness, dynamic and detached carelessness, headstrong or crazy carelessness or Negligence essentially.”

A specialist can be held obligated for carelessness just on the off chance that it tends to be demonstrated that he/she is capable of a disappointment that no other specialist with conventional aptitudes would be liable of it, if acting with sensible consideration. A slip in judgment comprises carelessness just if an expert who is sensibly able with the standard aptitudes and has acted with conventional consideration, would not have made a similar mistake.

Legal PRECEDENTS

The expansive standards regarding this matter have been clarified in detail by the three Judge Bench of the Supreme Court in Jacob Mathew v. Province of Punjab and Anr. [(2005) 6 SCC 1]. In section 41 of the choice, the Court saw that:

“The expert must bring to his errand a sensible level of ability and information and must exercise a sensible level of care. Neither the most elevated nor a low level of care and skill is the thing that the law requires.”

Carelessness can be both a Tort and a Criminal risk. Carelessness as a wrongdoing has by and large an exclusive requirement. Under the misdeed Law, carelessness is built up to the degree of the misfortune brought about. In any case, carelessness under the criminal law is dependent on the degree or measure of carelessness. Courts have emphasized that the weight of building up criminal carelessness lies with the individual calling for it. On the off chance that a specialist has a blameworthy psyche and his/her carelessness prompts the foolishness then the individual submitting the demonstration will be held at risk.

In Dr. Suresh Gupta v. Legislature of NCT of Delhi [(2004) 6 SCC 422] the Supreme Court saw that:

“Among common and criminal risk of a specialist causing passing of his patient the court has a troublesome assignment of gauging the level of recklessness and carelessness claimed with respect to the specialist. For conviction of a specialist for supposed criminal offense, the standard ought to be verification of wildness and intentional wrong doing for example a further extent of ethically culpable lead.

To convict, in this way, a specialist, the arraignment needs to come out with an instance of serious extent of carelessness with respect to the specialist. Unimportant absence of legitimate consideration, safeguard and consideration or coincidence may make common obligation however not a criminal one. The courts have, in this manner, consistently demanded on account of supposed criminal offense against specialist causing demise of his patient during treatment, that the demonstration griped against the specialist must show carelessness or imprudence of such a further extent as to show a psychological state which can be portrayed as absolutely emotionless towards the patient. Such gross carelessness alone is culpable.”

A serious extent of carelessness is required to prove the claim of criminal carelessness under Section 304-An of the Indian Penal Code, 1860. For fixing criminal risk on a clinical specialist a unimportant absence of required consideration, expertise and consideration isn’t adequate, it is required to be demonstrated that there was a “gross carelessness”. Under Indian Penal Code, Sections 52, 80, 81, 83, 88, 90, 91, 92 304-A, 337 and 338 examine the law of clinical misbehavior in India.

The direct of clinical negligence was brought under the Consumer Protection Act, 1986, by ethicalness of a milestone instance of the Indian Medical Association v. V. P. Shantha and others [(1995) 6 SCC 651] wherein the Court saw that:

“clinical consideration was characterized as an “administration” under this judgment that was secured by the Act, and it was additionally explained that an individual looking for clinical consideration might be considered as a shopper if certain models were met for instance there was an installment either for treatment or enrollment, or charges were deferred or it was paid by an insurance agency.”

After this judgment, it was viewed as that a few classifications of patients presently could bring charges against the careless medicinal services suppliers for remuneration under the Consumer Protection Act, 1986. Offices and specialists that offered a wide range of assistance liberated from cost to all customers were not to be held obligated under the Act.

The Supreme Court in V.N. Shrikhande v. Anita Sena Fernandes [(2011) 1 SCC 53] saw that:

“18. In instances of clinical carelessness, no restraint equation can be applied for deciding concerning when the reason for activity has collected to the shopper. Each case is to be settled on its own realities. In the event that the impact of carelessness on the specialist’s part or any individual related with him is patent, the reason for activity will be considered to have emerged on the date when the demonstration of carelessness was finished. On the off chance that, then again, the impact of carelessness is inactive, at that point the reason for activity will emerge on the date when the patient or his delegate complainant finds the damage/injury caused because of such act or the date when the patient or his agent complainant could have, by exercise of sensible persistence found the demonstration establishing carelessness.”

In this way, the Court held that there is no sweeping technique to choose with respect to when the reason for activity has resulted the shopper.

Moreover, Sections 80 and 88 of the Code specifies the barriers for specialists blamed for criminal obligation.

As indicated by Section 80:

“80. Mishap in doing a legal demonstration – Nothing is an offense that is finished unintentionally or disaster, and with no criminal expectation or information in the doing of a legitimate demonstration in a legal way by legal methods and with appropriate consideration and alert.”

As per Section 88:

“88. Act not planned to cause passing, done by assent in compliance with common decency for individual’s advantage – Nothing, which isn’t proposed to cause demise, is an offense by reason of any mischief which it might cause, or be expected by the practitioner to cause, or be known by the practitioner to probably cause, to any individual for whose advantage it is done in compliance with common decency, and who has given an assent, regardless of whether express or inferred to endure that hurt, or to face the challenge of that hurt.”

Enactments

Government at both the Central and the State level has attempted to ensure the nature of human services segment at all levels through declaring various statutes, guidelines and acts.

  1. The Medical Council Act, 2001 – The said Act canceled the Indian Medical Council Act, 1956 as was changed in 1964, 1993 and 2001. The Act accommodates the constitution of the Medical Council of India (MCI). The MCI directs principles of clinical instruction, authorization to begin schools, courses or increment the quantity of seats, enrollment of specialists, norms of expert lead of clinical professionals.
  2. Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002-This guideline sets out the lead of clinical experts, indicating the obligations and obligations of the doctors in and has additionally assembled the general rules required for moral clinical practice.
  3. Screening Test Regulations, 2002-The Regulations accommodates:

“An Indian resident having an essential clinical capability granted by any clinical organization outside India who is covetous of getting temporary or lasting enrollment with the Medical Council of India or any State Medical Council on or after 15.03.2002 will need to qualify a screening test led by the endorsed expert for that reason according to the arrangements of area 13 of the Act.”

  1. Indian Nursing Council-It is a national administrative body for medical attendants and medical caretaker instruction in India. It is likewise liable for consistency in nursing instruction.
  2. Medications and Cosmetics Act, 1940-The essential target of the Act is to guarantee that the medications and beauty care products sold in India are sheltered, viable and adjust to state quality guidelines.
  3. Drug store Act, 1948 – The Act accommodates:

“An Act to direct the calling of drug store. To improve arrangement for the guideline of the calling and practice of drug store and for that reason to establish Pharmacy Councils”

  1. Clinical Termination of Pregnancy Act, 1971 – The Act accommodates:

“An Act to accommodate the end of specific pregnancies by enrolled clinical professionals and for issues associated therewith or coincidental thereto.”

  1. Transplantation of Human Organ Act, 1994-This Act fills in as the essential enactment administering the procedures of organ gift and organ transplantation in India.
  2. Pre-natal Sex Determination Test Act, 1994-This demonstration was authorized to stop female foeticides and capture the declining sex proportion in India. The demonstration restricted pre-birth sex assurance.
  3. Medications and Magic Remedies (Objectionable Advertisement) Act, 1954 – The said Act gives as under:

“It disallows notices of medications and cures that guarantee to have supernatural properties, and makes doing so a cognizable offense.”

Finishing up REMARKS

There are no two different ways about the way that specialists owe an obligation of care towards the patients yet.

Zero Tolerance For Violence Against Doctors And Healthcare Workers

Nothing on earth can be more disgusting, more degrading and more demoralizing than to see that how brazenly so many dastardly and cowardly acts of unprovoked and uncalled for attacks against doctors and healthcare workers have been carried out ever since the outbreak of this corona pandemic is going on! We must be honest enough to concede that the Covid-19 pandemic is akin to a full fledged war which is completely unprecedented where we don’t even know where the enemy is hiding and who can spread it so easily by just body contact also! We also must be gracious enough to concede that the doctors and other health staff are our new frontline soldiers and they must be protected from violence against any lumpen elements and those who dare to attack them must be meted out the most severe punishment so that a stern and strong message goes out that violence against them who risk their own lives to protect their patients will not go unpunished and unaccounted for!

                                    Truth be told, doctors are rendering willingly so many sacrifices and hardships that it cannot be described in words! Dr Javed Ali Huda had barely removed his PPE after a long day attending to the patients at the emergency OPD of Meerut’s Lala Lajpat Rai Memorial (LLRM) Medical College when he received the heart breaking news of his father’s untimely demise. He had to give the funeral a miss. He laid bare his feelings while controlling his emotions that, “I wanted to go home and see my father one last time. But, I am a doctor and could not have risked the lives of others back home. I was put on a video call and my family sent me pictures of my father’s burial!” There are so many such similar instances where doctors have willingly given the highest priority to their sacred duty placing them above their family and their near and dear ones! Still can we ever allow violence against doctors who are the living form of “God” who attend to their patients most willingly without any discrimination under any circumstances?

                                             Needless to say, the dire need for a strict law to protect doctors and health workers was felt most when two medical doctors – Zakiya Syed and Trupti Katdare were attacked and pelted with stones by a violent mob in a dense settlement in Indore.  These two medical doctors had then fled to save their own lives but they then returned to the spot a day later along with their team of health workers to screen people for the coronavirus disease (Covid-19). Dr Zakiya Syed said that, “I am injured but not scared at all. This won’t deter me from doing my duty.”

                                It is certainly a solace to see that the Union Government too acted with alacrity and approved an ordinance to amend and strengthen the Indian Epidemic Diseases Act, 1897, making offences against doctors and nurses cognizable, non-bailable and carrying imprisonment terms from six months to seven years. We also saw how even the Indian Medical Association too taking serious note of the repeated attacks on doctors and health workers did not shy away from calling a two-day strike by the doctors on April 22 and 23. When the Union Home Minister Amit Shah assured them that no guilty attackers would ever be spared under any circumstances that the strike was ultimately called off!

                                                 It is also most reassuring to see that even the PM Narendra Modi has strongly condemned the growing attacks against doctors and reiterated his government’s full solidarity with doctors and health workers by following a zero tolerance policy against all such attackers. This alone explains why it has not dithered in enacting a strict law also to protect doctors from dastardly attacks by those with criminal bent of mind. This was in fact the crying need of the hour also!

                                                As it turned out, soon after the Union Cabinet had approved the ordinance, Prime Minister Narendra Modi said that there can be no compromise on the safety of healthcare professionals fighting the Covid-19 pandemic. He also eloquently pointed out that, “The Epidemic Diseases (Amendment) Ordinance, 2020 manifests our commitment to protect each and every healthcare worker who is bravely battling COVID-19 on the frontline. It will ensure safety of our professionals”  The Centre has also made it clear that the law will mandate that the police complete the probe in such cases within 30 days and that the courts pronounce judgment within a year! Very rightly so!

                                              Be it noted, SK Sarin who is Director of Institute of Liver and Biliary Sciences, Delhi has minced no words in observing in his enlightening editorial titled “The safety of healers” in ‘The Indian Express’ dated April 27, 2020 that, “While hundreds of acts of violence against doctors have been reported every year for the past two decades, many more are never brought to light. Doctors, nurses and healthcare professionals will remember the day the Union government passed an ordinance ensuring that acts of violence against doctors and other medical staff will be a cognizable and non-bailable. Imprisonment from six months to seven years and a penalty from Rs 50,000 to Rs 7 lakh can be sanctioned by the courts. Such punishments will serve as a deterrent to unruly patients and their relatives, if found guilty.”

                                                    To be sure, in this same enlightening editorial, Dr SK Sarin while continuing in the same vein adds a caveat by pointing out that, “Will the courts change their outlook in the wake of the new ordinance? If these very warriors are ostracised while returning from work or are thrown out of their houses, bruised by a crowd pelting stones, will the courts and judges rise to the occasion and take suo motu action? Will they be able to deliver timely and exemplary punishments and safeguard the dignity and lives of HCPs? Healthcare professionals need a sensitive and accountable judicial system and this ordinance should be given more punch and wider applicability in the times to come.”

                              Furthermore, AIIMS Resident Doctors Association (RDA) General Secretary Dr Srinivas Rajkumar T said while welcoming the Centre’s decision that, “We appreciate the central government for taking note of this situation, albeit late, and ensuring immediate amendments are made as feasible so that frontline warriors are able to serve the country without fear.”

                               Interestingly enough, the Union Health Ministry also advised the Chief Secretaries of all states and Union Territories to adopt adequate measures in ensuring the safety of the health workers. Separately, the Union Home Ministry in a letter asked all states and Union Territories to provide adequate security to doctors and front-line health workers who are facing attacks from unruly people. Amit Shah who is Union Home Minister also told a group of doctors and representatives of the Indian Medical Association (IMA) that safety of health care professionals treating the virus infected patients is non-negotiable.

                                 Going forward, the Home Ministry letter sent by Home Secretary Ajay Bhalla to all State Chief Secretaries also urged that governments impose strict penalties against those obstructing the functioning of healthcare workers and against those offenders who obstruct the last rites of healthcare workers who may have died due to Covid-19 or any other reason. It also asked states and Union Territories to appoint a nodal officer both at the state and at the district level on a 24×7 basis, to redress any safety issues of medical professionals. It also conceded that at this time, even a single incident of violence against healthcare professionals was likely to create a sense of insecurity among the entire healthcare community!

                            Of course, we must also pay attention to what Dr Ullas Batra who is Senior Consultant, Medical Oncology of Rajiv Gandhi Institute and Research Centre Delhi says on the proposed ordinance which the President recently approved also that, “This ordinance is exclusively for those doctors who are working to treat COVID-19 patients. In my opinion, it needs to be extended to all medical doctors.” Centre too must pay heed to what Dr Batra has said so plainly!

                                          No doubt, this new ordinance protects not just doctors but also paramedical staff and accredited social health activists. It is also provided that two times the cost to be recovered from vandals if cars or clinics of health care professionals are damaged! There is also the provision of Rs 50 lakh insurance for health workers.

                                 All said and done, what now truly matters most is strict, swift and sincere implementation of the new law to ensure that there is zero tolerance for any kind of violence or threat or intimidation in any form  against not just doctors but also health workers which include nurses, paramedical staff among others! It is solely because of them that India has managed to limit the death casualty to such a low level not crossing the figure of even ten thousand even though in advanced and developed countries like USA, the death toll has exceeded one lakh and ten thousand for which they deserve full credit also! This has certainly  enhanced the reputation of our country at the world stage also!

                             In other words, this alone explains that why even PM Narendra Modi has also while appreciating the relentless work done by them expressed his firm commitment and resolve to ensure that those who attack them are dealt with sternly and strictly and not left scot free under any circumstances for which he certainly deserves accolades! It must be now ensured that not even a single act of violence against doctors, nurses and health workers should ever go unpunished under any circumstances, come what may! This again is possible only if this new ordinance is implemented in totality against all those who dare to attack doctors and health workers in any way!

                                 In conclusion, the ball is now clearly in the court of the courts, police and law enforcing agencies who must lead from the front by ensuring that no guilty is ever spared under any circumstances for which special police officers should also be appointed to serve its purpose! This will certainly help resolve the issue of scarcity of law enforcers for immediate response!

                          Only then will a loud and clear message go out to one and all that there shall be zero tolerance from now onwards against any form of dastardly attack against doctors and health workers! Also, the government must now leave no stone unturned to ensure that the provisions of this new ordinance are disseminated widely using all the tools at its disposal so that people become aware fully about it and are able to use it when needed!

                          Even the political parties too must now step forward and lead from the front and ask their cadres to inform the people of this new ordinance! Only then can this new ordinance serve its true purpose for which it has been enacted! There can be certainly  no denying or disputing it!

Sanjeev Sirohi, Advocate,

s/o Col BPS Sirohi,

A 82, Defence Enclave,

Sardhana Road, Kankerkhera,

Meerut – 250001, Uttar Pradesh.