definition, types, illustrations, prevention, defenses against medical negligence

1. MEDICAL NEGLIGENCE
Dr. M BALAJI SINGH

2. Professional Negligence (Malpraxis):
Definition; Professional negligence is the absence of
reasonable care and skill, or willful negligence of
medical practitioner, in the treatment of a patient which
causes his bodily injury or death.
.

3. MEDICAL NEGLIGENCE……explained……..as
• Medical negligence is the failure of a medical practitioner to provide proper
care and attention and exercise those skills which a prudent, qualified
doctor would do under similar circumstances.
• Negligence is the breach of a legal duty to care.
• It means carelessness in a service in which the law mandates carefulness.
• Breach of duty initiate action against doctor

4. Act of commission – doing something unwanted
Act of omission – avoiding something needed
act by a medical professional which
deviates from the accepted standards of
practice of the medical community, leading
to an injury to the patient.

5. 4 ‘D’ S OF MEDICAL NEGLIGENCE
• 1. duty
• 2. dereliction
• 3. damage
• 4. direct causation

6. DUTY
Doctor patient relation ship ;
• Doctor accepting a particular person as his patient.
• Patient given consent to get treatment from concern doctor.
• A business or service contract established.

7. DUTIES OF A DOCTOR TOWARDS PATIENT
• Duty to take consent - permission from patient
• Duty to inform – options, alternatives, diagnosis, treatment modalities
, prognosis
• Duty to explain – how to take drug, special precautions, next visit, etc.
• Duty to perform - reasonable care and skill
- to attend the duty in time.
• Duty to keep - secrets of patient

8. DERELICTION (Negligence)
• Lack of reasonable care
• Lack of attention
• Deficiency in knowledge
• Absence of reasonable skill
• Ignoring precautions
• Defective communication

9. Examples for damages………
• Loss of life
• Loss of sensation
• Loss of organ
• Loss of function
• Loss of earning capacity
• Loss of potency
• Loss of joy in life
• Loss of health

10. Medical negligence……examples for damages.
The patient must suffer some loss or damages, e.g.
1) Loss of earning due to absence from work, or
reduction of his ability to work.
(2) Reduction in expectation in life.
(3) Loss of limb or sense.
(4) Pain and suffering.
(5) Loss of potency.
(6) Death. Etc.

11. • Examples of Negligence:
Failure to ( ACT OF OMMISSION)
(1) obtain informed consent
(2) examine patient personally
(3) attend the patient in time
(4) Immunize patient or to do sensitivity tests,
(5) give proper post-operative care,
(6) warn patient of side-effects,
(7) give proper instructions,
(8) Obtain consultation when necessary,
(9) keep abreast of advances in medical services.
(10) Failure to making correct diagnosis ,
(11) failure to prevent spreading of infection from his patients.
.

12. ACT OF COMMISSION
• Giving over dosed drugs- Eg. propofol
• Giving a wrong medicine – ignoring contraindications
• Giving drug in wrong route of administration
• Giving drug in wrong timing.
• Giving inappropriate instructions – E.g. Pantoprazole , NSAID in relation to
food
• Giving inappropriate combinations of drug- E.g.; warfarin and ibuprofen
• Ignoring serious drug interactions
• Wrong person - prescribing ACE inhibitors to pregnant

14. SIX COMMON causes OF MEDICAL MALPRACTICE
• 1. Misdiagnosis-
• 2. Delay in diagnosis allows the condition to become worse because the patient does
not receive the necessary treatment.
• 3. Fail to maintain up dated standards of care and skill. Too many patients- doctor is after
the profits- “putting profits over safety.”–
• 4. Birth injuries. Birth injuries often result in the need for lifelong medical care, which
can cost several million dollars.
• 5. Medical Product Liability: faulty medical devices
Eg; defective IVC filters, which are intended to prevent
blood clots can break, travel through the bloodstream, and cause serious injury or death.

15. SIX COMMON TYPES OF MEDICAL MALPRACTICE……….
6. surgical errors that may constitute malpractice include:
• Incorrect procedure
• Unnecessary surgery
• Damaging organs, nerves, or tissues
• Incorrect technic
• Insufficient care of anesthesia
• Un-sterile surgical instruments
• Leaving equipment inside the patient’s body.
• Inadequate ‘post operative’ care .

16. PROXIMATE CAUSE
• Direct causation
- Doctor’s negligent action and ‘damage’ should be directly
related.
- No intervening new action
• Novus actus interveniens ;
E.g. Patient consumed a new drug prescribed by
other doctor ( folk remedies) without the knowledge of First doctor.

17. Medical negligence -4 ‘D’s
Liability arises if the following conditions are satisfied:
(1) Duty: Existence of duty of care.
(2) Dereliction: Failure of the doctor to maintain care and skill.
(3) Damage: Damage which results must be
reasonably foreseable.
If no damage has occurred, the patient cannot sue
a doctor for negligence.
(4). Direct causation: Failure to exercise a duty of care
must lead to damage (proximate cause).

18. Medical negligence……types
• Civil
• Criminal

19. CIVIL NEGLIGENCE
Question of civil negligence arises:
demand of compensation
a. When a patient, or his relative brings suit in a civil court for
realization of compensation from his doctor.
b. When doctor brings a civil suit for the realization of his fees from
patient or his relatives, who refuse to pay the same, alleging
professional negligence

20. CIVIL NEGLIGENCE

21. CRIMINAL NEGLIGENCE…

22. Criminal Negligence
• Doctor shows gross incompetency and inattention in treating patient.
• criminal indifference ( lack of interest) in the patient’s
safety.
• Some times it may associated with drunkenness
or use of narcotic drugs by doctors- but it is rare

23. INDIAN PENAL CODE
Sec. 304-A IPC deals with criminal negligence;
whoever causes the death of any person illegally by
doing any rash or negligent action not
amounting to culpable homicide is punished with
imprisonment up to 2 years and with/without fine.

24. CRIMINAL NEGLIGENCE….
It arises:
(1) When a doctor shows, gross absence of skill or
care during treatment resulting in serious injury or death
(2) when doctor performs an negligent act, during treating a
assaulted person( assaulted by other person) , when he
dies, defense lawyer may attribute death due to negligence
of doctor.

25. CRIMINAL NEGLIGENCE…
Conditions to be satisfied:
(1) Lack of interest in obvious risk of injury.
(2) Actual foresight of the risk, but continuation of the same treatment. E.g.,
blood urea level is 42mg /dl, but doctor continued
giving inj. Gentamycin which is a potentially
nephrotoxic drug.
.

26. CRIMINAL NEGLIGENCE…
(3) Appreciation of the risk , but showing a high degree of negligence in the
avoidance.
(4) Failure to avoid a serious risk.
(5) Death resulting from anaphylaxis due to injection without prior test dose.

27. CRIMINAL NEGLIGENCE…
Examples:
(1) Amputation of wrong limb or operation on wrong patient .
(2) Leaving swabs, instruments, etc. in abdomen
(3) Performing criminal abortion
(4) Administration of wrong substance into eye causing loss of vision.

28. Civil Vs. Criminal Negligence

29. Precautions to avoid medical negligence …
We have to Take care……. but how extent?
Build up following things…….
• Knowledge
• Communication
• Record keeping
• Skill development
• Equipment
• Updated technics
• Attention towards work

30. PRECAUTIONS TO AVOID NEGLIGENCE
A,B,C,D,E.
• A- Awareness of laws against medical negligence
• B- Build strong infrastructure and systematic procedures –
contemporary practices, techniqes and skills, etc.
(Injury prevention program).

31. A B C D E…….. for prevention……
• C- Communication and informed Consent –
Good rapport with the patient, his family members, fellow physicians and
paramedical staff.
Contemporary knowledge: medico-legal seminars, journals, case studies
• D- Documentation- medical records……. Transparency: Maintain
complete, accurate, legible medical records .
Dedication towards patient.
• E- Empathetic attitude – treat with compassion…….

32. NEGLIGENCE prevention…….R R R
Rationale: Rationality in making correct diagnosis and updated
treatment. Reasonable care and skill.
Respect: Respect the feelings of the patient (Empathy)
Treat the patient with at most compassion and affection.
Risks: Anticipate the risks/ side effects/ reactions, take precautions, and
treat them promptly and aggressively.

33. DEFENSES AGAINST NEGLIGENCE
Doctor is not guilty if ……
• No duty
• No carelessness
• No damage
• No direct causation
• Act of God
• No time to file a case
• No evidence for negligence
• No breach of duty
• No co-operation from patent
• No second time trial

34. DEFENSES AGAINST NEGLIGENCE
(1). No duty owed to patient.- no ‘doctor-patient relationship’
(2) Duty discharged according to prevailing standards.
(3) Misadventure.
(4) Error of judgment.
(5) Contributory negligence.
(6) Res judicata, i.e. if a question of negligence against a doctor has already been decided by a court,
the patient cannot contest the same in another proceeding.
(7) Limitation of time (case to be filed within two years).Indian Limitation Act 1963.
(8). Informed consent is a good defense in civil negligence cases.

35. MISADVENTURE. unexpected reactions
an abnormal physical reaction by an individual to a food or drug-
IDIOCYNCRASY idiosyncratic drug reaction denotes an aberrant or
bizarre reaction or hypersensitivity to a substance, without connection to the
pharmacology of the drug.
Types
• 1. diagnostic
• 2. therapeutic
• 3. experimental;

36. Contributory negligence
• Contribution from the patient
• Along with doctor patient also negligent.
Examples
• 1. not giving proper history / fee
• 2. not following doctors instructions.
• 3. taking medicines other than prescribed by the doctor

37. MEDICAL
MALOCCURRENCE:
In spite of good medical attention and
care, patient fails to respond properly in
some cases
It is a defense against medical
negligence
(It is a favorable point to a doctor who is
facing a charge of medical negligence)

38. THE DOCTOR IS NOT NEGLIGENT
FOR
(1) An error of judgment or diagnosis, if he has secured all
necessary data.
(2) failure to cure or bad results, that may follow, if he has
exercised reasonable care and skill.
The degree of competence varies according to the status of the
doctor, i.e. house surgeon, general practitioner, specialist
(3) The doctor is following new developments and updated lines of
treatment.

39. When a police officer can arrest a RMP……
• Is the patients complaints is sufficient ?
• On public protest ?
• On the demand of patients relative ?
• Any other requirement ?

40. POLICE SHOULD NOT ARREST A DOCTOR…….
• If a patient or his relatives lodge a police complaint
• Court orders a panel of doctors (experts in that discipline ) to review the
case and related hospital records and if they found the doctor was
negligence –Prima Facie Evidence Of Negligence
• Prima facie evidence is a legal term used to denote enough evidence to prove
something by some basic facts, but the proof can be refuted.
• Then only concern negligent doctor is arrested under Sec.304(A) IPC.

41. BURDEN OF PROOF
• In civil case it lies on the shoulders of patient (plaintiff)
or his relatives
• In criminal case it lies on the investigating police officer

42. RES IPSA LOQUITUR……..

43. RES IPSA LOQUITUR
(1) It means “the thing or fact speaks for
itself.
(2) Conditions to be satisfied:
(a) The injury would not have occurred in the absence of
negligence.
(b) The doctor had exclusive control over instrument
/procedure.
(c) The patient was not guilty of contributory negligence.

44. RES IPSA LOQUITUR……..
(3) In such cases medical evidence is not necessary to prove
negligence of the doctor.
(4) This is applied both to civil and criminal negligence.
Examples:
(1) Failure to give tetanus toxoid injection to injured or
pregnant woman
(2) Causing burns by use of hot water bottles or from radio
therapy.
(3) Prescribing overdose of medicine producing ill-effects.
(4) Breaking of needles during injection.
(5) Blood transfusion mistakes.

45. CASE REPORT –1
POP STAR - MICHAEL JACKSON’S case
• On November 7, 2011, cardiologist Dr. Conrad Murray was found
guilty of involuntary manslaughter of pop superstar Michael
Jackson, who died of cardiac arrest on June 25, 2009.
• The jury’s decision - Dr. Murray’s conduct was reckless enough to
be viewed as criminally negligent under California’s penal
laws.
• Dr. Murray’s guilt- prescribing and reckless administering of the
powerful anesthetic drug propofol.
• Dr. Murray is sentenced - up to 4 years of inprisonment for
involuntary manslaughter.

46. DUTY
• It is undeniable that Dr. Murray owed a duty to Jackson and that
that duty required Murray to act in a manner befitting his
profession.

47. BREACH OF DUTY / BREACH OF STANDARD OF
CARE
• Prescribing 4 gallons of propofol, and allowing the drug to be
administered within Jackson’s home was an unorthodox practice
which has been recognized as the doctor’s major breach of duty.
• Propofol should be administered in the hospital setup with
monitoring facility with skilled nursing care only

48. DAMAGES
• Damages in a negligence case amount to the injury or other measurable loss
inflicted upon the plaintiff.
• The damages here were, obviously, the singer’s death. But also, there is an
element of pain and suffering which is called survival damages, and
Jackson’s loss of earnings over his expected lifetime, which falls under the
category of wrongful death damages.

49. CAUSATION
• After proving breach of duty, prosecutors argued that the
defendant’s negligence directly caused harm to the plaintiff.
• Combined with other drugs, the propofol prescribed to Jackson
caused the singer to go into cardiac arrest.
• Dr. Murray failed to perform all of the necessary steps of
cardiopulmonary resuscitation (CPR); specifically, he performed
CPR on Jackson’s bed rather than on a flat surface.
• These details further prove breach of duty, as well as served to
implicate Dr. Murray in causing Jackson’s death.

50. CASE REPORT -2
• GURGAON: Gurgaon police booked a case against Dr.
S. Iqbal a doctor of Max hospital, for his alleged
negligence which led to the death of 36-year-old
Dharmendra Sharma in the year of 2013 at the
hospital.
• The case was filed against the doctor after the district
civil surgeon analyzed the reports and held Dr. Iqbal
guilty of negligence.
• It was a simple kidney stone removal surgery. but he developed
complications immediately after the surgery.
• Inquiry Report by experts - "Bleeding after PCNL (Percutaneous
Nephrolithotomy) led to complication in the case. An early
intervention at the time of detection of first complication could
have altered the outcome in this case. Ultimately patient died due
to a series of complications he had gone through multiple
surgeries and remained in the ICU for over 76 days.

51. CASE REPORT -2 Dr. S. Iqbal v. Dharmendra
Sharma ………
• An FIR has been registered against the doctor., Ashok Kumar, SHO, Sector 29
police station investigating the case.
• Dr Iqbal was absconded after an FIR was filed against him. But soon he
surrendered before the court.
• After getting bail, Dr Iqbal's lawyer Ashwini Kumar said, "We took the defense
that the patient died because of his own negligence and not the carelessness of
one doctor. He stayed in the hospital for 76 days and 12 surgeries were
performed on him. Then, The Court convinced and
granted the bail to doctor. Defense Lawyer added, "When
the patient approached the doctor, his stone was 12mm wide which grew to
32mm as he didn't turn up again for next three months, and doctor performed the
operation according to the prevailing standards of the surgery
sorry to inform, The follow up of the case not traced in my literature search.

52. CASE REPORT 3…. BRENDA GORST - 73 YEAR OLD LADY –
SHORTENING OF LEG AFTER HIP SURGERY

53. CASE REPORT 3- BOTCHED HIP OPERATION
• Brenda Gorst 73 year old lady - her right leg was shorter than the other after blunder by
surgeon
• she had undergone surgery at Abergele Hospital in North Wales.
• She developed a life-threatening infection following hip operation
• She endured six major operations to correct the problem
• Brenda Gorst, left with one leg shorter than the other and turning
outwards at 90 degrees, following the botched operation.
• She won £250,000 (pounds)/ roughly 2.5 cores rupees damages after legal battle
with Betsi Cadwaladr University Health Board. Board has apologized for level of care and vows to
learn from mistakes made.

54. MEDICAL NEGLIGENCE IN INDIA ….AN OVER
VIEW

55. MEDICAL NEGLIGENCE IN INDIA ….AN OVER VIEW
• With the passage of time, there has been a change in the doctor - patient relationship
• Due to the increasing conflicts and legal disputes between the doctors and patients, most
of the legal systems have developed various rules and principles to deal with such
inadvertent behavior of doctors
• Hence, any negligence on part of the medical professional would be treated as either a
tort of negligence or a deficiency in service under Consumer Protection Act, 1986.
• Medical negligence is not purely a matter of consideration for judiciary but also the
technical inputs of specialized experts in the field have substantial weightage while
deciding the case of medical negligence against doctors.
courtesy:Bratin Kumar Dey, Advocate, High Court Calcutta.

56. AN OVERVIEW……
• Negligence matters are being verified by fellow doctors who
hardly ever support the patient.
• There are many landmark decisions delivered by the judiciary
such as Indian Medical Association case, Achutrao Haribhau
Khodwa case, Jacob Mathew case, Anuradha Saha case etc.
• wherein court considered the various aspects of medical
negligence to provide the remedy by imposing tortious, civil and
criminal liability.

57. AS PER SUPREME COURT - A DOCTOR IS NOT LIABLE FOR
NEGLIGENCE IF –
• 1) One can not proved that doctor is guilty of a failure to act with ordinary skills and fail to act
with reasonable care.
• 2) An error of judgment constitutes negligence only if a reasonably competent professional
with the same standard skills that the defendant professes to have, and acting with ordinary
care, would not have made the same error.
• 3) The principle of res ipsa loquitur comes into operation only when there is proof that the
occurrence was not unexpected, that the accident could not have happened without
negligence and lapses on the part of the doctor, and that the circumstances conclusively
show that the doctor and not any other person was negligent( no contributory
negligence).
• 4) A doctor can be held to be negligent only if the complainant can prove that the standard of
medical care given does not match the standards of care set up by the profession itself.
It says a wrong outcome to one of several different methods available to treat a patient
cannot be termed as negligence.

58. DOCTOR IS NOT LIABLE……
• 5) A simple lack of care, an error of judgment or an accident, even fatal, will not constitute
culpable medical negligence
• If the doctor had followed a practice acceptable to the medical profession at the relevant
time, he or she cannot be held liable for negligence merely because a better
alternative course or method of treatment was also available, or simply because a more
skilled doctor would not have chosen to follow or resort to that practice.

59. THE CONSUMER PROTECTION ACT, 1986

60. DOCTORS/HOSPITALS INCLUDED UNDER
THIS SECTION
• Under the Section 2(1)(o) of The Consumer Protection Act, 1986, the following
categories of doctors/hospitals included under this Section (i) All medical/dental
practitioners doing independent medical/dental practice unless rendering only free
service.
• (ii) Private hospitals charging all patients. (iii) All hospitals having free as well as paying
patients and all the paying and free category patients receiving treatment in such
hospitals. (iv) Medical/dental practitioners and hospitals paid by an insurance firm for the
treatment of a client or an employment for that of an employee.
• It exempts only those hospitals and the medical/ dental practitioners of such hospitals
which offer free service to all patients.
• (v) A patient treated free of cost in a charity or other hospital will still be a consumer as
per the Consumer Protection Act if the person buys medicines from the nursing home’s
pharmacy, the national consumer forum has ruled.

61. • (vi) Persons who availed themselves of the facility of medical treatment in a
Government Hospital are not ‘consumers’ as defined in Consumer
Protection Act and the said facility cannot be regarded as service “hired” for
“consideration.
• (vii) It was contended that direct and indirect taxes paid to the State by a citizen
constituted ‘consideration’ for the services and facility provided to a citizen by the State.
• The National Commission, making a distinction between ‘tax’ and ‘fee’ held that a tax is
levied as part of common burden while fee is for payment of specific benefit or privilege.
• Unlike ‘fee’, ‘tax’ in its true nature is a levy made by the state for the general purposes of
the Government and it cannot be regarded as payment for any particular or specific
service.

62. • (viii) On the question whether contributors to the CGHS Scheme and patients in a
‘paying ward’ in a Government Hospital are ‘consumers’ within the meaning
of the Act, it observed that contribution to CGHS should be taken to be in lieu of free
treatment in the diverse dispensaries, as well as the free provisions of medicines from
these dispensaries.
• In regard to ‘paying wards’, it further observed that these payments are specifically
related to special rooms/beds for which the separate charge is made; the (free) medical
facilities are common to all patients, inclusive of those in the paying wards, without
discrimination

63. In Jacob Matthews v State of Punjab case …..
• In a Jacob Matthews v State of Punjab, the Hon’ble Supreme Court framed guidelines are
as mentioned under :
• I. A complaint against a doctor is not to be entertained unless the allegation against him is
supported by a credible opinion given by another doctor
• II. The investigating officer before proceeding against the accused ought to get a medical
opinion from a competent doctor, preferably in the government services, qualified in
that field of medical sciences who can give an impartial opinion
• III. The arrest of the accused should be withheld unless it is believed by the
investigating officer unless he believes that it is necessary to arrest the accused so as to
further the investigation of the case.

64. In Laxman v. Trimbak case……
• The Hon’ble Supreme Court in Laxman v. Trimbak, held: “The duties which a doctor owes
to his patient are clear.
• A person who holds himself out ready to give medical advice and treatment impliedly
undertakes that he is possessed of skill and knowledge for the purpose.
• Such a person when consulted by a patient owes him certain duties viz., a duty of care in
deciding whether to undertake the case, a duty of care in deciding what treatment to give
or a duty of care in the administration of that treatment.
• A breach of any of those duties gives a right of action for negligence to the patient. The
practitioner must bring to his task a reasonable degree of skill and knowledge and must
exercise a reasonable degree of care.
• Neither the very highest nor very low degree of care and competence judged in the light
of the particular circumstances of each case is what the law requires.”

65. In Achutrao Haribhau Khodwa v. State of Maharashtra
In this case, the Supreme Court said:
• The skill of medical practitioners differs from doctor to doctor. The very nature of the
profession is such that there may be more than one course of treatment which may be
advisable for treating a patient.
• Courts would indeed be slow in attributing negligence on the part of a doctor if he has
performed his duties to the best of his ability and with due care and caution.
• Medical opinion may differ with regard to the course of action to be taken by a doctor
treating a patient, but as long as a doctor acts in a manner which is acceptable to the
medical profession and the Court finds that he has attended on the patient with due care
skill and diligence and if the patient still does not survive or suffers a permanent ailment, it
would be difficult to hold the doctor to be guilty of negligence

66. SPRING MEADOWS HOSPITAL V. HARJOL AHLUWALIA
• In this case Apex, has specifically laid down the following principles for holding doctors
negligent:
• “Gross medical mistake will always result in a finding of negligence. Use of wrong drug or
wrong gas during the course of an anesthetic will frequently lead to the imposition of
liability and in some situations even the principle of res ipsa loquitur can be applied.
• Even delegation of responsibility to another may amount to negligence in certain
circumstances.
• A consultant could be negligent where he delegates the responsibility to his junior with the
knowledge that the junior was incapable of performing of his duties properly.
• We are indicating these principles since in the case in hand certain arguments had been
advanced in this regard, which will be dealt with while answering the question posed by
us.”

67. Justice S.B.Sinha in Malay Kumar Ganguly v. Dr. Sukumar
Mukherjee
• Justice S.B.Sinha in Malay Kumar Ganguly v. Dr. Sukumar Mukherjee case has preferred
Bolitho test to Bolam test.
• The Supreme Court redefined medical negligence saying that the quality of care to be
expected of a medical establishment should be in tune with and directly proportional to its
reputation.
• The Court extended the ambit of medical negligence cases to include overdose of
medicines, not informing patients about the side effects of drugs, not taking extra care in
case of diseases having high mortality rate and hospitals not providing fundamental
amenities to the patient.
• The decision also says that the court should take into account patient’s legitimate
expectations from the hospital or the concerned specialist doctor

68. In V. Kishan Rao v. Nikhil Super Speciality Hospital
• In V. Kishan Rao v. Nikhil Super Speciality Hospital, the Hon’ble Supreme Court
expressed the opinion that Bolam test needs to be reconsidered in India in view of Article
, which guarantees right to medical treatment and care.
• However, the Court expressed its inability because of the binding precedent of Jacob
Mathew, which approved the test.

69. IN KUSUM SHARMA V. BATRA HOSPITAL AND MEDICAL
RESEARCH CENTRE
• the Hon’ble apex court reiterated the legal position after taking survey of catena of case
law. In the context of issue pertaining to criminal liability of a medical practitioner, Hon’ble
Mr. Justice Dalveer Bhandari speaking for the Bench, laid down that the prosecution of a
medical practitioner would be liable to be quashed if the evidence on record does not
project substratum enough to infer gross or excessive degree of negligence on his/her
part

70. VINITHA ASHOK V. LAKSHMI HOSPITAL
• In Vinitha Ashok v. Lakshmi Hospital, removal of pregnancy was done without
ultrasonography and uterus of the patient had to be removed.
• There was expert evidence to indicate that ultrasonography would not have established
ectopic pregnancy but some text books indicated otherwise.
• The general practice in the area in which the doctor practiced was not to have
ultrasonography done.
• Therefore no negligence was attributed on this ground even if two views could be possible

71. DR. P.N. RAO V. G. JAYAPRAKASU
• In Dr. P.N. Rao v. G. Jayaprakasu, a very promising young boy of 17 was admitted in a
government hospital for removal of tonsils.
• As a result of the negligence in the administration of anaesthesia during the operation,
the patient became victim of cerebral anoxia making him dependant on his parents. The
anesthetist, the surgeon and the gov

72. IN NIZAM’S INSTITUTE OF MEDICAL SCIENCES V. PRASANTH
S. DHANANKA
• In Nizam’s Institute of Medical Sciences v. Prasanth S. Dhananka, the complainant who
was then an engineering student suffered from recurring fever.
• The X ray examination revealed a tumour in left hemithorax with erosion of ribs and
vertebra.
• Even then without having MRI or Myelography done, cardiothoracic surgeon excised the
tumour and found vertebral body eroded.
• Operation resulted in acute paraplegia of the complainant. MRI or Myelography at the pre-
operation stage would have shown necessity of a nuerosurgeon at the time of operation
and the paraplegia perhaps avoided.
• Consent was not taken for removal of tumour but only for excision biopsy. The hospital
and the surgeon were held liable for negligence.

73. DR. BALRAM PRASAD V. DR. KUNAL SAHA
• In Dr. Balram Prasad and others v. Dr. Kunal Saha and another, Hon’ble Justice V. Gopala
Gowda, and Hon’ble Justice C. K. Prasad, were pleased to pass an award of adequate
and just compensation was finally decided by the Supreme Court on October 24, 2013,
and it awarded a little more than Rs. 6 crores plus interest , which has been so far the
highest compensation ever awarded by any court in India for medical negligence.
• Though the lawyers for the hospital and the doctors argued that the multiplier method
should have been used for calculating compensation, the Supreme Court was clearly of
the view that the method was not suitable for determining the quantum of compensation
for medical negligence.
• The Hon’ble Supreme Court rejected the multiplier method in this case and provided an
illustration to show how useless the method can be for medical negligence cases.
• “The multiplier method was provided for convenience and speedy disposal of no fault
motor accident cases.
courtesy: Bratin Kumar Dey , Advocate, High Court Calcutta

74. Thanking
you……knowledge is power
behind you.