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Indian Journal of Law and Legal Research Volume V Issue 11 1ISSN: 2582-8878

JUDICIAL INTERPRETATION OF REASONABLE CARE IN

MEDICAL NEGLIGENCE: A CRITICAL ANALYSIS

Ajay Naxane, MBBS, MD, DNB, LLB, NBT Law College, Nashik, affiliated to Savitribai
Phule Pune University, Maharashtra

ABSTRACT

Medical negligence is the failure of a medical professional to provide

reasonable care and skill while providing medical treatment. The liability for
negligence is based on the principle of a "reasonable degree of care." Judicial
pronouncements have established objective criteria for a reasonable degree
of care, which is defined as "what a professional with a reasonable degree of
skill would do in the situation." This article explores the meaning of a
reasonable degree of skill in light of some landmark Supreme Court
Judgements.

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Indian Journal of Law and Legal Research Volume V Issue 11 1ISSN: 2582-8878

Introduction

The Hippocratic Oath, which is an important ethical code for medical practitioners, includes
the principle of "First, do no harm". In India, this principle is considered a fundamental tenet
of medical practice, and healthcare providers are expected to adhere to a high standard of care
to ensure that patients are not harmed during medical treatment. This standard of care is based
on the principle of non-maleficence, which requires healthcare providers to take steps to avoid
causing harm to their patients. Non-maleficence is a key principle of medical ethics, and it is
considered an essential component of professional practice in the healthcare field.

However, the interpretation and application of this principle in the context of medical
emergencies can be challenging, as there may be conflicting priorities and uncertainties
regarding the appropriate course of action.The ethical and legal implications of medical
emergencies are complex and multifaceted, particularly in cases where healthcare providers
are faced with difficult decisions that involve balancing the principles of beneficence, non-
maleficence, and autonomy. While healthcare providers may act in good faith to prioritize the
immediate needs of the patient, there are situations where such decisions may lead to adverse
consequences and raise concerns of negligence

Medical negligence is a term used to describe the failure of a medical professional to provide
reasonable care and skill while providing medical treatment to a patient, resulting in injury,
harm, or death to the patient. In India, medical negligence is a civil and criminal offense that
can result in legal penalties for the medical professional or hospital responsible. This can
include damages, compensation, and other legal consequences.It is a critical issue in India's
healthcare system, as it poses a threat to patient safety and undermines the trust and confidence
that patients place in their healthcare providers. The legal concept of medical negligence holds
healthcare providers accountable for their actions, and it is an important tool for ensuring that
patients receive the high standard of care that they deserve.

Medical negligence cases are typically handled under the law of torts, which provides
individuals with the right to sue for damages when they have suffered harm as a result of the
negligence of another. Healthcare providers, hospitals, clinics, and other healthcare institutions
can all be held liable for medical malpractice.It is a complex legal concept that requires patients
to prove that their healthcare providers breached their duty of care and that this breach caused
them harm. The standard of care that healthcare

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Indian Journal of Law and Legal Research Volume V Issue 11 1ISSN: 2582-8878

providers are expected to meet is that of a reasonably competent healthcare provider in their
field of practice, who would have exercised the degree of skill and care that is expected of
them. This standard of care may vary depending on the nature of the medical condition being
treated, the patient's medical history, and other relevant factors.

The Indian Judiciary has recognized the importance of the principle of reasonable care in the
medical profession. However, the determination of what constitutes reasonable care is a
complex issue that requires a careful analysis of the specific circumstances of each case.

This article explores the concept of reasonable care and examines how Indian courts have
applied this principle in medical negligence cases. We will also examine the factors that are
taken into account when determining what constitutes reasonable care, and how healthcare
providers can ensure that they meet this standard in their practice.

Historical Overview of Interpretation of medical negligence: Bolam's Test.

Medical negligence is a concept that has evolved over centuries and has its roots in common
law. The origins of medical negligence can be traced back to the 19th century when the courts
in England began to recognize a duty of care owed by medical practitioners to their patients.

The concept was first recognized in the case of Bolam v. Friern Hospital Management
Committee in 1957.The case involved a patient, Mr. Bolam, who was receiving
electroconvulsive therapy for his mental illness at a hospital run by the Friern Hospital
Management Committee. During the course of the treatment, Mr. Bolam suffered a fracture of
the pelvis

Mr. Bolam sued the hospital, alleging that the fracture was caused by the negligence of the
hospital staff. At trial, the court was asked to consider whether the hospital staff had breached
their duty of care to Mr. Bolam.The court ultimately held that the hospital staff had not been
negligent. In reaching this decision, the court applied what has come to be known as the "Bolam
test." The Bolam test states that a medical practitioner is not negligent if they have acted in
accordance with a responsible body of medical opinion, even if other practitioners would have
taken a different course of action.In other words, a healthcare provider would not be considered
negligent if their actions were supported by a body of medical opinion that is widely accepted
as responsible by a reasonable body of practitioners in the field. This test has become a

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Indian Journal of Law and Legal Research Volume V Issue 11 1ISSN: 2582-8878

cornerstone of medical negligence law in the common law system, and is often cited in medical
negligence cases around the world.

The Bolam test, however, has been criticized on a number of grounds. One criticism is that it
places too much emphasis on the opinion of medical experts, and not enough on the individual
circumstances of each case. This can lead to a situation where a doctor is not found negligent
simply because their actions were in accordance with the opinions of their peers, even if those
actions were clearly inappropriate or harmful in the circumstances.

Another criticism is that the Bolam test can lead to inconsistent outcomes in cases where there
is a dispute among medical experts about the appropriate standard of care. In such cases, the
court may simply defer to the majority opinion, even if that opinion is not supported by the
evidence or is clearly at odds with the facts of the case.

In Arun Kumar Manglik v. Chirayu Health and Medicare Pvt. Ltd. 1,The Supreme Court
observed...

"36.The "Bolam test" has been the subject of academic debate and evaluation in India
and other jurisdictions.........it fails to make the distinction between the ordinary
skilled doctor and the reasonably competent doctor. The former places emphasis on the
standards adopted by the profession, while the latter denotes that negligence is
concerned with departures from what ought to have been done in the circumstances and
may be measured by reference to the hypothetical "reasonable doctor". The Court must
determine what a reasonable doctor would have done and not the profession...
"

In V Kishan Rao v Nikhil Super Speciality Hospital 2, the Apex court highlighted the
shortcomings of the Bolam test:

"19......It has been found that the inherent danger in the Bolam test is that if the
courts defer too readily to expert evidence medical standards would obviously decline.
Michael Jones in his treatise on Medical Negligence 3 criticized the Bolam test as it opts
for the lowest common denominator. The learned author noted that Bolam test should
be restricted to those cases where an adverse result follows a course of treatment which

1 Arun Kumar Manglik vs. Chirayu Health & Medicare Private Ltd. & Anr. Civil Appeal Nos. 227-228 of 2019
2 V.Kishan Rao vs. Nikhil Super Speciality Hospital & Anr.(2010) 3 WBLR (SC) 470
3 Michael Jones on Medical Negligence(sweet and Maxwell )4th Edn., 2008, para 3-039 at p. 246

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has been intentional and has been shown to benefit other patients previously. This
should not be extended to certain types of medical accidents merely on the basis of how
common they are. It is felt "to do this would set us on the slippery slope of excusing
carelessness when it happens often enough" .....

"
Current Judicial Interpretation of Reasonable degree of care

The degree of skill and care required by a medical practitioner is stated in Halsbury's Laws of
England4 :-

"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 a very low
degree of care and competence, judged in the light of the particular circumstances of
each case, is what the law requires, and a person is not liable in negligence because
someone else of greater skill and knowledge would have prescribed different treatment
or operated in a different way; nor is he guilty of negligence if he has acted in
accordance with a practice accepted as proper by a responsible body of medical men
skilled in that particular art, even though a body of adverse opinion also existed among
medical men."

It is difficult to precisely define the reasonable degree of care that is expected of medical
professionals in every circumstance, as it can vary depending on the individual case .For
example, a surgeon working in the emergency department and attending to victims of a road
traffic accident may need to triage patients based on his own personal beliefs and the resources
that are available to him at the time. However, if the same situation is evaluated retrospectively,
a different standard of care may emerge which may not take into account the limitations present
at the incident situation
.

This inconsistency in the determination of the reasonable degree of skill can create challenges
for both healthcare professionals and legal experts, as it requires a nuanced understanding of
the specific circumstances and context in which decisions are made.

4 Halsbury's Laws of England (Fourth Edition, Vol.30, Para 35)

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Indian Journal of Law and Legal Research Volume V Issue 11 1ISSN: 2582-8878

It is therefore important to recognize that the determination of the reasonable degree of skill is
not always clear-cut or straightforward, and may require consideration of multiple factors and
perspectives.

Although the specific requirements for demonstrating reasonable care can vary depending on
the circumstances, a pattern has emerged through various judicial pronouncements that can
help guide courts and litigants in assessing whether the requisite standard has been met.

This pattern is not always easy to discern, as it often involves a careful consideration of the
facts and circumstances of the case at hand. However, by examining previous cases and
analyzing the principles underlying those decisions, it is possible to identify certain key factors
that tend to be relevant when assessing whether reasonable care has been exercised.

In Laxman Balakrishna Joshi v. Trimbak Bapu Godbole & Anr5 the court relied on
established medical literature to establish a more objective and reliable standard of care.
However, it is important to recognize that this principle cannot be universally applied.
There may be cases where alternative treatments are supported by conflicting literature,
making it necessary to consider a range of evidence to determine the appropriate standard
of care. The court further observed

"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...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 a very low degree of care
and competence judged in the light of the particular circumstances of each case is
what the law requires."

In Jacob Mathew v State of Punjab6 . The supreme court relied on the The decision of
House of Lords in Maynard v. West Midlands Regional Health Authority, [1985] 1 All
ER 635 (HL) which emphasized that ....

5 Laxman Balakrishna Joshi v. Trimbak Bapu Godbole & Anr., 1969 (1) SCR 206,
6 Jacob Mathew v State of Punjab, AIR 2005 SC 3180: (2005) 6 SCC 1

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Indian Journal of Law and Legal Research Volume V Issue 11 1ISSN: 2582-8878

"..it is not enough to show that there is a body of competent professional opinion which
considers that decision of the defendant professional was a wrong decision, if there also
exists a body of professional opinion, equally competent, which supports the decision
as reasonable in the circumstances. It is not enough to show that subsequent events
show that the operation need never have been performed, if at the time the decision to
operate was taken, it was reasonable, in the sense that a responsible body of medical
opinion would have accepted it as proper."

Thus the requirement of objective evidence in the form of medical literature which was
followed in Laxman v. Trimbak case can be substituted with the opinion of the body of
competent, responsible professionals which may support the impugned line of treatment which
may have led to alleged act of medical negligence.

In Achutrao Haribhau Khodwa v State of Maharashtra7 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 testing 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.."

In Kusum Sharma V Batra Hospital8 , the Hon'ble Supreme Court has stated:

"...Negligence cannot be attributed to a doctor so long as he performs his duties with

reasonable skill and competence. Merely because the doctor chooses one course of
action in preference to the other one available, he would not be liable if the course of
action chosen by him was acceptable to the medical profession."

It can be concluded, therefore, that

? Achutrao Haribhau Khodwa v State of Maharashtra. AIR 1996 SC 2377.

8 Kusum Sharma V Batra Hospital (2010) 3 SCC
480

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Indian Journal of Law and Legal Research Volume V Issue 11 1ISSN: 2582-8878

1. Indian courts understand negligence as the breach of a duty caused by either an

omission to do something which a reasonable person guided by considerations which
ordinarily regulate the conduct of human affairs would do, or doing something which a
prudent and reasonable person would not do. This is an objective test which determines
breach by contrasting the facts with rules that ordinarily regulate human behavior.

2. Since the reasonable man is a legal fiction, it is often the intuition of the court that
determines the reasonableness of a certain action. This intuition is guided by an
evaluation of each case's facts thoroughly, without creating general standards.

3. Whether a person behaved to the best of their abilities in a given situation is not of much
material significance, but whether they conformed to the behaviors that may be
expected of a reasonable person of average skill.

4. The guiding principle when applying the reasonable degree of skill is that the
precautions taken must be proportionate to the risk.

5. The common standard of care is imputed on all individuals that are members of a
particular profession and specialization.

An alternative approach could involve responsible and reputable medical bodies in each
medical speciality field publishing their own guidelines on the reasonable standard of care for
various procedures typically performed. This would help to provide greater clarity for patients,
enabling them to know what to expect.

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