No Doctor would risk Reputation, Professional, Economic Stability by engaging in Medical Negligence: HC

Jodhpur: Granting relief, the Rajasthan High Court recently quashed the FIR against doctors booked for medical negligence during the treatment of a patient, who died after getting admitted for a minor uterine fibroid surgery.

While granting relief to the accused doctors, the HC bench comprising Justice Farjand Ali observed that it would be wrong to assume that a doctor or an institute would deliberately risk their reputation by engaging in rash and negligent medical practices.

"Moreover, this Court is also mindful of the fact that the reputation and functional credibility of private medical institutions are inherently tied to their standards of care and patient outcomes. In the modern healthcare ecosystem, no private hospital or its professional staff can reasonably be presumed to operate with a wilful disregard for human life, especially when such conduct would directly undermine their institutional standing, public trust, and economic viability. A medical practitioner operating within a private setup is guided not merely by the clinical interest of the patient but also by the ethical and reputational constraints of the institution under whose aegis he functions. It must further be appreciated that a single adverse outcome, if even remotely attributable to a negligent act, has the potential to cause irreparable damage to the professional standing of both the doctor and the hospital. In a sector where public confidence serves as the cornerstone of survival, the mere perception of substandard care can derail years of painstakingly built credibility. Private healthcare institutions operate not just as treatment facilities but as trust-based service entities— heavily reliant on goodwill, word-of-mouth, and community validation," observed the HC bench

"The inflow of patients, which sustains the operational and financial viability of such institutions, is directly proportional to the public’s perception of their clinical integrity. Consequently, even from a purely pragmatic or commercial standpoint, it defies logic to assume that a doctor or institution would deliberately risk such reputational capital by engaging in rash or negligent medical practices. The risk of professional ruin, economic decline, and eventual institutional collapse acts as a natural deterrent against any willful lapse in the standard of care. Indeed, the very business model of private healthcare is predicated on the maintenance of —professional goodwill and ethical reliability," the Court noted.

Further, the bench observed,

"The erosion of this trust, through real or perceived negligence, would cause a rapid attrition of patient inflow, leading not only to financial instability but to the eventual dismantling of the entire clinical establishment. Thus, the likelihood of a private medical practitioner, knowingly or recklessly, compromising patient care is not merely implausible—it is antithetical to both professional instinct and institutional self-preservation."

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Therefore, the Court observed that it is "inconceivable" that a licensed and qualified medical professional, having undergone rigorous academic training and extensive clinical exposure over several years, would "intentionally" pursue a line of treatment with the objective of "endangering human life."

These observations were made by the Court while considering the pleas moved by four doctors praying to quash an FIR under BNS Section 105 (culpable homicide not amounting to murder). It was alleged by the complainant that there was "grave medical negligence" in the treatment of his daughter-in-law, including the omission of pre-operative tests, delayed critical diagnostics and improper post-operative care, which resulted in the death of the complainant's daughter-in-law, who was admitted to the hospital in Jodhpur for undergoing a minor uterine fibroid surgery.

It was alleged by the complainant that his daughter-in-law was assured of the simplicity of the procedure, and shortly after admission, without comprehensive diagnostic work-up or pre-operative preparedness, she was rushed into the surgery involving "hysteroscopy, laparoscopy, and trans-cervical resection of myoma".

The complainant contended that essential pre-surgical protocols, including the INR (International Normalized Ratio) test, were not conducted. After the operation, the patients' condition reportedly deteriorated rapidly, with persistent unconsciousness, yet she was transferred to a general ward without requisite neurological assessment or CT brain imaging.

Further, the complainant alleged that despite signs if severe haemorrhage and administration of multiple blood transfusions, the hospital continued to misrepresent her clinical condition as stable. Later, on 07.09.2024, when the patient's condition worsened further, she was referred to Marengo CIMS Hospital, Ahmedabad. At the hospital, the patient was immediately diagnosed with critical intracranial haemorrhage confirmed–via CT scan. It was opiend that prior failure to undertake such imaging and timely intervention constituted a breach of medical protocol.

The complainant claimed that a report by a committee constituted under the District Collector's order also revealed stark inconsistencies between the hospital's version and the version by the patient's attendants.

Apart from this, the complainant also asserted that the hospital's director, later attributed the deteriorated health condition of the patient to a congenital AVM (arteriovenous malformation) and a brain tumour. However, imaging conducted at CIMS Hospital (Ahmedabad) reportedly refuted the presence of any such conditions. Ultimately, the patient passed away on 18.09.2024.

While considering the matter, the HC bench took note of the expert opinions of a State-Level Medical Expert Committee as well as a District-Level Medical Expert Committee. It observed that both of these reports concluded that there was no prima facie evidence of medical negligence. 

"It is a trite proposition that when a duly constituted medical board comprising domain experts has opined against the existence of negligence, and when no contra expert opinion has been produced to establish a reckless or impermissible departure from the standard of care, criminal prosecution under Section 105 BNS cannot be sustained. The law requires that for an act to constitute criminal medical negligence, it must transcend mere error of judgment and amount to a gross dereliction of duty, evidencing either mens rea or an utter disregard for patient safety—a threshold not satisfied in the instant case," the bench observed at this outset.

The Court observed that mere dissatisfaction with the result of the medical treatment could not in itself be a ground for criminal protection unless supported by cogent evidence reflecting gross recklessness or culpable negligence.

"Having regard to the allegations made and the circumstances surrounding the demise of the complainant’s daughter-in-law, this Court is conscious of the settled position of law pertaining to allegations of medical negligence which may give rise to criminal culpability. A mere adverse outcome of a medical procedure does not, ipso facto, constitute medical negligence. A private complainant, lacking in medical expertise, cannot conclusively impute criminal negligence to a medical practitioner solely on the basis of an unfortunate result or post-operative deterioration. The domain of medical negligence squarely falls within the realm of expert knowledge, and the threshold for initiating criminal prosecution against medical professionals is placed significantly high to protect bona fide medical judgment from frivolous or misconceived litigation," noted the Court.

Regarding the allegations of deliberate suppression of diagnostics or intentional withholding of information by the petitioners, the Court noted,

"Further, it is wholly unreasonable to expect that minute-to-minute details of the ongoing medical procedures or evolving diagnostic considerations would be exhaustively shared with the patient’s attendants, particularly in a high-pressure post-operative setting. Diagnostic reports, including those recommended but not undertaken, are part of the internal clinical deliberations and are generally accessible through proper channels; their nondisclosure to laypersons in real time does not, in and of itself, imply suppression or malafide intent. Allegations of nondisclosure must be evaluated in light of clinical exigencies, standard protocols, and practical limitations faced by the attending staff. Hence, the contention that there was deliberate suppression of diagnostics or intentional withholding of information lacks the evidentiary foundation necessary to invoke criminal liability in a medical negligence framework."

Regarding the doctor's role in this case, the Court, after perusing the record observed that it unequivocally reflected that the concerned attending physician, confronted with a critical and dynamically evolving clinical scenario, exercised his judgment in "real time, acting with the singular intent to preserve and restore the patient's health".

"The actions undertaken were rooted in his medical wisdom and situational appraisal, not in any form of disregard for the patient's well-being. Whether the chosen course of treatment ultimately succeeded or failed pertains to the unpredictability inherent in medical science and the complexity of human physiology—not to any criminal malintent. Medical decisions taken within the four walls of an operation theatre are often made under acute pressure, with constrained time and information, and under conditions where immediate response is paramount. It is imperative to recognize that the treating doctor, positioned bedside and bearing direct responsibility, exercises clinical discretion shaped by years of training, personal experience, and the unique circumstances presented by the patient at that precise moment," the bench observed. 

It also observed that the retrospective assertion that "another action should have been taken" or that "a different decision might have yielded a better result" is a manifestation of hindsight bias, and was not a valid metric to assess professional culpability.

"In medical jurisprudence, it is inappropriate—indeed, legally impermissible—to superimpose an idealized course of action derived from post-facto analysis over the real-time decisions made in emergent and lifethreatening situations.The clinical process, particularly in emergency operative settings, is governed not by hypothetical perfection but by a constrained equilibrium of risk and benefit, filtered through the doctor's best judgment at the time. The standard is not omniscience but reasonableness. It is a fallacy to presume that because an alternate method appears preferable in the calm of retrospect, the course actually followed was negligent or reckless," added the Court.

Even though the Court acknowledged the sorrow owing to the demise of a family member, it held that it was the solemn obligation of the legal system to distinguish between misfortune and culpability, and to ensure that human suffering did not substitute proof required under law. Accordingly, in light of the expert reports and the fact that the material on record could not establish even a prima facie case of gross medical negligence, the HC bench quashed the FIR.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/rajasthan-hc-med-negligence-286154.pdf

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