Every death of patient not medical negligence, death must be direct result of doctor's negligent act: Kerala High Court

The Kerala High Court recently held that a doctor can be held liable for medical negligence only if the patient died as a direct or proximate result of the doctor's acts, and not simply because things went wrong due to mischance or misfortune [Philip Thomas and Ors. v State of Kerala Ors.]..Justice Kauser Edappagath observed that every patient death cannot be termed medical negligence. .There should be sufficient evidence to accuse a medical professional of such negligence. The death should be a "direct or proximate result" of the negligent act alleged to attract criminal liability, the Court explained. Pertinently, a mere accident, an untoward incident or an error of judgment cannot be termed negligence per se, the Court said.“A medical professional cannot be held liable simply because things went wrong from mischance or misfortune. A mere deviation from normal professional practice is not necessarily negligence. Nor could mere accident or untoward incident be termed negligence, also an error of judgment is not negligence per se," stated the judgment. .Doctors are volunteers who take the risk of dealing with “the most intricate, delicate, and complex machine on earth – the human body”, the judge highlighted. Any medical intervention on such a “highly compound” machine carries inherent risks and there is always a chance that the medical treatment does not go as planned, it was observed.“When things go wrong, it is not always the fault of the doctor. A complication by itself does not constitute negligence. There is a big difference between an adverse or untoward event and negligence. However, there is a growing tendency to accuse the doctor of an adverse or untoward event,” the judge further noted. .He proceeded to emphasise that while dealing with medical negligence cases, courts should strike a careful balance between the doctor’s autonomy to make judgments and the rights of the patient, while also recognising the complexity of the human body, the inexactness of medical science and genuine scope of errors of judgment..“However, while dealing with criminal prosecution for medical negligence, the trial courts often ignore these principles. The subject matter of these appeals is one such typical case,” the High Court noted..The Court clarified that in order to convict a medical professional for medical negligence, the prosecution must prove culpable and gross negligence beyond a reasonable doubt. It should be shown that the doctor did or failed to do something which no ordinary skilled medical professional would have done or failed to do, the judge explained. The Court also noted that there is a growing tendency among the public to accuse medical practitioners after adverse and unfortunate events, causing professional damage and emotional drain for such medical practitioners.“Nothing can be more professionally damaging and emotionally draining than being arrayed as an accused in any such action. A surgeon, under fear of facing criminal prosecution in the event of failure for whatever reason – whether due to his fault or not- cannot perform at his best,” the court underscored..The Court was considering appeals filed by five medical professionals (two doctors and three nurses) against a trial court order convicting them under Sections 304A (causing death by negligence) and 201 (causing disappearance of evidence) of Indian Penal Code (IPC)..The case concerned the death of a 37-year-old woman who died after a sterlisation procedure by laparoscopy in 2006. After the surgery, she developed respiratory complications and was put under oxygen support. Even though she was shifted to a different hospital for expert management, she passed away. Thereafter, her uncle filed a medical negligence case against the medical team that was involved in her operation.The lower court sentenced the accused to undergo simple imprisonment for one year for the offense under Section 304 of the IPC and simple imprisonment for three months for the offense under section 201 of the IPC. This prompted the accused to approach the High Court in appeal. .The High Court, after examining the material on record, concluded that the medical professionals had done their best to save the life of the deceased and that there was no material to suggest that any of the alleged lapses in the pre-operative or post-operative management of the patient were the direct or proximate cause of death..The Court, therefore, concluded that the medical negligence case would not stand against the accused. “No doubt, this is an unfortunate case. But simply because a patient has not favorably responded to a treatment or a surgery has failed, the doctor cannot be held negligent per se for the offense under section 304A of IPC unless the prosecution establishes beyond reasonable doubt the culpable and gross negligent act on his part. That act must be the proximate or direct cause of death of the patient. Such a shred of evidence is lacking in this case. None of the witnesses and documents discussed in the above paragraphs points out gross or culpable negligence on the part of any accused,” the Court said.The Court found that the offence under Section 201 of IPC was not made out against the accused after observing that the mere failure to maintain surgery notes, nurses’ notes, or case sheets properly could not be construed as intentional or amount to causing the disappearance of evidence..Hence, the High Court set aside the trial court conviction in the case and acquitted the appellant-medical practitioners. .[Read Judgment]