Medical Professional Misconduct in India: A Jurisprudential and Regulatory Analysis

Medical Professional Misconduct in India: A Jurisprudential and Regulatory Analysis

Introduction

The past five decades have witnessed an intensified judicial and regulatory engagement with questions of medical professional misconduct in India. While the Hippocratic ethos long provided an informal normative compass, modern litigation and statutory codification have gradually supplied precise benchmarks for evaluating a physician’s conduct both in tort and in disciplinary arenas. This article critically analyses the Indian legal framework governing medical professional misconduct, drawing upon leading Supreme Court authority, consumer-protection jurisprudence, and the Medical Council of India (now superseded by the National Medical Commission) Regulations.

Normative and Regulatory Framework

Statutory Provisions

  • Indian Penal Code, 1860 – primarily §304-A (causing death by negligence) and, where appropriate, §§337-338 regarding endangering life or personal safety.
  • Consumer Protection Act, 1986 (as amended 2019) – definition of “service” in §2(1)(o) bringing paid medical services within consumer jurisdiction [1].
  • Indian Medical Council Act, 1956 (replaced by National Medical Commission Act, 2019) – §20-A empowering prescription of professional ethics; allied Regulations 2002 (hereinafter “MCI Regulations”).
  • Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994 (PCPNDT) – relevant where female foeticide is alleged, now expressly termed professional misconduct [2].

MCI Regulations, 2002

Regulation 7 enumerates illustrative acts of misconduct (e.g., failure to supply records within 72 hours, sex-selection tests) while Regulation 8.1 emphasises that the list is non-exhaustive, preserving residual jurisdiction over “any other form of professional misconduct” [3]. Sanctions range from reprimand to permanent erasure from the register, with mandatory public notice of deletion.

Conceptual Distinction: Negligence v. Professional Misconduct

Although the two notions often overlap, they are doctrinally distinct. Negligence focuses on breach of a duty of care causing compensable harm; misconduct centres upon derogation from the honour and dignity of the profession, irrespective of compensable injury. The Supreme Court in Jacob Mathew v. State of Punjab underscored this bifurcation, observing that “a simple lack of care, an error of judgment or an accident, is not proof of negligence” and certainly not of criminal misconduct unless it attains the threshold of gross recklessness [4].

Jurisprudential Evolution

Early Tort-Based Liability

In Dr. Laxman Balkrishna Joshi v. Dr. Trimbak Bapu Godbole the Court articulated the tripartite duties of a doctor—selecting whether to accept a case, choosing the method of treatment, and administering that treatment with due care—and found liability where a femoral-fracture patient died from shock owing to inadequate anaesthesia [5]. The decision imported the “reasonable competent practitioner” standard from common-law tort and remains the cornerstone for civil claims.

Consumer Protection Turn

Indian Medical Association v. V.P. Shantha irrevocably located paid medical services within the Consumer Protection Act, enabling patients to litigate negligence before quasi-judicial fora characterised by speed, informality, and expert inclusion [1]. Subsequent cases, notably Poonam Verma v. Ashwin Patel, expanded the doctrine by declaring that practice beyond one’s system of medicine constitutes negligence per se, relieving the complainant of proving breach of duty because the statutory violation itself satisfies the element [6].

Criminal Threshold: Gross Negligence

Criminal prosecution demands a qualitatively higher culpability. Dr. Suresh Gupta v. NCT of Delhi held that only acts displaying “gross negligence or recklessness” invite §304-A liability, a view later reaffirmed in Jacob Mathew and elaborated in Malay Kumar Ganguly [4][7][8]. In Jacob Mathew, the Court prescribed procedural safeguards: a competent medical opinion must precede arrest; and “Bolam compliance” rebuts criminality. This bifurcation balances patient safety with the need to protect professionals from chilling liability.

Disciplinary Dimension

High-court review of disciplinary sanctions illustrates the elasticity of “professional misconduct.” In Dr. Shalik Bhaurao Ade v. Medical Council of India, the Bombay High Court upheld the Council’s power to punish even un-enumerated misconducts when behaviour “tarnishes the image of the profession” [3]. Similarly, K. Nedumaran confirmed that dual employment compromising attendance amounts to professional impropriety [9].

Standards of Care and Evidentiary Tests

Bolam and Its Indian Reception

Indian courts consistently deploy the Bolam test—whether the defendant acted in accordance with practice accepted by a responsible body of peers. The test was expressly approved in Kusum Sharma v. Batra Hospital, which cautioned that availability of a “better alternative” does not ipso facto establish negligence [10].

Bolitho Addendum

Following UK authority, the Supreme Court in Malay Kumar Ganguly adopted the “Bolitho addendum,” requiring that the expert opinion relied upon must also withstand logical analysis, thereby preventing defensive citations of irrational professional custom [8].

Res Ipsa Loquitur

Although sparingly invoked, Indian consumer fora occasionally apply res ipsa loquitur where surgical gauze is left inside the body or wrong-site surgery occurs, situations in which negligence is self-evident and the evidentiary burden shifts to the hospital [11].

Emerging Arenas of Misconduct

  • Female Foeticide & Sex Selection: FOGSI v. Union of India affirmed that sex-selective abortion constitutes professional misconduct warranting “penal erasure” as well as criminal prosecution under the PCPNDT Act [2].
  • Record-Keeping: Maharaja Agrasen Hospital v. Rishabh Sharma emphasised that failure to provide records within 72 hours is misconduct under Regulation 7.2 [12].
  • Cross-System Practice: The principle in Poonam Verma continues to deter unqualified practitioners from prescribing outside their registered discipline.

Critical Appraisal

Indian jurisprudence has progressively harmonised tortious, consumer, criminal, and disciplinary standards, yet certain ambiguities persist. First, the coexistence of civil and disciplinary forums risks forum shopping and inconsistent outcomes. Establishing a statutory requirement for mutual consultation between consumer commissions and medical councils could mitigate conflict. Secondly, the “gross negligence” threshold, while shielding doctors from vexatious prosecution, may under-deter egregious but non-fatal misconduct. Legislative clarification, perhaps through graded penal provisions distinguishing between reckless disregard and wilful default, would enhance doctrinal coherence. Finally, the transition from MCI to the National Medical Commission necessitates careful preservation of precedential continuity so that accumulated jurisprudence retains normative authority.

Conclusion

Medical professional misconduct in India occupies a complex intersection of ethics, tort, consumer law, criminal law, and disciplinary regulation. Supreme Court jurisprudence—from Joshi to Kusum Sharma—has progressively refined doctrinal tests such as Bolam and gross-negligence thresholds, while statutory innovations extend consumer-orientation and ethical codification. Going forward, calibrated reforms aimed at procedural coordination and clearer substantive thresholds will further balance the twin imperatives of patient protection and professional autonomy.

Footnotes

  1. Indian Medical Association v. V.P. Shantha, (1995) 6 SCC 651.
  2. Federation of Obstetrics & Gynaecological Societies of India v. Union of India, (2019) 6 SCC 283 (PCPNDT-related misconduct).
  3. Dr. Shalik Bhaurao Ade v. Medical Council of India, 2015 SCC OnLine Bom 6764.
  4. Jacob Mathew v. State of Punjab, (2005) 6 SCC 1.
  5. Dr. Laxman Balkrishna Joshi v. Dr. Trimbak Bapu Godbole, (1969) 1 SCC 206.
  6. Poonam Verma v. Ashwin Patel, (1996) 4 SCC 332.
  7. Dr. Suresh Gupta v. Govt. of NCT of Delhi, (2004) 6 SCC 422.
  8. Malay Kumar Ganguly v. Dr. Sukumar Mukherjee, (2009) 9 SCC 221.
  9. Dr. K. Nedumaran v. Chairman, Ethics Committee, MCI, 2013 SCC OnLine Mad 909.
  10. Kusum Sharma v. Batra Hospital, (2010) 3 SCC 480.
  11. Naynaben Jagdishbhai Bhoi v. Dr. Pratik Patel, District Consumer Commission Kheda, 2024 (applying Bolam and res ipsa concepts).
  12. Maharaja Agrasen Hospital v. Rishabh Sharma, (2019) 9 SCC 177.