November 9, 2023November 9, 2023 Jacob Mathew v. State of Punjab (2005) 6 SCC 1 By Aarya Gurjar Facts The case of Jacob Mathew v. the State of Punjab dealt with the issue of the negligence of doctors. The accused was Dr Jacob Mathew and the informant was Mr Ashok Kumar Sharma.[1] The case is that the father of the informant Mr Jeevan Lal was admitted to CMC Hospital Ludhiana on 15th February 1995. On 22nd February 1995 at around 11 PM, Jeevan Lal faced difficulty in breathing.[2] The elder brother of the informant Mr Vijay Sharma was also present in the hospital. He asked the nurse attendant who was present at that time to call the doctor since it was an emergency case. The doctor Mr Jacob Mathew and Dr Allen Joseph came after nearly 20-25 minutes. The doctors gave him oxygen with the help of an oxygen cylinder but Jeevan Lal still faced difficulty in breathing. Jeevan Lal tried to get out of bed but the doctors stopped him. Meanwhile, Vijay Sharma noticed that the oxygen cylinder that the doctors were using was empty. He rushed into another room to find a gas cylinder and he found one. He brought the cylinder but there were no arrangements to fix the cylinder. The fixing of the cylinder resulted in a waste of over 7 minutes. After a while, another doctor came and checked the patient and declared him to be dead. The informant then filed an FIR against the doctors. He alleged that the doctors were negligent in giving proper treatment to the patient. The patient was given oxygen through an empty cylinder. It was Vijay Sharma who noticed the empty gas cylinder and took the necessary steps. The informant also complained that there was no arrangement of giving oxygen to the patient which resulted in further delay in giving oxygen to the patient. The patient’s body was sent to his village for cremation and Vijay Kumar’s sentence was recorded. The informant claimed that his father’s death had been caused due to the negligence of doctors in providing him oxygen at the right time due to which his father died out of suffocation. On the basis of the statement, a petition was filed under section 304A of IPC, read with Section 34 of IPC for the offense of criminal negligence, and a challan was issued against the 2 doctors.[3] Issues The court asked the Medical Council of India to assist it during the hearing. Two main issues were raised: Is there any test[4] to determine whether a doctor has acted in negligence? Is there any difference in civil and criminal law on the concept[5] of negligence? Arguments Petitioner The person who filed the complaint claimed that his father’s death resulted from the negligence of medical staff, including doctors and nurses, as well as the unavailability of oxygen cylinder. According to the complaint, an empty oxygen cylinder was attached to his father’s mouth, causing him to stop breathing, ultimately leading to his father’s demise.[6] Respondent According to the appellant, Jeevan Lal, who had passed away, was suffering from advanced-stage cancer. Based on the available information, no hospitals in the country would have admitted him because his cancer was terminal. Instead, he was supposed to be cared for at home, receiving appropriate care, food, comfort, and prayers. However, it is apparent from the records that his sons held influential positions in the government. They approached the hospital administrators and requested that their father be admitted to the facility under any circumstances, including out of compassion, to receive controlled medical treatment and proper nutrition. The informant and other family members who accompanied the deceased were well-informed that the illness had reached a severe and incurable stage, and the best option for comfort and tranquility was to be at home. Nevertheless, the complainant managed to get the deceased admitted as a patient, cleverly bypassing the attending physicians and hospital administration. Despite this, the patient received the highest level of care, caution, and medical assistance from the doctors and paramedical staff. The entire staff dedicated themselves to providing the patient with the appropriate medical care, and they were diligent in their attendance. However, as fate would have it, the complainant and his relatives filed an unnecessary and unwarranted police report against the accused individuals, likely due to being misinformed or believing false information. Contentions The accused argued that the police documents filed against them do not contain any specific accusations of wrongdoing or negligence attributed to them. The petitioners asserted that negligence, whether in civil law or criminal law, should be considered the same, with no jurisprudential distinction between the two. Judgment Based on the statement provided, a case was registered under Section 304A/34 of the Indian Penal Code (IPC). After the investigation, charges were formally filed against the two doctors. The judicial magistrate of first class in Ludhiana framed charges under Section 304A IPC against the two doctors. Subsequently, both accused individuals filed a revision petition challenging the charge framing order before the learned session judge, but their petition was rejected.[7] The appellant lodged a petition in the High Court under Section 482 of the Code of Criminal Procedure, seeking the cancellation of the First Information Report (FIR) and all subsequent legal proceedings. During the proceedings in the High Court, it was argued that there were no specific allegations of any wrongdoing or actions against the accused individuals within the extensive set of documents, including the police challan papers, filed against them. The learned single Judge, who presided over the case, concluded that the argument presented by the appellant could be raised as a defense during the trial. Consequently, the grounds for quashing the charges were not established, and the High Court rejected the petition. An application to reconsider the aforementioned order was also submitted but was subsequently dismissed. The case was presented before the respected Supreme Court bench, consisting of two judges. These judges referred to a recent decision by a two-judge bench of the Supreme Court in the case of Dr. Suresh Gupta vs. Government of NCT of Delhi. They had reservations about the correctness of the viewpoint established in that case. On September 9, 2004, they issued an order expressing the belief that the matter required examination by a panel of three judges. Consequently, the case was subsequently scheduled for a hearing before a three-judge panel. The Supreme Court issued guidelines regarding the prosecution of medical professionals in the following manner: The investigating officer and the private complainant cannot always be assumed to possess the knowledge of medical science required to determine whether the actions of the accused medical professional amount to recklessness or negligence under Criminal Law, as specified in Section 304-A of the Indian Penal Code. Initiating criminal proceedings against a medical professional can result in significant inconvenience and, at times, harassment. The professional may need to seek bail to avoid arrest, which may or may not be granted. In the end, they might be acquitted or discharged, but the damage to their reputation cannot be compensated for. It’s important to note that we are not implying that doctors can never be prosecuted for offenses involving recklessness or negligence. Our intention is to stress the necessity of caution and care in the interest of society. The service provided by the medical profession to humanity is among the noblest, and therefore, doctors need protection from baseless or unjust prosecution. Some complainants resort to criminal proceedings as a means to pressure medical professionals into providing unwarranted or unjust compensation. Such malicious actions must be prevented. To address this issue, the Government of India and/or the State Governments, in consultation with the Medical Council of India, should formulate and issue Statutory Rules or Executive Instructions that incorporate specific guidelines. Until such guidelines are established, we propose to establish certain guidelines for future cases involving the prosecution of doctors for offenses that involve criminal recklessness or negligence. A private complaint should not be entertained unless the complainant has presented prima facie evidence to the court, in the form of a credible opinion from another qualified doctor, supporting the charge of recklessness or negligence on the part of the accused doctor. The investigating officer should, before taking action against the doctor accused of recklessness or negligence, obtain an independent and competent medical opinion, preferably from a government-employed doctor with expertise in the relevant medical field. This doctor should be expected to provide an impartial and unbiased opinion based on the investigation’s collected facts. A doctor accused of recklessness or negligence should not be routinely arrested solely because charges have been filed against them. Unless their arrest is deemed necessary for furthering the investigation or collecting evidence, or unless there is a reasonable belief that the doctor may evade prosecution unless arrested, the arrest should be avoided. The court determined that: “We are convinced that, even if we assume that all the claims made in the complaint are true, they do not establish a case of criminal recklessness or negligence on the part of the accused-appellant. The complainant has not alleged that the accused-appellant was not a qualified doctor to treat the patient he agreed to treat. This is a situation where the unavailability of an oxygen cylinder, either due to the hospital’s failure to provide one or because the cylinder was found to be empty, is the issue. In such a scenario, it is possible that the hospital may bear civil liability, but the accused-appellant cannot be charged under Section 304A of the Indian Penal Code based on Bolam’s test. Therefore, the prosecution of the accused-appellant under Section 304A/34 IPC is dismissed.”[8] Analysis According to the Bolam test, if a doctor adheres to the standards established by the responsible body of their profession in a given situation, they cannot be held liable for medical negligence. In the mentioned case, the doctors were not found liable because they fulfilled their responsibilities diligently. However, the patient’s unfortunate outcome was due to the hospital administration’s negligence. Technically, this constitutes a case of medical negligence on the part of the hospital staff. This situation could potentially fall under Consumer Protection Law because it was the hospital administration’s duty to provide quality services to patients. In this case, they failed in their duty to deliver better services to their patients. Consequently, the affected party could also seek justice by approaching consumer forums. Concepts Involved The case of Jacob Mathew v. State of Punjab (2005) 6 SCC 1 was a landmark ruling by the Supreme Court of India addressing the matter of medical negligence. In this case, the appellant, Jacob Mathew, was a physician facing charges of medical negligence in connection with his treatment of a patient. The patient had suffered a leg injury and was admitted to the hospital where the appellant practiced. Unfortunately, the patient’s condition deteriorated, leading to a referral to another hospital where he eventually passed away. The patient’s family filed a complaint, alleging medical negligence on the part of the appellant. The primary issue considered by the Supreme Court of India was whether the appellant could be held accountable for medical negligence. The court ultimately concluded that the appellant was indeed guilty of medical negligence. The Supreme Court of India emphasized that doctors are held to a standard of care comparable to that of a reasonably skilled professional within the medical field. In this case, the court determined that the appellant had failed to meet this standard, and his failure was a direct cause of the patient’s demise. The significance of the Jacob Mathew v. State of Punjab (2005) 6 SCC 1 case lies in its establishment of the principle that doctors are expected to provide a level of care equivalent to that of a reasonably skilled professional in the medical profession. It further underscores that if a doctor falls short of meeting this standard of care, they may be found guilty of medical negligence. In summary, the Jacob Mathew v. State of Punjab (2005) 6 SCC 1 case, as decided by the Supreme Court of India, is a pivotal ruling that highlights the responsibility of doctors to deliver care at a standard equivalent to that of a reasonably skilled professional in the field. The case underscores the importance of upholding this standard to ensure the well-being of patients.[9] Conclusion The concept of negligence in tort law originated in English law and holds significant recognition in the Indian legal framework. Medical negligence is not a straightforward type of tort. It transforms from a simple tort when a patient receives incorrect treatment and may experience minor discomfort, to a potentially life-threatening situation where the patient might succumb to a minor injury or fracture. In cases of medical negligence, a doctor of reasonable competence is expected to exercise a notably high level of care. The standard of care is determined by comparing the doctor in question to a peer in the same medical field, rather than an average prudent person. In cases of negligence, there are two possible explanations – either the doctor or the staff was negligent, or in some instances, both the medical personnel and the doctor may have acted negligently. In most cases, joint and several liabilities apply, which means both the hospital and the doctor share responsibility and they will determine the degree of responsibility individually as per their agreement. Courts usually rely on expert testimony to assess negligence, except in cases of obvious protocol violations or actions deemed reckless and unreasonable. Due to the significant subjectivity involved in making these judgments, the precision and specificity that the law aims for can be challenging to achieve. Therefore, a well-established legal framework is needed not only in the medical field but also in other industries concerning consumer protection in India, as the law on medical negligence has been clarified by the Hon’ble Apex Court. [1] See, available at https://lawplanet.in/dr-jacob-mathew-vs-state-of-punjab-case/ last accessed on October 3 2023 [2] Aryaman Gupta, “JACOB MATHEW VS. STATE OF PUNJAB & OTHERS (2005) 6 SCC 1”, Journal of Legal Research and Juridical Sciences, VOL. 1 Issue 4, available at https://jlrjs.com/wp-content/uploads/2022/07/92.-Aryaman-Gupta.pdf last accessed on October 3 2023 [3] Himanshu Ranjan, “Case Summary: Jacob Mathew vs. State of Punjab”, Legal Service India, available at https://www.legalserviceindia.com/legal/article-6494-case-summary-jacob-mathew-vs-state-of-punjab.html last accessed on October 3 2023 [4] Arohi Ambade, “Case Summary: Jacob Mathew Vs State of Punjab”, July 7 2020, available at https://lawlex.org/lex-bulletin/case-summary-jacob-mathew-vs-state-of-punjab/24430 last accessed on October 3 2023 [5] See, available at https://thelawmatics.in/jacob-matthew-v-state-of-punjab-an-analysis/ last accessed on October 3 2023 [6] Ibid [7] Supra note 3 at 2 [8] Supra note 5 at 2 [9] See, available at https://www.barelaw.in/case-brief-of-jacob-mathew-v-state-of-punjab-2005-6-scc-1/#:~:text=Decision%3A%20The%20Supreme%20Court%20of,consent%20in%20Indian%20medical%20law. 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