Examine the care as well as the outcome
An adverse result deserves a careful response. Deciding whether it amounts to negligence requires examining the clinical circumstances and the care provided.
In Jacob Mathew v. State of Punjab, (2005) 6 SCC 1, the Supreme Court explained that a simple error of judgment or an accident does not, by itself, establish professional negligence. The judgment also distinguished civil negligence from the substantially higher degree of negligence needed for criminal liability. It arose under the former Indian Penal Code; a present-day case must be assessed under the law applicable to the alleged conduct. [1]
Kusum Sharma v. Batra Hospital, (2010) 3 SCC 480, likewise emphasised assessment against reasonable professional skill and care. The existence of more than one accepted approach does not make the selection of one approach negligent merely because another clinician would have chosen differently. [2]
What needs to be reviewed
A useful clinical review asks whether assessment and investigations were appropriate, whether the procedure was indicated, how relevant risks were discussed and how the treatment was performed. It should also examine recognition of the problem, subsequent management and referral where needed.
For example, the words “instrument separation” alone do not resolve an endodontic negligence question. A proper review requires the clinical record and relevant expert assessment. This is an illustration of the need for context, not a conclusion about any particular case.
Respond constructively when a problem occurs
My practical recommendations are to prioritise the patient’s immediate needs, explain the known facts clearly and document the findings and actions accurately. Arrange review or referral according to the clinical situation.
Preserve the original records. If a later note is needed, identify it as a dated addition and explain its purpose. Avoid speculation about another professional’s conduct before the complete information is available. Where a complaint or claim arises, obtain appropriate medico-legal and indemnity advice.
Consent and records have different roles
Consent records the patient’s decision about proposed care. Clinical notes document assessment, treatment and follow-up. Neither should be treated as an automatic answer to liability.
An adverse outcome calls for patient care and fair investigation. A reasoned assessment should recognise both a patient’s right to competent treatment and the uncertainty inherent in clinical practice.
Sources
[1] Supreme Court of India. Jacob Mathew v. State of Punjab & Anr., (2005) 6 SCC 1, judgment dated 5 August 2005, particularly the concluding principles on professional negligence. Judgment text: https://indiankanoon.org/doc/871062/
[2] Supreme Court of India. Kusum Sharma & Ors. v. Batra Hospital & Medical Research Centre & Ors., (2010) 3 SCC 480, judgment dated 10 February 2010, concluding principles. Judgment text: https://indiankanoon.org/doc/29738758/
Educational discussion of Indian legal principles. No conclusion about negligence can be drawn without reviewing the individual case.