INVESTIGATION OF MEDICAL MALPRACTICE

INTRODUCTION

The notion of the Bolam and Bolitho test is linked to medical malpractice by medical professionals. Medical negligence is when a medical authority acts in a way that deviates from the community's standard of care and causes harm to the patient. A doctor's medical negligence can be established by demonstrating a violation of duty on his part. Medical negligence is a heinous act committed by officials that results in a patient's death. In legal terms, medical negligence is a breach of a duty of care that causes harm. Damage can be measured in terms of health, financial loss, or the infliction of trauma or other conditions that last for the rest of the patient's life.



According to the "Black Law Dictionary," negligence is defined as the failure to exercise the standard of care that a reasonable person would have applied in a similar situation.

There are three components of Medical Negligence

  1. Existence of a legal duty

  2. Breach of legal duty

  3. Damages caused by a breach



Manusmriti references can be traced from ancient times, and negligence and medical malpractice were considered crimes rather than torts at the time. The Kautilya Arthshashtra further mentions that causing death while under medical treatment by a physician is a criminal offence.

In India, the Bolam test is used to investigate medical malpractice. In Jacob Mathew vs. the State of Punjab and Ors., the Bolam test evolved. In this case, the court established the Bolam test as one of the most effective methods of determining medical negligence; a medical professional would be found accountable for negligence if he lacked the necessary abilities.



BOLAM TEST

The Bolam test is a measure of whether one has discharged his or her standard of care in the management of the patient. This test was developed in the case of Bolam v Friern Hospital Management Committee (1957), 1 WLR 582.

Facts:- Mr. Bolam volunteered at Friern Hospital, a mental health facility administered by the Friern Hospital Management Committee. He agreed to be treated with electroconvulsive therapy. During the procedure, the claimant was injured. The claimant filed a lawsuit against the defendant, alleging that the doctor was negligent in not restraining them or administering the medicine. He sued the committee for not issuing relaxants, not restraining him, and not warning him about the risks involved.



The Bolam principle addresses the first element. It can be stated that a doctor is not negligent if what he did at the time was supported by a responsible body of medical opinion in the relevant specialty.

An issue, in this case, was how to judge a professional defendant's standard of care. To establish negligence requires proving that the defendant failed to uphold their duty of care to the claimant. To prove the violation, the claimant must show that the defendant did not act as a reasonable person in their situation would. Professionals must act like reasonable people.



The High Court held that the doctor had not breached his duty to the patient, and so the defendant was not liable. To put it another way, a man is not negligent if he is behaving in such a way just because there is a body of opinion that disagrees. Furthermore, it was standard practise in the profession not to inform patients about the risk of therapy (even if it was minor) unless they specifically requested information. He believed that what was the usual practise in a specific field had a lot to do with the level of care that was required. NC Nair set out the test and gave his final decision: "If he operated under a practise regarded as legitimate by a competent organisation of medical experts skilled in that particular art, he is not guilty of carelessness."



The Bolam rule, which originated in the United Kingdom, has been used in India to adjudicate allegations of medical malpractice. The history of the Bolam rule in the United Kingdom, as well as the Supreme Court's application of the rule in India, demonstrates a balance between judicial involvement and medical knowledge. Although it is well established that the courts, not medical experts, must ultimately decide whether a doctor's actions were negligent, the standards to be applied when evaluating expert evidence and the extent to which such cases must be deferred are still evolving. This rule has been consistently applied in the past to establish whether doctors have been negligent. This is significant because neither judges nor doctors can decide what standards must be applied when resolving cases of medical negligence on their own.



BOLITHO TEST

The Bolitho Test is an update to the Bolam Test, which was established in the 1996 court case of Bolitho v City and Hackney HA. It is one of the most important medical negligence judgments. The Bolam Test, which was established in 1957, stated that no doctor could be held negligent if they behaved "in conformity with a responsible body of medical opinion." The Bolitho Test helped to define "a responsible body," describing it as one whose opinion has a "logical basis." The Bolam Test and the Bolitho Test are the twin foundations of all medical negligence assessments when used together.


Bolitho v City and Hackney Health Authority [1996] 4 All ER 771

Facts:- On January 11, 1984, Patrick Nigel Bolitho was admitted to St. Bartholomew’s Hospital in London as a 2-year-old boy. He was admitted to the hospital with breathing difficulties. The on-duty doctor was tasked with dealing with the child's respiratory problems. The senior paediatric registrar explained that she was unable to leave an afternoon session. She responded that she had already requested the attendance of the senior house officer and that she would do so again. The senior house officer later claimed that her pager's batteries had died and that she had never received these messages.



Patrick passed out half an hour later. He went into cardiac arrest because he couldn't breathe. He was resurrected after about 10 minutes, although he had suffered severe brain damage. He died as a result, and his parents filed a claim for negligence against the hospital. The mother of the child filed a negligence action, alleging that the child required intubation and that the doctor failed to attend.



In Bolitho v City of Hackney Health Authority [1997] 4 All ER 771, the key difficulty was proving that the respondent had broken their duty of care to the claimant. The claimant must show that the breach and the injury produced by the breach are unrelated. Hospital staff will not be in breach of their duty if they behave according to the guidelines, according to Bolam v Friern, with a responsible group of other professionals with relevant skills approving the practices. The doctor, who did not attend there, testified that even if they had shown up, they would not have intubated the youngster. It was proper practice, according to an expert.



Judgment:- No liability of the senior paediatric was found. Even if she had been present, the doctor maintained she would not have intubated the youngster. The defendant (doctor) could not contend that her failure to appear caused no harm, according to the House of Lords. Because if she went, she might have already broken her responsibility by not intubating a child. The House of Lords decided that it was crucial to determine whether the doctor would have been in breach of duty if she had arrived but failed to intubate the child.

According to the Bolam test, every practise that a competent body of professionals deems proper must be based on logical and defensible grounds. In this scenario, not intubating the infant was neither unreasonable nor negligent, hence there was no violation of the law.



MODERN IMPLICATIONS

The Supreme Court in Achutrao Haribhau Khodwa vs State of Maharashtra And Ors on February 20, 1996, held that the skill of a medical practitioner varies from one doctor to the next, and the nature of the profession means that there may be more than one path of therapy that is appropriate for a given patient.

The case of Dr. Suresh Gupta v. Govt. of NCT of Delhi & Anr. The case concerns a doctor's criminal culpability in the event of medical malpractice. In this example, a young man died while undergoing medical treatment for a nasal abnormality. Even though it may create civil liability, the Supreme Court concluded in this instance that a doctor's lack of required care, attention, or competence would not be sufficient to find him criminally accountable for negligence under Section 304A of the IPC.



CONCLUSION

The Bolam test states that if a medical petitioner acts under the responsible body of opinion, they are not culpable. In comparison to the Bolam test, the Bolitho test has a narrower scope and must be relied on to satisfy the court on a reasonable basis.

Medical negligence occurs every day in Indian hospitals, and it is estimated that almost a million such incidents occur each year. Around one out of every ten patients is thought to suffer additional harm as a result of their hospitalization, and a portion of these persons will pursue personal injury compensation through a medical negligence lawsuit.



The Bolitho test allows for speedy alleviation because it raises the burden on the medical practitioner, allowing for more recompense. The Bolitho test, unlike the Bolam test, states that a court should not accept a defence position as "reasonable," "respectable," or "responsible" without first determining if the opinion is amenable to logical scrutiny.

Despite a body of professional opinion approving his actions, a doctor will be held liable for negligence in diagnosis and treatment if it has not been proven to the satisfaction of the court that the view relied on is reasonable or responsible. If it can be shown that the professional view cannot stand up to logical scrutiny, the court has the authority to rule that the body of thought is neither reasonable nor responsible."



This article is written by Priya sharma of The Maharaja Sayajirao University of Baroda.

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