Kusum Sharma v Batra Hospital and Medical Research Centre (2010)

This is the case for the policy half of a negligence answer — the protective principles that keep the standard of care from becoming a standard of perfection. Where Jacob Mathew protects doctors from prosecution begun on nothing, Kusum Sharma collects into one list the propositions by which courts and forums are to judge a negligence complaint at all.

It is also the answer to a very common examination direction — state the guidelines laid down by the Supreme Court for deciding medical negligence cases.

Kusum Sharma claimed Rs. 45 lakh for the death of her husband, a senior manager, alleging negligence by Batra Hospital. The National Commission dismissed the complaint, and the Supreme Court upheld the dismissal.

The complaint failed. The Court collected eleven propositions to guide courts; in substance:

1. Negligence is a breach of duty, or an act a prudent and reasonable man would not do.
2. Negligence to be established by the prosecution must be culpable or gross, not merely an error of judgment.
3. A doctor must bring a reasonable degree of skill and knowledge and a reasonable degree of care — neither the highest nor the lowest.
4. A doctor is liable only where his conduct fell below that of a reasonably competent practitioner in his field.
5. A difference of opinion is not negligence.
6. Taking a higher risk in a grave illness to redeem the patient is not negligence.
7. Choosing one acceptable course of action over another is not negligence.
8. Medicine could not be practised efficiently if no doctor could act without a halter round his neck.
9. Courts must not harass or humiliate doctors unnecessarily.
10. Doctors must be saved from complaints that use the criminal process to pressurise them or to extract uncalled-for compensation.
11. Doctors are entitled to protection so long as they act with reasonable skill and competence in the patient's interest.

The Court warned that consumer law should not become a halter round a doctor's neck that makes him afraid to take decisions at crucial moments.

The list is not a new test; it is the existing test seen from the side of the risk of over-deterrence. The chain runs: medicine is inherently uncertain and often requires risk to be taken → a rule that treats every bad outcome as a fault would make the prudent course always the least useful one → therefore the law fixes liability at conduct falling below the reasonably competent practitioner in the field, and expressly removes from the field of liability the things that are not fault — difference of opinion, a justified higher risk in a grave illness, a choice between acceptable courses, and an error of judgment.

Propositions 9 and 10 are the procedural expression of the same idea, and they connect directly to the guidelines in Jacob Mathew.

Put it at the end of the negligence answer, after duty, standard and proof: Jacob Mathew for the protection against prosecution, then Kusum Sharma for the eleven propositions and the balance the Court struck. In a problem where a doctor took an unusual or risky course in a serious illness and it failed, propositions 5, 6 and 7 decide the case, and proposition 2 disposes of an argument built on an error of judgment.

Pair it with the error-and-accident cases: that an inherent risk materialised, or that in a matter of opinion an error of judgment was made, is not by itself negligence; an error is negligence only if it is one a reasonably competent professional acting with ordinary care would not have made; and conduct must be judged by the knowledge of the time, not with hindsight.

What it does not decide: it does not lower the standard of care or create an immunity — proposition 11 protects only the doctor who acted with reasonable skill and competence; and it does not displace res ipsa loquitur where the obvious faults are present.

A caution on the source. This paper takes the eleven propositions from the Court's reported summary rather than from the full judgment; state them in substance and do not present them as a verbatim quotation.