Laxman Balkrishna Joshi v Trimbak Bapu Godbole (1969)

This is the Indian source of the duty element in medical negligence. Negligence has three components — duty, breach and damage — and this case supplies the first with a structure a student can apply mechanically: the doctor owes not one duty but three, at three different moments, and a breach of any one of them founds an action.

It also states the level of the duty — reasonable skill, neither the highest nor the lowest — and the one situation in which the law relaxes its judgment of the doctor's choice.

A doctor attempted to reduce a fracture without giving the patient an anaesthetic. The patient died of shock.

A person who holds himself out as ready to give medical advice and treatment impliedly undertakes that he has the skill and knowledge for that purpose. When consulted by a patient he owes:

1. a duty of care in deciding whether to undertake the case;
2. a duty of care in deciding what treatment to give; and
3. a duty of care in the administration of that treatment.

A breach of any of them gives the patient a right of action for negligence. The practitioner must bring a reasonable degree of skill and knowledge and exercise a reasonable degree of care — neither the very highest nor a very low degree. His discretion in choosing treatment is relatively ampler in an emergency. The doctor was held liable in damages.

The duty is derived from the holding out. A doctor is not liable because the patient trusted him; he is liable because, by professing to treat, he represented that he possessed the skill the treatment requires. That is why the standard is the skill professed, and why it is the skill of an ordinarily competent practitioner rather than of the best in the field — the representation is of competence, not of excellence.

The three duties then follow the life of the relationship: before it begins (should this case be taken at all, or referred?), during the decision (which treatment?), and in execution (was it administered with care?). Negligent acceptance, negligent choice and negligent performance are therefore all actionable, and it is worth naming which of the three has been broken.

The emergency qualification is consistent with all of this: where there is no time to deliberate, a wider range of choices is reasonable, so the same standard yields a more indulgent result.

It is the first case in any negligence answer: definition and the three components (from Jacob Mathew) → duty, using these three limbs → breach, tested by Bolam as restated in Jacob Mathew → damage and causation → remedies.

In a problem, use the three duties as a checklist. A doctor who takes on a case plainly beyond his competence breaches the first; a doctor who selects a treatment no competent practitioner would select breaches the second; a doctor who performs an accepted procedure carelessly — as on these facts, reducing a fracture without anaesthetic — breaches the third.

Pair it with the patient's own duties when contributory negligence is in issue: the patient must disclose the information needed for diagnosis, co-operate with investigations and follow instructions on drugs, food, rest and exercise, and failure in those weakens his claim; but his ignorance is the reason he consulted the doctor, so contributory negligence turns on whether he disregarded clear instructions actually given.

What it does not decide: it does not require the highest skill; it does not make a bad outcome evidence of breach; and it does not address criminal liability, where the threshold is higher.

A caution on the citation. Two other report references are in circulation for this decision in the study material for this paper. Use (1969) 1 SCR 206, which is the reference given when the case is restated in Jacob Mathew.