When medical treatment does not produce the expected result, the first reaction is often straightforward: something went wrong, so was the doctor negligent?
Not necessarily. Medical treatment involves risks, complications and professional judgment. A procedure may fail even when it has been performed properly, and a doctor may choose one recognised method of treatment over another. None of these facts, by themselves, establish medical negligence.
At the same time, patients are entitled to expect a reasonable standard of care. Where a medical professional fails to exercise the skill and care expected in the circumstances, and that failure causes injury, the law may provide a remedy.
Indian courts have developed the law of medical negligence through a series of decisions. In Jacob Mathew v. State of Punjab, (2005) 6 SCC 1, the Supreme Court explained the distinction between civil and criminal negligence and the standard applicable to medical professionals.
The starting point is therefore not simply whether treatment failed. The relevant questions are whether there was a duty of care, whether that duty was breached, whether the breach caused the injury, and whether resulting damage can be established.
What Counts as Medical Negligence?
Medical negligence is a form of professional negligence. A doctor or hospital owes a duty of care to a patient receiving treatment. That duty can arise at different stages, including diagnosis, deciding upon treatment, administering treatment, surgery, medication and post-operative care.
However, establishing a duty of care is only the first part of the inquiry.
The basic framework can be understood as:
Duty → Breach → Causation → Damage
First, there must be a duty to exercise reasonable care. Second, that duty must have been breached. The conduct is generally assessed against the standard expected from a reasonably competent practitioner in the relevant field. Third, the breach must have caused the injury complained of. Finally, there must be actual damage, injury or harm resulting from the breach.
In M.A. Biviji v. Sunita, (2024) 2 SCC 242, the Supreme Court reaffirmed that medical negligence involves establishing the relevant duty of care, breach of that duty and resulting damage, injury or harm attributable to the breach.
An Unsuccessful Treatment Is Not Automatically Negligent
A doctor is not expected to guarantee a successful medical outcome.
In Kusum Sharma v. Batra Hospital & Medical Research Centre, (2010) 3 SCC 480, the Supreme Court recognised that a medical professional is expected to possess and exercise a reasonable degree of skill and knowledge. The existence of a different possible course of treatment, or an unfortunate result, does not by itself establish negligence.
There may be situations where two or more approaches are medically recognised. A doctor choosing one accepted approach over another does not become negligent merely because the result was less favourable.
Similarly, the fact that a complication was a known or recognised risk of a procedure does not, by itself, rule out negligence. The relevant question remains whether reasonable care was exercised in deciding upon and carrying out the treatment, and whether any breach of that duty caused the resulting injury.
This distinction is particularly important because courts must assess treatment in light of the circumstances and information available to the medical professional at the relevant time, rather than simply judging the decision with the benefit of hindsight.
The Most Important Question: Did the Breach Cause the Harm?
Causation is often where a medical-negligence allegation becomes legally difficult.
A patient may have experienced harm after treatment, but the timing alone does not establish that the doctor's conduct caused it.
For example, a patient may develop a recognised complication following surgery. The existence of that complication does not automatically establish negligence, particularly if it is a known risk of the procedure. However, if evidence shows that the complication resulted from a failure to exercise reasonable care or another departure from the required standard of care, the fact that it was a recognised risk will not by itself protect the medical professional from liability.
A patient assessing a possible claim should therefore examine questions such as:
- What exactly did the doctor or hospital do, or fail to do?
- What should reasonably have been done in those circumstances?
- Was there a departure from the applicable standard of care?
- What injury or harm resulted from that departure?
- Can the injury be connected to the alleged breach through the available evidence?
The Supreme Court's decision in M.A. Biviji v. Sunita is particularly relevant because it emphasises the need to establish that the resulting harm was caused by the breach of duty.
Without that connection, an allegation may remain an unfortunate medical outcome rather than an actionable case of negligence.
How Can a Patient Assess Whether There May Be a Case?
A patient will usually not be in a position to determine the technical medical standard independently. However, the available facts and records can help identify whether the matter deserves further examination.
Certain circumstances may raise legitimate concerns. These may include an apparent failure to follow an appropriate treatment protocol, administration of the wrong medicine or dosage, an avoidable procedural error, inadequate monitoring where monitoring was required, or a failure to respond appropriately to a patient's changing condition.
Even these circumstances must be examined in context. The patient's existing medical condition, medical history, urgency of treatment, risks associated with the procedure, available treatment options and information available to the treating professional may all be relevant.
A second medical opinion can therefore be useful, particularly where the allegation concerns a technical medical decision. It can help address whether the treatment or decision was medically acceptable in the circumstances rather than simply whether the outcome was bad.
Medical Records Can Make a Significant Difference
Documentation is often central to a medical-negligence claim.
A patient should preserve relevant records such as prescriptions, diagnostic and laboratory reports, imaging reports, consent forms, case sheets, operation or procedure notes, discharge summaries, bills, medication records, follow-up records and communications with the hospital.
The purpose is not merely to collect as many documents as possible. These records can help establish what happened, what treatment was given, when decisions were made and how the patient's condition changed.
Where the case involves a disputed medical decision, an independent medical opinion may also assist in understanding whether the treatment departed from accepted professional practice.
However, expert evidence is not automatically required in every consumer medical-negligence case. In V. Kishan Rao v. Nikhil Super Speciality Hospital, (2010) 5 SCC 513, the Supreme Court held that consumer fora should not mechanically require expert evidence in every case. Expert assistance may be appropriate where the matter is sufficiently complicated, while straightforward cases may be decided on the material already available.
This is different from the safeguards applicable when criminal prosecution of a medical professional is being considered.
Civil and Consumer Negligence Is Different From Criminal Negligence
Medical negligence can have civil consequences without necessarily amounting to a criminal offence.
For civil liability, the central question is whether the required standard of care was breached and whether that breach caused the resulting loss or injury.
Medical services provided for consideration can also fall within consumer law. In Indian Medical Association v. V.P. Shantha, (1995) 6 SCC 651, the Supreme Court held that medical services rendered for consideration fall within the meaning of service under the consumer protection framework, subject to the principles explained in that decision.
The Consumer Protection Act, 2019 continues this framework. Section 2(11) defines deficiency to include any fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance of a service, including an act of negligence or an omission or commission that causes loss or injury to the consumer.
Depending on the facts, a patient may therefore pursue a remedy under consumer law where the requirements of the Act are satisfied.
Criminal liability is different. The Supreme Court in Jacob Mathew made it clear that negligence sufficient for civil liability does not automatically become criminal negligence. Criminal liability requires a substantially higher degree of negligence, traditionally described by the Court as gross negligence or negligence of a very high degree.
This distinction is important because criminal law carries consequences beyond compensation. An ordinary error of judgment or every instance of civil negligence is not, by itself, sufficient to establish criminal liability against a medical professional.
What Changed With the BNS?
The Indian Penal Code, 1860 has been replaced by the Bharatiya Nyaya Sanhita, 2023 (BNS), which came into force on 1 July 2024. 0
For deaths caused by rash or negligent acts, Section 106(1) of the BNS applies. It provides for imprisonment of up to five years and fine generally, while specifying imprisonment of up to two years and fine where the act is committed by a registered medical practitioner while performing a medical procedure.
The provision should be distinguished from the older Section 304-A of the IPC. Where the alleged conduct occurred before the BNS came into force, the applicable law may depend on the date and circumstances of the alleged offence and the relevant transitional provisions.
The underlying judicial distinction between civil and criminal negligence nevertheless remains important. A criminal allegation cannot be established merely by showing that treatment was unsuccessful or that the patient suffered harm.
The Significance of Supriya Kumari in 2026
The Supreme Court's decision in Supriya Kumari M.C. v. State of Kerala, 2026 INSC 537, decided on 25 May 2026, provides a recent illustration of the distinction between civil negligence and criminal culpability. The case concerned criminal proceedings against an anaesthetist under Section 304-A of the IPC arising from a patient's death in 2002.
The Supreme Court examined the allegations, expert material and connection between the appellant's conduct and the patient's death, and ultimately quashed the criminal proceedings against the appellant. 1
The decision arose under the IPC because of the date of the alleged conduct; it was not a case directly applying Section 106 of the BNS. Its relevance to the present framework lies in the Court's treatment of the higher threshold applicable to criminal medical negligence.
This illustrates an important point: in a criminal case, it is not enough to identify something that went wrong during medical treatment. The prosecution must establish the legally required degree of criminal negligence and the necessary connection between the accused's conduct and the resulting death.
Supporting Authority
The leading authorities provide a consistent framework for analysing medical negligence.
- Jacob Mathew v. State of Punjab, (2005) 6 SCC 1 explains the basic principles of medical negligence and distinguishes civil negligence from criminal negligence.
- Indian Medical Association v. V.P. Shantha, (1995) 6 SCC 651 recognises the applicability of consumer protection law to medical services rendered for consideration, subject to the principles laid down by the Court.
- Kusum Sharma v. Batra Hospital & Medical Research Centre, (2010) 3 SCC 480 discusses the standard of reasonable skill and care expected from medical professionals and cautions against treating every unsuccessful treatment as negligence.
- V. Kishan Rao v. Nikhil Super Speciality Hospital, (2010) 5 SCC 513 clarifies that expert evidence is not a compulsory requirement in every consumer medical-negligence case.
- M.A. Biviji v. Sunita, (2024) 2 SCC 242 reaffirms the importance of duty, breach, causation and resulting damage in establishing medical negligence. 2
- Supriya Kumari M.C. v. State of Kerala, 2026 INSC 537 provides a recent illustration of the higher threshold applicable to criminal medical negligence and the importance of a legally sufficient connection between the alleged conduct and the death. 3
Conclusion
So, how can a patient know whether they have a medical-negligence case?
The clearest starting point is not the outcome, but the process that led to it.
A bad result does not automatically mean negligence. A complication does not automatically mean negligence. Even a mistake does not necessarily amount to criminal negligence.
The stronger questions are whether a medical professional owed a duty of care, whether that duty was breached by falling below the expected standard of care, whether the breach caused the injury, and whether there is evidence of resulting damage.
For a patient, medical records are often the first place to look. Where the issue is technically complex, an independent medical assessment may help determine whether the treatment departed from accepted practice. If consumer liability is being considered, the law does not insist upon expert evidence in every case. Criminal prosecution, however, involves a substantially higher threshold.
In short, an adverse medical outcome may raise a question of negligence, but evidence of duty, breach, causation and damage may support a legal claim depending on the facts of the case.