Explainer: Why justice in medical negligence cases remains elusive

THE death of former Chief Justice of India JS Verma in April 2013 was not only a personal tragedy for his family, but also a test of India’s medical accountability system. More than a decade later, his family’s complaint of negligence was dismissed by the National Consumer Disputes Redressal Commission (NCDRC), underlining why justice in such cases remains elusive. The admission by the government in the recent Parliament session that there is no centralised data of medical negligence cases exemplifies the systemic gaps.

In the Justice Verma case, the Commission concluded that doctors and hospitals treating him had followed medical protocols and could not be held liable merely because the treatment did not succeed. Its findings relied heavily on reports by the Delhi Medical Council and the Medical Council of India, both of which had cleared the doctors of wrongdoing.

His family had pointed to what they saw as serious lapses, ignored abnormal reports, delayed endoscopy, improper transfusions, poor management during the final hours, and even breach of patient privacy.

Each allegation was rejected for want of clear proof, and the complaint seeking Rs 10 crore in damages was dismissed. The outcome was not unusual.

Tension between law and medicine

Courts demand strict evidence of negligence under what is known as the four Ds: duty, dereliction, direct cause, and damages. Families of patients often lack the resources or expertise to establish this chain of proof.

“Medical records are highly technical, committees of inquiry are usually composed of peers reluctant to indict colleagues, and hospitals mount strong legal defences. As a result, litigation is long-drawn and convictions remain rare, even as complaints rise steadily,” says Vineet Jindal, social activist and Supreme Court lawyer.

The tension between law and medicine lies at the heart of the problem. In principle, courts must protect doctors from unfair criminalisation, because medicine often involves risk and uncertainty. At the same time, patients expect accountability when avoidable errors cause harm. The gulf between these two positions means most cases collapse under the weight of technicalities.

Even well-documented claims, such as those brought by the Verma family, often fail to cross the high evidentiary bar.

No nationwide records

Independent research suggests the scale of the problem is far larger than what official records reveal. A 2022 study estimated up to 52 lakh malpractice-related cases in India every year, while litigation has grown nearly fourfold in the past decade.

Yet penalties are uncommon. Reports indicate that most error-related deaths stem from surgical mistakes and that a large proportion of emergency fatalities arise from mismanagement, but even these numbers come from scattered studies, not systematic government tracking. The Union Health Ministry recently told Parliament that it does not maintain nationwide records of negligence cases, meaning there is no authoritative count of how many patients suffer due to errors, how many complaints are filed, or how many doctors are penalised. In this vacuum, tragedies surface as isolated incidents, even when they reflect systemic inadequacies.

Only last month, the National Human Rights Commission took cognisance of the death of a 26-year-old woman in Jaipur, allegedly after doctors ignored her post-delivery bleeding. Her family said they were kept outside even as she writhed in pain.

The absence of a clear redressal system adds to the mounting concerns. “Patients and families face a wall of technicalities, expert bodies and prolonged procedures that make accountability almost impossible to secure. The Verma case exemplifies this gap between legal standards and public expectations: the courts rightly insist on proof, but the system rarely enables victims to provide it,” says Delhi-based advocate Bhisham Singh.

Making amends

The way forward, experts argue, is to build stronger mechanisms of accountability that are fair to doctors and accessible to patients. A national registry of negligence cases is a crucial starting point, ensuring that complaints and outcomes are tracked transparently.

“Oversight mechanisms must also be reimagined. Committees dominated by medical peers often lean towards professional solidarity, so including patient representatives, independent legal experts and ethicists can help restore credibility. The legal framework itself requires tightening, with time-bound hearings and deterrent penalties, while ensuring genuine errors made under difficult circumstances are distinguished from reckless neglect,” says Jindal.

International models to learn from

The UK’s National Health Service maintains a central database of patient safety incidents, which feeds directly into hospital accountability and training systems. New Zealand and Sweden have experimented with “no-fault compensation” schemes where patients harmed by medical errors receive assured compensation without lengthy legal battles, while doctors are shielded from criminal liability unless there is gross misconduct.

“Such systems not only deliver quicker relief to patients, but also encourage a culture of learning from mistakes rather than concealing them,” Singh added.