Battling bias: India’s medical councils often fail patients in medical negligence cases

For the last 10 years, Pramod Kumar Choudhary has been chasing down justice. A resident of Delhi’s RK Ashram and an employee of the New Delhi Municipal Corporation, his quest is driven by tragedy – the loss of his daughter Ritu Kumari.

Claiming medical negligence by a Delhi hospital, Choudhary’s story is all too familiar for numerous families in the national capital.

In October 2011, when Ritu was 10 years old, she was admitted at Delhi’s RLKC Metro Hospital with fever and signs of early-stage dengue. Her platelet count was normal and Choudhary was comforted by the doctors’ assurances of a brief stay and a speedy recovery.

His optimism soon collapsed into anguish. Ritu’s condition deteriorated rapidly. By the fourth day, she developed urinary complications and complained of agonising stomach pain. According to Chaudhary, he pleaded with the hospital’s doctors for 11 hours to do something for his daughter, but instead of providing “necessary care”, he was told to transfer her to a hospital better equipped for paediatric care.

Terrified, Choudhary moved his daughter to RML Hospital where Ritu began vomiting blood on arrival. She died a day later. Choudhary was informed his daughter had died from a “drug-induced reaction” – a drug that doctors said must have been administered before she was moved to RML Hospital.

Choudhary’s theory is that a doctor “administered some medicine at night” at RLKC resulting in Ritu’s death. He also said the hospital only provided him with a discharge summary and no other paperwork. With the hospital administration refusing to engage with him, he filed an RTI in 2012 asking for details on Ritu’s treatment. After radio silence, a year and two appeals, he finally got the information he asked for.

The details alarmed him. Ritu was administered Voveran, a controversial drug that’s banned by the World Health Organisation for the treatment of dengue, and other antibiotics “unsuitable” for dengue patients. 

Choudhary went to the police. In 2012, the Ranjit Nagar police station registered his complaint and sought a medical opinion from the Delhi Medical Council on whether this was a case of medical malpractice. In 2013, the council concluded its investigation and absolved the hospital of wrongdoing. Choudhury then appealed its decision before the Medical Council of India, which upheld the Delhi Medical Council’s decision in 2014.

Frustrated, Choudhury filed a legal lawsuit under IPC section 156/3 in the Tis Hazari court. In 2017, the court directed the Delhi police to register an FIR. The case is currently being heard at the Tis Hazari court for death caused by alleged negligence.

But the findings of an enquiry committee, set up on instruction of Chief Minister Arvind Kejriwal in 2018, validated Choudhury’s concerns. It noted that as per RML’s death summary, Ritu’s collapse “can be due to complication of dengue shock syndrome” which “may be the side effect of Voveran injection to a dengue patient”. It also said RML did not “properly” follow standard operating procedure while transporting Ritu to RML.

“The committee is of the opinion that patient may have gone into dengue shock syndrome with complication leading to death which can be aggravated by injection Voveran, if at all given,” the report concluded.

A long process with little resolution?

In India, the process to file complaints on medical negligence is a tedious one. Until 2019, the Medical Council of India and respective state councils were responsible for maintaining registers of qualified doctors and taking disciplinary action. Under the Indian Medical Council Act of 2002, any aggrieved person could appeal against a decision taken by a state medical council.

But in 2019, the National Medical Commission Act was passed, replacing the Medical Council of India with the National Medical Commission. Under the new act, only medical practitioners can appeal against decisions made by state medical councils. Patients can no longer do so.

Now, it’s interesting to look at the data specific to the Delhi Medical Council.

According to responses to an RTI filed by the Vidhi Centre for Legal Policy, appeals were filed against 140 decisions made by the Delhi Medical Council from January 2002 to September 2022. The DMC’s decisions were upheld in 56 of these complaints and overturned in 16. The outcomes of the remaining 68 complaints were not provided.

A second RTI filed by Vidhi revealed that the DMC conducted 3,836 enquiries against medical practitioners for professional misconduct/negligence between 2002 and 2022. Warnings were issued in 160 of these cases. The names of practitioners were temporarily removed from registers in another 160 cases.

Girish Tyagi, the registrar of the Delhi Medical Council, pointed out to Newslaundry that medical practitioners are permanently struck off only if there is “gross negligence”. Punishment, where applicable, is decided on a case-by-case basis. 

“Once a complaint is filed, the executive committee looks into the complaint before sending it to a disciplinary committee. If they find the complaint is vague, it is dismissed,” he said. “If the complaint is found to be valid, it’s sent to the disciplinary committee for further examination.”

DMC’s website indicates it received 209 complaints in 2023, of which 22 were dismissed and 52 disposed of. The orders of the disposed complaints are not uploaded on the website. When this reporter asked Tyagi about them, he ordered his subordinates to upload the order as soon as possible.

At the time of publishing this report, the orders were still not uploaded.

Vidhi also analysed 3,836 inquiries conducted by the Delhi Medical Council between 2002 and 2022. It discovered only 160 instances of disciplinary action against practitioners.

Importantly, on February 23, four people wrote a letter to the Chief Justice of the Delhi High Court, asking for permission to record his court’s video-conference proceedings in cases involving the erstwhile National Medical Commission. The letter alleged the commission “tends to vehemently support” medical practitioners accused in these cases and “deliberately shields offenders”.

“This raises a serious question about the integrity and independence of the body, which acts as an appellate authority and passes quasi-judicial orders…” the letter said. 

Involving the courts 

In 2018, Anshu Bala underwent a c-section at Nulife Hospital in Delhi’s GTB Nagar. Her baby was born with hypoxic brain damage and died in December 2023.

In 2018, Bala’s husband Alok Kumar filed a complaint with the Delhi Medical Council. He alleged Dr Shakuntala Kumar had “miscalculated” his wife’s delivery date, leading to an early surgical delivery and his child’s subsequent death. 

The DMC’s disciplinary committee investigated the matter and held that Shakuntala had been negligent. Her licence was cancelled for 90 days. Shakuntala then appealed to the Medical Council of India, which overturned the DMC’s decision and reinstated the doctor’s licence.

Crucially, the Medical Council of India had made its decision after appointing one Dr Sharda Jain for an expert opinion. Jain, the founder and secretary-general of the Delhi Gynaecologist Forum, had filed an affidavit in support of Shakuntala with the Medical Council of India. Shakuntala is also a co-convener of a postgraduate course under the forum while Jain is its chairman.

How then was Jain brought in as an impartial expert?

This conflict of interest prompted Bala’s husband Alok to approach the Delhi High Court. The court stayed the MCI’s decision. He also approached the Rohini district court asking that an FIR be registered against Shakuntala. In 2018, the district court accordingly directed the Delhi police to register an FIR under penal sections 336 (endangering life) and 338 (grievous hurt). But the FIR did not name the hospital or the doctor.

Alok told Newslaundry: “This exposes the troubling reality of how difficult it can be to achieve justice against resourceful doctors and hospitals.” As things stand now, the police filed a final report in the case, against which Alok filed a protest petition in court. The case is ongoing.

The DMC’s role also came under scrutiny in a much-publicised case last year. In December, the police arrested four people at Agarwal Medical Centre for allowing “fake” doctors to conduct surgeries. At least 15 people reportedly died. 

Damningly, at least 13 complaints had been filed with the DMC against the centre and its owner Dr Neeraj Agarwal since 2011. 

For instance, a complaint from 2014 alleged a patient had sustained “grievous injury” when a pregnancy was medically terminated at six months, well past the cut-off period of five months. In this case, the DMC’s disciplinary committee found Agarwal to be “highly unprofessional” and recommended that his licence be suspended for a month. Instead, the DMC’s executive council let the doctor off with a warning, observing that suspending his licence would be a “bit harsh”.

In 2018, a metropolitan magistrate at Tis Hazari court had referred a case to the DMC, where a patient alleged Agarwal had issued a “fake medical certificate”. The DMC suspended Agarwal’s licence for a month. The DMC also did not act on two other complaints – filed over three and two years ago, respectively – at all. 

Agarwal is presently in jail, no thanks to the DMC. 

‘Earth slipping from my feet’

In Haryana, Rakesh Kumar, 44, told Newslaundry he believes the Medical Council of India favoured a “delinquent” doctor who treated his son. 

Ten years ago, on April 14, 2014, Rakesh admitted his two-year-old son to Cygnus Maharaja Agrasen Hospital in Panipat for treatment for a kidney stone. He was told his son needed a “routine and safe” procedure called a mini-PCNL surgery.

Under urologist Dr Bodhiraj, the surgery was scheduled for the following day. At 7.30 am, the boy was wheeled into the operating theatre. At 9.30 am, while the family waited for an update, Rakesh noticed a “flurry” of activity, he claimed, with medical equipment being “hurried” into the OT. He asked nurses and doctors for an update but was told to wait.

Finally, at about 9.45 am, Dr Deepak Bharadwaj, the director of the hospital, informed Rakesh that his son had suffered a heart attack during the surgery. He survived but was on a ventilator. Doctors then advised Rakesh to move his son to Ganga Ram Hospital. An ambulance was swiftly arranged but hit heavy traffic on the road to Delhi. It finally redirected to Jaipur Golden Hospital where his son was declared dead on arrival.

“It felt like the earth was slipping from under my feet,” Rakesh said.

Jaipur Golden Hospital conducted a postmortem and concluded the child had died from a “haemorrhagic shock, following  injury to the right kidney and surrounding structures during surgical operation”. 

Rakesh approached the Haryana Medical Council with a complaint against Cygnus Maharaja Agrasen Hospital. The council directed an inquiry by the civil surgeon of Panipat. But then the HMC told Rakesh the doctor in question was registered with the Gujarat Medical Council. Citing “jurisdictional constraints”, it referred the matter to the Medical Council of India.

At the MCI, the ethics committee in 2016 flagged “grave” concerns about Dr Bodhiraj’s competence and the hospital’s preparedness to handle complications. It said this was Bodhiraj’s “first case of such a surgery on a child” and that he had tried to “hide the history when complications happened and could not explain why the child was referred to Ganga Ram Hospital 200 km away”.

The ethics committee recommended a two-year suspension of his licence. When this recommendation reached the executive committee for approval, the latter returned the matter, saying there was an “oversight” in Bodhiraj’s statement and there had been no input from an expert urologist. 

In response, the ethics committee said it had its own expertise in urology but sought the opinion anyway from the head of urology at AIIMS Delhi. Based on this opinion, it reiterated its original decision that Bodhiraj’s name be struck off the registers.

Yet again the executive committee sought further clarification. The ethics committee revisited the case. This time, it exonerated Bodhiraj and attributed the child’s death to a “known complication”.

Rakesh told Newslaundry the executive committee made sure the case was reviewed “until the doctor was exonerated”. “It is clear that the MCI’s motive was just to safeguard the doctor, not deliver justice to patients.”

In 2020, he challenged the MCI’s decision through a writ petition before the Delhi High Court. The court accepted it and the matter is pending. Meanwhile, Rakesh also filed a criminal complaint with the Panipat police based on the postmortem report.

Other cases

Newslaundry found three other cases that followed similar trajectories. The details are sketchy, since they are based on court judgements.

In 2013, Rashmi Dixit was undergoing treatment at Amar Leela Hospital and Heart Centre in Delhi in connection with infertility and ancillary gynaecological issues. She alleged her condition worsened, “almost led to her demise” and that she “lost her ability to ever conceive a child”. She filed a complaint with the DMC in June 2013.

Dixit alleged the doctor who treated her “had no qualification as a gynaecologist”. But in its investigations in 2014 and 2016, both the Delhi Medical Council and the Medical Council of India, respectively, said there had been “no wrongdoing”. Dixit eventually filed an appeal at the Delhi High Court. 

In November 2022, the high court observed that the doctor had “held herself out to be an expert in gynaecological and infertility related treatment despite having no formal medical education or training in the field”. It also said the doctor “misled the public of her qualifications by posting signs outside her cabin claiming to be an expert in these fields and made and used official stamps showing these false qualifications”.

On the inquiries, the court came down heavily on the DMC and MCI.

“The Delhi Medical Council carried out a superficial enquiry and reached a conclusion that there was no wrongdoing,” it said. “Medical Council of India concluded that the doctor was guilty of falsifying her medical credentials yet did not take any punitive action against her,” it said.

Similarly, in 2018, the parents of six-year-old Devarsh Jain filed a complaint against Fortis hospital in Shalimar Bagh in Delhi, claiming the child “sustained brain damage” soon after his birth. The DMC found no evidence of wrongdoing, and neither did the erstwhile National Medical Commission when the matter was escalated to it. 

The parents approached the Delhi High Court in 2023 questioning the qualification of the doctor involved. The court asked the DMC and NMC to file their responses. In their affidavits, both councils admitted the senior consultant in question did not hold a “recognised qualification”. However, they maintained the doctors had not been negligent and, on the basis of these affidavits, the police filed a closure report.

Finally there’s the case of Indra Prakash Singh Raghuvanshi, 66, whose wife died in 2019 from septicaemia and multi-organ failure after a Whipple surgery. Raghuvanshi claims his wife died due to medical negligence and that he was not briefed on the possible consequences of the surgery. He filed a complaint with the Delhi Medical Council, which dismissed his complaint.

Raghuvanshi told Newslaundry the DMC’s inquiry had been presided over by a senior consultant from the same hospital. He said he “lost hope”.

“I am getting older and can no longer make rounds in court,” he said. “I have a young daughter too whose responsibility is completely on me.”

What do doctors say?

Dr Arun Gupta, president of the Delhi Medical Council, told Newslaundry that the group adheres to the “highest transparency mechanism” with a three-tier structure to scrutinise complaints.

“Whenever we get a complaint, we refer them to the concerned hospital and the doctor seeking their written reply. So, they send us a reply with supporting documents. Then the executive committee of DMC - along with one doctor who is an expert on the subject – goes through the case. Then we decide based on merits as many people have no idea about the difference between complication and negligence,” he said. “If we find something that needs to be further probed, we refer to our second committee, the disciplinary committee, which has three non-medical nominated persons. After deliberation, the disciplinary committee submits its  recommendation before the council. Then the council again deliberates on it and has the power to accept or reject the recommendation.”

He added: “There is a three tier structure with experts, non-medico individuals, 25 member councils – what could be more transparent than this? Then again if someone is not satisfied, they can go to MCI and other appellate authorities.”

Why then is the DMC so frequently accused of bias?

“Most people have no idea about what is complication and what is negligence,” Gupta said. “...One may agree or disagree with our decision and can challenge it before the courts.”

Newslaundry also spoke to Dr Shivkumar Utture, current vice-president of the Indian Medical Association and former president of the Maharashtra Medical Council. Utture said there are a lot of complaints due to lack of proper “dialogue” between patients and doctors.

“There is a lot of misunderstanding as far as the treatment part is concerned,” he said. “We try to sensitise both doctor and patient on this point. IMA does not support gross negligence. However, we are definitely bothered about frivolous complaints against doctors.”

Utture believes these “frivolous” complaints stem from the fact that patients do not have to pay money to file a complaint with a medical council.

“The problem comes as it costs a doctor’s mental peace as these cases extend two years or more,” he said. “...In the case of Maharashtra, the hearings are in Mumbai and doctors have to travel from interior areas to Mumbai whenever there is a hearing. It not only costs them money and time, their absence these days also impacts patients in those areas.”

He continued: “We have been demanding before NMC that there should be something against these frivolous complaints also because it is easy to make a complaint against a doctor. While there are genuine cases as well, the majority of them are frivolous. For example, in the courts, if there is a frivolous complaint, the court has the power to take action against such complaints. But that power to take action against frivolous complaints is not with the councils.”

This piece is part of a project supported by the Thakur Family Foundation. The foundation has not exercised any editorial control over the contents of this report.

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