Jacob Mathew Judgement – Time to Trash ?

The 2005 Supreme Court judgment in Jacob Mathew v. State of Punjab was a landmark decision that protected doctors from frivolous prosecution by distinguishing civil and criminal negligence . While at the same time aiming to provide some relief to genuine sufferers. The intentions were surely noble. To see this Judgement and its summary, click here.

However, as with many well intended but poorly implemented and monitored judgements, the experience over the last two decades has clearly proven that instead of delivering Justice, the Judgement has only served to worsen matters, leaving thousands crying for justice and increasing frustration of the public with a medical “system” that seems licensed and protected to kill instead of cure !

The major issues are highlighted as under.

🗳️ 20-Year Failure to Implement Mandated Rules

In the Jacob Mathew Judgement, the Hon’ble Supreme Court directed the government to frame statutory rules for prosecuting doctors, but this has not been done for over 20 years ! Even when threatened with Contempt, the statutory body ( National Medical Commission ) given this task has been dragging its feet on this matter. This, despite. Its own mission and vision, as stated at its own website clearly stating, inter-alia:

• have an effective grievance redressal mechanism.
• enforce high ethical standards in all aspects of medical services

A 2025 PIL filed in the Supreme Court ( Sameekhsa Foundation Vs Union of India and Anr. ) has highlighted this inaction, with an RTI reply confirming that the National Medical Commission (NMC) has still not framed these guidelines!

So the Court’s interim guidelines have, by default of NMC, become permanent and highly unjust as explained further.

👨‍⚖️ Inherent Bias in the “Doctors Judging Doctors” System

In the absence of formal rules, investigations rely on inquiry committees dominated by doctors, which are inherently biased. In this context, the recommendations of the 92nd report on the functioning of the Medical Council of India (MCI) that was placed before the Parliament on March 8th 2016 make for very interesting reading. Only after submission of this Report was the Medical Commission of India dissolved and replaced with National Medical Commission. However, the NMC has seemingly made very, very little progress towards implementing the recommendations of the Report !

Some excerpts from this report are:

“ The Committee notes that the Ethics Committee of the MCI presently consists entirely of medical doctors and is thus a self-regulatory body. But all over the world, it has now been realized that the medical profession (or any profession for that matter) tends to protect its own flock. The Committee, therefore, recommends that the new Board of Medical Ethics should also have non-doctor lay members from different fields.” ( Page 65)

”The Medical Council of India, when tested on the above touchstone, has repeatedly been found short of fulfilling its mandated responsibilities…the MCI, as presently elected, neither represents professional excellence nor its ethos. The current composition of the Council reflects that more than half of the members are either from corporate hospitals or in private practice. The Committee is surprised to note that even doctors nominated under Sections 3(1) (a) and 3(1) (e) to represent the State Governments and the Central Government have been nominated from corporate private hospitals which are not only highly commercialised and provide care at exorbitant cost but have also been found to be violating value frameworks…the current composition of the MCI is biased against larger public health goals and public interest…” ( Page 87-88)

“The Committee observes that the oversight of professional conduct is the most important function of the MCI. However, the MCI has been completely passive on the ethics dimension which is evident from the fact that between 1963–2009, just 109 doctors have been blacklisted by the Ethics Committee of the MCI… Due to crass commercialization of the health sector, many unprincipled doctors and private sector hospitals have lost their moral compass and overcharge or subject their hapless patients to unnecessary surgeries and diagnostic procedures. The instance of unethical practice continues to grow due to which respect for the profession has dwindled and distrust replaced the high status the doctor once enjoyed in society. What is of greater concern to the Committee is that the medical profession has not been transparent in dealing with complaints. It is a matter of surprise that despite the worst kind of gross unethical practices happening by way of ghost faculty, fake patients and hired instruments and substantial amount of money (not white, of course) reportedly changing hands at the time of inspections, there is little proactive action on the part of the MCI to deal with this malady…” ( Page 102)

The PIL referred above seeks to address this drastic inequality by calling for multi-stakeholder panels including retired judges and patient representatives to ensure impartiality .

In a very recent case widely reported in the media too the National Medical Commission (NMC), despite its own statute and Hon’ble Supreme Court orders , refused to hear appeals from patients claiming medical negligence, while those of the doctors appealing against medical negligence expert opinions ( a very rare occurrence!) rendered against them by State Medical Councils were readily accepted! Hundreds of patients suffered. Only very recently has the NMC agreed to ” examine the issue of considering patient appeals” !! This clearly demonstrates how biased the National Medical Commission and the State Medical Councils are.

⚖️ Near-Impossible Burden of Proof on Victims

The Jacob Mathew judgment requires a private complainant to produce a “credible opinion” from another competent doctor to support their negligence claim before a court will entertain it . This creates an almost impossible hurdle, as finding a doctor willing to testify against a fellow professional is extremely difficult . This condition disproportionately affects the poor and illiterate who cannot afford lengthy legal battles . Although the Judgement clearly asks for such opinion to be “preferably from a doctor in Government service qualified in that branch of medical practice ” in almost all the cases, such opinion is given by the State Medical Councils in a very opaque manner, putting aside all principles of natural justice and procedures thereupon, and with a clear motive of protecting the doctors.

Further, the fact is that most cases of medical negligence and even outright crime are performed on hapless, choiceless and ignorant patients. Such crimes are most often committed in the privacy of Operating Theaters or Intensive Care Units. The only instruments that may establish any culpability are medical records. And such records are almost routinely delayed, misplaced, destroyed or even out rightly forged. Law as enshrined in NMC own statutes require complete medical records be given with 72 hours of a request from patient/ next of kin. However , this is rarely followed and even if there is clear evidence of manipulations and delays extending into years, no penalties follow!

And while the Hospital , Operating Theaters, ICUs etc are supposed to be closely monitored spaces with video recordings, such recordings are very conveniently put out only to support the cases of doctors, and equally conveniently destroyed otherwise !

📝 Vague Legal Standards Difficult to Apply

The Jacob Mathew case makes a doctor criminally liable only in cases of “gross” negligence, while ” simple” negligence may lead only to a civil liability..

Except that what constitutes ” simple” negligence and what makes for “gross” negligence is not defined anywhere in law and left to interpretation of any- which by default become the doctor/panel giving the “expert opinion”. Which, as already said, is inherently biased.

Even the Supreme Court in a later case (Martin F. D’Souza v. Mohd. Ishfaq, 2009, Civil Appeal 3541 of 2002) has acknowledged the ambiguity, noting that what constitutes “reasonable” care or the line between “simple” and “gross” negligence can be a matter of dispute even among experts . Paras 30 to 33 and many later may be referred to. This ambiguity makes it difficult for courts to adjudicate cases and for doctors to prospectively apply these standards to their practice .

🏛️ Subversion of Equal Application of Criminal Law

All above ensure that the Judgement effectively carves out a “special class” for medical professionals, making them immune from the criminal law that applies equally to all (other) citizens . This is an increasingly slippery slope, given also the massive privatization in the Medical Sector and its almost complete ignorance by the Government.

The dominant motive of the private sector is profit. And this race to profit invariably comes at a cost of patient safety with doctors , nurses and all other facilities overloaded or even staffed by ” quacks” in the desire to lower costs and increase profits. This shows up in several other aspects of the medical “system” as well- for instance spurious drugs, over-medication, forged diagnosis reports etc.

As has been oft said, private sector should never be allowed dominance in healthcare. This has also been amply set out in the 92nd report on the functioning of the Medical Council of India (MCI), in excerpts already out out above.

The core challenge remains balancing the protection of doctors from frivolous harassment with the need for effective accountability in cases of genuine medical negligence. The current framework, originally intended as a temporary measure, has left victims’ families “absolutely helpless” in their pursuit of justice

In essence, this is what the consequences of Jacob Mathew Judgement are for sufferers of medical negligence.

• While before this Judgement ” negligence” could trigger criminal liability, police could register FIRs and evidence could be examined during trial; after the Judgement, only ” gross” negligence can lead to such actions, when statutorily “gross” negligence is not even defined and left to the interpretation of judges, even when the negligent acts may have killed patients!
• It raises the proof bar very high for hapless, ignorant patients. Extreme misconduct has to be proven, not just an error or carelessness or incompetence- even though such carelessness might have lead to someone getting killed !
• All evidence- whatever it is – is still fully in control of the perpetrators themselves. The Judgement does not address this issue at all. Such evidence – medical records, video recordings etc. are all open to deletion, manipulation and forgery. Delays are deliberately made to give the perpetrators full chance to do whatever they wish to , with the evidence fully in their control ! It can then readily be understood then that Judgements based on such flawed evidences can never be just.
• The Judgement places very strong weightage to “expert opinion”. Which is given by “expert committees” comprising of Doctors themselves, mainly from the private sector ! The inherent strong bias of such committees can not be ignored
• And all the time the balance of power clearly leans in the favor of the medical fraternity. It is a battle of unequals. While the sufferer may have never been to a court in his/her life, the opponents ( usually very large hospital chains ) have a battery of lawyers, financial muscle and connections at their disposal.

Above discussions will readily make it clear to any unbiased reader that the Jacob Mathew judgment protects doctors, weakens patient justice, slows accountability, blocks access to courts, removes deterrence and normalizes institutional immunity. Without an overhaul of this Judgement victims will continue to rise and be counted as ” procedural” causalities, while doctors stay insulated and Justice stays only chimeric. This Judgment is totally out of sync with the realities of the medical “system” as it now exists in India.

The consequences of this gross and systemic imbalance are already there to be seen. Medical negligence cases have increased dramatically over the years, with almost 65,000 filed in 2025 alone ! There is rising patient mistrust and frustration. Which sometimes boils over as arguments with and attacks on doctors. These cases where patients / next of kin turn against the the very doctors supposed to help them shows how high the frustration and lack of trust must be.

Fact is that medical science is an inexact one. And no doctor is God. Proper healthcare demands then a balance between a patient expectations and his/her doctor’s skills. The medical fraternity is solely responsible with maintaining this balance. Any ethical doctor should strive to maintain this, and not be driven by the profit motive. The principles and ethics as enshrined in the Hippocratic Oath first formulated centuries ago ( various derivatives of which are taken by Doctors even now) are more relevant than ever before. And the most important tenet therein is : First Do No Harm . This safety can only be assured if there is accountability and trust. And trust can survive only if there is fair Justice – to all stakeholders per specifics of any case.

Time has thus come to move beyond the Jacob Mathew Judgement and set comprehensive guidelines inline with the demands of the present circumstances. It is time indeed to trash this Judgement, while learning valuable lessons from it as well as the experience of past twenty years.

And what should the new guidelines focus on ? This will require a sustained and multi-prong approach with all stakeholders involved and the voice of the most affected constituent – the patients- being center stage.

Some indicators of the reforms needed

• As clear a statutory definition of gross negligence as possible
• Immutable Digital records, provided immediately on demand.
• Independent medical investigation boards , to be provided completely anonymized complaints and records. For each case, such board should not be in the state where any of the patient/ complainant / doctor / hospital is based, to eliminate as much as possible even the suspicion of any bias
• Time-bound investigations and closures, with fast-track courts on medical negligence
• State funding for economically disadvantaged victims to initiate and progress through the multiple procedures and legal battles that a medical negligence case demands

Let us hope and pray such reforms come fast, else the common man is doomed !

Your comments and constructive suggestions on this article are welcome !