Introduction: The Jurisdictional Conundrum in Medical Negligence Litigation
In a seminal judgment delivered
on December 19, 2025, the Supreme Court of India in Kousik Pal v. B.M. Birla
Heart Research Centre & Ors. (Civil Appeal No. ______ of 2025) has
authoritatively delineated the often-contentious jurisdictional boundaries
between a Clinical Establishment Regulatory Commission and a State Medical
Council. This appeal, arising from a Special Leave Petition, centred on a
fundamental question of administrative and regulatory law: whether a commission
established under state legislation to oversee clinical establishments
possesses the requisite authority to adjudicate upon issues concerning the
qualifications of medical personnel and deficiencies in patient care services,
or whether such matters fall exclusively within the purview of professional
medical councils. For legal practitioners engaged in medical negligence
litigation, healthcare regulatory compliance, or constitutional writ
jurisprudence, this judgment provides crucial clarity on the scope of
concurrent and distinct powers held by these two critical bodies.
Factual Matrix: A Tale of
Alleged Negligence and Regulatory Adjudication
The factual substratum giving
rise to the legal controversy is tragically commonplace in medical litigation.
The appellant’s mother, Ms. Arad Pal, was admitted to the respondent-hospital,
B.M. Birla Heart Research Centre. After a five-day period with no improvement
in her condition, she was referred to another institute on May 7, 2017. Her
discharge summary, prepared by Dr. Tanmoy Chakraborty, described her as being
in ‘stable condition.’ She was transferred in the early hours of May 8, 2017,
and succumbed approximately sixteen hours later.
Aggrieved by his mother’s demise,
the appellant, Mr. Kousik Pal, lodged a complaint on May 12, 2017, with the
West Bengal Clinical Establishment Regulatory Commission (the Commission),
constituted under the West Bengal Clinical Establishments (Registration,
Regulation and Transparency) Act, 2017 (WBCE Act). The complaint alleged
negligence in detection, delay in shifting, improper medication, and
misdiagnosis. The Commission, in its order dated February 2, 2018, made several
pivotal findings:
1. It noted the lapse of Dr. Chakraborty in
erroneously describing the patient’s condition as ‘stable,’ which he admitted
was not a mere clerical error.
2. Crucially, it held that Dr. Ashok Giri, the
Head of the Non-Invasive Department, was not qualified to practice in the
concerned specialty, as his Post-Graduate Diploma from IGNOU was not recognized
by the Medical Council of India (MCI) or the West Bengal Medical Council
(WBMC). Consequently, his report was deemed “unauthorized and illegal.”
3. It further found that Ms. Chaitali Kundu, the
ECG Technician, was also unqualified, as her course and institution were not
recognized.
4. Based on these deficiencies in patient care
service and unethical trade practice, the Commission awarded compensation of
Rs. 20 lakhs to the appellant.
The Procedural Odyssey: From
Commission to Division Bench
The respondent-hospital and Dr.
Giri challenged the Commission’s order before the Calcutta High Court. A
learned Single Judge, in a judgment dated September 24, 2019, upheld the
Commission’s order, affirming that examining the qualifications of personnel to
determine a deficiency in service was within the Commission’s jurisdiction
under the WBCE Act.
This affirmation was, however,
overturned by a Division Bench of the High Court on December 15, 2023. The
Division Bench’s reasoning formed the crux of the appeal before the Supreme
Court. Its conclusions, inter alia, were:
a. Causation: Insufficient material
connected the ECG report by Dr. Giri and Ms. Kundu to the patient’s death.
b. Jurisdiction on Qualifications:
Pronouncements on the qualifications of medical professionals and allegations
of falsely claiming specialization constitute professional misconduct, falling
strictly within the disciplinary domain of the WBMC under the Indian Medical
Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002. The
Commission had no authority to adjudicate this.
c. Interpretation of MCI Communication: The
Bench interpreted letters from the MCI as not explicitly barring Dr. Giri from
interpreting ECGs or Ms. Kundu from conducting them.
d. Inextricable Link: It held that ‘patient
care’ and ‘medical negligence’ are so inextricably mingled that they cannot be
separated. Since negligence is for the specialized body (WBMC), the Commission
could not have adjudicated the issue at all.
The Supreme Court’s Analysis:
A Textual and Purposive Interpretation of the WBCE Act
Justice Sanjay Karol, authoring
the judgment for the Bench also comprising Justice Manoj Misra, embarked on a
meticulous analysis of the relevant statutory framework to resolve the
jurisdictional tussle. The Court’s reasoning provides a masterclass in
statutory interpretation, balancing text, context, and purpose.
1. Preamble and Object: Regulation,
Transparency, and Minimum Standards
The Court began with the Preamble
of the WBCE Act, 2017, which emphasizes the Act’s objective to ensure
“registration, regulation and transparency” and to “preserve minimum standards
of facilities and service.” The Court reasoned that ‘regulation’ implies
control, ‘transparency’ necessitates non-opaque practices, and ‘minimum
standards’ require the setting of a benchmark. A logical incident of ensuring
these standards is the power to verify that personnel employed by clinical
establishments possess the requisite qualifications. This, the Court held, is
fundamental to the Commission’s regulatory mandate.
2. Defining ‘Service Provider’ and the
Commission’s Duty under Section 38(1)(x)
The Court examined the definition
of ‘service provider’ under Section 2(v) of the Act, which includes “a medical
doctor… or other appropriately trained and qualified person with specific
skills.” The use of the terms “appropriately trained and qualified” is pivotal.
The Court held that to determine if a service provider meets this definition,
an examination of their credentials is not just permissible but necessary.
This interpretation was fortified
by Section 38(1)(x), which explicitly lists as a function of the Commission:
“ensure that only properly trained medical and para-medical personnel like
doctors, nurses, technicians, pharmacists are employed by the clinical
establishment.” The Court held that the Commission, in evaluating the
qualifications of Dr. Giri and Ms. Kundu, was performing this exact statutory
function. It was not punishing them for professional misconduct (a domain of
the WBMC) but was assessing whether the hospital had employed properly
qualified personnel as required by law—a clear deficiency in service.
3. Distinguishing ‘Deficiency in Service’ from
‘Medical Negligence’
This distinction forms the
jurisprudential core of the judgment. The Court meticulously dissected the
Division Bench’s finding that the two concepts are inseparable.
a. Statutory Carve-Out: The Court pointed
to the first proviso to Section 38(1)(iii) of the WBCE Act, which states:
“Provided that any complaint of medical negligence against medical
professionals will be dealt with by respective State Medical Councils.” This,
the Court noted, is a specific carve-out. The Commission’s order had scrupulously
adhered to this limit, expressly stating it was not entering into the question
of negligence.
b. Separate Inquiries: The Court elucidated
that while the facts underlying a complaint may relate to a poor medical
outcome, the legal inquiries conducted by the two bodies are distinct. The
WBMC’s inquiry is into the professional conduct of a specific doctor: Did the
doctor’s actions breach the standard of care expected of a medical
professional? This may lead to disciplinary action against the doctor’s
license.
The Commission’s inquiry, conversely, is into the service provided by
the clinical establishment as an entity: Did the establishment fail to meet the
minimum standards of service mandated by law, such as by employing an
unqualified person, leading to a deficiency? This may lead to penalties and
compensation against the establishment.
The Court warned that accepting
the High Court’s view of an “inextricable link” would render the Commission
dysfunctional in a vast number of cases, as most serious patient grievances
have some nexus to medical treatment. This, it held, would defeat the
legislative intent behind creating a separate, accessible forum for aggrieved
patients to seek redress for service deficiencies.
4. Analysis of ‘Deficiency’ and ‘Compensation’
under Sections 29 & 33
The Court reinforced its
conclusion by referencing other operative sections:
a. Section 29: Defines a “major deficiency”
as one that poses an “imminent danger to the health and safety” of a patient.
Employing a doctor whose qualification is not recognized for a critical
diagnostic procedure like an echocardiogram was held to squarely constitute
such a deficiency.
b. Section 33: Empowers the Commission to
award compensation for injury or death caused due to “negligence or any
deficiency in providing service.” The Court emphasized that the legislature’s
intent to zealously safeguard patient interests is evident from the provision
for substantial compensation (not less than Rs. 10 lakhs for death) and severe
ancillary penalties like license cancellation.
5. Rebutting the High Court on Qualifications
The Court found the Division
Bench’s reading of the MCI’s communication to be “incomplete.” The MCI’s letter
of June 25, 2019, stated clearly that the “minimum qualification required for
the clinical interpretation of echo cardiogram is MD (Medicine)” and concluded
that Dr. Giri “was not entitled to perform and interpret the data.” The Supreme
Court held that the Commission’s reliance on this authoritative communication
was correct. The High Court’s own test of applying the “lowest standard of
skill” further bolstered the Commission’s finding, as Dr. Giri lacked even the minimum
prescribed qualification.
Conclusion and Implication: A
Restored Equilibrium
Consequently, the Supreme Court
allowed the appeal, setting aside the Division Bench’s judgment and restoring
the orders of the Commission and the Single Judge. The compensation of Rs. 20
lakhs was directed to be paid with interest.
Implications for Legal
Practice:
1. Clarity on Forum Selection: Lawyers
representing complainants must carefully plead their case. A complaint focusing
on the hospital’s systemic failure (unqualified staff, lack of transparency,
overcharging) is within the Commission’s jurisdiction. A complaint focusing on
the doctor’s personal breach of professional standard of care must go to the
Medical Council. The same set of facts may give rise to parallel proceedings
before both fora, addressing different legal wrongs.
2. Strategic Litigation: For hospital
administrators and insurers, this judgment underscores the critical importance
of rigorous credential verification of all medical and para-medical staff. A
failure here is not merely an internal HR issue but a statutory “deficiency in
service” exposing the establishment to significant penalties and compensation
under Acts like the WBCE Act.
3. Interpretative Principle: The judgment
reaffirms the principle that the creation of a new regulatory body with specific
powers should not be diluted by conflating its functions with those of existing
bodies, unless the statute explicitly mandates it. The presence of a carve-out
(for medical negligence) implies that all other related powers are retained.
4. Patient-Centric Jurisprudence:
Ultimately, the ruling strengthens the regulatory architecture for patient
protection. It affirms that patients have a right to seek redress for
sub-standard services from an establishment, independent of the lengthy and
technically complex process of proving individual medical negligence before a
professional council.
Kousik Pal v. B.M. Birla Heart
Research Centre thus stands as a significant precedent, meticulously drawing
the jurisdictional lines that empower Clinical Establishment Commissions to
hold healthcare institutions accountable for the foundational standards of
their service, while respectfully leaving the adjudication of professional
ethical breaches to the specialized wisdom of Medical Councils. For the legal
community, it serves as an essential guide through the evolving landscape of
healthcare law and regulatory jurisdiction.
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