Law of Torts
Compensation in Medical Negligence, and Why the Compensation and Disciplinary Proceedings Run Independently
The principle is restitutio in integrum, applied to consequences that last a lifetime. Where medical negligence leaves a young person disabled, the award has to provide for future medical care, lost earnings and the cost of attendants and equipment over decades, which is why the leading awards are large. Nizam's Institute of Medical Sciences v. Prasanth S. Dhananka is the standing authority on the approach, and V. Krishnakumar on computing future expenses with an allowance for inflation. Separately, Kousik Pal v. B.M. Birla Heart Research Centre, decided in December 2025, confirms that the power to award compensation is separate and distinct from the disciplinary power of the State Medical Council.
The heads of compensation, the two leading awards, the 2025 decision, and the two proceedings
1. The Heads of Compensation
The head | What it covers |
Past medical expenses | Proved by the bills and vouchers, from the date of the negligence to the date of the award |
Future medical expenses | The cost of continuing treatment, surgery, therapy and medication, capitalised and with an allowance for inflation |
Loss of earnings, past | Earnings actually lost between the injury and the award |
Loss of earning capacity, future | Computed on the multiplier method where the disability reduces or destroys the capacity to earn |
Attendants, equipment and modifications | The cost of an attendant where the disability requires one, of a wheelchair or prosthesis, and of modifying a house or vehicle |
Pain, suffering and loss of amenity | A conventional sum for the non pecuniary consequences |
Loss of marriage prospects and of expectation of life | Where the disability has that effect |
In a fatal case, the dependants' loss | Under the ordinary principles governing a dependency claim |
2. The Leading Indian Award
📖 Nizam's Institute of Medical Sciences v. Prasanth S. Dhananka, (2009) 6 SCC 1 Facts The respondent, a young engineering student in his twenties, underwent surgery at the appellant institute for a tumour in the chest. The surgery was performed without the assistance of a cardio thoracic surgeon and without adequate preparation. He sustained damage to the spinal cord and was left permanently paraplegic, requiring lifelong care. Held The institute was negligent. The Supreme Court awarded compensation of approximately one crore rupees. Ratio In assessing compensation for a permanent and total disability the court should consider each head separately, take a broad and realistic view of what the claimant will actually need over his lifetime, and not be niggardly. The award must provide for future medical expenses, attendant care, equipment and loss of earning capacity over the whole of the expected period, and a figure that fails to do so is not compensation at all. |
📖 V. Krishnakumar v. State of Tamil Nadu, decided 1 July 2015 Facts A premature infant, born at about twenty nine weeks and weighing around 1250 grams, was not screened for retinopathy of prematurity during the critical period after birth, contrary to the established protocol for infants in that category. The condition progressed and the child was left permanently blind. Held The State, the government hospital and the treating doctors were negligent and liable. Compensation was awarded covering past and future medical expenses and the consequences of the disability. Ratio Where an established screening protocol exists for a high risk category of patient, a failure to follow it is negligence, and the resulting harm is foreseeable. Compensation follows the principle of restitutio in integrum, and future medical expenses must be computed with an allowance for inflation, since an award based on today's costs will not meet tomorrow's. |
3. The December 2025 Decision
📖 Kousik Pal v. B.M. Birla Heart Research Centre, 2025 INSC 1487, decided 20 December 2025 Facts The appellant's mother was admitted to the respondent hospital in May 2017. After five days without improvement she was transferred to another hospital, the discharge summary describing her condition as stable. She died approximately sixteen hours after the transfer. The appellant complained of medical negligence, and the question arose as to the respective jurisdictions of the State commission and the State Medical Council. Held The Court restored the Commission's findings and directed payment of compensation within eight weeks with interest. Ratio The power to grant compensation is separate and distinct from the power of the State Medical Council to examine medical negligence, and the exercise of the one does not interfere with the other. Deficiency in service and medical negligence are distinguishable concepts, and a body examining deficiency in the service provided is not thereby trespassing on the Council's function. Further, merely stating that a patient was erroneously described as stable cannot and should not absolve the concerned doctor of responsibility, proper disclosure of the patient's actual precarious condition being required. |
4. The Two Proceedings Compared
Compensation proceedings | Medical Council proceedings | |
The forum | A civil court, or a consumer commission at district, State or national level | The State Medical Council, and the national body on appeal |
Who initiates | The patient or his representatives | A complainant, or the Council of its own motion |
The object | To compensate the patient for his loss | To discipline the practitioner, protecting the public and the profession |
The question asked | Was there negligence or deficiency in service, and what loss followed? | Was there professional misconduct? |
The standard | The balance of probabilities | As the Council's regulations provide |
The remedy | Money | Censure, suspension, or removal from the register |
Effect of one on the other | None. The two are separate and distinct: Kousik Pal (2025) |
- Negligence and misconduct are not the same thing. A single careless act may cause serious harm and yet not amount to professional misconduct; and conduct may be grave misconduct without causing any loss to any patient.
- So a practitioner may be liable to compensate and not disciplined, or disciplined and not liable, and neither outcome is an answer in the other forum.
- A finding in one is not res judicata in the other, though it may be admissible evidence.
5. Medical Negligence Resulting in Disability or Death
- Where the negligence results in permanent disability, the largest heads are future medical expenses, attendant care and loss of earning capacity. Nizam's Institute is the guide, and the approach is to assess each head realistically over the expected lifetime.
- Where the claimant is young, the multiplier is high and the award correspondingly large, because the loss runs for decades.
- Where the negligence results in death, the claim is for the dependants' loss, computed on the ordinary principles of a dependency claim: the deceased's income, the deduction for personal expenses, the multiplier by reference to age, and the conventional sums for loss of consortium, loss of estate and funeral expenses.
- Interest runs on the award, and the courts commonly direct payment within a fixed period with interest on default, as in Kousik Pal.
- And the award must be realistic. A figure that leaves the claimant unable to meet the costs the negligence created is not compensation, which is the point Nizam's Institute makes in terms.
6. Why the Separation of Proceedings Matters
⚠ Each forum answers its own question It is tempting to treat the Medical Council as the body best placed to decide whether a doctor was negligent, and to treat its finding as decisive of the compensation claim. The Supreme Court in Kousik Pal rejected that approach, and the reason is that the two bodies are answering different questions. The Council asks whether the practitioner should continue to practise, and its concern is the protection of the public and the standards of the profession. The commission or court asks whether this patient has suffered a loss for which the law gives him compensation, and its concern is the patient in front of it. A practitioner may have done something regrettable that harmed a patient badly without having shown himself unfit to practise; and a practitioner may be unfit to practise for reasons that harmed nobody. Making either forum wait on the other would delay both, and would subordinate the patient's claim to a process in which he is not even a party. |
7. The Position Stated Shortly
1. The principle is restitutio in integrum, applied to consequences that may last a lifetime.
2. The heads are past and future medical expenses, loss of earnings and earning capacity, attendant care and equipment, and pain, suffering and loss of amenity.
3. Nizam's Institute of Medical Sciences v. Prasanth S. Dhananka awarded about one crore rupees to a young man left paraplegic after chest surgery.
4. The approach there is to assess each head separately, take a broad and realistic view, and not be niggardly where the disability is total and lifelong.
5. V. Krishnakumar v. State of Tamil Nadu holds that a failure to follow an established screening protocol is negligence, and that future expenses must allow for inflation.
6. Kousik Pal v. B.M. Birla Heart Research Centre, 2025 INSC 1487, decided 20 December 2025, holds that the power to grant compensation is separate and distinct from the power of the State Medical Council.
7. Deficiency in service and medical negligence are distinguishable concepts, and a body examining the former is not trespassing on the Council's function.
8. Describing a patient in a precarious condition as stable cannot absolve the doctor of responsibility.
9. A finding in one proceeding does not conclude the other, because negligence and professional misconduct are different questions.
10. In a fatal case the claim is for the dependants' loss, computed on the ordinary dependency principles.