Quantification of Compensation in Medical Negligence cases: Standards and Methods adopted by the Supreme Court

Transcription

1 Quantification of Compensation in Medical Negligence cases: Standards and Methods adopted by the Supreme Court INTRODUCTION Medicine is of all the arts the most noble but owing to the ignorance of those who practise it, and of those who, inconsiderately, form a judgment of them, it is at present far behind all the other arts. -Hippocrates. Medical Negligence occurs when a medical professional performs their job in a way that deviates from the accepted medical standard of care. The words of Hippocrates still resonate in the Indian statutory provisions in protecting the practitioners of the noble art, while also envisioning the possibility of deviation from the accepted standards by the ignorants who practice it. Ratanlal & Dhirajlal, Law of Torts defines negligence as the breach of a duty caused by the omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs would do, or doing something which a prudent and reasonable man would not do. Actionable negligence consists in the neglect of the use of ordinary care or skill towards a person to whom the defendant owes the duty of observing ordinary care and skill, by which neglect the plaintiff has suffered injury to his person or property. 1 This breach of duty when coupled with the professional nature of medical practice, constitutes medical negligence which attracts liability, civil or criminal depending on the degree of severity and culpability. 1 The Law of Torts, Ratanlal & Dhirajlal (Twenty-fourth Edition 2002, edited by Justice G.P. Singh) (at p )

2 The criminal liability of medical negligence is covered under Section 304A of the Indian Penal Code, It reads as follows: 304A. Causing death by negligence - Whoever causes the death of any person by doing any rash or negligent act not amounting to culpable homicide, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both. The culpability was attracted under the general penal law because the Medical Council of India did not exercise the powers vested in it by the Indian Medical Council Act, 1956 and failed to enforce statutory discipline or procedural guidelines regarding negligence among the medical practitioners. The legitimate public expectation of accountability of the medical practitioners was vitiated. Therefore, civil society found a way of meeting that need by suing medical practitioners under criminal and consumer law. For redressal, before the introduction of Consumer Protection Act, an aggrieved patient or his relatives could seek remedy only by filing a complaint against the doctor for monetary compensation in civil courts. The legal remedies were based on the law of torts and Section 1A of the Fatal Accidents Act, 1855, which reads as follows: 1A. Suit for compensation to the family of a person for loss occasioned to it by his death by actionable wrong - Whenever the death of a person shall be caused by wrongful act, neglect or default, and the act, neglect or default is such as would (if death had not ensued) have entitled the party injured to maintain an action and recover damages in respect thereof, the party who would have been liable if death had not ensued, shall be liable to an action or suit for damages, notwithstanding the death of the person injured and although the death shall have been caused under such circumstances as amount in law to felony or other crime. But to avail the damages through the aforementioned legal routes, an aggrieved patient or his relatives had to wait for years and spend considerable amount of money on litigations. The civil

3 court cases concerning compensation took the route of sub-court, district court, high court and Supreme Court. Alternatively, aggrieved relatives can file a criminal complaint with the police or a private complaint to the judicial magistrate. When a first information report (FIR) is filed against a doctor for the death of a patient who was under his treatment, under the Indian Penal Code (IPC) Section 304-A the doctor can be arrested. If the patient survives and suffers from the effects of alleged grievous injuries sustained during the treatment, the medical practitioner can be framed under either sections of IPC 337 or 338. However, Sections 87, 88, 89 and 92 of the IPC provide immunity from criminal prosecutions to doctors who act in good faith and for the patient s benefit as discussed above due to the very nature of the profession. Redressal under the Consumer Protection Act, 1986 also acts as an alternate, cheap and convenient system of remedy. In 1995, the Supreme Court decision in Indian Medical Association v VP Shantha 2 brought the medical profession within the ambit of a service as defined under section 2(1)(o) of the Consumer Protection Act, AIR 1996 SC 550: (1995) 6 SCC 651

4 CIVIL AND CRIMINAL NEGLIGENCE According to Charlesworth & Percy on Negligence 3, in current forensic speech, negligence has three meanings. They are: (i) a state of mind, in which it is opposed to intention; (ii) careless conduct; and (iii) the breach of duty to take care that is imposed by either common or statute law. The essential elements to constitute negligence, hence, would be duty, its breach, and resulting damage. Lord Atkin 4 while propounding on the subject stated that the element of criminality is introduced by the accused having run the risk of doing such an act with recklessness and indifference to the consequences. Simple lack of care that will constitute civil liability is not enough; for purposes of the criminal law there are degrees of negligence; and a very high degree of negligence is required to be proved before the felony is established. The degree of skill and care required by a medical practitioner is so stated in Halsbury's Laws of England 5. It states that the practitioner must bring to his task a reasonable degree of skill and knowledge, and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence, judged in the light of the particular circumstances of each case, is what the law requires, and a person is not liable in negligence because someone else of greater skill and knowledge would have prescribed different treatment or operated in a different way; nor is he guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art, even though a body of adverse opinion also existed among medical men. In February 2004, in Mohanan vs Prabha G Nair 6, a bench of the Supreme Court held that quashing the complaint by the high court at threshold where culpability could be established only on a proper analysis of expert evidence adduced by the complainant is not justified. It also held 3 10th Edition Andrews v. Director of Public Prosecutions, [1937] A.C (Fourth Edition, Vol.30, Para 35) 6 8 (2004) 3 SCC 391: AIR 2004 (SC) 1719; 1 (2004) CPJ 21 (SC)

5 that negligence of a medical practitioner could be ascertained only by scanning the material, if any, and expert evidence. However, in August 2004, in Dr Suresh Gupta vs Government of NCT of Delhi 7, the apex court reversed its earlier order in Mohanan's case. A bench of the Supreme Court held that for fixing criminal liability under Section 304A of IPC on a doctor or surgeon, the standard of negligence required to be proved should be so high as can be described as "gross negligence" or recklessness", and it is not merely lack of necessary care, attention and skill. But it was contended that the words - "gross, reckless, competence and indifference" - did not occur anywhere in the definition of "negligence" under Section 304A of the IPC. In August 2005, a three member bench of the Supreme Court in Jacob Mathew vs State of Punjab 8 reaffirmed the principles of law laid down in Suresh Gupta's case. In this case, the apex court dealt with the liability of a medical practitioner in criminal law and discussed the law of medical negligence in detail and indicated the parameters of fixing liability. Further, it highlighted the distinction between the concept of negligence in civil law and negligence in criminal law. The Hon ble Supreme Court 9 has iterated in the aforementioned case that with the awareness in the society and the people in general gathering consciousness about their rights, actions for damages in tort are on the increase. Not only civil suits are filed, the availability of a forum for grievance redressal under the Consumer Protection Act, 1986 having jurisdiction to hear complaints against professionals for 'deficiency in service' Criminal complaints are being filed against doctors alleging commission of offences punishable under Section 304A or Sections 336/337/338 of the IPC alleging rashness or negligence on the part of the doctors resulting in loss of life or injury (of varying degree) to the patient. The court in the aforementioned case also proposed to deal with the issues of determining the nature of medical negligence cases in the interests of settling the law. Mainly, the submissions made by the learned counsel for the parties and the intervenors centred around two issues (i) Is there a difference in civil and criminal law on the concept of negligence?; and 7 9 J T 2004 (6) SC 238: (2004) 6 SCC 422; AIR 2004 (SC) (crl.) of ibid

6 (ii) whether a different standard is applicable for recording a finding of negligence when a professional, in particular, a doctor is to be held guilty of negligence? The well established legal position is that where there is a proven case of medical negligence on the part of the medical practitioner, he/she shall be liable to pay compensation under civil law or law of torts. To attract culpability under criminal law, the degree of negligence is to be so gross and his act was reckless as to endanger the life of the patient. The liability would be made out under section 304A of Indian Penal Code. The House of Lords in R. Vs. Adomako 10 while elucidating the legal principle in favour of medical practitioners made the following observations in fixing criminal liability on them :- "Thus a doctor cannot be held criminally responsible for patient's death unless his negligence or incompetence showed such disregard for life and safety of his patient as to amount to a crime against the State." Thus, when a patient agrees to go for medical treatment or surgical operation, every careless act of the medical man cannot be termed as 'criminal'. It can be termed 'criminal' only when the medical man exhibits a gross lack of competence or inaction and wanton indifference to his patient's safety and which is found to have arisen from gross ignorance or gross negligence. Where a patient's death results merely from error of judgment or an accident, no criminal liability should be attached to it. Mere inadvertence or some degree of want of adequate care and caution might create civil liability but would not suffice to hold him criminally liable. 11 To sum up, a patient who alleges medical negligence can resort to any of the following legal remedies depending on the severity of the act in question: (a) Complaining to the State Medical Council, (b) filing a case before a consumer court, (c) filing a case before a civil court, and (d) filing a criminal complaint citing gross negligence [1995] 1 A.C Dr. Suresh Gupta vs Govt. Of N.C.T. Of Delhi & Anr Appeal (crl.) 778 of Mamdani B. Medical malpractice. Indian J Med Ethics. 2004;12:57 8.

7 And the victim of medical negligence intending to sue the medical professional or the facility has the following options: a) Compensatory action: seeking monetary compensation before the Civil Courts, High Court or the Consumer Dispute Redressal Forum under the Constitutional Law, Law of Torts/Law of Contract and the Consumer Protection Act. b) Punitive action: filing a criminal complaint against the doctor under the Indian Penal Code. c) Disciplinary action: moving the professional bodies like Indian Medical Council/State Medical Council seeking disciplinary action against the health care provider concerned. d) Recommendatory action: lodging complaint before the National/State Human Rights Commission seeking compensation.

8 CALCULATION OF COMPENSATION AND METHODOLOGY USED BY THE SUPREME COURT The basis of calculating the compensation in such cases is the legal principle of restitution in integrum. The said principle provides that a person entitled to damages should, as nearly as possible, get that sum of money which would put him in the same position as he would have been if he had not sustained the wrong. When a death occurs the loss accruing to the dependent must be taken into account; the balance of loss and gain to him must be ascertained; the position of each dependent in each case may have to be considered separately 13. While a person can be restored to his original position in terms of monetary losses, some damages like loss of life or limb seems incalculable in terms of money. Hence while fixing an amount of compensation payable to a victim of an accident, the damages can be assessed as pecuniary damages and special damages. Pecuniary damages are those which the victim has actually incurred and which is capable of being calculated in terms of money, whereas nonpecuniary damages are those which are incapable of being assessed by arithmetical calculations. In order to appreciate two concepts pecuniary damages may, include expenses incurred by the claimant: (i) medical attendance; (ii) loss of earning of profit upto the date of trial; (iii) other material loss. So far non-pecuniary damages are concerned, they may include (i) damages for mental and physical shock, pain suffering, already suffered or likely to be suffered in future; (ii) damages to compensate for the loss of amenities of life which may include a variety of matters i.e. on account of injury the claimant may not be able to walk, run or sit; (iii) damages for the loss of expectation of life, i.e. on account of injury the normal longevity of the person concerned is shortened; 13 Malay Kumar Ganguly vs Sukumar Mukherjee & Ors CRIMINAL APPEAL NOS OF 2005

9 (iv) inconvenience, hardship, discomfort, disappointment, frustration and mental stress in life. 14 While discussing the nature of non pecuniary losses, Halsbury's Laws of England 15 states that the damages awarded for pain and suffering and loss of amenity constitute a conventional sum which is taken to be the sum which society deems fairn being interpreted by the courts in the light of previous decisions. Thus there has been evolved a set of conventional principles providing a provisional guide to the comparative severity of different injuries, and indicating a bracket of damages into which a particular injury will currently fall. The particular circumstances of the plaintiff, including his age and any unusual deprivation he may suffer, is reflected in the actual amount of the award. The fall in the value of money leads to a continuing reassessment of these awards and to periodic reassessments of damages at certain key points in the pattern where the disability is readily identifiable and not subject to large variations in individual cases. No amount of compensation can restore the physical frame of the appellant. That is why it has been said by courts that whenever any amount is determined as the compensation payablefor any injury suffered during an accident, the objectis to compensate such injury "so far as money can compensate" because it is impossible to equate the money with the human sufferings or personal deprivations. Money cannot renew a broken and shattered physical frame. In its very nature whenever a Tribunal or a Court is required to fix the amount of compensation in cases of accident, it involves some guess-work, some hypothetical consideration, some amount of sympathy linked with the nature of the disability caused. But all the aforesaid elements have to be viewed with objective standards. When compensation is to be awarded for pain and sufferingand loss of amenity of life, the special circumstances of the claimant have to be taken into account including his age, the unusual deprivation he has suffered, the effect thereof on his future life. The amount of 14 Mr. R.D. Hattangadi vs M/S Pest Control (India) Pvt. Ltd AIR 755, 1995 SCC (1) Halsbury's Laws of England, 4th Edition, Vol.12, pg 446

10 compensation for non-pecuniary loss is not easy to determine but the award must reflect that different circumstances have been taken into consideration. 16 The supreme court has noted that the lack of uniformity and consistency in awarding compensation has been a matter of grave concern. If different tribunals calculate compensation differently on the same facts, the claimant, the litigant, the common man will be confused, perplexed, and bewildered. If there is significant divergence among tribunals in determining the quantum of compensation on similar facts, it will lead to dissatisfaction and distrust in the system. 17 The nature of quantification of compensation and reasoning of the same can be better appreciated by an analysis of judgements of the Hon ble Supreme Court on the subject of medical negligence. The Supreme Court observed in the case of IMA vs. V.P. Shanta and Ors. 18, as follows: A patient who has been injured by an act of medical negligence has suffered in a way which is recognized by the law and by the public at large as deserving compensation. This loss may be continuing and what may seem like an unduly large award may be little more than that sum which is required to compensate him for such matters as loss of future earnings and the future cost of medical or nursing care. To deny a legitimate claim or to restrict arbitrarily the size of an award would amount to substantial injustice. After all, there is no difference in legal theory between the plaintiff injured through medical negligence and the plaintiff injured in an industrial or motor accident. While deciding on a medical negligence case involving deviation from standard procedure which rendered the child blind for life, the Supreme Court in V. Krishnakumar vs State Of Tamil Nadu & Ors. 19 held that the negligence would affect the victim s education, career, as well as marriage prospects. She would need additional medical expenses and support for life, which was also 16 Supra note Sarla Verma vs. Delhi Transport Corporation (2009) 6 SCC III (1995) CPJ I (SC) 19 III(2015)CPJ 15 SC

11 considered while computing the quantum of compensation. The court recognised the time value of money and propounded upon the inflatory principle in this case. The apex court stated that Inflation over time certainly erodes the value of money. In the present case we are of the view that this inflationary principle must be adopted at a conservative rate of 1 percent per annum to keep in mind fluctuations over the next 51 years. The victim s present age is about 18 ½ years. If her life expectancy is taken to be about 70 years, for the next 51 years, the amount of expenditure, at the same rate will work out to Rs. 82,95,048/-. It is therefore imperative that we account for inflation to ensure that the present value of compensation awarded for future medical costs is not unduly diluted, for no fault of the victim of negligence. The formula to compute the required future amount is calculated using the standard future value formula:- FV = PV x (1+r)n PV = Present Value r = rate of return n = time period Accordingly, the amount arrived at with an annual inflation rate of 1 percent over 51 years is Rs.1,37,78, rounded to Rs.1,38,00,000/-. The liability was Rs 1,30,00,000 (State of Tamil Nadu and Hospital) and Rs 8,00,000 by the doctors. Further, the amount of Rs 42,87,921 in lieu of past medical expenses was ordered to be paid to the complainant. The Supreme Court while mooting on the quantum of compensation in case of motor vehicle accidents, elucidated upon the calculation with respect to the various considerations arising in the case and the concept of multiplier method in the case of Sarla Verma & Ors vs Delhi Transport Corp.& Anr 20. The tribunal deducted one-third towards the personal and living expenses of the deceased, and arrived at the contribution to the family as Rs.2250 per month (or Rs.27,000/- per annum). age of retirement was 60 years thus the period of service lost on account of the untimely death was 22 years. Therefore it applied the multiplier of 22.On appeal, The Delhi High Court stated that having regard to the fact that the deceased had 22 years of service left at the time of death and would have earned annual increments and pay revisions during that period, it held that the salary would have at least doubled by the time he retired. Only one fourth should be deducted towards 20 CIVIL APPEAL NO 3483 OF 2008

12 personal and living expenses of the deceased, instead of the standard one-third deduction. Having regard to the age of the deceased, the High Court chose the multiplier of 13. The Supreme Court finally decided one-fifth to be deducted as the personal and living expenses of the deceased. The multiplier will be 15 having regard to the age of the deceased at the time of death. The case also threw light on what could be considered just compensation. The judgement stated: Compensation awarded does not become 'just compensation' merely because the Tribunal considers it to be just Just compensation is adequate compensation which is fair and equitable, on the facts and circumstances of the case, to make good the loss suffered as a result of the wrong, as far as money can do so, by applying the well settled principles relating to award of compensation. It is not intended to be a bonanza, largesse or source of profit Assessment of compensation though involving certain hypothetical considerations, should nevertheless be objective. Justice and justness emanate from equality in treatment, consistency and thoroughness in adjudication, and fairness and uniformity in the decision making process and the decisions. The court also expressed its dissatisfaction with the non uniform approach in providing compensation. It stated that if there is significant divergence among Tribunals in determining the quantum of compensation on similar facts, it will lead to dissatisfaction and distrust in the system. In the Supreme Court judgement of Malay Kumar Ganguly vs Sukumar Mukherjee 21 directed the commission to establish the quantum of compensation where one, Anuradha Saha died due to the contributory negligence of Dr. Balram Prasad, Dr. Sukumar Mukherjee and Dr. Baidyanath Haidar. The compensation awarded after 15 years of litigation amounted to nearly 6 crore rupees with interest. Accordingly, in Dr. Kunal Saha vs Dr. Sukumar Mukherjee 22, the National Consumer Disputes Redressal in its voluminous judgement decided upon adequate compensation in case of medical negligence. The Supreme Court while remitting the matter to this Commission for the purpose of determination of compensation has itself to a great extent afforded the guidelines by 21 Supra note III (2006) CPJ 142 NC

13 making reference to a number of decisions of the Supreme Court which have great bearing on the question. The principles discussed in various cases are stated below. In Oriental Insurance Company Limited v. Jashuben and Ors 23, the Supreme court took cognizance of factors like the income at the time of death, the pay scale and the increments accordingly. One third of the payment was deducted as expenses on self and a multiplier of 13 was adopted. The court stated that indisputably, grant of compensation involving an accident is within the realm of law of torts. It is based on the same principle of restitution in integrum. When a death occurs the loss accruing to the dependent must be taken into account; the balance of loss and gain to him must be ascertained ; the position of each dependent in each case may have to be considered separately. The said principle has been applied by this Court in Gobald Motor Service Ltd. v. R.M.K. Veluswami 24. In R.D. Hattangadi v. Pest Control (India) (P) Ltd. 25 the court discussed the losses as being pecuniary damages and special damages. In addition to the above decisions referred in the Supreme Court judgment, the counsel for the parties have relied upon some more cases having bearing on the question of determination of compensation under the provisions of Motor Vehicle Act. It was contended that for determining the compensation in the cases arising out of negligence of medical professional or medical centres like hospitals, institutes and Nursing Homes by and large the principle and criteria laid down by the Supreme Court in relation to the cases arising out of the claim of compensation under Motor Vehicle Act has been generally adopted as the basis. The court held that The multiplier method was provided for convenience and speedy disposal of no fault motor accident cases. Therefore, obviously, a "no fault" motor vehicle accident should not be compared with the case of death from medical negligence under any condition. The aforesaid approach in adopting the multiplier method to determine the just compensation would 23 [(2008) 4 SCC 162] AIR, SCR (1) Supra note 14.

14 be damaging for society for the reason that the rules for using the multiplier method to the notional income of only Rs.15,000/- per year would be taken as a multiplicand. In case, the victim has no income then a multiplier of 18 is the highest multiplier used under the provision of Ss. 163 A of the Motor Vehicles Act read with the Second Schedule. Therefore, if a child, housewife or other non-working person fall victim to reckless medical treatment by wayward doctors, the maximum pecuniary damages that the unfortunate victim may collect would be only Rs.1.8 lakh. It is stated in view of the aforesaid reasons that in today's India, Hospitals, Nursing Homes and doctors make lakhs and crores of rupees on a regular basis. Under such scenario, allowing the multiplier method to be used to determine compensation in medical negligence cases would not have any deterrent effect on them for their medical negligence but in contrast, this would encourage more incidents of medical negligence in India bringing even greater danger for the society at large. Therefore, estimating the life expectancy of a healthy person in the present age as 70 years, we are inclined to award compensation accordingly by multiplying the total loss of income by 30. The court stated that there exists no straight jacket formula for apportionment of the awarded compensation amongst various doctors and hospitals when there are so many actors who are responsible for negligence and the apportionment has to be made by evolving a criteria / formula which is just going by the nature and extent of medical negligence and deficiency in service established on the part of different doctors and hospitals. On a consideration of the entirety of the facts and circumstances, evidence and material brought on record, we hold that overall compensation on account of pecuniary and non pecuniary damages works out to Rs.5,96,00,000/-

15 MULTIPLIER METHOD Division of opinion to use the method in case of medical negligence. The defendants in most medical negligence cases assert that the method of determining compensation ought to be the multiplier method, a method generally used for calculating compensation in cases of motor vehicles accidents. The principle argument for adopting the method is that it provides for a uniform and predictable quantum for compensation, a straight jacket formula to calculate the damages incurred. The method is adopted in case of motor vehicle accident cases to facilitate the no fault liability scenario and thus it accounts for the loss of income of the victim only. This sum is calculated by taking into account the multiplicand, that is, the victim's salary minus the amount he spends on himself, and the multiplier, that is, the total number of years that the victim would have earned his salary. The multiplier is calculated by taking into account, average life expectancy, the victim's age, the number of years that the victim will be unemployed, and any other factors concerning the victim's health. Defendants assert that this is the figure that will adequately calculate the loss incurred, and therefore it should be utilized in cases of medical negligence. However, compensation that is solely based on the income of the victim would imply that medical negligence causing death or injury to a wealthy individual is worth more than medical negligence that impacts an unemployed individual or homemaker or a child or senior citizen. The Supreme Court has, therefore, refused to restrict compensation to the multiplier method in the case of medical negligence. 26 Further, the Supreme Court has added other dimensions to the calculation of compensation such as the medical costs incurred by the victim during the litigation, cost of future medical expenses, compensation toward mental agony and physical pain, and compensation toward loss of consortium and cost of litigation. 26 Balram Prasad vs. Kunal Saha, (2014) 1 SCC 384.

16 The Supreme court is of the view that medical negligence cannot be treated at par with accident cases and hence the no fault liability, straight jacket formula principle cannot be attributed to it. The apex court iterated this in the Nizam Institute case 27. It stated that the learned counsel for the respondent has, further, submitted that the proper method for determining compensation would be the multiplier method. We find absolutely no merit in this plea. The kind of damage that the complainant has suffered, the expenditure that he has incurred and is likely to incur in the future and the possibility that his rise in his chosen field would now be restricted, are matters which cannot be taken care of under the multiplier method. CONCLUSION The concept of medical negligence is deeply ingrained in the law of torts. The monetary compensation can be sought through the civil channels like consumer forums or civil courts. Criminal liability can only be attributed when there is a prima facie case of gross negligence and recklessness due to the inherent nature of the profession. The interpretation of several prior cases can be effectively used to form principles propounding the quantum of compensation in cases of medical negligence to reduce the presently faced obstacles of uncertainty and non uniformity in the awarding of damages. While the traditional legal course often tends to be an expensive and arduous endeavour, the consumer protection act provides for an inexpensive, convenient and speedy alternative in adjudicating cases of such nature. In the case of Jacob Matthew, the Supreme Court stated the principles for the prosecution of medical professionals. The Court stated that, as we have noticed hereinabove that the cases of doctors (surgeons and physicians) being subjected to criminal prosecution are on an increase. Sometimes such prosecutions are filed by private complainants and sometimes by police on an FIR being lodged and cognizance taken. The investigating officer and the private complainant cannot always be supposed to have knowledge of medical science so as to determine whether the act of the accused medical professional amounts to rash or negligent act within the domain of 27 Nizam Institute of Medical Sciences v Prasanth S. Dhananka and Others SC 1047; (2009) 6 SCC

17 criminal law under Section 304-A of IPC. The criminal process once initiated subjects the medical professional to serious embarrassment and sometimes harassment. He has to seek bail to escape arrest, which may or may not be granted to him. At the end he may be exonerated by acquittal or discharge but the loss which he has suffered in his reputation cannot be compensated by any standards. We may not be understood as holding that doctors can never be prosecuted for an offence of which rashness or negligence is an essential ingredient. All that we are doing is to emphasize the need for care and caution in the interest of society; for, the service which the medical profession renders to human beings is probably the noblest of all, and hence there is a need for protecting doctors from frivolous or unjust prosecutions. Many a complainant prefers recourse to criminal process as a tool for pressurizing the medical professional for extracting uncalled for or unjust compensation. Such malicious proceedings have to be guarded against 28. As far as quantification of compensation is concerned, the court adopts the principle of restitution in integrum and tries to award a compensation that can be considered as a just and adequate compensation depending upon the facts of the case. The Supreme Court in awarding the said just and adequate compensation relies on various principles laid down in several cases in the past and applies them in case to case basis. Providing for a strait jacket formula for compensating in medical negligence cases would be deterrent to the very nature of the objective of the court proceedings. 28 Supra note 8