Professional Misconduct by Doctors

Key Takeaways

• Professional misconduct by doctors means conduct that violates the ethical, professional or regulatory duties attached to medical practice. It can arise from acts such as taking referral commissions, issuing false certificates, improper advertising, misuse of professional position or violation of ethical regulations.
• The principal ethical framework presently applicable to registered medical practitioners is the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, as amended. The NMC’s 2023 professional conduct regulations were kept in abeyance in August 2023, and the 2002 Regulations were expressly made effective again.
• Professional misconduct and medical negligence are related but different concepts. Misconduct mainly concerns professional discipline and ethics, while negligence concerns breach of the legally required standard of care resulting in harm.
• The list of misconduct contained in the ethical regulations is not exhaustive. Conduct that violates the professional code in letter or spirit may also attract disciplinary proceedings.
• Serious misconduct can result in disciplinary penalties, including temporary or permanent removal of the doctor’s name from the medical register, depending on the nature and gravity of the violation.
• Doctors are expected to maintain medical records, respect confidentiality, prescribe responsibly, avoid commissions and touts, accurately represent qualifications and comply with rules relating to consent, research and professional conduct.
• Courts have also developed important principles governing professional responsibility. In Jacob Mathew v State of Punjab, the Supreme Court explained the standard for medical negligence, while Poonam Verma v Ashwin Patel dealt with a practitioner treating patients in a system of medicine in which he was not qualified.

What Is Professional Misconduct by Doctors?

Professional misconduct by doctors refers to conduct by a registered medical practitioner that breaches the ethical, professional or legal standards governing the medical profession.

Doctors occupy a position involving a high degree of trust. Medical practice involves access to sensitive personal information, authority to prescribe medicines, responsibility for life and health and specialised knowledge that patients generally cannot independently evaluate. For this reason, medical practitioners are expected to comply not only with general law but also with professional standards governing their conduct.

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The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 prescribe standards concerning professional duties, patient care, medical records, advertising, confidentiality, commissions, professional relationships and misconduct.

The broader duties of a medical professional or doctor include obligations relating to competence, patient care, confidentiality, proper prescribing, medical records, professional integrity and compliance with law.

Importantly, professional misconduct is not restricted to a closed list of offences. Regulation 8.1 of the ethical framework recognises that the specified instances of misconduct are not exhaustive. Conduct that violates the ethical code in letter or spirit can therefore also be examined by the competent medical authority.

Which Law Regulates Professional Conduct of Doctors in India?

The present regulatory structure operates primarily under the National Medical Commission Act, 2019 and the ethical regulations governing registered medical practitioners.

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Under Section 27 of the National Medical Commission Act, the Ethics and Medical Registration Board (EMRB) has responsibilities relating to regulation of professional conduct and promotion of medical ethics. The Act also contemplates disciplinary action by State Medical Councils and provides a framework for complaints, grievances and professional or ethical misconduct.

The regulatory position regarding ethical rules requires particular attention.

The NMC notified the National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2023 in August 2023. However, by a notification dated 23 August 2023, those regulations were kept in abeyance with immediate effect.

The same notification clarified that the 2023 Regulations would not remain operative until further Gazette notification and expressly adopted the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 with immediate effect.

Therefore, discussions of professional misconduct must presently take the 2002 ethical regulations into account.

What Acts Amount to Professional Misconduct by Doctors?

Professional misconduct can take several forms. Some violations directly affect patient care, while others concern professional integrity, representation, financial arrangements or misuse of medical status.

Violation of Medical Ethics Regulations

A doctor can be proceeded against for violating the professional conduct and ethical regulations themselves.

This is significant because misconduct does not depend solely on proving that a patient suffered physical injury. Certain behaviour may be professionally improper even where no direct medical injury has occurred.

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For example, taking an unlawful referral commission may amount to professional misconduct even if the patient’s treatment itself was medically appropriate.

Failure to Maintain Medical Records

Medical records are an important part of professional medical practice.

The ethical regulations require physicians to maintain specified records relating to indoor patients for a prescribed period. They also provide for supplying medical records when properly requested by a patient, authorised attendant or legal authority.

Improper refusal, destruction or failure to maintain required medical records may therefore have professional consequences. The distinction between custody of records and a patient’s right of access is also important when determining rights relating to medical records.

Medical records are important because they document diagnosis, investigations, treatment decisions, medicines, procedures and progress of the patient. They may also become essential evidence in negligence proceedings, insurance disputes or regulatory investigations.

Issuing False Medical Certificates

Doctors are frequently authorised to issue medical certificates, fitness certificates, sickness certificates, reports and other documents that may be relied upon by courts, employers, educational institutions, insurers and public authorities.

Issuing a false, misleading or professionally improper certificate can amount to serious misconduct.

A doctor’s signature carries professional credibility. Deliberately certifying facts without proper medical basis can therefore undermine both patient safety and public confidence in the medical profession.

Improper Advertising by Doctors

Medical practitioners are subject to restrictions relating to advertising and solicitation of patients.

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Professional practice is traditionally distinguished from ordinary commercial advertising because patients may be particularly vulnerable to exaggerated claims concerning cures, success rates or qualifications.

Improper self-promotion, misleading claims, solicitation or advertising designed to attract patients contrary to the ethical regulations may attract disciplinary action.

Permissible professional announcements must be distinguished from promotional advertising. Certain limited information relating to commencement of practice, change of address, temporary absence or similar professional matters may be allowed within the regulatory framework.

Taking Commissions or Referral Fees

A doctor must not ordinarily give, solicit or receive a commission, gratuity, bonus or similar benefit in consideration for referring, recommending or procuring patients.

The restriction extends to arrangements involving referrals for treatment, diagnostic services, investigations or specimens.

Such arrangements create a conflict between professional judgment and financial interest. A referral is expected to be based on the patient’s medical requirements rather than the financial benefit available to the referring practitioner.

Using Touts or Agents to Obtain Patients

Medical professionals are prohibited from employing agents or touts for procuring patients.

This rule reflects the principle that medical services should not be marketed through improper patient-procurement practices.

A doctor who financially rewards intermediaries merely for bringing patients may therefore face ethical scrutiny even where the underlying treatment is otherwise proper.

Misrepresenting Medical Qualifications

A doctor must accurately represent professional qualifications.

Claiming to possess a qualification, speciality or expertise that is not actually held can mislead patients while making decisions concerning treatment.

A practitioner should not describe himself or herself as a specialist in a branch of medicine without holding the appropriate recognised qualification required for such representation.

Misrepresentation is particularly serious because patients frequently select doctors based on claimed expertise in a particular specialty.

Can Practising Another System of Medicine Amount to Misconduct?

Practising a system of medicine without the necessary qualification can have serious legal consequences.

The Supreme Court addressed this issue in Poonam Verma v Ashwin Patel.

The practitioner in that case was qualified in homoeopathy but treated the patient with allopathic medicines. The Supreme Court held that a person practising in a field of medicine in which the person was not qualified entered a prohibited field and treated such conduct as negligence per se in the circumstances of the case.

The decision is important because medical registration and qualification are connected to the particular system of medicine in which a practitioner is legally authorised to practise.

Professional competence cannot ordinarily be assumed merely because a person possesses a medical qualification in another system.

Can Improper Prescribing Amount to Professional Misconduct?

Yes. Prescription practices form an important part of professional responsibility.

Doctors are expected to prescribe medicines based on proper medical indications and within the scope of lawful medical practice.

Improper prescription of steroids, psychotropic substances or other regulated medicines without appropriate medical justification can attract ethical as well as statutory consequences.

Similarly, a practitioner cannot use medical status as a means of improperly supplying scheduled drugs, poisons or substances controlled under applicable law.

Prescription authority exists primarily for therapeutic purposes and must be exercised according to professional judgment.

Can Improper Conduct With Patients Amount to Misconduct?

The doctor-patient relationship involves trust, confidentiality and professional boundaries.

A doctor must not misuse the professional relationship for improper purposes. Conduct involving exploitation, abuse of professional authority or improper association with a patient may amount to professional misconduct.

The ethical obligation becomes particularly important because patients may be physically, emotionally or psychologically vulnerable while seeking medical treatment.

Professional boundaries therefore form an essential part of medical ethics.

Is Breach of Patient Confidentiality Professional Misconduct?

Confidentiality is one of the fundamental obligations associated with medical practice.

Doctors routinely receive information concerning diseases, family history, reproductive health, mental health, treatment and other sensitive matters. Such information is generally expected to remain confidential except where disclosure is permitted or required by law.

Unauthorised disclosure may raise questions of professional ethics as well as privacy and other legal rights. However, there are recognised circumstances in which a doctor may disclose a patient’s medical information without consent.

Confidentiality is therefore not absolute. Disclosure may sometimes be required by law, court order, statutory reporting requirements or other recognised circumstances.

The legality of disclosure depends upon the purpose, legal basis and circumstances involved.

Can Research-Related Violations Amount to Misconduct?

Medical research involving human participants must follow ethical standards.

A practitioner participating in clinical research or drug trials is expected to comply with relevant ethical requirements, regulatory provisions and applicable guidelines.

Conducting research without proper ethical safeguards, informed consent or regulatory compliance can expose participants to serious risks and may constitute professional misconduct.

Research obligations are particularly important because the relationship between researcher and participant can involve an imbalance of medical knowledge and decision-making power.

Is Lack of Informed Consent Professional Misconduct?

Consent is a central element of lawful medical treatment.

Patients must generally receive sufficient information to make a meaningful decision about significant procedures. Depending on the treatment involved, this may include information regarding the nature of the procedure, expected benefits, material risks, alternatives and possible consequences.

The question of whether failure to inform a patient about risks amounts to medical negligence depends upon matters such as the significance of the undisclosed risk, the nature of the procedure and the circumstances of treatment.

Certain specialised procedures are subject to more specific consent requirements under medical regulations and other laws.

Failure to obtain legally required consent may lead to civil liability, regulatory consequences or both, depending upon the circumstances.

Not every deficiency in consent automatically results in the same legal consequence. The seriousness of the violation depends upon the procedure, applicable legal requirements and resulting harm.

What Is the Difference Between Professional Misconduct and Medical Negligence?

Professional misconduct and medical negligence should not be treated as identical concepts.

Professional misconduct primarily concerns violation of professional or ethical standards.

Medical negligence concerns breach of the legally required standard of medical care that causes injury or damage.

For example, accepting an unlawful commission for referring a patient may amount to professional misconduct even where no negligent treatment occurs.

Conversely, an allegation that a surgeon failed to exercise reasonable care during an operation primarily raises the issue of medical negligence, although sufficiently serious conduct may also attract disciplinary scrutiny.

The same incident can therefore sometimes result in both negligence proceedings and professional disciplinary proceedings.

What Did the Supreme Court Say in Jacob Mathew v State of Punjab?

Jacob Mathew v State of Punjab is one of the leading Supreme Court decisions on medical negligence in India.

The Court explained that negligence involves breach of a duty resulting in damage. However, professional negligence has to be examined keeping in mind the special nature of professional judgment.

A doctor does not become negligent merely because treatment was unsuccessful or because another medical practitioner might have adopted a different method.

The Court emphasised that medical professionals are expected to exercise a reasonable degree of skill and knowledge and a reasonable degree of care.

For criminal negligence, the threshold is considerably higher. The negligence must be gross or of a very high degree before criminal liability can ordinarily arise.

This distinction protects patients from genuinely negligent medical conduct while also recognising that medical treatment inherently involves professional judgment, uncertainty and risk.

Does Every Medical Error Amount to Misconduct?

No. Every medical error does not automatically amount to professional misconduct or negligence.

Medicine is not an exact science in which every treatment guarantees a particular result. Different qualified practitioners may reasonably choose different treatment options.

An adverse result may occur despite proper medical care.

Therefore, the legal inquiry generally focuses on matters such as:

• Required competence: Whether the practitioner possessed the qualifications, knowledge and professional competence required to undertake the treatment.
• Reasonable care: Whether reasonable professional skill and care were exercised in the circumstances.
• Accepted medical standards: Whether the treatment followed practices accepted within the medical profession.
• Relevant circumstances: Whether appropriate risks, symptoms, investigations and other circumstances were considered while making treatment decisions.
• Professional obligations: Whether the alleged conduct violated an independent ethical or professional duty applicable to the practitioner.

The mere fact that treatment failed is ordinarily insufficient by itself to establish misconduct.

How Are Complaints Against Doctors Investigated?

Complaints involving professional misconduct may be examined by the competent medical regulatory authority. The available mechanisms for complaining against a medical professional depend upon whether the grievance concerns professional misconduct, negligence, compensation or criminal wrongdoing.

Under the existing regulatory framework, State Medical Councils play an important role in disciplinary proceedings against registered medical practitioners. The National Medical Commission framework also assigns responsibilities relating to professional conduct and ethics to the Ethics and Medical Registration Board.

A disciplinary inquiry ordinarily requires compliance with the principles of natural justice.

The doctor against whom allegations are made must be informed of the complaint and given an opportunity to respond. Evidence, medical records, expert material and other relevant documents may be considered before responsibility is determined.

The purpose of such proceedings is not merely to determine whether treatment was unsuccessful but whether the practitioner violated professional standards.

What Punishment Can Be Imposed for Professional Misconduct?

Professional misconduct can result in disciplinary sanctions.

Under the ethical regulations, where misconduct is established after inquiry, the competent Medical Council may impose an appropriate punishment. Depending upon the seriousness of the conduct, this can include removal of the practitioner’s name from the medical register for a specified period or permanently.

Temporary removal effectively prevents the practitioner from exercising the professional privileges attached to registration during the period of suspension.

More serious or repeated misconduct may justify stronger disciplinary action.

The nature of punishment generally depends upon factors such as:

• Seriousness of misconduct: More serious violations affecting professional integrity or patient safety may justify stronger disciplinary action.
• Impact upon the patient: Actual or potential harm caused to the patient can be relevant while assessing the gravity of misconduct.
• Degree of wrongdoing: Deliberate, reckless or repeated violations may be treated differently from isolated or less serious breaches.
• Previous disciplinary history: Earlier findings of misconduct may become relevant where violations are repeated.
• Risk to public safety: Conduct creating a substantial risk to patients or the public may require stricter regulatory intervention.
• Surrounding circumstances: The authority may consider the circumstances in which the violation occurred before determining an appropriate sanction.

Disciplinary action is distinct from compensation, criminal punishment or liability under other statutes.

Can the Same Conduct Lead to Other Legal Proceedings?

Yes. Professional disciplinary proceedings do not necessarily prevent other forms of legal action.

The same incident can potentially give rise to:

• Disciplinary proceedings: Professional or ethical misconduct may be examined by the appropriate medical regulatory authority.
• Civil proceedings: A patient may seek damages where actionable negligence causes injury or loss.
• Consumer proceedings: Medical services may give rise to consumer remedies where the requirements of consumer law are satisfied. The relationship between healthcare services and such remedies is discussed under medical negligence and consumer rights in healthcare.
• Criminal proceedings: Gross or very serious negligent conduct may attract criminal liability where the ingredients of the applicable offence are established.
• Proceedings under specialised laws: Separate consequences may arise under statutes regulating drugs, diagnostic practices, reproductive procedures or other areas of medical practice.

Each form of proceeding serves a different legal purpose and applies its own legal standards.

For instance, disciplinary proceedings focus on professional fitness and ethical responsibility, while a compensation claim focuses primarily on legally actionable injury and loss.

Conclusion

Professional misconduct by doctors covers a broad range of behaviour that is inconsistent with the ethical and professional responsibilities of medical practice. It is not limited to negligent treatment. Improper advertising, commissions, misuse of medical certificates, misrepresentation of qualifications, failure to maintain records, abuse of professional relationships and violations of ethical standards may independently attract disciplinary action.

The present professional ethics framework must also be understood correctly. Although the National Medical Commission introduced new professional conduct regulations in August 2023, those regulations were subsequently kept in abeyance. The NMC expressly restored the operation of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 until further notification.

At the same time, professional misconduct should be distinguished from medical negligence. Decisions such as Jacob Mathew v State of Punjab demonstrate that an unsuccessful treatment or ordinary error does not automatically establish negligence, particularly criminal negligence. On the other hand, Poonam Verma v Ashwin Patel illustrates the serious consequences that can follow when a practitioner enters a system of medicine in which the practitioner lacks the required qualification.

The law therefore attempts to maintain a balance between protecting patients, preserving professional accountability and recognising the specialised judgment involved in medical practice.