After the year 2005, his case has been cited in almost every judgment related to medical negligence. Every physician in India with even a slight interest in medicolegal cases must have heard his name. Amidst the current nationwide discussions on medical negligence, The Pacemakers team reached out to Dr. Jacob Mathew.

Here is  an exclusive interview with Dr. Jacob Mathew where he elaborates on the untold aspects of his historic case.

The Pacemakers: You must have faced great trials and tribulations during your venturesome expedition right from treating Jeevan Lal at MISS BROWN to 2005 till the exculpation particularly voyaging in an entirely uncharted field. How do you feel was the journey?

What was the response of the hospital administration and colleagues? 

Dr Jacob Mathew : That journey was indeed very stressful, emotionally turbulent, financially debilitating and living in the constant company of fear and impending doom. The administration provided the essential support by employing the advocate in the lower court to defend me and lent a sympathetic ear but did not involve themselves any further. Regarding colleagues, a couple of them worked to support me and put me on the right path but the majority had a negative attitude, negative approach and negative effect.

The Pacemakers:  Where do you feel a wide void existed that none of the advocates could explain the terminal stage of Bronchogenic carcinoma and the moribund state of the patient right from the trial court to the 2nd revision court that all acted alike and failed to decipher things, what now we can say, in the right perspective?

Was it a matter of shoddy investigation defective presentation or improper perception? 

Dr Jacob Mathew :  From ‘95 to ‘98 no substantial hearing/collection of evidence had occurred. Since I was on bail I had to present myself for every hearing, 6-7 weeks apart and on most occasions no hearing took place for one reason or the other. For the revision petition the courts relied on the documents from the lower court and did not seem to apply themselves independently to assess the sustainability of the charges. This was contrary to my expectations.

 The Pacemakers: How does it feel when you see that your case has become a beacon of hope and relief for lakhs of Indian doctors, many of whom might have to go through with same trauma had it not been your case.

Dr Jacob Mathew :  First of all, there is an immense sense of gratitude and a very deep respect towards the SC of India and the Honorable Lordships for utilizing my case to uphold the nobility of the medical profession and encourage the society in general to be more responsible and tolerant by not indiscriminately blaming doctors for every untoward medical incident and dragging them to the courts to extract vengeance. Second, yes, there is a lot of happiness and pride that the result of all the efforts for my stressful and humiliating trial has brought a lot of relief and confidence for my fellow-professionals and is always available to provide succor for the unfortunate who are needlessly facing a trial.

The Pacemakers: Government is making law reforms, IPC being reformed into BNS. What are your expectations from government in context of criminal prosecution of doctors in cases of medical negligence.

Dr Jacob Mathew :  This is the most opportune moment to inculcate the guidelines laid down by the SC into the laws which relate to prosecution for criminal medical negligence. 

The Pacemakers: There is still some confusion, one section of media is saying that status for doctors is same, IMA is still hopeful that it will be amended as per the statement of Hon HM. Your comments on the prevailing state of confusion?

 Dr Jacob Mathew :  The government has given legal recognition to the differentiation between civil and criminal negligence which was brought to fore without ambiguity by the SC in the judgment for my case. On the basis of this legal recognition the government has also reduced the term of punishment for criminal medical negligence. These are very positive developments. From what I understand the confusion arose because IMA got the impression that doctors were exempted from criminal prosecution for medical negligence. I believe this confusion arose because the HM was probably touching upon section 88 of IPC which is now section 26 of BNS. This section though general can be used by medical professionals to exclude them from criminal medical negligence proceedings in particular circumstances. The law has not been changed. This is how I understand the situation.

The Pacemakers: Do you think that if there is no fear of criminal prosecution in the minds of doctors, they will serve the society better? Has this fear

changed the way of practice of doctors and doctors have adopted a defensive approach? 

 Dr Jacob Mathew : It is true that the humiliation, stress and damage to well being is much more in criminal than civil prosecution for negligence and a doctor would dread to go through a criminal prosecution. But it is my belief that in a dire situation a doctor is not differentiating between a civil or criminal prosecution. The doctor just wants to avoid any legal harassment.

The possibility of a doctor facing a criminal prosecution for negligence will be very rare if the guidelines of the SC are implemented in letter and spirit. This awareness and reassurance would definitely make a doctor more positive and bolder to serve society better by taking the difficult choice rather than the safe choice. Having said that, the large number of cases under CPA and physical attacks on doctors certainly has led to defensive practice in my opinion

The Pacemakers: You faced the trial for 10 long years; you must have gone through lot of mental trauma. How this case has affected your professional, personal and social life?

Dr Jacob Mathew :  Yes, the mental trauma was tremendous. I was appearing for my final year residency exam and going through bail application and initial trial hearings at the same time. Thereafter, it limited my freedom of choice in place of work, availability to appear for entrance exams and the possibility of obtaining a super specialty degree. During this period and later even after a favorable verdict it was the gossip and personal opinions voiced without verifying facts by medical colleagues which invariably reached ears that could harm your professional career that caused psychological trauma and professional issues. I could never learn to relax. It was not fear or defensive practice rather I was always extra alert for various possibilities in outcome and always took extra precautions to prevent any misunderstanding with patients.

The positive aspect of it was that my communications and relationships with patients was always very clear and my documentation meticulous. In the subconscious the weight of the trial is always on the mind but the immediate few days before and after the trial date the mood and attitude is evidently affected. The most ardent concern is to protect your spouse and especially your young children who are very sensitive to mood changes, in order to keep their life normal and pleasant preventing psychological trauma. I think I chose silence and quietness to stay calm and keep things as normal as possible during these periods. I was an outgoing open person but the effects on my professional and personal life naturally made me withdraw from society at large 

The Pacemakers: Do you think guidelines given by Hon SC in your case are being followed in letter and spirit?

 Dr Jacob Mathew : No the guidelines have not been followed to the best of my knowledge. This instance of differentiating medical negligence by the government in law is a huge step forward and we should use the good will and earnest attitude of the government towards the medical fraternity to get the guidelines implemented 

The Pacemakers: Do you think that guidelines given in your case by Hon SC provide adequate protection to doctors and our associations should try to ensure that these guidelines are implemented in letter and spirit rather than asking for blanket cover against criminal prosecution of doctors in cases of medical negligence?

Dr Jacob Mathew : The SC guidelines have given adequate protection to doctors. These guidelines require that before a doctor can be approached or touched for a criminal negligence complaint/FIR, the court/police have to get a solid reliable medical opinion on the facts of the complaint/case thereby making a prima facie case to proceed with the prosecution. There is no question of arrest unless the doctor will abscond or tamper with evidence. And the SC has reminded the responsible medical professionals that they have to adhere to the Bolam test in formulating their opinion to make a prima facie case. So yes, our associations should be spending all their efforts in ensuring that these guidelines are implemented in letter and spirit rather than asking for a blanket ban. Though my heart would urge a blanket ban the truth is that as an honorable medical community and responsible members of the society we have a moral obligation towards society not to ask for a blanket ban. 

The Pacemakers: What's your message to the society and the system that often fails to differentiate between medical accident/ complication and negligence?

Dr Jacob Mathew :   To blame is human nature and in a moment of bereavement and desperation even more so. But yes society at large has to understand or rather be aware of the terms medical accident/ medical human error/ apart from medical negligence. Negligence is an inflammatory word while accident by itself is more tolerant and accepts that blame may not be appropriate. It also accepts the possibility of human error. The SC in their judgment have been at pains to request the society to be more tolerant and judicious in their use of law and courts to wreck vengeance on doctors. Time and again in the judgment they have reminded the society about the indiscriminate use of courts for this purpose and how it harms the doctor patient relationship, the services rendered by this noble profession and the general tolerant fabric of society. What society has to do in such unfortunate situations is to take a moment, step back and review the circumstances and the decision for litigation. They should then ask themselves the question whether by proceeding for the litigation are they doing so for a higher purpose where they believe that their efforts will make life safer for the society or are they motivated by personal vengeance and gain. If it is the latter then they should consider that there is a very high possibility of destroying a family(not individual) which will in turn harm society. May I add here that in my opinion the media- the reporter on the street, the news reporter, the media talk host- should never use the word medical negligence for every medical incident which comes to light/court. They should use the term only when, and if, the court has given the final verdict upholding negligence civil or criminal. They should use the term medical accident to cover and report the incident. Even when it goes for civil negligence it should be maintained as “ sued for compensation for medical accident/error “ and reserve the term negligence till affirmed by the court. This may go a long way in making people aware of these terms, the fact that every medical incident is not negligence and will bring down the combined subconscious anger in society that the word negligence arouses. The medical fraternity has to reach out and reassure the society that even as it tries to protect the nobility and respect of the profession it will never obstruct justice being imparted to any member of the society. In fact it will ensure that justice is delivered to the society.

(As told to Dr Raj Shekhar Yadav (Editor, The Pacemakers) in a personal conversation)

[The Pacemakers is thankful to Dr Jacob Mathew for this interview]