In the intense, emotionally charged critical care units—including Intensive Care Units (ICUs), Neonatal ICUs (NICUs), Pediatric ICUs (PICUs), and Emergency Departments (ERs)—medical professionals are rendering care to the most vulnerable, fragile and critically ill patients.
Critical care units are designed for patients who are at imminent risk of death or organ failure. In such emotionally charged and medically demanding scenarios, clinical decisions are made in seconds, information, under immense physiological, emotional, and systemic pressures.
In such settings, adverse outcomes are an unfortunate but expected possibility, even when care is delivered with precision and compassion. This reality often collides with public perception, where any unfavorable outcome is sometimes mistakenly seen as a result of medical negligence.
The confusion between medical complications and medical negligence is not merely academic—it has serious implications for doctor-patient trust, legal proceedings, media narratives, and the morale of healthcare professionals. Clarifying this distinction is essential.
Majority of patients who are admitted to critical care areas always have a serious illness. The shifting of patient to critical care parse vindicates that there are only 50 percent chances of survival and even who survive may live with disabilities.
The people have to understand that the conditions for which a patient is shifted and managed in critical care often are very sick and are in state of complex pathophysiological state, are generally unstable, compromised. Such situations usually demand highly invasive interventions such as mechanical ventilation, dialysis, or central lines, invasive pressure monitoring of systemic, lung and brain pressures.
While every step in critical areas is guided by established evidence-based standard treatment protocols, not all complications are preventable, and not every deterioration is due to error, and even patients die after receiving optimal treatment, which is one of the expected outcome and must be also an accepted outcome to the people.
The people must now understand it is wrong to say that death keeps no calendar; it is other way right death keeps its own calendar and no level of medical intervention whatsoever can delay it.
While handling a critically ill patient, who invariably demands medical, invasive, interventions, medical complications are bound to happen and such complications are unintended, though harmful events and may sometimes prove fatal.
Such unintentional harmful events does not qualify to Medical negligence, which is a legal term that involves:
- Breach of Duty – The provider did not responded (e.g., ignored a deteriorating vitals trend, did not follow a protocol).
- Causation – This failure directly caused harm (not just coincidentally).
- Damage – There is demonstrable harm (e.g., disability, death, prolonged hospitalization)
Citing an example of medical negligence is that administering a drug to which the patient is known to be allergic, without due verification. Failure to act on a dangerously dipping oxygen saturation. Discharging a neonate with persistent hypoglycemia without adequate workup and stabilization of blood sugars. Overlooking an obvious airway obstruction or delay in initiating CPR.
However, underlying scenarios are not Medical Negligence:
- A child with septic shock dies despite fluid resuscitation, antibiotics, and vasopressors
- A neonate with Grade 4 IVH develops hydrocephalus despite optimal care.
- A patient with massive stroke, heart attack, pulmonary embolism collapses during thrombolysis, even though all guidelines were followed.
- A patient develops severe known or unknown complication to drug.
The established fact of medical science is that a patient can develop severe allergy reaction to a drug used to treat allergy and severe suffocation and breathlessness to a drug used to actually treat the condition, what is known as pharmaco-genetics.
There should be no confusion between medical negligence and medical complications. What matters is Intent and context in this particular matter. If all reasonable steps were taken, the occurrence of a poor outcome is considered a medical complication—not negligence.
The major confusion in this scenario is created by sensational headlines in daily news papers often equating every death with doctor’s fault or systematic failure of hospital. Further Social media fuels outrage without access to facts or context. Such irresponsibility many a times result in Criminal prosecution of doctors, especially in India, sometimes happens without full medical investigation. Courts and regulatory bodies around the world recognize the difference between medical risk and recklessness.
The Supreme Court of India has emphasized:
“A doctor cannot be prosecuted for negligence merely because something went wrong. Only gross negligence or recklessness amounts to criminal culpability.” — Jacob Mathew vs. State of Punjab, 2005.
In modern critical care, systems are built to prevent, detect, and manage complications swiftly. There are laid down standard management protocols, which are foundation of any critical care system.
When a critically sick patient, due to any reason like road traffic accident, severe burn, poisoning, respiratory failure, heart failure, stroke, kidney failure, status asthamticus, status epilepticus, post operative patients, shock get admitted in to critical care, framed evidence based protocols are implemented within a golden minute, without estimating the final outcome. The intention of critical care teams is vividly clear to save a precious life at any cost, with any morbidity.
Yet, even flawless implementation doesn’t guarantee success. Many conditions evolve faster than our ability to reverse them. In some cases, medical science has simply not advanced far enough.
At last it is also very imperative for people at helm of affairs at any level to keep delivering systems upgraded with adequate man and machinery power, troubleshoot and upgrade the equipment and gadgets.
Good ICU care is not about perfect individuals—it’s about strong systems.
Medicine is an imperfect science practiced under uncertain conditions. In critical care, outcomes are dictated by many factors—some within, but many beyond, human control. While accountability is essential, punishing medical professionals for complications may lead to defensive medicine, poor morale, and hesitancy in life-saving interventions.
The bottom line is to move toward a healthcare system where justice, empathy, and evidence coexist—where professionals are supported, patients are respected, and truth prevails over fear.
(Author is Senior Pediatrician at Children’s Hospital, Bemina, Srinagar)
