MEDICAL NEGLIGENCE AND LIABILITY IN
PHYSIOTHERAPY TREATMENT: A LEGAL REVIEW
SYNOPSIS
1.
INTRODUCTION
2.
PROBLEM
STATEMENT
3.
OBJECTIVES
4.
METHODOLOGY
5.
UNDERSTANDING
MEDICAL NEGLIGENCE
6. The Four
Key Legal Elements of Negligence
7.
LEGAL
RESPONSIBILITIES OF PHYSIOTHERAPISTS
8.
COMMON
NEGLIGENCE SCENARIOS IN PHYSIOTHERAPY
9.
LIABILITY
OF PHYSIOTHERAPISTS UNDER INDIAN LAW
10. RISK MANAGEMENT & PREVENTION
STRATEGIES
11. DISCUSSION
12. CONCLUSION
INTRODUCTION
Physiotherapy
plays a crucial role in enhancing mobility, reducing pain, and improving
overall quality of life. As healthcare systems evolve, physiotherapists are
taking on greater clinical responsibilities, working independently, and
handling complex conditions. With this growing autonomy comes a proportional
increase in legal accountability.
Medical
negligence is no longer limited to doctors; physiotherapists can also face
legal action if their treatment causes injury or fails to meet accepted
professional standards. Many physiotherapists, especially students and new
practitioners, may not fully understand their legal obligations. This paper
aims to fill that gap by offering a clear and comprehensive legal perspective
on physiotherapy negligence.
PROBLEM
STATEMENT
There is a
noticeable lack of awareness among physiotherapists regarding legal duties,
boundaries of practice, documentation standards, and the consequences of
negligence. As a result:
This paper
addresses these issues by providing structured legal insight.
OBJECTIVES
The
objectives of this research are to:
METHODOLOGY
This study
follows a qualitative legal review methodology, involving:
·
Review
of general medical negligence principles in Indian law.
·
Interpretation
of standard physiotherapy guidelines and ethical codes.
·
Analysis
of common physiotherapy malpractice incidents reported in medico-legal
literature.
·
Understanding
patient rights, consent requirements, and consumer protection mechanisms.
No
clinical data or patient samples were used.
UNDERSTANDING
MEDICAL NEGLIGENCE
Medical
negligence occurs when a healthcare professional fails to provide the level of
care that a reasonably competent clinician would have provided under similar
circumstances. In physiotherapy, this includes both actions and omissions that
cause harm to the patient. Negligence is evaluated not only on the mistake
itself but also on whether the physiotherapist acted responsibly in preventing
foreseeable risks.
The
Four Key Legal Elements of Negligence:
DUTY OF
CARE
A
physiotherapist automatically owes a duty of care to the patient once a
therapeutic relationship is established. This means the therapist must act in
the patient’s best interest, use appropriate skills, and prioritize safety at
all times. Duty of care includes correct assessment, safe treatment planning,
and continuous monitoring.
BREACH
OF DUTY
A breach
happens when a physiotherapist fails to meet the accepted professional standard
of care. This could involve using outdated techniques, ignoring
contraindications, or providing treatment without proper assessment. Even small
deviations from standard practice may be seen as a breach if they put the
patient at risk.
CAUSATION
For a
negligence claim to succeed, the patient must prove that the physiotherapist’s
action directly caused the injury. It must be clear that the harm would not
have occurred without the therapist’s mistake. For example, if a patient
suffers burns due to incorrect electrotherapy intensity, the connection between
action and injury is straightforward.
DAMAGE/HARM
The
patient must demonstrate actual injury, whether physical, functional,
emotional, or financial. Harm may include increased pain, loss of mobility,
extended recovery time, or additional medical costs. The severity of harm
influences the extent of legal liability and compensation.
Examples
of Negligence in Physiotherapy
LEGALRESPONSIBILITIES
OF PHYSIOTHERAPISTS
Physiotherapists
have both ethical and legal duties that ensure patient safety and quality of
care. These responsibilities form the foundation of safe physiotherapy practice
and protect clinicians from legal consequences.
I.
Maintain
Professional Competence
Physiotherapists
must keep their knowledge updated with current evidence-based practices. Using
outdated or unproven techniques can be seen as negligence. Continuously
improving skill sets through workshops, certifications, and clinical updates
ensures that treatment is safe and effective.
II.
Obtain
Informed Consent
Informed
consent is a legal requirement and must be obtained before any treatment
begins. The physiotherapist must explain the nature of the procedure, expected
benefits, possible risks, and alternative options. Consent must be voluntary
and the patient should have the right to decline or ask questions. Written
consent is especially important for high-risk interventions.
III.
Accurate
Documentation
Every
session must include proper records of assessment findings, treatment
procedures, patient responses, and progress. Good documentation helps
physiotherapists defend themselves legally and shows that care was provided
responsibly. Incomplete or missing notes are considered a red flag in
medico-legal cases.
IV.
Maintain
a Safe Practice Environment
A
physiotherapist must ensure that the clinic environment and equipment are safe
for patient use. This includes regular machine checks, clean surroundings,
proper lighting, and adequate space to prevent collisions or falls. Safety
lapses that lead to injury can make the physiotherapist legally liable.
V.
Work
Within Scope of Practice
Physiotherapists
must perform only those procedures they are trained and licensed to do.
Diagnosing fractures, prescribing medications, or performing invasive
procedures without certification is illegal. Exceeding scope of practice can
result in immediate legal action and charges of professional misconduct.
VI.
Timely
Referral
If the
patient’s condition requires medical intervention beyond physiotherapy (e.g.,
suspected fracture, neurological deficits, severe infection), the
physiotherapist must refer them to a specialist or emergency care. Failure to
refer in time can worsen the patient’s condition and be classified as
negligence.
COMMON
NEGLIGENCE SCENARIOS IN PHYSIOTHERAPY
Ø Electrotherapy Burns
Burns may
occur when electrodes are improperly placed, intensities are too high, or the
equipment is faulty. Failure to check skin condition and denying the patient’s
feedback during treatment increases the risk. Such injuries clearly indicate a
lack of care and can lead to liability claims.
Ø Manual Therapy Injuries
Manual
therapy requires precise skill and understanding of biomechanics. Excessive
force, wrong technique, or manipulations in contraindicated conditions (such as
osteoporosis or acute inflammation) can cause serious injuries. This is one of
the most commonly reported causes of negligence claims in physiotherapy.
Ø Lack of Supervision
Patients
performing therapeutic exercises may lose balance, experience fatigue, or
execute movements incorrectly. Unsupervised exercise sessions, especially with
elderly or neurological patients, can result in falls or joint injuries. Courts
often view lack of supervision as a breach of duty.
Ø No Consent Before High-risk
Procedures
Procedures
like dry needling, cervical manipulation, or traction require explicit informed
consent because they carry higher risk. If a patient suffers an adverse event
without prior explanation, the physiotherapist may be held liable even if the
technique was performed correctly.
Ø Poor Record Keeping
Missing or
unclear documentation creates doubt about whether proper care was provided. In
many legal cases, physiotherapists lose simply because they cannot prove what
treatment was given. Proper records are considered evidence of responsible
professional behaviour.
Ø Exceeding Scope of Practice
Physiotherapists
must avoid performing medical tasks they are not legally authorized to do.
Examples include diagnosing complex medical conditions, altering medication
doses, or performing invasive procedures. Such actions can lead to serious
legal consequences, including malpractice claims and professional disciplinary
action.
LIABILITY
OF PHYSIOTHERAPISTS UNDER INDIAN LAW
Physiotherapists
in India may face different forms of legal liability depending on the nature of
the negligence and the type of harm caused. Liability is not limited to
physical injury alone; it can include financial loss, emotional suffering, and
long-term functional damage. Understanding these forms of liability helps
physiotherapists practice more safely and maintain professional accountability.
·
CONSUMER
PROTECTION ACT, 2019 (CPA) LIABILITY
The Indian
Parliament replace the old CPA by the new CPA at 2019 which has the most
advance statutes to prevent the consumer rights and their welfare from the
abuse by the market.
According
to Sec 2(42) of Consumer Protection Act,2019 "service" to include any description of
service made available to potential users, such as banking, insurance,
transport, and entertainment, for a consideration".
CASE
LAW:
Indian
Medical Association v. V.P. Shantha (1995): In this landmark case the SC held that medical
services provided for consideration (payment of fees) fall under the Consumer
Protection Act. This means patients are considered consumers, and
doctors/hospitals are service providers. Under the Consumer Protection Act,
physiotherapy services are treated as “medical services,” meaning patients are
legally considered “consumers.” If a patient feels that treatment was
negligent, unsafe, or performed without proper skill, they can file a complaint
in consumer court. Compensation can be awarded for physical harm, mental
suffering, prolonged recovery, or financial expenses such as additional
treatment costs. Physiotherapists may be held accountable even if the mistake
was unintentional, as CPA focuses on customer rights and service quality. This
is the most common legal route taken by patients in India.
·
CIVIL
LIABILITY (COMPENSATION CLAIMS)
Civil
liability usually results in compensation (money damages) rather than
punishment. If a hospital fails to provide proper treatment, the patient can
claim damages under CPA for deficiency in service.
CASE
LAW:
The
case of Kusum Sharma v. Batra Hospital (2010). Is filed a case against the doctor &
hospital.as a result judgement made that medical negligence and compensation
made for him by hospital. Professional liability involves disciplinary action
from physiotherapy councils, associations, or regulatory bodies (where
applicable). A physiotherapist can be investigated if a complaint is filed
regarding unethical behaviour, boundary violations, unsafe treatment, or
practicing beyond their scope. Penalties may include suspension, revocation of
membership, mandatory retraining, or warnings. Even if legal action is not
taken in court, professional bodies can still discipline practitioners to
maintain ethical standards in the profession. This ensures accountability
within the physiotherapy community.
·
VICARIOUS
LIABILITY (LIABILITY OF EMPLOYERS/CLINICS)
Vicarious
liability refers to if a nurse or doctor administered the wrong injection or
treatment, the hospital shall be sued along with the nurse or doctor, it placed
under criminal or civil liability under section of 304A,337,338 act.
CASE
LAW:
In
India the case of Balram Prasad v. Kunal Saha (2013) :
In this case shows
that One of the largest compensation awards in India for medical negligence.
Hospital and doctors were held liable for negligence leading to patient’s
death. According to this if the physiotherapist is working under an
institution’s supervision or employment. If a patient is injured due to poor
supervision, faulty equipment provided by the clinic, or lack of safety
protocols in the workplace, the employer can be legally liable. This ensures
that institutions maintain safe environments, provide proper training, and
enforce clinical guidelines. It also protects patients from systemic
negligence, not just individual mistakes.
·
CONTRACTUAL
LIABILITY (BREACH OF SERVICE AGREEMENTS)
Contractual
liability refers to that the doctor should follow the binding agreement. If the
doctor doesn’t follow or fulfil the promise or duties. they can be held liable for breach
of contract
Section 73
and 74 of the Indian contract Act,1872 which deals with damage and compensation
for the breach of contract.
CASE
LAW:
Indian
Medical Association v. V.P. Shantha case placed even this act also. The case arises that if doctor
does not follow his session or his treatment he may be accused to this act.
According to physiotherapy, if a physiotherapy package promises a certain
number of sessions, specific rehabilitation milestones, or structured progress
reports, failing to deliver these may be considered a breach of contract.
Although less common than consumer cases, these disputes can arise in sports
physiotherapy, corporate rehabilitation programs, or long-term therapy
arrangements. Clear communication and accurate documentation help avoid such
conflicts.
·
CRIMINAL
LIABILITY (FOR GROSS NEGLIGENCE)
Criminal
liability refers to the legal responsibility. a person who breaking the
law, which can lead to prosecution and punishment such as fines or
imprisonment.
Indian
Penal Code (IPC, 1860)
·
Section
304A →
Causing death by negligence (punishment up to 2 years + fine).
·
Section
337 →
Causing hurt by a rash or negligent act (up to 6 months + fine).
·
Section
338 →
Causing grievous hurt by a rash or negligent act (up to 2 years + fine).
Bharatiya
Nyaya Sanhita (BNS, 2023)
replaces IPC
·
Section
106(1) →
Causing death by negligence (similar to IPC 304A, punishment up to 2 years +
fine).
·
Section
125→ Causing
grievous hurt by rash/negligent act.
·
Section
125→ Causing
hurt by rash/negligent act
CASE
LAW:
Jacob
Mathew v. State of Punjab (2005, Supreme Court) the patient died due to medical
negligence Under criminal law, medical negligence is treated much more
seriously than civil liability. It applies only when the doctor’s conduct shows
gross negligence or recklessness Criminal liability applies in rare but serious
cases where the physiotherapist’s actions are considered “grossly negligent.”
This means the mistake was extremely careless, reckless, or dangerous, showing
complete disregard for patient safety. Examples include using malfunctioning
electrical equipment knowingly, performing traction with unsafe force, or
ignoring emergency symptoms during treatment. Criminal cases can involve
charges under the Indian Penal Code, such as causing grievous hurt. While rare
in physiotherapy, these cases carry severe consequences like fines, court
trials, or imprisonment
RISK
MANAGEMENT & PREVENTION STRATEGIES
a) USE WRITTEN
INFORMED CONSENT FORMS:
Provide
patients with clear information about the treatment, benefits, risks, and
alternatives. Ensure they understand and voluntarily agree before starting
therapy. Document the consent to protect both the therapist and the patient.
b) MAINTAIN
CLEAR AND DETAILED PATIENT RECORDS:
Record
assessments, treatment plans, progress notes, and patient responses accurately.
Good documentation supports clinical reasoning and serves as crucial legal
evidence if any dispute arises.
c) STAY
UPDATED WITH CLINICAL GUIDELINES:
Regularly
review current physiotherapy protocols, best-practice recommendations, and
evidence-based standards. This helps ensure safe, effective treatments and
reduces the risk of negligence claims.
d) SUPERVISE
HIGH-RISK EXERCISES:
Closely
monitor patients performing strenuous, advanced, or unstable movements.
Immediate supervision helps prevent injuries, ensures proper technique, and
allows timely correction of errors.
e) FOLLOW
SAFETY CHECKS FOR ELECTRICAL EQUIPMENT:
Inspect
machines (e.g., ultrasound, IFT, TENS) for proper functioning before use.
Regular maintenance and calibration prevent equipment-related accidents and
patient harm.
f) COMMUNICATE
OPENLY WITH PATIENTS:
Explain
treatment plans, expected outcomes, and possible side effects clearly.
Encourage questions and maintain transparency to build trust and avoid
misunderstandings.
g) USE
PROFESSIONAL INDEMNITY INSURANCE:
Maintain
valid insurance coverage to protect against legal claims and financial loss. It
provides security and ensures the physiotherapist can continue practice even in
case of unexpected disputes.
h)
PRACTICE
ONLY WITHIN SCOPE:
Provide treatments and
interventions that fall strictly within your professional training, licensure,
and competency. Avoid performing procedures you are not certified or adequately
skilled to do. Staying within scope prevents clinical errors, protects patient
safety, and reduces medico-legal liability.
DISCUSSION
The
findings show that most physiotherapy negligence cases arise from preventable
factors such as poor supervision, inadequate explanation, and insufficient
documentation. Physiotherapists must recognize that modern healthcare is
patient-centred and legally regulated. Understanding legal principles not only
protects physiotherapists from litigation but also improves the quality and
safety of patient care.
CONCLUSION
Medical
negligence in physiotherapy is a significant but preventable issue. By adhering
to professional standards, ensuring patient safety, obtaining informed consent,
and maintaining proper documentation, physiotherapists can greatly reduce legal
risks. Legal knowledge should be considered an essential component of
physiotherapy education and practice in India.