Res ipsa loquitur is a legal Latin Maxim which means “the thing (situation) speaks for itself.”

The principle of res ipsa loquitur is, in essence, an evidential principle, which, in certain cases, allows the court to draw an inference of negligence.

The maxim applies where an accident occurs in circumstances in which accident do not normally happen unless there has been negligence by someone. The fact of the accident itself may give rise to an inference of negligence by the respondent (doctor, nurse, hospital, etc.) which, in the absence of evidence in rebuttal, would be sufficient to impose liability.

In a case where negligence is evident, the principle of res ipsa loquitur operates and the complainant does not have to prove anything as the thing (res) proves itself.

On application of this maxim, it is for the doctor to satisfy the court that there was some other cause for the damage, or that the act which he did was not negligent.

The Hon’ble Supreme Court in the matter titled as “Jacob Mathew versus State of Punjab, 2005 (6) SCC 1 has held that the rule of res ipsa loquitor is not of universal application and has to be applied with extreme care and caution to the cases of professional negligence and in particular that of the doctors.

Essential criteria for application of the Latin Maxim res ipsa loquitor are:

1. The cause of accident must be unknown or unascertainable.
2. Common knowledge or expert evidence suggesting that the injury, by its very nature, cannot occur without negligence
3. The doctor must have been in control of the situation (instrumentalities)
4. Patient / attendant must not have contributed to the injury.

Thus, as a general rule, the maxim will not apply where the injury sustained by the patient is of a kind recognised as an inherent risk of the treatment, since such accidents can occur without negligence.

Some illustrations where the principle of res ipsa loquitur has been applied in the case of medical negligence:

• After a normal delivery and a minor sterilization surgery under local anaesthesia, the patient does not come out of hospital alive (Achutrao Haribhau Khodwa versus State of Maharashtra, 1996 (2) SCC 634)
• Mismatch in transfusion of blood resulting in death of the patient, after 40 days, was a case of medical negligence (PGIMER Chandigarh v. Jaspal Singh and others, (2009) 7 SCC 330)
• Two-month-old child was operated for inguinal hernia but was brought out of operation theatre with severe burns on both of his legs (Master P. M. Ashwin versus Manipal Hospital, Bangalore, 1997 (1) CPJ 238, Karn, SCDRC)
• The doctor after knowing that there was no fracture of the bone or the ligament, after taking X-ray put the right limb of the respondent in full plaster cast fully realising the hazards of a tight plaster cast even after noticing that there was reduction in blood supply (Adoration Convent versus Cicily, 2001 ACJ 1605, Kerala High Court)
• Abdominal pack was left behind in the abdominal region at the time of operation (Aparna Dutta versus Apollo Hospitals Enterprises Ltd., AIR 2000 Madras 340)
• Bilateral papilloedema lumbar puncture (LP) was done without administration of local anaesthesia and patient got into fit of convulsions, threw up frothy discharge from mouth, went into come and developed bedsores (Nirmal Kumar Jain versus Indraprastha Apollo Hospitals, 2007 (4) CPJ 274)
• Hysterectomy operation patient lost her ovaries and left kidney and was required to undergo other operations for control of faecal discharge from vagina (Saroj Chandhoke versus Ganga Ram Hospital, 2007 (3) CPJ 189)
• Procedure for administration of anaesthesia in upper respiratory tract was not followed (B. Reghupathi (Dr.) versus B Vasantha, 2008 (1) CPJ 1)
• In case of caesarean delivery there was administration of wrong dose of anaesthesia and the anaesthetist failed to reverse anaesthesia in time and patient became hypoxic and died (Rajiv Sharma versus Helvetia Klinic Pvt. Ltd. 2010 (2) CPJ 68, NCDRC).
• Hysterectomy sutures were removed prematurely because of which there was sudden burst of abdomen and then secondary suturing was performed under general anaesthesia (Nanjappa Hospital versus P. S. Shylia, 2011 (3) CPJ 360, NCDRC)
• In case of fracture left leg there was excess dose of anaesthesia was administered causing death of the patient (Kapildeo Singh (Dr.) versus Sagina Khatoon, 2011 (4) CPJ 218)
• In case of tubectomy, death of the patient occurred in just about 1 hour 15 minutes after the simple operation (Jagmal Singh versus Arpana Research and Charities Trust, 2013 ACJ 95)