The relationship between a patient and a medical practitioner is held together by an invisible but indispensable thread: trust. That trust is neither ornamental nor optional; it forms the constitutional, statutory, and moral foundation of the right to safe medical treatment. Yet, when the system designed to protect patients becomes unresponsive, the experience exposes an unsettling truth: mechanisms of accountability are often more accessible to the practitioner than to the injured patient.
A recent order passed by the High Court of Bombay at Goa on 10 November, 2025 has thrust this concern into sharp focus. The case concerns an allegation of unregistered surgical practice, medical negligence, and ethical violations in connection with a laparoscopic appendectomy performed upon a private patient on 1 August, 2023 at a dominant private hospital in Malbhat, South Goa located at the base of the slope opposite to the Carmelite Monastery and laying parallel to the railway tracks of the Madgaon Railway Station. The surgeon who performed the procedure was not registered with the Goa Medical Council (GMC) at the time of the surgery. The discharge summary issued on 11 August, 2023 reportedly omitted the fact that an appendiceal stump had been left behind and that a fecalith (a hardened stool mass) remained embedded in the abdominal wall near the laparoscopic port site.
What followed for the patient was not recovery, but prolonged suffering: an unhealed incision for over four weeks, medical uncertainty, recurring pain, and repeated consultations. An independent ultrasound and a subsequent CT scan in Delhi revealed the retained stump, the foreign material, and the presence of multiple tracts. A corrective surgery was eventually performed on 1 September, 2023 at a Super Speciality Hospital in Delhi. During this second operation, the retained fecalith was removed and the appendiceal stump excised. A significant section approximately ten centimetres of the anterior abdominal wall had to be resected due to tissue reaction and delayed healing.
These facts are not disputed; they are recorded in the Goa Medical Council’s judgment and order dated 19 July, 2024.
Yet, the outcome of the disciplinary proceedings was not what most would expect. Despite acknowledging the failure to sign the informed consent form, the unregistered surgical practice, and the presence of retained surgical material, the Ethics and Disciplinary Committee of the GMC imposed a fine of only ₹10,000 upon the surgeon and more significantly granted him registration during the pendency of disciplinary proceedings. Section 27 of the Goa Medical Council Act, 1991, clearly prescribes a fine of ₹50,000 and contemplates criminal proceedings for unregistered practice, including imprisonment of up to two years. Similar consequences are reflected in the National Medical Commission Act, 2019. Yet no criminal prosecution was initiated.
Instead, the focus of the regulatory process appeared to pivot towards regularising the doctor’s position during the pendency of disciplinary proceedings rather than determining accountability or protecting patient rights.
The next i.e. the appellate route proved equally restrictive. Under Clause 8.8 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, a private complainant is expressly permitted to file an ethics appeal against a State Medical Council decision. Acting on this provision, an appeal was submitted by the patient to the National Medical Commission (NMC). However, the Ethics and Medical Registration Board rejected the appeal on 20 November, 2024, stating that only doctors and recognised professionals may appeal under Section 30(3) of the NMC Act, 2019.
The situation presents a classic legal conflict: when a general law and a special regulation collide, “generalia specialibus non derogant” - the special prevails over the general. Yet the more troubling element is not merely the legal inconsistency, but the lived inequity resulting from it.
In an attempt to correct this procedural impasse, a writ petition was filed before the High Court on 9 August, 2024 seeking relief against the Goa Medical Council’s Order. On 10 November 2025, the High Court dismissed the Writ only on the grounds of maintainability, directing that a fresh petition incorporating subsequent developments be filed. The merits remain untested.
Meanwhile, the medical practitioner continues to work, operate, and benefit from the title of consultant surgeon. The patient continues navigating procedural hurdles, legal uncertainty, and repeated litigation two years after the initial harm.
This trajectory raises a pressing public concern: has the enforcement of medical ethics become optional unless the complainant possesses unlimited endurance and resources?
The legal framework for medical accountability was never intended to be adversarial towards the injured patient. The regulatory mandate exists not to defend institutions, but to uphold the integrity of medical practice, ensure patient safety, and deter unethical or illegal conduct.
Yet the lived experience reveals a serious systemic imbalance:
● An unregistered surgeon performed surgery for nearly ten months without scrutiny.
● The regulatory body discovered the violation only after the patient initiated proceedings.
● The punishment imposed was a nominal fine not proportionate to statutory mandates.
● Appellate rights vested under the 2002 Regulations were denied based on a contradictory statute.
Judicial recourse now requires restarting the process despite findings acknowledging retained foreign matter and ethical lapses.
Justice delayed in such circumstances is not merely delayed; it is disheartening, exhausting, and disproportionately burdensome for the victim.
Medical ethics are not symbolic guidelines; they are enforceable obligations. When a regulator acknowledges harm and yet fails to meaningfully act, public confidence is shaken not in medicine, but in accountability.
Until ethics are meaningfully enforced, the law risks becoming a silent observer in a space where it was meant to stand guard.
