A PROJECT REPORT ON

QUANTITATIVE ANALYSIS ON MEDICAL

NEGLIGENCE IN INDIA
SUBMITTED IN PARTIAL FULFILMENT OF THE
REQUIREMENT FOR THE AWARD OF THE DEGREE Of
M.Sc. Statistics
2020 -22

MAHARSHI DAYANAND UNIVERSITY, ROHTAK

(HARYANA)

SUPERVISOR INVESTIGATOR
Prof. S.C. MALIK ANJANA SUBHAGAN
DEPARTMENT OF STATISTICS M.Sc. Statistics

M.D.UNIVERSTY, ROHTAK ROLL NO.-20130

 DECLARATION

I hereby declare that the project entitled “QUANTITAIVE ANALYSIS OF MEDICAL

NEGLIGENCE IN INDIA” is a record of the original work done by me which is being

submitted for the partial fulfillment of the degree of M.Sc.(Statistics) to the Department of

Statistics, Maharshi Dayanand University, Rohtak, is based on the theoretical work carried out

by me under the supervision of Prof. S.C.Malik, Department of Statistics, M.D.University ,

Rohtak. The results embodied in the report have not been submitted to any university or

institution for the award of any degree or diploma.

Name- Anjana Subhagan

Roll no.- 20130

M.Sc. Statistics

Semester- IV
 ACKNOWLEDGEMENT

Firstly, I thank the almighty God for strengthening me and for being the source of wisdom
throughout the work. Completion of this project would have not been possible without the kind
support and help of many kind-hearted people. I would like to extend my sincere thanks to all of
them.

I am highly indebted and consider myself fortunate and greatly privileged to work under the
supervision and guidance of Prof. S.C. MALIK. I am thankful for his guidance and constant
supervision as well as for providing necessary information regarding the project and also for his
support in completing the project. There is no exaggeration to say that he is true motivator and
philosopher and guided me in this learning experience during my degree programmed.

I would also like to express my heartfelt thanks to Prof. Ratna Raj Laxmi , HoDepartment of
Statistics for the constant inspiration during the work. I would also like to thank all non-teaching
staff members for their co-operation and help. I should not forget to give my respect and sense of
gratitude to Mr. Rahul Thakur, research scholar in Statistics Department for his constant help
during the work .I highly acknowledge the help provided by the university library for the work. I
would like to express my gratitude towards my parents and friends for their cooperation and
encouragement which helped me in completion of this project. I will ever remain indebted to all
of them. Finally, I am grateful to the Department of Statistics for providing all the required
facilities.

Anjana Subhagan
 PREFACE

This project report has been prepared as a part of curriculum of M.Sc. Statistics. The purpose of
this project is to conduct an analysis on the number of cases of medical negligence in India.

The initial portion contains the basics about medical negligence suits, history and current
scenario in India. Then with the help of the statistical tools mentioned, project gives the analysis
and trend in future years of the number of cases in India by studying the data from year 2005 to
2019. All the details have been mentioned in the later part of the project. As you go ahead the
minute details of the study has been provided.
 CONTENT

Chapter No. Name

1. Introduction

2. Statistical Tools

3. Data Representation

4. Data Analysis

5. Conclusion

References

CHAPTER 1
INTRODUCTION
The “World Consumer’s Right Day” is celebrated globally on March 15th and the “National
Consumer’s Right Day” on December 24th each year in India to create awareness among
consumer’s about their rights. Supreme Court verdict in 1995 brought the medical profession
under the preview of the Consumer protection Act, 1986 .Doctors are always afraid of its impact
on them, many landmark judgments are given by various consumer forums against doctors and
health institutions to award compensation in alleged negligence cases, aftereffects of which can
be felt every moment a doctor think of providing its services to a new patient.

The Consumer Protection Act is a social legislation that lays down the rights of the consumers
and provides protection of the rights of the consumers. The first and the only Act of its kind in
India, it has enabled ordinary consumers to secure less expensive and often speedy outcome of
their grievances. The provisions of this Act cover ‘goods’ as well as ‘services’. The goods are
those which are manufactured or produced and sold to consumers through wholesalers and
retailers. The services are in the nature of transport, telephone, electricity, housing, banking,
insurance, medical treatment, etc. The principal issue which arose for decision by the Court was
whether a medical practitioner renders 'service' and can be proceeded against for 'deficiency in
service' before a forum under the Consumer Protection Act, 1986.

MEDICAL NEGLIGENCE:

“Any doctor not fulfilling the standards and quality of care in the appropriate treatment that are
set out in these Clinical Guidelines will have this taken into account if, for any reason,
consideration of their performance in this clinical area is undertaken.” Department of health,
1999.

To err is human. Though patients see the doctors as God and believe that their disease will be
cured and they will be healed by the treatment but sometimes even the doctors makes mistakes
which can cost a lot to the patients in many ways. Sometimes the mistakes are so dangerous that
a patient has to suffer immensely.

Medical negligence is the failure of a health-care provider to exercise the ordinary care and skill
that a prudent, qualified person would exercise under similar circumstances. When a patient is
injured by such malpractice the fairness of any compensation will depend upon the country's
legal system. Medical malpractice actions have two main objectives: quality control and
compensation for physical and emotional harm.

History

Medical negligence has been recognized more than 4000 years ago. The Babylonian king
Hammurabi formed a law that provided that a physician whose patient lost an eye as a
consequence of surgery should himself lose his hand. Ancient Egyptians provided for
banishment or death as the physician's penalty for malpractice, and the Romans also assessed
similar penalties. The traditional physician-patient relationship, based on mutual respect, has
begun to fade; and a business model with customer and provider has slowly and steadily
emerged in its place. As the public's knowledge of patients' rights increases, inappropriate
medical action resulting in harm is now commonly perceived in some countries as an opportunity
for financial compensation The "information age" is making medical negligence information,
including malpractice-claims data, more easily accessible to the public. The recent medical
malpractice "crisis" has seen skyrocketing limits and increasing fear of liability.

Medical negligence suits:

To prevail in a medical malpractice suit, the plaintiff (the person who brings the suit) must
demonstrate 4 key elements to the judge. These concepts are well known to most medical
personnel, but it is worthwhile to mention them here. They are, in order:

(1) The physician had a duty to treat or otherwise provide a service to the plaintiff (i.e., a
physician-patient relationship had been established).

(2) The physician breached that duty to the plaintiff. This usually requires the introduction of
medical expert testimony to demonstrate the physician fell below the "minimally acceptable
standard of care."

(3) This breach of the appropriate standard of care caused the plaintiff harm.

(4) Finally, although seemingly obvious, actual damages must be suffered by the plaintiff, and
they must be proven with specificity (i.e., quantified in some way)

Scenario of Medical Negligence in India

India is recording a whopping 5.2 million injuries each year due to medical errors and adverse
events. Of these biggest sources are mishaps from medications, hospital acquired infections and
blood clots that develops in legs from being immobilized in the hospital. A report by an Indian
doctor from Harvard School of Public health (HSPH) has concluded that more than 43 million
people are injured worldwide each year due to unsafe medical care. Approximately 3 million
years of healthy life are lost in India each year due to these injuries.

 Health care mishaps are the 8th leading cause of death in the world.
 Over 7 million people across the globe suffer from preventable surgical injuries every
year.
 Globally, 234 million surgeries take place every year, one in every 25 people undergo a
surgery at any given time.
 In developing countries, the death rate was nearly 10% for a major surgery.
 Morality from general anesthesia affected one in 150 patients while infections were
reported in 3% of surgeries with the mortality rate being 0.5%.
 Nearly 50% of the adverse effects of surgery were preventable.
 5.2 million medical injuries are recorded each year in India
 43 million people get injured each year due to unsafe medical care worldwide.

About two-thirds of medical injuries occur in low and middle income countries like India. India
records approximately 5.2 million cases a year, ranging from incorrect prescription, wrong dose,
wrong patient, wrong surgery, and wrong time to wrong drug. The kinds of malpractice are not
new in 1953, a boy with a fractured limb died in Pune as a doctor operated on him without
proper anesthesia. Sometimes it plays with life, sometimes it gifts an "Unwanted Child" as in the
instant case where the respondent, a poor laborer woman, who already had many children and
had opted for sterilization, developed pregnancy and ultimately gave birth to a female child in
spite of sterilization operation which, obviously, had failed. With public awareness, claims an
litigation are rising. In the country's consumer courts, they now top the list of 3.5 lakh pending
cases. According to Dr. Girish Tyagi, registrar of Delhi Medical Council, the authority for
dealing with such cases, the number of cases from overcharging, needless procedures, wrong
doctors to wrong decisions has zoomed in the last two years, from about 15 complaints a month
to 40 now. Nevertheless, it is challenging to provide consistent solutions to eliminate or
minimize events and work toward improving patient safety. Furthermore, it is essential that the
governing bodies for the healthcare system should enforce hospitals to establish a litigation
system by providing guidelines and steps to resolve the matter either by out of court settlement
or a full court trial. This system should include effective policy and procedure to ensure high
standards of effectiveness, transparency, and justice for all the involved parties.

MAGNITUDE OF THE PROBLEM IN DIFFERENT STATES OF INDIA

WEST BENGAL
One of the states with highest number of medical negligence in India. Reports suggest that nearly
150 suits are filed per year in this state with serious allegations against government as well as
private hospitals and till date over 500 medical negligence cases are pending in Bengal state.
Meanwhile, in a recent reply to information sought under Right to Information, Act, 2005 it has
been revealed that the West Bengal Medical Council (WBMC) has taken action against just four
doctors in the past four years. Members of the Medical Council of India have referred to three
State Medical Councils including WBMC of not deciding the complaints filed to them in a
timely manner resulting in complainants directly approaching MCI directly. Commenting of the
developments Kunal Saha, a doctor based in Ohio, US, who fought a long legal battle before
Supreme Court in October 2013 directed a private Kolkata Hospital to pay highest ever
compensation of Rs. 11.5 crore for death of his wife said that it is important that statistics related
to complaints made to the State Medical Councils come out. Medical negligence are not
seriously looked by the State medical council as the appointments to these bodies most of the
time are political in nature.

UTTAR PRADESH
Cases of medical negligence appear regularly in Uttar Pradesh. Health professionals, politicians,
and media commentators are rarely in agreement, except when it is to cite a “culture of blame” as
the greatest cause of litigation in medical error today. In August 2017, over 70 children - mostly
newborns - died at biggest government hospital in Gorakhpur, due to shortage of oxygen supply.
A probe committee formed by Chief Minister Yogi Adityanath submitted its report. The findings
of the report are not yet known but the UP government has said, those found guilty in the probe
will face action. The most common type of medical negligence is seen in operations and during
the delivery of the child etc. a number of cases has been filed against doctors who negligently
leave their surgical instruments in the body of the patient etc., still a number of doctors leave
their instruments in the stomach of the patient which could be fatal. In India doctors are treated
as gods, hence when some kind of negligent acts are carried out by them, they think that it was
the wish of god and don’t make the doctor responsible for this. Illiteracy is another big factor that
is not letting our people to know what kinds of wrongs are being committed in this state.

DELHI
Although being the capital of the country, well equipped with all national level facilities in government as
well as private hospitals, Delhi has always been in the news for medical negligence. The term negligence
has no defined boundaries and if any medical negligence is there, whether it is pre or post-operative
medical care or in the follow-up care, at any point of time by the treating doctors or anyone else, it is
always open to be considered by the Courts/Commission taking note of law laid down by this Court of
which a detailed reference has been made and each case has to be examined on its own merits in
accordance with law. On July 30, 2011, at 3.26 p.m., 10-year-old Yash Arora was declared dead at
Gurugram’s Medanta, the Medicity, one of India’s leading super-specialty hospitals. Yash had
gone through six readmissions, two liver transplants, and numerous bouts of infections over nine
months. The bill for his treatment amounted to ₹45 lakh. The child died due to infection that was
caused by the lack of attention by hospital administration caused by keeping him in the same
room post-surgery with a patient with condition of drug related tuberculosis. Medical negligence
is turning out to be heinous crime in the years with people losing their loved ones to problems
that was never due to their fault.

RAJASTHAN AND MAHARASHTRA

Both the states being listed among the largest states of India have a constant history of medical
negligence , neither they have escalated nor they have decreased which makes it a point of
concern as with time and with so much progression in technologies medical negligence cases
should shoot down. Citing one of the bizarre incidents in Maharashtra, a young man aged 20,
met with an accident on the sea beach in a village far away. From the city of Pune, this resulted
in the fracture of the femur of his left leg. After some temporary treatment by a local doctor who
tied wooden planks to his leg, he was brought to the respondent’s hospital for treatment. The
respondent had given specific instructions to his assistant to give 2 proper injection doses of
injection of morphia before bringing the patient to the operation theatre. But the assistant gave
the patient only one injection. The young boy died as the result of shock suffered for not having
given the adequate amount of anesthesia. In this case we see that the patient breached his duty of
care that he had towards the patient. Cases on wrong dosage of anesthesia is very commonly
seen, this is the reason that nowadays even other medical practitioners like dentists refuse to give
injections even though they are skilled in this field and wait for an authorized anesthetist to come
and give the injection with proper care and precaution. The Supreme Court also agreed with the
judgments of the lower court and stated that this was a clear case of medical negligence and the
respondent is liable to pay damages to the family of the young boy and there was a clear breach
of his legal duty of taking the necessary precautions before performing an operation.

ANDHRA PRADESH
Andhra Pradesh is one among the few states which has shown decline in cases registered;
starting with high range of cases being registered in the states over the years the medical council
of the state has managed to lower the range. This is one of the positive signs of the states Andhra
Pradesh (AP) is one of most progressive states in India and has achieved its demographic goal of
reaching replacement fertility levels, with a TFR of less than 2.1 (current level 1.8). It has also
almost accomplished their goals. It has some significant achievements in improving key health
indicators in the state; namely, maternal mortality rate (92 per 100,000 live births), and Infant
mortality rate (35 per 1000 live births), which are much below the national average (Govt. of
India). The coverage with full immunization among children aged 12-23 months is slightly
higher than the national average, at 65.3 % compared to 62.0%. About 40% of pregnant women
received full antenatal care and 76.3% received at least four requisite visits during pregnancy.
However, the state of nutrition among women and children was a concern, as 52.9% of pregnant
women and 58.6% of children were reported to be anemic. Malnutrition among children under
five was high, with 31.4% found to be stunted, 31.9% underweight, 17.2% wasted and 4.5%
severely wasted. Still, a lot needs to be done to achieve in the next 12 years.

KERALA AND TAMIL NADU

Southern most states of India, both of them also maintain a constant range of cases in medical
negligence. Although both the states in general are pretty good in providing medical assistance to
the citizens they have recorded many cases, most probably due to the high literacy rates people
are more aware of the norms of filing suits which helps as overall as a nation. At the heart of the
issue is the fact that the State’s public sector

Hospitals are mostly understaffed. In a casualty ward, sometimes one doctor is forced to take
care of 250-300 patients. As a consequence, dissatisfied patients are not a rarity. Doctors
working in late evening shifts are the most vulnerable as they often have to deal with those with
criminal backgrounds or people coming in an inebriated state. Overcrowding and the lack of
competent security arrangements often aggravate the situation. The deeper problem is the
breakdown of trust between people and the medical community. The advancements in health
technology and medical diagnostics have improved patient safety, but somehow the message that
not all medical complications are due to human error has not been effectively conveyed to the
public.

SIKKIM, MEGHALAYA AND MIZORAM

All the states representing the easternmost region of India including Arunachal Pradesh, Assam,
Manipur, Meghalaya, Mizoram, Nagaland, Tripura and Sikkim have an excellent graph of
medical negligence cases. Most of these states have a track record of maximum of only 10 cases
per year which is the least comparing all the states of India which is a great achievement in the
field of medical assistance and public sector. Maternal healthcare policies have been
implemented under National Rural Health Mission and Integrated Child Development
Programme to improve maternal health outcome by increasing number of safe and
institutional delivery and higher coverage of antenatal care. Janani Suraksha Yojana (JSY),
introduction of ANM and ASHA workers at grassroots level, 108 & 102 ambulance services
and Mobile Medical Unit are some examples. Assam Government has also introduced a
policy for eradication of anemia namely Mission Tejaswee, and Adoroni, an ambulance
facility for pregnant women and newborn to and fro of health institutions. Everyone, such as
national agencies like IMR, agrees that northeast has an impressive health indicator and can
do wonders if they are provided with proper guidance and resources.

ZONES OF INDIA

India is divided into six zones based upon climatic, geographical and cultural features. The data
is divided as per zones.

NORTH ZONE

North zone of India houses the sates of Himachal Pradesh, Punjab, Jammu & Kashmir, Delhi,
Rajasthan and Haryana.

NORTH EASTEREN ZONE

Assam, Sikkim, Nagaland, Meghalaya, Manipur, Mizoram, Tripura and Arunachal Pradesh are
located in this zone.

CENTRAL ZONE

Madhya Pradesh, Chhattisgarh, Uttarakhand, Uttar Pradesh are located in this region.

EAST ZONE

The east zone is comprised of states of Bihar, Orissa, Jharkhand, and West Bengal.

WEST ZONE

This zone has the states of Gujarat, Goa and Maharashtra.

SOUTH ZONE

States of Andhra Pradesh, Karnataka, Kerala, Tamil Nadu, Telangana and Puduchery occupy the
South Zone on India.
WHAT DOES NOT AMOUNT TO MEDICAL NEGLIGENCE?

If a patient has suffered an injury the doctor might not be held liable for negligence. In case of
error of judgment by the doctor, he shall not be charged against any such actions. Even doctors
are humans and, hence are prone to mistakes, and therefore, they shall be allowed some relief.
Merely based on the fact that the decision of doctor did not turn out to be favorable, he cannot
be held against such error in judgment. The courts have observed that merely because the doctor
chose a different procedure/ treatment to cure the problem and it did not work as expected, will
not make him liable. One must prove that there was a breach of duty on his part. A doctor
performing his duty with due care and caution could not be held liable for negligence. However,

where error in judgment was due to a negligent act, it shall then be termed breach of duty and
the doctor shall be held liable for his actions.

AIMS & OBJECTIVES

The following aims and objectives have been decided for the present study:

1. To study the pattern of medical negligence cases in India.

2. To study the reasons for medical negligence in India.

3. To study the pattern of cases in different states of India.

4. To study whether there is any significant difference in states having similar data of cases.
5. To forecast the number of cases in future in all over India and also in different states.

6. To study the overall trend of medical negligence in India.

7. To find the top contributing state and their impact.

8. To analyze the difference between factors which are affecting the cases in different states .

CHAPTER 2
STATISTICAL TOOLS

STATISTICAL TOOLS USED

BAR GRAPHS -A graph, in layman terms, is a pictorial representation of organized data that
helps the readers of the same to understand complex information more easily. They provide
information in easy-to-understand images. It presents categorical data with rectangular bars with
heights or lengths proportional to the values that they represent. The bars can be plotted
vertically or horizontally.
A bar graph shows comparisons among discrete categories. One axis of the chart shows the
specific categories being compared, and the other axis represents a measured value. Some bar
graph represents bars clustered in groups of more than one, showing the values of more than one
measured variable.

GROUPED BAR CHART- Bar graphs can also be used for more complex comparisons of
data with grouped bar charts and stacked bar charts. In a grouped bar chart, for each categorical
group there are two or more bars. These bars are color-coded to represent a particular grouping.
For example, a business owner with two stores might make a grouped bar chart with different
colored bars to represent each store: the horizontal axis would show the months of the year and
the vertical axis would show the revenue.

Series 1
3
Series 2
Series 3
2

0
Category 1 Category 2 Category 3 Category 4

LINE GRAPH – A line chart or graph is a type of chart which displays information as a series
of data points called ‘markers’ connected by straight line segments. It is a basic type of chart
common in many fields. It is similar to scatter plot except that the measurement points are
ordered (typically by their x-axis value) and joined with straight line segments. A line chart is
often used to visualize a trend in data over intervals of time, thus the line is often drawn
chronologically.
 14

12

10

8
Series 3
Series 2
6 Series 1

0
Category 1 Category 2 Category 3 Category 4

BEST FIT

It is simple to construct a “best fit” layer consisting of a set of line segments connecting adjacent
data points; however, such a “best fit” is usually not an ideal representation of trend of
underlying scatter data for the following reasons:

1. It is highly improbable that the discontinuities in the slope of the best-fit would correspond
exactly with the positions of the measurement value.
2. It is highly unlikely that the experimental error in the data is negligible, yet the curve falls
exactly through each of the data points.

A true best-fit layer should depict a continuous mathematical function whose parameters are
determined by using a suitable error-minimization scheme, which appropriately weights the error
in the data values. Such curve fitting functionality is often found in software. Best-fit curves may
vary from simple to complex linear equations like quadratic, polynomial, exponential and
periodic curves.

Some of the best trend line for the data:

The best fit layer can reveal perfect trends in the data leading to more conclusions or results from
the data table.

Linear
A linear trend line is a best-fit straight line that is used with simple linear data sets. Your data is
linear if the pattern in its resembles a line. A linear trend line usually shows that something is
increasing or decreasing at a steady rate.

Y-Values
3.5

2.5

2 Y-Values

1.5

0.5

0
0.5 1 1.5 2 2.5 3

Logarithmic

A logarithmic trend line is a best-fit curved line that is most useful when the rate of change in the
data increases or decreases quickly and then levels out. A logarithmic trend line can use negative
or positive value
 Y-Values
0.6

0.5

0.4
Y-Values
0.3

0.2

0.1

0
0.5 1 1.5 2 2.5 3 3.5

Polynomial

A polynomial trend line is a curved line that is used when data fluctuates. It is useful, for
example, for analyzing gains and losses over a large data set. The order of the polynomial can be
determined by the number of fluctuations in the data or by how many bends appear in the curve.
An order 2 polynomial trend line generally has only one hill. Order 3 has generally two hills and
similarly for higher orders.

Y-Values
450
400
350
300
250 Y-Values

200
150
100
50
0
1999.5 2000 2000.5 2001 2001.5 2002 2002.5 2003 2003.5
Power

A power trend line is a curved line that is best used with data sets that compare measurements
that increase at a specific rate. For example, the acceleration of a race car at one-second
intervals. You cannot create a power trend line if your data contains zero or negative values.

Y-Values
200
180
160
140
120
Y-Values
100
80
60
40
20
0
40 60 80 100 120 140 160

Exponential

An exponential trend line is a curved line that is most useful when data values rise or fall at
increasingly higher rates. You cannot create an exponential trend line if your data contains zero
or negative values.

Y-Values
60

50

40
Y-Values
30

20

10

0
1.5 2 2.5 3 3.5 4 4.5
TIME SERIES ANALYSIS

Time-series analysis is a statistical method of analyzing data from repeated observations on a

single unit or individual at regular intervals over a large number of observations. Time-series
analysis can be viewed as the example of longitudinal designs. The most widely employed
approach is based on the class of models known as Autoregressive Integrated Moving Average
(ARIMA) models. Basically time series data is a collection of observations indexed by time.

The various forces affecting the values of observation in a time series can be classified into
components of time series. One such component is Trend or long term movement.

TREND

The secular trend forms one of the four basic components of the time series. It describes the
movement over the long term of a time series that globally can be increasing, decreasing, or
stable. This trend may show the growth or decline in a time series over a long period. This is the
type of tendency which continues to persist for a very long period. Prices and export/ import
data, for example, reflect obviously increasing tendencies over time.

Measurements of Trends

Following are the methods by which we can measure the trend.

(i) Freehand or Graphic Method.

(ii) Method of Semi-Averages.

(iii) Method of Moving Averages.

(iv) Method of Least Squares.

We are describing here first two methods.

(i) Freehand or Graphic Method.

It is the simplest and most flexible method for estimating a trend. The working procedure of this
method is

Procedure:

(a) Plot the time series data on a graph.

(b) Draw a freehand smooth curve joining the plotted points.

(c) Examine the direction of the trend based on the plot

(ii) Method of Semi Averages

In this method, the semi-averages are calculated to find out the trend values. Now, we will see
the working procedure of this method.

Procedure:

(i) The data is divided into two equal parts. In case of odd number of data, two equal parts can be
made simply by omitting the middle year.

(ii) The average of each part is calculated, thus we get two points.

(iii) Each point is plotted at the mid-point (year) of each half.

(iv) Join the two points by a straight line.

(v) The straight line can be extended on either side.

(vi) This line is the trend line by the methods of semi-averages.

STATISTICAL HYPOTHESIS

Hypothesis Testing is a type of statistical analysis in which you put your assumptions about a
population parameter to the test. It is used to estimate the relationship between two statistical
variables.
Hypothesis is defined in two parts as null and alternative hypothesis.
The Null Hypothesis is the assumption that the event will not occur. A null hypothesis has no
bearing on the study's outcome unless it is rejected. The Alternate Hypothesis is the logical
opposite of the null hypothesis. The acceptance of the alternative hypothesis follows the rejection
of the null hypothesis.
Depending on the population distribution, you can classify the statistical hypothesis into two
types.
Simple Hypothesis: A simple hypothesis specifies an exact value for the parameter.
Composite Hypothesis: A composite hypothesis specifies a range of values.

F TEST
F test is a statistical test that is used in hypothesis testing to check whether the variances of two
populations or two samples are equal or not. In an f test, the data follows an f distribution. This
test uses the f statistic to compare two variances by dividing them. An f test can either be one-
tailed or two-tailed depending upon the parameters of the problem. The f value obtained after
conducting an f test is used to perform the Two-way ANOVA (analysis of variance) test.
1. The f test is a statistical test that is conducted on an F distribution in order to check the
equality of variances of two populations.
 2. The f critical value is a cut-off value that is used to check whether the null hypothesis can be
rejected or not.
3. A one-way ANOVA is an example of an f test that is used to check the variability of group
means and the associated variability in the group observations.

POPULATION- In statistics, population is the entire set of items from which you draw data for a
statistical study. It can be a group of individuals, a set of items, etc. It makes up the data pool for
a study.
SAMPLE-It represents the group of interest from the population, which you will use to represent
the data. The sample is an unbiased subset of the population that best represents the whole data.
MEAN-Mean is the average of the given numbers and is calculated by dividing the sum of given
numbers by the total number of numbers. In statistics, the mean is one of the measures of central
tendency. It is denoted by μ.
VARIANCE-The term variance refers to a statistical measurement of the spread between
numbers in a data set. More specifically, variance measures how far each number in the set is
from the mean (average), and thus from every other number in the set. Variance is often
depicted by this symbol σ 2 .The square root of the variance is the standard deviation (SD or σ).

ANALYSIS OF VARIANCE (ANOVA)

ANOVA is to test for differences among the means of the population by examining the amount
of variation within each sample, relative to the amount of variation between the samples.
Analyzing variance tests the hypothesis that the means of two or more populations are equal.

TWO-WAY ANOVA

The two-way ANOVA test reveals whether the two important variables affect the outcome or a
dependent variable. A two-way ANOVA is used to estimate how the mean of a dependent
variable changes according to the levels of two independent variables. We can use a two-way
ANOVA when we want to know how two independent variables, in combination, affect a
dependent variable.

ASSUMPTIONS IN TWO-WAY ANOVA

1. Independence of variables: The two variables for testing should be independent of each other.
One should not affect the other, or else it could result in skewness.
2. Homoscedasticity: In a two-way ANOVA test, the variance should be homogenous. The
variation around the mean for each set of data should not vary significantly for all the groups.
3. Normal distribution of variables: The two variables in a two-way ANOVA test should have
a normal distribution. When plotted individually, each should have a bell curve. If the data does
not meet this criterion, one could attempt statistical data transformation to achieve the desired
result.
4. The first column in the two-way ANOVA table is the degrees of freedom (df). The degree of
freedom is the number of independent values in the data after completing the calculations. To
calculate the degrees of freedom for each source of variance, use the following formulas:
  Degrees of freedom for factor 1 (df A) = the number of groups in the first factor - 1
 Degrees of freedom for factor 2 (dfB) = the number of groups in the second factor - 1
 Degrees of freedom for the interaction effect (dfI) = dfA * dfB
 Degrees of freedom for within (dfW) = the total number of observations - (the number of
groups in the first factor * The number of groups in the second factor)
 Total degrees of freedom (dfTotal) = the total number of observations – 1

1. First step toward calculating the Sum of Squares (SS) i.e. the second column in the two-
way ANOVA table- is to find the means for each factor and the total mean. To do this,
add up the values of the response variable for one factor and divide by the number
of observations within that factor. Repeat this process for the other factor. To find the
total mean, add all the response variable values and divide it by the total number of
observations. Once the means are calculated, find the Sum of Squares (SS) using the
❑
formula SS = ∑ ¿¿ )2 where x is the value of the factor and x̅ is the mean of the factor.
i
2. Then calculate Mean Sum of Squares, by dividing sum of squares by their degree of
freedom.
3. Then calculate F value as given in the table
where a, b are the number of factors and n is the total number of observations

Source Degree of Sum of square Mean sum of F test

freedom Square
Main effect A a-1 SSa SSa/a-1 MSa/MSw

Main effect B b-1 SSb SSb/b-1 MSb/MSw

Interaction effect (a-1)(b-1) SSi SSi/(a-1)(b-1) MSi/MSw

Within(Error) ab(n-1) SSw SSw/ab(n-1)

Total n-1 TSS

DECISION RULE:
MSa MSb MSi
FA= , FB = ,Fi = ,
MSe MSe MSe
Follows Snedecor’s F distribution with [a-1, ab(n-1)], [b-1, ab(n-1)], [(a-1)(b-1), ab(n-1)]
degrees of freedom.
If an observed value of F obtained is greater than tabulated value of F for given degree of
freedom at specified level of significance, then the null hypothesis is rejected at that level,
otherwise we fail to reject the null hypothesis of no difference.

POST HOC TESTS

A post hoc test is used only after we find a statistically significant result and need to determine
where our differences truly came from. There are many different post hoc tests that have been
developed, and most of them will give similar results. The most commonly used ones are
Critical Difference- If the factors show significant effect then we would be interested to find out
which pair(s) of treatments differs significantly. For this instead of calculating Student’s t for
different pairs of treatment means, we calculate least significant difference (LSD)at the given
level of significance.

The C.D between any two factors at level of significance α is given by multiplying variance of
difference with tabulated value of t distribution with corresponding degree of freedom. If the
difference between any two treatment means is greater than C.D it is said to be significant,
otherwise it is not significant.
 CHAPTER 3
DATA REPRESENTATION
For the purpose of project data has been collected from different state consumer court websites
of India. Data here mentioned is of whole India. After collecting data, it has been tabulated year
wise.
Data of total number of cases in all states and union territories is given in the tables below

Maharash Tripur
Year Andhra UP Delhi Kerala Rajasthan tr Punjab a Orissa
200
5 48 47 36 36 22 20 17 0 0
200
6 84 72 35 18 46 33 29 0 0
200
7 98 128 68 11 25 55 28 0 0
200
8 97 21 107 18 0 44 15 0 0
200
9 81 13 50 38 32 42 16 0 0
201
0 88 8 44 27 56 45 48 0 0
201
1 51 9 38 14 42 40 63 0 0
201
2 51 22 48 27 36 36 61 0 0
201
3 70 86 35 43 27 35 96 3 1
201
4 54 160 9 42 33 69 82 0 0
201
5 29 171 294 52 65 92 95 0 9
201
6 29 166 62 40 89 85 67 4 10
201
7 28 143 57 28 68 66 64 3 20
201
9 19 107 38 34 86 75 45 4 6

BENGA Guja Uttarakhan Chattisgar Chandig Harya Karnata

year L rat MP TN d h arh na k
200
5 16 15 13 8 7 3 2 0 0
200
6 22 35 48 3 6 16 2 0 0
200
7 18 54 84 6 16 14 5 0 0
200
8 46 45 107 11 13 22 15 0 0
200
9 36 22 83 11 10 9 0 0 0
201
0 53 50 72 13 23 8 3 0 0
201
1 39 54 33 36 8 12 8 0 0
201
2 80 37 39 35 7 13 3 0 0
201
3 142 60 19 50 16 13 0 0 0
201
4 121 56 15 43 12 36 6 17 0
201
5 118 59 67 80 11 19 4 64 0
201
6 141 35 57 75 13 42 4 78 4
201
7 164 44 62 50 7 38 10 97 0
201
9 87 0 86 32 27 23 18 32 35

Meghal Go Himacha
Year Assam aya a l Pondichery Manipur Bihar
200
5 1 0 0 0 0 0 0
200
6 0 2 2 2 1 0 0
200
7 0 0 2 0 0 1 0
200
8 0 0 0 6 2 0 1
200
9 0 0 0 4 2 0 0
201
0 0 0 0 7 0 1 0
201
1 1 0 2 3 0 2 3
201
2 1 0 1 3 0 0 4
201
3 2 1 0 7 1 0 15
201
4 12 0 6 4 1 0 20
201
5 5 0 2 0 2 1 29
201
6 4 0 1 4 4 5 32
201
7 8 0 0 4 4 5 12
201
9 4 0 0 6 1 4 0

Telanga J& Arunach Andama

Year Sikkim na K al Jharkhand Mizoram n
200
5 0 0 0 0 0 0 0
200
6 0 0 0 0 0 0 0
200
7 0 0 0 0 0 0 0
200
8 0 0 0 0 0 0 0
200
9 1 2 0 0 0 0 0
201
0 0 10 1 1 0 0 0
201
1 0 8 1 0 9 1 0
201
2 0 7 3 0 6 0 1
201
3 0 38 2 0 13 0 0
201
4 0 42 1 0 10 0 0
201
5 0 41 3 0 15 0 0
201
6 0 43 0 0 16 0 0
201
7 0 52 1 0 9 1 0
201
9 6 29 0 0 9 0 0

Representing the data in 5 zones of India

Zone 1- North zone comprising Delhi, Haryana, Jammu & Kashmir, Himachal Pradesh, Punjab
 Zone 2- Central zone comprising Madhya Pradesh, Chhattisgarh, and Uttar Pradesh

Zone 3- East zone comprising Bihar, Jharkhand, Orissa, and West Bengal

Zone 4- West zone comprising Goa, Gujarat and Maharashtra

Zone 5- South zone comprising Andhra Pradesh, Karnataka, Kerala, Puduchery, Tamil Nadu and
Telangana

The data from year 2005 to 2019 is presented below:

Year zone 1 zone 2 zone 3 zone 4 zone 5

2005 77 70 16 35 92

2006 114 142 22 70 106

2007 126 242 18 111 115

2008 143 163 47 89 128

2009 102 115 36 64 134

2010 159 111 53 95 138

2011 155 62 51 96 109

2012 154 81 90 74 120

2013 71 134 171 95 202

2014 152 223 151 131 182

2015 525 268 171 153 204

2016 304 278 199 121 199

2017 301 250 205 110 162

2019 225 243 102 75 150

Now representing the data of different zones through bar chart, so as to visualize the increase and
decrease in number of cases in each zone
 Bar chart representing the number of cases in Zone 1 is given as

FIGURE 1

Interpretation- Number of cases in zone 1 was maximum in the year 2015, and
minimum in the year 2013. Number of cases showed a steady increase from 2005 to
2008, then were almost constant from year 2010 to 2012 and then a sudden decrease in
2013 and a surge in 2015

 Bar chart representing the number of cases in Zone 2 is given as

 Interpretation – Number of cases was maximum in the year 2016 and minimum in the
year 2011. Cases have experienced a steady growth from the year 2005 to 2007 and then
a steady decrease to 2011. And then increase from 2012 to 2016. And were almost
constant in further years.

 Bar chart representing the number of cases in Zone 3 is given as

FIGURE 3

Interpretation –Number of cases increased from 2005 to 2013 and then decreased in the
year 2014, the increased from 2015 to 2017. Number of cases was maximum in 2017 and
minimum in 2007.

 Bar chart representing the number of cases in Zone 4 is given as

 FI
GURE 4

Interpretation- Number of cases were maximum in the year 2015 and minimum in the
year 2005. Cases showed a steady growth from 2005 to 2007 and then a decrease from
2008 to 2009 and remained steady from 2010 to 2011 and a steady increase till 2015 and
decreased till 2019.
 Bar chart representing the number of cases in Zone 5 is given as

FIGURE 5

Interpretation- Number of cases showed a steady increase from the year 2005 to 2010
then a decrease in 2011 and a surge in 2013, then a constant decrease till 2019. Maximum
number of cases were seen in the year 2015 and minimum in the year 2005
 CHAPTER 4
DATA ANALYSIS
 First, finding the best fit for the data of each zone and forming the trend line

We will use the regression line y=a+bx where a and b are parameters.

 The trend line for 1st zone is

FIGURE 6

Interpretation – Since the R value is 0.613 so we can interpret that there is positive relation
between years and the number of cases in Zone 1, so if year is increased then the number of
cases will also increase. And R 2 value is approximately 0.37 so we can say that the independent
variable can describe 37% changes in dependent variable .i.e. years can describe 37% changes in
cases. Also we can forecast the number of cases in future years through the trend line
For the year 2025 the approximate number of cases will be 419.And for the year 2030 the
approximate number of cases will be 505.

 The trend line for 2nd zone is

 FIGURE 7

Interpretation – Since the R value is 0.65 so we can interpret that there is positive relation
between years and the number of cases in Zone 2, so if year is increased then the number of
cases will also increase. And R 2 value is approximately 0.43 so we can say that the independent
variable can describe 43% changes in dependent variable .i.e. years can describe 43% changes in
cases in zone 2.
Also we can forecast the number of cases in future years through the trend line
For the year 2025 the approximate number of cases will be 300
And For the year 2030 the approximate number of cases will be 360.

 The trend line for 3rdzone is

 FIGURE 8

Interpretation – Since the R value is 0.84 so we can interpret that there is high positive relation
between years and the number of cases in Zone 3, so if year is increased then the number of
cases will also increase. And R 2 value is approximately 0.72 so we can say that the independent
variable can describe 72% changes in dependent variable .i.e. years can describe 72% changes in
cases in zone 3.
Also we can forecast the number of cases in future years through the trend line
For the year 2025 the approximate number of cases will be 270
And For the year 2030 the approximate number of cases will be 340.

 The trend line for 4th zone is

FIGURE 9

Interpretation – Since the R value is 0.64 so we can interpret that there is high positive relation
between years and the number of cases in Zone 4, so if year is increased then the number of
cases will also increase. And R 2 value is approximately 0.42 so we can say that the independent
variable can describe 42% changes in dependent variable .i.e. years can describe 42% changes in
cases in zone 4.

Also we can forecast the number of cases in future years through the trend line

For the year 2025 the approximate number of cases will be 140

And For the year 2030 the approximate number of cases will be 160.
  The trend line for 5th zone is

FIGURE 10

Interpretation – Since the R value is 0.78 so we can interpret that there is high positive relation
between years and the number of cases in Zone 5, so if year is increased then the number of
cases will also increase. And R 2 value is approximately 0.61 so we can say that the independent
variable can describe 61% changes in dependent variable .i.e. years can describe 61% changes in
cases in zone 5. Also we can forecast the number of cases in future years through the trend line.
For the year 2025 the approximate number of cases will be 225 And For the year 2030 the
approximate number of cases will be 252.

 Two – way ANOVA

Here Two-way ANOVA is applied to test whether the two factors are affecting the
number of cases are significant .i.e. zones and years are significant, and also is there any
interaction effect.
For testing this we first set up the hypothesis to be tested.

 H0: The means of number of cases in all years are equal

 H1: The mean of at least one year is different

 H0: The means of number of cases in all zones are equal

 H1: The means of the cases in zones are different
 H0: There is no interaction effect of zones and years
 H1:There is no interaction effect of zones and years
Now the table for ANOVA is

SUMMARY Count Sum Average Variance

2005 5 290 58 988.5
2006 5 454 90.8 2139.2
2007 5 612 122.4 6350.3
2008 5 570 114 2138
2009 5 451 90.2 1574.2
2010 5 556 111.2 1663.2
2011 5 473 94.6 1705.3
2012 5 519 103.8 1095.2
2013 5 673 134.6 2870.3
2014 5 839 167.8 1283.7
2015 5 1321 264.2 23176.7
2016 5 1097 219.4 5321.3
2017 5 1028 205.6 5528.3
2019 5 795 159 5449.5

zone 1 14 2608 186.2857 14634.99

zone 2 14 2382 170.1429 6093.055
zone 3 14 1332 95.14286 4973.978
zone 4 14 1319 94.21429 913.2582
zone 5 14 2037 145.5 1424.577

Now the resultant table for ANOVA is

Source
of
Variatio
n SS df MS F P-value F crit
219826. 16909.7 6.07710 1.05E- 1.91345
Rows 6 13 4 8 06 5
Column 100443. 25110.8 9.02445 1.3E- 2.54976
s 2 4 1 1 05 3
144691.
Error 6 52 2782.53

464961.
Total 4 69
 POST HOC ANALYSIS

Multiple Comparisons
Dependent Variable: Cases
LSD

(I) Zone (J) Zone Mean Difference (I- Std. Error Sig. 95% Confidence Interval
J) Lower Bound Upper Bound

2.00 16.14286 28.30439 .570 -40.3849 72.6706

3.00 91.14286* 28.30439 .002 34.6151 147.6706

1.00
*
4.00 92.07143 28.30439 .002 35.5436 148.5992

5.00 40.78571 28.30439 .154 -15.7421 97.3135

1.00 -16.14286 28.30439 .570 -72.6706 40.3849
*
3.00 75.00000 28.30439 .010 18.4722 131.5278
2.00 *
4.00 75.92857 28.30439 .009 19.4008 132.4564
5.00 24.64286 28.30439 .387 -31.8849 81.1706
*
1.00 -91.14286 28.30439 .002 -147.6706 -34.6151
*
2.00 -75.00000 28.30439 .010 -131.5278 -18.4722
3.00
4.00 .92857 28.30439 .974 -55.5992 57.4564
5.00 -50.35714 28.30439 .080 -106.8849 6.1706
*
1.00 -92.07143 28.30439 .002 -148.5992 -35.5436
*
2.00 -75.92857 28.30439 .009 -132.4564 -19.4008
4.00
3.00 -.92857 28.30439 .974 -57.4564 55.5992
5.00 -51.28571 28.30439 .075 -107.8135 5.2421
1.00 -40.78571 28.30439 .154 -97.3135 15.7421

2.00 -24.64286 28.30439 .387 -81.1706 31.8849

5.00
3.00 50.35714 28.30439 .080 -6.1706 106.8849

4.00 51.28571 28.30439 .075 -5.2421 107.8135

*. The mean difference is significant at the 0.05 level.

Interpretation:
1. COMPARISON WITH ZONE 1- There was no significant effect of zone 1 and
zone 2 as well as zone 5 as p-value is greater than 0.05, so LSD post hoc test
revealed that there is no significant difference between number of cases in zone 1
and zone 2 as well as zone 5. But for all other zones there is significant difference
in number of cases. Difference in number of cases in zone 1 and zone 3 is 1226,
while zone 1 produces greater number of cases. Difference in number of cases in
zone 1 and zone 4 is 1289, while zone 1 produces greater number of cases.
2. COMPARISON WITH ZONE 2- There was no significant effect of zone 2 and
zone 1 as well as zone 5 as p-value is greater than 0.05, so LSD post hoc test
revealed that there is no significant difference between number of cases in zone 2
and zone 1 as well as zone 5. But for all other zones there is significant difference
in number of cases. Difference in number of cases in zone 2 and zone 4 is 1063,
while zone 2 produces greater number of cases. Difference in number of cases in
zone 2 and zone 3 is 1050, while zone 2 produces greater number of cases.
3. COMPARISON WITH ZONE 3- There was no significant effect of zone 3 and
zone 2, zone 4 as well as zone 5 as p-value is greater than 0.05, so LSD post hoc
test revealed that there is no significant difference between number of cases in
zone 3 and zone 2, zone 4 as well as zone 5.
4. COMPARISON WITH ZONE 4- There was no significant effect of zone 4 and
zone 2, zone 3 as well as zone 5 as p-value is greater than 0.05, so LSD post hoc
test revealed that there is no significant difference between number of cases in
zone 4 and zone 2, zone 3 as well as zone 5
5. COMPARISON WITH ZONE 5- There was no significant effect of zone 5 and
zone 1, zone 2, zone 3 as well as zone 4 as p-value is greater than 0.05, so LSD
post hoc test revealed that there is no significant difference between number of
cases in zone 5 and zone 1, zone 2, zone 3as well as zone 4.
 Chapter 5
Conclusion and Suggestion
OVERALL TREND OF MEDICAL NEGLIGENCE CASES IN INDIA:
From the Bar graphs and Trend line we can conclude that the annual number of medical
negligence cases were increasing gradually i.e. there is an increase trend of cases in India. The
most productive year for medical negligence cases was 2015. Zone 1 i.e. North Zone contributed
the highest number of cases to medical negligence in the period. And for each separate zone;
highest and lowest number of cases in zone 1 was in 2015 and 2013 respectively. Highest and
lowest number of cases in zone 2 was in 2015 and 2011 respectively. Highest and lowest number
of cases in zone 3 was in 2017 and 2005 respectively. Highest and lowest number of cases in
zone 4 was in 2015 and 2005 respectively. Highest and lowest number of cases in zone 5 was in
2015 and 2005 respectively. In most of the cases the crime rate has only increased with time
which is a cause to be taken care of.

From Two-Way Analysis of Variance we can conclude that there is significant effect of years on
the number of cases. And there is a significant effect of zones also on the number of cases.

From Post Hoc Analysis of Zones, we can conclude that there is significant difference between
number of cases in Zone 1 and Zone 3 , with higher number of cases in zone 1 also difference
between number of cases in zone 1 and Zone 4 is also significant. Similarly there is significant
difference between Zone 2 and Zone 3 as well as Zone 4, with higher number of cases in Zone 2.

Comments:
Zero reporting of decided medical negligence cases can be attributed to lack of computerization
and upload of medical negligence cases, lack of awareness among public about consumer rights.
Good quality of healthcare services and no deficiency in service by the healthcare institutions in
these states. Less cost / non availability of healthcare services can also be a reason for non-
reporting of medical negligence cases.
Free healthcare services provided by government healthcare institution can also be one of the
reasons for non-reporting of decided medical negligence cases from these states.

Suggestions
 Auditing medical records should be a more fact finding exercise rather than fault finding.
Good clinical practice must always prevail because it would incorporate the moral
 philosophy of good medicine. The criterion of good clinical practice as stipulated by the
law is that of a reasonably skilled doctor in his profession.

 Physicians should be encouraged to let the practice of "good medicine" be the best form
of. Risk prevention. This obviously includes good communication with patients and their
families regarding the risks, benefits, and possible complications of the planned medical
regimen. Many physicians unfortunately take a cynical approach to the problem of
medical liability and practice medicine with the goal of "not being sued" versus simply
providing quality, cost-efficient care.

 Medical Colleges and research institutions should come forward to encourage medical
fraternity/medical researchers to do more research to provide more insight into medical
negligence cases in India. This will help in improving the quality of healthcare in India.

 Governments at all levels, healthcare institutions and medical colleges should adopt
“Zero Tolerance” policy regarding medical negligence cases.

 Healthcare institutions of these states need to review reasons for lack of quality of
healthcare / deficiency of healthcare services so that number of medical negligence cases
can be decreased in future.

 Every Doctor who enters into the medical profession has a duty to act with a reasonable
degree of care and skill. This is what is known as ‘implied undertaking 'by a member of
the medical profession that he would use a fair degree of skill.

 Since many cases of proved medical negligence are due to lack of ethical practices, it is
pertinent to give due emphasis on teachings of medical ethics in media curriculum
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