Medical Negligence Case | Supreme Court Discharges Anaesthetist Who Prescribed Medicine Over Phone To Staff Nurse

The Supreme Court on Monday (May 25) discharged an anaesthetist for an alleged post-surgery complication to the patient because of the medication prescribed by her over the phone to the nurse, which resulted in the death of the patient.

The Court held that an anaesthetist would not be held guilty under Section 304-A of IPC, for the post-surgery complication, which resulted due to improper application of medicine to the patient by the staff nurse, which was entirely beyond the physical control of the off-duty anaesthesian.

“Legally, an anaesthetist whose duty hours have concluded cannot be held criminally liable for a subsequent procedural error committed by a staff nurse. Even if the prosecution's case is taken at face value that the appellant suggested a painkiller over the phone, such an act constitutes standard medical advice for postoperative pain, not gross criminal recklessness. The failure of the nurse to accurately locate the epidural space might represent a deficiency in service (civil liability), but it fundamentally lacks the gross culpability or mens rea required to invoke Section 304-A IPC.”, observed a bench of Justice Pankaj Mithal and Justice Prasanna B. Varale, while setting aside the Kerala High Court's order refusing to quash the medical negligence case (Section 304-A IPC) against the Appellant- anaesthetist.

The case arose from the death of patient, who was admitted to Dhanalakshmi Hospital, Kannur, in May 2002 for piles surgery. The prosecution alleged that after the surgery, when the patient complained of severe pain, the appellant, who was the senior anaesthetist, negligently instructed a nurse to administer the analgesic sensorcaine instead of personally doing so. The patient later collapsed and died. A post-mortem attributed the death to acute coronary insufficiency, noting an 80% blockage in the left coronary artery.

However, the Appellant-anaesthetist defended herself from the alleged act, relying on Jacob Mathew vs. State of Punjab, (2005) 6 SCC 1, to contend that prescribing a medicine over a phone call constitutes standard medical advice for postoperative pain, not gross criminal recklessness.

Finding force in the Appellant's contention, the judgment authored by Justice Varale observed that the Appellant would have been held liable if she failed to take a reasonable care, which is expected in an ordinary prudence by a medical professional. Though, she was not present during the SOS call, physical presence of other doctors on-duty, including an on-duty anaesthesiologist, at the hospital, cannot be deemed to account a negligence on the Appellant's part.

“The report indicates that appellant completed her shift at 5:00 p.m. and left only after ensuring the patient was stable. When the emergency arose at 8:00p.m., other doctors on-duty, including an on-duty anaesthesiologist, were physically available at the hospital. Even if it is assumed that the appellant answered an SOS call from home and advised a painkiller, relying on the on duty hospital staff to properly execute standard post-operative pain management cannot be deemed factually negligent.”, the court observed.

“The act must be of such a nature that "no medical professional in his ordinary senses and prudence would have done or failed to do".”, observed the Court, emphasizing that the medical professionals cannot be booked for negligence once they have reportedly taken due care and caution while doing treatment.

Non-inclusion of an anaesthetist in the expert medical panel proved fatal to the prosecution's case

The Court also noted a legal flaw in the prosecution's case: the four-member expert medical panel constituted to review the case did not include an anaesthetist. Jacob Mathew (supra) strictly mandates that before initiating a criminal prosecution against a doctor, the investigating officer must obtain an independent medical opinion, preferably from a doctor qualified in the specific branch of medical practice involved.

The absence of a peer specialist, the Court observed, rendered the panel inherently incompetent to evaluate the technical nuances of epidural anaesthesia and catheter management.

“The appellant has also raised a ground pointing out to a legal flaw, namely non-inclusion of the anaesthetic in the four-member expert medical panel constituted to review the case. The absence of a peer specialist renders the panel inherently incompetent to evaluate the technical nuances of epidural anaesthesia and catheter management. The panel's conclusion that the appellant was "grossly negligent" for not waiting to see the drug's effect, despite her shift ending hours prior to the emergency, was highlighted as medically absurd. The prosecution's reliance on this flawed expert report violates the protective legal safeguards laid down by the Supreme Court to  prevent the harassment of medical professionals.”, the court observed.

In terms of the aforesaid, the appeal was allowed, and the Appellant stands discharged from the case.

Headnote

Criminal Procedure Code, 1973 (CrPC) – Section 482 – Indian Penal Code, 1860 (IPC) – Section 304-A – Medical Negligence – Quashing of Criminal Proceedings – Exoneration on Merits in Civil/Consumer Proceedings – Effect on Parallel Criminal Prosecution – The appellant, a senior anaesthetist, challenged the criminal prosecution initiated against her under Section 304-A read with Section 34 of the IPC for alleged gross negligence leading to the death of a patient post-surgery - The prosecution alleged that the appellant orally instructed an inexperienced staff nurse to administer a specialized analgesic injection ('sensorcaine') instead of doing it personally, which allegedly did not enter the epidural space, failing to alleviate pain and triggering a fatal cardiac event - Held, allowing the appeal and quashing the criminal proceedings, that for a criminal charge under Section 304-A of the IPC to survive, the negligence or recklessness must be of such a high degree as to be "gross" - An anaesthetist whose duty hours have concluded cannot be held criminally liable for a subsequent procedural error committed by a staff nurse in the mechanical execution of a standard post-operative pain management instruction - the family of the deceased pursued a parallel civil claim before the District Consumer Disputes Redressal Forum, which categorically exonerated the appellant on merits, finding that she had not given instructions to the nurse to administer the injection - This exoneration remained unchallenged and attained finality. Once an accused is exonerated on merits in civil proceedings, allowing a criminal prosecution to continue on identical allegations and facts constitutes a gross abuse of the process of law, as the standard of proof required in criminal cases is higher than that in civil cases. [Paras 18, 21-29]

Medical Negligence – Expert Panel Guidelines – Absence of Peer Specialist – The investigative guidelines require an independent medical opinion from a doctor qualified in the specific branch of medicine involved before initiating criminal prosecution against a medical professional - The constitution of a four-member expert medical panel without an anaesthetist to review a case involving technical nuances of epidural anaesthesia constitutes a significant legal and procedural flaw, rendering its conclusion incompetent. [Paras 26, 27]

Criminal Law – Proximate Cause (Causa Causans) – To fasten criminal liability under Section 304-A IPC, there must be a direct and proximate nexus between the alleged negligent act and the death - Where the post-mortem report conclusively establishes that the immediate cause of death was acute coronary insufficiency resulting from an underlying, undisclosed 80% blockage in the coronary artery, the actions of an off-duty anaesthetist are far too remote to attract criminal culpability. [Relied on Jacob Mathew v. State of Punjab, (2005) 6 SCC 1; Radheyshyam Kejriwal v. State of West Bengal, (2011) 3 SCC 581; Videocon Industries Ltd. and Anr. v. State of Maharashtra and Ors., (2016) 12 SCC 315; Prem Raj v. Poonamma Menon, (2024) 6 SCC 143; Para 20-28]

Cause Title: SUPRIYA KUMARI M.C. VERSUS STATE OF KERALA & ORS.

Citation : 2026 LiveLaw (SC) 540

Click here to download judgment

Appearance:

For Petitioner(s) Mr. R. Basant, Sr. Adv.(argued by);  Mr. Akshay Sahay, Adv. Mr. Kavinesh RM, Adv. Mr. Divyanshu Sahay, AOR

For Respondent(s)/ R-1 Mr. Harshad V. Hameed, AOR (argued by); Mr. Dileep Poolakkot, Adv. Mrs. Ashly Harshad, Adv. Mr. Mahabir Singh, Adv. Mr. Anshul Saharan, Adv.

R – 2-4 Mr. Abhishek Chauhan, Adv. (argued by); Mr. RSM Kalky, Adv. Mr. S.P. Singh, Adv. Mr. Ajit Kumar Ekka, Adv. Mr. Alok Kumar, Adv. Ms. Shriya Sethi, Adv. Mr. Ravi Prakash, AOR