In a historic ruling, the Supreme Court of India has dismissed culpable homicide charges against a doctor who, over the phone, ordered a nurse to give an injection that is said to have killed a patient. The court, which had Justices Vikram Nath and Sandeep Mehta sitting on it, held that though the doctor's conduct may have been negligent, it does not qualify as culpable homicide under Section 304 Part I of the Indian Penal Code (IPC). Rather, the charge in this case would be under Section 304A of the IPC, which is for causing death by negligence.
The case began on February 21, 2013, at Thiruvallur, Tamil Nadu, when a lady was admitted to a private nursing home with the complaints of headache, vomiting, dizziness, and fever. The nurse, after receiving telephonic orders from the doctor, gave her some injections. The patient then developed complications, and she was shifted to a government hospital, where she was declared dead. The post-mortem report held her death due to an acute hypersensitive drug reaction.
After the patient's husband complained, the doctor was charged under Section 304 Part I of the IPC, which pertains to culpable homicide not amounting to murder and is punishable with a maximum of ten years' imprisonment. The doctor challenged this charge in the Madras High Court. But on August 11, 2021, the High Court refused to strike down the proceedings, citing prima facie evidence sufficient to continue under the more serious charge, particularly as the doctor was not present physically while treating the patient and had provided instructions remotely.
In appeal, the Supreme Court quoted its 2005 judgment in the Jacob Mathew case, which sets out the test for criminal liability in medical negligence. The Court pointed out that only if an act of medical negligence involves intent or knowledge on the part of the doctor that death was a likely result will it amount to culpable homicide. Otherwise, the act can be termed as per Section 304A of the IPC and can be given a lesser sentence of two years. [1]
The court declared, "After going through the facts and the circumstances of this case, in our considered view the registering the FIR under Section 304 Part I of the IPC and lodging of police report under Section 173(2) CrPC also under Section 304 Part I of IPC cannot stand the test of times." Hence, the Court held the charge made under Section 304 Part I be dismissed and that the case continue under Section 304A. The sessions judge is directed to file the case records with a suitable magistrate for trial under the right section to gauge the extent of criminal negligence, if any. [2]
This decision strengthens the judicial practice that criminal liability in medical negligence must be reserved for cases of gross recklessness or intentional intent. It emphasises the need to differentiate between medical mistakes and criminal conduct, so that healthcare professionals are not unnecessarily punished for unintended consequences. [3]
The Supreme Court's reference to the Jacob Mathew case serves to highlight the application of the Bolam Test in the Indian context. Derived from the 1957 English case of Bolam v. Friern Hospital Management Committee, this test holds that a medical practitioner will not be found to be negligent if he acted in line with a practice widely accepted as reasonable by a respectable body of medical practitioners. [4] In the Jacob Mathew judgment, the Supreme Court embraced this standard, declaring that liability occurs only when a doctor is not equipped with the required skills or is not exercising reasonable competence.
In a similar ruling last October, the Supreme Court further elucidated that doctors cannot be charged with negligence merely because a treatment or operation does not produce desired outcomes. The Court reiterated that culpability must be founded on evident deviation from standard medical practices.
The sequence of judgements attempts to balance the culpability of doctors with an appreciation for the uncertainties and inherent dangers involved in medical interventions. By establishing an elevated standard for criminal responsibility, the judiciary endeavours to safeguard doctors from arbitrary prosecution while permitting actual instances of gross negligence to be judiciously addressed.
The Supreme Court ruling in this case is an important reminder of the significance of intent and knowledge in establishing criminal liability in cases of medical negligence. It emphasises the necessity of a balanced approach that takes into account the particular facts and the professional standards prevailing at the time of the event. [5]
Supreme Court of India. (2005). Jacob Mathew v. State of Punjab & Anr., AIR 2005 SC 3180.
Indian Penal Code, Section 304A. Retrieved from https://indiankanoon.org/doc/786174/
Supreme Court of India. (2024, October). Medical Negligence and Criminal Liability. Retrieved from https://www.livelaw.in/supreme-court/medical-negligence-liability-2024
Bolam v. Friern Hospital Management Committee. (1957). 1 WLR 582 (UK).
Indian Penal Code, Section 304. Retrieved from https://indiankanoon.org/doc/768531/
(Input from various sources)
(Rehash/Pragati Sakhuja/MSM)