The Supreme Court quashed criminal proceedings against anaesthetist Dr. Supriya Kumari in a Kerala medical negligence case, holding that an off-duty doctor cannot face criminal liability for a procedural error allegedly committed by a nurse without proof of gross negligence or recklessness.
The Supreme Court has recently quashed criminal proceedings against a senior anaesthetist accused of medical negligence in connection with the death of a post-operative patient in Kerala, holding that an off-duty doctor cannot be held criminally liable for a procedural error allegedly committed by a nurse. The judgment was delivered on May 25 by a Bench of Justices Pankaj Mithal and Prasanna B Varale.
The Court observed that criminal liability in medical negligence cases requires proof of gross negligence or recklessness and not merely an error in medical procedure or treatment.
While allowing the appeal filed by anaesthetist Dr. Supriya Kumari, the Bench held:
“Legally, an anaesthetist whose duty hours have concluded cannot be held criminally liable for a subsequent procedural error committed by a staff nurse.”
The case arose from the death of a patient, KP Muralidhar, who underwent piles surgery at a hospital in Kannur in May 2002. Following the surgery, the patient reportedly experienced severe pain and his condition deteriorated. He later collapsed and died.
According to the prosecution, the anaesthetist had allegedly instructed a nurse over telephone to administer a painkiller injection instead of personally supervising the procedure. It was alleged that after the injection was administered, the patient lost consciousness and eventually died.
Initially, the FIR in the matter was registered only against the surgeon. However, after further investigation, police filed charge sheets against the surgeon, the anaesthetist and the nurse under Sections 304-A and 34 of the Indian Penal Code, accusing them of causing death by negligence with common intention.
During the proceedings, the prosecution claimed that the nurse improperly administered the painkiller injection, allegedly resulting in complications that contributed to the patient’s death.
However, the Supreme Court noted that the prosecution had failed to conclusively establish that the anaesthetist had actually instructed the nurse to administer the injection. The Court further observed that even if such telephonic advice had been given, it would amount only to standard post-operative pain management advice and not criminal recklessness.
The Court held,
“Even if it is assumed that the appellant-accused answered an SOS call from home and advised a painkiller, relying on the duty hospital staff to properly execute standard post-operative pain management cannot be deemed factually negligent,”
The Bench explained that the prescribed medicine, Sensorcaine, was admittedly the correct analgesic required for the patient’s post-operative care. According to the Court, any alleged mishap occurred because the nurse may have failed to properly inject the medicine into the epidural space an act that was entirely beyond the physical control of the off-duty anaesthetist.
The judgment stated,
“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,”
The Court also took note of the medical evidence placed on record. The post-mortem examination had revealed that the patient suffered from an 80 percent blockage in the left coronary artery. The official cause of death was recorded as acute coronary insufficiency resulting in a heart attack.
Referring to this medical evidence, the Supreme Court observed that the alleged procedural lapse by the nurse could not legally be treated as the direct cause of death.
The Court noted,
“The post-mortem certificate conclusively established that the deceased had an asymptomatic 80% blockage in his coronary artery. The medical evidence proved that the immediate cause of death was acute coronary insufficiency resulting in a heart attack,”
The Bench further explained that while improper administration of the painkiller may have failed to relieve the patient’s pain, leading to stress that possibly triggered the cardiac event, the chain of causation was too remote to attract criminal liability against the anaesthetist.
The Court observed,
“Criminal liability under Section 304-A IPC necessitates a direct, proximate nexus between the negligent act and the death (causa causans). Legally, the appellant’s actions were far too remote from the ultimate cause of death,”
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The judgment also referred to parallel consumer proceedings initiated by the deceased patient’s family before the District Consumer Disputes Redressal Forum in Kannur. In 2017, the Consumer Forum had concluded that the anaesthetist had not instructed the nurse to administer the injection and had instead held the hospital liable.
The Supreme Court noted that this finding had attained finality since it was never challenged before the appellate consumer forum. The Court further criticised the expert medical panel constituted during the criminal investigation, pointing out that the panel did not include an anaesthetist.
The Court observed,
“The absence of a peer specialist renders the panel inherently incompetent to evaluate the technical nuances of epidural anaesthesia and catheter management,”
Dr. Supriya Kumari’s discharge plea had earlier been rejected by the trial court in 2011, and her challenge before the sessions court was dismissed in 2018. Subsequently, the Kerala High Court also refused to quash the criminal proceedings in October 2024, following which she approached the Supreme Court.
Setting aside the Kerala High Court’s order, the apex court ultimately discharged the anaesthetist from the criminal case, reiterating that criminal prosecution in medical negligence matters can proceed only when the conduct of the medical professional demonstrates gross negligence of a very high degree.
The ruling is expected to have significant implications for future medical negligence prosecutions, particularly in cases involving post-operative treatment, supervisory liability and criminal culpability of medical professionals.
Case Title: Supriya Kumari M.C. v State of Kerala.
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