Off-Duty Anaesthetist Cannot Face Section 304-A Prosecution for Nurse's Execution Error, Supreme Court Rules
A bench of Justices Pankaj Mithal and Prasanna B. Varale quashes criminal proceedings against a Kerala anaesthetist, holding that a nurse's procedural error cannot ground criminal negligence against an off-duty doctor.
The Supreme Court has quashed a Section 304-A IPC prosecution against Dr. Supriya Kumari M.C., a senior anaesthetist from Kannur, Kerala, who had faced criminal proceedings for over two decades following the post-operative death of a patient in 2002. A division bench of Justices Pankaj Mithal and Prasanna B. Varale held that the chain of events leading to the patient's death was too remote from any act attributable to the appellant, that the nurse's inconsistent statements carried no evidentiary value, and that the appellant's categorical exoneration by the consumer forum on merits barred continuation of the criminal case on identical facts. The Court discharged the appellant from all offences alleged in C.C. No. 501/2008 pending before the Judicial Magistrate First Class-I, Kannur.
How a 2002 Hospital Death Became a Two-Decade Criminal Case
On 28 May 2002, patient K.P. Muralidhar was admitted to Dhanalakshmi Hospital, Kannur, for a piles surgery scheduled the following morning. The surgery was conducted around 9:30 a.m. on 29 May 2002. The patient was shifted to the post-operative care ward in the evening, where his condition began deteriorating after 8 p.m. He collapsed at around 4 a.m. on 30 May 2002. Post-mortem examination revealed an 80% blockage in the left coronary artery; the cause of death was recorded as “death due to acute coronary insufficiency.”
The prosecution's case was that Dr. Supriya Kumari, who was the senior anaesthetist on call, should have personally administered post-operative analgesia to the patient. Instead, she allegedly instructed nurse Rosamma Varghese (accused no. 3) to administer the analgesic sensorcaine. The nurse administered the injection, but the prosecution alleged it did not enter the epidural space, failing to alleviate pain and triggering the fatal cardiac event.
The initial FIR, No. 432/2002, was lodged on 30 May 2002 by the deceased's brother against the surgeon, Dr. Mujeeb Rahiman (accused no. 1), under Section 304-A IPC. No allegations were made against Dr. Supriya Kumari in that FIR. The first chargesheet, filed on 15 April 2004, brought in the appellant as accused no. 2 and the nurse as accused no. 3, under Sections 304-A and 34 IPC.
The accused challenged that chargesheet before the Kerala High Court in Crl. M.C. No. 1813/2005. The High Court quashed it, granting liberty to the investigating agency to seek further investigation. An expert panel of four members was constituted, which in its final report dated 10 July 2008 unanimously concluded that the death occurred due to gross negligence on the part of hospital staff and could have been prevented if analgesia had been ensured by qualified persons. A second chargesheet was filed on 9 September 2008, cognisance was taken, and the case was registered as C.C. No. 501/2008.
A second quashing petition, Crl. M.C. No. 1603/2009, was dismissed by the High Court on 22 May 2009, with liberty to seek discharge under Section 239 CrPC. The discharge application, CMP 2492/2009, was dismissed by the Judicial Magistrate on 9 June 2011. The revision before the Additional District and Sessions Judge-II, Thalassery, was dismissed on 11 July 2018. A third round before the High Court under Section 482 CrPC, Crl. M.C. No. 6415/2018, was dismissed on 16 October 2024, with the High Court directing that all contentions be raised before the trial court at the appropriate stage.
Dr. Supriya Kumari then approached the Supreme Court by way of Special Leave Petition (Crl.) No. 124 of 2025, which was converted into a criminal appeal.
Consumer Forum Had Already Exonerated the Appellant on Merits
Running parallel to the criminal proceedings, the deceased's family had filed a consumer complaint, CC No. 123/2004, before the District Consumer Disputes Redressal Forum, Kannur. The Forum, in its order dated 17 April 2017, found that the appellant had not given any instructions to the nurse to administer any injection and that the decision may have been the nurse's and the surgeon's. The Forum held the hospital liable and imposed no liability on accused nos. 1 to 3.
When the family appealed this order before the Kerala State Consumer Redressal Commission in First Appeal No. 396/2017, they challenged only the quantum of compensation fixed at Rs. 12 lakhs. The appellant's exoneration was left entirely unchallenged and thus attained finality.
The Court found this sequence decisive. Senior Advocate R. Basant, appearing for the appellant, relied on Radheyshyam Kejriwal v. State of West Bengal, (2011) 3 SCC 581, where the Court had laid down that if exoneration in adjudication proceedings is on merits — where the allegation is found to be not sustainable at all and the person held innocent — criminal prosecution on the same set of facts and circumstances cannot be allowed to continue. The bench also noted reliance on Videocon Industries Ltd. and Anr. v. State of Maharashtra and Ors., (2016) 12 SCC 315, and Prem Raj v. Poonamma Menon, (2024) 6 SCC 143, which the Court said firmly established that once an accused is exonerated on merits in civil proceedings, allowing a criminal prosecution to continue on identical allegations constitutes a gross abuse of the process of law.
Nurse's Contradictory Statements and the Absent Anaesthetist on the Expert Panel
The Court found considerable force in the submission that nurse Rosamma's statements were irreconcilably inconsistent. In her first two statements, she said it was the surgeon who instructed her to administer the sensorcaine injection. In her third statement, she alleged it was the appellant who instructed her while being physically present in the ward. The surgeon's own statement before the expert panel, however, said that nurse Rosamma had consulted the appellant over the phone about the injection, after which it was given.
The Court held that these contradictions left the statements devoid of any evidentiary value capable of constituting a criminal act, and particularly a rash and negligent act, against the appellant.
A separate infirmity in the prosecution's case was the composition of the expert panel itself. The appellant pointed out that the four-member panel did not include an anaesthetist, rendering it inherently incompetent to evaluate the technical nuances of epidural anaesthesia and catheter management. The Court noted that the panel's conclusion that the appellant was grossly negligent for not waiting to observe the drug's effect — despite her shift having ended hours before the emergency arose — was highlighted as medically unsound. The prosecution's reliance on this flawed expert report, the Court found, violated the protective safeguards laid down in Jacob Mathew v. State of Punjab, (2005) 6 SCC 1.
The Section 304-A Threshold and the Doctrine of Proximate Cause
The Court's analysis of the criminal negligence standard drew heavily on Jacob Mathew. That decision established that for negligence to amount to a criminal offence, the element of mens rea must be shown to exist, and the degree of negligence must be much higher — gross or of a very high degree. The Court quoted the governing test: the act or omission must be such that “no medical professional in his ordinary senses and prudence would have done or failed to do.”
Applying this standard, the Court found that the appellant had completed her shift at 5:00 p.m. and left only after ensuring the patient was stable. When the emergency arose at 8:00 p.m., other doctors on duty, including an on-duty anaesthesiologist, were physically available at the hospital. Even accepting the prosecution's case at face value — that the appellant answered an SOS call from home and advised a painkiller — the Court held that relying on on-duty hospital staff to properly execute standard post-operative pain management cannot be deemed factually negligent. The prescribed medicine, sensorcaine, was undisputedly the correct analgesic for the situation.
The Court further held that any mishap occurred purely in the mechanical execution by the nurse, who allegedly failed to inject the drug properly into the epidural space. This was entirely beyond the physical control of the off-duty appellant. The failure of the nurse to accurately locate the epidural space might represent a deficiency in service attracting civil liability, but it fundamentally lacks the gross culpability or mens rea required to invoke Section 304-A IPC.
On the question of causation, the Court held that criminal liability under Section 304-A IPC requires a direct, proximate nexus between the negligent act and the death. The post-mortem certificate had conclusively established that the deceased had an asymptomatic 80% blockage in his coronary artery, and the immediate cause of death was acute coronary insufficiency. While the improper administration of the painkiller by the nurse might have failed to alleviate surgical pain — which in turn induced stress that triggered the fatal cardiac event — this chain of events could not legally be attributed to the appellant. The Court held that fastening criminal liability on an off-duty anaesthetist for an underlying, undisclosed cardiac condition stretches the legal doctrine of proximate cause beyond permissible limits.
Order
The Supreme Court allowed the appeal and set aside the order dated 16 October 2024 passed by the High Court of Kerala at Ernakulam in Crl. M.C. No. 6415 of 2018. The criminal case in C.C. No. 501/2008 pending before the Judicial Magistrate First Class-I, Kannur, stands quashed. The appellant, Dr. Supriya Kumari M.C., is discharged from all offences alleged against her. Pending applications, if any, stand disposed of.