Simply Because Patient Didn't Respond Favourably To Treatment Or Surgery Failed, Doctor Cannot Be Held Negligent: Kerala High Court

A single bench of the court was hearing criminal appeals by three doctors and three nurses convicted by a lower court under sections 304A and 201 read with Section 34 of India Penal Code, 1860 for medical negligence. They were sentenced to simple imprisonment for a year for the offence under section 304A r/w 34 of IPC and simple imprisonment for three months for the offence under section 201 r/w 34 of IPC. 

Justice Kauser Edappagath while acquitting the accused persons noted that the action of the medical professional should be the proximate or direct cause of death of the patient to establish a case of medical negligence and such evidence is lacking in the case. According to the court, nothing was brought on record to show gross and culpable negligence on part of the medical professionals.

“There is always the chance that the treatment does not go as planned. When things go wrong, it is not always the fault of the doctor. A complication by itself does not constitute negligence. There is a big difference between an adverse or untoward event and negligence. However, there is a growing tendency to accuse the doctor of an adverse or untoward event. Nothing can be more professionally damaging and emotionally draining than being arrayed as an accused in any such action.”

In an unfortunate incident at Deen Hospital, Punalur, a 37-year-old woman lost her life after a laparoscopic sterilization, commonly considered to be a simple medical procedure for birth control. After the procedure, she developed respiratory complications and despite being shifted to two different hospitals later on for urgent care, her life could not be saved.

The doctors, gynaecologist and nurses involved in the incident were booked for medical negligence and convicted, following which the criminal appeal was filed before the High Court.

The court observed that every death of a patient cannot, on the face of it, be medical negligence. There must be sufficient evidence to prove that the death is due to the alleged medical negligence

The court placed reliance on the “Bolam Test” most commonly relied on in medical negligence jurisprudence in India and based on the landmark English case of Bolam v. Friern Hospital Management Committee {[1957] 1 W.L.R. 582}. The standard of care, according to the Bolam Test, is that a medical professional is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art.

The court also noted that the question of degree is always relevant to impute criminal liability on medical negligence. In this regard, the court referred to the case of Dr. Suresh Gupta v. Govt. of NCT of Delhi [(2004) 6 SCC 422], where the Apex Court held that the degree of negligence required should be gross or reckless and that a mere lack of necessary care, attention, or skill was insufficient to hold one criminally liable for negligence.

The counsel for the accused averred that in the absence of evidence on record to prove culpable negligence against the accused, the court below grossly erred in convicting the medical professionals.

Senior Public Prosecutor Smt. T. V. Neema on the other hand opposed the contention of the accused and argued that necessary ingredients of sections 304A and 201 r/w 34 of IPC had been established.

The main allegations against the doctor involved in the incident was that he is not a qualified anesthesiologist, and that he administered spinal anesthesia instead of general anesthesia which resulted in the death of the patient. The prosecution also alleged that a proper pre-operative evaluation of the patient was not done.

After the case was registered by the Punalur Police, the investigation officer requested the District Medical Officer, Thiruvananthapuram, to constitute an expert panel and to give their views on the allegation of medical negligence. The matter was then referred to an apex body which came out with its reports.

The court relied on the reports of the apex body to conclude that the doctor, who administered anesthesia, was qualified to do so, as he had an MBBS degree and had undergone one-year Senior House Surgency in anesthesia at Medical College, Thiruvananthapuram. The court also observed that there was nothing on record to prove that the administration of anesthesia, whether spinal or general, was the proximate cause of the death of the patient.

The court on a careful perusal of records observed that laparoscopic sterilization could be done either under spinal anesthesia or general anesthesia, even though local anesthesia is the preferred choice for a tubectomy operation. The court in this regard referred to the observation of the Supreme Court in Jacob Mathew v. State of Punjab and Another (AIR 2005 SC 3180) which noted that a medical practitioner cannot be held criminally liable simply because things went wrong through an error of judgment in choosing one reasonable course of procedure/treatment in preference of another.

The court concluded that there was no convincing evidence to connect the accused with the alleged incident. According to the court, the prosecution failed to prove beyond reasonable doubt that the accused persons were responsible for the death of the patient and hence were entitled to get the benefit of doubt. The court also observed that:

“…..The Judicial Forums, in the process of fixing parameters of liability in the cases of medical negligence, must aim at striking a careful balance between the autonomy of a doctor to make judgments and the rights of a patient to be dealt with fairly, recognizing the complexity of the human body, inexactness of medical science, the inherent subjectivity of the process, and genuine scope for error of judgment. However, while dealing with criminal prosecution for medical negligence, the trial courts often ignore these principles.”

The court found the accused persons not guilty of the offences charged against them and accordingly acquitted them, setting aside the conviction and sentence of the lower court.

Cause Title: Dr. Balachandran v. State of Kerala and other connected matters

Citation : 2023 LiveLaw (Ker) 61 

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