Courts must refrain from applying general presumption in medico-legal cases: HC relief to doctors Accused of Forging Lab Reports

Jodhpur: Observing that judicial restraint is paramount at the stage of cognizance in medico-legal cases, the Jodhpur bench of Rajasthan High Court recently opined that in cases concerning doctors/hospital administration involving allegations of forging pathological reports, meticulous judicial scrutiny was required before taking cognizance, especially when the doctor had not refuted the authenticity of the signatures.

With this, the Court exonerated a group of doctors who were charged with forging pathological reports. Four doctors filed pleas before the HC bench after the Trial Court as well as the revision court took cognizance of the offences for cheating and forgery against them based on a complaint filed by the complainant.

Explaining the consequences that doctors and hospitals might face if the courts rely on general presumptions, the HC bench comprising Justice Farjand Ali observed, "However, courts must exercise extreme caution to avoid being influenced by mere bald or motivated allegations unsupported by substantive evidence. Invoking presumptions under the guise of Section 114 of the Indian Evidence Act, 1872, at the stage of taking cognizance, is particularly fraught with risks. This provision allows courts to presume certain facts based on common experience and logical inference, but employing such presumptions prematurely without any solid evidentiary backing can lead to serious injustices. Relying on general presumptions at this stage, particularly in medico-legal cases, can unjustly call into question the professional competency and integrity of medical practitioners and institutions."

"In medico-legal matters, where the stakes often involve not just reputations but also public trust in healthcare systems, the consequences of presumptive reasoning are magnified. The courts must refrain from applying the theory of general presumption in such cases until clear, scientific, and legally admissible evidence is presented to substantiate the allegations. Presumptions, when invoked prematurely, risk overshadowing the objective evaluation of facts and can lead to unnecessary stigmatization of professionals whose actions may be entirely lawful and appropriate. Judicial restraint is, therefore, paramount at the stage of cognizance in medico-legal cases. Courts must ensure that decisions to proceed are grounded in demonstrable and credible evidence, such as conclusive findings from forensic or scientific tests. This approach prevents misuse of Section 114, which, if misapplied, can undermine the foundational principles of fairness and due process," the bench further noted.

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The complainant filed a complaint before the learned Civil Judge (JD)-cumJudicial Magistrate, Jodhpur City, alleging that his brother-in-law was admitted to Escorts Goyal Heart Centre, jodhpur on 03.10.2006, and he passed away during his treatment. Post his demise, the hospital administration refused to provide complete medical records, including pathological reports, despite repeated requests.

Further, he had alleged that when the treatment records and reports were provided on 29.11.2006, the complainant identified discrepancies in the pathology reports more particularly regarding the inconsistency with the signatures so appended over the pathological reports. The complainant got the same examined by a private handwriting expert who in turn suggested that the signatures were found to be appended by different persons over the reports.

The complainant had also alleged that the hospital administration, in collusion with the treating doctor, allegedly generated false bills based on fabricated pathological reports and despite knowing that the reports were false, the doctors prescribed a flawed medical treatment plan, which ultimately proved fatal for the deceased. The complainant was charged a total of ₹22,040 for the pathological reports and ₹88,815 for the entire treatment and medical expenses, all of which are claimed to be based on false and fabricated reports and actions.

Consequently, the trial court, in support of the complaint, proceeded to initiate the process of taking cognizance by recording the statements under Sections 200 and 202 of the Cr.P.C of the complainants. Later, the court took cognizance of the offences through order dated 19.04.2008 and thereafter, issued process against petitioners through a bailable warrant.

Challenging the Trial court's order, the complainants approached the Rajasthan High Court. While considering the matter, the HC bench referred to Lord Denning's observation in the case of Roe and Woolley v. Minister of Health (1954), in which it was held that "It is so easy to be wise after the event and to condemn as negligence that which was only a misadventure. We ought to be on our guard against it, especially in cases against hospitals and doctors. Medical science has conferred great benefits on mankind but these benefits are attended by unavoidable risks. Every surgical operation is attended by risks. We cannot take the benefits without taking the risks. Every advance in technique is also attended by risks. Doctors, like the rest of us, have to learn by experience; and experience often teaches in a hard way."

Referring to this, the HC bench observed that cognizance serves as a crucial gateway to the judicial process, ensuring that courts engage only when a case presents a clear and sufficient legal foundation for proceeding.

"In cases where allegations are raised against Doctors’ or against the Hospital administration for forging pathology reports and appending signatures by individuals other than the doctor, the process of taking cognizance requires meticulous judicial scrutiny, especially when the doctor has not refuted the authenticity of the signatures," noted the High Court.

Opining that judicial restraint is of paramount importance at the stage of cognizance in medico-legal cases, the HC bench further noted that "By adopting this measured approach, the judiciary not only safeguards the reputations of individuals and institutions from unwarranted harm but also reinforces public confidence in both the legal and medical systems. It ensures that only cases with genuine merit proceed to trial, thereby maintaining the sanctity of the judicial process."

In respect to this case, the Court noted that the patient was admitted to a hospital where multiple diagnostic and pathological reports were prepared under the administration and supervision of the hospital staff. "To assert that minor discrepancies in the style or tenor of a signature could entirely invalidate the authenticity or reliability of such reports is both implausible and detached from the extensive processes involved in their preparation," it noted.

The Court underlined that no reasonable assumption supported the contention that the medical staff, in collusion with the hospital administration, acted with such deliberate precision and intent as to fabricate pathological reports for administering false or misguided treatment. "The allegation, devoid of substantive evidence, fails to align with the factual framework of the case," noted the Court.

"It is quite established rather a conclusive practice that Pathological reports are generated through advanced diagnostic tools and techniques, which are designed to ensure precision, minimize human error, and eliminate subjective bias. These include sophisticated methodologies such as immunohistochemistry (IHC) for tissue analysis, polymerase chain reaction (PCR) for genetic or infectious detection, automated haematology and biochemistry analyzers for blood tests, enzymelinked immunosorbent assay (ELISA) for protein quantification, and radiological imaging techniques like MRI and CT scans. Such methods are governed by strict protocols, quality controls, and automated systems, leaving negligible room for human interference or intentional manipulation," the Court noted at this outset.

"Additionally, these reports are prepared under the oversight of certified medical professionals who adhere to ethical and procedural standards. The mere allegation of a signature discrepancy does not negate the integrity of findings derived from these scientifically validated processes. It is also significant that the individual responsible for verifying and signing the reports has not disputed the signatures or claimed any forgery. This absence of contestation further diminishes the credibility of the allegations," it further observed.

The Court further observed that even if there were differences in the style or appearance of the signatures, such inconsistencies absent conclusive proof of falsification cannot suffice to render the reports forged or fabricated. Pathological findings, central to medical treatment, result from the collective efforts of medical experts, technicians, and automated systems. Allegations of intentional falsification, particularly in the absence of credible evidence, are untenable in light of the circumstances, observed the Court.

It also noted that the findings of the Penal and Ethical Committee of the Rajasthan Medical Council, a panel of experts, reinforced this position and the committee found no evidence of mala fide intent or professional misconduct on the part of the hospital or the doctor. "This expert opinion further underscores the fallacy of the allegations, which lack factual and evidentiary support," it noted.

"Thus, the pathological reports, rooted in advanced scientific techniques and professional oversight, cannot be dismissed on the basis of alleged signature discrepancies. Such isolated irregularities fail to undermine the credibility of the diagnostic process or substantiate a broader claim of forgery or manipulation. The allegations do not stand, given the prevailing circumstances of the case, and must be viewed in the context of the comprehensive medical treatment provided, where authenticity and accuracy remain unimpeached unless conclusively proven otherwise," observed the HC bench.

The Court also analyzed the charges in light of the ingredients of the specific sections under the IPC and observed that the existence of a "false document" was a prerequisite for invoking the charge of forgery. However, in this case, the court noted that no authority or the purported author of the pathological report had questioned its authenticity.

It was held by the bench that even if it was assumed that the report was not signed by the same person whose name was written at the bottom of the report, it did not prove to be a false document unless it was coupled with dishonesty or fraudulency on part of the accused with an intention to cheat the complainant.

At this outset, the bench observed, 

"The jurisprudential cornerstone for establishing culpability under these statutory provisions lies in unequivocal evidence demonstrating deliberate deceit, fraudulent intent, and the creation or utilization of a 'false document' as defined under Section 464 IPC. In the absence of such evidence, the allegations remain speculative and unsubstantiated. Consequently, it is incumbent upon the judiciary to exercise heightened scrutiny and circumspection before attributing criminal culpability under the aforementioned sections,"

Referring to the Trial Court's order, the High Court noted that it did not demonstrate that the learned Magistrate as well as the revisional court undertook a comprehensive examination of whether the allegations aligned with the essential elements of the offence. However, it also observed, 

"Although this court is conscious of the fact that the comprehensive examination at the stage of cognizance is not warranted but the cases where criminal complaint is against the Doctors and the health care institutions then the degree of examination and process of evaluation must on high pedestal where such allegations like in the present case so levelled might be the product of afterthought resentment of affairs prevailed post incident of an unfavourable human expectation."

Accordingly, the Court held that the cognizance taken by the trial court was based on mere presumption rather than credible evidence. With this observation, the bench set aside the trial court's order and exonerated the doctors of the charges.

To view the HC order, click on the link below:

https://medicaldialogues.in/pdf_upload/rajasthan-hc-order-268007.pdf

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