Patient death after doctor administers Spinal Anaesthesia without Specialist: HC says Medical negligence cannot be equated with culpable homicide

Ernakulam: Holding that medical negligence by doctors without intention or knowledge that death was a likely consequence, does not amount to culpable homicide, the Kerala High Court quashed criminal proceedings against a surgeon who was accused of negligence in the death of a 10-year-old girl during appendectomy at a private nursing home in Palakkad in 2012.

The court emphasised that even if a medical error leads to death, it cannot be equated with culpable homicide unless there is a clear element of intent or awareness of the potential of the outcome. In other words, the court intended to say that not all cases of medical negligence that result in a patient’s death should be treated as serious criminal offences like culpable homicide under Section 304 of the Indian Penal Code (IPC).

Section 304 IPC deals with culpable homicide not amounting to murder, which means a death caused by an act that would be murder, but with mitigating circumstances like the absence of intent to kill or knowledge that death was likely.

Hence, Single Bench Justice Kauser Edappagath said, 

"An act of medical negligence, even if resulting in death, would not automatically constitute culpable homicide unless there is intent or knowledge that the death would be a likely consequence. Medical negligence cannot be equated with culpable homicide. In medical negligence cases, if the death is due to failure to exercise reasonable care or a breach of duty by a medical professional, Section 304 A may be invoked."

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The case arose out of an incident at Kerala Nursing Home, Palakkad, in 2012, when the doctor (petitioner) then serving as a visiting surgeon, had performed an appendectomy on Athira, a 10-year-old child, on May 8, 2012. The petitioner himself administered spinal anaesthesia to the child just before the surgery without seeking the service of an anaesthetist. 

During the surgery, the child developed complications due to the anaesthesia. The surgery started at 03.35 p.m and at 03.45 p.m., the oxygen saturation came down to 80%, and the child developed cardiac arrest. At around 4 pm, the child was declared dead. Following her death, her mother filed a complaint. 

Based on a complaint by the child’s mother, the Palakkad South Police registered a case and subsequently filed a charge sheet under Section 304 IPC, alleging that the accused knew that administering anaesthesia without expert supervision could be fatal.

The doctor first moved the Sessions Court with an application seeking to be discharged from the case. However, the Sessions Court dismissed the same, prompting him to approach the High Court.

The advocates representing the petitioner contended that even assuming the allegations to be true, the doctor's actions did not satisfy the legal requirements under Section 304 IPC. It was argued that the doctor did not have the knowledge that his act was likely to cause death and that the case might amount to medical negligence, but not culpable homicide.

"The crucial question is whether the act of the petitioner would fall within the contours of Section 304 of IPC. Section 304 of IPC has two parts. Both parts deal with culpable homicide, not amounting to murder. The first part deals with culpable homicide not amounting to murder when the act is done with the intention to cause death or bodily injury, as is likely to cause death. The second part deals with culpable homicide not amounting to murder when the act is done without any intention to cause death or bodily injury, as is likely to cause death but with the knowledge that his act is likely to cause death," the bench noted. 

On the other hand, the counsel for the child's mother argued that the prosecution’s materials clearly showed the doctor administered anaesthesia without an anaesthetist and was aware that this could lead to death, thereby attracting Section 304(II) IPC.

After examining the final report, medical board opinion, and related documents, the court observed that the materials on record do not even prima facie suggest that the petitioner had the degree of knowledge to the extent that his act was likely to cause the death of the child. Doctors with an MBBS registration are qualified to give anaesthesia.

Notably, the court acknowledged that the petitioner had served as an anaesthetist in the District Hospital, Palakkad, as per a 1974 government order, and was thus legally permitted to administer anaesthesia.

Further, the Court found that even if the prosecution's allegations were accepted, they would not constitute an offence under Section 304 of the IPC. Therefore, the trial court had erred in rejecting the petitioner’s plea for discharge.

Setting aside the impugned order, the High Court allowed the criminal revision petition and discharged the petitioner from the case.

"It is settled that if the evidence which the prosecution proposes to adduce to prove the guilt of the accused, even if accepted before the cross-examination or rebutted by defence, if any, cannot show that the accused has committed the offence, there will be no sufficient ground for proceeding with the trial. The prosecution allegations, even if admitted as true in their entirety, would not make out an offence under Section 304 of IPC. Hence, there is no sufficient ground for proceeding against the petitioner. The trial court went wrong in dismissing the petition for discharge filed by the petitioner. The petitioner is accordingly discharged. The impugned order is set aside, and the criminal revision petition is allowed," the bench stated.

To view the order, click on the link below: