Full Judgment Text
REPORTABLE
2026 INSC 537
IN THE SUPREME COURT OF INDIA
CRIMINAL APPELLATE JURISDICTION
CRIMINAL APPEAL NO. OF 2026
(@SPECIAL LEAVE PETITION (CRL.) NO. 124 of 2025)
SUPRIYA KUMARI M.C. ………APPELLANT(S)
VERSUS
STATE OF KERALA & ORS. ……RESPONDENT(S)
J U D G M E N T
PRASANNA B. VARALE, J.
1. Leave granted.
2. The present appeal has been preferred by the appellant
challenging the order dated 16.10.2024 passed by the High Court
of Kerala at Ernakulam in CRL. MC No. 6415 of 2018. The
appellant's application filed under Section 482 of Code of Criminal
Procedure (hereinafter referred to as ‘CrPC’) to quash orders dated
Signature Not Verified
Digitally signed by
RASHI GUPTA
Date: 2026.05.25
18:27:21 IST
Reason:
09.06.2011 in C.M.P. No. 2492 of 2009 in C.C. No. 501 of 2008
passed by the Court of the Judicial Magistrate of the First Class-I,
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Kannur as confirmed in order dated 11.07.2018 passed in Crl.
R.P. No 17 of 2011 by the Court of Additional District & Sessions
Judge-II, Thalassery was rejected by the High Court.
FACTUAL MATRIX
3. Briefly stated, the prosecution’s case is that the patient, K.P.
Muralidhar, was admitted at the Dhanalakshmi Hospital, Kannur
on 28.05.2002 and piles surgery was scheduled on 29.05.2002.
The appellant herein is a doctor who was working as a senior
anaesthetist at the said hospital. On 29.05.2002 the surgery was
conducted around 9:30 a.m. and the patient was shifted to the
post-operative care ward in the evening wherein his health
started deteriorating after 8 p.m. and eventually he collapsed on
30.05.2002 at around 4 a.m. Post-mortem conducted revealed
that the deceased’s left coronary had a blockage of 80% and the
cause of death was identified to be ‘death due to acute coronary
insufficiency’. The prosecution alleges that the death was caused
due to the negligence of the appellant, who was on call and was
expected to administer anesthesia personally to the patient post-
surgery, instead the appellant instructed the same to the
attending nurse Rosamma Varghese (accused no. 3). Nurse
Rosamma who following her instructions administered the
analgesic ‘sensorcaine’ a few hours after which the patient lost
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consciousness and collapsed.
4. Subsequent to the death, First Information Report
(hereinafter referred to as ‘FIR’) bearing No. 432/2002 was lodged
on 30.05.2002 at the Kannur Town Police Station against Dr.
Mujeeb Rahiman (surgeon- accused no. 1) under Section 304-A of
the Indian Penal Code, 1860 (hereinafter referred to as ‘IPC’) by
the brother of the deceased. No allegations were made against the
appellant in this FIR.
5. On 15.04.2004, first chargesheet was filed under Section
304-A and Section 34 IPC against accused no. 1, the appellant
(accused No. 2) and the nurse (accused No. 3). Being aggrieved,
the accused filed Crl. M.C. No. 1813/2005. The High Court of
Kerala at Ernakulam quashed charge-sheet against all accused
with liberty to the investigating agency to move for further
investigation seeking leave of the Magistrate concerned to conduct
and complete further investigation. Therefore, an expert panel of
four members was constituted which in its final report dated
10.07.2008 unanimously opined that the death occurred due to
gross negligence on the part of the hospital staff and that the
same could have been prevented if analgesia was ensured by
proper introduction of the drug by qualified persons.
Subsequently, another charge-sheet dated 09.09.2008 was thus
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filed against accused no. 1 to accused no. 3 under Sections
304-A and 34 of the IPC. Cognizance was taken and the case was
registered as C.C. No. 501/2008 on the files of Ld. JMFC, Kannur.
6. Thereafter, a second quashing petition Crl. M.C. No.
1603/2009 was preferred against the second charge-sheet which
was dismissed by the Hon’ble High Court vide order dated
22.05.2009 giving liberty to the appellant to seek for discharge as
provided under Section 239 of CrPC. Following which, CMP
2492/2009 in CC 501/2008 was filed by the appellant before the
Ld. JMFC, Kannur which was dismissed vide order dated
09.06.2011. This order dated 09.06.2011 was challenged by the
appellant in Crl. Rev. Petition No. 17/2011 which was dismissed
by the Sessions Court vide order dated 11.07.2018. Aggrieved by
the Sessions Court order, the appellant preferred Crl. M.C. No.
6415/2018 under Section 482 CrPC before the High Court. The
High Court vide order dated 16.10.2024 dismissed the same
observing that the contentions raised by the appellant are to be
raised before the trial court at the appropriate stage.
7. In the interregnum, the deceased’s family was also
prosecuting the claim against the hospital and against accused
no. 1 to accused no. 3 before the District Consumer Redressal
Forum Kannur in CC No. 123/2004. The forum vide order dated
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17.04.2017 found that the appellant had not given any
instructions to the nurse to administer any injection and that it
may have been the nurse's and the surgeon’s calling and thus
held the hospital liable and no liability was imposed on accused
no. 1 to 3. This judgement was challenged by the family of
deceased vide first appeal no. 369/2017 before the Kerala State
Consumer Redressal Commission, Thiruvananthapuram but only
to the extent of the inadequacy of compensation which was fixed
at Rs. 12 Lakhs (Emphasis supplied).
8. The appellant herein has challenged the order dated
16.10.2024 passed by the High Court before us.
CONTENTIONS
9. Mr. Basant, learned senior counsel for the appellant
submitted that the allegations against the appellant that she
orally instructed the nurse (accused No. 3) to administer the
analgesic injection instead of personally doing it is inconsistent
and also quite belated. The learned senior counsel vehemently
submitted that the expert panel report dated 10.07.2008, clearly
shows that nurse Rosamma in her three statements changed her
stand and these statements are inconsistent and contrary to each
other. In the first two statements, it was stated by nurse
Rosamma that it was the surgeon who instructed her to give
5
rd
sensorcaine injection whereas in her 3 statement, nurse
Rosamma alleged that it was the appellant who instructed her
while being physically present in the ward. Learned counsel
further pointed out that as per statement of surgeon recorded by
the expert panel, it is stated that nurse Rosamma consulted the
appellant over phone about the sensorcaine injection and
thereafter it was given to the patient. Thus, the learned counsel
submits that in view of these inconsistent and contrary
statements of nurse Rosamma, no evidentiary value can be
attached to these statements, so as to sustain the allegations
against the appellant. The learned counsel further submits that
even assuming that the appellant instructed nurse Rosamma
(accused no. 3) to administer the injection such instruction cannot
be termed to be “rash and negligent act”. In support of his
submission the learned counsel placed heavy reliance on the
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judgment of this Court in Jacob Mathew vs. State of Punjab in
which this Court, explained and interpreted the “rash and
negligent act” holding that the act or omission must be such
“which is in the given fact and circumstances, no medical
professional in his ordinary senses and prudence would have done
or failed to do”.
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(2005) 6 SCC 1
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10. The learned counsel submitted that in the present case, her
duty hours were over by 5 p.m. and on SOS call orally prescribed
a medication, which there is no dispute was a proper prescription.
It was contended that the nurse’s failure to administer the
injection properly or to call the RMO on duty or any other
available doctor to give the injection cannot be a reason for the
appellant to face a criminal prosecution, and doing so would
only constitute giving a draconian interpretation to Section 304-
A. Further, he submitted that it has been alleged that while
conducting the postmortem test, a swelling was found by the
doctor conducting the test based on which he concluded that the
injection did not enter the epidural space. The counsel submitted
that allegedly, four injections were given to the deceased by the
nurse, and that there is not enough material to ascertain if each
time the medicine did not enter the epidural space. Further, the
existence of asymptomatic coronary artery disease was known for
the first time only in the postmortem report which supplements
the possibility that the cause of death cannot solely be attributed
to the anesthetic injection not entering the epidural space. In the
absence of positive material to prima facie make out a case of
gross negligence, the learned counsel contended, no offence can be
attracted under Section 304-A IPC. The learned counsel further
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contended that even assuming the injection did not enter the
epidural space where it was supposed to enter, at the worst it
becomes a case of deficiency in service only incurring a civil
liability.
11. Lastly, the learned senior counsel submitted that the
District Consumer Redressal Forum Kannur in its judgment dated
17.04.2017 in CC No. 123/2004 only held the hospital along with
accused no. 1 and accused no. 3 liable but did not hold the
appellant liable. He submitted that it is a well settled position of
law that once a person is exonerated in civil proceedings, allowing
criminal proceedings to continue for the same allegation is an
abuse of the process of law. Reliance for the same was placed on
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Radheyshyam Kejriwal v. State of West Bengal , Videocon
3
Industries Ltd. and Anr. V. State of Maharashtra and Ors ,
4
and Prem Raj v. Poonamma Menon . The learned counsel also
submitted that the family of the deceased challenged the order of
Kerala State Consumer Redressal Commission by filing First
Appeal No. 396 of 2017 only to the extent of inadequacy of
compensation by family, clearly suggests that the family was not
aggrieved by the services rendered by accused no. 2 and accused
2
(2011) 3 SCC 581
3
(2016) 12 SCC 315
4
(2024) 6 SCC 143
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no. 3 as a medical professionals, and in such a situation, allowing
a criminal prosecution against the appellant would be nothing but
an abuse of process of law.
12. Per contra, the learned counsel for the respondent No.1
contended that the medical negligence on the part of the appellant
has been duly proved through the postmortem report, inquiry
conducted by the Directorate of Health Service, and also by the
expert panel report.
13. The learned counsel submitted that after the surgery when
the deceased suffered severe pain and complained of the same,
epidural sensorcaine injection was administered by the nurse after
consulting the appellant on call, and since this anesthesia was not
effective, severe pain at the operation site was not alleviated which
in turn triggered acute coronary insufficiency and eventually led
to his demise. It is submitted that in the expert report the
postmortem findings mention that “even though it is noted in the
case sheet that sensorcaine was given intrathecally repeatedly by
the staff nurse, the lack of alleviation of pain and the swelling seen
around the needle puncture mark in the lumbar region suggests that
the catheter might have slipped (an expected complication) and thus
the drug could not have reached intrathecally. On the other hand,
the drug injected might have entered into the muscle around the
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needle puncture." which clearly states that the anesthesia
administered never reached the targeted site which led to the
death of the patient.
14. The learned counsel further submitted that as per the
expert panel report, it is clearly observed that the sensorcaine
injection given outside the epidural space were not diagnosed in
time, and that the staff nurse who gave the injection as per the
advice of the appellant, only had one year of experience which was
not sufficient for taking up such a specialized technique of
anesthesia and that neither was she supervised by the anesthetist
nor the RMO was called in by her while administering the
injection. The counsel submitted that the expert panel report
states “the death of Sri.K.P.Muralidharan was due to gross
negligence on the part of the hospital staff. Death could have been
prevented if analgesia was ensured by proper introduction of the
drug by qualified persons” which clearly established negligence on
the part of the appellant and in turn induces liability.
15. On the issue of non-compliance of the direction laid down in
the case of Jacob Mathew (supra) in constituting the expert panel
without an anesthetist, the counsel vehemently contended that
the issue was already dealt by the Hon’ble Additional Sessions
Court-II, Thalasserry in its order dated 11.07.2018 in Crl. R.P. No.
10
17/2011 wherein it was observed that as in the State of Kerala,
the Government circular No. 73231/SS-B4/92/Home dated
20.09.1993 was already issued prior to the judgement of this
Hon’ble Court in Jacob Mathew (supra) , thus it was doubtful as
to how the above guidelines were to be applied to the State.
Further, in Para 27 of its order, the learned Court observed that
the guidelines laid down by this Court in the case of Jacob
Mathew (supra) in Para 52 of the judgement were only directory
and not mandatory in using the word “preferably”. It was also
submitted by the counsel that the Hon’ble Commission on the
issue whether there is any negligence, or deficiency of services on
the part of the opposite parties found that there are gross
negligence and deficiency of service on the part of the opposite
parties and did not exonerate the appellant herein.
ANALYSIS
16. We have given our thorough consideration to the
arguments advanced at the Bar and the material on record.
17. The High Court vide order dated 16.10.2024 dismissed the
same observing that these contentions raised by the appellant are
to be raised before the trial court at the appropriate stage, and
disposed of the case with the following directions-
a. “All the contentions raised by the petitioner in this Crl.MC
11
are left open and the petitioner is free to agitate the same
before the trial court at the appropriate stage.
b. While deciding the matter, the trial court will decide the
matter independently, untrammeled by any observation in
Annexures D and E orders.
c. The petitioner is free to file an application for personal
exemption from appearance before the trial court, within a
period of 30 days and if, such an application is filed, the
learned Magistrate will allow the same on condition that the
petitioner will appear on posting days on which her presence is
inevitable.
d. Registry will forward a copy of this order to the trial court,
forthwith.”
18. To consider the rival submissions of the learned counsel
appearing for the respective parties, we find merit in the
submissions of learned Senior Counsel Mr. R. Basant representing
the appellant, who was justified in his submissions, that the
Hon’ble High Court has failed to consider the expert panel in its
proper perspective. There is a considerable force in the
submissions of Ld. Counsel Mr. Basant that expert panel clearly
shows an inconsistent and contrary stand taken by nurse
Rosamma in her statements and as such these statements are
devoid of any evidentiary value so as to constitute a criminal act,
generally against the appellant and particularly the rash and
negligent act against the appellant. It will not be out of place to
state that the surgeon (accused no. 1) admitted before the expert
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panel that she had consulted the appellant over phone regarding
the injection after which the injection was administered. Now the
statements of nurse Rosamma are giving a totally different
version, as such there is absolutely no material having any
evidentiary value against the appellant.
19. The report indicates that appellant completed her shift at
5:00 p.m. and left only after ensuring the patient was stable.
When the emergency arose at 8:00p.m., other doctors on-duty,
including an on-duty anaesthesiologist, were physically available
at the hospital. Even if it is assumed that the appellant answered
an SOS call from home and advised a painkiller, relying on the on
duty hospital staff to properly execute standard post-operative
pain management cannot be deemed factually negligent.
20. The prescribed medicine, sensorcaine, was undisputedly the
correct and necessary analgesic for the situation. Any mishap
occurred purely in the mechanical execution by the nurse
allegedly failing to inject it properly into the epidural space which
was entirely beyond the physical control of the off-duty appellant.
21. The most potent legal defence in favour of the appellant is
her complete exoneration by the consumer courts. The family of
the deceased pursued a parallel civil claim for medical negligence
before the District Consumer Disputes Redressal Forum, Kannur
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(CC No. 123/2004). Following a rigorous evaluation of evidence,
the Forum passed a judgment on 17.04.2017 holding the hospital,
the surgeon (A1), and the nurse (A3) liable for deficiency of service,
but categorically exonerated the appellant from any liability. The
Forum expressly accepted that the appellant had not given any
instructions to the nurse to administer the injection.
22. When the deceased's family appealed this judgment before
the State Consumer Redressal Commission (First Appeal No.
396/2017), they only challenged the quantum of compensation
(Rs. 12 lakhs), explicitly leaving the appellant's exoneration
unchallenged and finalized. Senior Advocate Mr. Basant relied on
a formidable line of Supreme Court jurisprudence, including
Radheyshyam Kejriwal (supra) , wherein C.K. Prasad J.,
speaking for the majority summed up as under:
“38. The ratio which can be culled out from these decisions
can broadly be stated as follows:-
(i) Adjudication proceedings and criminal prosecution can
be launched simultaneously;
(ii) Decision in adjudication proceedings is not necessary
before initiating criminal prosecution;
(iii) Adjudication proceedings and criminal proceedings are
independent in nature to each other;
(iv) The finding against the person facing prosecution in
the adjudication proceedings is not binding on the
proceeding for criminal prosecution;
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(v) Adjudication proceedings by the Enforcement
Directorate is not prosecution by a competent court of
law to attract the provisions of Article 20(2) of the
Constitution or Section 300 of the Code of Criminal
Procedure;
(vi) The finding in the adjudication proceedings in favour
of the person facing trial for identical violation will
depend upon the nature of finding: If the exoneration
in adjudication proceedings is on technical ground and
not on merit, prosecution may continue; and
(vii) In case of exoneration, however, 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 underlying principle being the higher
standard of proof in criminal cases.”
23. Learned Senior Counsel for the appellant also placed his
reliance on Videocon Industries Ltd. (supra) , and Prem Raj
(supra) which firmly establishes 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.
24. For a criminal charge under Section 304-A of the IPC to
survive, the prosecution must prove a "rash and negligent act."
The appellant's counsel relied heavily on the landmark Supreme
Court decision in Jacob Mathew (supra) , which established that
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criminal medical negligence requires a significantly higher
threshold than civil torts. The act must be of such a nature that
" no medical professional in his ordinary senses and
prudence would have done or failed to do" .
25. Legally, an anaesthetist whose duty hours have concluded
cannot be held criminally liable for a subsequent procedural error
committed by a staff nurse. Even if the prosecution’s case is taken
at face value that the appellant suggested a painkiller over the
phone, such an act constitutes standard medical advice for post-
operative pain, not gross criminal recklessness. 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.
26. The Jacob Mathew (supra) guidelines strictly mandate that
before initiating a criminal prosecution against a doctor, the
investigating officer must obtain an independent medical opinion,
preferably from a doctor qualified in the specific branch of medical
practice involved.
“ 48. ….
(5) The jurisprudential concept of negligence differs in civil
and criminal law. What may be negligence in civil law may
not necessarily be negligence in criminal law. For negligence
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to amount to an offence, the element of mens rea must be
shown to exist. For an act to amount to criminal negligence,
the degree of negligence should be much higher i.e. gross or
of a very high degree. Negligence which is neither gross nor
of a higher degree may provide a ground for action in civil
law but cannot form the basis for prosecution.
(6) The word "gross" has not been used in Section 304-A IPC,
yet it is settled that in criminal law negligence or recklessness,
to be so held, must be of such a high degree as to be "gross".
The expression "rash or negligent act" as occurring in Section
304-A IPC has to be read as qualified by the word "grossly".
(7) To prosecute a medical professional for negligence under
criminal law it must be shown that the accused did something
or failed to do something which in the given facts and
circumstances no medical a professional in his ordinary senses
and prudence would have done or failed to do. The hazard
taken by the accused doctor should be of such a nature that
the injury which resulted was most likely imminent.”
“52. Statutory rules or executive instructions incorporating
certain guidelines need to be framed and issued by the
Government of India and/or the State Governments in
consultation with the Medical Council of India. So long as it is
not done, we propose to lay down certain guidelines for the
future which should govern the prosecution of doctors for
offences of which criminal rashness or criminal negligence is
an ingredient. A private complaint may not be entertained
unless the complainant has produced prima facie evidence
before the court in the form of a credible opinion given by
another competent doctor to support the charge of rashness or
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negligence on the part of the accused doctor. The investigating
officer should, before proceeding against the doctor accused of
rash or negligent act or omission, obtain an independent and
competent medical opinion preferably from a doctor in
government service, qualified in that branch of medical practice
who can normally be expected to give an impartial and
unbiased opinion applying the Bolam test to the facts collected
in the investigation. A doctor accused of rashness or
negligence, may not be arrested in a routine manner (simply
because a charge has been levelled against him). Unless his
arrest is necessary for furthering the investigation or for
collecting evidence or unless the investigating officer feels
satisfied that the doctor proceeded against would not make
himself available to face the prosecution unless arrested, the g
arrest may be withheld.”
27. The appellant has also raised a ground pointing out to a
legal flaw, namely non-inclusion of the anaesthetic in the four-
member expert medical panel constituted to review the case. The
absence of a peer specialist renders the panel inherently
incompetent to evaluate the technical nuances of epidural
anaesthesia and catheter management. The panel's conclusion
that the appellant was "grossly negligent" for not waiting to see the
drug's effect, despite her shift ending hours prior to the
emergency, was highlighted as medically absurd. The
prosecution's reliance on this flawed expert report violates the
protective legal safeguards laid down by the Supreme Court to
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prevent the harassment of medical professionals.
28. 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. 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. While the
improper administration of the painkiller by the nurse might have
failed to alleviate the surgical pain—which in turn induced stress
that triggered the fatal cardiac event—this chain of events cannot
legally be attributed to the appellant. Fastening criminal liability
on an off-duty anaesthetist for an underlying, undisclosed cardiac
condition stretches the legal doctrine of proximate cause beyond
permissible limits.
29. In view of above, the appeal needs to be allowed.
Resultantly, the appeal is allowed and disposed of. The order
impugned in the appeal passed by the learned High Court of
Kerala at Ernakulam in Crl. M.C. No. 6415 of 2018 are hereby
quashed and set aside. Needless to state, that the prosecution
against the appellant by way of criminal case in the C.C. No.
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501/2008 pending before the Judicial Magistrate First Class-I,
Kannur stands quashed and the appellant is discharged from the
offences alleged against her. Pending applications, if any, stand
disposed of.
........................................J.
[PANKAJ MITHAL]
.........................................J.
[PRASANNA B. VARALE]
NEW DELHI;
MAY 25, 2026.
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