The Supreme Court of India, on February 21, 2025, overturned culpable homicide charges against a doctor who prescribed medication to a nurse via telephone.

In a landmark judgment with far-reaching implications for the medical profession, the Supreme Court of India has overturned charges of culpable homicide against a doctor who prescribed medication over the phone, resulting in the patient's subsequent death. The ruling clarifies the boundaries of criminal liability in cases of medical negligence, emphasizing the critical distinction between reckless disregard for life and unintentional lapses in professional judgment.

A bench of Justices Vikram Nath and Sandeep Mehta held that while the doctor's actions could potentially constitute negligence, they did not meet the high threshold required for a charge under Section 304 Part I of the Indian Penal Code (IPC) - now Section 105 of the Bharatiya Nyaya Sanhita (BNS), 2023 -, which pertains to culpable homicide not amounting to murder. The Court directed that the case be considered under Section 304A IPC) - now Section 106 of the Bharatiya Nyaya Sanhita (BNS), 2023 -, the provision specifically designed for instances of causing death by negligence, which carries a significantly lesser penalty.

Background of the Case - A Tragedy in Tamil Nadu:

The case originated from an incident on February 21, 2013, in Thiruvallur, Tamil Nadu. A woman was admitted to a private nursing home exhibiting symptoms such as headache, vomiting, dizziness, and fever. According to the prosecution's account, a nurse administered injections to the patient based on instructions received during a phone call with the attending doctor, who was not physically present at the facility. Shortly after the injections, the patient's condition deteriorated rapidly, and she lost consciousness. She was rushed to a government hospital, where she was pronounced dead.

The post-mortem examination attributed the cause of death to an acute hypersensitive drug reaction, suggesting an adverse reaction to the medication administered. The deceased woman's husband filed a police complaint, alleging that the doctor had acted negligently by prescribing medication without personally examining the patient. This led to the initial filing of charges under Section 304 Part I of the IPC (Section 105 BNS). This section carries a maximum sentence of 10 years imprisonment, as it addresses acts performed with the knowledge that they are likely to cause death.

The trial court accepted the case, and the doctor subsequently appealed to the Madras High Court, seeking to quash the proceedings. The High Court, however, denied relief, asserting that there was sufficient prima facie evidence to suggest the doctor bore responsibility under Section 304 Part I (Section 105 BNS). The High Court highlighted the doctor's absence from the hospital and reliance on telephonic instructions to the nurse as factors supporting the charge.

The Supreme Court Steps In - Upholding the Importance of Intent:

Dissatisfied with the Madras High Court's decision, the doctor appealed to the Supreme Court, which ultimately reversed the lower court's ruling, finding the culpable homicide charges to be excessive and inappropriate. The Supreme Court underscored the vital distinction between criminal negligence, as defined by Section 304A IPC (Section 106 BNS)., and the deliberate or knowledge-based actions that constitute culpable homicide under Section 304 Part I IPC (Section 105 BNS).

The apex court heavily relied on its precedent-setting 2005 ruling in Jacob Mathew v. State of Punjab, reaffirming the principle that medical professionals should not face prosecution for culpable homicide unless there is irrefutable evidence of a deliberate or reckless disregard for human life.

The Jacob Mathew case firmly established that:
"To hold a medical professional criminally liable under Section 304A IPC (Section 106 BNS), the standard of negligence must be gross or reckless, not simply a lack of due care. The negligence has to be so egregious that it deviates significantly from the accepted standards of medical practice and demonstrates a complete indifference to the patient's well-being."

Applying this established principle, the Supreme Court reasoned that while the doctor's act of prescribing medication over the phone without a direct physical examination might constitute medical negligence, it did not rise to the level of culpable homicide. There was no evidence presented to suggest the doctor intended to cause harm or possessed direct knowledge that the prescribed medication would inevitably lead to the patient's death.

Furthermore, the Court emphasized that mistakes in medical treatment should not automatically result in criminal charges unless the error is of such a magnitude that it transcends ordinary negligence and demonstrates a clear and unacceptable departure from established medical norms. In this context, Section 304A IPC (Section 106 BNS), which carries a maximum punishment of two years for causing death by negligence, was deemed the more fitting charge.

Impact on Medical Practice and the Rise of Telemedicine:

This judgment is poised to have a significant and positive influence on the medical community, particularly in the context of the increasing prevalence of remote consultations and telephonic prescriptions. Telemedicine has experienced a surge in popularity, especially in the wake of the COVID-19 pandemic, offering convenient access to healthcare for many. However, this case underscores the critical need for caution and adherence to established protocols when treating patients remotely, without the benefit of a direct physical examination.

The ruling also provides a sense of relief to the medical fraternity, reinforcing the crucial principle that honest errors in medical judgment should not be automatically equated with criminal intent unless gross negligence and recklessness are definitively established. It is in accordance with the Supreme Court's prior affirmations:

• Doctors should not be subjected to unwarranted criminal prosecution for decisions made in good faith and within the bounds of accepted medical practice.
• Holding doctors criminally liable under severe provisions such as Section 304 IPC (Section 105 BNS) could have a chilling effect, deterring medical professionals from making necessary but potentially high-risk decisions in critical situations, ultimately hindering patient care.
• Medical negligence claims should primarily be addressed through civil litigation and professional disciplinary measures, reserving criminal prosecution for the most egregious cases of recklessness or deliberate misconduct.

Conclusion: Balancing Accountability and Protecting Medical Professionals:

By quashing the culpable homicide charge and directing the case to be considered under Section 304A IPC (Section 106 BNS), the Supreme Court has reinforced a vital distinction between criminal intent and professional negligence within the medical profession. This landmark decision not only provides crucial legal clarity for doctors but also safeguards medical professionals from being unjustly penalized for the unintended consequences of their treatments.

However, the judgment also serves as a potent reminder of the continued responsibility of medical practitioners to exercise the utmost caution, diligence, and adherence to established protocols, particularly in the context of remote consultations, to effectively minimize risks to patient safety. The case stands as a significant precedent in the delicate balancing act between ensuring medical accountability and protecting medical professionals from excessive and potentially detrimental criminalization. It reinforces the principle that while medical professionals are accountable for their actions, the fear of prosecution should not impede their ability to make timely and critical medical decisions in urgent cases.

Written By: Md.Imran Wahab, IPS, IGP, Provisioning, West Bengal
Email: imranwahab216@gmail.com, Ph no: 9836576565