The Supreme Court has ruled that an anaesthetist cannot be held criminally liable for a subsequent procedural error by a staff nurse leading to a patient’s death once her duty hours have ended.

A bench of Justices Pankaj Mithal and Prasanna B Varale quashed criminal proceedings under Section 304-A IPC against anaesthetist Dr Supriya Kumari M C in a case stemming from a patient’s death in 2002 following piles surgery.

The court held there was no prima facie evidence of gross rash or negligent conduct on the part of the off-duty anaesthetist.

It reiterated the high threshold for criminal medical negligence laid down in the Jacob Mathew case and observed that any lapse, if at all, amounted to a civil deficiency in service.

"An anaesthetist whose duty hours have concluded cannot be held criminally liable for a subsequent procedural error committed by a staff nurse. Even if she suggested a painkiller over the phone, such an act constitutes standard medical advice for postoperative pain, not gross criminal recklessness," the bench said.

The court emphasised that criminal liability under Section 304-A IPC requires a direct and proximate nexus (causa causans) between the alleged negligent act and the death.

It clarified that the nurse’s failure to properly administer the epidural injection might constitute a deficiency in service but lacked the gross culpability or mens rea needed for criminal prosecution.

The bench also noted the mandatory requirement that before initiating criminal prosecution against a doctor, the investigating officer must obtain an independent medical opinion, preferably from a specialist in the relevant field.

The incident occurred at Dhanalakshmi Hospital, Kannur, in May 2002. Patient K P Muralidhar underwent piles surgery on May 29. His condition deteriorated in the post-operative ward, and he died on May 30, 2002, at around 4 am. The anaesthetist, who had completed her duty, was allegedly consulted over the phone and suggested pain relief.

The prosecution claimed the nurse administered an epidural injection following this advice, but improper administration led to complications that triggered a fatal heart attack.

Notably, the initial FIR filed by the patient’s brother did not name the appellant doctor. She was later implicated in a second charge sheet.

An expert panel had blamed gross negligence by hospital staff.

The court gave significant weight to the fact that the appellant had been fully exonerated by the consumer forum in a related case.

The deceased’s family had challenged only the quantum of compensation before the State Commission but accepted the doctor’s exoneration, making it final.

The bench pointed out inconsistencies in the nurse’s statements and the flawed composition of the expert panel, which did not include an anaesthetist.

It described the panel’s conclusions regarding the appellant as “medically absurd,” especially holding an off-duty doctor liable for not monitoring the drug’s effect hours after her shift ended.

The court further noted that the patient had an underlying 80 per cent blockage in his coronary artery, which was asymptomatic.

The immediate cause of death was acute coronary insufficiency triggered by stress from post-operative pain.

Attributing this to the off-duty anaesthetist stretched the doctrine of proximate cause too far, the bench observed.

Allowing the appeal against the Kerala High Court’s order of October 16, 2024, the court quashed the criminal proceedings against the doctor, discharging her from all charges.

Source: https://www.deccanherald.com/amp/story/india/anaesthetist-not-criminally-liable-for-nurses-procedural-error-after-duty-hours-supreme-court-4017180