2026 INSC 537 1

REPORTABLE

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

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

3

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 P olice 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

5

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.

CONTENTION S

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

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sensorcaine injection whereas in her 3

rd 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

judgment of this Court in Jacob Mathew vs. State of Punjab

1 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”.

1

(2005) 6 SCC 1

7

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

8

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

Radheyshyam Kejriwal v . State of West Bengal

2, Videocon

Industries Ltd. and Anr. V. State of Maharashtra and Ors

3,

and Prem Raj v. Poonamma Menon

4. 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.

11

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

12

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

13

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 total ly 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 8:00 p.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

16

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

17

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

19

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.

20

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.