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Reportable

IN THE SUPREME COURT OF INDIA

CRIMINAL APPELLATE JURISDICTION

CRIMINAL APPEAL NO.    1433              OF 2013     (Arising out of Special Leave Petition (Criminal) No.649 of 2011)

A.S.V. Narayanan Rao …Appellant

Versus

Ratnamala & Another …Respondents

J U D G M E N T

Chelameswar, J.

1. Leave granted.

2. This appeal arises out of an order dated 28th October  

2010  in  Criminal  Petition  No.6506  of  2007  of  the  High  

Court of Andhra Pradesh.   

3. The  aforementioned  criminal  petition  was  filed  

praying  that  the  proceedings  initiated  against  the  

appellant herein in C.C. No.600 of 2006 on the file of the  

XIV  Additional  Chief  Metropolitan  Magistrate,  Hyderabad  

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for  the  offence  punishable  under  section  304A  IPC  be  

quashed.   The  said  petition  along  with  another  similar  

petition by one of the co-accused was heard and disposed  

of by a common order (order in appeal).

4. While the petition filed by the appellant herein was  

dismissed by the High Court, the other petition of the co-

accused was allowed.

5. The appellant is a cardiologist.  The husband of the  

first respondent (one Divakar)  approached the appellant  

herein, complaining of a pain in the chest on 22.04.2002.  

Divakar was admitted in the hospital where the appellant  

was working  and kept  in  the  Intensive  Care  Unit  (ICU).  

Thereafter,  the  appellant  informed  the  first  respondent  

that  Divakar  had  suffered  a  mild  heart  attack.     On  

23.04.2002, an angiogram was conducted which showed  

three blocks in the vessels carrying blood to the heart.  On  

25.04.2002  at  9.30  a.m.,  the  appellant  unsuccessfully  

attempted to perform an angioplasty on Divakar.  Around  

1.30  in  the  afternoon,  the  appellant  informed  the  first  

respondent that the angioplasty failed as the blocks were  

calcified.  Same day at around 3.30 p.m., by-pass surgery  

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was  conducted  on  Divakar  in  the  same  hospital.  

Subsequently,  various  complications  developed  and  

eventually Divakar died on 09.05.2002.  

6. On  14.05.2002,  the  first  respondent  lodged  a  

complaint against the appellant and others under section  

304A IPC which came to be registered as FIR No.416 of  

2002.

7. The police on investigation submitted a final report  

on  02.02.2005  treating  the  case  to  be  one  of  lack  of  

evidence.   The  respondent  filed  objections  before  the  

Metropolitan Magistrate to the final report and prayed the  

Magistrate to take cognizance of the offence.  The learned  

Magistrate  by  his  order  dated  11.12.2006  came  to  the  

prima facie conclusion that there exists material to  try the  

accused  for  the  offence  punishable  under  section 304A  

IPC. Challenging the said order the appellant approached  

the  High  Court  by  way  of  Criminal  Petition  No.6506  of  

2007.  

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8. By  judgment  under  appeal,  the  High  Court  opined  

that the material on record “clearly shows negligence on  

the part of A1”1 and declined to quash the proceedings.

9. Mr. P.S. Narasimha, learned senior counsel appearing  

for  the  appellant  submitted  that  the  High  Court  clearly  

erred in  dismissing the petition of the appellant  herein.  

Learned senior counsel argued that the law laid down by  

this Court in Jacob Mathew Vs. State of Punjab & Anr.  

(2005) 6 SCC 1 has completely been ignored by both the  

learned  Magistrate  and  the  High  Court in  deciding  to  

proceed with the case against the appellant herein.  On  

the other hand, learned counsel for the first respondent  

submitted that the conduct of the appellant in undertaking  

the angioplasty without having a standby surgical unit is  

clearly  in  violation  of  the  established  practice  of  the  

medical  profession  and  therefore  a  clear  case  of  

negligence warranting punishment of the appellant.

1 The sworn statement of Dr. P.V.N. Rao also discloses that  A1 without consulting the Anesthetist   and without a surgical  stand conducted Angioplasty, which should be done by the Surgeon, as the  surgeon was out of station which fact he came to know through the Anesthetist.  The operation was  delayed by 5 hours due to want of surgeon who has to come from New Delhi, which clearly shows  the  negligence  on the  part  of A1.   Further  as  the  patient  was a  chronic  smoker  he  should  be  prepared before undertaking Angioplasty and the Cardiac Anesthesian should be consulted for fitness  of the patient before conducting the same.

The entire record adduced does not indicate as to whether A1 assessed the condition of the   patient  on  consultation  of  the  cardio  Anasthesian  and  obtained  the  fitness  certificate  for  going   Angioplasty on the patient.  

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10. This  Court  in  the  case  of  Jacob  Mathew (supra)  

considered exhaustively the various aspects of negligence  

on the part of a doctor and laid down inter alia;

“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  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”.”

11. This Court further opined that though doctors are not  

immune  from  legal  proceedings  in  the  event  of  their  

negligence in discharging their professional duties, in the  

interest of the society, it is necessary to protect doctors  

from  frivolous  and  unjust  prosecution.   It  was  further  

pointed out  the need to frame either  statutory rules or  

administrative  instructions  incorporating  guidelines  for  

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prosecuting  doctors  on  charges  of  criminal  negligence.  

This Court therefore, ordered that until such guidelines are  

laid  down,  the  following  procedure  is  required  to  be  

followed:-

“52.   …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 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 arrest   may be withheld.”

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12.  From the final report submitted by the police in the  

instant  case,  it  can  be  gathered  that  the  records  

pertaining to the treatment given to the deceased were  

forwarded to the Andhra Pradesh Medical Council and also  

the Medical Council of India which opined that the “doctors  

seem to have made an attempt to do their best as per  

records”.

13. However, the High Court thought it fit to continue the  

prosecution of the appellant for two reasons (1) that the  

appellant chose to conduct the angioplasty without having  

a surgical standby unit and such failure resulted in delay  

of  5  hours  in  conducting  by-pass  after  the  angioplasty  

failed; and (2) that the appellant did not consult a Cardio  

Anesthesian before conducting an angioplasty.   According  

to the High Court, both the above-mentioned ‘lapses’ on  

the part of the appellant “clearly show the negligence” of  

the appellant.

14. The basis  for  such conclusion though not  apparent  

from the judgment, we are told by the learned counsel for  

the first respondent, is to be found in the evidence of Dr.  

Surajit  Dan  given  before  the  A.P.  State  Consumer  

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Redressal Commission in  C.D. No. 38 of 2004.  It may also  

be  mentioned  here  that  apart  from  initiating  criminal  

proceedings  against  the  appellant  and  others,  the  first  

respondent  also  raised  a  consumer  dispute  against  the  

appellant  and  others.  It  is  in  the  said  proceedings,  the  

above-mentioned  Dr.  Dan’s  evidence  was  recorded  

wherein  Dr.  Dan  in  his  cross-examination  stated  as  

follows:-

“…Whenever  Cardiologist  performs  an  angioplasty, he requests for the surgical team  to be ready as standby.   I  was not put on   standby in the instant case….”

He further stated;

“…The failure of angioplasty put the heart in   a  compromised  position  of  poor  coronary  perfusion  that  increases  the  risk  of  the  emergency surgery after that.   In a planned   coronary surgery, the risk is less than in an   emergency surgery….”

However, the same doctor also stated;

“….The  time  gap  between  the  angioplasty  failure and the surgery is not THE FACTOR for   the death of the patient.   The time gap may   or may not be a factor for the enhancement   of the risk.”

15. Unfortunately,  the  last  of  the  above  extracted  

statements of Dr. Surajit Dan is not taken into account by  

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the High Court which statement according to us is most  

crucial  in  the  context  of  criminal  prosecution  of  the  

appellant.

16. The High Court unfortunately overlooked this factor.  

We, therefore, are of the opinion that the prosecution of  

the appellant is uncalled for as pointed out by this Court in  

Jacob Mathew case (supra) that the negligence, if any,  

on the part of the appellant cannot be said to be “gross”.  

We, therefore, set aside the judgment under appeal and  

also the proceedings of the trial court dated 11.12.2006.  

17. The appeal  is  allowed,  however,  there  shall  be  no  

order as to costs.

….………………………………..J.                                      (H.L. Gokhale)

……………………………………J.                                      (J. Chelameswar)

New Delhi; September 13, 2013

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