Medical Negligence

Source: Allahabad High Court 

Why in News? 

Recently, Justice Prashant Kumar dismissed the doctor's plea, observing that private hospitals misusing patients as 'guinea pigs/ATMs' for profit cannot be protected under the guise of medical diligence.  

• The Allahabad High Court held this in the matter of Dr. Ashok Kumar Rai v. State of U.P. and another (2025). 

What was the Background of Dr. Ashok Kumar Rai v. State of U.P. and another, Case? 

• Mrs. Usha Pandey, wife of Brijesh Pandey from village Saroura, Deoria, was admitted to Savitri Nursing Home owned by Dr. Ashok Kumar Rai on 28th July 2007 for delivery, having been under his ante-natal care since March 2007 with a previous caesarean section history. 
• The patient was admitted on 28th July 2007, consent for caesarean surgery was obtained from family members at 11:00 AM on 29th July 2007, but the surgery was only performed at 5:30 PM on the same day, resulting in the death of the foetus. 
• An FIR was lodged on 29th July 2007 alleging medical negligence due to delayed surgery, physical assault on family members by nursing home staff when they objected, and financial exploitation with demands of ₹8,700 plus additional ₹10,000 without providing proper discharge documentation. 
• The post-mortem examination of the deceased foetus revealed the cause of death as "Prolonged Labour", indicating that timely surgical intervention could have prevented the death. 
• The Chief Medical Officer constituted a Medical Board which examined only the applicant's version and concluded no negligence, but crucially, the post-mortem report and contradictory medical records were not placed before the Board. 
• Multiple discrepancies emerged including different times of admission stated in various documents (10:30 AM in FIR, 3:30 PM to Medical Board, 7:00 PM in cross-FIR), and two different Operation Theatre notes raising questions about manufactured evidence. 
• After the Investigating Officer submitted a final report closing the case based on the Medical Board's findings, the complainant filed a protest petition on 15th March 2008 challenging this closure. 
• The Magistrate rejected the final report, found prima facie case of medical negligence, and issued summons against Dr. Ashok Kumar Rai under Sections 304A, 315, 323, and 506 IPC, prompting him to file this application under Section 482 CrPC seeking quashing of the summons and entire proceedings. 
• The central question before the Court was whether the unexplained 4-5 hour delay between obtaining consent for surgery and actually performing the operation, which allegedly led to foetal death due to prolonged labour, constituted criminal medical negligence warranting prosecution. 

What were the Court’s Observations? 

• The Court observed that while medical professionals deserve protection from frivolous prosecutions to maintain the doctor-patient relationship, such protection only extends to those who exercise due diligence and skill, and cannot shield doctors who operate nursing homes without proper facilities, doctors, and infrastructure while enticing patients merely to extract money. 
• The Court found the Medical Board's clean chit unreliable because crucial evidence including the post-mortem report showing death due to "prolonged labour" and contradictory Operation Theatre notes were not placed before the Board, making their investigation one-sided and incomplete. 
• The Court emphasized that for criminal liability in medical negligence cases, the degree of negligence must be gross or of very high degree with mens rea, distinguishing it from civil negligence, and requiring conduct that falls below ordinary standards of care expected from a competent medical professional. 
• The Court found this to be a "classic case" where consent was obtained at 12:00 PM but surgery was delayed until 4:00-5:00 PM without any justifiable reason, coupled with post-mortem evidence of death due to prolonged labour, clearly establishing prima facie medical negligence and malafide intention to cheat the patient. 
• The Court made strong observations that private hospitals and nursing homes have started treating patients as "guinea pig/ATM machines" only to extort money, operating without adequate medical staff and calling doctors only after admitting patients rather than maintaining proper medical infrastructure. 
• The Court characterized the case as "pure misadventure" where the doctor admitted the patient, obtained consent for surgery, but failed to perform the operation timely due to lack of an anaesthetist, with the unexplained 4-5 hour delay being directly attributable to the applicant's inadequate medical facilities. 
• The Court held that the material contradictions in evidence regarding time of admission, consent, and surgery, along with the existence of two different OT notes and undisputed post-mortem findings, raised disputed questions of fact that could only be adjudicated through trial, making the case inappropriate for quashing under Section 482 CrPC. 
• The Court concluded that allowing the criminal proceedings to continue serves the broader public interest in ensuring medical accountability, sending a clear message that inadequate medical facilities and delayed treatment resulting in patient harm will face legal scrutiny while maintaining the balance between protecting genuine medical professionals and holding negligent practitioners accountable. 

What is Medical Negligence Under Bharatiya Nyaya Sanhita,2023 (BNS)? 

• Section 106(1) of BNS criminalises causing death by any rash or negligent act that does not amount to culpable homicide, covering both general negligence and specific medical negligence by registered medical practitioners during medical procedures. 
• The provision establishes a two-tier punishment system - general cases of negligent death carry imprisonment up to five years with fine, while registered medical practitioners performing medical procedures face reduced imprisonment up to two years with fine, recognising the complex nature of medical practice. 
• The law specifically defines "registered medical practitioner" as one who possesses medical qualifications recognised under the National Medical Commission Act, 2019, and whose name is entered in the National Medical Register or State Medical Register, ensuring only qualified professionals receive the benefit of reduced punishment. 
• The reduced punishment for medical practitioners applies only when the negligent act occurs "while performing medical procedure", meaning the negligence must be directly connected to the execution of medical treatment, diagnosis, or surgical intervention rather than administrative or non-medical activities. 
• The provision maintains that the negligent act must cause death and not amount to culpable homicide, establishing a clear distinction between ordinary negligence (Section 106) and more serious forms of homicide that involve criminal intent or knowledge of likelihood of death. 
• The differential punishment reflects legislative recognition that medical practice involves inherent risks and complex decision-making, requiring a balanced approach that holds medical professionals accountable while not deterring them from performing necessary medical procedures due to fear of excessive criminal liability.