The Supreme Court of India has ruled that criminal proceedings against a medical professional cannot be sustained when the procedure adopted is supported by medical opinion and there is no evidence of fabrication or manipulation of the consent form.
Background of the Case
A Bench of Justice Manoj Misra and Justice Pamidighantam Sri Narasimha set aside the order of the Madras High Court, observing that continuing criminal proceedings without any evidence of interpolation in the consent form would amount to an abuse of the process of law.
The case originated from a complaint filed by the father of a minor child who underwent surgery for an undescended testicle at a hospital in Chennai. The complainant alleged that consent was given only for Orchidopexy, a procedure to reposition the testicle, and not for Orchidectomy, which involves removal of the testicle. It was claimed that the surgeon assured removal would not be necessary, but during the procedure, the testicle was removed. The complainant further alleged that the consent form was manipulated by inserting the term Orchidectomy later, amounting to forgery. Based on these allegations, an FIR was registered in 2006 under various sections of the Indian Penal Code, including those related to causing hurt, forgery, criminal conspiracy, and destruction of evidence. After investigation, a charge sheet was filed against the appellant doctor, and cognizance was taken by the Magistrate.
The appellant approached the High Court seeking quashing of the proceedings, but the High Court declined relief and directed an expeditious trial, leading to the present appeal before the Supreme Court.
Medical Board Findings and Investigative Material
A key aspect of the case was the opinion of a Medical Board constituted pursuant to High Court directions. The Board examined medical records and histopathology reports and concluded that the removed testicle was small, cystic, dysplastic, and exhibited focal fibrosis. The Board observed that in cases of undescended testis, especially when the testis is non-functional or presents as a nubbin, removal is a medically accepted course of action due to risks such as malignancy.
The Medical Board gave a conclusive opinion stating that left orchidectomy surgery done to the child was an appropriate surgical procedure as per medical ethics and should have been done with parental consent. Further clarification from the Directorate of Medical and Rural Health Services reiterated that the procedure was medically appropriate and that consent had been obtained through a standard printed form. It was also noted that the consent form contained the expression Bilateral Orchidopexy / Left Orchidectomy, indicating that both procedures were contemplated.
Submissions Before the Supreme Court
On behalf of the appellant doctor, it was argued that there was no allegation of medical negligence and that the Medical Board had clearly endorsed the procedure as appropriate. The only dispute related to consent, which was unsupported by any material evidence. The appellant stressed that the consent form had been examined by competent authorities and no interpolation or manipulation was found. There was no forensic evidence to suggest that the term Orchidectomy was added subsequently.
The State argued that even if the procedure was medically justified, the absence of clear consent would still raise issues requiring trial. Whether consent existed or was manipulated was a question of fact that should be decided based on evidence. The complainant, appearing in person, reiterated that he had not consented to removal of the testicle and alleged that the doctor proceeded despite his refusal and later altered the consent form.
Court's Analysis
The Supreme Court began by noting that the appellant was a qualified surgeon and his professional competence was not in question. The Court emphasized that criminal law treats medical professionals differently, recognizing the nature of their work and the complexities involved in medical decision-making. Referring to statutory protections, the Court noted that provisions such as Sections 88 and 92 of the IPC grant protection for acts done in good faith for the benefit of a patient.
The Court referred to its landmark judgment in Jacob Mathew v. State of Punjab and reiterated that 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 no medical professional in ordinary senses and prudence would have done or failed to do. The Court also recalled that criminal proceedings against doctors should be supported by credible medical opinion, and a private complaint may not be entertained unless the complainant produces prima facie evidence in the form of a credible opinion given by another competent doctor.
Although the present case did not directly involve negligence, the Court underscored the importance of medical opinion in assessing such disputes. The Court identified the central issue as whether the consent obtained was limited to Orchidopexy or extended to Orchidectomy, and whether there had been any interpolation in the consent form. The Court noted that ordinarily, an issue of tampering or interpolation in a document is to be determined in a trial, and courts must be loath to examine such issues in a summary proceeding. However, there is no absolute bar on examining such issues under Section 482 CrPC when necessary to prevent abuse of process.
Upon examining the record, the Court found that a consent form had indeed been executed prior to surgery. Importantly, the consent form mentioned both procedures, Orchidopexy and Orchidectomy, separated by a slash. The Court observed that a perusal thereof would indicate that both types of surgery were mentioned by putting a slash, meaning that the other surgery was one of the options available. The Court further noted that there was no material to show that the term Orchidectomy was entered by a different ink or in a different handwriting. Additionally, the Director of Medical Services had not found anything suspicious in the consent form, further weakening the allegation of forgery.
Role of Medical Opinion
The Court placed significant reliance on the Medical Board's opinion, which clearly stated that Orchidectomy was a medically valid and sometimes preferable option in such cases. The Court stressed that the operating surgeon is the best judge of which one of the two procedures is to be adopted. Given that the procedure was medically justified and supported by expert opinion, the Court found no basis to attribute criminal liability.
Taking an overall view of the matter, the Court held that there was no evidence to support the allegation of consent manipulation and that the medical procedure adopted was appropriate. The Court concluded that continuance of criminal proceedings against the appellant would be nothing but abuse of the process of the court and, therefore, the same is liable to be quashed.
Accordingly, the Supreme Court allowed the appeal, set aside the High Court's order, and quashed the criminal proceedings pending before the Magistrate.
