# **IN THE HIGH COURT OF KERALA AT ERNAKULAM**
**PRESENT:**
## **THE HONOURABLE MR.JUSTICE P.BHAVADASAN**
**TUESDAY, THE 23RD DAY OF JULY 2013/1ST SRAVANA, 1935**
## **Crl.MC.No. 1394 of 2013 ()**
**----------------------------------SC 1675/2011 of I ADDL. SESSIONS COURT, KOLLAM. CP 108/2011 of JUDICIAL FIRST CLASS MAGISTRATE COURT,KARUNAGAPPALLY .**
**.........**
## **PETITIONER(S)/4TH ACCUSED:**
**--------------------------------------------------**
**DR.B.RAVIKUMAR, KOZHIKOTE HOUSE, TC-9/2160 SASTHAMANGALAM P.O. THIRUVANANTHAPURAM**
## **BY ADVS.SRI.NAGARAJ NARAYANAN**
**SRI.SAIJO HASSAN**
**SRI.PRATHAP PILLAI SRI.BENOJ C AUGUSTIN SRI.SEBIN THOMAS SRI.I.J.AUGUSTINE SMT.J.KASTHURI**
## **RESPONDENT(S)/STATE:**
**---------------------------------------**
**STATE OF KERALA REPRESENTED BY THE PUBLIC PROSECUTOR, HIGH COURT OF KERALA, ERNAKULAM.**
## ***ADDL. R2 IMPLEADED.**
**2. SMT.A.T.MANI, W/O.K.V.UNNIKRISHNAN RESIDING AT KUTTIPARAMBIL THEKKETHIL VEEDU, MAHADEVIKADU, KARTHIKAPPILLY TALUK, ALAPPUZHA DISTRICT 690 516.**
***ADDL.R2 IS IMPLEADED AS PER ORDER DTD. 26/03/2013 IN CRL.MA.2737/2013 IN CRL.MC.1394/2013.**
**ADDL.2 BY ADVS. SRI.SUMAN CHAKRAVARTHY SRI.SANDEEP T.GEORGE BY PUBLIC PROSECUTOR SRI.DHANESH MATHEW MANJOORAN**
**THIS CRIMINAL MISC. CASE HAVING BEEN FINALLY HEARD ON 12-07-2013, THE COURT ON 23/07/2013 PASSED THE FOLLOWING:**
**tss**
## **CRMC. NO. 1394/2013**
## **APPENDIX**
## **PETITIONER'S ANNEXURES**
**A1:- CERTIFIED COPY OF THE FINAL REPORT/CHARGE SHEET DTD. 20.12.2012 IN SC1675/2011 (ARISING FROM CP. NO.108/2011 ON THE FILE OF THE JUDICIAL FIRST CLASS MAGISTRATE COURT, KARUNAGAPPALLY ALONG WITH THE STATEMENT OF CHARGE WITNESSES.**
**A2:- COPY OF THE IST INFORMATION REPORT IN CRIME NO.378/2004 U/S. 174 OF THE CR.PC.**
**A3:- COPY OF THE MINUTES OF THE SAID MEETING OF THE EXPERT COMMITTEE OF DOCTORS ON 23.6.2008.**
**A4:- COPY OF THE MINUTES OF THE MEETING OF THE MEDICAL EXPERT COMMITTEE HELD ON 2.2.2009.**
**A5:- COPY OF THE LETTER DTD. 12.3.2009 ISSUED BY THE DISTRICT MEDICAL OFFICER, TO THE DIRECTOR OF HEALTH SERVICE.**
**A6:- COPY OF THE MINUTES OF THE SAID MEETING OF THE MEDICAL EXPERT COMMITTEE HELD ON 12.1.2010.**
**A7:- COPY OF THE REPORT DTD. NIL OF THE MEDICAL BOARD CONVENED ON 27.2.2-010-.**
**A8:- COPY OF THE WP(C) 214022008 FILED BY THE MOTHER OF THE DECEASED PATIENT.**
## **A9:- COPY OF THE JUDGMENT DTD 15.6.210 IN WP(C) 21402/08.**
**A10:- COPY OF THE CONTENT OF THE E-MAIL SENT BY DR. SHYLAJA, FORMER DIRECTOR OF HEALTH SERVICES TO THE PETITIONER.**
**A11:- COPY OF THE ORDER DTD. 24.12.2012 IN CC.36/2006 OF THE CONSUMER DISPUTE REDRESSAL FORUM, KOLLAM.**
## **RESPONDENT'S ANNEXURES**
## **NIL**
**TRUE COPY**
## **P.A. TO JUDGE**
**tss**
## P. BHAVADASAN, J.
- - - - - - - - - - - - - - - - - -
Crl.M.C. No. 1394 of 2013
- - - - - - - - - - - - - - - - - - Dated this the 23[rd] day of July, 2013.
## ORDER
This is a petition filed Section 482 of the Code of Criminal Procedure seeking to have Annexure A1 final report quashed as far as the petitioner is concerned, who is arrayed as the fourth accused in Crime No. 57/CR/Klm/09 of CBCID, Kollam, which has been taken on file as C.P. 108 of 2011, which on committal was came to be numbered as S.C.1675 of 2011 and is pending before the First Additional Sessions Court, Kollam.
2. Little did Smt. Lakshmi Santhosh know what fate had in store for her when she walked into the Parabrahma Specialty Hospital, Ochira at about 8 a.m. on 14.12.2004. She was carrying at the relevant time. It appears that she felt a slight abdominal pain and therefore, they decided to have a routine check up. Smt. Lakshmi Santhosh was a Staff Nurse of VSM Hospital, Mavelikkara and her mother was the Head
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Nurse in the said Hospital and her mother had been a Nurse for the last 40 years. The Casualty doctor in the Parabrahma Hospital examined Smt. Lakshmi Santhosh and gave Cyclopam injunction and digene gel and she was allowed to go home. As she was coming out of the hospital, she was informed that she should meet the Surgeon also. The Surgeon after examination, found nothing wrong with Smt.Lakshmi Santhosh, but he, by way of abundant caution asked her to consult the Gynecologist also. As per the said advise, Smt.Lakshmi Santhosh met Dr.Girija, Gynecologist of the hospital. Though the Gynecologist found that Smt. Lakshmi Santhosh is not suffering from any gynecology problem, she found urinary problems and therefore, she was admitted in the said hospital. She was administered Ampicillin injunction which resulted in causing acute respiratory problems to Smt.Lakshmi Santhosh, a condition medically described anaphylactic shock. The Casualty doctor, who is the first
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accused in the case, was contacted and he attended to Smt.Lakshmi Santhosh and she was given Efcorlin and Dexona injunction and as the situation did not improve, it so happened that Dr.Ajith gave Diazepam injunction. That worsened the condition of Smt.Lakshmi Santhosh who went into a morbid stage. The petitioner herein was called in to attend the patient. Having found that Smt.Lakshmi Santhosh had gone into a morbid stage, she was asked to be shifted to VSM Hospital which had ventilator facility and which is absolutely necessary for the resurrection of Smt.Lakshmi Santhosh. She was taken to VSM Hospital and taken to the ICU immediately. The petitioner herein followed Smt.Lakshmi Santhosh in his vehicle and as soon as he reached the VSM Hospital, he went to the ICU and came out and assured the relatives that she will get better soon and he left the hospital. A short while thereafter, the doctor informed the relatives of Smt.Lakhsmi Santhosh that she was no more.
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3. Initially, no one suspected the mode of treatment administered to Smt.Lakshmi Santhosh. But later, the mother of the victim seems to have sent a complaint which resulted in registration of the crime and ultimately resulted in the investigation being handed over to CBCID. During investigation, it was revealed that the doctors who had attended to and treated Smt. Lakshmi Santhosh were grossly negligent, the case sheet of Smt.Lakshmi Santhosh was not properly maintained and she was administered medicines without ascertaining her medical history and finally that there was gross negligence on the part of the doctors in taking necessary steps when Smt.Lakshmi Santhosh went into coma. After investigation, final report was laid before the JFCM Court, Karunagappally for offence punishable under Section 304 read with Section 34 of Indian Penal Code, in which the petitioner is shown as the fourth accused. Cognizance of the offence was taken by the JFCM Court, Karunagappally as C.P.108 of 2011
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and finding that the offence is exclusively triable by a court of Sessions, committed the case to Sessions Court, Kollam, which made over the case to First Additional Sessions Court as S.C. 1675 of 2011.
4. The petitioner would say that even assuming all what is stated is true, and the entire evidence collected during investigation is taken as established, there is nothing to show that the petitioner was in any way responsible or had in any manner contributed to the death of Smt.Lakshmi Santhosh. There is nothing to show that he had attended to the patient, treated her or administered any medicine to her. All that the prosecution has against the petitioner is Annexure A7 report drawn up by the apex body constituted as per Circular No.73304/SSB3/2007/Home dated 16.6.2008 in which there is a vague assertion that the cause of death of Smt.Lakshmi Santhosh was due to the collective negligence on the part of the doctors who had attended to her including the petitioner.
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5. The petitioner would point out that there is nothing to show that either he had not done what he should have done or he had done something which he should not have done when he was called upon to attend to Smt.Lakshmi Santhosh. An expert committee of the doctors constituted to ascertain the cause of death met on 23.6.2008 and gave an opinion that the cause of death could be ascertained after the final opinion of the forensic department and the said committee again met on 2.2.2009 and 12.1.2010. The committee formed the opinion that there was no negligence on the part of the doctors who had attended to the patient and the said report is produced as Annexure A5. Subsequently, a medical Board was constituted under the Convenorship of Director of Health Services which had met on 27.2.2010 and opined that there is collective negligence as already mentioned.
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6. The petitioner would say that none of the committees met for conducting enquiry into the death of Smt.Lakshmi Santhosh had attributed any role to the petitioner and the only material that is now available against the petitioner is Annexure A7 report of the Expert Committee. That being vague and there being no other material against the petitioner, it may not be in the interests of justice to direct him to face trial. Even assuming that the petitioner had informed the relatives of Smt.Lakshmi Santhosh when Smt.Lakshmi Santhosh had reached VSM Hospital and was in the ICU that Smt.Lakshmi Santhosh would get better soon, which he knew to be false, still that by itself is insufficient to create any criminal liability on him. None of the ingredients necessary to constitute offence under Section 304 of I.P.C. is available as against the petitioner and therefore, he prays that proceedings as far as he is concerned may be quashed.
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7. Learned Public Prosecutor very vehemently opposed the petition. It was pointed out by him that the petitioner cannot so easily wash off his hands and he had a role to play in the incident. It was pointed out that when he was called upon to attend the patient, he did not do anything and he remained satisfied by seeing that that the patient is shifted to VSM Hospital. He did not accompany the patient to the hospital and just followed the patient in his car. After reaching VSM Hospital, the patient was taken to the ICU and the petitioner had occasion to see the patient in the ICU. Knowing fully well that the patient would not survive or that the patient was already dead, he chose to inform the relatives of the patient that she would get very well soon. This deliberate false statement by the petitioner shows his complicity in the incident. At any rate, the involvement of the petitioner and the extent of his liability and the degree of negligence and lack of care on his part are to be determined
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during trial and it may not be proper for this court to exercise its power under Section 482 of Cr.P.C. and quash the proceedings as against the petitioner.
8. The defacto complainant, who is none other than the mother of the deceased was impleaded as additional second respondent. She has entered appearance through a counsel and informed the court that she has not much grievance as against the petitioner. But that is not the case as against the other accused persons. It was also pointed out that infact the petitioner should figure as a witness for the prosecution and if this court finds that the proceedings are to be quashed as against the petitioner, court may direct that he be cited as a prosecution witness in the case.
9. This case reveals yet another story of carelessness, indifference and callous attitude displayed by the doctors of a hospital by name Parabrahma Hospital at Oachira. A lady who had no particular disease and who had gone for a
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routine check up with a slight abdominal pain ended up in breathing her last in the hospital. It is true that several committees were constituted and all the Committees have come to the conclusion that there is no wilful negligence on the part of the doctors who had attended to the patient. However, Annexure A7 produced along with the petition which is the report of the apex body already made mention of says that there was collective negligence on the part of the doctors who had attended to Smt. Lakshmi Santhosh, the patient. Surprisingly enough, it does not mention about the role played by each of the doctors and the credibility or correctness of the action taken by the respective doctors at the respective moments. The husband and the daughter of the deceased had approached the Consumer Disputes Redressal Forum seeking compensation for the death of Smt.Lakshmi Santhosh and the said forum passed Annexure A10 order wherein it was found that the first and the second accused herein were negligent
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which caused the death of Smt.Lakshmi Santhosh and awarded a sum of Rs.15,00,000/- as compensation. It exonerated the petitioner from all liability.
10. It is not in dispute that initially Smt.Lakshmi Santhosh was seen by the duty doctor and then she was referred to the Surgeon and then to the Gynecologist. It was Dr.Girija, who had admitted the patient in the hospital. It appears that Dr.Girija, after examining the patient, directed X-ay to be taken and blood test to be conducted. IV drip was also given. As per the records, Smt.Lakshmi Santhosh was administered Ampicillin injunction and she soon began to struggle and developed severe respiratory problems. The first accused was called and he initially gave dexona and efcorlin injunction. It is claimed that the patient developed fits and diazepam injunction was given to the patient. The condition of Smt.Lakshmi Santhosh worsened and she was removed to ICU. It was thereafter that Dr.Mathew, the Anesthetist, and
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Dr. Ravikumar were called to attend to the patient. Dr.Mathew intubated the patient and finding that the patient was in a critical condition, Dr.Ravikumar, the petitioner herein, advised that she be taken to a hospital where there was ventilator facility. It was then Smt.Lakshmi Santhosh happened to be removed to VSM Hospital, Mavelikkara. There is considerable controversy regarding the question as to whether Smt.Lakshmi Santhosh had already died or she had breathed her last at VSM Hospital Mavelikkara. The fact remains that the death certificate was issued by the petitioner from the Parabrahma Hospital. It is not in dispute that the petitioner, who had accompanied Smt.Lakshmi Santhosh to VSM Hospital and who had visited the deceased in the ICU at VSM Hospital, after coming out from the ICU, informed the relatives that her condition will improve soon. This was misleading because if one has to go by the records, there was no chance of survival as far as the deceased was concerned and the petitioner must
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have been aware of the same. The materials now before the court show that the petitioner was called at a time when the patient had gone into the morbid condition and there is no material or any report of any Committee suggesting that the petitioner had omitted to do something which he could have done to save the petitioner or he had done something which ought not to have been done. There is nothing to show that the patient could have been managed in such a critical condition by any method except putting the patient on ventilator. Of course, there is materials to show that she should have been given adrenalin injunction, since respiratory problem had developed as a result of ampicillin injunction. There is an allegation that proper test dose was not taken before ampicillin injunction was given to Smt.Lakshmi Santhosh. Whatever that be, the materials do not disclose that Dr.Ravikumar had ever treated the patient or attended her or had prescribed any medicines for her. His role is confined to
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the last stage when Smt.Lakshmi Santhosh had gone into morbid stage which is noticed by the various committees constituted and the Consumer Disputes Redressal Forum.
11. It is surprising to note that the apex body was very casual in its approach and seems to be influenced by the birds of the same feather syndrome and was keen to exonerate the doctors who had actually attended to and treated the patient. The statement of C.W.8, the charge witness, would indicate that the calamity occurred due to the administration of ampicillin injunction. C.W.8 is a Cardiologist attached to VSM Hospital, Mavelikkara. C.W.7 has opined that a patient who is administered with ampicillin, if reacts to the same, is administered Diazepam, it will be counter productive. On the other hand, when the patient develops acute respiratory problem due to ampicillin injunction, life saving medicine Adrinal should be administered to her instead of diazepam. He is of the opinion that when a patient has
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developed reaction to ampicillin injunction, administration of diazepam was fatal. It is significant to notice that Annexure A7 which is the report of the apex body, is totally silent about this aspect. In the findings recorded by the body, it is seen stated that cause of death is anaphylactic shock due to ampicillin injunction. Significantly enough the report is silent about the act of Dr.Ajith, who is the first accused herein, who administered diazepam injunction to Smt.Lakshmi Santhosh who had shown acute reaction to ampicillin injunction. More curiously enough, the said report draws the conclusion that there was no negligence on the part of any particular doctor, but there was collective negligence.
12. There is considerable substance in the grievance voiced by the petitioner that except for Annexure A7, there is absolutely no material to connect the petitioner to the death of Smt.Lakshmi Santhosh.
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13. The next question that arises for consideration is whether this court will be justified in the facts and circumstances of the case in quashing the proceedings as against the petitioner. The power of this court under Section 482 of Cr.P.C. is indeed very wide. However, that power is to be exercised only sparingly and in exceptional circumstances. In fact a perusal of Section 482 of Cr.P.C. would show that its scope is considerably limited. The said provision reads as follows:
“482. Saving of inherent power of High Court.Nothing in this Code shall be deemed to limit or affect the inherent powers of the High Court to make such orders as may be necessary to give effect to any order under this Code, or to prevent abuse of the process of any Court or otherwise to secure the ends of justice.”
14. A reading of the provision shows that the power under the said Section is to be exercised under three contingencies, they are, (i) to give effect to an order under the
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Code, (ii) to prevent abuse of process of court, and (iii) to secure the ends of justice. Among the three, (ii) and (iii) work in both ways. While they deal with prevention of harassment of innocent persons, they also ensure that a just cause is not thrown out. Even though the power is wide, it is circumscribed by self imposed restrictions. Normally, the courts will not interfere at the stage of investigation or filing of charge unless there are compelling circumstances. Usually, in matters provided by the Code, the inherent powers are not invoked. In the decision reported in R.P. Kapur v. State of Punjab (AIR 1960 SC 866) some of the categories of cases where inherent jurisdiction to quash proceedings is exercised are noticed. They are :
“(i) Where it manifestly appears that there is a legal bar against the institution or continuance of the criminal proceeding in respect of the offence alleged. Absence of the requisite sanction may, for instance, furnish cases under this category.
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(ii) Where the allegations in the First Information Report or the complaint, even if they are taken at their face value and accepted in their entirety, do not constitute the offence alleged; in such cases no question of appreciating evidence arises; it is a matter merely of looking at the complaint or the First Information Report to decide whether the offence alleged is disclosed or not.
(iii) Where the allegations made against the accused person do constitute an offence alleged but there is either no legal evidence adduced in support of the case or the evidence adduced clearly or manifestly fails to prove the charge. In dealing with this class of cases it is important to bear in mind the distinction between a case where there is no legal evidence or where there is evidence which is mainfestly and clearly inconsistent with the accusation made and cases where there is legal evidence which on its appreciation may or may not support the accusation in question. In exercising its jurisdiction under S. 561-A the High Court would not embark upon an enquiry as to whether the evidence in question is reliable or not. That is the
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function of the trial magistrate, and ordinarily it would not be open to any party to invoke the High Court's inherent jurisdiction and contend that on a reasonable appreciation of the evidence the accusation made against the accused would not be sustained.”
In the decision reported in Raj Kapoor v. State (Delhi Admn.) (AIR 1980 SC 258), it was observed as follows:
“10. The first question is as to whether the inherent power of the High Court under Section 482 stands repelled when the revisional power under Sec. 397 overlaps.The opening words of Section 482 contradict this contention because nothing in the Code, not even Section 397 can affect the amplitude of the inherent power preserved in so many terms by the language of S. 482. Even so, a general principle pervades this branch of law; when a specific provision is made easy resort to inherent power is not right except under compelling circumstances. Not that there is absence of jurisdiction but that inherent power should not invade areas set apart for specific power under the
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same Code.In Madhu Limaye's case AIR 1978 SC 47 this Court has exhaustively and, if I may say so with great respect, correctly discussed and delineated the law beyond mistake. While it is true that Sec. 482 is pervasive it should not subvert legal interdicts written into the same Code, such, for instance, in Section 397 (2). Apparent conflict may arise in some situations between the two provisions and a happy solution:
"would be to say that the bar provided in subsection (2) of Section 397 operates only in exercise of the revisional power of the High Court meaning thereby that the High Court will have no power of revision in relation to any interlocutory order. Then in accordance with one or the other principle enunciated above, the inherent power will come into play, there being no other provision in the Code for the redress of the grievance of the aggrieved party. But then if the order assailed is purely of an interlocutory character which could be corrected in exercise of the revisional power of the High Court under the 1898 Code, the High Court will refuse to exercise its inherent power. But in case the
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impugned order clearly brings about a situation which is an abuse of the process of the Court or for the purpose of securing the ends of justice interference by the High Court is absolutely necessary, then nothing contained in Section 397 (2) can limit or affect the exercise of the inherent power by the High Court. But such cases would be few and far between. The High Court must exercise the inherent power very sparingly. One such case would be the desirability of the quashing of a criminal proceeding initiated illegally, vexatiously or as being without jurisdiction." (at p. 51)
In short, there is no total ban on the exercise of inherent power where abuse of the process of the court or other extraordinary situation excites the court's jurisdiction. The limitation is self-restraint, nothing more. The policy of the law is clear that interlocutory orders, pure and simple, should not be taken up to the High Court resulting in unnecessary litigation and delay. At the other extreme, final orders are clearly capable of being consdiered in exercise of inherent power, if glaring injustice stares the court in the face. In between is a tertium
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quid, as Untwalia, J. has pointed out as for example where it is more than a purely interlocutory order and less than a final disposal. The present case falls under that category where the accused complain of harassment through the court's process. Can we state that in this third category the inherent power can be exercised? In the words of Untwalia, J:
"The answer is obvious that the bar will not operate to prevent the abuse of the process of the Court and/or to secure the ends of justice. The label of the petition filed by an aggrieved party is immaterial. The High Court can examine the matter in an appropriate case under the inherent powers. The present case undoubtedly falls for exercise of the power of the High Court in accordance with Section 482 of the 1973 Code, even assuming, although not accepting, that invoking the revisional power of the High Court is impermissible."
I am, therefore clear in my mind that the inherent power is not rebuffed in the case situation before us. Counsel on both sides, sensitively responding to our allergy for legalistics, rightly agreed that the fanatical insistence on the formal filing of a copy of
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the order under cassation need not take up this court's time. Our conclusion concurs with the concession of counsel on both sides that merely because a copy of the order has not been produced despite its presence in the records in the court, it is not possible for me to hold that the entire revisory power stands frustrated and the inherent power stultified.”
15. What at worst could be said as against the petitioner is that he had failed to give supportive treatment. But there is no material to show as to what is meant by failure on the part of the petitioner to give supportive treatment. Except for the collective negligence as stated by the apex body in its order as Annexure A7, there is no material to show as to what omission or commission had occurred on the part of the petitioner to mulct him with liability. Of course, the fact that he had given a wrong information to the relatives of Smt.Lakshmi Santhosh after vising the patient in VSM Hospital is there.
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16. But that by itself may not be a sufficient ground to proceed against him and to direct the petitioner to face trial.
17. Though not of much relevance and significance, one cannot omit to note that the Consumer Disputes Redressal Forum had exonerated the petitioner. In fact, one would have expected the petitioner to be cited as the prosecution witness who could have deposed what had transpired in the hospital and under what circumstance he was compelled to refer the patient to VSM Hospital. Of course, the prosecution may have a justification that the apex body has stated that the death was due to the collective negligence on the part of the doctors who had treated and attended to the patient. But that vague statement by itself is not sufficient to proceed against the petitioner.
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18. As already stated, as of now, there is no material to show that the petitioner had treated or prescribed medicines to the patient, or attended to her before he saw her in a morbid stage. There is also nothing to show that the petitioner had failed to take steps that should have been immediately taken considering the state of affairs of the patient.
19. Under these circumstances, there is considerable justification in the complaint voiced by the petitioner that he is being unnecessarily prosecuted for the offence under Section 304 of Indian Penal Code.
20. One can only say that as per the materials now available, there is nothing to show that the petitioner had contributed in any manner to the death of Smt.Lakshmi Santhosh. In fact, the defacto complainant does not seem to have much grievance against him. Her wrath is directed
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against the first and second accused. One must remember that she is a Nurse with vast experience.
21. Under these circumstances, it is felt that the prosecution of the petitioner for the offence under Section 304 of I.P.C. will not be justified and as rightly pointed out by the learned counsel for the petitioner, it is only harassing the petitioner. However, it may so happen that during the evidence it may come out that the petitioner had a role, in which case, the court concerned has ample powers under Section 319 of Cr.P.C. to proceed against the petitioner.
In the result, this petition is allowed and the proceedings as far as the petitioner is concerned in S.C.1675 of 2011 on the file of the First Additional Sessions Court, Kollam, including that portion of the charge laid as against him stands quashed reserving the liberty of the trial court to proceed against the petitioner if situation so demands under Section 319 of Cr.P.C. and also enabling the trial court to
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examine the petitioner as a court witness in case the prosecution choose not to examine him as their witness.
P. BHAVADASAN, JUDGE
sb.