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Ernakulam: Quashing the criminal proceedings against a doctor under Section 304 A of the Indian Penal Code, 1860, the Kerala High Court recently observed that a medical practitioner would only be liable under this section if he had committed a rash or negligent act that resulted in the patient’s death.

“The law is thus well laid down that a medical practitioner can be prosecuted for medical negligence only if the procedure/treatment adopted by him is contrary to the general and approved practice. Moreover, for attracting the offence under Section 304A, the doctor should have committed a rash or negligent act,” observed the HC bench comprising Justice V.G. Arun.

“Here it is essential to note that, as far as rash acts are concerned, the criminality lies in running the risk of doing such an act with recklessness or indifference as to the consequences. Criminal negligence on the other hand is the gross and culpable neglect or failure to exercise that reasonable and proper care and precaution to guard against injury, either to the public generally or to an individual in particular which, having regard to all the circumstances out of which the charge has arisen, it was the imperative duty of the accused to have adopted. For attracting the offence under Section 304A, the death must also be the direct or proximate result of the rash or negligent act of the accused,” it further noted.

The plea was filed by the accused, an on-call Medical Officer, seeking quashment of criminal proceedings for medical negligence. The matter concerned a remand prisoner who suffered head injuries after a fall back in January 2021. Even though initially he was treated at local hospitals, due to a lack of beds, he was referred to the Government Medical College Hospital, Kottayam. 

After he suffered another seizure, the patient was referred for a neurosurgery consultation, and the Senior Resident examined him and informed the accused doctor about his condition over the phone. The accused doctor advised a CT scan and pre-operative investigations to be prepared for an emergency surgery.

The next day, when the accused’s duty ended at 8:00 a.m., another doctor (co-accused) assumed the charge as the on-call Medical Officer. It was alleged that even though an emergency surgery was advised after the worsening scan results, the procedure was delayed due to the unavailability of the operating theatre. The patient died in the afternoon on the same day, while awaiting surgery.

Consequently, an FIR was registered, and the patient’s death led to public protests alleging custodial torture, promoting a Crime Branch investigation. An Expert Panel was constituted to investigate the complaints against the doctors, and the panel concluded that the patient had not received reasonable medical care while undergoing the treatment. Accordingly, the accused doctors were booked under Section 304 A IPC.

Challenging this, the petitioner doctor filed the plea before the High Court. The accused’s counsel contended that even if the prosecution allegations were accepted, the offence under Section 304-A IPC would not be attracted because the golden hour, as far as a person with seizure was concerned, was six hours and the inordinate delay in providing proper treatment and medication worsened the patient’s condition.

It was argued that by the time the accused doctor was informed about the patient, already 18 hours had elapsed after the first CT-scan, and it was also the peak pandemic period, and the Government advisories prevented the accused from examining the patient physically. Further, the counsel submitted that in the appeal filed by the accused against the Expert Panel Report, the State Level Apex Expert Committee held that there was no gross and culpable negligence by the doctors at the Medical College in giving treatment to the patient.

On the other hand, the Public Prosecutor submitted that the matter was still being investigated and the investigating officer was not bound by the Apex Body’s findings. Therefore, if there were sufficient materials to prove the accused’s complicity, he could be prosecuted for the alleged offence.

While considering the matter, the HC bench opined that while negligence was an omission to do something which a reasonable man, guided upon those considerations which ordinarily regulated the conduct of human affairs, would do, or the doing of something which a prudent and reasonable man would not do, medical negligence occurred when a doctor breached his duty of care, causing harm to a patient.

The HC bench referred to the Supreme Court order in the case of Suresh Gupta (Dr.) v. Govt. of NCT of Delhi, where the Apex Court had held that “for fixing criminal liability on a doctor or a surgeon, the standard of negligence required to be proved must be so high as can be described as ‘gross negligence’ or ‘recklessness’. It was not merely lack of necessary care, attention and skill.”

The findings in the case of Suresh Gupta were affirmed by the Apex Court in the case of Jacob Mathew v. State of Punjab, where the Court observed that “A simple lack of care, an error of judgment or an accident, is not proof of negligence on the part of a medical professional. So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alternative course or method of treatment was also available or simply because a more skilled doctor would not have chosen to follow or resort to that practice or procedure which the accused followed. When it comes to the failure of taking precautions, what has to be seen is whether those precautions were taken which the ordinary experience of men has found to be sufficient; a failure to use special or extraordinary precautions which might have prevented the particular happening cannot be the standard for judging the alleged negligence.”

Further referring to other judicial precedent, the HC bench observed that a medical practitioner can be prosecuted for medical negligence only if the procedure/treatment adopted by him is contrary to the general and approved practice. Moreover, for attracting the offence under Section 304A, the doctor should have committed a rash or negligent act.

The HC bench observed that in this case, the allegation against the petitioner doctor was about the failure to provide timely treatment.

 “Indisputably, there was delay in bringing the patient to the Medical College Hospital after the first seizure. Even after admitting the patient, petitioner was informed about his condition only by 05:20 am on 13.01.2021. Immediately the petitioner directed to conduct CT scan, since no decision could be taken based on the earlier CT scan, which was conducted many hours back and when the patient was in a much better condition. The CT scan report was received at 07:45 am and the petitioner advised for immediate surgery. The petitioner cannot also be attributed with gross negligence for his failure to examine the patient physically since the Covid related SoPs prevented such examination. Further, the petitioner’s duty time ended by 8 am and the delay in conducting the surgery occurred due to nonavailability of operation theatre. Pertinent in this context to note that the Expert Panel had only opined that the patient had not received reasonable standard of care while under treatment in Government Medical College, Kottayam, without naming any particular doctor. Even that opinion of the Expert Panel has lost its relevance in view of the conclusive unanimous opinion of the State Level Apex Body that there was no gross and culpable negligence from the part of the treating doctors for giving treatment to *** (patient).”

Accordingly, the bench observed that the criminal proceedings against the accused doctor were liable to be quashed. It stated,

“In the light of the above undisputed facts, and in view of the law laid down by the Apex Court, it can unhesitatingly be held that the prosecution of the petitioner for the offence under Section 304A amounts to an abuse of process of court. As held by the Supreme Court in State of Haryana and Others v. Bhajan Lal and Others [1992 SCC (Cri) 426], an FIR is liable to be quashed when the allegations, even if accepted in their entirety, do not make out the ingredients for constituting the offence alleged against the accused.”

“For the aforementioned reasons, the Crl.M.C is allowed. FIR and all further proceedings against the petitioner in Crime No.10 of 2021 of the Crime Branch, CU-II Unit, Ernakulam are quashed,” the HC bench further noted.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/kerala-hc-ipc-304-a-298145.pdf

Also Read: Some doctors disregard human life, maligning noble profession: HC refuses to quash FIR under IPC 304A against Specialist

A new study published in BMC Nephrology found that hydroxychloroquine (HCQ) therapy demonstrated a trend toward reducing proteinuria in patients with primary glomerular diseases. Importantly, HCQ did not significantly impact estimated glomerular filtration rate (eGFR), indicating preserved kidney function during treatment. The study also highlighted HCQ’s favorable safety profile, making it a promising adjunct therapy in managing proteinuria in these patients.

Researchers found that the application of hyperbaric oxygen therapy (HBOT) in addition to current medical treatment significantly improves hearing gain in the case of sudden sensorineural hearing loss (SSNHL). SSNHL, an acute hearing impairment happening in thousands of individuals each year, is a challenging condition with unclear pathogenesis and variable responsiveness to treatment. The study was recently published in the journal Laryngoscope by Issac L. and colleagues.

Recent study investigates the expression of mitofusin 2 (Mfn2) in placentas and peripheral blood from patients with early-onset preeclampsia (eoPE) and late-onset preeclampsia (loPE), exploring its potential as a diagnostic and therapeutic target for preeclampsia. Preeclampsia, a serious condition occurring after 20 weeks of gestation, presents significant morbidity and mortality risks, particularly differentiating between eoPE (before 34 weeks) and loPE (after 34 weeks) due to varying placental and maternal pathophysiologies.

Role of Mfn2 in Preeclampsia

Mfn2, a mitochondrial outer membrane protein critical for mitochondrial dynamics, was previously noted to be downregulated in preeclampsia, associated with increased apoptosis and mitochondrial dysfunction. The study emphasizes the differences in placental pathology between eoPE and loPE, highlighting impaired remodeling of uterine spiral arteries in eoPE, leading to ischemia and hypoxia. In contrast, loPE presents with maintained or higher placental perfusion levels.

Mfn2 Expression Analysis

Quantitative assessments revealed a significant decrease in Mfn2 mRNA levels in placentas from eoPE patients compared to both loPE and normal control groups, while loPE did not show significant downregulation compared to controls. Peripheral blood analyses indicated higher levels of Mfn2 protein in both preeclampsia groups compared to controls, with eoPE showing the highest levels. Notably, Mfn2 levels were positively correlated with the severity of preeclampsia, such as systolic and diastolic blood pressure and proteinuria, with stronger correlations in eoPE. The findings suggest a stratification in the role of Mfn2 between the two conditions, establishing that the reduction of Mfn2 in eoPE is indicative of significant mitochondrial dysfunction, while the elevated serum levels in both preeclampsia types may reflect a compensatory response to placental mitochondrial damage. Moreover, these elevated Mfn2 levels were negatively correlated with birth weight and Apgar scores, indicating poor pregnancy outcomes associated with elevated Mfn2 levels.

Conclusion and Future Directions

In summary, this investigation highlights Mfn2’s potential as a biomarker for preeclampsia severity and progression, distinguishing the distinct roles of mitochondrial dysfunction in eoPE and loPE. The findings support the hypothesis that early identification of impaired Mfn2 expression could facilitate enhanced diagnostic and therapeutic strategies for preeclampsia management, advocating for further research to validate these findings in larger cohorts and longitudinal studies.

Key Points

– -Expression Analysis of Mfn2-: Significant downregulation of Mfn2 mRNA levels was identified in placentas from patients with early-onset preeclampsia (eoPE) when compared to both late-onset preeclampsia (loPE) and normal control samples, while loPE did not exhibit significant differences in Mfn2 levels compared to controls.

– -Peripheral Blood Findings-: Elevated Mfn2 protein levels were observed in peripheral blood from both eoPE and loPE patients compared to controls, with eoPE showing the highest serum Mfn2 levels. This suggests a potential compensatory mechanism in response to placental mitochondrial damage.

– -Correlation with Disease Severity-: Mfn2 levels exhibited positive correlations with the severity of preeclampsia indicators such as systolic and diastolic blood pressure, as well as proteinuria. These correlations were found to be more robust in the eoPE cohort, indicating that altered Mfn2 expression may reflect the severity of the condition.

– -Implications for Pregnancy Outcomes-: Elevated Mfn2 levels in both types of preeclampsia were negatively correlated with birth weight and Apgar scores, suggesting that higher Mfn2 may be associated with adverse pregnancy outcomes and poorer fetal health.

– -Differentiation of Pathophysiology-: The study emphasizes the divergent mechanisms of placental pathology between eoPE and loPE, with eoPE characterized by impaired remodeling of uterine spiral arteries, leading to ischemic conditions, whereas loPE maintains or improves placental perfusion levels.

– -Future Research Directions-: The findings propose Mfn2 as a potential biomarker for assessing preeclampsia severity and progression, underscoring the need for further investigations in larger cohorts and longitudinal studies to validate Mfn2’s utility in diagnostic and therapeutic approaches for preeclampsia.

Reference –

Dandan Sun et al. (2025). A Mitochondrial Regulator Protein, Mitofusin 2, Is Elevated In The Maternal Blood Of Women With Preeclampsia. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07663-4.

Following the death of a 9-year-old girl from amoebic encephalitis— a rare and often fatal brain infection caused by free-living amoeba commonly found in contaminated water, health authorities in Kozhikode have issued a high alert.

The child was first admitted to a local hospital last week with a high fever. As her condition worsened rapidly, she was shifted to Kozhikode Medical College. Despite treatment, she succumbed on the same day.

According to health officials, this is the fourth case reported from Kozhikode
this year — raising concerns about possible contaminated water sources in the
district. Efforts are now underway to trace the exact pond or water body where
the infection may have been contracted. Doctors explain that the infection is
usually caused by Naegleria fowleri, often referred to as the “brain-eating
amoeba.”

It thrives in warm freshwater lakes, rivers, and ponds. Infection
occurs when contaminated water enters the nose, usually during swimming or
diving, before reaching the brain. What makes it dangerous?

Symptoms such as severe
headache, fever, vomiting, stiff neck, and confusion appear suddenly,
progressing rapidly to coma. The fatality rate stands at over 97%, even with
treatment. Is it treatable?

Doctors use antifungal drugs like amphotericin B,
often in combination with miltefosine and other medicines, but survival remains
rare. Early detection is critical. How can you stay safe?

Avoid swimming or
watersports in warm freshwater bodies. Never use tap water in nasal rinsing
devices (like neti pots) — only distilled or sterilized water. Ensure proper
chlorination of swimming pools. Health experts emphasize: If you develop sudden
fever or headache after swimming in freshwater, seek medical help immediately.