The Supreme Court of India has held that criminal proceedings against a medical professional cannot be sustained where the procedure adopted is supported by medical opinion and there is no material on record to indicate fabrication or manipulation of the consent form.A bench of Justice Manoj Mishra and Justice Pamidighantam Sri Narasimha set aside the order of the Madras High Court and observed that, in the absence of any evidence suggesting interpolation in the consent form, continuation of criminal proceedings would amount to an abuse of the process of law.Background of the CaseThe case arose from a complaint filed by the father of a minor child who had undergone surgery for an undescended testicle at a hospital in Chennai. According to the complainant, consent had been given only for “Orchidopexy,” a procedure aimed at repositioning the testicle, and not for “Orchidectomy,” which involves removal of the testicle.It was alleged that prior to the surgery, the operating surgeon had assured that in most cases removal of the testicle would not be necessary. However, during the procedure, the testicle was removed. The complainant further alleged that the consent form had been manipulated by inserting the term “Orchidectomy” later, thereby amounting to forgery.Based on these allegations, an FIR was registered at PS Ambathur on 08.08.2006 (ie, FIR No. 1196 of 2006) under Sections 312, 325, 426, 120-B, 406, 465, 468, 471 and section 501 (1) & (2) of the Indian Penal Code, 1860, offenses relating to causing hurt, forgery, criminal conspiracy, and destruction of evidence. Following 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 proceedings, but the High Court declined relief and directed expeditious trial, leading to the present appeal before the Supreme Court.Medical Board Findings and Investigative MaterialA key aspect of the case was the opinion of a Medical Board constituted pursuant to directions of the High Court. The Board examined the 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 where 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… is an appropriate surgical procedure as per medical ethics and it should have been done with the consent of parents.”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 CourtOn 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. It was submitted that the only dispute related to consent, and even that was unsupported by any material evidence.The appellant stressed that the consent form had been examined by competent authorities and no interpolation or manipulation had been found. It was further argued that there was no forensic evidence to suggest that the term “Orchidectomy” had been added subsequently.The State, however, argued that even if the procedure was medically justified, the absence of clear consent would still raise issues requiring trial. It was argued that 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 had 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 that 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:“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 his ordinary senses and prudence would have done or failed to do.”The Court also recalled the requirement that criminal proceedings against doctors should be supported by credible medical opinion, observing:“A private complaint may not be entertained unless the complainant has produced 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 underlined the importance of medical opinion in assessing such disputes.The Court identified the central issue as whether the consent obtained from the complainant was limited to Orchidopexy or extended to Orchidectomy, and whether there had been any interpolation in the consent form. The Court noted that it is ordinarily a matter of trial to determine whether a document has been tampered with, observing:“Ordinarily, an issue of tampering/interpolation in a document… is to be determined in a trial… courts must be loath to examine such issues in a summary proceeding.”However, the Court clarified that 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, i.e., “Orchidopexy” and “Orchidectomy,” separated by a slash.The Court observed:“A perusal thereof would indicate that… both types of surgery… are mentioned by putting a slash (/), which means 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” had been inserted later, stating:“There is no material on record that alternative surgery… 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 OpinionThe 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 surgeon is best placed to decide which procedure is appropriate during surgery, observing:“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:“Continuation of criminal proceeding 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.CRIMINAL APPEAL No………….. OF 2026 (Arising out of SLP (Crl) No.14803/2023)DR. S. BALAGOPAL VERSUS STATE OF TAMIL NADU & ANR.For Petitioner(s) Mr K. Ravi Anantha Padmanabhan, Sr. Adv. Mr. TRB Sivakumar, AOR Mr. Deva Vrat Anand, Adv.For the respondent(s) Mr. V Krishnamurthy, Sr. AAG Mr. D.kumanan, AOR Ms. Deepa S, Adv. Mr. Sheikh F Kalia, Adv. Mr. Veshal Tyagi, Adv. Mr. Chinmay Anand Panigrahi, Adv. Ms. Azka Sheikh Kalia, Adv. Responder-in-person(The author of this article, Vatsal Chandra is a Delhi-based Advocate practicing before the courts of Delhi NCR.)
