Kerala High Court Rules Prescribing Medicine Over Phone Does Not Constitute Criminal Negligence

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Anusha Paul

Published on May 21, 2025, 01:50 PM | 5 min read

Kochi : The Kerala High Court has ruled that prescribing medication over the phone does not, in itself, amount to criminal negligence, even in cases where the patient later passes away, provided the treatment follows acceptable medical standards. The ruling was delivered by Justice G. Girish, who allowed a petition filed by Dr. Joseph John MD, a doctor facing prosecution under Section 304 A of the Indian Penal Code for allegedly causing the death of a patient through negligent treatment.

The case stemmed from an incident in which Dr. John was contacted by a co-accused nurse, who informed him of a patient's sudden deterioration in health. Despite being notified, the doctor did not physically examine the patient and instead advised a course of treatment over the telephone. The patient eventually succumbed to the illness, and the doctor was accused of failing to refer the patient to a specialist or initiate an immediate in-person evaluation, allegedly amounting to negligence.

In challenging the criminal proceedings, Dr. John argued that his treatment plan, based on the patient's prior condition and symptoms relayed by the nurse, was medically sound. The Court examined the Section 161 Cr PC statement made by the father of the deceased, alongside expert medical opinions submitted during the case. The expert panel concurred with the treatment adopted by Dr. John.

The Court observed that the petitioner had previously treated the patient for a similar illness and prescribed medicines along with a direction for laboratory evaluation of renal complications. The judge remarked, “The course adopted by the petitioner prescribing certain medicines for the same illness of patient which he had medically managed on 21.05.2012, and also directing the laboratory evaluation for ascertaining renal complications, has not been found to be wrong by any of the members of the Expert Panel.”

Justice Girish noted that there was no evidence on record to demonstrate that the doctor's actions amounted to gross negligence. He further stated, “As far as the present case is concerned, it has to be stated that there is absolutely nothing on record to show that the act of the petitioner prescribing some medicines and directing the laboratory evaluation of vitals of the patient, amounted to gross negligence which is never expected from a Doctor of similar stature. On the other hand, there are materials to show that the course so adopted by him would have been followed if the same contingency was faced by any other medical professional in the field. That being so, the criminal prosecution initiated against the petitioner can only be termed as an abuse of process of court which has to be terminated at the threshold.”

Referring to settled legal precedents on medical negligence laid down by the Supreme Court, the High Court clarified that criminal liability under Section 304A IPC requires gross or reckless conduct far beyond mere error of judgment. The Court reiterated that even when a patient’s death results from an unintended mistake or omission, that alone does not constitute a criminal offence.

“The law is thus trite that even in a case where a patient's death results merely from error of judgment or an accident, no criminal liability could be attached to it, and mere inadvertence or some degree of want of adequate care and caution might create civil liability, but would not suffice to hold the medical professional concerned criminally liable,” Justice Girish stated.

The Court also held that while criminal prosecution was unwarranted, the incident might give rise to civil liability on the part of the hospital or its administrative apparatus. The judgement brings much-needed clarity in the context of evolving medical practices, especially the increased reliance on telephonic and digital consultations. The onset of the COVID-19 pandemic led to the widespread adoption of remote diagnosis and treatment, making tele-medicine an essential part of healthcare delivery.

To regulate this, the Ministry of Health and Family Welfare, in coordination with the erstwhile Medical Council of India (now the National Medical Commission), issued formal Tele-medicine Practice Guidelines in March 2020. These guidelines permit registered medical practitioners to diagnose and prescribe certain categories of medicines through telephonic or digital communication, provided proper protocol is followed.

Under the guidelines, remote consultations are allowed when a patient’s identity and consent are clearly established, and when the doctor reasonably believes that a clinical assessment can be made without physical examination. However, the guidelines stress that in-person consultation is preferable where there is any ambiguity, severity, or risk that requires a more detailed evaluation. Doctors are expected to exercise their professional discretion in choosing whether to prescribe remotely or recommend an in-person visit. In this case, the Kerala High Court found that Dr. John had acted within reasonable professional standards, as the patient had a known medical history, and the treatment recommended had already been part of prior management for a similar condition.

The case, Dr. Joseph John MD v. The State of Kerala and another (Crl.M.C. No. 5692/2018; 2025 LiveLaw (Ker) 281), was argued by advocates C.R. Syamkumar, P.A. Mohammed Shah, Sooraj T. Elenjickal, K. Arjun Venugopal, V.A. Haritha, Sidharth B. Prasad, R. Nandagopal and Gayathri Muraleedharan on behalf of the petitioner. The state was represented by Public Prosecutor Sangeetharaj N.R.

This judgement is expected to influence future cases involving tele-medicine and may offer reassurance to medical professionals who are increasingly offering consultations over phone or video calls. It also reinforces the judiciary’s stance that criminal law should not be used to penalise professionals acting in good faith within the boundaries of accepted medical practices.