JUDGMENT
1. Section 314 of the Indian Penal Code prescribes that if an act is done with the intent of causing the miscarriage of a woman with a child, and it results in the death of such woman, that the accused shall be punished in the manner prescribed by that Section. The issue canvassed in this appeal centres around the question as to whether the accused, who undoubtedly attempted to cause a miscarriage of a pregnant woman, but was unsuccessful in the process, and was convicted for the death of the person was rightly held guilty, when it was demonstrated that the girl had died several weeks later of septicemia without it having been established that the accused was in any way responsible for her fatal condition. Conversely, merely because there was a time-lag between the date when the deceased was treated and the subsequent death and the unfortunate situation that adequate and proper surgery and corrective action was not made available to the deceased, could it exonerate the accused from the liability under this Section. On these points canvassed in the present appeal, which are of far-reaching importance and for purposes of their resolution, a reference to the material aspects of case is essential.
2. The appellant, a nurse, has assailed her conviction under section 314 of the Indian Penal Code by the learned 3rd Additional Sessions Judge, Satara, who has sentenced her to suffer rigorous imprisonment for 4 years and to pay a fine of Rs. 200/-, in default, to suffer rigorous imprisonment for one week.
3. The Prosecution alleges that a resident of Karad, an unmarried girl by the name of Prabhavati, found herself pregnant and that she suppressed this fact for a few months until it became no longer possible to conceal the pregnancy. She mentioned her problem to her sister Shanta (P.W. 4) who, in turn, happened to talk to her colleague in the printing press Hasina (P.W. 3). As a result of the consultations, Prabhavati and Shanta went to consult Dr. Kolekar. It is alleged that the accused was working as a nurse in that hospital. Since the doctor was not available, the accused is alleged to have volunteered to help Prabhavati for a much smaller fee. The accused is alleged to have taken the girl on 22-11-1983 to the room of one Wankundare and it is further alleged that she gave an injection on the abdomen of Prabhavati. It further appears that on the next day some intravenous saline was administered and the Prosecution alleges that since the abortion had not taken place on 23-12-1983, the accused attempted to induce an abortion by using forceps and a tube. When this process was not successful, Bhanudas Amalkar (P.W. 9), who had been styled at some parts of the record as a doctor, but, in fact, at the highest, was an attendant in a hospital, was requested to assist. He did not do anything on the evening of that day, but it appears that on the next day, he was alone with the deceased administering certain treatment for about 2 hours as a result of which the abortion finally resulted.
4. We are not concerned with the various details, but suffice it to state that the girl went home in the evening and her condition progressively deteriorated. She was shifted to the Cottage Hospital initially on 29-11-1983 and thereafter to the District Hospital as her condition had become serious. Her dying declarations were recorded on 3-12-1983 first by a Police Constable and thereafter by the Tahsildar and Prabhavati finally died on 4-12-1983. Pursuant to the subsequent investigation, the accused was arrested and it is alleged by the Prosecution that on 24-12-1983 she produced the tube with two needles attached to it and a forcep which, according to the Prosecution, were the instruments that had done all the damage. The accused was thereafter charge-sheeted, put on trial and the learned Additional Sessions Judge convicted the accused under section 314 of the Indian Penal Code. It is against this conviction that the present appeal has been directed.
5. It is unnecessary for me to reproduce in detail the various parts of the evidence. Shri Mohite, learned Counsel appearing on behalf of the accused, has taken me though the oral and documentary evidence which consists essentially of two sections. The first of it consists of the evidence of Hasina (P.W. 3), which is not of much consequence, Shanta (P.W. 4), the sister of the deceased, Bhanudas Awalkar (P.W. 9) and Baburao Wankundare (P.W. 2) in whose room the entire treatment was administered. Apart from this, we have on record the evidence of Maruti Naikwadi (P.W. 7), the Tahasildar, who recorded the dying declaration, and the evidence of other doctors who had treated the girl, performed the post-mortem etc.
6. The principal ground canvassed by Shri Mohite is that there is no evidence on the basis of which it can be conclusively established that the present accused did any act that could have resulted in the death of Prabhavati. For this purpose, he has minutely analysed the oral evidence of the Prosecution witnesses starting with Hasina (P.W. 3), who obviously has tried her best to conceal her role in the entire incident. The evidence of the sister Shanta (P.W. 4), however, is of some importance because even though it indicates that the accused did apparently agree to help the deceased Prabhavati to have an abortion, and even though she took her to the room of Baburao Wankundare (P.W. 2) and even though thereafter did administer some forms of treatment, that, in fact, the abortion did not take place as a result of all these acts. In the present proceedings, we are not concerned with the inducing of abortion because the charge being one under section 314 of the Indian Penal Code, it is essential for the Prosecution to demonstrate that the death of Prabhavati was on account of the act committed by the present accused. For this purpose, Shri Mohite has pointed out to me, and very rightly, that the evidence of Hasina (P.W. 3) and that of Shanta (P.W. 4), who is the sister of the deceased Prabhavati, did not support each other and, more importantly, that the two dying declarations of Prabhavati, which are substantially similar to each other, almost contradict the evidence of the sister, Shanta (P.W. 4). The most significant evidence is that of the so-called doctor Bhanudas Awalkar (P.W. 9). As far as this evidence is concerned, it does not inspire any confidence whatsoever and it is very clear on a mere perusal of his evidence that this witness has been making an attempt to detach himself as much as possible from what had happened. He solemnly states on oath before the Court that even though he was called there, that he virtually did nothing short of re-inserting the saline needle through which intravenous drip was administered to Prabhavati. It is very clear that this witness is suppressing the truth, but one tell-tale circumstance and one on which Shri Mohite placed strong reliance is of crucial importance. This circumstance, namely, the fact that in spite of the accused having volunteered to help and her having tried to induce an abortion that Prabhavati had not aborted assumes significance. Even though Bhanudas Awalkar (P.W. 9) does not admit it, we have evidence on record that this man was passing off as a “doctor” though he could be more appropriately defined as an abortionist and it was for this reason that his assistance was sought. There is little dispute about this aspect of the case because Prabhavati as also her sister very clearly indicate that it was pursuant to whatever treatment this witness administered that the abortion resulted. This fact assumes dual significance because I am in agreement with the submissions canvassed by Shri Mohite that if, as a result of any act on the part of the accused at an earlier point of time, any serious internal injuries had been caused to Prabhavati, that she would have bled profusely and she would have also been in such pain that there would have been no option except to remove her to a hospital. It is, therefore, quite obvious that prior to the stage when Bhanudas Awalkar (P.W. 9) started the operation that on injury could have taken place.
7. I shall now come to the medical evidence because Shri Mohite has also relied on the fact that the death of Prabhavati took place as late as on 14-12-1983 and the most important aspect of the medical evidence, namely, the fact that the cause of death was given as a septicemia. We have on record a considerable amount of medical evidence, all of which indicates that there were several ruptures and tears in the internal parts of the vagina as also the rectum and that it was these ruptures which were the main cause for the development of a septicemia. The unfortunate part of the matter was, as Shanta (P.W. 4) has admitted, that when the deceased was taken to the Cottage Hospital, they had suppressed from the doctor the fact that an abortion had taken place. It was only at a sufficiently advanced stage that the doctor came to known of this fact by which time it was obviously too late. Whether or not Prabhavati could have been saved with better medical treatment is incidental, but the issue that falls for determination is as to whether it can safely be concluded that the death of Prabhavati took place because of some act on the part of the present accused in the course of attempting a miscarriage.
8. As far as this aspect of the matter is concerned, to my mind, the medical evidence is conclusive and it would be virtually impossible to fasten the liability for the death of Prabhavati on anything that had been done by the accused. In the third week of November when, undoubtedly, the deceased had been under her treatment for two or three days, even if the Prosecution were to contend, as was sought to be submitted by the learned A.P.P., Shri Patil, that the Court will have to draw an inference that the damage done by the Accused clearly resulted in the death of Prabhavati. We unfortunately do not have on record any material on the basis of which it can be safely held that the tears which were subsequently detected, had occurred at the hands of the Accused. As indicated by me, subsequent to the stage at which she had treated the deceased, it was Bhanudas Awalkar (P.W. 9) who had performed certain operations on her and it would be highly improper under these circumstances to fasten the liability for the condition of Prabhavati on the Accused.
9. The learned Additional Sessions Judge has, undoubtedly, relied on several circumstances and has also placed reliance on the dying declarations. I do not propose to discrab the dying declarations, but it needs to be mentioned, in passing, that even if the dying declarations are accepted, that they do not establish anything beyond what has been indicated by me above, namely, that the deceased did go to the Accused in the hope of attempting an abortion, that the Accused did administer certain treatment to her but that Prabhavati was very much alive for several weeks thereafter. The nexus between whatever acts done by the Accused and the death of Prabhavati has got to be direct. There has got to be on record cogent and convincing evidence that one has led to the other. In the absence of this, the conclusions drawn by the trial Court would be rendered unsustainable. 10. Section 314 of the Indian Penal Code reads as follows :-
“314. Whoever, with intent to cause the miscarriage of a woman with child, does any act which causes the death of such woman, shall be punished with imprisonment of either description for a term which may extend to ten years, and shall also be liable to fine; and if the act is done without the consent of the woman, shall be punished either with imprisonment for life, or with the punishment above mentioned.
Explanation – It is not essential to this offence that the offender should know that the act is likely to cause death.”
The wording of the Section is abundantly clear that it foists on a person who, in the course of inducing a miscarriage, does an act which results in the death of a woman, the liability for such consequence. The explanation to the section clarifies that it is not essential to this offence that the offender should know that the act is likely to cause death. The Courts have held that even in a situation where a poisonous drug was administered to a woman to procure miscarriage and it was not proved that the accused knew that the drug was likely to cause death, that it still constituted an offence under this Section (See Kalachand Cope (1868) 10 WR (Cr.) 59). The direct implication obviously is that unlike Section 299 of the Indian Penal Code, the nature of the act is not the qualifying aspect but, more importantly, the consequences thereof. In other words, if what is done for purposes of inducing a miscarriage causes the death of a woman, it would be no defence to argue that the character of the act was not of such a nature as would cause death or that it can be demonstrated that there never was any intention to cause death.
11. In these cases, the law envisages a peculiar situation and for good reason because a heavy responsibility rests on the party whether it is a doctor, a midwife or any other person who is involved in the operation to take special care of the consequences of that act. The framers of the Code did have in mind both categories of cases, the first of them being where the woman concerned is in the hands of a qualified Medical Pactitioner or a hospital and the second one being of the more familiar situations where for reasons of embarrassment or poverty, assistance of a less qualified type is sought as a solution to the problem. What is implied in this Section is that in either case the gravity and seriousness of the entire operation needs to be taken cognizance of and to my mind an equal responsibility is cast in relation to the aftercare. The law will not excuse a situation where the operation has been complete and the woman has been sent away and no precautions are taken to ensure that her condition does not deteriorate ending in possible death. The very strong incidence of infection, of haemorrage of a total collapse and as has happened in the present case, a situation whereby gangrene could set in, has been taken cognizance of by the law. It is very essential, therefore, that the responsibility which is expected of is recognised and adhered to. There is, therefore, a clear and definite responsibility in such cases that the after-care or the follow-up be rigorously adhered to because it is no defence to plead that the death occurred sometime after the patient left or when she was under the treatment of some other person or that the requisite and adequate legal (sic) facilities were unfortunately not made available.
12. It is, however, necessary to qualify that the criminal liability envisaged by the Section will not extend to a case where the death was caused by totally extraneous factors or ones which were not directly connected with the operation relating to the miscarriage. It will have to be demonstrated that there is a direct nexus between the act of the Accused and the cause of death. The Courts while construing rash and negligent acts under S. 304-A of the Indian Penal Code have occasion to hold that the death should have been the direct result of the act of the Accused and that act must be the proximate and efficient cause without the intervention of another’s negligence. It must be the cause causans; it is not enough that it may have been the causa sine qua non. This High Court has endorsed this principle in Omkar’s case reported in 4 BLR 679 and once again reiterated it in Haridas’s case reported in 61 B.L.R. 1309. The Supreme Court has also reiterated this principle in Kurban Hussain’s case and A. D. Bhatt’s case . What needs to be emphasised very strongly is that the evidence will have to be quite conclusive in establishing both aspects, namely, the fact that a particular act was done for purposes of causing a miscarriage and that it was that very act which ultimately caused the death of the woman. The fact that a miscarriage was induced and that the woman died subsequently does not necessarily link up one with the other though there may be strong grounds to suggest this and the Court is, therefore, required to ascertain with a degree of certainty through a meticulous scrutiny of the medical evidence and to decide as to whether the act of the Accused can be categorised as being directly responsible for the death that has occurred. As an example, in cases where it is demonstrated that an abortion has been performed and the woman has been sent away shortly thereafter in the full knowledge that injury has been caused to areas of her body which, in the absence of special treatment, will most certainly result in grave infection and death and, in fact, such a result occurs the provisions of this section would be attracted. If, on the other hand, a death does occur, but it is demonstrated that it was due to supervening extraneous or unconnected factors, the mere fact that the Accused was responsible for the miscarriage at an earlier point of time, though in close proximity, would not fasten any such liability.
13. An aspect which the Court has to specially bear in mind in such situations is that medical persons invariably act in teams and it will, therefore, be very crucial that the liability will have to be fastened only if it can be undisputedly demonstrated that a particular person or set of persons were involved. Secondly, as has happened in the present case where due to the act of the deceased or her relations, more than one person or persons have been involved in the treatment at different stages, it will be essential to look for unimpeachable evidence for purpose of ascertaining at which particular point of time the damage was done. The classic situation would be where an unqualified quack messes up a case and the woman thereafter goes to another doctor who attempts to undo the damage but is unsuccessful and is sought to be prosecuted on the ground that the death took place shortly after his treatment, often times it would be the medical evidence alone which would conclusively settle this issue.
14. Having regard to the state of the record in this case, to my mind, the submissions advanced by Shri Mohite are liable to be upheld.
15. In the result, the appeal is allowed. The conviction and sentence recorded against the Accused are set aside. The fine, if paid, is directed to be refunded to her. The bail bond of the Accused to stand cancelled.
16. Appeal allowed.