Can a consent form listing multiple surgical options with a slash be considered forged under Section 465 IPC?

No. The Supreme Court held that listing alternative procedures with a slash on a standard consent form does not constitute forgery, especially when medical experts confirm the procedure was appropriate and no forensic evidence of tampering exists.

Is a doctor criminally liable if a patient later claims they did not consent to a procedure that was medically justified?

Not necessarily. The Court emphasized that where medical experts affirm the procedure was appropriate and no evidence of fraud or malice exists, mere denial of consent by the complainant, without corroboration, cannot sustain criminal proceedings.

Can a High Court quash criminal proceedings under Section 482 CrPC based on medical expert opinions?

Yes. The Supreme Court affirmed that when expert reports conclusively support the accused’s conduct and no evidence of tampering exists, continuation of proceedings amounts to abuse of process and warrants quashing under Section 482 CrPC.

Slash in consent form not forgery Supreme Court

The Supreme Court has clarified that the mere inclusion of multiple surgical options on a printed consent form, separated by a slash, does not constitute forgery or interpolation - especially when medical experts affirm the procedure as clinically appropriate. This judgment reinforces the high threshold for invoking Section 482 CrPC to quash proceedings in medical malpractice cases where no forensic evidence of tampering exists.

Background & Facts

The Dispute

The dispute arose from a surgical procedure performed on a one-and-a-half-year-old boy suffering from bilateral undescended testes. The father, the de facto complainant, alleged that he consented only to Orchidopexy (repositioning the testicle), but the surgeon, Dr. S. Balagopal, performed Orchidectomy (removal of the testicle) without explicit consent. The complainant further alleged that the consent form was altered post-procedure by inserting the term "Orchidectomy" to falsely suggest prior authorization.

Key Facts

The child was admitted to Sri Ramachandra Medical Centre (SRMC), Porur, on 23.08.2005 for hernia surgery.
The surgeon, Dr. Balagopal, examined the child and identified the left testicle as small, cystic, and dysplastic - consistent with a "nubbin of tissue."
On 24.08.2005, the surgeon performed Orchidectomy on the left side.
The consent form, signed by the father, contained the phrase: "Bilateral Orchidopexy/Orchidectomy" with a slash (/) between the two terms.
The father claimed he was not informed about Orchidectomy and believed only Orchidopexy was planned.
The consent form was submitted to the Investigating Officer and later reviewed by the Director of Medical and Rural Health Services, Chennai.
No forensic analysis was conducted to determine whether "Orchidectomy" was added in different ink or handwriting.
The histopathology report confirmed the removed tissue was a dysplastic, non-malignant testicle with focal fibrosis.

Procedural History

24.08.2005: Surgical procedure performed.
08.08.2006: FIR No. 1196 of 2006 registered at T-15 SRMC Police Station under Sections 312, 325, 426, 120-B, 406, 465, 468, 471, and 501(1)&(2) IPC.
2007: Charge sheet filed against Dr. Balagopal under Sections 336, 201, 465, and 471 IPC.
2008: Two petitions filed under Section 482 CrPC: one by the complainant seeking a Medical Board, and one by Dr. Balagopal seeking quashing.
19.03.2013: High Court dismissed the quashing petition but ordered constitution of a Medical Board and stayed proceedings pending further investigation.
01.07.2013: Medical Board convened.
29.07.2013: Medical Board submitted report concluding Orchidectomy was medically appropriate and ethical.
24.02.2014: Director of Medical and Rural Health Services opined that consent was obtained in good faith and no interpolation was evident.
2016: Dr. Balagopal filed Crl. O.P. No. 23349 of 2016 seeking quashing of C.C. No. 13 of 2008.
25.09.2023: High Court dismissed the petition, holding the issue of consent required trial.
06.04.2026: Supreme Court heard appeal and delivered judgment.

The Parties' Positions

Appellant (Dr. S. Balagopal): Argued that the consent form was standard, the slash indicated alternative options, and the procedure was medically justified. No evidence of forgery existed. The criminal proceeding was an abuse of process.

Respondent (State of Tamil Nadu): Contended that the complainant denied consent for Orchidectomy, and whether the form was altered was a factual issue requiring trial.

De facto Complainant (Father): Alleged verbal refusal of Orchidectomy and claimed the form was backdated and manipulated to cover negligence.

Relief Sought

Dr. Balagopal sought quashing of C.C. No. 13 of 2008 and all related proceedings, arguing that continuation of the case would constitute abuse of judicial process.

The Legal Issue

The central question was whether the presence of "Orchidectomy" alongside "Orchidopexy" on a printed consent form, separated by a slash, constitutes forgery under Section 465 IPC or whether such a notation, in the context of medical practice and expert opinion, can be reasonably interpreted as an alternative option - thereby rendering criminal proceedings an abuse of process under Section 482 CrPC.

Arguments Presented

For the Appellant

The appellant’s counsel emphasized that the consent form was a standard hospital document listing both procedures with a slash, indicating choice. No forensic evidence showed alteration in ink or handwriting. The Medical Board’s unanimous opinion confirmed Orchidectomy was the appropriate clinical decision for a dysplastic, non-functional testicle. The Director of Medical Services explicitly stated there was no irregularity in the consent form. The complainant’s allegations were purely oral and contradicted by contemporaneous medical records. Quashing was warranted under Section 482 CrPC to prevent abuse of process.

For the Respondent

The State argued that the complainant’s sworn statement denying consent for Orchidectomy created a genuine factual dispute. Whether the term was inserted after the fact was a question of evidence to be resolved at trial. The High Court correctly held that such issues cannot be decided summarily under Section 482 CrPC. The absence of a forensic report did not negate the possibility of tampering.

The Court's Analysis

The Court began by acknowledging the unique position of medical professionals under the Indian Penal Code, particularly Sections 88 and 92, which recognize good faith acts for patient benefit - even without consent. It then referenced Jacob Mathew v. State of Punjab, emphasizing that criminal liability for medical negligence requires gross deviation from professional standards, not mere error.

The Court noted that the dispute was not about negligence but about consent. The Medical Board’s report, comprising specialists in Pathology, Oncology, and Pediatric Surgery, unanimously concluded that Orchidectomy was a medically sound and ethically acceptable procedure for a dysplastic testicle with risk of malignancy. The Director of Medical Services, after reviewing the consent form, found no evidence of forgery.

"A perusal thereof would indicate that in the column where the nature of proposed surgery is to be mentioned, both types of surgery i.e., Orchidopexy and Orchidectomy are mentioned by putting a slash (/), which means that the other surgery, namely, Orchidectomy, was one of the options available."

The Court held that in medical practice, consent forms often list multiple possible procedures with slashes to indicate alternatives. The absence of any forensic report proving interpolation - such as differing ink, handwriting, or physical alteration - was decisive. The complainant’s assertion of verbal refusal was not corroborated by contemporaneous documentation.

The Court further clarified that while Section 482 CrPC generally avoids adjudicating factual disputes, it permits quashing where the proceedings are manifestly abusive or where the allegations, even if accepted, do not constitute an offence. Here, the procedure was justified, the consent form was standard, and no evidence of malice or forgery existed.

"Continuance of criminal proceeding against the appellant would be nothing but abuse of the process of the court and, therefore to secure the ends of justice, the same is liable to be quashed."

The Verdict

The appeal was allowed. The impugned order of the Madras High Court dated 25.09.2023 was set aside. The criminal proceedings in C.C. No. 13 of 2008 before the Judicial Magistrate I, Poonamallee, were quashed. There was no order as to costs.

What This Means For Similar Cases

Practitioners must now argue that standard medical consent forms listing multiple procedures with slashes (/) are not inherently fraudulent.
Absence of forensic evidence of tampering is a decisive factor in Section 482 CrPC quashing applications.
Courts should not treat medical documentation as suspect without objective proof of alteration.

Medical Expert Opinions Carry Weight in Quashing Proceedings

When independent Medical Boards confirm clinical appropriateness, courts must weigh this heavily against uncorroborated oral allegations.
Prosecution of doctors for procedural choices requires more than patient dissatisfaction - it demands evidence of gross negligence or malice.
The Bolam test, though not directly applied, underpins the Court’s deference to professional judgment.

Section 482 CrPC Can Be Used to Curtail Frivolous Medical Prosecutions

This judgment expands the scope of Section 482 CrPC to include cases where the factual basis of the complaint, even if true, does not constitute a criminal offence.
Lawyers should consider Section 482 petitions early in medical malpractice cases where expert reports support the doctor’s conduct.
The burden shifts to the complainant to produce credible, corroborated evidence of forgery or bad faith.

Slash in Medical Consent Form Not Forgery | Section 482 CrPC Quashes Criminal Proceedings : SC