Supreme Court Declines to Cancel Bail of Cardiologist Accused in PMJAY Angioplasty Case

Case : 

The Supreme Court’s refusal to cancel the Gujarat High Court’s order granting regular bail to a cardiologist accused of performing allegedly unnecessary angioplasties under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY), in a series of cases that resulted in two deaths, reiterates the Apex court’s stand on issues regading medical negligence. 

According to the prosecution, a free screening camp organised in Borisana village resulted in 19 villagers being transported to a private hospital. All underwent coronary angiography, seven underwent angioplasty with stent placement, and two patients died shortly thereafter. Police records allege lack of clinical indication in certain cases, defective or coerced consent, inadequate post-procedural care, and financial gain through inflated PMJAY claims based on overstated arterial disease. 

The bench acknowledged the seriousness of the allegations, which include loss of life, alleged misrepresentation of diagnostic findings to obtain government reimbursement, and absence of informed consent. However, it declined to interfere with the bail order, noting the period of custody already undergone, completion of investigation, and the absence of circumstances justifying continued incarceration. The doctor was permitted to continue practice under supervision. 

From clinical judgment to criminal allegation: 

For doctors, the case illustrates how routine interventional decisions can shift from the civil domain of medical negligence into criminal proceedings once allegations move beyond error of judgment and into fraud or mala fide intent. 

Insurance Linked Incentives and Anti Fraud Oversight: 

PMJAY reimburses empanelled hospitals through fixed packages for high-value procedures such as angioplasty. Parliamentary disclosures and operational guidelines emphasise a zero-tolerance approach to fraud, enforced through de-empanelment, recovery of claims, and criminal referral. National and state anti-fraud units actively monitor utilisation patterns. In this case, authorities suspected that outreach camps were used to channel patients towards invasive procedures primarily to trigger insurance reimbursement. 

Erosion of Informed Consent Practices: 

Indian law is unequivocal that consent for major diagnostic and therapeutic procedures must be specific, informed, voluntary, and contemporaneous. Admission-time or blanket consent has no legal validity. In Samira Kohli v. Dr Prabha Manchanda, the Supreme Court held that performing an unconsented procedure constitutes assault and deficiency in service, regardless of clinical benefit. Allegations that patients were persuaded through fear or misinformation point to systemic consent failures rather than isolated documentation errors. 

Absence of Robust Appropriate-Use Oversight: 

Indian studies applying appropriate-use criteria to coronary interventions have consistently identified a proportion of procedures as inappropriate or of uncertain benefit. In the absence of strong institutional peer review, audit mechanisms, and mortality review processes, commercial and administrative pressures may influence clinical decisions, particularly where patients are socio-economically vulnerable and dependent on public insurance schemes. 

These factors collectively created the conditions in which allegations of fraud and gross negligence emerged following adverse outcomes. 

The legal story till date: 

Supreme Court (February 2026) 

The Supreme Court’s order was limited to the question of bail. It recorded prolonged custody since November 2024, completion of investigation, and absence of supervening circumstances warranting cancellation of bail. Reiterating settled principles, the Court emphasised that bail is not punitive and that continued incarceration of professionals pending trial must remain an exception. 

Gujarat High Court Trajectory 

In May 2025, bail was denied after the High Court recorded prima facie observations suggesting systematic exploitation of PMJAY rather than mere medical negligence. Following substantial custody and completion of investigation, regular bail was granted in December 2025, subject to conditions. 

Liability Remains a Trial Issue 

Substantive culpability will be determined at trial. In Jacob Mathew v. State of Punjab, the Supreme Court restricted criminal liability against doctors to cases of gross negligence or recklessness and cautioned against routine arrests without credible medical opinion. That protection does not extend to allegations of deliberate misrepresentation, coercion, or financial fraud. 

Exposure beyond the operating surgeon 

Liability, if established, may not be confined to the individual cardiologist. Hospital management, administrators, personnel involved in organising screening camps, staff processing PMJAY claims, and any individual misrepresenting clinical findings may face exposure. Charges under the Bharatiya Nyaya Sanhita relating to cheating, fraud, conspiracy, or culpable homicide carry serious penal consequences. De-empanelment and financial recovery are likely collateral outcomes. 

Medico-legal issues surrounding the issue: 

Informed Consent 
Consent must be obtained by the operating clinician, documented in the patient’s language, and must include risks, benefits, alternatives, and costs. Emergency exceptions are narrow. Anything less is legally indefensible. 

Negligence and Fraud 
Ordinary negligence attracts civil liability. Gross negligence and recklessness invite criminal scrutiny. Allegations involving coercion, falsification, or financial motive cross decisively into fraud. 

Government Scheme Compliance 
Doctors in empanelled hospitals must understand claim protocols, resist volume-driven administrative pressure, and flag irregularities. Anti-fraud frameworks operate independently of professional hierarchy. 

Takeaways from the issue: 

The Supreme Court’s order neither dilutes accountability nor vindicates the accused. It underscores a more uncomfortable reality: ethical indication, robust consent, and institutional oversight are no longer matters of professional virtue alone. They have become elements of criminal risk management within publicly funded, insurance-driven healthcare systems. 

The law will pursue fraud and gross misconduct. It will also protect professional liberty until guilt is established. Practising within this balance is now an unavoidable part of medical practice in India.