Background: Iatrogenic fentanyl overdose highlights the critical need for meticulous oversight in medication administration. The principle of vicarious liability in healthcare amplifies institutional accountability, particularly in cases alleging criminal negligence resulting in patient deaths. Recent Indian criminal laws, including the Bharatiya Nyaya Sanhita (BNS), Bharatiya Nagarik Suraksha Sanhita (BNSS), and Bharatiya Sakshya Adhiniyam (BSA), have introduced frameworks that influence these liability considerations. Objective: To analyze the legal and medical aspects of fentanyl poisoning under the lens of vicarious liability, using the reported case as a focal point, and propose preventative measures to mitigate such incidents. Methods: A detailed case analysis was conducted alongside a review of legislative changes and best practices for medication safety. The study integrates statistical trends and judicial outcomes to formulate actionable recommendations. Results: The malpractice lawsuit underscores systemic issues, including delayed care, excessive medication dosages, and procedural lapses. While judicial outcomes favored good faith protections, the case underscores the importance of institutional vigilance. Conclusion: Strengthening institutional protocols, legislative clarity, and professional training are vital to prevent medication-related iatrogenic injuries and to balance accountability with fair treatment in healthcare.