APPEARED AT THE TIME OF ARGUMENTS For the Complainant : Mr. Adnan Irshad, Advocate Mr. Animesh Khanna, Advocate For the Opposite Parties : Mr. Anuj Jain, Advocate Mr. S. K. Tiwary, Advocate with Dr. S. Chumber (OP-2) in person Pronounced on: 5th June 2020 ORDER PER DR. S. M. KANTIKAR, PRESIDING MEMBER Complaint: 1. The complainant, Mrs. Tanveer Jahan, filed this complaint under section 21 of the Consumer Protection Act, 1986 (for short ‘the Act,1986) for the alleged deficiency in service and medical negligence on the part of opposite parties no. 1 to 5, which resulted into injuries and permanent damage to the complainant. The complainant alleged that the present case was a saga of in-despicable devastation inflicted on the complainant and family of the complainant besides the criminal acts of commission and omission of the treating doctors who pushed the patient into the jaws of death. 2. The complainant (for short ‘the patient’) about 35 years of age was suffering from recurring pain in the abdomen for one year in 1997. On 22.04.1998 she got admitted in Surgical Unit II, All India Institute of Medical Sciences (AIIMS) under Dr. S. Chumber the opposite party no. 2 for laparoscopic cholecystectomy surgery fixed on 02.05.1998. She was diagnosed as gall bladder stone. On 01.05.1998, one Dr. Chander Mohan, a duty doctor in the unit demanded Rs. 5000/- from the complainant’s husband towards operation. Also, one Dr. Shiv Shankar, a junior resident persuaded him for the payment. In a bewildered position and keeping in mind the welfare of his wife, he paid Rs. 5,000/- in cash. Both the doctors disclosed that Rs.3,000/- would be paid to the operating doctor and the rest amount of Rs.2,000/- will be divided amongst Dr. Sikha, a Sr. Resident of Unit-II and the staff assisting during surgery. After the said payment Dr. Chander Mohan gave a cyclostyled printed pro-forma of medicines with several tick marks and a prescription to purchase surgical items from the nearby medical store. Accordingly, patient’s husband purchased the items and handed over to Dr. Chander Mohan at 9.00 p.m on the same day. 3. On 02.05.1998 in the morning around 8.00 a.m. the patient was operated and brought in a semiconscious state from the operation theatre. Her pulse was feeble and rate was high. The blood pressure was falling. It was alleged that the patient regained consciousness on the next day i.e. 03.05.1998, but her condition was not satisfactory. However, her husband maintained his calm and followed the instructions of the doctor and the nursing staff by reposing faith on them. The complainant further alleged that on 02.05.1998, in the night at 9.00 p.m. Dr. Shiv Shankar again demanded Rs.5,000/- from the patient’s husband in the name of Dr. S. Chumber, but he declined to pay it, therefore Dr. Chander Mohan and Dr. Shiv Shankar threatened that the patient would be discharged from the hospital and endangering the life of the patient. Her husband sent a detailed complaint to various authorities including the opposite party no. 1 but there was no action. Due to non-payment of money, keeping vengeance the patient was forcibly discharged in precarious condition in early hours at about 7 am 04.05.1998. Though the female attendant, Dr. Vinita, begged with mercy of the doctors but patient was discharged. The abdominal drain tube was removed; the urinary bag which was attached was spared. It was alleged that the doctors at AIIMS were greedy and lure for the money. Their attitude towards the patient was willful callous and apathetic. Thus it was disregard for the human life by the casualness, carelessness and absence of reasonable skill and care. The reasons given in the discharge slip depict a vengeful attitude adopted by Dr. S. Chumber and his team consisting of Dr. Shikha, Dr. Chander Mohan and Dr. Shiv Shankar. The complainant alleged that she was discharged on the advice of Dr. S. Chumber. It was an attempt to cover up for negligence committed by the OP-1. 4. Knowing the untimely discharge of the patient, her brother-in-law Mr. SAS Kirmani and a family friend Dr. Das Gupta, tried to speak Dr. S. Chumber (OP-2) at 10.00 a.m. but Dr.S.Chumber refused to talk with them. Therefore, arrangement for shifting was made but no other hospital was ready to admit the patient in view of post-operative complications. Finally at 12 noon they succeeded in admitting the patient in Sukhda Hospital at Greater Kailash. Immediately, the doctors in Sukhda Hospital initiated life saving measures. The patient was running high fever, shivering with pain followed by uncontrollable vomiting and loose motions. She was transfused four units of blood due to sever loss of blood and to control septic shock. Patient’s condition became critical and as an emergency she was admitted in Sir Ganga Ram Hospital (for short “SRGH”) on 11.05.1998. It was alleged that the condition of patient was due to complications following the surgery at AIIMS. She stayed in SRGH initially for 19 days. She underwent two lifesaving surgeries one on 14.05.1998 and second on 21.05.1998. The 2 -3 liters of collected biliary discharge in abdomen was removed and abdomen was washed. Patient was discharged from SRGH on 29.05.1998 with one drainage tube. About 500 ml biliary discharge daily was seen for about 2 months in the home. The patient once again admitted at SRGH on 27.07.1998 for reconstructive surgery, but after investigations liver abscess of right lobe of liver was diagnosed and it was treated by sophisticated technique and patient was discharged on 01.08.1998. Thereafter, she suffered jaundice on 10.2.1999, and she developed internal fistula therefore reconstructive surgery was deferred and she was instructed for regular check up at the SRGH. The patient remained in bed in despicable and vegetative condition in home. Ultimately she was admitted in SRGH on 09.11.1999 for reconstructive surgery. On 15.11.1999 five hours marathon surgery of Hepaticojejunostomy was performed by Dr. C. S. Rama Chandran and patient was discharged on 30.11.1999. Complaint alleged that due to repeated surgeries she neither could do her regular activities nor do any domestic work. She was bed ridden since the date of admission in AIIMS and till the filing of the present complaint. Her life became miserable. She suffered severe financial constraints due to heavy expenditure on medicines, transportation, consultations etc. Her family became under debts and entire family was thrown into disarray. The complainant stated that her son suffered the sun stroke due to repeated visits to SRGH in the scorching heat of May 1999, which incurred additional cost. 5. According to the complainant, the cause of action first arose when the patient was operated in AIIMS on 02. 05.1998. The second cause of action arose on 04.05.1998 when the patient was forcibly discharged from AIIMS. However, it was a continuous cause of action till 30.11.1999 when she underwent the corrective surgery at SRGH. Being aggrieved, the complainant filed a consumer complaint against the OPs for the loss and injury suffered due to alleged negligent cholecystectomy performed by the OPs. The complainant is seeking total compensation of Rs.37.85 lakh under different heads. Defense: 6. The opposite parties no. 1 and 2 filed their written version and denied all the allegations. Dr. D. K. Sharma, the medical superintendent, OP-1 denied the negligence during treatment at AIIMS. However, costs of consumables used in the procedure are taken from patients admitted to private wards. OPs denied of any money demanded or taken for the procedure. The complaint was filed with mala fide intention and willfully. The opposite parties have treated the patient with the skill and as per standard of practice. The patient did not suffer any injury which either for caused permanent damage or put the patient’s life at risks. The patient was earlier seen by some other surgeon but the patient’s attendants were not satisfied and they wanted the OP-2 Dr. Chumbar should operate upon her. Thus, some problem of patient with earlier surgeon also cannot be ruled out. She was diagnosed as a case of gallstones. The patient was brought by Dr. Maya, the Additional Prof. of Anaesthesia to OP- 2, Dr. S. Chumber, in the surgical OPD, who was aware of the procedural aspects at AIIMS. The patient was accommodated early for admission, as she had some impending commitments; though there was a waiting period for 9 to 12 months for such operations. 7. Dr. S. Chumber, was in-charge/Head of surgical unit-II, had performed more than 670 laparoscopic cholecystectomies from July 1994. OPs denied the allegation of Rs. 5,000/- having been demanded or paid to any doctor. On getting information of such allegations, the OP-2 investigated the matter, but nothing was found. Even, the patient was known to Dr. Maya, but nothing was informed either to Dr.Maya or any authority at AIIMS. 8. On 02.05.1998, OP-2 performed laparoscopic cholecystectomy in the morning and the patient was shifted in the recovery area. The recovery room was manned by several anesthetists, other doctors and nurses. The patient shifted to the concerned ward after regaining adequate consciousness. Patient’s blood pressure and pulse rate was normal and she was not in the state of shock as alleged. According to the anesthetist at 12.45 PM the patient was conscious. There was no pain, pulse rate was 80 per minute and blood pressure was normal. The post-operative recovery/progress was satisfactory-uneventful. On 03.05.1998 the patient was reviewed during rounds by OP-2 and the doctors in surgical unit II. She was recovered well after the operation. Again in the morning on 04.05.1998, the patient was reviewed. The bile stained abdominal discharge was reduced to a minimal and no bile was present. Therefore, as a standard surgical practice the drain left in sub-hepatic area was removed. Her progress was satisfactory; therefore it was decided to discharge her. Before discharging the patient, there was discussion on several aspects of treatment and post-operative care. During operative procedure, OP-2 noted the chole-cysto-hepatic duct in biliary anatomy, therefore, for an academic purpose to determine the entire biliary tract, it was advised to take a date for HIDA scan, it was OPD procedure. The opposite party denied that the condition of the patient was precarious at the time of discharge. 9. The OP-2 further stated that he was informed by the senior resident about the patient’s attendants who were repeatedly misbehaving with the duty staff. On 03.05.1998, night, the patient’s husband and few other people without permission were going through case paper and the operation record. It was objected by the doctor on duty, but patient’s husband abused the doctors and threatened them of dire consequences. The OP-2 on seeing the recovery and fit condition of patient on 03rd and 4th May 1998, took a decision to discharge her. It has nothing to do with the misbehavior of the attendants. However, OP- 2 directed the senior resident to record in the case sheet/ in the discharge summary about all the events that happened. 10. OP-2 further stated that the patient’s attendants were bringing their own experts to see the case-sheet or monitor the treatment plans. Thus, such interference may result in a conflict of treatment plans, which generally discouraged by the treating doctors at AIIMS. At one occasion, the patient’s brother accompanied by one Dr. Jain intervened and threatened the entire unit, with dire consequences if the patient is discharged. The complainant because of early discharge from AIIMS, built entire story of bribe. The patient’s relatives wanted hospital stay till the removal of the sutures, at least for a week to 10 days. Laparoscopic Cholecystectomy is a Day-Care procedure in AIIMS and in several centers. The OP- 2 denied that there was unusual or excess blood loss due to slipped ligature from cystic artery. The OT records are well maintained and without contradiction. The OP- 2 further submitted that the medical record from Sukhda Hospital were not convincing as alleged. As per the 1st ultrasound (USG) done at SRGH on 11.05.1998 the Common Bile Duct (CBD), Cystic duct (CD) and portal vein were within normal limits. Similar findings were noted in USG performed on 30.07.1998 subsequently. Therefore, the USG findings on both the occasion confirm that the laparoscopic cholecystectomy was uneventful and there was no biliary injury. Therefore, the patient’s allegation of injury to bile duct is not sustainable. Arguments: 11. The learned counsel on both the sides has argued vehemently. They have reiterated the facts and submissions made in their respective affidavits of evidence. The OP-2 Dr. S. Chumbar was also present during arguments. Discussion/Findings: 12. The question before us is whether there was any deficiency in service or any negligence during the treatment of patient at AIIMS. According to the complainant, it was a simple operation of removal of gall stones with gall bladder (cholecystectomy), but the OP-2 Dr. S. Chumbar performed laparoscopic cholecystectomy operation negligently on 02.05.1998 and prematurely discharged the patient on 04.05.1998 which resulted into further complications and sufferings to the patient. Thus, the patient underwent number of corrective surgeries. She suffered heavy expenditure and lost mental peace of her family. 13. Let us go through the treatment record of AIIMS. The patient was admitted in AIIMS on 22/04/1998 with the complaints of pain in right hypochondriun for one year and pain in right loin region for 8 months. After relevant investigations diagnosed as Gall Stones disease. After pre anesthetic checkup and informed consent; OP-2 performed the laparoscopic cholecystectomy on 02.05.1998 and the patient was discharged on 04.05.1998 after the clinical discussion. The handwritten Discharge summery and the daily clinical notes showed: 2/5/98-E Lap chole Patient conciuos , but drowsy No pain,No nausea or vomitting Not passed urine, has the urge PR: 90/m BP: 120/80 Per Abdomen (P/A) – soft Mild tender(ness) present Bowel Sounds (B/S) present Intake / T Output = 900 Drain: 20 ml Signed. 3/5/98-M Same findings Xxxx Intake /Output = 2160/1050 Drain –Nil Yesterday drain – 30 ml 3/5/98-E Patient General Condition – Fair No fresh complaints Passed flatus, not passed stools PR: 88/mt BP: 110/76 m (?) H/L – NAD No jaundice Per Abdomen (P/A) – soft Mild tender(ness) present Bowel Sounds (B/S) present Intake / T Output = 1 unit dextrose + oral/Urine output Adequate Advised to stop IV (intravenous) fluids Full oral intake (liquids + semisolids) Signed/- Thus is clear that on 03.05.1998 post operatively on day 1 (POD-1) patient was allowed to take Orally liquids and semisolids. 4/5/98 8.00 AM General Condition (GC) fair No fresh complaints Orally taking adequate fluids Urine output adequate Passing flatus Pulse Rate – 80/min Blood Pressure – 120/70 m (?) H/C – NAD Per Abdomen (P/A) – soft No tender(ness) present Bowel Sounds (B/S) present Drain 10 ml, serosanguinous, overnight Signed/- 14. It was clear that on 04.05.1998 at 8.00 a.m., the condition of patient was fair. No fresh complaints. The patient was taking adequate fluids, passing flatus, pulse rate was 80/mm, blood pressure was 120/70, abdomen was soft and no tenderness. The bowel sounds (B/S) was present. It was recorded that 10 ml of serosanguinous discharge noted during overnight period, therefore at 9.00 a.m., the drain was removed as advised by Dr. S. Chumber. In view of accessary cystic duct from the bed of liver noted during surgery, a date for HIDA scan was taken. 15. We further note that, in the same progress sheet, it was recorded by the senior resident Dr. Sikha Gupta, that patient’s attendants were constantly quarrel in the ward, examining the documents and accused the doctor on duty for taking money. During the morning rounds it was decided to discharge the patient immediately on a short of Discharge slip. At the time of discharge, Patient’s vitals (signs) were stable and the patient was taking orally and passing stools normally. Her drainage tube was also taken out. 16. It is pertinent to note the operative findings recorded by Dr.Chumbar with a diagram as : Gall bladder enlarged, full of stones- cystic duct and artery (N) Accessary duct present at bed of liver which was clipped and divided. Drainage tube kept in the subhepatic space. In our view the OP-2 performed the laparoscopic cholecystectomy procedure with due skill and in careful manner, without injury to the main branches of the biliary tree, including the common bile duct, common hepatic duct, or right and left hepatic ducts. Thus, although a patient may have suffered complications of an unexpected injury, it does not necessarily mean that a treating surgeon was negligent. An injured patient may automatically assume and allege that the doctor failed to satisfy the standard of care. 17. The concept of medical negligence has been discussed in various judgments of Hon’ble Supreme Court and this commission. We would like to quote the noted paragraphs from the Hon’ble Supreme Court’s judgment in the case of Kusum Sharma & Others vs Batra Hospital & Medical Research Centre and others, (2010) 3 SCC 480. The court observed that: 50. Medical science has conferred great benefits on mankind, but these benefits are attended by considerable risks. Every surgical operation is attended by risks. We cannot take the 25benefits without taking risks. Every advancement in technique is also attended by risks. 51. In Roe and Woolley v. Minister of Health (1954) 2 QB 66, Lord Justice Denning said : It is so easy to be wise after the event and to condemn as negligence that which was only a misadventure. We ought to be on our guard against it, especially in cases against hospitals and doctors. Medical science has conferred great benefits on mankind but these benefits are attended by unavoidable risks. Every surgical operation is attended by risks. We cannot take the benefits without taking the risks. Every advance in technique is also attended by risks. Doctors, like the rest of us, have to learn by experience; and experience often teaches in a hard way." It further observed that: 72. The degree of skill and care required by a medical practitioner is so stated in Halsbury's Laws of England (Fourth Edition, Vol.30, Para 35):- 36 "The practitioner must bring to his task a reasonable degree of skill and knowledge, and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence, judged in the light of the particular circumstances of each case, is what the law requires, and a person is not liable in negligence because someone else of greater skill and knowledge would have prescribed different treatment or operated in a different way; nor is he guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art, even though a body of adverse opinion also existed among medical men. Deviation from normal practice is not necessarily evidence of negligence. To establish liability on that basis it must be shown (1) that there is a usual and normal practice; (2) that the defendant has not adopted it; and (3) that the course in fact adopted is one no professional man of ordinary skill would have taken had he been acting with ordinary care." 73. In Hucks v. Cole & Anr. (1968) 118 New LJ 469, Lord Denning speaking for the court observed as under:- "a medical practitioner was not to be held liable simply because things went wrong from mischance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference of another. A medical practitioner would be liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field." 81. It is a matter of common knowledge that after happening of some unfortunate event, there is a marked tendency to look for a human factor to blame for an untoward event, a tendency which is closely linked with the desire to punish. Things have gone wrong and, therefore, somebody must be found to answer for it. A professional deserves total protection. The Indian Penal Code has taken care to ensure that people who act in good faith should not be punished. Sections 88, 92 and 370 of the Indian Penal Code give adequate protection to the professional and particularly medical professionals 18. In the case - Achutrao Haribhau Khodwa and others versus State of Maharashtra and others (1996) 2 SCC 634, the Hon’ble Supreme Court held as below: “The skill of medical practitioners differs from doctor to doctor. The very nature of the profession is such that there may be more than one course of treatment which may be advisable for treating a patient. Courts would indeed be slow in attributing negligence on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution. Medical opinion may differ with regard to the course of action to be taken by a doctor treating a patient, but as long as a doctor acts in a manner which is acceptable to the medical profession, and the Court finds that he has attended on the patient with due care skill and diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold the doctor to be guilty of negligence.” 19. In the instant case, admittedly the AIIMS is one of the premier institute in India. Dr.S.Chumbar (OP-2) has vast experience of doing laparoscopic surgeries. The entire medical record is maintained properly the every details of the treatment. We are unable to find out any procedural shortcomings or deficiency for OP-2 or the team of doctors in his surgical unit 2. Post operatively the patient was monitored properly. Generally, the laparoscopic cholecystectomy is a day care procedure and patient may be discharged after a day or two. According to the discharge slip, the patient was discharged after proper review, there was no biliary discharge and the condition of patient was satisfactory. Though the patient got treated in Sukhda Hospital (04.05.1998 to 11.05.1998) and in SRGH (11.05.1998 to 29.05.1998). The complainant failed to produce entire treatment (medical) record from both the hospitals. Therefore, without entire medical record it is difficult to conclusively establish medical negligence caused during the 1st surgery at AIIMS done by OP-2. 20. We further note from the available medical that: The complainant produced discharge summery of Sukhda Hospital only. It is pertinent to note that the patient was in Sukhda Hospital for 7 days, she was given IV fluids and antibiotics. Nothing is forthcoming about the efforts if any made for removal of alleged abdominal fluid collection. Patient was shifted to SRGH on 11.05.1998 with a diagnosis of “post lap. Cholecystectomy CBD injury with biliary peritonitis with septic shock”. However, the USG conducted by qualified radiologist at SRGH (on 11.05.1998 and 30.07.1998) did not report any dilatation of intra hepatic biliary radicals. The Common duct and portal vein were within normal limits. Thus, it confirms that there was no biliary injury (BDI) as alleged.
21. This commission vide order dated 01.09.2011 sought an opinion from the expert committee constituted by DGHS. We have perused the opinion dated 4.11.2011 issued by the Department of Surgery, Dr. Ram Mahohar Lohiya Hospital (RML), New Delhi. The conclusion is reproduced as below: CONCLUSION: The Committee reached the following conclusion. The CBD injury found by the surgeon at Sir Ganga Ram Hospital in this case could have been caused during laparoscopic cholecystectomy operation performed at AIIMS. We here specifically note that, the expert committee opined without any medical record either from Sukhda Hospital or SRGH. It expressed the probability. Expert committee did not mention whether there was any fault or short comings in the laparoscopic surgery, or the treatment (pre or post-operative care) given at AIIMS. plaintiff claimed the doctor treating him was negligent in using a needle which was unsuitable. Lord President Clyde at p.217 stated: To succeed in an action based on negligence, whether against a doctor or anyone else, it is of course necessary to establish a breach of that duty to take care which the law requires, and the degree of want of care which constitutes negligence must vary with circumstances… But where the conduct of a doctor, or indeed of any professional man, is concerned, the circumstances are not so precise and clear as in the normal case. In the realm of diagnosis and treatment there is 22. A doctor cannot be accused of medical negligence unless it is substantiated with the opinion of medical experts, the Supreme Court has said. A bench of Justices Mr. Abhay Manohar Sapre and Mr. Vineet Saran also said that there has to be “a direct nexus” between sufferings of a patient and the medical aid that she has received, to sue the doctor. “Suffering from ailment by the patient after surge”. The court said the complainant had failed to prove that her sufferings were results of improper performance of conventional surgery by the doctor and that if the surgery had been successful, she would not have suffered any kind of these ailments. It also noted the doctor had taken consent from her husband when he found that the open surgery had to be performed during her operation. 23. Regarding the Bile Duct Injuries (BDI) we have gone through the standard book A companion to a Specialist Surgical Practice: Hepato-biliary and Pancreatic Surgery ( 6th edition) by Rowan W. Parks. It was stated that in the majority of the patients, with a BDI will present within the first few weeks following LC. The main symptoms will be fever, pain, and mild hyperbilirubinemia (2.5 mg/dL) from biloma or bile peritonitis. Usually, bile will be observed leaking externally from a drain or surgical incision. In the case of injuries involving occlusion of the common hepatic or bile duct without an intra-peritoneal bile leak, the main symptoms will be jaundice with or without abdominal pain The intraoperative problems have been related to three main causes 1)Dangerous surgical technique,2)dangerous anatomy and 3)dangerous pathology ( Johnston,1986), Insufficient preoperative assessment of complicated situation is another avoidable reason for intraoperative difficulties. Dangerous technique arises from inadequate or imprecise application of the principles of cholecystectomy, insufficient experience, and inadequate incision. Some of the anatomic variations are particularly a dangerous; especially narrow CBD is mistaken for cystic duct. Dangerous pathology includes chronic or acute inflammation that results in obscured anatomy and increased vascularity in the Callot’s triangle, and associated portal hypertension which makes dissection haemorrhagic and dangerous. Dangerous anatomy: It is important for surgeons to have a thorough understanding of anatomy in every single operation that is performed and in the biliary tract, such knowledge becomes even more emphatic. It would be ideal to have pre-operative knowledge of the anatomy. The incidence of anatomical abnormalities in the extra-hepatic biliary tree is noted be between 30-40%. To assess the anatomy before operation, one would require a magnetic resonance choledochogram (MRCP). This is not a practical solution in any situation, and not necessary. Intra-operative cholangiography is appropriate and is practiced either selectively or in all cases. Although some authors mention that surgeons should be aware of all possible anatomical variations, we feel it may not be completely true. This is amply demonstrated a published case series of IBDI, where most injuries occurred when the anatomy of the biliary tree was considered to be normal [5]. The principles to follow are staying close to the gall bladder during dissection and not dividing any structure until identified. Dangerous pathology: This is important particularly when operating on patients with a history of acute or chronic inflammation of the GB. This could result in fore- shortening of the cystic duct and difficult dissection in Calot's triangle. Such a situation should be recognized early and converted to open surgery if needed. Dangerous pathology is probably the only instance where the surgeon may be excused for causing IBDI. Dangerous surgery (or surgeon): Several factors may be contributory; commencing from access (whether open or Veress needle), quality of the instruments (electrical injury), and the skill of the surgeon - all are of equal importance. Supervised training, in a systematic manner, would be most important to minimize such complications. 24. However, in the instant case to three main causes are not visible. The OP-2 was an experienced surgeon in AIIMS faculty. The laparoscopic procedure was neither dangerous surgical technique nor there was dangerous anatomy and dangerous pathology. The surgical procedure and post-operative period was uneventful. Thus, the complainant failed to prove negligence on the part of AIIMS or the treating doctors. The patient was discharged from AIIMS at proper time in good condition after confirming no biliary discharge; it was not an intentional discharge, though there was an unwanted interference from the patient’s attendants during the treatment was evident in this case. 25. Based on the foregoing discussion, in the given facts and the entire evidence adduced before us, it is not feasible to attribute negligence / deficiency on the OP hospital and doctors, it is difficult to conclusively establish medical negligence / deficiency on the OP hospital and doctors. 26. The complaint is dismissed. | 
