1. This is a Complaint by the son of Late Mr. Arun Kumar Mahajan, alleging that the Opposite Party No.-4, Dr. Praveen Kumar Bansal who is an Oncologist in the Opposite Party No.-1 Asian Institute of Medical Sciences (AIMS), Faridabad has committed negligence by not treating his late father according to settled medical protocols that is expected from a medical doctor for Myasthenia Gravis and he did not refer the patient to a Neurologist inspite of the fact that the disease is a Neurological disease. The contention is that Opposite Party No.-4 took this decision after almost the disease persisted for 4 months by referring the patient to Opposite Party No.-4, Dr. Sushma Sharma in the same hospital and later on to Dr. Najeeb-ur-Rehman, Oppsoite Party No.-3, both of whom are Neurologists. This reference was made with a diagnosis of Myasthenia Crisis. The contention is that no treatment was given for Myasthenia at any stage and therefore the Opposite parties allowed this situation to aggravate the cause of their negligence that ultimately led to the death of the patient on 22.09.2013.
2. Learned Counsel for the Complainant explained that this dis-order of Myasthenia relates to narrowing of the food pipe which gets constricted on account of various factors resulting in difficulties in swallowing of food in any form and which also results in the weakening of muscles consequently leading to other complications and if not attended to appropriately the same transforms into the crisis that can result in death.
3. Learned Counsel submits that the patient was a known case of Myasthenia for the past 10 years before his death and he was receiving treatment intermittently from the All India Institute of Medical Sciences (AIIMS). It is stated that the patient for the first time approached the Opposite party No.-1 Hospital and he was examined on 01.03.2013 by Dr. Praveen Bansal who is an Oncologist. The fact that the patient was a known case of Myasthenia Gravis has been noted in the history that was recorded at the time of his examination whereupon certain tests were advised and he was admitted and treated for the same. He was discharged and then on not having satisfactorily recovered he again visited the hospital and was again admitted on 27.06.2013. Learned Counsel submits that the patient was admitted with complaints of fever, cough and on and off difficulty in breathing and was managed and then discharged mentioning the treatment advised. The discharge summary dated 01.07.2013 is extracted herein under:

DEPARTMENT OF MEDICAL ONCOLOGY

DISCHARGE SUMMARY

DIAGNOSIS:

MYASTHENIA GRAVIS/DIABETES MELLITUS TYPE-II

HISTORY OF PRESENT ILLNESS & HOSPITAL COURSE:

Patient is a known case of myasthenia gravis having hypoplastic anemia. Patient on cyclosporine and prednisolone. Patient is a known case of CAD and type 2 diabetes mellitus on medications. This time patient admitted with complaints of fever with chills cough on and off, difficulty in breathing. Patient was admitted and managed in IMC with I/V antibiotic and supportive care was given. Patient was shifted to ward on 28/06/13. Patient managed supportively with I/V fluids and other supportive give. Now the patient is stable and being discharged with following advice.

CONDITION ON DISCHARGE: Stable

DISCHARGE ADVICE:             

Inj. Insulin as per sliding scale (HIR) plain

DEPARTMENT OF MEDICAL ONCOLOGY

DISCHARGE SUMMARY

PREVENTIVE STRATEGIES:

DIET

• Hygienic homemade cooked food allowed
• Avoid raw vegetable salads, fruits
• Packed fruit juices allowed
• Use Packed/Filtered/Boiled water
• Plenty of oral fluids

NEXT APPOINTMENT:

Review in Medical Oncology OPD on 08/07/2013

In case of any medical emergency come to Asian Institute of Medical Sciences Sec-21A, FBD, Badkal Flyover, Faridabad or may call at 0129/425300 or 105758

4. The patient again developed problems and he was again admitted on 21.07.2013 in the hospital and was discharged on 30.07.2013. The advice tendered and the diagnosis is contained in the Discharge summary dated 30.07.2013 which is extracted herein under:

DEPARTMENT OF MEDICAL ONCOLOGY

DISCHARGE SUMMARY

DIAGNOSIS:

MYASTHENIA GRAVIS/DIABETES MELLITUS TYPE-II

HISTORY OF PRESENT ILLNESS & HOSPITAL COURSE:

Patient is a known case of myasthenia gravis having hypoplastic anemia. Patient on cyclosporine and prednisolone. Patient is a known case of CAD and type 2 diabetes mellitus on medications. This time patient admitted with complaints of fever with chills cough on and off, difficulty in breathing. Patient was admitted and managed in IMC with I/V antibiotic and supportive care was given. Patient was shifted to ward on 28/06/13. Patient managed supportively with I/V fluids and other supportive give. Now the patient is stable and being discharged with following advice.

CONDITION ON DISCHARGE: Stable

DISCHARGE ADVICE:

Inj. Insulin as per sliding scale (HIR) plain

DEPARTMENT OF MEDICAL ONCOLOGY

DISCHARGE SUMMARY

PREVENTIVE STRATEGIES:

DIET

• Hygienic homemade cooked food allowed
• Avoid raw vegetable salads, fruits
• Packed fruit juices allowed
• Use Packed/Filtered/Boiled water
• Plenty of oral fluids

NEXT APPOINTMENT:

Review in Medical Oncology OPD on 08/07/2013

In case of any medical emergency come to Asian Institute of Medical Sciences Sec-21A, FBD, Badkal Flyover, Faridabad or may call at 0129/425300 or 105758

5. This second treatment is also by Dr. Bansal of the Oncology Department.
6. The third time the patient again found himself to be uncomfortable with no expected recovery and came to be admitted in the same hospital under Dr. Bansal on 07.08.2013. During treatment he was also reviewed by a Nephrologist as is recorded in the Discharge Summary dated 16.08.2013 which is extracted herein under:

DEPARTMENT OF MEDICAL ONCOLOGY

DISCHARGE SUMMARY

DIAGNOSIS:

MYASTHENIA GRAVIS/HYPOPLASTIC ANEMIA/DIABETES MELLITUS TYPE-II

HISTORY OF PRESENT ILLNESS & HOSPITAL COURSE:

Patient is a known case of myasthenia gravis having hypoplastic anemia. Patient on cyclosporine and prednisolone. Patient is a known case of CAD and type 2 diabetes mellitus on medications. CT chest was done and suggestive of small anterior mediastinal mass with bilateral bronchiolitis involving mid and lower zone of lung. Patient presented to us with complaints of cough. On investigation found to have hyperkalemia. Patient admitted and shifted to ICU. Patient managed conservatively with broad spectrum, I/V antibiotics, I/V antifungal, Nebulization and other supportive care with correction of hyperkalemia. He was also reviewed by Nephrologists. Patient improved and shifted to ward. Patient managed symptomatically in ward. Now patient is stable and discharged with following advice.

CONDITION ON DISCHARGE: Stable

DISCHARGE ADVICE:

DEPARTMENT OF MEDICAL ONCOLOGY

DISCHARGE SUMMARY

Check RBC thrice a day before meals

Inj. Insulin as per sliding scale (HIR) plain

Inj. Insulin RBS 150 no Insuline

151 to 200 = 4 units

201 to 250 = 6 units

251 to 300 = 8 units

301 to 350 = 10 units

351 to 400 = 12 units

401 to 450 = 16 units

>450 inform doctor.

PREVENTIVE STRATEGIES:

DIET:

• Hygienic, homemade cooked food allowed
• Avoid raw vegetable salads, fruits
• Packed fruit juices allowed
• Use Packed/Filtered/Boiled water
• Plenty of oral fluids

NEXT APPOINTMENT:

Review in Medical Oncology OPD on 23/08/13 (Friday)

In case of any medical emergency come to Asian Institute of Medical Sciences Sec-21A, FBD, Badkal Flyover, Faridabad or may call at 0129/425300 or 105758

7. According to the Complainant the condition of the patient did not improve and he was again admitted in the hospital on 27.08.2013 and it is for the first time that the Complainant was diagnosed with acute Myasthenia Crisis. On such identification he was transferred to the Neurological Department under Opposite Party No.-5 Dr. Sushma Sharma. This is evident from the Admission Sheet dated 27.08.2013 which is on record.
8. Looking to his conditions he was shifted to the ICU for which a consent was taken by the Complainant and the said consent form dated 27.08.2013 is on record. Another Consent was taken for surgical process which was to be carried out duly signed by the Complainant who was attending to his father.
9. According to the learned Counsel the Complainant was advised to be administered Mestinon 60mg 6 times a day every four hourly on 27.08.2013 itself. The notesheets thereafter indicate that he was clinically stable and was being attended by two doctors and was conscious and oriented on 28.08.2013. He was advised fluid diets oral semi solid forms that are evident from the note sheets and was continued under treatment of the Neurological Department of the Hospital by Dr. Sushma Sharma and subsequently by Dr. Najeeb-ur-Rehman.
10.  In order to facilitate his intake an advise was rendered on 13.09.2013 that the patient needed assisted feeding and regular Physiotherapy and further advise was given to remove the ryle tubes that has been inserted earlier.
11. Learned Counsel for the Complainant submits that there are some unexplained notings particularly on 17.09.2013 when Dr. Najeeb-Ur-Rehman took over where the progress sheets record that the patient was advised for ryles tube which was refused. Learned Counsel submits that there was no question of any refusal or otherwise nor there was any consent indicated on the sheet about the refusal for continuance of the ryles tube. This is again repeated on 18.09.2013 and the learned Counsel submits that this was an absolutely unwarranted endorsement for which there is no explanation by the Opposite Parties. On 20.09.2013 the patient was found to be conscious and oriented with high fever. But the breathlessness increased on 21.09.2013 when he was advised for oxygen inhalation and to be shifted to the ICU for further management.
12. The contention therefore is that the patient entered into this crisis because of no treatment of Myasthenia having been administered right from March, 2013 onwards. The submission is that Dr. Bansal never paid attention to this or diagnosed the apprehension of the crisis in which the disease transformed during the entire process. The contention is that had the patient been treated for Myasthenia Gravis the same would not have resulted into Myasthenia Crisis.
13. It is then pointed out that on 22.09.2013 the patient suffered further distress and was put on ventilator and he was also advised strangely enough for stopping from feeding by ryles tube. Learned Counsel submits that when Ryles Tube had already been removed and that its re-introduction had been refused, it is not understood as to why this instruction to stop feeding through ryles tube was given on 22.09.2013. Such notings therefore casts doubt as neither the Complainant nor his father had given instructions for removing ryles tubes.
14.  Learned Counsel therefore crystalised his submission with a five-fold argument, firstly that no proper diagnosis was made by Dr. Bansal who was an Oncologist and he failed to refer the patient to a Neurologist. The second argument is that even the consents which were taken for surgery and for putting the patient on ventilator were all paper transactions and hence the same was not an appropriate informed consent. It is further submitted that it is a fact that the Opposite parties did not treat the patient for Myasthenia Gravis and for this he submits that the Opposite Parties themselves in the Written Version in Paragraph No.-6 have stated that the patient had a Neurological disease for which he was already been treated by experts at the All India Institute of Medical Sciences (AIIMS) and he did not wish any consultation or treatment by the Neurologists at Opposite Party No.-1 Hospital. Learned Counsel submits that it stands established that the Opposite Parties did not treat the patient with any medicines that ought to have been administered and which would suggest treatment of Myasthenia Gravis. The contention is that this treatment was never carried out by Dr. Bansal is now evident from Paragraph No.-8 of the Written Version.
15. It is his submission that this converted into a crisis because of this negligence that aggravated in its form resulting in the death of the patient.
16. The other contentions are about the in-appropriate notings regarding the ryles tube which casts a serious doubt on the management of the patient and also incorrect endorsements as noted above.
17. He then submitted that Dr. Bansal was an Oncologist and on the subsequent admission the patient was also referred to a Cardiologist and then to a Nephrologist between 01.03.2013 and 27.08.2013. During this period no reference was made to the Neurologist and it is for the first time that when the condition of the patient deteriorated that on 27.08.2013 he was referred to a Neurologist namely Dr. Sushma Sharma and then taken care of by Dr. Najeeb-Ur-Rehman. The essence of the argument is had the Complainant being treated for Myasthenia Gravis he would not have entered the crisis and this was not only on account of the negligence of an incorrect line of treatment adopted by the doctors and the hospital.
18. Learned Counsel has stated that this stands confirmed with the death summary issued by the hospital which is extracted herein under:

DEPARTMENT OF NEUROLOGY

DEATH SUMMARY

DIAGNOSIS:

PNEUMONIA WITH ARDS

SEPTIC SHOCK WITH MOF

MYASTHENIC CRISIS

THYMOMA

DIABETES MELLITUS TYPE-II

CAS (POST CABG)

BRIEF HISTORY OF ILLNESS & HOSPITAL COURSE:

Patient 60 years old male came to AIIMS with complaints of cough with loss of appetite a known case of myasthenia gravis dyselectrolytemia/ diabetes mellitus type-II, 2 Post CABG was admitted and fully analysed. On examination Bp-120/80mmHg, Oxygen saturation-93°/min. On R.A chest bilateral cristes present, PA soft. On investigations inwere send ABG suggestive of metabolic acidosis, blood reports showed of hyperkalemia increased blood sugar. TLC was raised. Urine R/E suggestive of leucocytosis and hypernatremia. Patient CECT was done suggestive of thymoma. Patient was intubated in view of breathing difficulty. In view of long requirement of ventilation patient was tracheostomized. Later patient shifted to ward where tracheostomy was closed. On 21/09/13 patient was shifted to CCu, flow low SPO2. On 22/09/13 early morning patient suddenly developed acute respiratory distress and was intubated and later on shifted to ICU. Patient condition continuously deteriorated. On his blood pressure was falling with respiratory distress. Patient was placed on high Iontropes, X-ray revealed bilateral pneumonia. Poor prognosis of patient was explained to relatives at 6:45pm. Patient developed bradycardia with hypoxemia on high iontropes with low SPO2. Patient’s CPR was intubated and despite all resuscitation effort. Patient could not be resuscitated hence declared dead at 7:25pm on 22/09/13.”

19. To support this contention of negligence learned Counsel for the Complainant has also pointed out to the opinion given by Dr. Ravi Kumar Bhaskaran from Thiruvananthapuram whose Affidavit dated 08.09.2017 has been filed on record to urge that after having examined all the documents, the said doctor was of the opinion that Dr. Bansal Oncologist did not have knowledge about the symptoms of Myasthenia Gravis or Crisis and that the concerned doctor ought to have consulted a Neurologist knowing fully that the patient was a known case of Myasthenia Gravis. The contention is that the aforesaid expert report clearly demonstrates and supports the negligence which is gross grave and grievous. The said opinion is on a notarised Affidavit from Thiruvananthapuram, Kerala that has been placed on record.
20. Dr. M. C. Gupta, learned Counsel for Opposite Party No.-1 to 3 proceeded to counter the aforesaid arguments and he contends that after this stated expert opinion of Dr. Ravi Kumar Bhaskaran was placed on record, Dr. Bansal and Dr. Najeeb-Ur-Rehman moved a Complaint on 15.10.2016 before the State Medical Council of Kerala which is stated to be the Travancore Cochin Council of Modern Medicine.
21. The response received on 03.03.2018 from the said Council has been placed on record to urge that Dr. Ravi Kumar was only a General Physician and was unlikely to have any knowledge or expertise of managing a crisis of Myasthenia Gravis. It was intimated that the said doctor was also heard by Council and the Committee came to the conclusion that Dr. Ravi Kumar was not competent to give his opinion. The said report was forwarded and has been filed before this Commission. The same has not been contested and the said communication has not been contested and Dr. Gupta states that it is not understood that as to why the Complainant chose this particular doctor, that to be from Kerala to give an opinion when this could have been very easily done from any doctor or any institution in Delhi itself.
22. Dr. Gupta therefore casts serious doubt on the intention on such report which itself has been found to have no foundation.
23. Having heard learned Counsel for the parties and having perused the record, the primary dispute central around as to whether Dr. Bansal who was an Oncologist was negligent in adopting a line of treatment in respect of the ailment of Myasthenia which according to the Complainant was Myasthenia Gravis and hence the protocol observed was not in tune with the expected medical treatment that has to be administered for this disease.
24. In order to examine the same, the first argument with regard to the competence and qualification of Dr. Bansal deserves to be analyzed. It is not disputed that symptoms of Myasthenia can be examined by a doctor who is possessed of an MBBS Degree. The question is as to whether he can also be treated by such a doctor, keeping in view the present instance when Dr. Bansal is specialist in Oncology. There is no material so as to construe that Myasthenia can not be diagnosed and also treated by any qualified MBBS medical practitioner as it is a common weakening of the muscle  i.e. caused on certain fundamental neurological and physical problems. However, Myasthenia Gravis which is a severe form of complication of the decease is undoubtedly a neurological problem and therefore it might need a Neurological Specialist.
25. In the present case, the allegation against Dr. Bansal is on the assumption that Myasthenia Gravis had already set in when the patient was examined at the outset by Dr. Bansal in March, 2013. In the line of treatment adopted there is no  case set up that wrong medicines were administered or the medicines administered had created any adverse impact for bringing about the situation. What has been alleged is that no treatment was given  for Myasthenia Gravis.
26. The probable inference which can be drawn from these pleadings is that Dr. Bansal, even though an Oncologist was not incompetent to examine and diagnose the patient. It is also evident from the record that when the patient was admitted on the 4^th occasion on 27.08.2013 that he was for the first time diagnosed with acute Myasthenia Crisis/Gravis. It is at this stage that he was transferred to the Neurological Department and the protocol was observed by referring him to the Neurologist of the hospital Dr. Sushma Sharma under whom the patient was being  treated and then subsequently by one of her other colleagues Dr. Najeeb-Ur-Rehman. Thus in the wake of the aforesaid facts  and the sequence of events, it cannot be said that Dr. Bansal was incompetent to deal with the patient  at the first stage or even thereafter from March, 2013 onwards. The repetitive approach of the Complainant to the same hospital and doctor in spite  of the fact that the Complainant alleges that the patient had not set his path to recovery contradicts the stand of the complaint inasmuch as if the patient or the Complainant wasnot satisfied with the treatment that commenced in March 2013 then their voluntary act of approaching the same doctor again and again and being admitted on  four occasions in the hospital, enhances the probability that the Complainant or the patient had not doubted the examination and diagnosis by Dr. Bansal and visited the same Doctor in the same hospital spread over several months and then finally being admitted on 17.08.2013. The patient was ultimately brought under the care of a Neurologist and this protocol could not be commented as suffering from any deficiency of medical negligence.
27. It is after the treatment was carried out for Myasthenia Gravis that the patient was taken care of subsequently who ultimately died on 22.09.2013. Thus   to doubt the competence of the doctors or the hospital keeping in view the choice of the Complainant/Patient in visiting the same hospital therefore leads to a probable conclusion that the Complainant was being treated appropriately who had a weak constitution and a past long medical history of Myasthenia. After all Dr. Bansal is a qualified doctor having a medical degree of MBBS and also of Medicine. His credentials indicate that he is an MD in Medicine and DM in Oncology. There is nothing on record to suggest that such qualifications, if possessed by a doctor, can be considered to be unqualified or incompetent to treat such a patient. Consequently, Dr. Bansal cannot be held to be incompetent for discharging his duties as a doctor and possessed of the ordinary skills that were required. Dr. Bansal had advised the treatment that was undertaken by the patient. There being no indication of any wrong medicine or a medicine creating any adverse impact, it cannot be said that there was any negligence or deficiency in the treatment that was offered through Dr. Praveen Kumar Bansal. It is not the case of the Complainant that no adequate medicines were given or otherwise also any shortcoming in the administering of medicines.  It is thus evident that there is no pleading or evidence about any medicine which ought to have been given and was not administered.
28. One of the other doubts created by the learned Counsel for the Complainant is with regard to the continuous feeding of the patient with ryles tube. The submission is that the endorsement of the patient or attendant  having refused the continuous of the ryles tube is incorrect as no such instruction was given. This fact cannot be verified as the patient is already dead and there is nothing on record to demonstrate that there was any refusal by the patient. The second aspect is about an endorsement on 22.09.2013 by the doctor to stop feeding through ryles tube. The submission is that the tube had already been removed and therefore of giving an instruction for stoppage of feeding through ryles tube indicates that the order sheets / case sheets were being prepared aimlessly and carelessly. It is therefore submitted that this was also apparent negligence on the part of the Opposite Parties inasmuch as the ryles tube had already been removed and there was no occasion to have given any instruction for removal of the ryles tube.
29. This issue does not in any way turn on the negligence or the otherwise the status of the claim inasmuch as the continuous or otherwise of the prescence ryles tube cannot be a controlling factor in order to assess the primary dispute that has been raised by the Complainant of the patient not having been treated appropriately for Myasthenia Gravis. The removal or otherwise of the ryles tube therefore does not seem to have any bearing on the nature of the allegations with regard to no treatment having been given by the Opposite Parties to the Complainant for Myasthenia Gravis.  The Complainant has not been able to establish as to how the continuance or removal of a ryles tube had any impact on the line of treatment administered to the patient of the Complainant.
30. The third issue is with regard to the evidence of Dr. Ravi Kumar Bhaskaran from Kerala. Learned Counsel for the Opposite Parties is correct in the submission that it is not understood as to why the Complainant chose Dr.  Ravi Kumar Bhaskaran as an expert from Kerala. It is submitted on behalf of the Opposite Parties that there was no dearth of experts in the field in and around Delhi and as a matter of fact Delhi has the most premier institutions for rendering an opinion as an expert body. Learned Counsel for the Opposite Parties appears to be correct in his submission that this choice of a doctor from Kerala, who from the disclosure does not appear to be of some exceptional expertise is a choice which ultimately also has proved a failure keeping in view the inquiry made against him by Dr. Bansal and the intimation given  in this regard by the Kerala State Medical Council. The Complainant has not been able to establish that the opinion given by Dr. Ravi Kumar Bhaskaran was clinching or otherwise could have been relied on as the Kerala Medical Council has found Dr. Bhaskaran to be not competent to render any such opinion on the facts of the present case.
31. The question therefore of relying on the evidence and affidavit of Dr. Bhaskaran does not appear to be a safe proposition when the Medical Council of Kerala has doubted the competence of Dr. Bhaskaran to render an opinion in the matter.
32. There is one thing which deserves to be noticed and that is that the patient was also diagnosed for Thymoma. This is a lump, the growth whereof obstructs the swallowing of food.  This had been detected long back before 2005 and he was advised for the treatment of removal of such a growth. This was also repeated in 2008 but there is a gap as to why the patient did not receive the said treatment. The cause therefore which may have been existing for Myasthenia Gravis possibly because of such a growth had been located and might have caused the respiratory distress to the Complainant. There is no explanation in the complaint as to why the patient did not undertake any treatment for Thymoma nor does it seems to have been treated by the doctors in the hospital nor the same has even been mentioned in the said expert opinion of Dr. Ravi Kumar. There was therefore no treatment undertaken by the patient and there is a complete silence in the pleadings and also in the evidence about the treatment of Thymoma that had been located way back in the year 2005.
33. Nonetheless coming to the treatment given by the hospital, the entire day to day case sheet indicates medicines and support systems being administered to the patient who was being attended regularly from the date of his admission till he ultimately passed away. The Medicines administered are not stated to be inappropriate for fighting the said problem and treating the patient.
34. The main thrust of the argument of the learned Counsel is that it is at a later stage that the Opposite Parties referred the patient to a Neurologist and this delay resulted in the complications and the ultimate death of the patient.
35. What is to be noticed is that the treatment given by the Neurologist Dr. Sushma Sharma and Dr. Najeeb-Ur-Rehman was also in tune with the treatment which was being given earlier. It is nowhere indicated that the earlier line of treatment was wrong or incorrect nor any evidence has been brought forth by the complainant to demonstrate any fault in the protocol and the sequence of the treatment that was administered to the patient by the neurologists. An allegation being moved without any supporting evidence therefore cannot be proof of negligence. The standard of proof as is well-known keeping in view the Bolam test as explained in Jacob Mathew v. State of Punjab [(2005) 6 SCC 1 : 2005 SCC (Cri) 1369] and the subsequent decision in the case of Kusum Sharma Vs. Batra Hospital And Medical Research Centre & Ors (2010) 3 SCC 480. The act or omission of the treating doctor in not following the protocol has nowhere been established in this case.
36. As observed above, there is no explanation as to why Thymoma had not been treated or the treatment undertaken by the patient prior to 2013. There is neither any explanation nor it is the allegation of the Complainant that this was a possible cause of the complication that arose later on which could not be managed by the hospital.
37. The issue of ryles tube not having been deployed and the evidence indicating contradictions in its deployment, suffice it to state that the literature that has been filed regarding Gastroentric tube feeding and its techniques, problems and solutions does not establish negligence. In the instant case, it is evident that the ryles tube was removed possibly because the patient was unable to accept the initiation of feeding through the ryles tubes and the doctor accordingly suggested oral feeding which stands recorded in the case sheet. Consequently the argument advanced on the basis of the same does not appeal to reason.
38. All said and done in the absence of any such clinching evidence as against the Opposite Parties regarding medical negligence or deficiency, the complaint cannot succeed and is hereby rejected.