DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BARNALA, PUNJAB.

 

Complaint Case No : CC/189/2020

Date of Institution   : 08.09.2020

Date of Decision    : 29.05.2024

Yes Garg, aged about 14 years, minor son of Parmod Kumar, through Natural Guardian father Parmod Kumar son of Bhagwan Dass resident of Street No. 4, Tapa Mandi, Tehsil Tapa, District Barnala.      

                          …Complainant Versus

1. Managing Director, Dayanand Medical College & Hospital Ludhiana. 

2. Nodal Officer, Dayanand Medical College & Hospital Ludhiana.

3. Dean, Department of Plastic Surgery, Dayanand Medical College & Hospital Ludhiana;

4. Dr. S. Budhi Raja, Pediatric Surgery, Dayanand Medical College & Hospital Ludhiana;

5. Dr. Rohit Verma, ENT, Dayanand Medical College & Hospital Ludhiana;

6. Dr. A.K. Chaudhary, Neuro Surgeon, Dayanand Medical College & Hospital Ludhiana;

7. Dr. R.K. Mittal, Professor, Dayanand Medical College & Hospital Ludhiana;

8. Dr. Karam Singh, M.Ch (Resident) Plastic & Reconstruction Surgery, Dayanand Medical College & Hospital Ludhiana;

9. Dr. Rajinder Mittal, Dayanand Medical College & Hospital Ludhiana;

10. Dr. Suneet Kant Kathuria, Plastic Surgery Anesthesia, Dayanand Medical College & Hospital Ludhiana;

11. Dr. H.S. Sethi, Ortho, Dayanand Medical College & Hospital Ludhiana.  

12. United India Insurance Company Limited, Rani Hospital, G.T. Road, Opposite General Bus Stand, Khanna, Ludhiana, through its Divisional Manager/Branch Manager.

                       …Opposite Parties

Complaint Under Section 35 of Consumer Protection Act, 2019.

Present: Sh. Puneet Pabby Adv counsel for complainant.

Sh. S.S. Saini Adv counsel for opposite parties No. 1, 4 to 6, 8 to 11.

Opposite party No. 2 exparte.

Opposite parties No. 3 & 7 deleted.

Sh. N.K. Singla Adv counsel for opposite party No. 12.

Quorum:-

1. Sh. Jot Naranjan Singh Gill : President

2.Sh. Navdeep Kumar Garg : Member

ORDER 

JOT NARANJAN SINGH GILL, PRESIDENT

The complainant namely Yes Garg, aged about 14 years, minor son of Parmod Kumar, through Natural Guardian father Parmod Kumar has filed the present complaint under Section 35 of the Consumer Protection Act 2019, (amended upto date) against Managing Director, Dayanand Medical College & Hospital Ludhiana and others (hereinafter referred as opposite parties).  

2. The facts leading to the present complaint are that the complainant has met with road accident on 15.10.2019 and was admitted to local hospital i.e. Sub Divisional Hospital, Tapa from where the complainant was referred to Higher Medical Institution for management and FIR was also lodged with P.S. Tapa regarding the accident. It is further alleged that the complainant was admitted at  Dayanand Medical College & Hospital Ludhiana on 15.10.2019 where HRD No. 829925 and Admission No. 2019072449 was issued to the complainant. The complainant was diagnosed with RSA with Fracture B/L, ZM, NN and left ZF with Avulsion of B/F Maxillary Canines and incisors and the complainant has to go through under procedure ORIF with plating of B/L ZM and NN and left ZF fracture with soft tissue repair on 16.10.2019. It is further alleged that this treatment of the complainant was carried with consultation of pediatric surgeon Dr. S. Budhi Raja, Dr. Rohit Verma ENT, Dr. A.K. Chaudhary Neuro Surgeon, Dr. H.S. Sethi Ortho Surgeon and Dr. Suneet Kant Kathuria. It is alleged that the complainant got admitted on 15.10.2019 and was discharged on 21.10.2019 and charged with hefty amount from the complainant to the tune of Rs. 1,65,585/- alongwith pharmacy charges. The complainant was not feeling satisfied with treatment given to the complainant by the opposite parties. The complainant used to complain about chewing problem i.e. the complainant could not chew his food properly and feel pain. The complainant approached the opposite parties but they failed to cure the problem. It is further alleged that the complainant took advice of Dr. Tarjan Sharma Dentist and owner of Tarzan Dental Health Care Barnala, where Dr. Tarzan Sharma diagnosed that there is occlusion abnormal and the complainant has to undergo oral surgery, that means the opposite parties has not done medical treatment well with the complainant. The opposite parties has done medical negligence while providing treatment to the complainant. It is further alleged that the complainant also took opinion of dentist at CMC Ludhiana. The complainant approached Dr. Nitin D Bhola, Maharashtra for treatment. Dr. Nitin D Bhola is consultant with Shvaas Multispecialty Hospital, Wardha and also runs Dr. Bhola's Multispecialty Dental Clinic Wardha. It is further alleged that the complainant was satisfactorily treated by Dr. Nitin D Bhola and also has given written opinion regarding medical negligence done by the opposite parties towards the complainant. The complainant has to undergo treatment under guidance of Dr. Nitin D Bhola at Shvaas Multispecialty Hospital, Wardha and completely treated the complainant and removed the medical problem of inability of chewing of food by the complainant which was caused due to medical negligence of opposite parties. The complainant got admitted on 9.1.2020 and discharged on 13.1.2020 and has to undergone treatment of Lefort I Level Ostetomy of maxilla for correction of Occlusion on 9.1.2020. Dr. Nitin D Bhola has also issued medical certificate dated 13.1.2020 regarding the same. It is further alleged that the complainant has to go under medical treatment again due to medical negligence of the opposite parties and again has to spent hefty amount for treatment. The complainant has to spent Rs. 4,00,000/- approximately in treatment including travel expenses, boarding expenses etc. The complainant has approached the opposite parties in order to claim loss, caused to the complainant by the opposite parties that due to medical negligence and the complainant has to undergo pain, trauma, mental agony because the opposite parties are accused of medical negligence. The complainant many times visited in the hospital of opposite parties but till today despite various efforts the opposite parties has not accede the requests of the complainant. Hence, the present complaint is filed for seeking the following reliefs.- 

i)To pay Rs. 10,00,000/- regarding medical negligence.

ii)To pay Rs. 4,00,000/- spent by the complainant in order to correct the occlusion abnormality caused due to medical negligence of the opposite parties. 

iii)To pay Rs. 5,00,000/- as compensation on account of causing pain, trauma, mental agony to the complainant and Rs. 15,000/- on account of litigation expenses.   

3. Notice was sent to the opposite party No. 2, but opposite party No. 2 failed to appear and was proceeded against exparte vide order dated 5.11.2020. 

4. In view of the statement of Ld. Counsel for the complainant that he withdraw the complaint qua the opposite party No. 3, the opposite party No. 3 is deleted from the arena of opposite parties vide order dated 21.12.2020. Further, in view of the statement of Sh. S.S. Saini Advocate dated 24.11.2020, the opposite party No. 7 is also deleted from the arena of opposite parties vide order dated 7.12.2020. 

5. Upon notice of this complaint, the opposite parties No.1, 4 to 6 and 8 to 11 appeared and filed written version taking preliminary  objections interalia on the ground that the complaint is bad for non-joinder and misjoinder of the necessary parties. The complainant has not impleaded Dayanand Medical College & Hospital Ludhiana, where the opposite party No. 4 to 6 and 8 to 11 are serving, as necessary party to the present complaint and even Dayanand Medical College & Hospital Ludhiana is being run and manged by the Managing Society known as Managing Society of Dayanand Medical College & Hospital Ludhiana, but the complainant has also not impleaded the said Managing Society as necessary party to this complaint. Further the complainant in his complaint alleged that he took the subsequent treatment from Christian Medical College & Hospital, Ludhiana, Dr. Tarzan Sharma, Dr. Gandhi, Dr. Nitin Bhola of Dr. Bhola Multispecialty Hospital and obtained their opinion. But none of the doctors from whom the complainant took the subsequent treatment is impleaded as necessary party to the present complaint. The impleadment of the above three doctors from whom the complainant took the subsequent treatment is most necessary for just decision of the present complaint and to elucidate the truth in the present case. But the complainant purposely not impleaded the said doctors and as such the present complaint is also bad for non-joinder of the necessary parties and is liable to be dismissed on this score only. It is further alleged that the complainant has unnecessarily dragged some other doctors of Dayanand Medical College & Hospital Ludhiana for of their no fault and also without leveling a single allegation against them and even otherwise they have no relation with his surgery and alleged malocclusion. There is no Managing Director or Nodal Officer of Dayanand Medical College & Hospital Ludhiana and even there is no Dean of Plastic Surgery Department. Moreover Dr. S. Budhiraja is from Pediatric Surgery Department, Dr. Rohit Verma is from ENT Department, Dr. A.K. Chaudhary is from Neurosurgery Department, Dr. Suneet Kant Kathuria is from Anesthesia Department and Dr. H.S. Sethi is from Orthopedics Department have no relation with the surgery done by the Plastic Surgeon. Moreover Dr. Rajinder Kumar Mittal impleaded twice as opposite party No. 7 & 9 and as such the present complaint is bad for misjoinder of the parties and is liable to be dismissed on this score only. It is further alleged that no expert opinion/medical literature has been annexed by the complainant to substantiate his false allegations of medical negligence leveled against the answering opposite parties. In the absence of any expert opinion/medical literature, the bald allegations of the complainant are not ipsi-dixit sufficient to prove the case of medical negligence against the answering opposite parties. The present complaint is the result of misuse of the process of law and the answering opposite parties have been roped into the present false and frivolous litigation unnecessarily just to harass them and to fetch the money by illegal means. It is further alleged that complicated question of law and facts are involved in the present complaint, which cannot be decided in the summary proceedings before this Commission and controversy in dispute requires voluminous oral and documentary evidence, which can only be led in the Civil Court and examination and cross examination has to be conducted for elucidating the true facts which can be done only before the Civil Court. 

6. On merits, it is admitted to the extent that the complainant was got admitted in a very serious condition through Emergency of  Dayanand Medical College & Hospital Ludhiana on 15.10.2019 by Mr. Parmod Garg vide MRD No. 829925, Admn. No. 2019072449 and the complainant was admitted as a case of Road Side Accident with the following multiple fractures:

(i)Fracture medial and posterolateral walls and floor of bilateral orbits with evidence ear foci in preseptal region.

(ii) Comminuted fractures all walls of bilateral maxillary sinuses with evidence of hemosinus.

(iii) Fracture bilateral ethmoid septae, frontal septum and inferior wall of right sphenoid sinus with evidence of hemosinus. 

(iv) Fracture bilateral nasal bones, bony nasal septum, bilateral medial and lateral pterygoid plates, left zygoma and zygomatic arch. 

(v) Fracture coronoid process of mandible on left side.

Besides the above said fractures, there was history of vomiting and nasal bleed for which nasal packs were already there, done outside. It is further alleged that on physical examination of the patient, the BP of the patient was found to be 110/70 mmHg, pulse rate 94/m and respiratory rate 18/m. Patient was alert and Glasgow Coma Scale (GCS) was 15/15. There was facial oedema, nasal bleed and nasal crepitis, Besides the crepitis in zagomatic area, maxillary abnormal morbility was also present. Dental malocclusion was present and there was also 1 cm wound on left side of face. On admission the patient was examined by the team of doctors of different specialties according to the requirement of management of a trauma patient. The patient was seen by Dr. Sushil Budhiraja, Professor & Head, Department of Pediatrics Surgery and his team. The patient was also examined by the Plastic Surgery team and advised CT Scan of face. Then the patient was seen by Dr. Puneet Aulakh Pooni, Professor & Head, Department of Pediatrics and her team and thereafter the patient was examined by ENT team and noted nasal bone fracture. Then the patient was examined by Dr. H.S. Selhi, Professor, Department of Orthopedics and his team. The patient was also examined by Dr. A.K. Chaudhary, Professor & Head, Department of Neurosurgery and his team. The CT Scan of the face of the patient showed the above noted multiple fractures. It is further alleged that after carrying out all required pre-operative investigations and initial work up and stabilizing the patient, the patient was shifted to Plastic Surgery Ward under the care of Dr. Rajinder Kumar Mittal, Professor & Head, Department of Plastic Surgery (opposite party No. 9) and it was planned to conduct open reduction and internal fixation with plating of the fractures. Informed consent for the surgery was obtained by explaining the condition of the complainant including the fractures suffered by the complainant. They were also informed about the procedure to be carried out including its all known possible complications. It was also explained to the attendants about functional and aesthetic outcome of surgery, which may be less than expected because of multiple comminuted fractures and loss of multiple teeth (six in number). After explaining about the surgery and possible complications, an informed consent was obtained and the patient was taken up for surgery of the multiple facial fractures by plastic surgery team. It is further alleged that the surgery was performed keeping all the aseptic precautions. Intra operative findings were recorded including mobile and loose left incisor of maxilla, which was removed and loss of other maxillary incisor and cannines was also noted. Arch bar placed over mandible. Eyelets were placed over left half of maxilla. Right maxillary arch bar was also placed. Inter-maxillary fixation was done in normal occlusion according to the standard protocol of medial norms. Upper gingivobuccal incision was given to approach the maxillary fractures and maxillary fractures were identified. L-Shaped plates were placed over lateral buttresses on both sides. Straight plate was placed over medial buttresses (Naso Maxillary) on both sides. Through the pre-existing laceration, left zgomatic frontal fracture was identified and the same was reduced and fixed with five hole plate. Soft tissues were repaired in layers according to the standard medical norms. Inter maxillary fixation was released and throat pack was removed and after the surgery, the patient was shifted to Recovery Ward in a stable condition. After six hours of stay, in recovery Ward, the patient was shifted to Plastic Surgery Ward. It is further alleged that on 17.10.2019 the patient was reviewed by Plastic Surgery Team and noted facial edema. Dental occlusion was satisfactory. Suture line was intact and accordingly the patient was advised liquid diet and chlorohexidine mouth wash. The patient was reviewed from time to time by the team of Plastic Surgery Department on daily basis. Dental occlusion found to be maintained after the surgery. On 21.10.2019 the patient was discharged from the hospital in a satisfactory condition. At the time of discharge, occlusion was maintained. The patient was advised for liquid diet only and to take water after every diet with further advise of chlorohexidine mouth wash three times a day on regular basis and also advised for follow up in Plastic Surgery after 3 days. The best possible treatment and care was given to the complainant in rendering the treatment to the complainant. It is further admitted to the extent that the complainant remained admitted with the answering opposite parties w.e.f. 15.10.2019 to 21.10.2019 and he paid Rs. 1,65,585/- on account of his treatment charges including the cost of multiple implants used for the surgery of the complainant. It is further submitted that all the implants used for the surgery of the complainant were of special brands i.e. “Stryker”, which is an American Brand. It is further alleged that the complainant has failed to specify any date on which he approached the answering opposite parties after his discharge and even he failed to specify whether the follow up advise given to the complainant at the time of discharge was followed or not and whether the instructions of the treating doctor were followed or not. At the time of discharge, the occlusion was maintained as clearly mentioned in the discharge card. The complainant never complained about the occlusion problem to his treating doctor, which is otherwise a known complication of surgery of multiple comminuted facial fractures suffered by the complainant. It is further alleged that as per the medical literature, malocclusion (if any) is a known complication of maxillo facial multiple comminuted fractures as suffered by the complainant. Malocclusion may occur inspite of best possible treatment and care given to any patient and as such merely on the basis of malocclusion if any, no negligence in rendering the treatment and carrying out such type of surgery done on the complainant, can be attributed to the treating surgeon and as such the complainant has no case of medical negligence against any of the opposite parties as best possible treatment and care was given to him by the team of doctors. It is further submitted that malocclusion, abnormal occlusion and faulty occlusion is one and same thing, which means that occlusion is not normal and this is the known complication. It is further submitted that the complainant has drawn his own conclusion of medical negligence without any base and medical background and even Dr. Tarzan Sharma has no where stated in his prescription slip that there was any negligence on the part of the opposite parties in rendering the treatment to the complainant. No such opinion of any dentist of Christian Medical College & Hospital is produced by the complainant with his complaint and only a receipt dated 2.1.2020 of Rs. 300/- is produced by the complainant, which cannot be treated as medical opinion. It is denied that Dr. Nitin D Bhola gave his opinion in writing regarding alleged medical negligence on the part of the answering opposite parties. Infact in the alleged certificates purported to be issued by Dr. Nitin D Bhola, he only mentioned that there was faulty occlusion, which means malocclusion and the same is known complication as observed in various medical journals, text books and studies. It is further submitted that in case of postoperative malocclusion, the occlusion can be maintained in the initial postoperative period by applying elastic bands in the Arch Bar, which were fixed at the time of surgery. However, during the postoperative period, the complainant was maintaining his occlusion and there was no such complaint regarding malocclusion. It is further submitted that as result of the surgery, the complainant fractures were completely healed as clearly indicated by Dr. Nitin D Bhola in his discharge summary, which is the result of successful surgery done by the opposite parties by proper plating. It is further submitted that after the gap of more than two and half months, to maintain the occlusion, second surgery was required and even in case the complainant would have come to the opposite parties, the same should have been done by the opposite parties also. It is further submitted that the placing of dental implants in upper canine, central and premolar region, were required as the patient had lost his six teeth in the accident as clearly indicated by Dr. Nitin D Bhola in his alleged certificate dated 13.1.2020. As such, there is no medical negligence or deficiency in service on the part of the opposite parties in rendering the treatment to the complainant and prayed for the dismissal of complaint with exemplary cost. 

7. The opposite party No. 12 filed written version by taking preliminary objections on the grounds that the complaint is not maintainable, complaint is bad for non-joinder and mis-joinder of necessary parties, complainant has concealed material facts, complainant has not come with clean hands, Commission has got no jurisdiction etc. On merits, it is denied that the complainant has met with any road accident on 15.10.2019 and was admitted to local hospital at Tapa and referred to higher Medical Institution for management. It is denied that the complainant was admitted in DMC&H, Ludhiana on 15.10.2019 and was discharged with RSA with fractures as alleged and has to go through under procedure ORIF with plating on 16.10.2019 and was discharged on 21.10.2019. It is also denied that hefty amount from the complainant to the tune of Rs. 1,65,585/- was charged as alleged. No intimation was received by the answering opposite party with regard to the alleged treatment and expenses from anyone. It is also denied that the complainant took the advise of Dr. Tarzan Sharma, Dentist and owner of Tarzan, Dental Health Care, Barnala and the doctor diagnosed that the complainant has to undergo oral surgery. It is denied that the complainant also took opinion of Dentist of CMC&H, Ludhiana. It is also denied that the complainant has undergone treatment under guidance of Dr. Nitin D Bhola at Wardha and he removed the alleged medical problem of inability of chewing of food by the complainant which was caused due to the alleged medical negligence of opposite parties. It is denied that the complainant got admitted on 9.1.2020 and was discharged on 13.1.2020 and has to undergone alleged treatment and the complainant has to spent Rs. 4,00,000/- approximately in treatment as alleged. It is further submitted that M/s Dayanand Medical College and Hospital, Managing Society had purchased Errors and Omissions policy No. 2006002719P105582145 from the period from 17.7.2019 to 16.7.2020 from the answering opposite party and voluntary excess clause is Rs. 5 lacs for each and every claim subject to terms and conditions of the insurance policy. Dr. Rajinder K Mittal C/o DMC&H, Ludhiana has also purchased Professional Indemnity Doctors Policy No. 2006002719P106310793 for the period from 9.8.2019 to 8.8.2020 from the answering opposite party and voluntary excess clause is Rs. 1 lac for each and every claim subject to terms and conditions of insurance policy. All other allegations are denied and prayed for the dismissal of complaint with costs. 

8. Complainant filed rejoinder to the written version filed by the all the answering opposite parties and denied the averments of the written version filed by the answering opposite parties. 

9. In order to prove his case the complainant tendered into evidence affidavit of Parmod Kumar Ex.C-1, copy of admission record dated 15.10.2019 Ex.C-2, copy of FIR Ex.C-3, copy of Discharge Summary dated 21.10.2019 Ex.C-4, copy of claim bill Ex.C-5, copy of OP Bill Ex.C-6, copy of bill dated 21.10.2019 Ex.C-7, copies of bills of DMC Ex.C-8 to Ex.C-10, copy of Prescription slip Ex.C-11, copy of certificate dated 13.1.2020 Ex.C-12, copy of Medical certificate Ex.C-13, copy of IPD final bill dated 13.1.2020 Ex.C-14, copy of billing detail dated 13.1.2020 Ex.C-15, copy of Discharge Summary card dated 13.1.2020 Ex.C-16, copies of flight tickets Ex.C-17 & Ex.C-18, copies of Train tickets Ex.C-19 to Ex.C-21, copy of Hotel expenses bill Ex.C-22, copy of OPD Cash memo Ex.C-23, copies of bills of Shivaas Pharmacy Ex.C-24 to Ex.C-43 and closed the evidence. 

10. To rebut the case of the complainant the opposite party No. 1 tendered into evidence affidavit of Dr. Sandeep Sharma Ex.O.P1/1 and closed the evidence. 

11. The opposite party No. 4 tendered into evidence affidavit of Dr. Sushil Budhiraja Ex.O.P4/1 and closed the evidence. 

12. The opposite party No. 5 tendered into evidence affidavit of Dr. Rohit Verma as Ex.O.P5/1 and closed the evidence.

13. The opposite party No. 6 tendered into evidence affidavit of Dr. Ashwani Kumar Chaudhary Ex.O.P6/1 and closed the evidence. 

14. The opposite party No. 8 tendered into evidence affidavit of Dr. Karan Singh Ex.O.P8/1 and closed the evidence. 

15. The opposite party No. 9 tendered into evidence affidavit of Dr. Rajinder Kumar Mittal Ex.O.P9/1, affidavit of Dr. Sanjeev Uppal Ex.O.P9/2, copy of patient file Ex.O.P9/3, copy of material challan Ex.O.P9/4, copies of medical references Ex.O.P9/5 to Ex.O.P9/12, affidavit of Dr. Ramneesh Garg Ex.O.P9/13 and closed the evidence. 

16. The opposite party No. 10 tendered into evidence affidavit of Dr. Suneet Kant Kathuria Ex.O.P10/1 and closed the evidence. 

17. The opposite party No. 11 tendered into evidence affidavit of Dr. Harpal Singh Selhi Ex.O.P11/1 and closed the evidence. 

18. The opposite party No. 12 tendered into evidence copies of policies Ex.O.P12/1 & Ex.O.P12/2, affidavit of Baldev Singh Ex.O.P12/3 and closed the evidence. 

19. We have heard the learned counsel for the parties and have gone through the record on file. Written arguments filed by the parties.

20. The point in controversy before us is whether the line of treatment (maxillofacial fractures) adopted by the opposite parties was not in consonance with medical protocol due to which the complainant had to take treatment  from Dr. Nitin D Bhola, Maharashtra and had to spend hefty amount for treatment and the opposite parties have committed any negligency/deficiency in service or not.  

21. It is the case of the complainant that he has met with road accident on 15.10.2019 and was admitted to local hospital i.e. Sub Divisional Hospital, Tapa (Ex.C-2) from where the complainant was referred to Higher Medical Institution for management and FIR (Ex.C-3) was also lodged with P.S. Tapa regarding the accident. It is further alleged by the complainant in the complaint that the complainant was admitted at Dayanand Medical College & Hospital Ludhiana on 15.10.2019 where MRD No. 829925 and Admission No. 2019072449 was issued to the complainant (Ex.C-4). The complainant was diagnosed with RSA with Fracture B/L, ZM, NN and left ZF with Avulsion B/F Maxillary Canines and incisors and the complainant has to go through under procedure ORIF with plating of B/L ZM and NN and left ZF fracture with soft tissue repair on 16.10.2019. It is further alleged by the complainant that this treatment of the complainant was carried with consultation of pediatric surgeon Dr. S. Budhi Raja, Dr. Rohit Verma ENT, Dr. A.K. Chaudhary Neuro Surgeon, Dr. H.S. Sethi Ortho Surgeon and Dr. Suneet Kant Kathuria. It is further alleged by the complainant that the complainant got admitted on 15.10.2019 and was discharged on 21.10.2019 and charged with hefty amount from the complainant to the tune of Rs. 1,65,585/- alongwith pharmacy charges. The complainant was not feeling satisfied with treatment given to the complainant by the opposite parties because the complainant used to complain about chewing problem i.e. the complainant could not chew his food properly and feel pain. The complainant approached the opposite parties but they failed to cure the problem. It is further the case of the complainant that the complainant took advice of Dr. Tarjan Sharma Dentist and owner of Tarzan Dental Health Care Barnala (Ex.C-11), where Dr. Tarzan Sharma diagnosed that there is occlusion abnormal and the complainant has to undergo oral surgery, that means the opposite parties has not done medical treatment well with the complainant. It is further the case of the complainant that the complainant also took opinion of dentist at CMC Ludhiana (Ex.C-23). Then the complainant approached Dr. Nitin D Bhola, Maharashtra for treatment and Dr. Nitin D Bhola is consultant with Shvaas Multispecialty Hospital, Wardha and also runs Dr. Bhola's Multispecialty Dental Clinic Wardha.

22. It is further the case of complainant that the complainant was satisfactorily treated by Dr. Nitin D Bhola and also has given written opinion regarding medical negligence done by the opposite parties towards the complainant. The complainant has to undergo treatment under guidance of Dr. Nitin D Bhola at Shvaas Multispecialty Hospital, Wardha and completely treated the complainant and removed the medical problem of inability of chewing of food by the complainant which was caused due to medical negligence of opposite parties. The complainant got admitted on 9.1.2020 and discharged on 13.1.2020 (Ex.C-16) and has to undergo treatment of Lefort I Level Ostetomy of maxilla for correction of Occlusion on 9.1.2020. Dr. Nitin D Bhola has also issued medical certificate dated 13.1.2020 (Ex.C-13) regarding the same. It is further alleged by the complainant that the complainant has to go under medical treatment again due to medical negligence of the opposite parties and again has to spent hefty amount for treatment and the complainant has to spent Rs. 4,00,000/- approximately in treatment including travel expenses, boarding expenses etc. 

23. On the other hand, the case of the opposite parties No. 1, 4 to 6, 8 to 11 is that the complaint is bad for non-joinder and misjoinder of the necessary parties and the complainant has not impleaded Dayanand Medical College & Hospital Ludhiana, where the opposite party No. 4 to 6 and 8 to 11 are serving, as necessary party to the present complaint and even Dayanand Medical College & Hospital Ludhiana is being run and manged by the Managing Society known as Managing Society of Dayanand Medical College & Hospital Ludhiana, but the complainant has also not impleaded the said Managing Society as necessary party to this complaint.  Further, there is no Managing Director or Nodal Officer of Dayanand Medical College & Hospital Ludhiana and even there is no Dean of Plastic Surgery Department. It is further alleged by the opposite parties in their written version that complicated question of law and facts are involved in the present complaint, which cannot be decided in the summary proceedings before this Commission and controversy in dispute requires voluminous oral and documentary evidence, which can only be led in the Civil Court and examination and cross examination has to be conducted for elucidating the true facts which can be done only before the Civil Court. 

24. It is further the case of the opposite parties that it is admitted to the extent that the complainant was got admitted in a very serious condition through Emergency of  Dayanand Medical College & Hospital Ludhiana on 15.10.2019 by Mr. Parmod Garg vide MRD No. 829925, Admn. No. 2019072449 (Ex.O.P9/3). The complainant was admitted as a case of Road Side Accident with the following multiple fractures:

(i)Fracture medial and posterolateral walls and floor of bilateral orbits with evidence ear foci in preseptal region.

(ii)Comminuted fractures all walls of bilateral maxillary sinuses with evidence of hemosinus.

(iii) Fracture bilateral ethmoid septae, frontal septum and inferior wall of right sphenoid sinus with evidence of hemosinus. 

(iv)Fracture bilateral nasal bones, bony nasal septum, bilateral medial and lateral pterygoid plates, left zygoma and zygomatic arch. 

(v)Fracture coronoid process of mandible on left side.

It is further alleged by the opposite parties in their written version that besides the above said fractures, there was history of vomiting and nasal bleed for which nasal packs were already there, done outside. It is further alleged that on physical examination of the patient, the BP of the patient was found to be 110/70 mmHg, pulse rate 94/m and respiratory rate 18/m. Patient was alert and Glasgow Coma Scale (GCS) was 15/15. There was facial oedema, nasal bleed and nasal crepitis, Besides the crepitis in zagomatic area, maxillary abnormal morbility was also present. Dental malocclusion was present and there was also 1 cm wound on left side of face. On admission the patient was examined by the team of doctors of different specialties according to the requirement of management of a trauma patient. The patient was seen by Dr. Sushil Budhiraja, Professor & Head, Department of Pediatrics Surgery and his team. The patient was also examined by the Plastic Surgery team and advised CT Scan of face. Then the patient was seen by Dr. Puneet Aulakh Pooni, Professor & Head, Department of Pediatrics and her team and thereafter the patient was examined by ENT team and noted nasal bone fracture. Then the patient was examined by Dr. H.S. Selhi, Professor, Department of Orthopedics and his team. The patient was also examined by Dr. A.K. Chaudhary, Professor & Head, Department of Neurosurgery and his team. The CT Scan of the face of the patient showed the above noted multiple fractures. It is further alleged by the opposite parties that after carrying out all required pre-operative investigations and initial work up and stabilizing the patient, the patient was shifted to Plastic Surgery Ward under the care of Dr. Rajinder Kumar Mittal, Professor & Head, Department of Plastic Surgery (opposite party No. 9) and after explaining about the surgery and possible complications, an informed consent was obtained and the patient was taken up for surgery of the multiple facial fractures by plastic surgery team and the surgery was performed keeping all the aseptic precautions. It is further the case of the opposite parties that on 17.10.2019 the patient was reviewed by Plastic Surgery Team and noted facial edema and dental occlusion was satisfactory. Suture line was intact and accordingly the patient was advised liquid diet and chlorohexidine mouth wash. The patient was reviewed from time to time by the team of Plastic Surgery Department on daily basis and dental occlusion found to be maintained after the surgery. On 21.10.2019 the patient was discharged from the hospital in a satisfactory condition and at the time of discharge, occlusion was maintained. The patient was advised for liquid diet only and to take water after every diet with further advise of chlorohexidine mouth wash three times a day on regular basis and also advised for follow up in Plastic Surgery after 3 days. It is further submitted that all the implants used for the surgery of the complainant were of special brands i.e. “Stryker”, which is an American Brand. It is further the case of the opposite parties that the complainant has failed to specify any date on which he approached the answering opposite parties after his discharge and even he failed to specify whether the follow up advise given to the complainant at the time of discharge was followed or not and whether the instructions of the treating doctor were followed or not. It is further the case of the opposite parties that as per the medical literature, malocclusion (if any) is a known complication of maxillo facial multiple comminuted fractures as suffered by the complainant and malocclusion may occur inspite of best possible treatment and care given to any patient and as such merely on the basis of malocclusion if any, no negligence in rendering the treatment and carrying out such type of surgery done on the complainant, can be attributed to the treating surgeon and as such the complainant has no case of medical negligence against any of the opposite parties as best possible treatment and care was given to him by the team of doctors. 

25. The opposite parties have placed on record a detailed affidavit of treating doctor, Dr. Rajinder Kumar Mittal, Professor & Head Department of Plastic Surgery, Dayanand Medical College & Hospital, Ludhiana, (Ex.O.P9/1) in which he submitted that he did MBBS in the year of 1992 from Punjab University, Chandigarh and then MS in General Surgery in the year of 1996 from the same University. Thereafter, he did MCH. in Plastic Surgery from Delhi University in the year of 2001. He further submitted that he was appointed as Senior Resident in Dayanand Medical College & Hospital, Ludhiana and remained on the same post w.e.f. 13.1.1997 to 28.2.1998 and then he was appointed as Senior Resident in Safdarjung Hospital, New Delhi and remained there as Senior Resident w.e.f. 3.6.1998 to 30.4.2022. He was appointed as Assistant Professor in the Department of Plastic Surgery in Dayanand Medical College & Hospital, Ludhiana in the year of 2002 and then promoted as Associate Professor in the same institution in the year of 2006 and he was promoted as Professor in the same institution in the year of 2010. Further, in the year of 2020, he was designated as Head of Plastic Sugery Department and have more than 24 years of post graduation experience and thus during this long spell of time he has attendant, treated and conducted procedures and surgeries on countless number of patients and he is fully qualfied and skilled to treat the patients having maxillofacial fractures as suffered by the complainant. The maxillofacial surgeries and other facial surgeries are within the domain of Plastic Surgeons. The deponent has conducted a large number of such type of surgeries during the last 24 years. So, form the perusal of affidavit it is evident that the Dr. Rajinder Kumar Mittal who has conducted the surgery/treatment of the complainant is a qualified doctor to perform the above said surgery. 

26. We have also gone through the affidavit of Dr. Karan Singh Senior Resident, Department of Plastic Surgery, Dayanand Medical College & Hospital, Ludhiana, (Ex.O.P-8/1), who was the part of the treating team by whom the treatment to the complainant was rendered. In the affidavit Dr. Karan Singh has reiterated the averments as mentioned in the written version. 

27. The opposite parties in support of their case have also placed on record expert evidence by way of affidavit of Dr. Sanjeev Uppal, Ex-Professor & Head Department of Plastic Surgery, Dayanand Medical College & Hospital, Ludhiana, as expert evidence (Ex.O.P-9/2). In the affidavit Dr. Sanjeev Uppal stated that he did MBBS in the year 1981 from Government Medical College & Hospital, Patiala and then MS in General Surgery in the year of 1985 from the same college. Thereafter, he did MCH. in Plastic Surgery from the same college in the year of 1992. After that he was appointed as Assistant Professor in the Department of Plastic Surgery in Dayanand Medical College & Hospital, Ludhiana, in the year 1994. Thereafter, he was promoted as Associate Professor in the same institution in the year 2000. After that he was again promoted as Professor in the same institution in the year of 2006 and in the year of 2010, he was designated as Head of Plastic Surgery Department. He was retired as Professor & Head, Department of Plastic Surgery of Dayanand Medical College & Hospital, Ludhiana, in the year 2020 and he has more than 28 years of post graduation experience. He further submitted that I am expert and highly qualified in the field of plastic surgery and I have attended, treated and conducted procedures/srugeries on countless number of patients. The surgeries for fractures of mandible, maxilla, zygome and zygomatic arch alongwith other facial bones are within the domain of Plastic Surgeons. In the affidavit he further submitted that he has gone through the patient file (Ex.O.P9/1) as well as the medical literature. In the affidavit he further submitted that on 17.10.2019 the complainant was reviewed by Plastic Surgery Team and noted facial edema. Dental occlusion was satisfactory. Suture line was intact and accordingly the complainant was advised only liquid diet and chlorophexidine mouth wash. The complainant was reviewed from time to time by the team of Plastic Surgery Department on daily basis. Dental occlusion found to be maintained after the surgery. He further submitted that as per medical literature malocclusion (if any) is a known complication of maxillo facial multiple comminuted fractures as suffered by the complainant. Lastly concluded that the treatment rendered by Dr. Rajinder Kumar Mittal to the complainant during his admission is according to the prescribed medical norms and there is no negligence in treating the complainant on the part of Dr. Rajinder Kumar Mittal. 

28. The opposite parties have also placed on record expert evidence by way of affidavit of Dr. Ramneesh Garg Professor, Department of Plastic Surgery, Dayanand Medical College & Hospital, Ludhiana, (Ex.O.P9/13) in which he submitted that he did MBBS in the year of 2000 from Dayanand Medical College & Hospital, Ludhiana and MS in General Surgery from Government Medical College, Patiala. Thereafter, he did MCh. in Plastic Surgery from Dayanand Medical College & Hospital, Ludhiana in the year 2009 and after that he was appointed as Assistant Professor in the Department of Plastic Surgery in Dayanand Medical College & Hospital Ludhiana in October 2010. Then he was promoted as Associate Professor in February 2015 and he was again promoted as Professor in the same department in the year of 2019. He further submitted that he has 11 years of post graduation experience and thus during this long spell of time he has attendant, treated and conducted maxillary and mandibular procedures/surgeries on countless number of patients and he is fully qualfied and skilled to treat the patients having maxillofacial fractures as suffered by the complainant. The deponent has conducted more than 600 such type of surgeries in the last 11 years. Lastly concluded that the treatment rendered by Dr. Rajinder Kumar Mittal to the complainant during his admission is according to the prescribed medical norms and there is no negligence or deficiency in service in rendering the treatment to the complainant on the part of Dr. Rajinder Kumar Mittal. 

29. We have perused the discharge summary of complainant of Dayanand Medical College & Hospital, Ludhiana Ex.C-4 and Ex.O.P9/3 vide which it is mentioned that the complainant admitted on 15.10.2019 and was discharged on 21.10.2019 and on 16.10.2019 Procedure adopted that “QRIF WITH PLATING OF B/L ZM, NM AND LEFT ZF FRACTURE WITH SOFT TISSUE REPAIR”. It is further mentioned in the clolumn of ON LOCAL EXAMINATION: 

FACIAL EDEMA

1X1 CM WOUND RIGHT CHEEK

NASAL CREPITATION PRESENT

MAXILLA ABNORMAL MOBILITY PRESENT

MANDIBLE ABNORMAL MOBILITY ABSENT

OCCLUSION NOT MAINTAINED

DIAGNOSIS: A/H/O RSA WITH FRACDTURE B/L ZM, NM AND LEFT ZF WITH AVULSION OF B/L MAXILARY CANIES AND INCISORS. It is further mentioned in colunm patient's condition at the time of discharge: stable, suture line intact, occlusion maintained patient will need dental prosthesis at later date. It is further mentioned in the follow up advice: Follow up in plastic surgery after 3 days, Rest for four weeks, only liquid diet, Water Intake After Every Diet, Chorhexidine Mouth Wash Three Times a Day. It is further mentioned in Medication & Other Instructions: TAB CEFUROXIME 500MG BD X 5 DAYS, TAB DOLO 650 MG SOS PO. X 5 DAYS. It is further mentioned WHEN TO OBTAIN URGENT CARE: BLEEDING, FEVER, FACIAL EDEMA. URGENT CARE TELEPHONE NUMBER: 01614687304, 01614687700 is also mentioned in the discharge summary. It is further mentioned in the discharge summary that the patient is presently being discharged in stable condition. But there is nothing on record from the side of complainant to prove that the complainant/patient has ever gone for follow up after three days as adviced by the opposite parties in the discharge summary. Moreover, the complainant has failed to place on record any prescription slip of the opposite parties after the discharge from the hospital regarding any complaint/problem occured to the complainant as alleged by the complainant in his complaint. Moreover, there is nothing in the complaint that the complainant had taken precautions as per the advice of the doctors. 

30. The another allegation of the complainant is that due to the medical negligence of the opposite parties the complainant used to complain about chewing problem i.e. the complainant could not chew his food properly and feel pain and had to undergo treatment under guidance of Dr. Nitin D Bhola at Shvaas Multispecialty Hospital, Wardha, who completely treated the complainant and removed the medical problem of inability of chewing of food by the complainant which was caused due to medical negligence of opposite parties. The complainant in his complaint has further alleged that Dr. Nitin D Bhola has given written opinion regarding medical negligence done by the opposite parties towards the complainant. We have perused the medical certificate of Dr. Nitin D Bhola, Multispecialty Dental Clinic dated 13.1.2020 Ex.C-12 vide which it is mentioned that “It is for information that Mr. Yes Garg, Age 15 resident of Tapa, Distt. Barnala, Punjab, reported to me with a complaint of poor esthetics, inability to chew and loss of anterior teeth in upper arch. He gave a H/O of RTA on 15.10.2019 and suffered multiple facial fractures. He was operated on 16.10.2019 at an DMC hospital in Ludhiana, Open reduction and fixation of maxilla and zygoma was performed. At present he had faulty occlusion with only one point contract. Upper anterior six teeth were missing and there was elongation of face. I had done a Lefort I level osteomy of maxilla for correction of occlusion, fixation with help of titanum screws and plates, placement of implant in upper anterior region and bone grafting under general anesthesia. The procedure was performed on 9th January 2020, at Shvas hospital wardha. He is adviced to review after 15 days. Date of admission in hospital 9.1.2020, date of discharge from hospital 13.1.2020”. We have also perused the discharge summary/card Ex.C-16 of Dr. Nitin Bhola at Shvaas Multispecialty Hospital, Wardha of patient which also shows the date of admission 9.1.2020 and date of discharge 13.1.2020. It is further mentioned regarding Operation Done: Lefort I esteotomy for correction of post traumatic malocclusion & placement of dental impl on 9.1.2020. It is further mentioned in the column Notes “under all aseptic precautions and under general anesthesia with nasotracheal intubation. Maxillary vestibular incision given to expose the entire maxilla. The fracture sites had healed completely. Gross communition noted in the left maxillary sinus region. Bone plates sand screws placed during previous opertion were removed. Lefort I isteotomy marking done, cuts taken with saw. Maxilla mobilised. MMF was done after acieving the occlusion with help of arch bars and wire. Fixation was done with titanium bone plates and screws at right and left maxillary buttress and lateral nasal aperture. Alar cinch and and septum to ANS fixation was achieved with help of 1-0 prolene. Dental implants were placed in upper canine, central and premolar region, bone grafting and titanium mesh was used to cover the defect. Vestibular incision closed with 3-0 vicryl. Patient extubatedand shifted to recovery”. It is further mentioned under the head of condition on discharge that at time of discharge patient has recovered well. The healing is satisfactory. So, from the perusal of the above said documents Ex.C-12 & Ex.C-16 nothing shows that Dr. Nitin D Bhola has given his opinion in writing that the problem i.e. the complainant could not chew his food properly and feel pain as alleged by the complainant has been occured to the complainant due to the medical negligence of the opposite parties. Moreover, the complainant has failed to place on record affidavit of Dr. Nitin D Bhola in support of his allegations. Further, it is no where mentioned in the above said documents Ex.C-12 & Ex.C-16 by Dr. Nitin D Bhola that the opposite parties have committed any deficiency in service while treating the patient or the treatment given by the opposite parties to the patient is not in consonance with medical protocol. We have also perused the prescription slip of Tarzan Dental Health Centre, K.C. Road, Barnala dated 28.12.2019 Ex.C-11 vide which the patient was adviced implant and grafting and refer to oral surgeon because occlusion abnormal mandible fracture?. It is further mentioned “Refer to Dr. Gandhi for consultation”. So, in this prescription slip it is nowhere mentioned that the above said problem has been occured to the complainant due to the medical negligence of opposite parties. Moreover, from this prescription slip it is made out that the patient approached the Tarzan Dental Health Centre on 28.12.2019 for consultation/treatment i.e. two months later after the treatment/oral surgery done at DMC, Ludhiana. We are of the view that the patient was supposed to approach the DMC, Ludhiana, regarding the problem which has been occured to the complainant as alleged above by the complainant as per advice for follow up and for taking further treatment. 

31. On the other hand, from the side of complainant to rebut the case of the opposite parties, the complainant has failed to place on record any expert opinion/medical evidence to substantiate his allegations of medical negligence leveled against the opposite parties. Moreover, the complainant in his complaint alleged that he took the subsequent treatment from Christian Medical College & Hospital, Ludhiana, Dr. Tarzan Sharma and Dr. Nitin D Bhola of Dr. Bhola Multispecialty Hospital and obtained their opinion. But none of the doctors from whom the complainant allegedly took the subsequent treatment is impleaded as necessary party to the present complaint. The impleadment of the above said three doctors from whom the complainant allegedly took the subsequent treatment was most necessary for the just dicision of the present complaint and to elucidate the truth in the present case. But the complainant purposely not impleaded the said doctors reasons best known to him.  

32. The opposite parties No. 1, 4 to 6, 8 to 11 have placed on record medical literature Ex.O.P9/7 Journal of Oral and Maxillofacial Surgery December 2004 Volume 62, Issue 12 at Page No. 1445-1594, Passive Under Chapter Passive Repositioning of Maxillary Fractures: An Occasional Impossibility Without Osteotomy, in which it is mentioned that “Unfortunately, even when this protocol is strictly adhered to, malocclusion may still occur (Fig 1). The most prequent malocclusion after a maxillary fracture are an anterior openable and/or a Class III tendency. This is usually evident the first day after surgery if the patient is not left in MMF after surgery. While such a malocclusion can be caused by improper osteostynthesis, it is less likely than a malocclusion because of insufficient mobilization of the maxilla during the surgery”. The opposite parties have further placed on record medical literature Ex.O.P9/12 Clinics Volume 64, Number 9, 2009, Clinical Science Oral Maxillofacial Fractures Seen At A Ugandan Tertiary Hospital: A Six-Month Prospective Study, vide which it is mentioned that “Of the 132 patients treated, postoperative complications were observed in 39 patients (30%). Infection was the most common complication, accounting for 19 cases (48.71%), followed by malocclusion in 7 cases (18%)”. Further, as indicated in standard Text Book of Maxillofcial Trauma by Peterson, Page 462 and the same is reproduced as under:

Complications;

Complications associated with maxillary fractures and their repair are listed in Table 20-1. 

“Table 20-1 Complications Associated with Maxillary Fractures

Infraorbital nerve paresthesia, Enophthalmos, Infection, Exposed hardware, Deviated septum, Nasal obstruction, Altered vision, Nonunion, Malunion or malocclusion, Epiphora, Foreign body reactions, Scarring, Sinusitis”.

33. Ld. Counsel for the opposite parties No. 1, 4 to 6, 8 to 11 has placed on record judgment of the Hon'ble Supreme Court of India  2005(3)CLT 358 in case titled Jacob Mathew Vs State of Punjab and another Criminal Appeal Nos. 144-145 of 2004 held in Para No. 49 (3) A professional may be held liable for negligence on one of the two findings: either he was not possessed of the requisite skill which he professed to have possessed, or, he did not excerice, with reasonable competence in the given case, the skill which he did possess. The standard to be applied for judging, whether the person charges has been negligent or not, would be that of an ordinary competent person excersing ordinary skill in that profession. It is not possible for every professional to possess the highest professional may be possessed of better qualities, but that cannot be made the basis or the yardstick for judging the performance of the professional proceeded against on indictment of negligence. 

34. In another case the Hon'ble Supreme Court of India 2009(2) CLT 381 in case titled Martin F. D'Souza Vs Mohd. Ishfaq held in Para No. 47 that Simply because a patient has not favourably responded to a treatment given by a doctor or a surgery has failed, the doctor cannot be held straightway liable for medical negligence by applying the doctrine of res ipsa loquitur. No sensible professional would intenionally commit an act or ommission which would result in harm or injury to the patient since the professional reputation of the professional would be at stake. A single failure may cost him dear in his lapse. 

35. Ld. Counsel for the opposite parties also relied upon the judgment of the Hon'ble Supreme Court of India (2009) 7 S.C.R. 272, in case titled Dr. C.P. Sreekumar, M.S. (Ortho) Vs S. Ramanujam, Civil Appeal No. 6168 of 2008 May 1, 2009 held in Para No. 16 B that; We find from a readinig of the order of the Commission that it proceeded on the basis that whatever had been alleged in the complaint by the respondent was in fact the inviolable truth even though it remained unsupported by any evidence. As already observed in Jacob Mathew's case the onus to prove medical negligence lies largely on the claimant and that this onus can be discharged by leading cogent evidence. A mere averment in a complaint which is denied by the other side can, by no stretch of imagination, be said to be evidence by which the case of the complainant to provide the facta probanda as well as the facta probantia. Ld. Counsel for the opposite parties has further relied upon the judgment of the Hon'ble National Consumer Disputes Redressal Commission, New Delhi, 2010(2)CLT 518 in case titled Prabha Shankar Ojha Vs Neelmani Rai (Dr.) held in Para No. 9 that; It is, by now, well-settled that onus of proof is on the party who alleges medical negligence. This has further been elaborated in subsequent judgments that mere statement of party is not enough. Allegation of negligence has to be proved with the help of expert medical opinion. Admittedly, in the present case, petitioner has not brought on record any expert evidence to show as to what the Doctor did was not to be done as per accepted medical practice or what he should have done as per accepted medical practice, which he failed to do. 

36. Ld. Counsel for the opposite parties also relied upon the judgment of the Hon'ble Punjab State Consumer Disputes Redressal Commission, Chandigarh 2015(1) CLT 385 in case titled Dr. Surinder Goyal Vs Surjit Singh & others held in Para (ii) that Consumer Protection Act, 1986, Section 2(1)(g) & 13- Medical negligence- Expert evidence- Held- The adjudicating authority District Forum is just like a layman and is not expert in medical science- It has to take the assistance of expert evidence and the medical literature on the record, to come to the correct conclusion- Appeal allowed. Further, it is mentioned in the column of Observation: Medical negligence- Usually, when a person files complaint against the medical practitioner, he exaggerates his claim- Solid evidence is required to establish it before the Consumer Forum. 

37. In the absence of any cogent and confidence inspiring evidence on the file from the side of complainant we disagree with the allegations of the complainant. As such, we don’t find any merit in the present complaint and same is accordingly dismissed. However, there is no order as to costs or compensation.

38. Copy of this order be supplied to the parties free of costs as per rules. File be consigned to the records after its due compliance. 

ANNOUNCED IN THE OPEN COMMISSION:

       29th Day of May, 2024

 

            (Jot Naranjan Singh Gill)

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(Navdeep Kumar Garg)

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