BEFORE THE DISTRICT CONSUMER’S FORUM: KURNOOL Present: Sri. M.Krishna Reddy, M.Sc., M.Phil., Male Member President (FAC) And Smt. S.Nazeerunnisa, B.A., B.L., Lady Member Wednesday the 26TH day of June, 2013 C.C.No.35/2012 Between: 1. W.Radhakrishna, S/o Ayyanna. 2. W.Anil Krishna, S/o W.Radhakrishna. 3. W.Akhila, D/o W.Radhakrishna. All are R/o H.No.15/56, Upstairs, Khadakpura Street, Kurnool – 518 001. …Complainants -Vs- 1 Deepak Tej Hospital,Represented by Dr.K.Ram Chandra Naidu, Beside Dr.W.Seetharam Clinic, D.No.40-582-2-1-A, Dharmapeta, Kurnool – 518 004. 2 Dr.K.Ram Chandra Naidu,Deepak Tej Hospital, Beside Dr.W.Seetharam Clinic, D.No.40-582-2-1-A, Dharmapeta, Kurnool – 518 004. ...Opposite ParTies This complaint is coming on this day for orders in the presence of Sri.D.S.Sai Leela, Advocate for complainants and Sri.Syed Shafaquath Hussain, Advocate for opposite parties and upon perusing the material papers on record, the Forum made the following. ORDER (As per Sri. M.Krishna Reddy, Male Member, President (FAC)) C.C. No.35/2012 1. This complaint is filed by the complainant under section 11 and 12 of C.P. Act, 1986 seeking a direction on opposite parties for the payment of :- (a) Rs.5,00,000/- the amount incurred towards medical expenditure and attendant charges; (b) Rs.10,00,000/- as compensation for mental agony and hardship; (c) Rs.2,000/- towards cost of the case and interest on the claim. 2. Venkateswaramma, since deceased, this complaint is filed by her husband, son and daughter who are complainants, alleging medical negligence on the part of opposite party No.2 doctor and his opposite party No.1 Hospital. Deceased Venkateswaramma was admitted in opposite party No.1 Hospital on 18-05-2011 with the complaint of Pain Abdomen and hernia. Dr.K.Rama Chandra Naidu conducted operation for obstructed/strangulated incisional hernia on 19-05-2011, though the condition of patient was diagnosed as surgical emergency and though compatible blood was ready on 18-05-2011. Opposite party No.2 postponed operation till next day to suit his convenience, even that surgery was not conducted properly which led to anastamotic leak, respiratory distress and septicemia in the form of fever. Opposite party No.2 doctor has not treated septicemia properly and used expensive antibiotics without doing blood culture and identifying causative organism. He has not consulted physician immediately after the patient developed sudden respiratory distress. Opposite party No.2 planned for laparotomy on 3rd post operative day but suddenly changed his mind and started conservative treatment. He advised the patient to take oral fluids and soft diet which resulted in peritoneal collection of fecal matter leading to complications. He has not planned for decompressive therapy. Further opposite party doctor planned for second surgery without anticipating complications, preoperative preparation and post operative care. He neither explained high risk status of the case nor possible table death of the patient to the complainants. He has not taken high risk consent from the complainants for second surgery. Opposite party No.2 informed the time of operation as 1½ hours, but the patient was brought out side after six hours, in unconscious state on Oxygen Supply. Complainants saw the patient in Operation Theater not responding to verbal stimuli or touch stimuli. Opposite parties advised the complainant to shift the patient to Gowri Gopal Hospital, Kurnool because the ventilator in opposite party No.1 Hospital was not working properly. The patient though developed respiratory distress prior to second laparotomy, opposite party No.2 proceeded for surgery of high risk case without I.C.U. facilities, skilled staff and functioning ventilator by not referring the case to a better equipped Hospital. Opposite parties did not anticipated hemorrhagic complications due to adhesions and bleeding, during surgery and have reserved only one bag of compatible blood one day before, that was donated by complainant’s daughter. When the surgery was going on more blood donors were asked to be brought. Immediately three donors donated blood and one more bag was arranged from out side. The complainants submit that though the patient died in Operation Theater on table, the opposite parties fabricated saying the patient was alive by maintaining positive pressure ventilation, and asked complainants to shift the patient to Gowri Gopal Hospital, Kurnool. At that critical juncture opposite party No.2 declared that the patient was dead. This clearly indicates the careless attitude of opposite parties and to shift the responsibility on other Hospital. The complainants concluded that delayed surgery, not excersising skill during surgery, led to anastamotic leak, postoperative morbidity like septicemia and respiratory distress. Septicemia was not treated by using sensitive antibiotics after conducting blood culture. Anastamotic leak was not identified earlier and allowed oral fluids and soft diet. If the first surgery was done properly it would not have led to second surgery and associated death. Because of sudden death of Venkateswaramma the first complainant lost his wife at the age of 55 Years, second and third complainants lost love and affection of their mother. The complainant suffered mental agony and also spent Rs.5,00,000/- towards medical expenditure and attendant charges. A legal notice was issued to opposite parties claiming compensation, alleging medical negligence. In reply opposite parties denied their liability with all false allegations. In view of the reasons stated above this complaint is filed before this Forum praying a direction on opposite parties for the payment of claims as claimed for. 3. Persuent to the notice of this Forum, opposite parties filed written version denying their liability to complainant’s claim. Opposite party No.2 admitted the admission of Smt.Venkateswaramma in opposite party No.1 Hospital with pain abdomen on 18-05-2011 at 9.55 P.M. but refused to accept the charge of medical negligence in treating her in his Hospital by him. The allegations of complainant that opposite party No.2 delayed surgery to suit his convenience, surgery not conducted properly, post operative morbidity like septicemia and respiratory distress developed due to improper surgery, used expensive antibiotic to treat septicemia without doing blood culture test, not identified anastamotic leak early and advised oral fluids and soft diet which made the case complicated, not planned for de-compressive therapy to treat respiratory distress, lack of care and skill in first surgery that led to second surgery and associated death, not planned for sufficient compatible blood reserve anticipating adhesions and bleeding during second surgery, carried out surgery without I.C.U. facility, skilled staff and functioning ventilator in opposite party No.1 Hospital, not explained high risk status of the case and not obtained the consent for operation from the complainants, asked complainants to shift the patient to Gowri Gopal Hospital to shift responsibility on others, patient died on the table but fabricated saying that she is alive are all not true and invented for wrongful gain. According to opposite parties the facts of the case are venkateswaramma, wife of first complainant and mother of second and this complainants having been refused on account of bad condition by Vijaya Hospital and C.N. Hospital, Kurnool was brought to opposite party No.1 Hospital on 18-05-2011 at 9.55 P.M. with pain abdomen and swelling since one day. Previously she had under gone two caesarean operations, one abdominal hysterectomy and incisional hernia repair. She has morbid obesity. She was diagnosed incisional hernia with intestinal obstruction/strangulation. She was admitted and resuscitative measures to improve intravascular volume, antibiotic coverage and investigations were ordered. After assessing the fitness for operation she was posted for surgery on 19-05-2011 at 10.00 A.M. surgery went on well and during surgery hernia sac opened gangrenous segment resected and end to end anastamosis done. Dense adhesions were found between bowels all over abdomen. Drains were kept, mesh hernioplasty was done and abdomen closed. Patient was kept in I.C.U. for three days and monitored by opposite party No.2 doctor. On third post operative day she was shifted to room. On the same day at 8.00 P.M. she developed respiratory distress. Immediately she was shifted to high dependency unit and treated with nebulisation, chest physiotherapy and bronchodilator. E.C.G. and X-Ray were done. Dr.Sivarajappa, Physician attended on her and treatment advised by him was followed. As the patient had good bowel sounds and no vomiting, Ryle’s tube removed, oral fluids and soft diet were allowed to initiate nutritional support, which is crucial after initial stabilization. Mild anastamotic leak was found on 25-05-2011. Since the tubes draining the leak adequately and patient was passing flatus, she was treated conservatively. De-compressive therapy was not planed because of distal small bowel leak. As the leak increased and the tubes were inadequately draining, contaminating mesh and wound, patient developed fever. Therefore appropriate culture based antibiotics were started. Anastamotic leak is not due to negligence of doctor, factors like distal kinks due to adhesions, local vascularity of tissues and obesity are responsible. Second operation for ileastomy and mucus fistula to divert fecal stream was planned after explaining complications to the complainants. After arranging required blood reserve, operation was started on 29-05-2011 at 12.00 P.M. Because of dense adhesions between entire small bowel loops the surgery lasted for six hours, surgery was done carefully with dedicative and skilful dissection. As the patient was morbid obese with thick abdominal wall, it was very difficult to bring out the bowel loop to the abdominal surface, which caused delay in surgery. The patient after coming into conscious requires respiratory support and ionotropic support to maintain blood pressure. Hence she was shifted to high dependency unit at 6.00 P.M. and kept on mechanical ventilator support. Dr.Ramanjaneyulu, Anaesthesiologist along with I.C.U. staff continuously monitored the vital parameters of patient. Inspite of best supportive measures provided, the patient suffered first cardiac arrest at 10.30 P.M. and resuscitated. But unfortunately again she suffered second cardiac arrest at 11.00 P.M. and died inspite of best effects. The allegation that Smt.Venkateswaramma died on table in Operation Theater is false, Dr.Santhiraj, Anaesthesiologist who was called by the complainants at 5.00 P.M. on 29-05-2011 to over see the operation, present in Operation Theater and in the Hospital till the dead body of Smt.Venkateswaramma was shifted to the complainants house. Opposite party No.2 doctor is highly qualified, well experienced surgical gastroenterologist and advanced laparoscopic surgeon. Opposite party No.1 Hospital is also well equipped Hospital having tertiary care centre for abdominal surgeries, I.C.U unit, ventilator and skilled staff. Third complainant being final year M.B.B.S. Student knew very well that opposite party No.1 Hospital is the best Hospital in Rayalaseema for these kinds of surgeries. Opposite parties asserted that there was no negligence on their part either in conducting operation or taking post operative care. The allegations of negligence in the complaint are imaginary and ill motivated. The claim of complainant is also fanciful and exorbitant. In view of the above said reasons opposite parties prayed for the dismissal of the case with cost. 4. Both parties filed sworn affidavits. Ex.A1 to A8 are marked by complainant. Ex.B1 to Ex.B15 are marked by of opposite parties. Six third party affidavits and depositions of RW1 to RW4, RW6 and RW7 are also filed on behalf of opposite parties. 5. Both sides filed their written arguments and submitted oral arguments. 6. Now the points for consideration are: i. Whether the complainant made out any case to prove deficiency against opposite parties? ii. Whether the complainant is entitled for any reliefs? iii. To what relief? 7. The complainant attributing medical negligence on opposite parties alleging carelessness in treatment and management of illness of deceased Venkateswaramma in opposite party No.1 Hospital filed this complaint. The facts in the case in brief are that deceased Venkateswaramma who was in high risk state due to pain abdomen and refused by Vijaya Hospital and C.N. Hospital, Kurnool was referred to opposite party No.1 Hospital on 18-05-2011. Opposite party No.2 doctor diagnosed her illness as obstructed incisional hernia and admitted in opposite party No.1 Hospital on 18-05-2011 at 9.55 P.M. planning for surgery. Opposite party No.2 ordered some tests, antibiotic coverage and resuscitative measures to ascertain the fitness of the patient for surgery. Operation was performed on 19-05-2011 at 10.00 A.M. Dr.Ramanjaneyulu was anaesthesiologist. The operation done was gangrenous segment resection and end to end anastamosis. Drains were kept, abdomen closed and mash hernioplasty was done. Patient after surgery was kept in I.C.U. for three days and shifted to room. Opposite party No.2 doctor monitored the patient periodically. On the same day at 8.00 P.M. the patient developed respiratory distress. Again she was shifted to high dependency unit and treated. As the patient had good bowel sound, Ryle’s tube was removed and treated conservatively administrating culture based antibiotics and advising fluids and soft diet orally to initiate nutritional support. E.C.G. was taken Dr.Sivarajappa, Physician was called on 25-05-2011 and treatment advised by him was followed. As the drain was inadequately draining the leak and contaminating the wound the patient developed fever. So second surgery to do ileastomy and mucus fistula was planned for diversion of fecal stream, keeping compatible blood reserve. The surgery was commenced on 29-05-2011 at about 12.00 P.M. The surgery lasted six hours. The patient was shifted to high dependency unit at 6.00 P.M. and kept on mechanical ventilator support. Opposite party No.2 along with Dr.Ramanjaneyulu and I.C.U. staff continuously monitored the vital parameters of the patient. Unfortunately the patient suffered two heart attacks and died at 11.00 P.M. Dr.Shantiraj who was called by complainant to oversee the operation, present in the operation theater and in hospital from 5.00 P.M. till the dead body of deceased Smt.Venkateswaramma was shifted to their house by the complainant. Ex.A1 is ultrasound report of Abdomen Examination of Smt.Venkateswaramma, discloses that she was suffering from incisional hernia. Ex.A2 two E.C.G. reports taken on 18-05-2011 and 25-05-2011 together with a bunch of Prescriptions and Medical Bills. Ex.B3 referral letter of C.N. Hospital, Ex.B4 referral letter of Vijaya Hospital both are evidences that Venkateswaramma had under gone there surgeries prior to 18-05-2011, referred to opposite party No.1 Hospital in high risk state. Ex.B2 patient slip dated 18-05-2011. Dr.Rama Chandra Naidu, Diagnosed the illness of Smt.Venkateswaramma as obstructed incisional hernia, and planned for surgery. Ex.B1 Case Sheet of patient in two volumes. Ex.B6 to Ex.B10 test reports of Smt Venkateswaramma on various dates. Ex.A3/Ex.B5 Death Summary, Ex.A4 Death Certificate of Smt.Venkateswaramma. Ex.B14 and Ex.B15 Doctors notes of Dr.Sivarajappa and Dr.Ramanjaneyulu respectively. RW1 to RW4, RW6 and RW7 are depositions of five doctors. Ex.B11 to Ex.B13 are copies of educational qualifications of opposite party No.2 doctor. No expert doctor was examined nor his affidavit filed on record. The complainants attributing medical negligence on the part of opposite parties during the treatment of Smt.Venkateswaramma in opposite party No.1 Hospital by opposite party No.2 doctor listed the following deficiencies. 1. Delayed surgery to suit the convenience of opposite party No.2 doctor though it is surgical emergency. 2. Failure to exercise care and skill in performing surgery which led to anestamotic leak. 3. Failure to detect anestamotic leak early which led the case complicated. 4. Failure to prescribe antibiotics on the basis of blood culture. 5. Treated anestomatic leak by conservative method instead of laporatamy. 6. Not consulted physician immediately after the patient developed respiratory distress. 7. Failure to plan de-compressive therapy. 8. Failure to take pre operative care and anticipate post operative complications during second surgery. 9. Failure to explain high risk involved and takes consent from relatives or patient. 10. Failure to inform operation time correctly. Operation took six hours but time informed was 1½ hours. 11. Lack of I.C.U. facity, ventilator facility and skilled staff after second surgery and failure to refer to a better equipped Hospital. 12. Failure to reserve sufficient compatible blood anticipating adhesious and bleeding in second surgery. 13. Suppressed the table death of patient in operation theater and tried to fabricate that patient is alive. 14. Tried to refer the patient to other hospital at the last hour and shift the responsibility on others. It is stated that first complainant lost his wife, second and third complainants lost love and affection of mother. The complainants incurred Rs.5,00,000/- for treatment. They submitted that opposite parties are liable to pay Rs.10,00,000/- for causing mental agony. None of them are supported by any material and particulars. 8. Persual of submissions made by both parties and evidences on record including medical literature on the subject it is admitted that deceased Smt.Venkateswaramma was admitted in opposite party No.1 Hospital on 18-05-2011 at 9.55 P.M. with a complaint of pain abdomen and swelling. She had under gone three surgeries prior to her admission in opposite party No.1 Hospital. She was morbid obese. Her condition was stable but in high risk state. Vijaya Hospital and C.N. Hospital, Kurnool refused admission to her and referred to opposite party No.1 Hospital. Opposite party No.1 Hospital is a well equipped hospital having I.C.U., Functioning Ventilator and skilled staff. Ex.B3 and Ex.B4 disclose the above said fact. Dr.Rajasekar as RW2 and Dr.S.V.Rama Mohan Reddy as RW3 reiterated the same thing in their depositions. Opposite party No.2 doctor is director of opposite party No.1 Hospital. He is highly qualified surgical gastroenterologist, has done his M.S. and M.Ch. from A.I.I.M.S., Delhi. He has greatest skill to operate Venkateswaramma for the disease she was suffering from. Ex.B11, Ex.B12 and Ex.B13 are copies of his convocation Certificates. Opposite party No.2 doctor diagnosed obstructed incisional hernia on Smt.venkateswaramma and ordered for pre operative evaluation, antibiotic coverage and revival of intravascular volume to assertain her fitness for surgery. Surgery was performed on 19-05-2011 at 10.00 A.M. after a gap of 12 hours from the time of admission. As per medical literature, prior to surgical relief of obstruction, fluid and electrolyte replacement may be used exclusively. Surgical treatment though necessary shall be delayed until resuscitation is complete. The timing of surgical intervention of clinical advice is that “the sun should not both rise and set” on a case of unrelieved intestinal obstruction is sound unless there are positive reasons for delay. In case of obstruction secondary adhesious conservative management may be continued up to 72 hours in the hope of spontaneous resolution. Sourse: Treatment of acute intestinal obstruction chapter 69. Short Practice of Surgery - Bailey and Love. The first phase of treating enteroentrneous fistula is recognition/stabilization, for which time course permitted is 24 – 48 hours. Sourse: Page 191 – Maingot’s Abdominal surgery. In view of the above medical notes in the instant case performing surgery after 12 hours of admission is not a delayed surgery. Operation was successful, gangrenous segment resected and end to end anastamosis was done. Drains fixed to drain out fluids, mesh hernioplasty was done and abdomen closed. Ex.B1 is evidence. After surgery the patient was kept in I.C.U. Opposite party No.2 doctor continuously monitored her adducing antibiotic empherically. On third part operative day the patient was shifted to room. On the same day at 8.00 P.M. the patient developed respiratory distress. Immediately she was shifted to I.C.U. and treated by intensivist. Soon after receiving culture reports on 23-05-2011 Ex.B7, Ex.B8 and Ex.B9 culture evidence based antibiotics were administered. Affidavit of Dr.Srinivasa Rao, Microbiologist is a supporting evidence to it. On 25-05-2011 E.C.G. was taken and Dr.Sivarajappa am experienced physician was called and the treatment given by him was followed. Ex.B14 affidavit of Dr.Sivarajappa and his deposition as RW4 are on record to support the above said fact. So the allegation of complainant that physician was not consulted is false. As the patient had good bowel sounds and no vomiting, Ryle’s tube removed, oral fluids and soft diet was given to intiate nutritional support. Opposite party No.2 doctor Rama Chandra Naidu as RW1 stated that on 25-05-2011 anastomatic lack was detected and treated conservatively administering culture based antibiotics and giving fluids and soft diet orally. In the medical literature it is stated that anastomatic leak is common in patients with adhesious following previous operations. It is also stated that 70 - 90 % enterocutaneous fistulas occur in post operative period. One of the reason for this is disruption of ananstomoses due to adhesiolysis. Anastamotic leak cause loss of fluid minerals trace elements and protein. The daily amount of out put provides information regarding mortality, some times spoutomeous closures. Operative repair should be attempted only after a trial of conservation management. Attempting enteral feeding is most appropriate in most fistula patients. Drainge from fistula may be expected to increase with the commencement of enteral feeding, however spontaneous closure may still occur. Sourse : Pages 186 – 193 Maingots abdominal surgery. According to the above medical literature anastomatic leak in patients like Venkateswaramma is common. So it can not be said that the leak is due to improper surgery. Merely because leparatomy converted into conservative treatment it can not be said that the conservative treatment adopted by opposite party No.2 to deal leak was counter indicative. The leak management was tried in accordance with the standard procedure laid down by experts. Inspite of conservative treatment there was increase in leak and it was contaminating the mesh and wound because of inadequate drain. So opposite party No.2 felt that second surgery is required and it was performed on 29-05-2011. The patient was morbid obese. The operation was major. The relatives of patient were explained the high risk involved, by Dr.Ramanjaneyulu at 12.30 P.M. on 29-05-2011. The consent of the patient was taken. The alleged informed consent was lacking is false. The evidence is Ex.B1 case sheet Vol.II. Dr.Ramanjaneyulu anesthesiologist in the operation, advised the patient’s relatives to keep two bottles of compatible blood reserve. The same was noted in Ex.B15. The surgery planned was ileostamy and mucus fistula which was started at 1.15 P.M. on 29-05-2011. It was stated that there was dense adhesions between loops of ileum, dissection was done carefully. At the end of operation the patient was conscious but requiring respiratory support and ionotropie support to maintain blood pressure. The patient was shifted to ICU at 6.00 PM and she was kept on mechanical ventilator support. The operation took almost 6 hours. The OP.2 doctor stated that as the patient was morbid obese with thick abdominal wall it was difficult for him to bring out the bowl loop to abdominal surface, that created the delay during the surgery. Dr.Ramanjaneyulu who was witness in his affidavit and deposition as RW.6 also reiterated the same reason for the delay in operation room. In the medical literature it is stated that the definitive operative reconstruction of these complicated patients with gastro intestinal cutanious fistula requires the commitment of significant time and resourses. The surgical team should expect to be in operation room for up to 7 or 8 hours. Source: page 194 Maingots’s abdominal surgery. Dr.Santhiraju, Anaesthasiologist and family friend of complainant was called by the complainant at 5.00PM, present in operation room to oversee the operation and treatment. It was stated that opposite party No.2 doctor and Dr.Ramanjeneyulu along with other staff monitored vital parameters of the patient hourly in I.C.U. The allegation that opposite parties advised the complainants to shift the patient to Gowri Gopal Hospital is rejected to due lack of proof. The patient suffered first heart attack at 10.30 P.M. and resuscitated. Again she suffered another heart attack at 11.00 PM. and died. Dr.Ramanjaneyulu declared her dead at 11.30 P.M. on 29-05-2011. Ex.B15 contains all this data. Opposite parties stated that it is not table death. Dr.Santhiraju who come at 5.00 P.M. was in the hospital till the dead body of deceased Venkateswaramma was shifted to her home. In the affidavit and in deposition Dr.Santhiraj stated that late Venkateswaramma was conscious when she was shifted to I.C.U. at 6.00 P.M. It disclosed that her death was not in operation room. He witnessed her death at 11.00 P.M. So the allegation that opposite parties suppressed the table death of the patient Smt.Venkateswaramma in operation room is not acceptable. In medical litrature it is admitted that in enterocutaneous fistula cases the mortality remains high between 10 – 30% ref. Maingot’s Abdominal Surgery. The counsel for opposite parties filed few land mark judgments I (2010) CPJ 29 (SC), III (2005) CPJ 9 (SC), I (2005) CPJ 10 (NC), II (2010) CPJ 505 and I (2008) CPJ 354 to prove that there was no medical negligence on opposite party No.2. According to the citations on scrutiny of leading cases of medical negligence in our country and other countries some basic principles emerged to determine the guilty of negligence of medical professionals. Some of them are noted here. 1. Negligence in law is explained as some failure to do some act which a reasonable man in the circumstances would do or doing of some act which a reasonable man in the circumstances would not do. 2. Doctors negligence. A medical parctitioner who is consulted by a patient owes him certain duties namely, duty of care in deciding whether to under take the case, a duty of care in deciding what treatment to give and a duty of case in his administration of that patient. A breach of any of these duties will support on action for negligence. 3. Negligence has 3 components “duty”, “breach” and “resulting damage”. Breach is failure to attain standard of care prescribed by law. As long as doctors have performed their duties and excercise an ordinary proffessional skill and competence they can not be held guilty of medical negligence. 4. A medical practioner is not expected to achieve success in every case that he treats. The duty of the doctor like that of other professionals is to exercise reasonable skill and care. 5. A surgeon can not and does not guarantee that the result of surgery would invariably be benefited, the only assurance that he can give is that he is possessed of requisite skills in that field. While dealing whether the doctor is guilty of medical negligence the above said well settled principles must be kept in view. In the instant case, from the case history and other documents which are on record it is evident that all possible care was taken by opposite parties in respect of deceased Smt.Venkateswaramma prior, during and in the post operative period. Complainant has not been able to produce any evidence to point out imperfect surgery and post operative treatment by opposite parties. A mere allegation does not make the case solid and unflappable. The complainant on whom the burden of proof lies neither filed any affidavit or opinion form expert doctor nor examined expert doctor to assertain that opposite party doctor performed surgery carelessly and negligently. There is no force in complainant arguments. In view of the reasons stated above it is concluded that opposite party No.1 hospital and opposite party no.2 doctor, with all required facilities in the hospital attended the patient with utmost care, caution, skill and knowledge and the patient was treated with total devotion and dedication. Opposite party can not be held guilty of medical negligence in service by imagination. By applying the settled principles in dealing the cases of medical negligence this Forum holds that complainant failed to made out any case of medical negligence on opposite parties. 9. In the result the complaint is dismissed without costs. Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 26th day of June, 2013. Sd/- Sd/- LADY MEMBER PRESIDENT (FAC) APPENDIX OF EVIDENCE Witnesses Examined For the complainants : Nill For the opposite parties : RW1 to 4, 6 & 7 List of exhibits marked for the complainants:- Ex.A1 Photo copy of Examination of Abdomen Report of Smt.Venkateswaramma dated 18-05-2011 along with Scanning Report. Ex.A2 Photo copy of E.C.G. Reports dates 18-05-2011 and 25-05-2011along with A bunch of Prescriptions and Medical Bills. Ex.A3 Death Summary Report dated 29-05-2011. Ex.A4 Death Certificate of Late Smt Venkateswaramma issued by Registrar of Births and Deaths Kurnool Municipal Corporation, Kurnool District dated 17-06-2011. Ex.A5 Office copy of Legal Notice dated 15-11-2011. Ex.A6 Postal Receipts (Nos.2) Ex.A7 Postal Acknowledgements (Nos.2) Ex.A8 Reply Notice dated 08-12-2011. List of exhibits marked for the opposite parties:- Ex.B1 Case Sheet Smt.Venkateswaramma containing two Books. Ex.B2 Admission Slip dated 18-05-2011. Ex.B3 Referral Letter of C.N. Hospital dated 18-05-2011. Ex.B4 Referral Letter of Vijaya Hospital dated 18-05-2011. Ex.B5 Photo copy of Death Summery Report dated 29-05-2011. Ex.B6 Six Test Report of Deepak Tej Hospital. Ex.B7 Sputum Culture Report of Palanki Lab Sciences dated 23-05-2011. Ex.B8 Drain Fluid Culture Report of Palnki Lab Sciences dated 23-05-2011. Ex.B9 Blood Culture Report of Palanki Lab Sciences dated 23-05-2011. Ex.B10 E.C.G Report dated 18-05-2011. Ex.B11 Photo copy of M.B.B.S Provisional Certificate of OP.No.2. Ex.B12 Photo copy of Master of Surgery Certificate of OP.No.2. Ex.B13 Photo copy of M.Ch Certificate of OP.No.2. Ex.B14 Doctor’s Order dated 25-05-2011. Ex.B15 Doctor’s Order dated 29-05-2011. RW1 Deposition of Dr.K.Ram Chandra Naidu dated 14-03-2013. RW2 Deposition of Dr.K.Raja Sekhar dated 14-03-2013. RW3 Deposition of Dr.S.V.Ram Mohan Reddy dated 14-03-2013. RW4 Deposition of Dr.P.Siva Rajappa dated 14-03-2013. RW6 Deposition of Dr.M.Ramanjaneyulu dated 14-03-2013. Rw7 Deposition of Dr.G.Shanthi Raj, dated 14-03-2013. Sd/- Sd/- LADY MEMBER PRESIDENT (FAC) // Certified free copy communicated under Rule 4 (10) of the A.P.S.C.D.R.C. Rules, 1987// Copy to:- Complainant and Opposite parties : Copy was made ready on : Copy was dispatched on : | 
