IN THE CONSUMER DISPUTES REDRESSAL FORUM, KOLLAM
Dated this the 30th Day of January 2019
Present: - Sri. E.M.Muhammed Ibrahim, B.A, LL.M. President
Smt.S.Sandhya Rani, BSc,LL.B, Member
CC No.257/18
Gayatri Venugopal : Complainant
W/o Hareesh Hariharan
Vattothukuzhiyil, Palapra
Vengathanam P.O, Kottayam.
[By Adv.T.P.Satheesh]
V/s
1.Director : Opposite parties
Mary Queens Mission Hospital
Palampra P.O
Kanjirappally
Kottayam
2.Dr.Baby Nehru Zacharias
Gynaecologist, Mary Queens Mission
Hospital, Palampra P.O
Kanjirappally
Kottayam-686518
[By Adv.Sri.M.C.Suresh]
ORDER
E.M.MUHAMMED IBRAHIM , B.A, LL.M,President
This is a case based on a consumer complaint filed under Section 12 of the Consumer Protection Act.
The facts of the case in short are as follows.
The 1st opposite party is Mary Queen’s Mission Hospital, Kanjirappally. The 2nd opposite party is the doctor, who treated the complainant at 1st opposite party hospital. It is alleged that the complainant was admitted in the 1st opposite party hospital during the period of her pregnancy on 31.07.12 and on 01.08.12 at about 10.30, she gave birth to a male child. Later she was discharged on
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06.08.12. But on the next day, 07.08.12 at 6 p.m she has been again admitted at 1st opposite party hospital due to fever with chills and rigor from the day of discharge. But on that day the 2nd opposite party was on leave when the complainant was re-admitted. She was given various medicines by the then duty gynaecologist and lastly the 2nd opposite party reached at the hospital examined the complainant and informed that episiotomy wound of the complainant is gaping. According to the complainant she lost her capacity to retain stool and urine and noticed passage of stools through vagina along with urine on these days and thereby physical condition of the complainant was complicated and it caused danger to the life of the complainant. So she was forced to get discharge from the 1st opposite party hospital and got admitted at Amrita Institute of Medical Sciences and Research Centre, Cochin on 13.08.12. On 14.08.12 loop sigmoid colostomy has been done at AIMS and discharged on 22.08.12. On clinical examination at AIMS it was found that the complainant has bilateral hydroureteroneshrosis with over distended bladder and it was caused due to retention of large quantity of urine. According to the complainant, these abnormalities have caused due to the negligence of the opposite parties, and the same was caused due to the defects in the treatment of the 2nd opposite party. The post-delivery treatment of the opposite parties were defective. According to the complainant if she was not taken to the AIMS, her life would have lost, due to the negligent act of the opposite parties, and another surgery has also been recommended to be carried out during December 2012 at AIMS to cure defect caused by the opposite parties. According to the complainant, the act of the opposite parties are illegal unfair and unethnical and against the medical laws and regulations. And the above said act of opposite parties are also unfair trade practice and deficiency in service. Hence the complaint.
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Opposite parties resisted the complaint with tooth and nail. According to them the complaint is not maintainable. However opposite party 1&2 would admit that the complainant consulted the 2nd opposite party from 28.05.2012 onwards that her expected date of delivery (EDD) was on 29.02.12. She brought a USG report dated 30.12.11, which showed Single Line Intra Uterine Foetus(SLIUP) of 7 week with corrected EDD on 19.08.12. On the basis of Glucose Tolerance Test she was diagnosed to have Gestational Diabetes Mellitus and underwent treatment for GDM as per the physician’s advice. She was on continuous insulin treatment till delivery after repeated periodic blood sugar estimation. Then on 12.07.12 she reported with complaints of generalized itching all over body which was treated as per advice of physician and dermatologist. Thereafter she was admitted at the 1st opposite party hospital on 31.07.12 for elective labour induction in view of her GDM. Under all aseptic care and precautions, Foley’s catheter was inserted extra amniotically at 12.50 p.m and Pitocin drip started at 6 A.M on 01.08.12. At about 8.15 a.m, the 2nd opposite party conducted per vaginal examination and artificial rupture of membrane was done. As per PV findings, cervix was fully effaced, 5 cm dilated, clear liquor drained and pelvis appeared normal. And she had delivered a male baby weighing 2.8 kg with right medio lateral episiotomy at 10.20 am on 01.08.12. While suturing episiotomy a small tear was detected on the rectal mucosa and the same was sutured with 1-0 catgut. Episiotomy was sutured in layers and the patient was put on Cap. Ampiclox 500 mg, T.Emanzen D1,Cap.Brodvit G1, and T Dulcolax 2 for soft evacuation. The postpartum period was eventful and she passed motion regularly and her blood sugar examination postpartum period showed normal result. Then she was discharged on 06.08.12 with advice to continue T.Dulcolax.
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It is further contented that on 07.08.12, the complainant again came to the casualty in the 1st opposite party hospital with fever. As the 2nd opposite party was on leave on that day another gynaecologist Dr.Leela George Chandy attended the complainant and as per clinical history complainant was having straining at stools most probably she might have discontinued Tab.Dulcolax which was prescribed for soft evacuation. On examination she was found to have urinary tract infection and rectovaginal fistula(RVF) and prescribed inj.Taxim,inj.Metrogyl and other supportive measures. Thereafter on 10.08.12 the 2nd opposite party was examined the patient and treatment continued for Urinary Tract Injection (UTI) with injection of episiotomy wound and rectovaginal fistula. Then the complainant was referred for surgical consultation and the surgeon advised suturing after settling the infection under antibiotics prophylaxis. And she was advised RVF repair after controlling infection. The UTI and episiotomy infection was getting under control by conservative line of management under antibiotics. While the patient was recovering from infection, the bystanders insisted for discharge from the hospital to take the patient to AIMS Kochi. So she was discharged for further treatment in higher centre as per request and issued a detailed discharge summary. According to the opposite parties the occurrence of teat on rectal mucosa is a reported known complication in vaginal delivery with RML episiotomy and the complainant was managed with due care and caution as per accepted line of treatment for the diagnosed UTI and episiotomy infection and recto-vaginal fistula.
According to opposite party 1&2 the allegation of the complainant that she had chills and rigor from the day of discharge is false. The bilateral mild bydroureteronephrosis detected on 17.08.12 can hardly be correlated to treatment given at the 1st opposite party hospital as it is likely to be secondary to urinary retention/distended bladder developed while she was under treatment
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in the higher centre. The retention of urine developed in post colostomy period. It is further contented that there was no fault or failure on the part of the 2nd opposite party in the management of delivery of the patient and RML episiotomy is a routine procedure in vaginal delivery which was carried out with due care and caution. The complainant was given adequate care and treatment with proper antibiotics and supportive measures based on proper investigations. Suturing was adequate and proper as evident from the fact that she was passing motion normally during post partum period till discharge and had no complaints and she was continuing medicines for soft evacuation. The subsequent infection can cause detachment of suturing leading to RVF which is a reported known complication and which was not caused due to any act or omission on the part of the 2nd opposite party. So subsequent treatment of the complainant was not necessitated by any negligence on the part of the 2nd opposite party. According to the opposite parties there is no deficiency in service or unfair trade practice on the part of opposite parties in the treatment of the complainant. The 2nd opposite party is having qualification of MBBS,DGO with experience of 25 years as a Consultant Gynaecologist. The opposite parties prayed for the dismissal of the complaint with cost.
CDRF Kottayam has recorded evidence of both sides. Evidence on the side of the complainant consists of the oral evidence of PW1, PW2, Ext.A1 to A11 and Ext.X1 and X2 documents. Evidence on the side of the opposite parties consists of the oral evidence of DW1 and Ext.X3 document.
Originally the complaint was filed before the CDRF, Kottayam by Gayathri Venugopal. The complaint was taken into file as CC.351/12 by that forum. After recording evidence the complaint was dismissed by the then President of CDRF, Kottayam. But two members differed in their decision and wrote a descending note and allowed the complaint directing the 1st and 2nd
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opposite parties to pay a sum of Rs.8,05000/- jointly and severally to the complainant within 30 days of the receipt of order.
Aggrieved by the above inconsistent orders the opposite parties preferred Appeal No.1/2018 and later the complainant filed Appeal No.179/18. The CDRC, Thiruvananthapuram disposed off both the appeals together vide common judgement dated 30.05.18 by setting aside the order and the descending order and remanded the complaint and also transferred the complaint from CDRF Kottayam to this forum with a direction to pass appropriate orders after recording findings on evidence tendered in the case, as expediously as possible, at any rate, within a period of three months from the date of receipt of the case records and appearance of parties.
The case records has been received by this forum on 19.11.18 and the complaint was taken into file in the present number. In response to the notice both parties appeared before the forum on 05.12.18.
Both sides have filed notes of arguments. Heard both sides.
Points for consideration are:-
1.Whether there is any deficiency in service or unfair trade practice on the part of the opposite parties?
2.Whether the complainant is entitled to get the reliefs sought for?
3.Relief and costs.
Point No.1&2
For avoiding repetition of discussion of materials these two points are considered together. The complainant has been examined as PW1. She has given evidence in tune with his complaint and proves Ext.A1 to A11, Ext.X1 & X2 documents. According to PW1 she was admitted in the 1st opposite party hospital during the period of her pregnancy on 31.07.12 that the 2nd opposite party Gynaecologist has attended and treated her that on 01.08.12 at about 10.30 am she gave birth to a male child and thereafter on 06.08.12 2nd opposite
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party discharged her. But on the next day (07.08.12) at about 6.00 pm she has been re-admitted at the 1st opposite party hospital due to fever with chills and rigor from the day of discharge and at that time the 2nd opposite party doctor was on leave. However the complainant was admitted again at the 1st opposite party hospital and given various medicines by the then duty Gynaecologist. Lastly when the 2nd opposite party arrived at the hospital on the next day examined her and informed that episiotomy wound of the complainant is gaping. According to PW1 she lost her capacity to retain stool and urine and noticed passage of stools through vagina along with urine on these days and thereby physical condition of the complainant became complicated causing danger to her life. So she managed to obtain discharge from the 1st opposite party hospital and got admitted at Amrita Institute of Medical Sciences and Research Centre, Cochin on 13.08.12. On the next day ie, on 14.08.12 loop sigmoid colostomy has been done and after necessary treatment discharged on 22.08.12. According to PW1 on clinical examination at AIMS it was found that the complainant has bilateral hydroureteronephrosis with over distended bladder and it was caused due to retention of large quantity of urine. PW1 has specifically sworn that these abnormalities have caused due to fault of treatment by the 2nd opposite party at the 1st opposite party hospital. According to PW1 the post-delivery treatment of the opposite parties were defective and if she was not taken to AIMS her life would have been lost, due to the inaction as well as defective treatment of the opposite parties. PW1 has also deposed that she has incurred huge expenses and even now her treatment was going on due to the negligent act of the opposite parties that another surgery also has been done during the month December 2012 at AIMS to cure defects in the treatment caused by the opposite parties. According to PW1 the act of the opposite parties are illegal, unfair, unethical and against the medical laws and regulations which amounts to unfair trade practice and deficiency in service.
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Inspite of lengthy cross examination, nothing material has been brought out to discredit the above version of PW1.
The opposite parties would admit that the complainant was a patient at the 1st opposite party hospital and the 2nd opposite party treated her right from 28.05.12. Her expected date of delivery(EDD) was on 29.07.12. It is brought out in evidence that on the basis of Glucose Tolerance Test the complainant was diagnosed to have Gestational Diabetes Mellitus and underwent treatment for GDM as per the physician’s advice. She was on continuous insulin treatment till delivery after repeated periodic blood sugar estimation. She was admitted to the 1st opposite party hospital on 31.07.12. Under all aseptic care and precautions, Foley’s catheter was inserted extra amniotically at 12.50 pm and Pitocin trip started at 6 am on 01.08.12. At about 8.15 am the 2nd opposite party conducted per vaginal examination and artificial rupture of membrane was done. Ultimately she delivered a male baby weighing 2.8 kg with right medio lateral episiotomy at 10.20 am on 01.08.12. While suturing episiotomy a small tear was detected on the rectal mucosa and the same was sutured with 1-0 catgut. Episiotomy was sutured in layers and she has been given necessary medicines for soft evacuation. The post-partum period was eventful and she passed motion regularly and her blood sugar examination post-partum period showed normal result and she was discharged on 06.08.12 with advice to continue T-Dulcolax.
It is also brought out in evidence that on 07.08.12 the complainant was brought again to the casualty in the 1st opposite party hospital with fever. As the 2nd opposite party was on leave on that day another gynaecologist Dr.Leela George Chandy attended the complainant and as per clinical history the complainant was having straining at stools. On examination she was found to have urinary tract infection and rectovaginal fistula (RVF) and prescribed inj.Taxim, Metrogyl and other supportive measures. On 10.08.12 the 2nd
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opposite party was examined the complainant and continued the treatment for Urinary Tract Infection(UTI) with infection of episiotomy wound and ectovaginal fistula. Then the complainant was referred for surgical consultation and the surgeon advised suturing after settling the infection under antibiotics prophylaxis. She was advised RVF repair after controlling infection. The UTI and episiotomy infection was getting under control by conservative line of management under antibiotics. According to opposite party 1&2 while the patient was recovering from infection, the bystanders insisted for discharge from the hospital to take the patient to AIMS, Cochin. Hence she was discharged for further management at higher centre as per request and also issued a detailed discharge summary. The opposite parties would further content that occurrence of tear on rectal mucosa is a reported known complication in vaginal delivery with RML episiotomy and the complainant was managed with due care and caution as per accepted line of treatment for the diagnosed UTI and episiotomy infection and recto-vaginal fistula. According to the opposite parties the allegation of the complainant that she had chills and rigor from the day of discharge is false, that there was no fault or failure on the part of the 2nd opposite party in the management of delivery of the patient and RML episiotomy is a routine procedure in vaginal delivery which was carried out with due care and caution.
The oral evidence of PW1 regarding medical negligence and deficiency in service on the side of 2nd opposite party doctor stands corroborated by the oral evidence of PW2 is Sudheer.O.V, the doctor who treated the complainant at AIMS and issued Ext.A9&A10 certificates. The evidence of PW2 would show that the delivery of the complainant was FTND episiotomy was normally conducted. If a person has been subjected to RML episiotomy and done FTND normally there is no chance of any complication. However the complainant has sustained obstetric trauma as a result of the obstruction caused by the head of
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the baby while delivery. Usually in such circumstance by using forips or using vacuum child can be taken out. If no child birth instrument is used in such circumstance there is chance of trauma. He would further admit that as per Ext.X1 nurses daily record Page No.39 patient was discharged on 13.08.12 and it is written that patient was having no complication. It is also recorded in Ext.X2 documents that after 5th day of delivery the patient has told that stools has been entered in vagina and on his examination that fact was convinced. No medicine has been administered for that ailment. But the patient was referred to PW2. PW2 would further admit that in Ext.A1 there is no endorsement to the effect that there was 4th degree perennial tear. It is also seen from Ext.A2 that the complainant has sustained urinary infection if perennial laceration has not been dictated in time there is chance for causing RVF. In order to repair of the injury of RVF RPAIDF surgery done with the help of a plastic surgery. Though there are several method of treatment , surgical method is highly necessary. According to PW2 even after laying in the position flap the decease has not become cured. There was the leak between rectum and vagina persisted and stool was coming from the opening of rectum and vagina. After about 3 years treatment only the above ailment has become cured. The complainant has been subjected to 5 operations. There was blind tract and therefore there is chance for coming discharge. PW2 has further deposed that during his 17 years professional experience, he had handled such a complicated patient like the complainant for the 1st time. According to PW2 after dictating RVF colostomy has been done immediately and the same could have been done at the 1st opposite party hospital also. If it is delayed the condition of the complainant would become miserable and there is chance for infection. PW2 has categorically deposed that if the complainant has brought to the AIMS wherein he has been working with RVF he would have given colostomy treatment immediately. PW2 would further admit that after delivery the stool and urine
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coming through vagina is not a silly disease. According to PW2 what is written in Ext.X1 nurses report to the effect that the patient was not having any complaint is incorrect. It is brought out during cross examination of PW2 that the ailment of the patient has been detected by him by physical examination and also as narrated by the complainant that when he examined the patient he noticed RVF and on 10.08.12 he has noted that fact in the case sheet.
The 2nd opposite party who treated the complainant has been examined as DW1. He has deposed in tune with the contention of the opposite parties. According to DW1, the complainant was given adequate care and treatment with proper antibiotics and supportive measures based on proper investigations. The subsequent infection can cause detachment of suturing leading to RVF which is reported known complication and which was not caused due to any act or omission on the part of the 2nd opposite party. According to DW1 that subsequent treatment of the complainant was not necessitated by any negligence on the part of the 2nd opposite party doctor and there is no deficiency in service or unfair trade practice on the part of the opposite parties. It is also brought out in evidence that the 2nd opposite party is having qualification of MBBS, DGO with experience of 25 years as a consultant Gynaecologist. According to DW1 he has never deviated from any accepted medical practice at any point of time in the treatment of the patient, that the occurrence of complication necessitating further treatment and expenses is not sufficiency to hold the medical practitioner liable for compensation.
In view of the oral evidence of PW1 and PW2 it is clear that the complaint in connection with her delivery at the 1st opposite party hospital has sustained severe complications due to the negligence and laxity on the part of opposite party 2 who treated her and has undergone continuous treatment for about 3 years .
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The learned counsel for the complainant by relying on the dictum laid down by the Hon’ble Supreme Court in Krishna Rao Vs Nikhil Super Speciality Hospital and another reported in 2010(5)SCC 5B has argued that in a case , negligence is evident, the principle of Res Ipsa Loquitor operates and the complainant does not have to prove anything as the things (res) proves itself. In such circumstance the opposite party doctor has to prove that he has taken care and caution and done his duty to repel the charge of negligence. It is well settled that once the initial burden has been discharged by the complainant by making out a case of negligence on the part of the hospital or the doctor concerned, the onus of proof shift on the hospital and the treating doctor has to satisfy the court that there was no lack of care or diligence.
Now we shall consider whether the opposite parties have discharged their burden. The doctor and hospital has to anticipate problems arising out of complications especially when the complainant was a diabetic patient and had to take precautionary measures. Now it is to be considered whether there is any deficiency in service ie, unsatisfactory service on the part of the treating doctor and the hospital. In other words it is to be considered whether the manner of treatment administered by 2nd opposite party is not as required. In view of the facts and circumstance of the particular case the learned counsel for the opposite parties have argued that every medical procedure involves risk and the benefit of the mankind conferred by medical science are attended by the risk and we cannot take the benefits without taking the risk.
In view of the materials available on record it is clear that the complainant delivered a male baby weighing 2.8 kg with right medio lateral episiotomy at 10.30 am that the operation stared at 8.15 am on 01.08.12 and the delivery was at 10.20 am and 2 and odd hours has been taken in the delivery. It is also brought out in evidence while suturing episiotomy a small tear was detected on the rectal mucosa and the same was sutured with 1-0 catgut.
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Episiotomy was sutured in layers and the patient was given capsules. However no explanation is forthcoming as to the reason for the small tear on the rectal mucos. The 2nd opposite party doctor could have anticipated problem arising out of the complication and could have resorted to various other methods to pull out the child from the womb without spending that much time. It is clear from the available materials that due to the above injury sustained the stool was mixed with urine and came out through vagina which according to PW2 is very serious and the complainant had to suffer untold miseries. It is also brought out in evidence that Recto vaginal Fistulas are often the result of trauma during
child birth, were improper medical interventions used such as episiotomy with forceps/vacuum extraction or in situations were there is inadequate healthcare. In the case of the complainant it was dictated that there was tear and mucosa. Therefore it is clear that the artificial rupture made by the 2nd opposite party is so extensive and wide. It cut the rectum also and as a result flatulence and faces were escaping through vagina.
It is true that in Ext.X3 opinion of the medical board it is reported that Recto Vaginal Fistulas is a known complication of vaginal delivery. According to medical board the above complication was repaired primarily. The medical board report has been vehemently opposed on behalf of the complainant by stating that the opinion expressed by the medical board is not in tune with the facts and circumstances of the case of the complainant and the same has been issued without any physical examination of the complainant only with a view to assist the 2nd opposite party doctor from the alleged negligence. In the light of the facts and circumstances available on record the above arguments cannot be brushed aside.
The oral evidence of PW2 doctor who treated the complainant and issued Ext.A9 certificate would indicate that obstetric trauma resulted in perennial tear and recto vaginal fistula which is a defect which requires surgery. According
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to PW2 if perennial laceration is identified in proper time, there is every chance of Recto vaginal Fistula. Admittedly the medical board has expressed its opinion without conducting any physical examination of the complainant. It is an admitted fact that the 4th degree perennial tear during FTND on 01.08.18 is artificial. As it has become so wide and lengthy that it cuts the anus also while making the tear by the 2nd opposite party. In the circumstance and also in view of the oral evidence of PW2 the opinion of the medical board that recto vaginal fistula is known complication of vaginal delivery cannot be accepted at all. It is clear from the available materials it has occurred out of the negligence of the 2nde opposite party in making the rupture in the membrane leading to vagina to rectum which has not been taken into consideration by the Medical Board.
In view of the facts and circumstance of the case it is clear that there is deficiency in service and medical negligence on the part of the 2nd opposite party doctor who treated the complainant at the 1st opposite party hospital . It is clear from the available materials that the 1st opposite party is the hospital wherein the complainant has undergone treatment from 31.07.12 to 22.08.12. The 1st opposite has employed the 2nd opposite party doctor who treated the complainant. It is clear from the available materials that there is negligence and deficiency in service on the part of the 2nd opposite party in treating the complainant. Hence the 1st opposite party hospital is having vicarious liability for the negligent treatment of the 2nd opposite party. Hence the 1st opposite party is legally bound to indemnify the 2nd opposite party who is an employee of the 1st opposite party. In the circumstance both opposite parties are jointly and severally liable to pay compensation and costs if any awarded to the complainant. The point answered accordingly.
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Point No.2
It is clear from the available materials that due to the negligent treatment of the 2nd opposite party the complainant has to suffered a lot. She had been bedridden for about 3 years. In view of Ext.A11 series to A13 series medical bills it is clear that the complainant had spent a huge amount to the tune of Rs.579194/- to meet the medical expenses. The learned counsel for the complainant has further argued that the complainant though cured from her illness now she has been suffering destitution. Her husband has filed OP divorce and OP (G&W) before the Family court, Ettumannoor and now she has been living along with her child under the mercy of her aged parents andnow her life is in a pathetic condition. However there is absolutely no evidence either oral or documentary to prove that her husband has neglected to maintain her nor filed OP divorce and OP (G&W) as argued by the learned counsel for the complainant. It is clear from the available materials that as a result of the negligent treatment of the 2nd opposite party at the 1st opposite party hospital the complainant has to suffer a lot she was bedridden for about 3 years apart from the monitory loss sustained by her as evidenced by Ext.A11 series to Ext.A13 series documents. In the circumstances we are of the view that the complainant is entitled to get a substantial amount as compensation including medical expences, mental agony and other financial loss. In view of the facts and circumstances of the case physical ailment and mental agony and financial loss suffered by the complainant we are of the view that compensation to the tune of Rs.10,00,000/- (Ten Lakh) will be reasonable and sufficient. The point answered accordingly.
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Point No.3:-
In the result the complaint stands allowed directing the opposite parties to pay compensation to the tune of Rs.10,00,000/- (Ten Lakhs) to the complainant within 45 days from the date of receipt of a copy of this order failing which the complainant is at liberty to recover Rs.10,00,000/- with interest @ 9% p.a from the date of complaint till realisation from opposite party No.1&2 jointly and severally and from their assets.
The complainant is also allowed to recover Rs.10,000/- as costs of the proceedings from opposite party No.1&2 and from their assets.
Dictated to the Confidential Assistant Smt. Deepa.S transcribed and typed by her corrected by me and pronounced in the Open Forum on this the 30th day of January 2019.
E.M.Muhammed Ibrahim:Sd/-
S.Sandhya Rani:Sd/-
Forwarded/by order
SENIOR SUPERINTENDENT
INDEX
Witnesses Examined for the Complainant:-
PW1 : Gayathri Venugopal
PW2 : Dr.Sudheer.O.V
Documents marked for the complainant
Ext.A1 : Discharge Summary
Ext.A2 : Discharge summary from AIMS dated 22.08.12.
Ext.A3 : Discharge summary from AIMS dated 25.09.12
Ext.A4 : Discharge summary from AIMS dated 10.02.13
Ext.A5 : Discharge summary from AIMS dated 26.04.13
Ext.A6 : Discharge summary from AIMS dated 29.05.13
Ext.A7 : Discharge summary from AIMS dated 19.06.14
Ext.A8 : Discharge summary from AIMS dated 06.07.14
Ext.A9 : Certificate issued by Dr.Sudheer.O.V of AIMS.
Ext.A10 : Certificate issued by Dr.Sudheer.O.V of AIMS.
Ext.A11 series : Medical bills
Ext.X1 : Medical records from Mary Queen Mission Hospital
Ext.X2 : Medical records from AIMS
Witness examined for the opposite party:-
DW1 : Dr.Baby Nebu Zacharia
Documents marked for the opposite party
Ext.X3 : Opinion of Medical Board dated 01.11.14
E.M.Muhammed Ibrahim:Sd/-
S.Sandhya Rani:Sd/-
Forwarded/by Order
SENIOR SUPERINTENDENT
