By: Sri. Mohandasan K., President
Complaint in short is as follows: -
1. The wife of the complainant Mrs. Ancy was having abdominal pain, was taken to the first opposite party. After serious of various tests and examinations the first opposite party stated that there is cyst in the ovary and it is to be removed by a simple operation. The first opposite party and her husband who also a doctor stated that there are two types of operations. One is an opened procedure and the other is laparoscopic procedure. It was stated that if the open operation is done the period of stay in hospital and house will be longer. The procedure and the after period will be painful. So, the laparoscopy is the ideal operation which requires minimum stay and less pain. The complainant is having minor children and so the complainant decided to agree for laparoscopic procedure even though the same is very costly. The first opposite party and her husband detailed the procedure and stated that the operation is a simple one and the patient can go house on the third day. There on be need of blood, the wound will be minimum, there on be any risk and there will be less pain are the advantages spoken to by the first opposite party. The first opposite party stated that the charge will be Rs.30,000/- and the total cost will be around Rs.60,000/-. If laparoscopy is done and Rs.20,000/- will be charged if open operation is done along with other expenses. The complainant and his wife believed the promises and the assurance given by the first opposite party. The first opposite party and her husband, the second opposite party stated that the hospital is having all facility to tackle any emergency and they are having experts’ staff and doctors. They having a laparoscopic surgeon to do the operation. The first opposite party admitted the wife of complainant in Prasanthi Hi tech hospital owned by the opposite parties on 07/02/2021. The tests were done and the first opposite party stated that everything is fine. On 08/02/2011 at about 2 pm the patient was taken in to operation theatre and the first opposite party doctor informed that the operation will be done by 5 pm. At about 8 pm the first opposite party doctor contacted the complainant and his son and stated that blood is needed. The complainant and son contacted the blood bank and purchased two sachets of blood. When the complainant enquired why the blood was needed, the first opposite party doctor stated that the laparoscopy procedure was a failure and she done open operation and that is why the blood was needed and everything is all right. The said procedure was done without the consent of the complainant or any other person. The complainant and son was standing outside whole day and the first opposite party not informed these facts to them. No consent was obtained. When the complainant insisted to see his wife the first opposite party given permission to see her a glimpse. The complainant and son were waiting outside were Ancy was admitted and it was seen that the portable scanning machine was brought to the room where Ancy was lying, a number of times in the night. No information is given by the opposite party or other nurses. No information was passed regarding the status of the patient. It was informed that the laparoscopic surgeon was not came and the operation was done by the first opposite party alone with the help of her husband, the second opposite party. In the morning of 09/02/2011 the complainant requested the first opposite party doctor to see his wife. The first opposite party stated that she needs two more bottle of blood. The complainant brought two more bottles of blood and requested the first opposite party to see his wife. After much pleading the first opposite party consented to see the wife and she was seen very weak and not able to talk. The condition was not seen well. The complainant contacted the first opposite party and enquired is there any problem. The complainant stated that if anything is wrong, he wants to take her to medical college. The first opposite party stated that there is bleeding and no need for worry, she will be all right. The complainant believed the assurance and promises. Even though requested, no permission was given to see the patient afterwards. The nursing staff was arrogant and they were not ready to hear anything. No details were given and the first opposite party doctor was not seen anywhere thereafter. On 10/02/2021 after requesting the complainant was allowed to see Ancy. She was not well and not responding and then the complainant contacted the first opposite party and enquired what happened to her. The first opposite party stated that the laparoscopy procedure was failed and she done an open operation and that also failed. The condition of the patient is not good and directed the complainant to take her to a good hospital. The first opposite party stated that the hospital is not equipped to meet emergency. The first opposite party wrote a letter to medical college hospital, Kozhikode and there after she changed her mind. She said that the Moulana Hospital in Perinthalmanna is also equipped to meet emergency case and she will inform the details to the doctors there for further steps. The bills as demanded were paid in time to the opposite parties. The first opposite party arranged an air-conditioned ambulance with nurses. The patient was taken in to Moulana hospital as directed by the first opposite party. She informed that she had arranged everything there in the hospital. The patient was in a bad condition. She was not responding and the doctor stated that the bleeding is still there. When the patient and complainant reached there in Moulana hospital, Perinthalmanna, a team of doctors and nurses were waiting there and immediately the patient was taken in to the operation theatre. Dr. Mahadevan informed that some vein or something is cut during the operation and in order to correct the same immediate surgery is needed. The hospital authorities stated that Rs.47,000/- is need for the operation. The same was paid and emergent operation was done. The doctors working in the Moulana hospital allowed the complainant to see the wife who is seen admitted in SICU. She was seen sleeping after the operation. The complainant was allowed to see his wife Ancy on 11/02/2011 and 12/02/2011. On 13/02/2011 when the patient was seen she talked to the complaint. On 01/12/2021 and 15/02/2021 also the wife was seen better and she talked to complainant. The complainant was directed to arrange blood during these days and the same was arranged. The patient was seen improving but she was weak. During this day bleeding was there and blood was given to her. On 18/02/2011 it was informed that she is having breathlessness and immediate surgery was done but she died on the same day at 3.45 PM. The patient was under the care of the doctors of the Moulana hospital, Perinthalmanna. Ancy died from Moulana hospital and the complainant informed these matters to police. The postmortem was done at Kozhikode medical college and she was taken in to Marthoma hospital Chungathara and kept in mortuary for a day. She was criminated thereafter. The Perinthalmanna Police registered crime number 198/2011 and investigation is pending in the matter. The first opposite party negligently done the operation and cut two veins causing bleeding. Thereafter without consent she done an open operation and kept the patient under her care without any expertise. The hospital was not equipped to meat such emergency and finally when the patient was about to die, she was directed to go to a good hospital. Had there any negligence on the side of first opposite party, the second opposite party is liable for the acts of the first opposite party. The treatment and nursing service was very bad and below quality. The complainant and wife were enticed by first opposite party to do the laparoscopic procedure stating the same is a simple procedure and they are having laparoscopic surgeon. It was further alleging that in the hospital of the second opposite party, laparoscopic surgeon was there and, in his absence, the first opposite party done the operation. She is not having enough expertise and she cut veins negligently and bleeding occurred. On account of her negligence the patient was blooded to death. The information was concealed from the knowledge of the complainant till the condition was worsened. There was pubic agitation and there was protest. The same were resisted by the opposite parties by force and influence. The negligent act done by the first opposite party was the sole reason for the death of Ancy, the wife of complainant. The complainant and three children were put to suffer irreparable loss and hardship. The complainant spent Rs.2,00,000/- for the treatment. The blood was purchased from Thrissur once, two times from Kozhikode, Ambulance was arranged two times. The body was taken for Kozhikode MCH for postmortem, the complainant and children were staying in hospital for days, there was much hardship, and finally they lost everything. The sole reason for all these were the negligence of first opposite party. Had she been vigilant and proper action was taken in time, the life ought to have saved. She concealed everything from the complaint. The complainant requested the opposite party to issue a copy of the case sheet. The first opposite party and her husband, the second opposite party behaved in the rude manner and stated that no records are available. The first opposite party stated that she will make records to counter any claim if made. The opposite parties were behaved in haste manner possible and they know that they have committed gross deficiency in service. The complainant lost his wife. The three children lost their beloved mother. She was aged only 43 years and she was healthy. The first opposite party done illegal act with negligence, that caused the death of Ancy. The opposite parties are jointly and severally liable to compensate the complainant. The complainant restricts the claim for Rs.16,00,000/- as compensation, Rs.2,00,000/- towards the treatment, Rs.1,00,000/- for other expenses incurred by the complainant. The opposite parties made advertisements and public representation that their hospital is Hi tech with all facilities. In reality the same is not existing and even the medical records are not given to patient during the treatment. The opposite parties were concealing everything from the complainant. The complainant was enticed by the words of opposite parties when consulted at first time and during the counseling’s before operation. They were stating lie and the complainant lost everything. Hence the complainant prays for an order as stated in the complaint.
2. On admission of the complaint notice was issued to the opposite parties and on receipt of notice they entered appearance and filed detailed version denying the entire averments and allegations in the complaint. The opposite parties submitted that the complaint is not maintainable either in law or on fact, frivolous, vexatious and devoid of truth or bona fides. There is no negligence or deficiency in service on the part of the first opposite party and the complainant is not entitled to get any relief as prayed for in the complaint.
3. The complaint is bad for non-joinder of necessary party. The facts of the complaint shows that the first opposite party referred the patient to Medical College Hospital, Kozhikode on 10/02/2011, when the complainant insisted for a reference to higher center. But the complainant took the patient to Moulana hospital, Perinthalmanna and treated there from 10/02/2011 to 18/02/2011 and patient died while under the treatment of the said hospital due to the multi organ failure. Due to disseminated intravascular coagulation as per post-mortem findings. Hence the submission of the opposite parties is that Moulana Hospital, Perinthalmanna is also a necessary party to the proceedings as the modality of treatment of the patient from 10/02/2011 to 18/02/2011 as got vital importance to be considered for a just and reasonable disposal of the issue.
4. The opposite party submitted that the complaint is purposely framed by suppressing the true facts solely for the undue financial advantage of the complainant. The opposite party submitted that the patient named Ancy came to the second opposite party hospital and consulted the first opposite party in the outpatient department on 04/02/2011 with compliant of dull acting pain on left lower abdomen for 2-3 years. The patient had a history of consultation with some other doctors for the same complaint and she was advised to undergo surgery. On examination she was diagnosed to have left ovarian cyst with internal Echoes. Based on the diagnosis the patient was advised surgery for removal of ovarian cyst. The first opposite party explained the merits and demerits of both open and laparoscopic ovarian cystectomy to the patient and her relatives and they opted for laparoscopic surgery as it requires minimum hospital stay. But the first opposite party also informed the patient and her husband about the circumstances like presence of thick adhesions and chance of unexpected bleeding etc. under which the laparoscopic procedure should have been converted to open surgery. Hence after fully conversant with the prose cons of laparoscopic surgery for cyst removal, the patient got admitted to the hospital on 07/02/2011. The patient under went all necessary pre operative anesthetic assessment and evaluation and found fit for surgery. The patient and her husband voluntarily gave written informed consent for laparoscopic surgery and for conversion to open surgery if intra operatively necessitated due to adhesions, bleeding etc.
5. The opposite party under all aseptic care and precautions conducted laparoscopic surgery at 9 PM on 08/02/2011. Intra operatively then adhesions and fibrosis found on the ovarian cyst in the left adenexe. While carefully releasing adhesions, excessive bleeding occurred from the left lateral wall. As attempt to stop bleeding laparoscopically failed and the surgery was converted to laparotomy. There was bleeding from left lateral wall of cyst. Blood collected in the pelvic cavity sucked out and bleeding site was clamped. The ovarian cystectomy became difficult than expected owing to the presence of dense adhesions. There was slight bleeding from left lateral pelvic wall which was sutured with catgut and bleeding controlled. The abdomen was closed after putting suction drain and the specimen sent for histopathology. The patient was shifted to post operative ward and put on ventilator support for two hours. The patient had been kept under close observation and monitoring. The complainant and other relatives were informed about the occurrence of bleeding and conversation to laparotomy for completing procedure. Four units of red cell concentrate and Four units of fresh frozen plasma were transfused on the same day. All vital parameters checked and assed periodically. On 09/02/2011 her vitals remained normal and urine output was satisfactory and drain showed minimal collection. On examination abdomen was found soft and no distension. Hence the first opposite party advised USG examination and the report showed minimal free fluid in the abdominal cavity. One unit of red cell concentrate was given and anti-biotic and analgesics medication continued. The condition of the patient remained stable during the first and second post operative day. On 10/02/2011, 3 units of red cell concentrative were given. As the drain showed 400 ML fluid collection and platelets count was found low. The first opposite party advised platelets transfusion and re-laparotomy in view of drained fluid. The condition of the patient and the need for re exploration was discussed with the bystanders and the bystanders requested for reference to higher center. The patient’s BP, SPO2 and other vitals remained normal. As per the request the patient was referred to medical college hospital Kozhikode for further management in an ambulance along with experienced staff. The occurrence of bleeding was not caused due to any act or omission on the part of the first opposite party but due to the severity of the disease process itself. In the case of the patient, there were dens adhesions and fibrosis in the left adenexe and it made the laparoscopy difficult and to be converted to open surgery. The first opposite party acted with due diligence and care while removing the adhesions and severity of the adhesions led to bleeding while trying to release them. The bleeding was caused due to severity of adhesions, which was detected in time and controlled by following standard procedure. The occurrence of bleeding is unconnected with any act or omission on the part of the first opposite party and hence it cannot be equated with fault in surgery but an inherent complication occurred due to the severity of adhesions. Once the bleeding was noticed, first opposite party had promptly done all what could be reasonably and medically under taken to arrest bleeding. In the light of the above-mentioned fact the opposite party submit that there was no negligence or deficiency in service on the part of the first opposite party.
6. The opposite party submitted that before consulting with the first opposite party, the patient had a history of consultation with some other doctors and confirmed her diagnosis of ovarian cyst and definitive about the need for surgery. The statement that the first opposite party stated that ovarian cyst can be removed by a simple operation is not correct and so denied. The opposite party submitted that they had a detailed discussion with the patient and her husband about the merits and demerits of laparoscopic as well as open surgery. The patient and her husband were also informed about the circumstances under which laparoscopic surgery should have been converted to open surgery. The statement regarding the advantages of laparoscopic surgery allegedly spoken to by the first opposite party is not tenable or sustainable and so denied. The opposite party specifically denied that the complainant was told the laparoscopic procedure would devoid of any risk and there would not be any need for blood as stated in the complaint. The opposite party did not make any comparative presentation of the different type of surgery on the basis of its cost. The first opposite party did not give any promises or assurances to the complainant or his wife. The first opposite party submitted that she is well experienced in laparoscopic surgical procedure and the patient and her by standers consulted the first opposite party for the procedure to be done by her.
7. The opposite party submitted that the laparoscopic surgery was started at 4 PM on 08/02/2011 and the unexpected events led the procedure to be completed with laparotomy and the said fact was promptly informed the bystanders. The ovarian cystectomy could not be completed laparoscopically because of bleeding and the chance of such eventuality was already informed the patient and her husband and consent was also obtained for conversion to open surgery. The statement that the procedure was done without consent of the complainant or any other person is highly ill motivated and hence denied. Further statement that complainant was not informed about the condition of the patient is false and hence denied. The first opposite party had detailed discussion with the complainant regarding progress of the management in the post operative ward in regular intervals and also allowed to see the patient kept under post operative care and observation. The complainant was never told about any other laparoscopic surgeon for conducting the operation and consent was given authorizing the first opposite party to undertake the laparoscopic procedure assisted by staffs attached to gynecology department.
8. The opposite party denied the allegation that the complainant was allowed to see the patient after much bleeding is not correct. The opposite party also contended that the complainant wanted to take the patient to medical college hospital and then told that there was bleeding and nothing to be worried. The first opposite party had duly informed the condition of the patient to the bystanders and in view of 400 ml drained fluid, re exploration was suggested and contra statement that the complainant believed assurance and promises is purposely stated for undue advantage and hence denied. It is also denied the allegation that despite request no permission was given to see the patient and that the nursing staff was arrogant and heedless is made with ulterior motive and so denied. The opposite party denied that the first opposite party was not seen anywhere and no details were given is false and it is purposely stated for undue advantage of the complainant. The opposite party denied the allegation that the complainant saw the patient on 10/02/2011 and then the patient was not well and not responding is not correct. On 10/02/2011 patients BP, SPO2 and other vital remained normal and plates transfusion was adduced as the count was low. The averment to the effect that the first opposite party admitted laparoscopy and laparotomy was failure and directed the complainant to take the patient to a good hospital is purposely framed for undue gain and so denied. The submission of the opposite party is that the laparoscopic procedure cannot be termed as a failure in strict sense as impact the procedure could not completed laparoscopically due to excessive bleeding on releasing adhesions. The opposite party denied the allegation that the first opposite party stated that the hospital is not equipped to meet emergency is also purposely stated for undue gain. Opposite party further stated that the allegation that the opposite party wrote reference letter to MCH and changed her mind and talked about facilities in Moulana hospital is utter false. It is submitted that the opposite party referred the patient to MCH Kozhikode and it was on the decision of the complainant and other bystanders the patient was shifted to Moulana Hospital. The patient was taken to Moulana Hospital as directed by the first opposite party is not correct and so denied. It is also denied that the patient was taken to Moulana hospital in a bad condition without response is not correct and so denied. The allegation that the information allegedly got from Dr. Mahadevan that some vein or something is cut during the operation and as a corrective measure immediate surgery was needed is absolutely wrong and baseless
9. The opposite party submitted that the treatment given to the patient in Moulana hospital are not pertaining to the knowledge of first opposite party and so it is denied. The opposite party submitted that the complainant himself admit that till 15/02/2011 the patient’s condition was improving and she talked to the complainant. The submission of the opposite party is that the complainant himself admitted that the patient developed breathlessness on 18/02/2011 and taken up for surgery and died on the same day at 3.45 pm while undergoing treatment in Moulana Hospital and the cause of death as per postmortem examination is due to multi organ failure due to disseminated intra vascular coagulation and so there is no merit in attributing negligence against the first opposite party for the occurrence of bleeding during cystectomy or in the post management .
10. The opposite party denied the allegation that she negligently done the operation and cut two veins causing bleeding is not tenable or sustainable. It is further submitted that the open operation was done without consent of the patient and after that the patient kept without any expertise is also false and so denied. It is submitted that the complainant was made aware of the fact that open surgery would have been necessary in the event of difficulty to proceed laparoscopically due adhesions, occurrence of bleeding etc. and surgeon on the spot as to decide on her own judgment what was best for the patient. The first opposite party is well qualified, experienced in laparoscopic surgery with sufficient skill and expertise and the complainant specifically authorized the first opposite part to do laparoscopic / open surgery by giving consent. The opposite party denied the allegation that the second opposite party hospital is not equipped with met emergency and the patient was referred to good hospital when she was about to die. The first opposite party had exercised utmost care and caution in the treatment of the patient and death was not caused due to any negligence on her part. The allegation that nursing service and treatment was very bad and below quality is highly ill motivated and so denied. The allegation that the complainant and his wife were enticed by the first opposite party to do laparoscopy by stating it as a simple procedure and having a laparoscopic surgeon is falsely stated with ulterior motive and hence denied. Laparoscopic ovarian cystectomy is not a simple procedure and it has its own inherent risk factors and difficulties to complete procedure laparoscopically. The patient consulted with first opposite party and took her advice for surgery implies that the complainant and patient never intended the laparoscopy to be done by some other doctor since other vise they would have consulted the laparoscopic surgeon with whom they propose other than the first opposite party. The allegation that the first opposite party is not having enough expertise and she negligently cut vein and bleeding is not tenable or sustainable. The opposite party also denied the statement that on account of the negligence of the first opposite party the patient was bleed to death and it was concealed from the knowledge of the complainant till condition worsened, there was public agitation and protest and the same was resisted with force is also false and so denied.
11. The opposite party also contended that the patient was managed and completed the procedure by laparotomy and the post operative management was also as per accepted medical practice and there was no negligence or deficiency in service on her part. She submitted that nothing has been concealed from the complainant and referred the patent to medical college hospital for further management as per request. The complainant never requested the first opposite party for treatment records since she is not the custodian of the treatment records. It is also denied the allegation that the first opposite party behaved in rude manner and that she would make records to counter any claim if made is purposely stated for undue advantages. It is also denied the allegation that the first opposite party behaved in rude manner with knowledge that she committed gross deficiency in service.
12. The opposite party submitted that she is having qualification of MBBS, MD (OBG) Diploma in laparoscopic surgery, working as gynecologist and laparoscopic surgeon with 15 years’ experience with a good service record. Hence the submission is that there was no negligence or deficiency in service on the part of the first opposite expiry at any point of time in the treatment of the patient and so the complaint is liable to be dismissed with cost of the opposite parties.
13. The complainant and opposite parties filed affidavit and documents. The documents on the side of complainant marked as Ext. A1 and A2 (series- 54 in number). Exits. X1 to X4 are also marked. Opposite parties did not file any document. The complainant was examined as PW1 and doctor Mohammed Ismayil examined as PW2. Opposite party No.1 Dr. Jessy Joy was examined as DW1. Ext. A1 is copy of postmortem dated 19/02/2021. Ext. A2 (series) comprising 54 in number are various treatment records of the complainant. Ext.X1 is copy of FIR No.198/11, Perinthalmanna Police station, dated 08/02/2011 along with inquest report. Ext. X2 treatment records produced from the Maulana hospital in respect of patient Ancy, wife of Mathew, date of admission 10/02/2011 and date of discharge 18/02/2011. Ext.X3 is medical board report issued from Medical Collage hospital, Calicut dated 21/06/2017. Ext. X4 is treatment record produced from the Prasanthi HI tech hospital in respect of patient Ancy dated 08/02/2011. Both sides filed notes of argument also.
14. Heard both sides, perused affidavit and documents and also argument notes.
The following points arise for consideration: -
1) Whether there is deficiency in service and unfair trade practice on the part
of the opposite parties?
2) Relief and cost?
15. Point No.1
The case of complainant is that his wife was taken to the opposite parties with complaint of abdominal pain and on discussion with the opposite parties it was decided to undergo laparoscopic surgery to remove the cyst in the ovary. But the opposite party, due to failure of laparoscopic surgery converted the surgical procedure in to laparotomy without the prior consent of the complainant or the patient and the laparotomy was also failed. Then the complainant demanded to shift the patient to higher treatment center and the opposite party issued referral letter to the medical college hospital, Calicut and immediately after that advised to take to Moulana hospital, Perinthalmannna and said that there also all Hitch treatment facilities are available and accordingly the patient was shifted to the Moulana Hospital. The patient was undergone surgery and treatment at Moulana hospital and subsequently the patient died from the Moulana hospital on 18/02/2011. The reason for the death was multi organ failure due to DIC i.e., Disseminated Intravascular Coagulation. The complainant alleges there was negligence from the side of opposite parties while doing surgical procedure from their hospital.
16. The opposite parties submitted that there was no negligence or deficiency in service on the part of the opposite parties. The surgery as well as the treatment was given to the patient as per the accepted medical protocol and with due care and caution. The opposite parties submitted that the patient was consulted by the first opposite party in the OP department on 04/02/2011 with complaint of dull acting pain on left lower abdomen since 2- 3 years. She had history of consultation with some other doctors and she had advised by them to undergone surgery. On examination by opposite party, it was diagnosed the patient was left ovarian cyst with internal echoes. Based on the diagnosis the patient was advised surgery for removal of ovarian cyst. The first opposite party explained the merits and demerits of both open and laparoscopic ovarian cystectomy to the patient and her relatives and patient opted for laparoscopic surgery. The first opposite party also informed the patient and her husband about the circumstances like presence of thick adhesions and chance of unexpected bleeding etc., under which the laparoscopic procedure should have been converted to open surgery. Hence after fully conversant with pros and cons of laparoscopic surgery, for cyst removal the patient got admitted in the hospital on 07/02/2011. The patient underwent all necessary pre-operative anesthetic assessment and evaluation and found fit for surgery. The patient and her husband voluntarily gave written informed consent for laparoscopic surgery and for conversion to open surgery if intra operatively necessitated due to adhesions, bleeding etc.
17. The opposite party, under all aseptic care and precautions conducted laparoscopic surgery at 4 PM on 08/02/2011. Intra operatively dense adhesions and fibrosis was found on the ovarian cyst in the left adenexe. While carefully releasing the adhesions, excessive bleeding occurred from the lateral wall. As attempt to stop bleeding laparoscopically failed and the surgery was converted to laparotomy. There was bleeding from left lateral wall of cyst. Blood collected in the pelvic cavity sucked out and bleeding site was clamped. There was slight bleeding from left lateral pelvic wall which was sutured with catgut and bleeding controlled. The abdomen was closed after putting suction drain and the specimen sent for histopathology. Thereafter patient was kept under close observation and monitoring. The patient was given four units of red cell concentrate and four units’ fresh frozen plasma were transfused on the same day of surgery. On 09/02/2011 her vital remained normal and urine out was satisfactory and drain showed minimal collection and abdomen was found soft and no distention. So, the opposite party advised USG examination and the report showed minimal free fluid in the abdominal cavity. Then one unit of red cell concentrate was given, antibiotic analgesics medication continued. The condition of the patient remained stable during the first operative day. On 10/02/2011 three units of red cell concentrate were given. But the drain showed 400 ml fluid collection and platelets count was found low. Then the opposite party advised platelets transfusion and re-laparotomy. The same was discussed with bystanders and the by standers requested for reference to higher center. The patient’s BP, SPO2 and other vital remained normal. As per the request the patient was referred to medical college hospital Kozhikode for further management in an ambulance along with experienced staffs.
18. The occurrence of bleeding according to opposite party was not caused due to any act or omission on the part of the opposite party, but due to the severity of the disease process itself.
19. The first opposite party contended that they acted with due diligent and care while removing the adhesions and severity of the adhesions led to bleeding while trying to release them. According to opposite party the bleeding was caused due to severity of adhesions, which was detected in time and controlled by standard procedure. The occurrence of bleeding is unconnected with any act or omission on the part of the first opposite party and hence it cannot be equated with fault in surgery but an inherent complication occurred due to the severity of adhesions.
20. The Commission perused the treatment records Ext X4 of patient. It shows that there was consent from the patient as well as the complainant for the laparoscopic ovarian cystectomy to the patient. So, the contention of the complainant that the surgery was done without the consent of the complainant cannot be accepted. The complainant has got a contention the transferring of laparoscopic surgery in to open surgery was not informed to the complainant even though they were present in the hospital while undergoing the surgery to the patient. The opposite party contended that due to dense adhesion and bleeding from the lateral wall of cyst necessitated the transferring the procedure from laparoscopy to open surgery. It is also contended that the same facts were thoroughly discussed with the complainant and the patient while obtaining the consent for the surgery. On perusal of document, we cannot say that the act of the opposite party converting from laparoscopic procedure to open surgery as a mistake, if there is sufficient reason to do so and which is done in good faith for the benefit of the patient. So, the contention of the complainant regarding consent cannot be upheld and there is no fault on the part of the opposite party in transferring the procedure from laparoscopic surgery to open surgery. The complainant also has got a contention that the opposite party had assured that there is a laparoscopic surgeon in the hospital and that surgeon will do the procedure. But there is no document to support the contention of the complainant but the opposite party has deposed that she is a qualified laparoscopic surgeon and there was no assurance to the complainant as stated.
21. The allegation of the complainant is that while conducting the surgical procedure from the opposite party hospital the patient sustained cut injury to iliac artery with 2 cm dimension and also puncture injuries with dimension of 1x1 cm, 3 cm. The fact reveals from postmortem report Ext A1 and also from the treatment records Ext X2 obtained from the Moulana hospital Perinthalmanna.
22. Ext.X2 is the treatment record summoned from Moulana Hospital Perinthalmanna, where the patient was treated subsequent to the treatment from the opposite party hospital and from where the patient died. Therein Ext. X2 document reveals the treatment given from the Moulana hospital from 10/02/2011 to 18/11/2011. It can be seen from the “operation records” of X2 re-laparotomy that there was external iliac artery and vein tear repair and hematoma. The operation note reveals the huge clot within the pelvis and on removing the clot the lateral iliac vessel was seen torn. There is also a certificate prepared by doctor Muhamed Ismail, MS, FICS, FMAS, chief surgeon dated 18/02/2011. The certificate states that the patient was referred to emergency department on 10/02/2011 with features of intra-abdominal bleeding following laparoscopic ovarian cystectomy done from private hospital Manjeri. At the time of admission patient had features of hypovolemic shock with severe pallor. PW2 deposed that”patient ആശുപത്രിയിലേക്ക് എത്തിയത് critical and life-threatening stage ലാണ്”. Certificate further state that emergency exploratory laparotomy was done. On Exploration there was large hematoma over the left external iliac vessels with vicryl sutures seen. On removing the clots, external iliac vessels were seen torn with significant hemoperitoneum. Cardio thoracic surgeon was called and iliac artery and vein were repaired. Hemostasis attained. Multiple blood transfusion was given. Patient was put on ventilatory support. Postoperative period patient developed Acute Renal Failure, DIC, severe thrombocytopenia, jaundice, Multi organ failure and ARDS, Cardiology, pulmonology and nephrology consultation were done. Managed with higher antibiotics, multiple blood transfusions, with ventilator support. Tracheostomy was done due to thick secretions and clots blocking endotracheal tube frequently and for continued ventilatory support. In spite of all these supportive machines, succumbed to death on 18/02/2011.
23. Ext. A1 is the copy of postmortem report of the patient. The said document reveals injuries – ante mortem. They are as follows: -
1. Transverse surgical sutured wound 19 cm lower abdomen 12 cm below
umbilicus 8cm inner to right hip bone.3cm right to the left end, there was similar
another wound vertically down to the thigh. The wound was sutured in layers.
The tissue showed blood infiltration. Left external iliac artery found repaired
2cm distally and the surrounding area infiltrated with blood and tissue was
oedematous.
2. Puncture wound 1x1 cm, 3 cm right to the right end of injury No.1
3. Sutured surgical wound 2cm oblique left side of abdomen 3.5 cm above and 1.5
cm left to the left end of injury No.1.
4. Contusion 13x 5 cm (upper) to 12 cm (lower) on the left side of abdomen 22 cm
outer to umbilicus 26 cm below axilla.
5 Sutured wound 5 cm vertical, front of neck from sternal notch (tracheostomy
wound).
6. Abrasion 7x 09 cm on over jaw 1cm below hip bone, 1cm inner to the right end of
angle of mouth.
7 Sutured wound 0.8 cm right side of neck 7cm below ear lobule.
8. Multiple punctures wound over an area 3.5x2cm right side of neck, 4.5 cm below
ear low lobule.
9. Contusion 2x2 cm.70 cm proximal to the ileocecal junction.
10. Contusion 4.5x2.5cm. 5cm proximal to the ileocecal junction.
The postmortem report concludes that death due to multi organ failure due to disseminated intravascular coagulation.
24. Ext. X2 series, the treatment records from Moulana hospital includes the letter issued by opposite party No.1 to the department of OBG, IMCH, Casualty, Calicut. The content of the referral letter issued by the opposite party is that the patient had undergone laparoscopy for hemorrhagic ovarian cyst (Lt) converted to laparotomy due to dense adhesion and excessive bleeding on 8th February. Ovarian cystectomy done and sent for HPE. Bleeding controlled and abdomen closed on layers, after putting drain. 4 unit of packed blood cells & 3 units of FFP given. Still there is collection in the drain, there more pints of packed cell-transfusion given and planed for re laparotomy. Now patient is hemodynamically stable, urine output 1100 ml. Since the relatives want reference referred to higher center.
25. The complainant examined Dr. Mohamed Ismail, who treated the patient at Moulana hospital as PW2 as expert witness. Doctor deposed before the commission that the patient brought to the hospital in a critical and life threating stage. He deposed that the reason for bleeding to the patient was due to injuries sustained to the iliac artery and iliac vein. There is no mentioning of the injuries sustained to the iliac artery and iliac vein in the treatment records of opposite party No.2 hospital. The letter of reference issued by opposite party No.1 has not mentioned the injuries of iliac artery and iliac vein. He stated that what is written in the referral letter is excessive bleeding alone. There was torrential bleeding and so it can be inferred that bleeding is from iliac vein and iliac artery. There was also suturing over the iliac artery vein. When the doctor removed blood clotting there, he could see blood ousting from both injured parts. PW2 deposed further that the condition of the patient while brought to the hospital was in a condition of hypovolemic shock with severe pallor condition. The hypovolemic shock is the condition when excessive bleeding occurs. PW2 further deposed that “രോഗി വന്ന ഉടനെത്തന്നെ ഒരു emergency surgery ക്ക് വിധേയയാക്കുകയാണ് ഉÙ¡യത്. Large quantity of Haematoma കാണാനാണ് open ചെയ്തപ്പോw സാധിച്ചത്. Haematoma നീക്കം ചെയ്ത സമയത്താണ് രോഗിയുടെ Left external iliac vessels were seen torned. ആയതിv നിന്ന് blood ooze ചെയ്യുന്ന അവസ്ഥയിലായിരുന്നു ഉÙ¡യിരുന്നത്. Vein suture ചെയ്യുന്നതിന് ഒരു extra care ഉം ആയതിv പ്രാവീണ്യമുള്ള ഡോക്ടറും ആവണമെന്നുള്ളതിന് cardio thoracic surgeon ന്റെ സേവനം ഉപയോഗപ്പെടുത്താu കാരണം. ഒരു Higher treatment centre എന്ന നിലയിv ഞാu ജോലി ചെയ്യുന്ന ആശുപത്രിയിv Cardio Thoracic surgeon available ആണ്. ഈ surgeon ന്റെ സഹായത്തോടെ രോഗിയുടെ Vein നിന്നുള്ള bleeding നിര്ത്താu സാധിച്ചു .രാത്രി ഹോസ്പിറ്റലിv നിന്ന് ലഭിച്ച reference പ്രകാരം രോഗി stable ആണെന്ന രൂപത്തിലാണ് reference നല്കിയത്. Iliac vessels എന്ന് പറയുന്നത് Pelvic side v നിന്നും കാലിന്റെ ഭാഗത്തേക്ക് പ്രധാന രക്തയോട്ടം നല്കുന്ന vessels ആണ് എന്നു പറഞ്ഞാv ശരിയാണ്. He adds that “lilac vessels ന് 2 cm ഒ അതിv കൂടുതലോ വലിപ്പത്തിv ഒരു cut injury സംഭവിക്കുകയാണെങ്കിv അത് വളരെ ഗുരുതരമായ പരിക്കായി കണക്കാക്കേÙതാണ്. Multi organ failure ലേക്ക് എത്തിച്ചേരാനുള്ള ഒരു കാരണമാണ്. The doctor also stated that if the cut injury sustained to iliac vessels were could manage immediately bleeding and fluid lose could have avoided.
26. From the perusal of documents i.e., operation notes of the opposite parties, operation notes from Moulana hospital, certificate issued by Dr. Mohamd Ismayil in addition to the postmortem certificate reveals that there was cut injury to the lateral iliac vessel and vein of the patient. But the perusal of operation notes of opposite parties and the referral letter issued by the first opposite party do not disclose cut injury sustained to the pelvic artery of complainant. It is also relevant the deposition of PW2 that the injury seen sustained to the patient was serious in nature and even though he was a competent surgeon, he called the assistance of a cardio vascular surgeon to manage the injury. If that is the nature of the injury, the attempt of the opposite party to manage the same without disclosing the exact fact cannot be treated as a proper procedure to be followed by a medical practitioner. The opposite party cross examined the PW2 and suggested that it is not necessary to manage injuries by a vascular surgeon while doing separation of adhesions. It is accepted medical complication that the procedure for removal of adhesion may result injuries. But the present case is not a simple injury occurred during the separation of adhesion. In this case the cut injury of 2cm dimension was caused to the iliac artery. The deposition further clarifies that torrential bleeding was there during the surgery. The torrential bleeding to be distinguished from normal bleeding. It can be seen that initially the opposite party opted laparoscopic surgery and due to complication on account of adhesion and fibrosis converted to the open surgery. During the open surgery the opposite party has noted that only bleeding from the lateral wall of cyst. None of the documents from the side of opposite parties reveals the exact extent of cut injury sustained to the iliac artery and the gravity there off. It is admitted that the opposite party had converted laparoscopic surgery in to open surgery for the effective management of the complication. But thereafter the opposite party did not trace the exact reason for the bleeding. The surgery was done on 08/02/2011 but the patient was taken to the higher center only on 10/02/2011. Meanwhile the patient had suffered to the maximum extent of complications due to the cut injury sustained to the iliac artery vessel.
27. The question is whether the act of the opposite party can be treated as accepted medical complication and the opposite party followed the treatment of accepted medical protocol. The specific contention of the opposite party is that bleeding during laparotomic ovarian cystectomy due to the presence of dense adhesion is a known complication and the first opposite party had managed it and completed the procedure by laparotomy and the post-operative management also was in accordance with accepted medical practice and there was no negligence or deficiency in service on her part. She has not conceded anything from complainant and relatives and she referred the patient to medical college hospital for further management as per request.
28. The opposite parties rely upon Ext.X3, the medical board report issued from medical college hospital Calicut. The Ext. X3 does not reveal what are the document referred for the conclusion of finding. Ext. X3 document narrated the treatment history of the patient and the following are the comments from the medical board on examination of the case.
1 Decision for laparoscopy for removal of Hemorrhagic cyst is correct.
2) The decision to convert to laparotomy due to dense adhesions and bleeding is
correct and recommended.
3) Closure was done after attaining hemostasis and intraperitoneal drain was correctly put.
4) Decision to do re-laparotomy due to persisting intraperitoneal bleeding is correct.
5. Blood and blood product were transfused promptly.
6. Patient was promptly referred to higher center on request of the relatives.
7. Bleeding was due to iliac artery and vein tear…
Bowel, Bladder, vessel injuries are possible complications of laparoscopic procedure.
Hypotension, vessel spasm, adhesions, hematoma formation may prevent recognition and identification of tears as has happened during laparotomy at Prasanthi Hospital.
Unfortunate death has occurred to due hypotension, shock followed by Sepsis possibly due to iliac vessel tear, tear is a complication of laparoscopic procedure. Complication of laparoscopy is not medical negligence.
Ext. X3 further states that there is no negligence of management and treatment from both gynecologist and surgeon.
29. The Ext. X3 was issued by the medical board on reference by the Consumer Commission. But in this complaint the patient was undergone treatment from two hospitals i.e., one from the opposite party hospital at Manjeri and the other is from Moulana hospital, Perinthalmanna. The report of medical board appears that they considered treatment of the patient at both centers for assessing negligence and management of patient. The treatment at opposite party hospital was from 07/02/2011 to 10/02/2011 and thereafter at Moulana hospital Perinthalmanna from 10/02/2011 after noon to 18/02/2011 till death. The finding is that the treatment is as per the medical protocol.
30. But surgery note during relaparotomy reveals that the closure of abdomen by opposite party was done before attaining hemostasis. Further medical board report X 3 reveals that the opposite parties failed to recognize and identify tears during laparotomy and that may be due to hypotension, vessel spasm, adhesion, hematoma formation. Ext.X3 categorically express the concern that hypotension, vessels pasam, adhesions, hematoma formation may prevent recognition and identification of tears as has happened during laparotomy at Prasanthi hospital. The case of the complainant also is that the opposite parties did not made attempt to identify the exact cause for bleeding while doing laparotomy. The laparoscopic procedure was converted to laparotomy for effective management of the complicated situation. It is also noted by the medical board that there was iliac artery vein tear. If the opposite party was able to identify the cut injury sustained to iliac artery and vein tear at the time of laparotomy done on 08/02/2011, it could have properly managed on the same day and the further complication could have avoided. Only on 10/02/2011, considering the quantity of fluid collection, the opposite parties suggested re laparotomy and then the relatives requested for shifting the patient to higher medical center. It was noticed from the higher medical center that there was cut injury to the iliac artery and vein tear. Then the iliac artery injury was managed by a cardio vascular surgeon in presence of an expert surgeon PW2. It is important to note that none of the documents issued from the opposite party hospital reveals the incidents of cut injury to iliac artery and vein tear. The attempt of the opposite party to manage torrential bleeding without sufficient experience cannot be treated as a proper management of the patient. The delay in providing proper treatment to the patient caused further complications and unfortunate demise of the patient. Hence from the documents and the averments in the affidavit we are not convinced with the finding in Ext. X3 and we are of the opinion that there was negligence on the part of the opposite parties in providing proper treatment to the complainant. Ext. X3 certificate issued by the medical board has observed the treatment process, procedure and the complications in the medical treatment and in surgical procedures. The commission also admit the chance for complication in every surgical procedure. So, chance for complication during laparotomy is accepted one. But in this case the procedure suggested was laparoscopic one and later due to complications it was converted to open surgery. But while doing surgery there was cut injury sustained to the iliac artery and vein tears also. The opposite party not properly managed the cut injury to the iliac artery. The opposite parties not made attempt to find out the real cause for bleeding especially while there was torrential bleeding. The torrential bleeding itself reveals the cut injury to the iliac artery which is one of the important arteries of human body. The management of the iliac artery cut injury was not duly managed by the opposite party. Non disclosing of the cut injury to the iliac artery in surgery note as well as the referral letter can be treated as an unfair medical practice from the side of the doctor. Hence the commission do not uphold the findings of X3 document, but find there was apparent negligence on the side opposite party in treating the patient as contended by the complainant in the complaint.
31. The opposite parties cited decisions to establish the case of the opposite parties. The contention is that in medical negligence it should be established specific act of negligence and to be proved through the expert evidence. It is submitted that a finding of medical negligence on the part of medical man is akin to capital punishment and a doctor can be condemned for medical negligence only if the complainant has conclusively proved that there was negligence on the part of concerned doctor with positive proof and medical authorities, and never on assumptions and presumptions. It is further contended that only because the patient died or suffered any mishap it cannot be taken as medical negligence of the treating doctor, especially because medical science is not an exact science and in spite of all care, caution and attention on the part of the treating doctor, something may always go wrong. The commission have gone through the submissions of the opposite parties. It is well settled position that the occupational negligence and professional negligence has to be treated in a different way. But in this case the complainant was taken to the opposite party for a cyst removal only. Though the opposite party contended that the complainant had earlier consultation with other doctors and a history of three years treatment, no document is seen in the record for the contention. The patient here in had undergone pre-operative procedures and investigations. The complainant had given consent for the laparoscopic surgery also. The opposite party did laparoscopic surgery and due to complication, it was converted to laparotomy. The opposite party completed laparotomy and closed the abdomen. But after two days at the instance of the relatives of patient the opposite party referred to the higher center for further management of patient. But neither the treatment record nor the referral letter to the higher center reveals the cut injury sustained to the iliac artery, one of the important vessels of human body. The contention of the opposite party is that injuries are accepted complications of surgical procedure and there is no negligence on the part of the opposite party. All the medical complications cannot be treated alike. The present complication is not of biological reason or medical reason. The complication here in is the result of negligent act of the doctor. The perusal of document substantiates the case of complainant. The complainant has got a specific case that the opposite party did laparoscopic surgery without due care and thereby caused cut injury to the iliac artery and also tried to suppress the injuries from the treatment records as well as from the referral letter. The complainant further submits that if the patient was not shifted to the higher treatment center even the fact could not have brought out, we find substance in the contention of complainant.
32. The patient herein was aged 43 years at the time of taking to the first opposite party hospital. Due to the medical negligence on the part of the opposite parties she died after 10 days and the reason for the death is multi organ failure due to disseminated intra vascular coagulation. The documents shows that the cut injury sustained to the iliac artery led to the complications and untimely demise of patient. The complainant spent lot of amounts for the treatment at the hospital of the opposite party and thereafter at Moulana hospital Perinthalmanna. The complainant suffered mental agony and sufferings due to the untimely loss of his wife. No amount can cop up the loss of his life partner. It is held by apex court itself that the determination of damages for loss of human life is an extremely difficult task. There is no specific yardstick to fix quantum of compensation in case of death in medical negligence cases. The widely accepted method is multiplier method as in motor accidents claims. Hence Commission is bound to consider the economic, social status of the parties including the age of the victim. There are no details regarding the social status and income of the deceased patient in this complaint. As per medical records the deceased was 43-year-old at the time her death. The death happened in the year 2011. Considering the deceased as house wife, we fix her income as 4000/-rupees per month and out of which 1/3 is to deducted towards her personal expenses. Then the annual income after deducting expenses towards personal expenses will be Rs.32000/-. Considering the age of deceased, the multiplier applicable will be 15. The incident was taking place in the year 2011 and due to various reasons, the matter was prolonged up to this time. The claim of the complainant as compensation is Rs.16,00,000/-. But there is no basis for the claim. The complainant also prays for Rs.3,00,000/- towards medical treatment and other incidental expenses. Ext.X2 and X4 documents includes medical bills. It appears there is more than 2,50,000/-rupees as medical bills. The patient was taken to medical college hospital for postmortem and so there will be reasonable expenses towards transport. Compensation claimed for treatment expenses can be treated as reasonable one. The complaint and his family have suffered pecuniary loss and non-pecuniary loss including mental agony, hardships, inconvenience and loss of consortium. Considering the entire aspects, we allow Rs.4,80,000/-(32000 x 15) as compensation on account of pecuniary loss, 3,00,000/- rupees towards mental agony, hardships, inconvenience and loss of consortium in favor of complainant. Complainant entitled for rupees 3,00,000/- towards treatment expenses. The opposite parties also directed to pay rupees 25,000/- towards cost of the proceedings. It can be seen that the first opposite party who committed negligence in treating the wife of the complainant who is working in the second opposite party hospital. Hence, the first and second opposite parties are liable to compensate the complainant.
In the light of above facts and circumstances we allow this complaint as follows: -
- The opposite parties are directed to pay Rs.4,80,000/- (Rupees Four lakh and eighty thousand only) to the complainant on account of future pecuniary loss to the complainant due to medical negligence in treating the patient.
- The opposite parties are directed to pay Rs.3,00,000/- (Rupees three lakh only) towards the treatment and other expenses to the complainant.
- The opposite parties are directed to pay Rs.3,00,000/- (Rupees Three lakh only) to the complainant on account of mental agony, loss of consortium, hardships and inconvenience caused to the complainant.
- The opposite parties are further directed to pay Rs.25,000/- (Rupees twenty five thousand only) as cost of the proceedings
The opposite parties shall comply this order within one month from the date of receipt of copy of this order, falling which the opposite parties are liable to pay interest at the rate of 9% per annum from the date of order till date of payment.
Dated this 19th day of December, 2022.
Mohandasan K., President
PreethiSivaraman C., Member
Mohamed Ismayil C.V., Member
APPENDIX
Witness examined on the side of the complainant: PW1 & PW2
PW1: Mathew (Complainant)
PW2: Dr. Mohammed Ismail.
Documents marked on the side of the complainant: Ext.A1 and A2
Ext.A1: Copy of postmortem dated 19/02/2021.
Ext.A2 (Series): Treatment Records (54 pages)
(Page No.1): Letter dated 10/02/2011.
(Page No.2): CBC report issued by opposite party dated 10/02/2011
(Page No.3): Laboratory report issued by opposite party dated
08/02/2011
(Page No.4): CBC report issued by opposite party dated 08/02/2011
(Page No.5): Laboratory report issued by opposite party dated
08/02/2011
(Page No.6): Final test report issued by City scan centre Manjeri dated
28/01/2011
(Page No.7): Laboratory report issued by opposite party dated
10/02/2011
(Page No.9): Post mortem report issued by Directorate of medical
education department of Forensic Medicine
Medical College, Calicut dated 19/02/2011 & Certificate of
chemical analysis for the year 2014, FIR.
(Page No.10): Laboratory investigation report issued by Moulana
Hospital, Perinthalmanna dated 10/02/2011
(Page No.11): Laboratory investigation report issued by Moulana
Hospital, Perinthalmanna dated 11/02/2011.
(Page No.12): Laboratory investigation report issued by Moulana
Hospital, Perinthalmanna dated 12/02/2011.
(Page No.13): Laboratory investigation report issued by Moulana
Hospital, Perinthalmanna dated 12/02/2011.
(Page No.14): Laboratory investigation report issued by Moulana
Hospital, Perinthalmanna dated 13/02/2011.
(Page No.15): Laboratory investigation report issued by Moulana
Hospital, Perinthalmanna dated 14/02/2011.
(Page No.16): Laboratory investigation report issued by Moulana
Hospital, Perinthalmanna dated 15/02/2011.
(Page No.17): Laboratory investigation report issued by Moulana
Hospital, Perinthalmanna dated 16/02/2011.
(Page No.18): Laboratory investigation report issued by Moulana
Hospital, Perinthalmanna dated 17/02/2011.
(Page No.19): Cash bill issued by Al-shifa hospital Perinthalmanna dated
10/02/2011
(Page No.20): Cash bill issued by Al-shifa hospital Perinthalmanna dated
13/02/2011
(Page No.21): Cash bill issued by Al-shifa hospital Perinthalmanna dated
14/02/2011
(Page No.22): Cash bill issued by Al-shifa hospital Perinthalmanna dated
16/02/2011
(Page No.23): Cash bill issued by Al-shifa hospital Perinthalmanna dated
17/02/2011
(Page No.24): Blood bank test bill issued by Govt. Hospital,
Perinthalmanna dated 10/02/2011
(Page No.25): Blood bank test bill issued by Govt. Hospital,
Perinthalmanna dated 11/02/2011
(Page No.26): Blood bank test bill issued by Govt. Hospital,
Perinthalmanna dated 12/02/2011
(Page No.27): Blood bank test bill issued by Govt. Hospital,
Perinthalmanna dated 14/02/2011
(Page No.28): Blood bank test bill issued by Govt. Hospital,
Perinthalmanna dated 15/02/2011
(Page No.29): Cash bill issued by Moulana Hospital Perinthalmanna
dated 10/02/2011
(Page No.30): Cash bill issued by Moulana Hospital Perinthalmanna
dated 11/02/2011
(Page No.31): Cash bill issued by Moulana Hospital Perinthalmanna
dated 12/02/2011
(Page No.32): Cash bill issued by Moulana Hospital Perinthalmanna
dated 17/02/2011
(Page No.33): Cash bill issued by Al-shif Hospital Perinthalmanna
dated 18/02/2011
(Page No.34): Cash bill issued by Moulana Hospital Perinthalmanna
dated 18/02/2011
(Page No.35): Cash Bill issued by Korambayil Hospital, Manjeri dated
09/02/2011
(Page No.36): Janakeeya Samathi bill dated 11/02/2011
(Page No.37): Cash Bill issued by Korambayil Hospital, Manjeri dated
09/02/2011
(Page No.38): Cash Bill issued by Korambayil Hospital, Manjeri dated
08/02/2011
(Page No.39): Cash Bill issued by Korambayil Hospital, Manjeri dated
10/02/2011
(Page No.40): Cash bill issued by National Hospital; Calicut dated
13/02/2011.
(Page No.41): Pharmacy bill issued by Moulana Hospital
Perinthalmanna dated 10/02/2011
(Page No.42): Pharmacy bill issued by Moulana Hospital
Perinthalmanna dated 11/02/2011
(Page No.43): Pharmacy bill issued by Moulana Hospital
Perinthalmanna dated 11/02/2011
(Page No.44): Pharmacy bill issued by Moulana Hospital
Perinthalmanna dated 12/02/2011
(Page No.45): Pharmacy bill issued by Moulana Hospital
Perinthalmanna dated 13/02/2011
(Page No.46): Pharmacy bill issued by Moulana Hospital
Perinthalmanna dated 14/02/2011
(Page No.47): Pharmacy bill issued by Moulana Hospital
Perinthalmanna dated 10/02/2011
(Page No.48): Pharmacy bill issued by Moulana Hospital
Perinthalmanna dated 15/02/2011
(Page No.49): Pharmacy bill issued by Moulana Hospital
Perinthalmanna dated 16/02/2011
(Page No.50): Pharmacy bill issued by Moulana Hospital
Perinthalmanna dated 18/02/2011
(Page No.51): Pharmacy bill issued by Moulana Hospital
Perinthalmanna dated 17/02/2011
(Page No.52): Pharmacy bill issued by Moulana Hospital
Perinthalmanna dated 10/02/2011
(Page No.53): Cash bill issued by opposite party dated 04/02/2011
(Page No.54): Cash bills issued by MIMS hospital; Calicut dated
13/02/2011 & 14/02/2011.
(Page No.55): Newspaper cutting
Witness examined on the side of the opposite party: DW1
DW1: Dr. Jessy Joy (Opposite party No.1)
Documents marked on the side of the opposite party: Nil
Ext.X1: Copy of FIR No.198/11, Perintalmanna Police station, dated 08/02/2011 along
with inquest report.
Ext.X2: Treatment records produced from the Maulana hospital in respect of patient
Ancy, wife of Mathew, date of admission 10/02/2011 and date of discharge
18/02/2011.
Ext.X3: Medical board report issued from Medical Collage hospital, Calicut dated
21/06/2017.
Ext.X4: Treatment record produced from the Prasanthi HI tech hospital in respect of
patient Ancy dated 08/02/2011.
Mohandasan K., President
PreethiSivaraman C., Member
VPH Mohamed Ismayil C.V., Member
