By Smt. C.S. Sulekha Beevi, President,

1. Brief facts:-

On seeing an advertisement of second opposite party hospital, complainant who was suffering from piles approached the hospital and consulted first opposite party doctor on 16-5-2005. After examination first opposite party advised for surgery and suggested to undergo Stapler Haemorroidectomy Operation as treatment for the disease. That he was told by first opposite party that this surgery though more expensive than the conventional surgery had no risks, and that it had the advantages of less pain, less wound, less bleeding and short stay in the hospital. It is stated that believing these assurances complainant opted for this surgery and approached opposite party hospital again on 17-5-2005. He was admitted for surgery on this day and several pre-operative tests were done. He was taken to the operation waiting room at 11 O'clock and then to the operation theatre at 3.30 PM. He regained consciousness at 6.30 PM. After the complainant was shifted to his room, he experienced difficulty in passing urine. There was pain and abdominal distention. Till 8.30 he was unable to void urine by himself. His wife informed the matter and then a nurse came and applied catheter. Though some urine was drained the pain and distention persisted. Though complainant send his wife again to call the doctor first opposite party did not come to attend him. Dr. Mahesh and two nurses came and examined the complainant. That Dr. Mahesh scolded the nurse who had applied the Catheter and that this doctor pulled out the catheter by force. Due to this urine and blood came out and complainant experienced much pain. Dr. Mahesh advised that his Blood Pressure was very low and to lie down with his legs in a higher position. Since the pain of urine retention continued complainant was taken to the operation theatre from where Supra Public Catheter (hereafter mentioned as SPC) was inserted for draining the urine. After applying SPC complainant was relieved of the pain. He was discharged with SPC in situ on 19-5-2005 with advice to review after two weeks. That complainant suffered much pain and inconvenience since the SPC was not removed. On 01-6-2005 complainant again went to opposite party hospital. Then the draining pipe of SPC was blocked by the doctor and he was advised to pass urine in the normal pathway. First opposite party prescribed medicines for 3 days and also advised to do urine culture. At home complainant had fever and consulted first opposite party through telephone. First opposite party advised to take paracetamol tablets and to come to hospital next day if his fever did not subside even after taking paracetamol. Since his fever persisted complainant approached opposite party hospital again on 03-6-2005 and was then admitted under the care of urologist Dr. S.P. Rajan. X-ray was taken and he was informed that there was injury to the urethra and there was a block in the urinary tract. That this block had to be removed. That some things were done to remove this block which was painful. Blood clots came out while passing urine. There was urine infection for which complainant was given injections and medicines. He was discharged on 05-6-2005. It is stated that opposite parties failed to give proper treatment, and that first opposite party neglected to attend the complainant after surgery. That the incorrect application of Foley's Catheter resulted in injury to urinary tract causing block and resulted in urine retention and urine infection. Complainant thus had to suffer much pain and hardships and did not get the advantages of the surgery as offered and promised by first opposite party. Complainant alleges deficiency in service. That complainant spend more than Rs.60,000/- for treatment which opposite parties are bound to refund. Hence this complaint.

2. First and second opposite parties have filed separate written versions. Denying the allegation of medical negligence it is submitted by first opposite party that he is the consultant surgeon working in second opposite party hospital. It is admitted that complainant consulted him on 16-5-2005 with problem of piles/haemorroids. That on examination complainant had bleeding per rectum, pain and mass per rectum while defection. He gave history of hypertensive being on treatment. Complainant was diagonised as a case of 3º Haemorroids with Benign Hypertrophy of Prostate (hereafter mentioned as BHP) Grade II. That first opposite party advised the complainant that the ideal treatment for 3º piles was surgery and explained to the complainant and his wife the various modalities of surgery available and also their advantages and disadvantages. After discussion complainant opted for Stapler Haemorroidectomy or Minimal Invasive Procedure for Haemorroids (hereafter mentioned as MIPH). Since they had not come prepared for the surgery they informed first opposite party that they would come on the next day. Complainant then came on 17-5-2005 and was admitted for surgery. That complainant was fully conversant with the factual situation and the risk involved in the operation. Complainant and his wife agreed and have signed the consent forms. That necessary investigations and preanaesthetic check-ups were done. MIPH was done on 17-5-2005 under spinal anesthesia. The intra-operative period was uneventful. The patient was then shifted to post operative room and was continuously monitored. Since all the vital parameters were within the normal limits, he was shifted to the room at 6.30 PM. Patient later complained of pain and inability to pass urine. On examination there was mild swelling of the lower abdomen indicating retention of urine. Hence it was decided to drain the bladder by introducing Foley's catheter. This attempt failed because the tube did not pass beyond the obstruction in the urethra due to BHP. Hence it was decided to drain the bladder by S.P.C. The urologist of the hospital was called who put Trochar SPC under local anaesthesia. The procedure was uneventful. The bladder was drained and the patient was relieved of the pain. Necessary antibiotics and analgesics were also given. Since the patient was recovering normally and as there was no further complaint, he was discharged on 19-5-2005 with SPC. He was advised by urologist to come for review and removal of catheter after two weeks. Patient came for review on 01-6-2005. On that day he did not have any complaints. On per rectum examination there was induration at the operated site. The urologist advised clamping of SPC and to pass urine through normal way. He also advised urine culture and sensitivity and to come for review after 3 days. However, the patient came on 03-6-2005 with complaint of fever and burning micturation. Retrograde Urethrogram (RUG) – X-ray was taken which was found to be normal indicating that urinary tract was normal and there was no obstruction. Since the patient was passing urine normally the SPC was removed. Requisite antibiotics were given to control infection and complainant was discharged on 05-6-2005. He recovered and has not come for treatment thereafter. That the advantages of MIPH are short stay in the hospital, minimal bleeding and lack of pain. That first opposite party has never told the complainant that there would be no risk at all. That every surgery has it's own risk. That the patient did not have any complaint of pain or bleeding on the operated site. He does not have any complaint about the ailment for which he was treated. That the complainant developed urine retention which was secondary to BHP for which first opposite party is not responsible. That MIPH was done under spinal anaesthesia and the averment that complainant regained consciousness at 6.30 PM is denied as false. That immediately when the patient complained about urine retention proper treatment by applying catheterisation was given. Catheterisation failed due to BHP. That the next step in such cases was to do SPC. Since inserting SPC needed expert management urologist was called who inserted SPC. That complainant who was discharged on 19-5-2005 has come for review only on 01-6-2005. That if he had such difficulty of pain, fever or haematuria he would have reported immediately after discharge. The allegations that inside the X-ray room he was told that there was block inside urethra caused due to injury is denied as false. That no such injury or block was caused. The patient developed fever due to urinary tract infection which is common in any patient undergoing catheterisation. Urine retention was a complication of BHP. That there was no negligence or medical deficiency on the part of first opposite party and that the complaint is to be dismissed.

3. Second opposite party has filed version adopting the contentions of first opposite party. It is stated that there was no mistake or negligence on the part of first opposite party doctor or the nurses. That opposite parties are not liable to compensate the complainant in any manner.

4. Evidence consists of the oral evidence of complainant who was examined as PW1 and a witness examined on his side as PW2. Exts.A1 to A14 marked for complainant. Opposite party was examined as DW1. Exts.X1, X2, X1(a) and X1(b) also marked.

5. Points for consideration:-

(i) Whether opposite parties are deficient in service.

(ii) If so, reliefs and costs.

6. Point (i):-

Complainant alleges medical negligence against opposite parties mainly on the following grounds.

(i) That due to negligence of first opposite party in conducting MIPH surgery complainant had to suffer urinary retention and urinary infection which caused much pain and hardships to him. That such complication arose due to the neglect of first opposite party to attend the complainant during post operative period and due to the block/injury caused in the urethra by improper catheterisation.

(ii) That if opposite party had inserted the catheter prior to surgery the complication of urinary retention and infection could have been avoided. That opposite party did not apply reasonable care to apply the catheter prior to surgery.

(iii) That complainant who approached opposite party with problem of piles opted for MIPH surgery as treatment believing the assurances given by first opposite party that this surgery had the advantages of less pain, less bleeding, less wound, and short stay in the hospital. That complainant who paid more and opted for MIPH surgery did not get these advantages. Due to the neglect of first opposite party in conducting the surgery properly, complainant did not get these advantages and that this amounts to deficiency in service.

7. These allegations are refuted by opposite parties basing on the following contentions:-

(i) That complainant was properly attended during the surgery and during post operative period. That the treatments given were correct and the MIPH surgery was conducted in a proper manner which was successful. After surgery when patient made complaints of urine retention and pain he was immediately attended and catheterisation was done which is the correct treatment for such situation. That retention of urine was due to Benign Hypertrophy of Prostate (BHP). That catheterisation failed due to presence of BHP. The next step in such cases was to do SPC and Dr. Mahesh who is a surgeon did SPC. After inserting SPC, urine was drained from the bladder and patient was relieved of the pain. Patient was also treated with analgesics and antibiotics. That correct and proper treatment was given to the patient for his complaints after the MIPH surgery. That no block in urethra was caused due to the negligence of opposite parties. The obstruction was due to BHP. Proper care was given after which complainant recovered fully.

(ii) Opposite party denies that failure to insert catheter prior to surgery is negligence. It is submitted that it is the discretion of a surgeon to insert the catheter before or after surgery.

(iii) That complainant had opted for MIPH surgery fully understanding the advantages and risk involved in the operation. The disease/piles for which complainant underwent treatment under first opposite party was cured and the MIPH surgery was successful. That in MIPH surgery complainant had less wound, less bleeding and short stay in the hospital. He was again admitted for urine infection and not due to any error in MIPH surgery. He was discharged after two days and recovered fully. That by inpatient admission of two times the total stay of the complainant in the hospital was only for four days. That complaints of urine retention and urine infection are normal complications after surgery. That such complications are accepted and recognized complications in any surgery to perianal region. That there is no deficiency in service.

8. To analyse medical negligence in this case we place before us the observations made by the Apex Court in Jacob Mathew Vs. state of Punjab and Anr. 2005 (3) CPR 70 SC which is as under:

“A simple lack of care, an error of judgment or an accident, is not proof of negligence on the part of a medical professional. So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alternative course or method of treatment was also available or simply because a more skilled doctor would not have chosen to follow or resort to that practice or procedure which the accused followed. When it comes to the failure of taking precautions what has to be seen is whether those precautions were taken which the ordinary experience of men has found to be sufficient; a failure to use special or extraordinary precautions which might have prevented the particular happening cannot be the standard for judging the alleged negligence.”

9. Admittedly complainant had haemorroids (piles) and approached first opposite party for treatment. He under went MIPH surgery as treatment to his disease. Complainant does not have a case that is disease/piles was not cured after the surgery or that any problem occurred at the site where MIPH surgery was done. His grievance is that due to negligence of opposite parties there was urine retention and urine infection after MIPH by which he had to suffer much pain and inconveniences and that therefore did not get the advantages offered by opposite party for MIPH surgery. Complainant also alleges neglect on the part of first opposite party to attend to him after surgery and states that his complaint of urine retention after surgery was attended only by nurse and another junior doctor.

10. It is not in dispute that a few hours after surgery complainant voiced pain and abdominal distention due to urine retention. It is also admitted that at that time he was first attended by the duty nurse and thereafter by Dr. Mahesh. First opposite party has submitted that this junior doctor is also a surgeon working as assistant to him. Complainant does not allege that Dr. Mahesh did not attend to him properly or that Dr. Mahesh did anything wrong. In fact it is admitted case that on complaint and indications of urine retention the nurse inserted catheter. Though some urine was drained, the retention continued. Then Dr. Mahesh examined the patient who removed the Foley's catheter and inserted Supra Public Catheter by taking the patient to the operation theatre. The grievance of the complainant that first opposite party did not personally attend to him does not find favour with us. The treatment records reveal that his complaint was attended by duty nurse and the duty doctor. The contention that the Chief surgeon who conducted the surgery himself has to attend every beck and call of the patient cannot be accepted. It is brought out in evidence of PW2 that the treatment for urine retention is to apply catheter and also administer analgesics. It is also brought out in evidence that when Foleys catheterisation fails the next step is to do SPC. It is stated by complainant that after doing SPC he was relieved of pain and his problem of urine retention was solved. Thus evidently the problem exhibited by complainant was attended to and also properly managed by opposite party hospital. We do not consider that first opposite party can be attributed with negligence for his absence at that time. It is recognized practice in medical treatment that duty nurses and duty doctors attend to the immediate needs of the patient. This is the reason why they are stationed in the ward as duty nurse and duty doctor. Such nurse and doctor may be acting after discussing with the main doctor/surgeon. In this regard DW1 has deposed in page 3 of cross-examination as under:

“I myself did not do the catheterisation of the complainant. In the post operative ward there will be a doctor to attend the patient. This complainant was having urinary retention and severe pain by 9.30 PM. Dr. Mahesh, my assistant attended the patient. From the case sheet it cannot be seen that nurse has put the catheter. Witness adds that from the nurses chart it is seen that catheter was put. I have not attended the complainant at 9.30 PM or afterwards because we have a call duty surgeon in the hospital and my colleague Dr. Mahesh who is also a surgeon attended the patient on that particular day. Urologist was informed and urology opinion was taken. Urologist advised SPC which was done by Dr. Mahesh. It is seen from the document in X1 that on 18-5-2005 Dr. Mahesh has done the SPC.”

It is seen in page 7 of Ext.X1 case sheet that on 17-5-2005 complainant was given test dose of Ampioclox injection at 4.30 PM. Below this it is written “Dr. Mahesh informed – Catheterisation”. Thus the nurses chart in Ext.X1 case sheet proves that nurse as well as Dr. Mahesh had immediately attended the patient and properly managed his complaints after surgery. From the above discussions we do not find that there was any deprivation of medical care to complainant by first opposite party after the surgery.

11. It is the further allegation that due to improper Catheterisation by the nurse a block was caused in the urethra which resulted in urine retention and urine infection. Complainant submits that when he showed symptoms of urine retention the nurse inserted a catheter. Though some urine was drained the pain and abdominal distention due to urine retention continued. That then Dr. Mahesh came along with the nurse who inserted the catheter and that Dr. Mahesh pulled out the catheter forcefully by which blood and urine came out. That thereafter SPC was done by Dr. Mahesh after taking the complainant to operation theatre. It is submitted by complainant that due to improper catheterisation by the nurse injury was caused in the urethra which caused obstruction for passing the urine and also resulted in urine infection. To substantiate this contention complainant places reliance on Ext.A14 which is the Retrograde Urethrogram (RUG) – X-ray of the urethra and tract. It was pointed out to us by counsel for complainant that the black spot seen in urethra in the RUG is a blood clot which was caused by injury during improper catheterisation.

12. Refuting these allegations it is submitted on behalf of opposite party that the catheterisation failed because the complainant had BHP. It is sworn by opposite party in para 7 that the inability to pass urine was due to presence of BHP which is an enlarged gland surrounding the neck of the bladder and urethra. It is submitted by opposite party that Foley's Catheter though entered the urethra partially it was not able to go beyond the obstruction of BHP. That realising the fact that enlarged prostate was causing severe stenosis of the urethra the catheter that was partially inserted was removed, and SPC was done which was successful. To substantiate this contention opposite party placed reliance on Ext.P1 case sheet in which the diagnosis is noted as “3º Haemorroids - BHP Grade 2 +. That Foleys Catheterisation failed due to obstruction of BHP and has not caused any injury or obstruction in urethra.

13. This contention raised by opposite party that complainant suffered from 3º Haemorroids - BHP Grade 2 + which was the reason for obstruction, is denied by complainant. Complainant submits that he had only haemorroids/piles and did not have any BHP. It is also submitted on behalf of complainant that the contention of opposite party that complainant had BHP and that this caused difficulty in passing urine and obstruction in catheterisation is only an after thought and that the medical records are fabricated by opposite party to suit this contention and to absolve them from liability. It was argued on behalf of complainant that opposite party has noted only 3º haemorroids as diagnosis in Ext.A1 discharge card. Whereas in Ext.X1(a) which is the 2^nd page in Ext.X1 case sheet opposite party has entered 3º Haemorroids - BHP Grade 2 + also as diagnosis. It is submitted by complainant that this is an insertion. We have given careful consideration to these rival contentions and perused the evidence and records in this regard carefully. It is seen that in Ext.A1 discharge card the diagnosis noted is only 3º haemorroid. The treatment noted in Ext.A1 is Stapler Haemorroidectomy. We have to say that the discharge card does not mention that Foley's Catheterisation failed and that Supra Public Catheterisation was done under Local Anaesthesia. It can be understood that this is because the discharge card is only a brief summary of the diagnosis and treatment undergone by the patient in a hospital. It need not always contain the whole details of treatment and examinations as stated in the case sheet. On perusal of Ext.X1(a) we find that complainant has endorsed on top of it by writing his name and affixing his signature. This handwriting and signature tallies with the handwriting and signature of the complainant in the deposition signed by him, his vakalath, complaint and Ext.X1(b) consent form. In other pages of Ext.X1 case sheet the name of patient appears to be entered by the hospital. Therefore we can definitely say that Ext.X1(a) page is part of Ext.X1 case records and this page is not an insertion/addition. Further the ink and writing with which BHP Grade 2+ is written in X1(a) is all through same in this page and in no way raises a suspicion of insertion or correction. What we are able to infer from the evidence adduced and records produced before us is that complainant had approached first opposite party with complaints of the disease of piles/haemorroids only. It is stated in Ext.X1(a) that by per rectal examination opposite party diagnosed 3º haemorroids and BHP Grade II. We are able to assume that since complainant consulted first opposite party with complaint of haemorroid only opposite party treated him only for haemorroids and not for BHP though the doctor could diagonise both diseases by per rectal examination. Therefore BHP did not find a place in the discharge card. But it was entered by opposite party in the case sheet as part of his findings on per rectal examination. The denial on the part of complainant that he had no BHP may be because of the fact that complainant had not been consciously realising the symptoms of BHP. As per Mosby's dictionary BHP is 'enlargement of the prostate gland, common in men after the age of 50. The condition is not malignant or inflammatory but is usually progressive and may lead to obstruction of the urethra and to interference with the flow of urine, possibly causing frequency of urination, the need to urinate during night, pain and urinary tract infections.' The evidence of PW2 in this regard is noteworthy. PW2 states in page 2 of chief as under:

“I have not treated the patient for BHP. It is not correct to say that the treatment for BHP is surgery. Surgery is not the sole treatment. B.H.P. Grade two will not vanish within a short duration. It is not correct to say that if a person is having B.H.P. Grade two he needs treatment. The size of prostate is not a criteria to determine treatment. I have not referred the earlier diagnosis of first opposite party (Dr. Ismail). I cannot commend upon Ext.A1 since it is a surgeons discharge card. In Ext.A1 and duplicate copy in Ext.X1 I have not noted any B.H.P. A disease of B.H.P. Grade two can be easily diagnosed by per rectum.”

Moreover complainant has stated in cross examination that opposite party told him that he had haemorroid as well as B.H.P. In page 1 of cross examination PW1 deposes as under:

“1- എതൃകക്ഷി ഡോക്ടര്‍ എന്നെ പരിശോധിച്ച് എനിക്ക് surgery വേണമെന്നു പറഞ്ഞു. ഞാന്‍ തനിയെ ആണ് ആശുപത്രിയില്‍ പോയത്. എനിക്ക് 3º haemorroids and BHP grade 2 എന്നാണ് ഡോക്ടര്‍ പറഞ്ഞത്. Surgery-ക്ക് മുന്‍പുളള പരിശോധനകള്‍ surgery-യുടെ അന്നാണ് ചെയ്തത്. Surgery ചെയ്യുന്ന സമയത്ത് എനിക്ക് 57 വയസ്സ് പ്രായമുണ്ട്. “

It is candid from the evidence tendered and records that complainant had BHP. So the contention of opposite party that inability to void urine and failure of catheterisation was due to BHP is more probable.

The other document that complainant relies to substantiate the negligence committed while inserting Foleys catheter is Ext.A14 which is the X-ray (RUG). It is submitted by counsel for complainant that the black spot seen in Ext.A14 is a blood clot caused by the injury due to improper catheterisation. DW1 and PW2 who are experts have denied this and have stated that this black spot seen in the urethra is not a blood clot but only an air bubble. There is no evidence that any injury/block was caused by opposite party during catheterisation.

14. It is also contended by complainant that such improper catheterisation and injury to urethra resulted in urine infection which amounts to medical deficiency. Admittedly complainant had urine infection. After the MIPH surgery on 17-5-2005 he was discharged on 19-5-2005 with SPC. It is seen from Ext.X1 case sheet that he consulted opposite party on 01-6-2005 and he had complaints of urine infection. It is also seen noted in Ext.X1 that complainant was on the same day referred to Urologist of the same hospital. This Urologist Dr. S. P. Rajan is examined as PW2. Ext.X2 is the case sheet which shows that complainant was admitted under the care of this urologist from 03-6-2005 to 05-6-2005. Complainant was discharged as recovered on 05-6-2005. Complainant does not have a case that he has any problem after this last discharge. If at all any complication of urine retention and urine infection had occurred it is seen that this complication was properly treated and managed by opposite parties.

15. It is the further case of complainant that the complication of urine retention and urine infection could have been avoided if first opposite party had applied the catheter prior to surgery. It is submitted by complainant that the failure on the part of first opposite party to insert catheter prior to surgery would prove absence of reasonable care and caution on the part of first opposite party which amounts to negligence. The evidence of the expert PW2 who is an Urologist in this regardis as under:

“It is a surgeon's preference to put the catheter before or after surgery. I deny to the suggestion that all surgeons will put catheter before operation.”

So the contention that opposite party committed medical negligence in not taking precaution to apply catheter prior to surgery is not supported by any medical evidence.

16. On behalf of opposite parties it is submitted that urine retention and urine infection are common and accepted complication in surgeries done in the perianal region. PW2 Dr. S.P. Rajan has deposed in page 3 as under:

“Urinary retention is a common accepted complication of rectal or peri-anal procedures. Foleys Catheterisation may fail even if it is done by doctors.”

In this connection opposite parties relied upon the article published in Hongkong Med. J. Vol.9 April, 2003 by Doctors. W.L. Law (M.S. FRCS (Edin) ), H.M. Tung (MBBS FRCS (Edin) ), KW Chu (MBBS FRCS (Edin) ) Department of surgery Tung Wah Hospital, Hongkong. The key words in this article are Ambulatory Stapled Haemorroidectomy – Post operative complications.

In page 103 it is stated as under:

“One patient in the day surgery group could not be discharged because of urinary retention and three required re-admission to hospital because of secondary haemorrhage (n=1) or fever (n=2).”

In page 105 it is stated as under:

“Of the 24 patients scheduled to have ambulatory surgery, 23 were discharged the same day. The only patient admitted to hospital had urinary retention and insertion of a urinary catheter was required.”

In the same page 105 it is stated as under:

“Complications following surgery occurred for eight patients. These included secondary haemorrhage (n=1), urinary infection (n=1), urinary retention (n=3), urinary urgency (n=2), and fever (n=1). All complications were treated conservatively and no further procedure was required for their management.”

In page 106 it is stated as under:

“Complications following stapled haemorrhoidectomy are mostly urological. Urinary retention is one of the most important reasons for hospital stay and re-admission following haemorrhoidectomy.”

17. The above medical literature along with the evidence of PW2 would amply prove that urine retention and urine infection is an accepted and recognized complication in the given situation. The argument of the complainant that he did not get the advantages of MIPH surgery which were less wound, less pain and less stay in the hospital also does not have any force. It is crystal clear that complainant did not have complaint of excess wound infection or pain in the site where MIPH was performed. His complaint of pain and distention was only due to urine retention which are normal and accepted complication. His little longer stay that too a re-admission for two days was only due this complication and not due to any complication which was proximate and direct to the conduct of MIPH surgery. We have also to state that Ext.X1 case sheet shows that complainant has given proper consent for doing the stapler haemorroidectomy as well as for doing the Supra Public Catheterisation. In such a case it can be presumed that complainant has undertaken the risk/complication inherently and potentially involved in the treatment. Admittedly he has recovered of the disease as well as the complication. A medical practitioner cannot be held deficient in service simply because things went wrong by some mischance. A doctor cannot predict with certainty the outcome of a treatment. Complainant has failed to establish any case in his favour.

Applying the principles of Bolam test as exphazised by the Apex Court in the said judgment and analysing the evidence and materials on record we are able to reach the inescapable conclusion that there is no medical negligence/medical deficiency in service on the part of opposite parties. Point found against the complainant.

18. In the result we dismiss the complaint. Parties are directed to suffer their respective costs.

Dated this 21^st day of April, 2009.

Sd/-

C.S. SULEKHA BEEVI, PRESIDENT

Sd/-

MOHAMMED MUSTAFA KOOTHRADAN, Sd/-

MEMBER E. AYISHAKUTTY, MEMBER

APPENDIX

Witness examined on the side of the complainant : PW1 and PW2

PW1 : Sri. K. Vasudevan Nair, complainant.

PW2 : Dr. S.P. Rajan, Urologist.

Documents marked on the side of the complainant : Ext.A1 to A14

Ext.A1 : Discharge card dated, 19-5-2005 given by opposite party to complainant.

Ext.A2 : Out patient card dated, 17-5-2005 given by opposite party to complainant.

Ext.A3 : Prescription dated, 17-5-2005 given by opposite party to complainant.

Ext.A4 : Prescription dated, 18-5-2005 given by opposite party to complainant.

Ext.A5 : Prescription dated, 17-5-2005 given by opposite party to complainant.

Ext.A6(series) : Pharmacy bills and receipts (15 Nos.) given by opposite party to complainant

Ext.A7 : Discharge card dated, 05-6-2005 given by opposite party to complainant.

Ext.A8 : Prescription dated, 01-6-2005 given by opposite party to complainant

Ext.A9 : Prescription dated, 04-6-2005 given by opposite party to complainant

Ext.A10 : Prescription dated, 04-6-2005 given by opposite party to complainant

Ext.A11 : Prescription dated, 01-6-2005 given by opposite party to complainant

Ext.A12(series): Pharmacy bills and receipts (8 Nos.) given by opposite party to complainant

Ext.A13 : Lab report dated, 16-6-2005

Ext.A14 : X-ray taken from opposite party to complainant.

Witness examined on the side of the opposite parties : DW1

DW1 : Dr. Muhammed Ismail, First opposite party.

Documents marked on the side of the opposite parties : Nil

Third Party Document marked : Ext.X1, X1(a) and X1(b) and X2

Ext.X1 : Case Sheet pertaining to the treatment of complainant as IP No.506/1709

given by opposite party for the period from 17-5-2005 to 19-5-2005.

Ext.X1(a) : Page No.2 of Ext.X1.

Ext.X1(b) : Page No.4 of Ext.X1.

Ext.X2 : Case sheet pertaining to the treatment of complainant as IP No.506/1709

given by opposite party for the period from 03-6-2005 to 05-6-2005.

Sd/-

C.S. SULEKHA BEEVI, PRESIDENT

Sd/-

MOHAMMED MUSTAFA KOOTHRADAN, Sd/-

MEMBER E. AYISHAKUTTY, MEMBER