Sri. P. Satheesh Chandran Nair (President):

The complainant filed this complaint u/s.12 of the C.P. Act 1986.

2. The case of the complainant is as follows.  The complainant is a 21 years old housewife who approached the 1^st and 2^nd opposite party for her pregnancy consultation on 27/08/2012 as O.P. No. 12/3/112509.  The 2^nd opposite party examined the complainant and advised ultra sound scanning on the same day.  It is said that the foetus growth was 16 weeks and nothing found abnormal.  On 01/10/2012, the complainant consulted the 2^nd opposite party as a regular check-up and 2^nd opposite party advised her to undergo Obstetric Sonography.  It is found that a foetus growth of 20 weeks and nothing found abnormal even on that day.  On 12/11/2012 and 28/12/2012 the complainant underwent for Obstetric Sonography as suggested by the 2^nd opposite party and found a foetus growth of 26 weeks and 32 weeks respectively. In that Obstetric Sonography no abnormality was also found.   On 30/01/2013 the complainant was admitted in 1^st opposite party’s hospital due to acute abdominal pain. The 2^nd opposite party conducted obstetric test and told that nothing wrong with the child and 38 weeks growth for the foetus.  On the same day at 12 noon the complainant gave birth to a female baby by a normal delivery.  The child was attended by the 3^rd opposite party in 1^st opposite party hospital.   At the time of discharge some medicines have also given to the complainant.  It is further contended that from the very birth of the child she was suffering from acute suffocation of bronchitis and the child became blue.  The complainant consulted 3^rd opposite party and complied all the ailments of the child so that he conducted Echo Cardiogram.  It is opined that the child has recurrent respiratory tract infection and complex congenital heart disease.  Though the medicines are recommended and administered all are invain.  It is stated that the sufferings of the child is beyond imagination and her pain and gester is untolerable.  Therefore, the complainant was constrained to took the baby at Sree Chitra Tirunal Institute for Medical Science and Technology for better treatment.  The MRI report from the said hospital was so shocking and unbelievable to the complainant.  As per the MRI report the child is having various malformalities in its internal organs such as heart, liver etc.  It is contended that all this informalities seen on the child could have been found by the opposite parties during pre-natal check-up.   The MRI Diagnosis reveals the following.

1. Right sided situe ambiguous (asplenia syndrome) with dextro cardia, common atrial chamber, common A-V Valve and single ventricular physiology having right ventricular morphology No.4V regurgitation noted with good systolic contractility of the dominant ventricle. 
2. Supracardiac type total pulmonary venous connection noted with vertical vain draining into the left SVC.  Right SVC, Left SVC and NC are noted draining into the common atrial chamber towards left side of the residual interatrial sapta.
3. Pulmonary artisia with PDA dependent pulmonary circulation.  PDA shows severe stenosis at the distal part and is noted supplying good sized RPA.  LPA is hypoplastic and shows severe stenosis of the origin.  Left upper lobar lung segments showed hypoperfusion.
4. A2.5mm aorto pulmonary collateral is noted arising from abdominal aorta as described with suggestion of supply to bilateral lower lobes via small branches.  No exclusive MAPCA supplied lung segment seen.  According to the  complainant of this malformalities  could have been easily be detected at the pre-natal check-up.

                   3. According to the complainant this malformalities could have been easily detected at the pre-natal test conducted by opposite party during her pregnancy.  It is contended that if the scanning might have been conducted by the Radiologist the 4^th opposite party, all the complications can be avoided. Here the ultrasound scanning have been done by the Gynecologist, the 2^nd opposite party herself.  The 3^rd opposite party who attended the child at the time of birth also failed to detect the malformalities of the child.  It is further contended that the opposite parties are not discharged reasonable care and professional calibre in discharging their duties.  The act of the opposite parties clearly comes under deficiency in service as described in Consumer Protection Act.  The female child is now having an age of one and a half years who is under the constant care and treatment of the complainant physically and medically.  The complainant belongs to a poor middle class family spend a huge amount towards the treatment expenses, besides that the huge amount spent by the complainant for her pre-natal check-ups and delivery.  Though the complainant claimed a relief of Rs. 25lakhs she limited his claim up to Rs. 20,00,000/- considering the pecuniary jurisdiction of this Forum.  It is contended that on 02/09/2013 due to acute breathing problem the complaint along with her child consulted the Cardiologist and the child is subjected to colour Doppler through an Echo Cardiography found the defect of the internal organs. The 3^rd opposite party who attended the child since birth miserably failed to detect the abnormality and the cause of the sufferings of the child.  On 04/09/2014 the child was taken to Amrita Institute of Medical Sciences and Research Centre at Cochin an Echo Cardiography test has done to the child and it was found that the total internal organs of the child are not in the correct position and this is the reason for the defect in the body functions of the child.  According to the complainant this defect could have been detected during the period of pre-natal check-up.  As a part of the procedure of the subsequent treatment AIMS advised that the baby has to undergo step by step surgery.  It is contended that all this grievances are informed to opposite parties by the complainant and at last on 16/05/2014 the complainant issued a legal notice against the opposite party calling upon to redress the grievances of the complainant.  Though the opposite parties received the notice, they replied the notice denying the claims of the complainant.  Hence this complaint, to pay a compensation of Rs. 20,00,000/- with interest and such other relief which the Forum thinks fit to allow. 

                   4. This Forum entertained the complaint and issued notice to opposite party 1 to 4 for appearance.  All the opposite parties entered appearance and filed separate versions.  As per I.A.44/15 the National Insurance Company Limited is also included in the party array as additional 5^th opposite party.  The additional 5^th opposite party also entered appearance and filed their version.  The 1^st opposite party version is as follows.  According to the 1^st opposite party the complaint is not maintainable either in law or on fact.  It is admitted that the complainant herein was admitted in opposite parties hospital on 27/08/2012 and she had gone for her 1^st trimester screening elsewhere and she was told to be normal except for fibroid uterus complicating pregnancy.  It is contended that the complainant underwent base line obstetric ultrasonography of 2^nd trimester by an experience radiologist.  According to 1^st opposite party no gross anomalies seen on foetus.  It is contended that even after conducting follow up and sonography by the obstetrician there is no specific indications for a targeted foetal scanning test or foetal echo test which are necessitated to the complainant.  According to this opposite parties 2 to 4 are professionally best in qualification and outstanding in their respective profession.  The hospital has all the best equipments and facilities in all the departments.  The hospital is having insurance and as such the insurance is a necessary party for the proceedings.  Hence it is prayed that 1^st opposite party may be exonerated from any liability claimed by the complainant. 

                   5.  The version of 2^nd and 4^th opposite party is as follows.  According to this opposite parties the complaint is not maintainable either in law or on facts.  According to the 2^nd opposite party the complainant had been under regular antenatal check up with her since 27/08/2012 and her expected delivery date was on 13/02/2013.  The first trimester scanning of the complainant conducted elsewhere and reported normal findings except for fibroid uterus.  On 27/08/2012 this opposite party directed for a baseline obstetrics ultra sound scanning on reported fibroids and the same was conducted with utmost care and attention by 4^th opposite party.  On that scanning it was found that no fibroid in the uterus or anomalies in foetus.  The follow up of the scannings were done by the 2^nd opposite party to assess foetal position, gestational age and volume of liquor etc as per accepted practice.  It is contended that the complaint has any history of the exposure to medications of anti-convulsants, lithium, retinoic acid or alcohol etc so as to advice specifically targeted anomaly scanning test or foetal echocardiography to the complainant.   It is contended that even in the routine scanning done during her antenatal period there was no extra cardiac anomaly, foetal growth retardation or decreased liquor volume were seen on her.  It is stated that the complaint was admitted with signs of active pain on 30/01/2013 and gave birth to a female baby having a weight of 2,25kg by a normal vaginal delivery.  Even at the time of parturient period there was no evidence of foetal heart variations.  According to this opposite parties when they attended and treated the complainant (delivery time)the new born baby did not show any signs or symptoms allowing to cardiac cause rather the baby was active and sucking well and there was no indication for any neonatal echocardiogram during hospital stay.  It is further contended that the complainant’s child was brought opposite party’s hospital with an episode of acute bronchitis when the baby was about six months old who was attended by the 3^rd opposite party by giving nebulization and antibiotics.  Further the clinical and craniological examination and consultation reveal that the child developed complex congenital heart disease and referred to pediatric cardiologist at AIMS Kochi.  It is stated that in ultra sound which create a two dimensional image of a three dimensional baby and in pre-natal testing ultra sound is an imaging modality which carries only 70-80% accuracy.  Ultra sound scanning is not a perfect depiction of the foetus and the factors like maternal obesity, paucity and amount of amniotic fluid, the hyper foetal parts as well as acoustic window etc. pose difficulty in examining some foetal areas.  The 2^nd and 4^th opposite party had exercised due diligence and care in the management of the delivery of the complainant and there was no negligent or deficiency in service in their part.  The allegation of the complainant to the effect that from the very birth of child she had been suffering from acute suffocation of bronchitis, turned blue and constantly crying are false allegations.  It is stated that the baby was brought with complainants of acute bronchitis in her infantile period or six months which shows baby remained symptomless initially even without murmurs and failure to thrive until she presented with repeat episodes of bronchitis in her mid-infantile period are  false.  It is again contended that the 2^nd trimester scanning was done by the fourth opposite party and no anomalies were noted as per sonoligical examination.  At that time the complainant did not have shown any previous obstetric problems or any problem during antenatal period which warranted any special scanning procedure under supervision of a radiologist other than an obstetric scanning.  It is again contended that there was no failure on the part of the 2^nd and 4^th opposite parties either in diagnosis or in treatment of the complainant and no negligence or deficiency can be alleged against them.  It is also stated that they are not liable to compensate the complainant either jointly or severely.  According to this opposite parties it is reliably known that the child was advised for an immediate surgical intervention for congenital heart disease from AIMS Kochi and the same was also refused by the complainant.  The amount of compensation claimed is highly exaggerated and without any substance or merit. Therefore the opposite parties are prayed to dismiss the complaint with cost them.  

                6.  The version of 3^rd opposite party is as follows.  According to 3^rd opposite party the case is not maintainable either in law or on facts.  It is admitted that the complaint consulted the opposite parties on 27/08/2012 for pre natal care and also advised to undergo periodical check-up.  It is contended that the trimester screening report was normal except for fibroid uterus complication.  He also admitted the trimester scanning 3 to 7 were conducted by the 2^nd and 4^th opposite party in 1^st opposite party’s hospital.  It is further contended that the complainant’s child was delivered normally on 30/01/2013 and the baby was feeding well and gained weight as a normal one.  It is pointed out that the baby not showed any evidence of respiratory distress or cardiac failure in the hospital.  It is stated that on 03/02/2013 the baby was consulted by the opposite party with an episode of bronchitis at the age of seven months old.  Further it was revealed that the baby had complex congenital heart diseases.  When it was revealed, without any delay, the patient was referred to AIMS Kochi for better consultation and treatment.  Subsequently for further treatment she had referred to Sree Chitra Institute of Medical Science, Thiruvananthaputam.  According to this opposite party the treatment history from 27/08/2012 to till the date of discharge, there was no negligence or failure from the part of the opposite party.  This opposite party also opined that ultra sound scanning is an imaging modality which carries only 70-80% accuracy.  Targeted anomaly scan and foetal echocardiography is necessary to detect, complex congenital heart disease at about 18-12 weeks of gestation.  It is again contended that since the complainant had no previous obstetric problems nor did she have any problems during pregnancy which warranted any special scanning procedure.  It is further contended that the symptoms of congenital heart diseases where not seen in the prenatal stages and even after the delivery i.e, after 7 months of birth.  According to him the child was hemodynamically stable and feeding well and there was no indications of targeted neonatal echocardiogram.  He pointed out the indications of targeted neonatal echocardiogram as follows:

1. Infants with perinatal asphysia,
2. Abnormal cardiovascular adaptations, presenting with hypotension, lactic acidosis, oliguria in first 24 post natal hours,
3. Suspected persistant pulmonary hypertension in neonates and
4. Congenital diaphragmatic hermia.

It is stated that none of the above criteria was seen in the child so as to have neonatal echocardiogram.  When it is understood that the child is suffering repeated bronchitis, guidelines and protocols issued by Indian academy of pediatrics-Neonatal Institute of Excellence U.K, were followed and implemented. Therefore there was no wrong in the method of treatment followed by the opposite parties.  The opposite parties are not liable to pay any claims as stated by the complainant since of the allegations are baseless exorbitant and imaginary.  Therefore this opposite party prayed to dismiss the complaint with cost to them.

7. The additional 5^th opposite party is impleaded in the party array as per the order in I.A. 79/2014.  The version of additional 5^th opposite party is as follows.  According to this opposite party the complaint is not maintainable either in law or on fact.  It is contended that none of the other respondents or complainant maintains the contention that a claim had been taken up with the 5^th opposite party and that they have denied the claim.  It is true that the 1^st opposite party has been insurance coverage in the category of errors and omissions insurance policy vide No. 571402/46/12/8700000003 from 26/04/2012 to 25/04/2013 and thereafter from 26/04/2013 to 25/04/2014 under policy No. 571402/46/13/8700000005.  It is contended that as per the terms and conditions of the policy that the coverage under the policy cannot be extended to the beneficiary i.e, the complainant because the 1^st opposite party’s hospital does not fall under the indemnity clause.  According to this opposite party the indemnity applies only to claims arising out of bodily injury or death of any patient caused by or alleged to have been caused by error, omission or negligence to professional service rendered or which should have been rendered by the insured or qualified assistants named in the schedule or any staff who are impleaded by the insured.  These opposite parties have got it knowledge of this complaint only on receipt of notice from this Forum on 19/12/2014.  This 5^th opposite party adopts the contentions of other opposite parties in the written version only to the extent of it resist the allegation of professional negligence.  Therefore, this additional 5^th opposite party prayed to dismiss the complaint with cost to them. 
8.   We peruse the complaint, versions as well as the records before us and we framed the following issues for consideration.
   1. Whether the complaint is maintainable before this Forum?
   2. Whether the opposite parties committed any deficiency in service against the complainant?
   3. Regarding the relief and costs?

9.  In order to prove the case of the complainant, the complainant she who filed a proof affidavit in lieu of her chief examination and examined her as PW1.  Ext. A1 to A10 were also marked through PW1.  Ext. A1 is the case summary dated: 19/03/2014 issued by the 2^nd opposite party.  Ext. A2 is the  certificate issued by 2^nd opposite party dated: 11/03/2014.  Ext. A3 is the copy of the Echo Cardiography case sheet dated: 04/09/2013 issued by Amritha Institute of Medical Sciences and Research Centre.  Ext. A4 is the copy of the MRI Report dated: 28/10/2013 issued by Sree Chitra Tirunal Institute for Medical Sciences and Technology.  Ext. A5 series are the Scan Report issued by the 1^st opposite party – (5 in Nos).  Ext. A6 series are the Laboratory result (18 in Nos).  Ext. A7 series are the office copy of the Advocate Notice with Postal Receipts and Acknowledgement Cards (3in Nos). Ext. A8 is the reply notice dated:22/05/2014. Ext. A9 is the Patient Medical record file of the complainant issued by the 1^st opposite party.  Ext. A10 is the patient record file of the child of this complainant issued by the 1^st opposite party.  When PW2 is examined through him Ext. A11 and A12 are marked.  Ext. A11 is the Cardiac Catherization Report issued by Amritha Hospital dated: 07/11/2015.  Ext. A12 is the discharge summary which was issued by Amritha Hospital, Cochin on 07/04/2016.  When PW3 is examined Ext.A13 is also marked.  Ext. A13 is also discharge summary of the child Ameya Anoop which was issued on 07/04/2016.  Ext. A14 is a medical bill of the child Ameya Anoop which was produced by one Mathew George Account Officer of opposite party’s hospital and Ext. A15 is medical bill of the complainant Remya Anoop which was also produced by the same persons of 1^st opposite party’s hospital.  Ext. A14 and A15 are suo-moto marked by this Forum since the opposite parties have no objection for marking it.  Ext. A16 is the case summary and discharge card issued by Sree Chithra Hospital, Thiruvananthapuram dated: 05/07/2016.  On the other side 2^nd opposite party filed a proof affidavit in lieu of her chief examination and examined her as DW1.  Through the DW1 Ext. B1 was also marked. Ext. B1 is the details of Insurance coverage policy.  After the closure of evidence we heard both sides.  At the time of hearing the complainant as well as 2^nd & 4^th opposite party are also filed argument notes.

   10. Point No.1:- When we examine the evidence of this case it is to see that all the opposite parties are raised a contention to the effect that this case is not maintainable either in law or on fact.  It is to see that the complainant in this case was treated in 1^st opposite party’s hospital from 27/08/2012 and delivered a child on 30/01/2013 from the same hospital.  After the birth of the child it is seen that some cardiac and some respiratory problem arised on the child and subsequently it is found that all this defects were arised even at the time of pregnancy.  The opposite parties in this case are not denied the treatment and other kinds of consultations given to the complainant at the time of pregnancy and after delivery.  It is also evident to see that for pre-natal checkup, treatment for the complainant and the child in 1^st opposite party’s hospital, the complainant paid money to 1^st opposite party’s hospital as consideration.  Therefore, we can easily come to a conclusion to the effect that the complainant is a consumer and the 1^st to 4^th opposite parties are service providers of the complainant.   Point No.1 is found in favour of the complainant. 

11.   Obstetric Sonography.  There is no dispute that the complainant admitted on 30/01/2013 at opposite party’s hospital and gave birth to a child on that day and the 3^rd opposite party also attended the new born child.  It is seen that the complainant is discharged on 03/02/2013.  We do admit that even at the time of the pregnancy treatment and at the time of delivery of the new baby, the complainant had no allegation of negligence on the side of 1^st to 3^rd opposite party.  It is noted that from the very birth of child she has been suffering from acute respiratory distress as a result of this the child turned blue and the child was crying constantly.  The complainant argued that when the child suffered acute respiratory problem 3^rd opposite party was careless to diagnose the cause of suffering of the child.  It is also come out in evidence to see that the child taken to Amritha Hospital, Kochi and Sree Chithra Hospital, Thiruvananthapuram for echocardiography and MRI scan.  The above said diagnosis revealed that the child is suffering from congenital abnormalities in visceral organs such as heart, liver, spleen etc.  It is argued that these abnormalities found on the child could have been found by the opposite parties during the time of the trimester scanning.  The complainant’s leaned counsel also argued that the above said abnormalities could be easily detected even in the 2^nd trimester scanning.  It is submitted that the opposite parties did not discharge reasonable care and professional caliber to diagnose these abnormalities.  If the opposite parties applied reasonable care and attention at the time of pre-natal checkup, the birth of child with congenital abnormalities could have been avoided.  It is further submitted that the lifelong suffering both to the complainant and her female child are the result of the negligence on the part of the opposite party.  In order to substantiate the case of the complainant the complainant she who filed a proof affidavit in lieu of his chief examination and she is examined as PW1.  Ext. A1 to A16 were also marked in favour of  PW1.  When we go through the proof affidavit of PW1 we can see that the proof affidavit is more or less as per the tune of the complaint.  Ext. A1 is the case summary of the complainant’s treatment at 1^st opposite party’s hospital from 27/08/2012 to 03/02/2013 which was issued by 1^st opposite party on 19/03/2014.  When we go through the Ext. A1, we can see that the complainant was undergone pre-natal care before the 1^st and 2^nd opposite party without fail.  Ext. A1 also shows that the new born baby was attended by the 3^rd opposite party and both of them were discharged on 03/02/2013.  The Ext. A2 is a certificate issued on 11/03/2014 which was issued by the 3^rd opposite party it reveals that the baby is suffering recurrent respiratory tract infection and an episode of turning blue.  The certificate also shows that the baby was suffering acute bronchitis which was treated with I.V Fluid, antibiotics etc. etc.  Ext. A3 is a certificate issued by Amritha Institute of Medical Sciences and Research Centre, Kochi dated:04/09/2013 the diagnose report is as follows: “Right isomerism, Complete AVCD, Common Atrium, Single ventricle, Long segment pulmonary atresia, Confluent Pas fed by vertical PDA, Bilateral SVC? TAPVC to mid LSVC”.  Ext. A4 is an MRI report issued by department of interventional Radiology and Imagine Signs – MRI Report by Sree-Chithra Institute of Medical Science, Thiruvananthapuram.  When we examine Ext. A4 a detailed MRI diagnose report can be seen.  The MRI diagnose is as follows: “(a). Right sided Situs ambiguous (asplenia syndrome) with dextrocardia, common atrial chamber, common A-V value and single ventricular physiology having right ventricular morphology.  No AV regurgitation noted with good systolic contractility of the dominant ventricle. (b). Supracardiac type total pulmonary venous connection noted with vertical vein draining into the left SVC. Right SVC, Left SVC and IVC are noted draining into the common atrial chamber towards left side of the residual interatrial septa.  (c) Pulmonary atresia with PDA dependent pulmonary circulation.  PDA shows severe stenosis at the distal part and is noted supplying good sized RPA, LPA is hypoplastic and shows severe stenosis of the origin.  Left upper lobar lung segments show hypoperfusion. (d) A 2.5 mm aortopulomonary collateral is noted arising from abdominal aorta as described with suggestion of supply to bilateral lower lobes via small branches.  No exclusive MAPCA supplied lung segment seen”.

        12.  When we peruse the Ext. A5 series which shows that on 27/08/2012, 01/10/2012, 12/11/2012, 28/11/2012 and on 30/01/2013 the complainant was undergone ultra sound scanning in connection with her pregnancy at opposite party’s hospital.  It is also revealed that in all these ultra sound scanning report no abnormality can be seen as described above.  Ext. A6 series are (18 Nos.) shows that in 1^st opposite party’s hospital the complaint was under gone for different laboratory test of blood and urine of each consulting date either the complainant or the opposite parties did not point out any kind of abnormalities on the basis of  Ext. A6 series.  Ext. A7 series (3 in Nos.) shows that the complainant’s counsel issued legal notices to opposite party 1 to 3 and the said notice are received by the concerned in time.  The Ext. A8 is the reply notice to Ext. A7 legal notice to the concerned.  The contents of the reply notice shows that the opposite parties are strongly opposed the allegation of negligence alleged against them.  The Ext. A9 and A10 are the treatment records of the complainant and her new born baby respectively.  The Ext. A11 dated: 20/03/2015 and the Ext. A12 dated: 07/04/2016 are final diagnosis report and surgical report which were issued from Amritha Hospital, Kochin respectively.  The final diagnosis reports stated as follows: “Mean Glenn pressure was 15mm Hg.  There was normal atrial and ventricular filling pressures.  The left pulmonary venous pressure was also normal.  There was abrupt cut off left pulmonary artery after a very short Proximal stump for a distance of approximately 1cm.  Repeated attempts to cross the proximal stump of left pulmonary artery in order to recanalise it were unsuccessful.  There was no venous collaterals.  There was normal drainage of all right and left hepatic veins into IVC”. The doctor who issued Ext. A11 was examined as PW2 and he deposed in chief “The misplacement are the internal organs are not located normally they are situated towards the middle line.  In this case the liver is in the middle.  The patient has single ventricle.  Normally human beings have two ventricle.  The patient has only common Atrium (Normally have two)”.  On the basis of the Ext. A11 and the deposition of PW2 we can clearly come to a conclusion that child was born with so many abnormalities and all these abnormalities are congenital also.  Ext. A13 is the discharge summary dated: 07/04/2016 issued by Amritha Hospital, Kochi.  Ext. A13 reveals that on 19/03/2015 the child was admitted in Amritha Hospital for a surgery and the child was discharged on 22/03/2015.  The diagnosis report Ext. A13 shows that a surgery was conducted on new born child for controlling the abnormalities seen on her.  Ext. A14 and A15 are medical bill issued by Poyyanil Hospital for the treatment of the complainant and her new born baby.  Ext. A14 and A15 are produced by the custodian of the said records of Poyyanil Hospital (OP2) and the said documents are suo-moto marked by this Forum since there is no objection on the other side against the marking of this documents.  Ext. A16 dated 05/07/2016 which was issued by PW2 also shows that the new born child is suffering congenital problem and the diagnosis is as follows: “CCHD, SA/SS, DXTROCARDIA, COMMON ATRIUM, LEFT PV TO VV TO, COMMON ATRIUM, COMMON AV VALVE, SV OF INTERMEDIATE MORPHOLOGY, LONG SEGMENT PULONARY ATRESIA, LEFT ARCH,PDA SUPPLYING RPA, MAPCA S FROM DTA”.

          13. The learned counsel appearing for the complainant argued that on a perusal of Ext.A3, A4 & A16 the major abnormalities of Citus Ambiguous with Dextocardia, spleen problem of liver, common atrial and chamber single ventricles are seen.  When we peruse the testimony of PW2 in-cross of opposite party 2,3 and 4 he also opined that foetal echo cardiac test result is not recorded in variability in all cases and the said test are being conducted in the high risk category of this kind.  It is noted that at the time of cross-examination the contesting opposite parties has not raised any series contention with regard to Ext. A5 scanning reports which are 5 in number.  When we refer Ext. A5 ultra sound scanning report of the PW1 we can see that only ‘x’ marks are seen against the columns of fetal moments, fetal cardiac activity and for fetal breathing .In Ext. A5 page 2 to 5 the same kind of marking only can be seen.  The scanning report dated 27/08/2012 is also not written in the proper foam as seen in Ext. A5 page 2 to 5.  When we consider the abnormalities of the child the non-completion of Ext. A5 page 2 to 5 with regard to fetal moment, fetal cardiac activity and fetal breathing have to be considered as a grave negligence on the part of 2^nd opposite party.  It is interesting to see that Ext. A5 page 2 &3 there is no mention with regard to fetal breathing.

          14. The PW3 is the professor of Paediatrician Cardiology of Amritha Hospital, Cochin named Dr.K. Mahesh.  He produced the discharge summary of the child of the complainant Ameya Anoop which is marked as Ext. A13.  The opposite party 1 to 5 have not cross-examine this witness.  Therefore we can rely Ext. A13 the discharge summary of the daughter of the complainant Ameya Anoop which was marked as Ext. A13.  Ext. A13 is a document which elaborately discussed the abnormalities found on the child of the complainant.     

      15. PW4 is the doctor who is working in Sree Chithra Hospital, Thiruvananthaputam, he who produced Ext. A16 MRI Scan report of the daughter of the complainant Ameya Anoop.  He deposed that the child is in need of further surgery, the internal organs of the child are displaced and the child has only two chambers in the heart. In chief he deposed ഈ കുട്ടിയുടെ രോഗം നിർണ്ണയിച്ചപ്പോൾ ടിയാളുടെ രോഗം വ്യക്തമായി. Ext. A16 ൽ വിവരിച്ചട്ടുണ്ട്.  രണ്ട് അറകൾ വേണ്ട സ്ഥാനത്ത് ഒന്നും രണ്ട് വാൽവ് വേണ്ട സ്ഥനത്ത് ഒന്നും ആണ്. രക്തകുഴൽ സ്ഥാനം മാറി കണ്ടു. നാലു വാൽവ് വേണ്ട സ്ഥാനത്ത് 2 വാൽവ് ഉള്ളൂ എന്നും കൂടാതെ ശ്വാസകോശത്തിവലേക്ക് രക്തം വരുന്നത് abnormal      ആണ് എന്നും ഹൃദയം സ്ഥനം തെറ്റി വലത് വശത്ത് ആയിട്ട് ആണ് എന്നും ബോദ്ധ്യപ്പെട്ടിട്ടുണ്ട്. In-cross PW4 answered “28 ആഴ്ചകൾക്ക് ശേഷം പരിശോധിച്ചാൽ  advance pregnancy ൽ എല്ലാ defect ഉം മനസ്സിലാക്കാം. Heart ൻറെ സ്ഥാനമാറ്റം നേരത്തേ തന്നെ മനസ്സിലാക്കാം. In a suggestive question of 2^nd opposite party counsel he further answered “advance pregnancy ൽ ഈ defects മനസ്സിലാക്കാൻ കഴിയുന്നത് foetal echo test കൊണ്ടാണ് ഇത് സാധാരണ നടത്തുന്ന  pre-natal test അല്ലെ എന്ന് പറയുന്നു. (A) അറിയില്ല. Though the learned counsel of the opposite party suggested a question with regard to foetal echo test on high risk group pregnancy the answer of PW4 was also not infavour of 2^nd opposite party.

            16. The 1^st opposite party filed an argument note and pleaded that there is no negligence on the side of 1^st opposite party’s hospital since 1^st opposite party’s hospital is having of kinds of modern facility and 2^nd opposite party and 3^rd opposite party are so expert in their discipline.  It is also argued that no particular negligence can be attributed against 2^nd to 4^th opposite party therefore, 1^st opposite party is not at all liable to the complainant.  It is pleaded that the 1^st opposite party’s hospital is having an insurance with additional 5^th opposite party, therefore even if any negligence found against 1^st opposite party it has to be paid by 5^th opposite party Insurance Company.  1^st opposite party learned counsel further argued that the abnormalities seen on the new born baby can be detected during the pregnancy if a specialized test conducted on the mother/complainant.  In this case no abnormalities were found in prenatal checkup and ultra sound scanning done in 1^st opposite party’s hospital there by there is no need of suggesting a specialized test i.e, fetal echo cardiography.  According to the learned counsel of 1^st opposite party if a patient has not disclosed any ‘risk categories’ at the time of examination normally the gynecologist (OP2) does not conduct the fetal echo test.  It is further argued that the congenital defects happened in the child is an act of god hence nobody can blamed for it. 

          17. The learned counsel appearing for 2^nd opposite party and 4^th opposite party also filed an argument note in favour of their contention.  It is admitted that the complainant who was an age of 21 years for her primi gravida admitted in 1^st opposite party’s hospital and she delivered a female child on 30/01/2013.  On 27/08/2012 onwards the 2^nd trimester ultra sonography scanning had begun at 1^st opposite party’s hospital and subsequent 4 trimester ultra sonography scannings were done at 1^st opposite party’s hospital and no specific indication for a targeted foetal scanning or any foetel echo cardiography were necessitated on the basis of the findings arrived by 2^nd opposite party in 1^st opposite party’s hospital.  It is admitted that the new born baby of the complainant was admitted in 1^st opposite party’s hospital for acute bronchitis which was treated with IV fluid antibiotics.   According to 2^nd opposite party she was got knowledge about the complex congenital heart disease of the baby when she has seen the records from Amritha Hospital, Kochi and Sree Chithra Hospital, Thiruvananthapuram. The 2^nd opposite party strongly contended that the abnormality subsequently found on the baby of the complainant was a congenital problem which could not detected through an ultra sound scanning.  The main issue to be answered is whether the congenital heart abnormalities found on the child is due to any negligence or deficiency of treatment on the part of the opposite parties one and two. 

          18. According to 2^nd opposite party’s learned counsel congenital heart disease is a major cause of neonatal distress and the same is the most common cause of death in the new born baby other than problems related to pre-maturity.  The instants of congenital cardio vascular anomalies are 8-10 when 1,000 live births, with the mortality rate greatest in the neonatal period.  The reason for the congenital heart anomalies are genetic causes-primarily single gene mutation and chromosomal abreactions or environmental factors such as maternal infection or exposure to radiation or noxious subjects etc.  The above said congenital anomaly is explained in Mosby’s Medical Dictionary.  We do admit that the abnormality seen in the new born child of the complainant happened at the time of congenital period.  The question to be considered is whether 2^nd opposite party doctor failed to know the congenital problem of the baby at the time of pre-natal checkup or not.  It is argued that foetal echo cardiology test is not normally done as part of routine anti-natal checkup.  The foetal cardiac defects are especially difficult to diagnosis in pre-natal checkup due to the complicity of heart anatomy.  When we go through the testimony of PW1 in-cross we can see that the PW1 has taken a strong stand to the effect that even at the time of pre-natal checkup the defect if any of the child could have been detected by 2^nd opposite party.  In-cross of 2^nd opposite party PW1 answered “congenital anomaly scan നടന്നിരുന്നെങ്കിൽ ഗർഭസ്ഥശിശുവിൻറെ രോഗാവസ്ഥ നേരത്തേ അറിയുമായിരുന്നു എന്ന് എന്നോട് അമൃതയിലെയും, ശ്രീചിത്രയിലേയും  Doctor പറഞ്ഞിരുന്നു  O.P II Doctor എനിക്ക് എല്ലാ മുൻകരുതലും എടുത്ത ചികിത്സിച്ചിരുന്നു എന്ന് പറയുന്നത് ശരിയല്ല.  എനിക്ക് പലവിധ test കളും നടത്തിയെങ്കിലും കുട്ടിക്ക് കുഴപ്പം ഉള്ളതായി പറഞ്ഞിരുന്നില്ല. On the basis of the above testimony it can be inferred that PW1 believes that 2^nd opposite party doctor had not taken sufficient precautious and utmost care in attending or verifying various pregnancy test of the complainant PW1.  It is to be noted that whether the complainant is succeed to prove her contention and allegation against 2^nd opposite party in this regard.    When we go through the testimony on DW1 in-cross of the complainant she answered “Ext. A9 Page No.1 ൽ complicating pregnancy fibroid uterus എന്ന് രേഖപ്പെടുത്തിയിട്ടുണ്ട് (Q&A) ഇപ്രകാരം എഴുതാൻ ഇടയായത് patient പറഞ്ഞത് അനുസരിച്ചാണ്. Previous history  ആയി ആസ്മ fever ഉം എഴുതിയിട്ടുണ്ട്.  She again adds in-cross “16 weeks ൽ 2 മത്തെ scanning ഞാൻ ചെയ്തു ഈ patient ന് 5 scanning total ചെയ്തു  16 ആം ആഴ്ചയിലും 21 ആം ആഴ്ചയിലും 27ആം  ആഴ്ചയിലും 31 ആം  ആഴ്ചയിലും 38ആം  ആഴ്ചയിലും ഈ patient \v scanning നടത്തിയത് On the basis of the above testimony we can see that the patient was conducted all the test which was directed by 2^nd opposite party. ഗർഭാവസ്ഥയിലുള്ള ശിശുവിൻറെ heart beat ആഴ്ചകൂടുതോറും വ്യത്യാസം വരും. 110-120 beat per minute ആയിരിക്കും ശിശുവിൻറെത്  1^st stage ൽ120 to 160 ആയിരിക്കും ശിശുവിൻറെ heart beat second and III stage - ൽ 7-8 weeks – ന് ഉള്ളിൽ ശിശുവിൻറെ heart beat  അറിയാം ഓരോ scanning ഉം ടി ശിശുവിൻറെ heart beat measure ചെയ്യണം. 16 weeks പ്രായമുള്ള ഗർഭസ്ഥശിശുവിൻറെ features visible ആണ്  Visceral organs II^nd trimester  visible ആവും Organs എവിടെ എന്ന് കാണം. ഹൃദയത്തിൻറെ 4 chamber ഉം visible ആവും. Pre – natal scanning ചെയ്യുന്ന defect എന്ത് ആണ്.30/01/2013 ന് മുൻപ് ചെയ്ത 5 scanning ഉം image-ൽ രൂപപ്പെട്ട കാര്യങ്ങൾ ഞാൻ ശ്രദ്ധിച്ചിരുന്നു.  ആദ്യത്തെ ഒരു scanning മാത്രമാണ്.  Radiologist ചെയ്തത്. ബാക്കി 4 scan ഉം ഞാൻ ആണ് ചെയ്തത്.  ഞാൻ ചെയ്ത scan ൽ ശിശുവിന് എന്തെങ്കിലും അപാകത ഉള്ളതായി image -ൽ കണ്ടില്ല.  ഞാൻ ചെയ്യുന്ന scanning growth and movements മാത്രമാണ് നോക്കുന്നത്.  If we believe the above testimony of 2^nd opposite party it can be understood that 2^nd opposite party doctor verified and examined the development of the heart and the respiratory movement of the baby in all ultra sound tests.  It is clear that when we refer Ext. A5 the 2^nd opposite party totally failed to ascertain the fetal cardiac activity, fetal breathing because the column for writing the result is seen blank in Ext. A5 page 2 to 5.  Therefore the opinion given by 1^st opposite party before the Forum is not at all believable and her conclusion has any merit at all.  It is also to see that even at the time of the examination of DW1 she has not given any specific opinion with regard to the reason for none completion of Ext. A5 page 2 to 5 as stated above.  When we evaluate the evidence of this case we can see that the 2^nd opposite party doctor has done nothing to identify whether this complaint comes under high risk group on the eve of the findings arrived by the doctor such as fibroid pregnancy.  The learned counsel appearing for the Complainant argued that the medicine foundation of the International Society of Ultrasound in Obstetrics and Gynecology-Sonography is concerned as a tool for diagnose the fetal defects.  When DW1 is further cross-examined by the complainant counsel she answered “PNDT ACT എന്താണെന്ന് അറിയാമോ (A) അറിയാം. (Q) ആ നിയമത്തിൽ പറയുന്ന പ്രധനപ്പെട്ട diagnostic technics അറിയാമോ. (A) അറിയാം.  ഈ കേസിലെ complainant ൻറെ കാര്യങ്ങൾ ഈ ടെക്നിക്സ് ഒന്നും തന്നെ ഞാൻ apply ചെയ്തിട്ടില്ല. (Q) ultra sound scanning മേൽ പറഞ്ഞ പ്രകാരമുള്ള technics ഉൾപ്പെട്ടതല്ലെ. (A) അതെ(Q) Pregnancy time ൽ amniotic Fluid ൻറെ അളവ് test ചെയ്ത തോത് അറിയേണ്ടതല്ലെ. (A)അതെ. on the basis of the testimony of DW1 it can be inferred that though DW1 has a clear knowledge of the above diagnostic technic she did not apply that technic when she evaluate the ultra sound scanning report of Ext. A5 series.  Again DW1 admitted in-cross “Ext. A9 ൽ page No.41,42,43,44,45 ൽ (41 to 45) obstetric sonography എന്ന് പറയുന്നത് ഭ്രൂണത്തെ സംബന്ധിച്ചുള്ള പരിശോധന അല്ലെ. (A)അതെ. (Q) ടി പരിശോധന chromosominal abnormalities, genetic and metabolic disorders  എന്നിവ മനസ്സിലാക്കുന്നതിന് വേണ്ടിയല്ലെ (A) അതെ. If 2^nd opposite party conducted a proper examination on the basis of an Obstetric Sonography as per Ext. A9 (Page 41 to 45) she could have been find the chromosominal abnormalities on the new born baby.  Again she adds “Ext. A9  page No.43 to 45 ൽ sonography ൽ കോളങ്ങൾ ഒന്നും തന്നെ പൂരിപ്പിച്ചുകാണുന്നില്ലല്ലോ. (Aപരിശോധിച്ചു. പൂരിപ്പിച്ചിട്ടില്ല. (Q) പരിശോധിക്കാത്തതുകൊണ്ടല്ലേ രേഖപ്പെടുത്താതിരുന്നത് (A) അല്ലെ. Abnormality ഒന്നും കണ്ടിരുന്നില്ല. Again she adds ഞാൻ നടത്തിയ scanning ൽ visceral organs കാണാം എന്നാൽ abnormality കാണാൻ ബുദ്ധിമുട്ടാണ് Ext. A4 എൻറെ ശ്രദ്ധയിൽപെട്ടതാണ്. അതിൽ പറഞ്ഞിരിക്കുന്ന situs ambiguous എന്നത് organs ൻറെ സ്ഥാനമാറ്റം ആണ്. Spleen absent എന്ന് പറഞ്ഞിരിക്കുന്നത് ഒരു organ ഇല്ല എന്നതാണ്. Dextro cardia എന്ന് പറയുന്ന അവസ്ഥ ഹൃദയത്തിൻറെ സ്ഥാനമാറ്റം ആണ്. We do admit that Ext. A4 is the MRI report of Sree Chitra Hospital, Thiruvananthapuram. On a reading of her testimony it also clear that she had knowledge about the change of heart position of the baby and the absence of spleen even at the time of prenatal checkup of the complainant.  Again she answered “(Q) ഒരു ഭ്രൂണത്തിൻറെ internal organs ൻറെ സ്ഥാനമാറ്റങ്ങൾ  2^nd trimester ൽ വ്യക്തമാകുമല്ലൊ (A) വ്യക്തമാകും. (Q) Dextro cardia എന്ന അവസ്ഥ ബോധ്യപ്പെട്ടാൽ ഭ്രൂണത്തിൻറെ കൂടുതൽ പരിശോധനയ്ക്കുള്ള ചൂണ്ടുപലകയല്ലെ. (A) അതെ.  This portion of the testimony of DW1 again conferred her negligence with regard to the findings on the trimester examination of the complainant.

          19. When we appreciate the whole evidence adduced by both parties in this case we can see that the complainant has failed to adduce any evidence against 3^rd or 4^th opposite parties in this case.  We can see that 3^rd opposite party has attended the new baby of the complainant at the time of delivery and when the child suffered acute bronchitis he examined the patient and refer the case to major hospital for further treatment and examination.  We cannot see any kind of negligence or deficiency in service on the part of the 3^rd and 4^th opposite party.  It is come out in evidence that 4^th opposite party radiologist has conducted only one sonography test dated: 27/08/2012.  Therefore the 3^rd and 4^th opposite parties are exonerated from all charges.  When we look into the contention of the additional 5^th opposite party National Insurance Company Limited it shows that none of the opposite party or the complainant raised any contention that an insurance claim has been denied by this opposite parties.  As such no allegation of deficiency in service can be attributed against this opposite party.  It is also admitted that 1^st opposite party the Poyanil Hospital is enjoying an insurance coverage under 5^th opposite party under the category of errors, omissions insurance policy vide policy No. 571402/46/1`28700000003 from 26/04/2012 to 25/04/2013 and their after from 26/04/2013 to 25/04/2014 under policy No. 571402/46/138700000005.  When we refer Ext.B1 the insurance policy we can see that there is an insurance coverage of Rs.20,00,000/- to 1^st opposite party’s hospital. When we evaluate the whole version of additional 5^th opposite party we can inferred that the insurance company has to be indemnified the insured for error, omission or negligence happened from professional services.  The learned counsel of the complainant also cited certain decisions in his favour.  He 1^st refer an introduction in a text book related to Diploma in Fetal Medicine & ISUOG Educational Series it read “Ultrasound is the main diagnostic tool in the prenatal detection of congenital abnormalities.  It allows examination of the external and internal anatomy of the fetus and the detection of not only major defects but also of subtle markers of chromosomal abnormalities and genetic syndromes.  Although some women are at high risk of fetal abnormalities, either because of a family history or due to exposure to teratogens such as infection and various drugs, the vast majority of fetal abnormalities occur in the low-risk group.  Consequently, ultrasound examination should be offered routinely to all pregnant women.  The scan, which is usually performed at 18-23 weeks of pregnancy, should be carried out to a high standard and should include systematic examination of the fetus for the detection of both major and minor defects”.  He also cited another decisions reported in SCC (2000) 7 668 in Charan Sign Versus Healing Touch Hospital and Others by our Hon’ble Supreme Court the citation is “While quantifying damages, Consumer Forums are required to make an attempt to serve the ends of justice so that compensation is awarded, in an established case, which not only serves the purpose of recompensing the individual, but which also at the time, aims to bring  about a qualitative change in the attitude of the service provider.  Indeed, calculation of damages depends on the facts and circumstances of each case.  No hard and fast rule can be laid down for universal application.  While awarding compensation, a Consumer Forum has to take into account all relevant factors and assess compensation on the basis of accepted legal principles, on moderation”. 

                  20. When we go through this decision we can see that the awarding of compensation is not only for the complainant but it bring a qualitative change in the attitude of the service provider.  When we think about the quantum of the compensation the future of the child a part from the mental agony sustaining by the parents are also to be considered in the light of this decision.  In another decision reported in 2010 KHC 4333 in Kishan Rao V. Versus Nikhil Super Specialty Hospital and Another a division bench of our Hon’ble Supreme Court held “In a case where negligence is evident, the principle of res ipsa loquitur operates and the complainant does not have to prove anything as the thing(res) proves itself – Appellant complainant got his wife admitted in respondent hospital as his wife was suffering from fever – Death of patient – District Forum holding that the patient was subjected to wrong treatment of typhoid when she was suffering from malaria, awarded compensation of Rs.2 lakhs – State Commission allowed the appeal – State Commission also held that there was no expert opinion –National Commission upheld findings of State Consumer Forum – In the facts and circumstances of the case expert evidence is not required and District Forum rightly did not ask the appellant to adduce expert evidence – Respondent No.1 is directed to pay the appellant the amount granted in his favour by the District Forum”.   Therefore, we can come to a conclusion that the error, omission or negligence happened on the part of 2^nd opposite party when she is working at the 1^st opposite party’s hospital.  It is also found that the additional 5^th opposite party has to indemnify 1^st opposite party’s hospital for the insurance coverage of Rs. 20,00,000/- as per Ext. B1.  The complainant herein prayed to award a medical negligence claim of Rs. 25,00,000/-.  The compliant limited the claim up to Rs. 20,00,000/-for the purpose of the pecuniary jurisdiction of this Forum.  The claim included all the medical treatment expenses, mental agony, compensation cost etc.etc.    We do admit that a child who is suffering the above stated abnormalities whose future life is a challenge to the complainant and her family and it caused mental agony and all kinds of difficulties to them.  Here mental agony cannot be calculated in terms of money.  Anyway considering the nature and circumstances of this case we find that the complainant is succeeded to prove her case and we find that 2^nd opposite party has committed deficiency in service or negligence in her profession towards the complainant.  It is admitted that 2^nd opposite party is working in 1^st opposite party’s hospital.  Therefore an employer and employee relationship is existing between 1^st and 2^nd opposite party.  If an employee does a wrongful act in the course of his employment the employer or the master is also liable along with the employee.  Here 1^st opposite party has a vicarious liability for the act of 2^nd opposite party. Additional 5^th opposite party has to indemnify the act of 1^st opposite party since a valid insurance policy is existing.  The1^st and 2^nd opposite parties are jointly and severely liable to the complainant.  Therefore Point No.2 and 3 are also found in favour of the complainant.   

21.   In the result we pass the following orders.

1. The 1^st and 2^nd opposite parties are here by directed to pay an amount of  Rs. 15,00,000/- (Rupees Fifteen lakhs only) to the complainant including the cost of treatment, mental agony, and compensation with 10% interest to the complainant on receipt of this  order onwards.
2. In view of the valid policy additional opposite party 5 - the insurer should make the following payment - The additional opposite party 5 shall produce an account payee cheque in the name of the complainant for the award amount Rs. 15,00,000/- (Rupees Fifteen lakhs only) (relief 1 only) with 10% interest within one month of receipt of this order. (interest of the above amount shall be calculated from the date of order onwards)
3. The 1^st and 2^nd opposite parties are also directed to pay a cost of Rs. 5,000/- (Rupees Five Thousand only) with 10% interest to the complainant on the date of receipt of order onwards. 

      Dictated to the Confidential Assistant, transcribed and typed by her, corrected by me and pronounced in the Open Forum on this the 31st day of July, 2017.

                                                                                    (Sd/-)

                                                          P. Satheesh Chandran Nair,                                                                                                                                                                                                                                              

                                                                 (President)

Smt. Sheela Jacob (Member)               :    (Sd/-)

Appendix:

Witness examined on the side of the complainant:

PW1 :  Remya Anoop

PW2 :  R. Krishna Kumar

PW3 :  Dr. K. Mahesh

PW4 :  R. Krishna Moorthy

Exhibits marked on the side of the complainant:

A1 : The case summary dated: 19/03/2014 issued by the 2^nd opposite party.

A2 : The certificate issued by 2^nd opposite party dated: 11/03/2014.

A3 : Copy of the Echo Cardiography case sheet dated: 04/09/2013 issued by 

       Amritha Institute of Medical Sciences and Research Centre

A4 : Copy of the MRI Report dated: 28/10/2013 issued by Sree Chitra Tirunal          

        Institute for Medical Sciences and Technology.

A5 series : The Scan Report issued by the 1^st opposite party – (5 in Nos.)

A6 series : The Laboratory result (18 in Nos.) 

A7 series : The office copy of the Advocate Notice with Postal Receipts and 

                 Acknowledgement Cards (3in Nos.)

A8 : Reply notice dated:22/05/2014

A9 : Patient record file issued by the 1^st opposite party.     

A10 : Patient record file.

A11 : Cardiac Catheterization Report dated: 07/04/2016 issued by Amrita

         Hospital, Cochin.

A12 : Copy of discharge summary dated:07/11/2015 issued by Amrita Hospital.

A13 : Copy of discharge summary dated: 21/03/2015 issued by Amrita Hospital.

A14: Discharge bill details issued by Poyanil Hospital, Kozhencherry.

A15: Discharge bill details issued by Poyanil Hospital, Kozhencherry.

A16: Case summary and discharge record dated: 05/07/2016 issued by Sree          

        Chitra Hospital, Thiruvananthapuram

Witness examined on the side of the opposite parties:

DW1: Dr. Shyama Daniel

Exhibits marked on the side of the opposite parties:  

B1 : Details of Insurance coverage policy

                                                                                                        (By Order)

Copy to :- (1) Remya Anoop,             

                     Achariparampil House, Edayaranmula P.O,

  Aranmula Village, Pathanamthitta.

2. The Administrator, P.B.No.15, Kozhencherry Village, Pathanamthitta.
3. Dr. Shyama Daniel, Consultant,

      Gynecologist, Poyyanil Hospital, P.B.No.15,

      Kozhencherry Village, Pathanamthitta.

4. Dr. Vivan Thomas, Pediatrician,

      Poyyanil Hospital, P.B. No.15, Kozhencherry Village,

      Pathanamthitta District.

5. Radiologist, Poyyanil Hospital,

      P.B. No.15, Kozhencherry Village, Pathanamthitta. 

6. The National Insurance Co. Ltd,

      Kallunkathara Building,

      Main Road, Pathanamthitta.

7. The Stock File.