IN THE CONSUMER DISPUTES REDRESSAL FORUM, PATHANAMTHITTA, Dated this the 7th day of October, 2010. Present : Sri. Jacob Stephen (President). Smt. C. Lathika Bhai (Member) N. Premkumar (Member) O.P.No.174/04 (Filed on 13.08.2004) Between: Saramma John, W/o. K.T. John, Kamalakunnel House, Kuttapuzha. P.O., Thiruvalla, Pathanamthitta. (By Adv. T. Zakir Husain) ..... Complainant. And: 1. Pushpagiri Hospital, Thiruvalla, rep. by the Director. Addl.2. Rev. Dr. Abraham Kakkanatt, Executive Director, Pushpagiri Hospital (By Adv. G.M. Idiculla) Addl. 3. Dr. B.K. Singh, Chief Surgeon, Pushpagiri Hospital, Thiruvalla. (By Adv. P.K. Mathew) Addl.4. The Branch Manager, New India Assurance Co. Ltd., Salim Buildings, Changanassery (By Adv. Sam Koshy) ..... Opposite parties. O R D E R Sri. N. Premkumar (Member): Complainant filed this complaint for getting a relief from the Forum. 2. Fact of the case in brief is as follows: 1st opposite party is the hospital represented by its Director. 2nd opposite party is the Executive Director of the hospital. 3rd opposite party is the Chief Surgeon of the 1st and 2nd opposite parties hospital. The 4th opposite party is the Branch Manager of New India Assurance Co. Ltd., Changanassery. 3. The complainant was brought to the opposite parties hospital on 29.7.02 following an accident fall in the kitchen of her residence. An X-ray was taken and fracture was reportedly noticed at the neck of the femur and she was admitted in the ward. The 3rd opposite party examined her and advised for partial hip replacement operation, as the only solution and assured the complainant of attaining complete recovery and normally within three weeks of the operation, since it involved no risks or complications as he assured. As such, the complainant gave her consent to be operated upon on the basis of the assurance from the 3rd opposite party. 4. The complainant underwent surgery for partial hip replacement on 1.8.2002. Few days after the operation, the husband of the complainant noticed that the place of incision was not properly and adequately covered. Attention of the duty nurse was drawn but the said nurse avoided to attend the matter claiming it was already healed. A few days later, on 20.8.02 puss containing blood was oozing through the place of operation and the culture report confirmed severe infection. As the wound get healed, the complainant was discharged on, on 6.9.02 and she was instructed to report at the O.P. Clinic after two weeks for a check up with a fresh blood examination report. Complainant reported at O.P. Clinic on 20.9.02 with a fresh blood examination report of 19.9.02 and informed the doctor about pain, swelling redness at the place of operation and the difficulty to walk. The doctor there upon prescribed pain reliever and ointment for local application and advised to apply hot pad at bed time. The doctor also assured that there was nothing to worry about and the complainant need not take it seriously as, these complaints were only incidental to such an operation. 5. The complainant thereafter left for USA to visit her children and while being there, around 21.10.02, she started feeling very severe pain at the operated place and found that using of the pain reliever and other remedies prescribed by hospital and doctors were not giving any relief, as such, she had no other alternative, but to seek medical aid on emergency ground at orthopedic O.P. Clinic in USA. Doctors, who examined the complainant in USA informed that the fracture was minor, not displaced the bone and therefore, cutting out the femur was unnecessary and happened to be cruel. Instead, if they had left the femur in place reinforced by two screws, she could have attained full recovery within days thereby avoided the complainant becoming disabled for life. The length of her operated leg had also become short. 6. They informed that when the complainant was discharged from opposite parties’ hospital, infection was still present as evidenced in their own blood test report dated 19.9.02. Since such infection was not treated in full elimination, infection was spreading, causing severe pain and degenerated the bone structure at the place of operation. 7. Since the medical treatment in USA is very expensive, the complainant came to Thailand on 22.1.03 at the request of her daughter, who is residing in Thailand. The complainant get admitted in the hospital and had to undergo an emergency operation on 28.1.03 by which the artificial prosthesis placed by the opposite party hospital was removed due to infection and the pus was drained out as stated in the attached medical report from hospital of Thailand. They gave antibiotics through vain (I.V)for 4 weeks two times a day, and her pain and hip swelling got relieved but confined to wheel chair. The complainant was then discharged from Thailand Hospital on 1.3.03 with the instruction to continue intake of antibiotic medicines to eliminate infection completely in order to facilitate the next final operation of total hip replacement. But although the infection was getting reduced, it was slow and time consuming. As such, the complainant returned to Thiruvalla 1st August 2003. 8. On 19.9.03 the complainant went to Amrita Institute of Medical Science, Ernakulam for a medical check up. They admitted her and operated her hip on 22.9.03 for a final cleaning to eliminate infection trace to prepare her for total hip replacement operation. She was discharged on 7.10.03. Medical bill of the said hospital is Rs. 31,551. Then on 20.10.03 the complainant was admitted again in Amrita Institute of Medical Science, Ernakulam for a revision hip replacement surgery and discharged on 3.12.03 after the operation. Medical bill stands at Rs.1,67,749. The complainant has suffered disability due to the faulty treatment undertaken by the opposite parties. The complainant has so far incurred about Rs.7,62,200 for her follow up treatment, which was necessitated by the act of the opposite parties. Besides, the complainant has suffered physical pain and mental anguish due to the gross negligence on the part of the opposite party hospital. 9. The opposite party failed to exercise reasonable care and skill it ought to have taken. The standard of care expected from the opposite party was also conspicuously absent. The complainant, in short, suffered the disability as well as physical pain, mental agony and financial loss solely due to the deficiency in service and negligence on the part of the opposite parties. Therefore, opposite parties are liable to compensate the complainant for disability, physical pain, mental anguish and treatment expenses as compensation with cost. Hence this complaint. 10. Opposite parties 1 and 2 entered appearance and filed version stating that complaint is not maintainable either in law or on facts. The complainant, Saramma John was seen by the Medical Officer at casualty on 29.7.02. She was suffering from pain left hip following a fall. She has a fracture neck of left tumor. She was put on skin traction. After due consultation she was certified fir for operation. With obstructive pulmonary disease and ostopenic bone and the need for early ambulation, the decision for hemiarthroplasty was taken. 11. As screw fixation has its own problems besides, revision procedure in two years a second surgery was to be avoided. Procedure done was hemi replacement arthroplasty as this is an accepted procedure through out the world. This was done under full aseptic precaution. Antibiotics were continued and on the 10th day sutures were removed and the wound healed. As there was serosanguinous discharge, she was sent for culture, due to great staphylo Cocus Sensitive to Ciprofloxacin, she was given the same antibiotic given earlier and she was cured. When she came back for follow up on 28.9.04, she was walking full weight with the help of a single strick X-ray showed a sell seated prosthesis. This was corroborated by the orthopaedician she consulted in U.S also. 12. Complainant’s E.S.R showed high increased counts and advised re-investigation. But she was in a hurry to leave for USA, she was advised further investigation there and advised wheel chair at the air port for support. Even the last X-ray showed no bad sign of any sort or lack of proper treatment. The procedure done was the most suitable one for the patient. Her chart and case sheet shows proper care and expertise done on her. At discharge, she had no pain free hip movement and was walking full weight. Dr. Anant Kumar’s statement only proves that no active infection was there at the time of discharge or last follow up. On discharge, she was symptom free and the wound healed completely. 13. The patient being a chronic diabetic patient is likely to have delayed low-grade infection from endogenous causes in patients. Her Hb A1 C reports, regarding glycemic control, which she left for USA, is doubtful. The complainant is put to strict proof of any alleged lack of service of the opposite parties. The opposite parties have done the best in the situation and this complaint itself malicious. 14. 3rd opposite party entered appearance and filed separate version stating that complaint is not maintainable either in law or on facts. It is frivolous, vexatious and devoid of truth or bonafides. There is no negligence or deficiency in service as alleged by the complainant. The complainant was seen by the Medical Officer and duty Orthopaedician of the 1st and 2nd opposite parties hospital on 29.7.02 at 7.10 p.m in casualty. She had presented with pain left hip following a fall. She was a known diabetic, asthemetic, hypertensive on treatment. She was diagnosed to have a fracture neck of left femur and was admitted in F-ward, where she was put on skin traction with 3 Kg weight. Given her age and medical condition, full and proper pre-anesthetic work up was done in consultation with the cardiologist and physician. Her cardiac function, blood parameters and electrolytes were checked and her condition was optimized for surgery. Since she was leaving for the U.S in a matter of weeks early ambulation was a priority. She was advised hemiarthroplasty. 15. 3rd opposite party denied the averment of complainant that partial hip replacement was advised to her as the only solution for the fracture neck of femur. The complainant was advised hemiarthroplasty not as the only option but as the best-suited option for her. The decision for hemiarthroplasty was taken considering the complainant’s medical status including presence of diabetes, cardiac illness and chronic obstructive pulmonary disease, osteopenic bone and the need for early ambulation. 16. The 3rd opposite party admitted that he examined the complainant in the ward. On detailed examination and assessment of the complainant’s condition, advised her hemiarthroplasty after explaining other possibilities and their advantages and disadvantages. Partial hip replacement (hemiarthroplasty) was advised not as the only solution as alleged, but as the best possible method of treatment considering different factors. The decision to undergo hemiarthroplasty was taken by the complainant herself after studying the different options offered. The averment that by attaining complete normalcy within three weeks since it involved no risks or complications allegedly assured by 3rd opposite party is patently false and hence denied. No doctor would or could give such an assurance of complete normalcy since the final outcome depends on a lot of factors like diabetes, ostopenia, Chronic Obstructive Airway disease, Grade 3 effort angina, likely to cause complications. The 3rd opposite party had not given any such assurance as alleged. 17. Complainant underwent surgery after necessary preoperative investigations and checkups and the surgery of hemiarthoroplasty was done with utmost care and caution and strict asepsis. The procedure done was hemi replacement arthroplasty with an Austin Moore prosthesis by a posterior (Moore’s) approach in which the hip is exposed, the fracture seen the head removed and replaced with the prosthesis. This is an accepted procedure world wide. Full aseptic precautions were maintained during the procedure. She was given pre-operative antibiotics parentrally, which was continued post operatively. She was nursed in the ICU post operatively till she fully recovered (one day) and then shifted to her room. During the postoperative period, antibiotics were continued, and she was a febrile throughout her postoperative period. In due course the drain was removed and on the 10th day, sutures were removed and the wound had healed well. Antibiotics were continued her catheter was removed to decrease all possible source of infection. 18. After suture removal she had serosanguinous discharge, which was sent for culture. The culture report showed presence of Staphylococcus sensitive to Ciprofloxacin, she was started on the same antibiotic and full course was given following, which it subsided. She was duly discharged on 6.9.2002 with antibiotics and antidiabetic drugs with other supportive medicines and advises for blood sugar checkup. She came for follow up on 20.9.2004 and was seen in OPD. She came walking with full weight bearing with the help of a single stick. 19. No signs of infection were present at that time and she had a good range of hip movement, which was pain free. The X-rays showed a well-seated prosthesis with no sign of infection. This is corroborated by the Orthopaedician she consulted in the US in his report. Her blood reports showed a high ESR and increased counts. She was advised to get a report investigation but as she was adamant on leaving to the US she was asked to get it done there with further follow up. To prevent unnecessary strain on her she was advised to use a wheel chair at airports and not to strain herself. 20. The allegation that few days after operation the husband of the complainant noticed that the place of operation was not covered, that the attention of the nurse was drawn, but the nurse avoided to attend to the matter claiming it was already healed, and that the doctor attached to the ward had to instruct the nurse for a proper dressing are all false, baseless, and denied by 3rd opposite party. The surgical wound was always kept covered in the postoperative period. The surgery was done with aseptic precautious and the patient was on post operative antibiotics and she had no evidence of infection. On the 10th postoperative day the sutures were removed and the wound was found to have healed. The averment that few days later on 20.8.2002, pus containing blood was oozing through the place of operation and the culture report confirmed severe infection is not entirely true and hence denied. The true fact is that after suture removal, the complainant had serosanguinous discharge, which was sent for culture. As the culture report showed presence of Staphylococcus sensitive to Ciprofloxacin, she was started on the same antibiotic and full course was given following, which it subsided. 21. It is true that the complainant was discharged on 6.9.2002 and she reviewed on 20.9.2002. But the allegations that the complainant told the doctor about pain, swelling, redness at the place of operation and difficulty to walk, are false and hence denied by 3rd opposite party. The averments that she was advised pain reliever and ointment for local application and advised to apply hot pad at bedtime, that the doctor assured that there was nothing to worry about and hence complaints were only incidental to such an operation and complainant need not take it seriously, are also denied. The complainant did not have any pain at the time of review and there was no joint line tenderness. She came walking on her feet, bearing weight with the help of a walking stick. No signs of infection were present and she had a good range of hip movement, which was pain free. The X-ray showed a well-seated prosthesis with no sign of infection. Her blood report showed a high ESR and increased counts. She was advised to get a repeat investigation after one week, but as she was adamant on leaving to the US. So she was asked to get it done there with further follow up. To prevent unnecessary strain on her, she was advised to use a wheel chair at airports and not to strain herself. The patient was prescribed vitamin tablets and no regular pain relievers were prescribed and only a mild pain reliever was prescribed for SOS use (to be used if need arose). 22. The modality of investigations and treatment underwent by the complainant at USA are not in the knowledge of the 3rd opposite party. The allegations that the doctors who examined the complainant in USA informed that the fracture was minor, not displaced the bone, and therefore cutting out the femur was unnecessary and happened to be cruel are also denied. The contention that if the femur was left in place reinforced by two screws, she could have attained full recovery within days, thereby avoided the complainant becoming disabled for life are also highly incorrect in the clinical situation of the complainant when she approached the 3rd opposite party and are also denied. Why the patient underwent hemiarthroplasty and not screw fixation is explained as follows: (1) The patient had Osteopenic bone and so screws have a high chance of failure. (2) Chance of avascular necrosis and non union to the extent of 25%, each which is more likely in a diabetic patient with risk factors, like asthma, COPD and cardiac disease as in the case of the complainant. (3) Need of second operation is 32% in screw fixation in 2 years. (4) The patient was to leave to the USA in a week and needed early ambulation and if screw fixation was done ambulation would be possible only after 6 to 8 weeks at a minimum and that too provided only that she developed no other complications like a vascular necrosis and delayed union. Early ambulation was only possible with hemiarthroplasty. 23. The 3rd opposite party had taken all aseptic precautions and the complainant was put on postoperative antibiotics to avoid infection. The patient remained a febrile in the postoperative period. After suture removal when serosanginous discharge was noted, the patient was given appropriate antibiotics as per culture and sensitivity study reports. At the time of review, on 20.9.02, the patient had no clinical signs of infection. There was no joint line tenderness. She came walking on her feet bearing weight with the help of a walking stick. No signs of infection were present and she had a good range of hip movement, which was pain free. The X-ray showed a well-seated prosthesis with no sign of infection. These facts are further proved correct by the reports by the doctors who treated the complainant at USA and which were sent by the complainant to the 1st opposite party. The notes of the doctor at “Indian Peaks and Family Meet” Lafayette, states thus -“well healed surgical scar over the hip. No redness, no warmth, no induration”, clearly indicating that there was noting clinically to suspect infection. The notes of the doctor Ananthkumar at Denver Orthopaedic Clinic states that there was no calcar reabsorbtion and no bony destruction in canal or acetabulum on X-rays dine in 28 August 2002 (at the First Opposite Party Hospital), thereby showing that there was no radiological evidence of infection at the time of discharge. Therefore the said reports from USA also prove that the preponderance of evidence was in favour of no significant infection clinically or radiologically at the time of discharge or review at Pushpagiri hospital by the 3rd opposite party. 24. The complainant had an increased ESR at the time of review on 20.9.2002. The patient had no clinical evidence of infection. Therefore the complainant was advised to repeat the test after a week. But she did not stay back for review with the 3rd opposite party and left India. She was advised proper glycemic control and medical follow up and this was all what the 3rd opposite party could do since the complainant left India and was not under the follow up with the 3rd opposite party. It is pertinent to note that the glycemic control of the complainant was not proper after leaving India since the HbAIC reports from USA show poor glycemic control. Delayed low-grade infection can occur endogenously in patients. The complainant being a diabetic is more prone for developing infections. What a treating doctor can do is to take necessary precautionary measures, to give antibiotics preoperatively and post operatively, to control diabetes and to follow up the patient regularly. The 3rd opposite party has followed all these measures. The complainant did not have any clinical evidence of infection at the time of review. The complainant did not have any pain at the time of review and there was no joint line tenderness. She came walking on her feet bearing weight with the help of a walking stick. No signs of infection were present and she had a good range of hip movement, which was pain free. The X-ray showed a well-seated prosthesis with no sign of infection. These facts are also supported by the notes of the doctors at USA. 25. The blood test done on 19.9.2002 showed only a non-specific sign of raised ESR which could be due to many non-specific reasons and could not be taken as alone indicative of infection in the absence of any clinical or radiological evidence of infection. The 3rd opposite party had as a measure of abundant caution, advised further follow up and repeat investigations after a week, which the complainant had not complied with. If the complainant had left India, it was her duty to follow up with a doctor in time, if she could not review with the 3rd opposite party as advised. There is no point in blaming the 3rd opposite party for any infection that developed later on account of her diabetic state resulting in later bony changes and limb shortening occurring thereof. 26. The averments regarding the treatment at Thailand and at Amrita Hospital and the expenses thereof are not known to the 3rd opposite party and are therefore denied. In any case such treatment was necessitated by the complainant’s illness and not because of any fault of 3rd opposite party. The opposite parties had given the appropriate and standard treatment as indicated by the condition of the patient. Any alleged disability is not due to any fault on the part of the 3rd opposite party. There is no negligence or deficiency in service on the part of the 3rd opposite party. The 3rd opposite party had shown reasonable skill and given utmost care and attention in the patient and the false allegations of mental anguish and physical pain cannot be attributed to any acts of omission or commission on the part of the 3rd opposite party. The amount claimed in the complaint under different heads are highly exaggerated and claimed without any basis. The complainant has filed a frivolous and vexatious complaint to harass the 3rd opposite party. The 3rd opposite party is a well-experienced Senior Orthopaedic surgeon with MS Ortho and 28 years of experience after post graduation and the 1st opposite party hospital is a modern well-equipped hospital and medical college with all necessary facilities for treatment. Therefore 3rd opposite party canvassed for the dismissal of the complaint with cost. 27. From the above pleadings, following points are raised for consideration: (1) Whether the complaint is maintainable before the Forum? (2) Whether the reliefs sought for in the complaint are allowable? (3) Reliefs & Costs? 28. Evidence of the complainant consists of the proof affidavit filed by the complainant along with certain documents. She was examined as PW1 and the documents produced were marked as Ext.A1 to A12. Evidence of opposite parties consists of proof affidavit filed by the opposite parties. Apart from proof affidavit, no documentary evidence adduced by opposite parties. After the closure of evidence, both parties were heard. 29. Point Nos. 1 to 3:- In order to prove the complainant’s case, complainant filed proof affidavit along with certain documents. She was examined as PW1 and the documents produced were marked as Ext.A1 to A12. Ext.A1 series are the medical report cum bills from Bumrungrad Hospital, Bankok, Thailand. Ext.A2 series are the medical reports dated 21.11.02, 6.12.02, 17.1.03 issued from Denver Orthopaedic Clinic, USA. Ext.A3 is the discharge summary dated 7.10.03 from Amritha Institute of Medical Science, Ernakulam. Ext.A3(a) is the Medical bills from Amritha Institute of Medical Science, Ernakulam. Ext.A4 is the discharge summary dated 3.12.03 from Amrita Institute of Medical Science, Ernakulam. Ext.A4(a) is the bill dated 27.10.03 from Amrita Institute of Medical Science, Ernakulam. Ext.A5 is the medical bills (26 Nos.) from Pushpagiri Hospital for Rs.41,193/-Ext.A6 is the medical bill from Bumrugrad Hospital, Thailand. Ext.A7 is the medical bills from Denver Orthopaedic Clinic, USA. Ext.A8 is the X-ray films. Ext.A9 is the artificial posthesis. Ext.A10 is the certificate issued from Amrita Institute of Medical Science Hospital, Kochi dated 29.3.05. Ext.A11 is the certificate issued from Amritha Institute of Medical Science Hospital, Kochi dated 6.12.05. Ext.A12 is the certificate issued from Lakeshore Hospital, Kochi dated 16.9.09. 30. On the basis of the averment and contention of the parties, we have perused the entire material on record. It is seen that there is no dispute regarding the treatment in 1st and 2nd opposite parties’ hospital and hemiarthroplasty done by 3rd opposite party. According to the complainant after partial hip replacement surgery, the place of incision was not properly and adequately covered. Puss containing blood was oozing through the place of operation and culture report confirmed severe infection. As the wound got healed, the complainant was discharged. After that she again reported in OP Clinic about pain, swelling redress at the place of operation and difficulty to walk. The doctor there upon prescribed pain reliever and ointment for local application. After one month complainant visited USA and there she feels very severe pain at the operated place and pain reliever and other remedies prescribed by 1st and 2nd opposite parties hospital were not giving any relief. She was admitted at Orthopaedic Clinic at USA. Doctors informed that the fracture was minor, not displaced the bone and therefore, cutting out the femur was unnecessary and happened to be cruel. They also found infection through blood test. Since medical treatment in USA is very expensive complainant went to Thailand and treated at Bumrungrad Hospital, Bankok. She had undergone emergency operation by removing the artificial prosthesis placed by opposite parties 1 and 2 hospital. Pain and hip swelling got relieved and returned to Thiruvalla. On 19.9.03 complainant was admitted in Amrita Institute of Medical Science Hospital, Ernakulam for a final cleaning to eliminate infection trace to prepare for total hip replacement operation. A revision hip replacement surgery conducted. Complainant suffered the disability as well as physical pain, mental agony and financial loss due to the failure of hemiarthroplasty done by the 3rd opposite party in 1st and 2nd opposite parties’ hospital, which is a clear deficiency of service. 31. According to opposite parties, hemiarthroplasty was done after explaining the merits and demerits and considering the complainant’s medical status including present diabetes, cardiac illness, chronic obstructive pulmonary disease and osteopenic bone. She was duly discharged on 6.9.02 with antibiotics with other supportive medicine and advice for blood sugar check up. The X-rays showed a well-seated prosthesis with no sign of infection. But her blood report showed a high ESR and increased counts. She was advised to get a repeat investigation, but she was adamant on leaving to USA. She was asked to get it done there with further follow up. According to opposite parties, they were given appropriate and standard treatment. They are not known to the treatment done at Thailand and Amrita Hospital. The alleged disability is not due to their fault. There is no negligence or deficiency in service on their part. 32. On a perusal of Ext.A1, A2, A3, A4, A5, A6, A7, A8, A9, A10, A11, it is learned that complainant has undergone treatment in Bumrugrad Hospital, Bankok, Thailand, Derver Orthopaedic Clinic USA and Amritha Institute of Medical Science Hospital, Ernakulam. Ext.A12 is the certificate issued from Lakeshore Hospital, Kochi. All the said documents also shows that complainant is still ailing after hemiarthroplasty from 1st and 2nd opposite parties’ hospital. According to opposite parties, complainant is suffering from diabetes, cardiac illness, chronic obstructive pulmonary disease and osteopenic bone. 33. Moreover complainant has not taken any steps for producing the treatment record consists of hemiarthroplasty done at 1st and 2nd opposite parties’ hospital. What prevented them from taking steps to bring the same before the Forum? Without perusing the treatment record we are not inclined to find any failure or shortcoming on opposite parties’ part. Complainant produced Ext.A5 bills only. We cannot come to a conclusion based on Ext.A5 alone. Moreover complainant has not taken any step to adduce any evidence of the treated doctors or experts. In the absence of cogent evidence, we cannot find any deficiency on opposite parties’ part. Hence complaint is not allowable. 34. In the result, complaint dismissed. No cost. Declared in the Open Forum on this the 7th day of October, 2010. (Sd/-) N. Premkumar (Member) Sri. Jacob Stephen (President) : (Sd/-) Smt. C. Lathika Bhai (Member) : (Sd/-) Appendix: Witness examined on the side of the complainant: PW1 : Saramma John PW2 : K. Thomas John Exhibits marked on the side of the complainant: A1, A1(a) & A1(b) : Medical report issued from Bumrungrad Hospital, Bankok, Thailand to the complainant. A2, A2(a), A2(b) & A2(c) : Medical reports dated 21.11.02, 6.12.02, 17.1.03 issued from Denver Orthopaedic Clinic, USA to the complainant. A3 : Discharge summary dated 7.10.03 issued from Amrita Institute of Medical Science, Ernakulam to the complainant. A3(a) : Medical bills dated 7.10.03 for Rs.1,163/- from Amrita Institute of Medical Science, Ernakulam to the complainant. A4 : Discharge summary dated 3.12.03 issued from Amrita Institute of Medical Science, Ernakulam to the complainant. A4(a) : Bill dated 27.10.03 for Rs. 7,521/-from Amrita Institute of Medical Science, Ernakulam to the complainant. A5(series) : Medical bills (26 Nos.) issued from Pushpagiri Hospital for Rs.41,193/- to the complainant. A6 : Medical bill issued from Bumrugrad Hospital, Thailand to the complainant. A7 : Medical bills issued from Denver Orthopaedic Clinic, USA to the complainant. A8 : X-ray films. A9 : Artificial prosthesis. A10 : Certificate dated 29.3.05 issued from Amrita Institute of Medical Science Hospital, Kochi to the complainant. A11 : Certificate dated 6.12.05 issued from Amrita Institute of Medical Science Hospital, Kochi to the complainant A12 : Certificate dated 16.9.09 issued from Lakeshore Hospital, Kochi to the complainant. Witness examined on the side of the opposite parties: Nil. Exhibits marked on the side of the opposite parties: Nil. (By Order) Senior Superintendent. Copy to:- (1) Saramma John, Kamalakunnel House, Kuttapuzha. P.O., Thiruvalla, Pathanamthitta. (2) The Director, Pushpagiri Hospital, Thiruvalla. (3) Rev. Dr. Abraham Kakkanatt, Executive Director, Pushpagiri Hospital, Thiruvalla. (4) Dr. B.K. Singh, Chief Surgeon, Pushpagiri Hospital, Thiruvalla. (5) The Branch Manager, New India Assurance Co. Ltd., Salim Buildings, Changanassery. (6) The Stock File.
| | HONORABLE LathikaBhai, Member | HONORABLE Jacob Stephen, PRESIDENT | HONORABLE N.PremKumar, Member | | 
