STATE CONSUMER DISPUTES REDRESSAL COMMISSION, U.T., CHANDIGARH (Appeal No.48 of 2010) Date of Institution: 03.02.2010 Date of Decision : 06.12.2010 United India Insurance Company Limited, Regional Office, SCO No.123-124, Sector 17-B, Chandigarh through Sh. Anil Kakkar, its Deputy Manager. …Appellant. V e r s u s1. Smt. Inderjit Arora wife of Sh. J. S. Arora resident of #6183, Modern Housing Complex, Manimajra, Chandigarh. 2. Inscol Multi-Speciality Hospital, Sector 24-A, Chandigarh through its Managing Director Sh. Daljit Singh Gujral. 3. Sh. Daljit Singh Gujral, Managing Director, Inscol Multi-Speciality Hospital, Sector 34-A, Chandigarh. 4. Dr. Jayant Banerji, Medical Superintendent, Inscol Multi Speciality Hospital, Sector 34-A, Chandigarh. 5. P. S. Mann, Inscol Multi-Speciality Hospital, Sector 34-A, Chandigarh. 6. Mrs. Alveena Samson, Asstt. Nursing, Superintending, Inscol Multi-Speciality Hospital, Sector 34-A, Chandigarh. ….Respondents. BEFORE: HON’BLE MR. JUSTICE PRITAM PAL, PRESIDENT. MRS. NEENA SANDHU, MEMBER S. JAGROOP SINGH MAHAL, MEMBER. Argued by: Sh. D. P. Gupta, Advocate for the appellant. Sh. Gaurav Chopra, Advocate for respondent No.1. Ms. Jaishree Thakur, Advocate for respondents No.2,3, & 5. Sh. R. N. Raina, Advocate for respondent No.4. Respondent No.6 already exparte. (Appeal No.49 of 2010) Date of Institution: 03.02.2010 Date of Decision : 06.12.2010 Dr. Jayant Banerji, the then Medical Superintendent, Inscol Multi Speciality Hospital, Sector 34-A, Chandigarh. …Appellant. V e r s u s1. Smt. Inderjit Arora wife of Sh. J. S. Arora resident of #6183, Modern Housing Complex, Manimajra, Chandigarh. 2. Inscol Multi-Speciality Hospital, Sector 24-A, Chandigarh through its Managing Director Sh. Daljit Singh Gujral. 3. Sh. Daljit Singh Gujral, Managing Director, Inscol Multi-Speciality Hospital, Sector 34-A, Chandigarh. 4. P. S. Mann, Inscol Multi-Speciality Hospital, Sector 34-A, Chandigarh. 5. Mrs. Alveena Samson, Asstt. Nursing, Superintending, Inscol Multi-Speciality Hospital, Sector 34-A, Chandigarh. 6. United India Insurance Company Limited, SCO No.123-124, Sector 17-B, Chandigarh through its Manager. ….Respondents. Argued by: Sh. R. N. Raina, Advocate for the appellant. Sh. Gaurav Chopra, Advocate for respondent No.1. Ms. Jaishree Thakur, Advocate for respondents No.2, 3 & 4. Sh. D. P. Gupta, Advocate for respondent No.5. Respondent No.6 already exparte. (Appeal No.50 of 2010) Date of Institution: 03.02.2010 Date of Decision : 06.12.2010 1. Inscol Hospital, SCO No.18-19, Sector 34-A, Chandigarh through its Director Mr. Daljit Singh. 2. Mr. Daljit Singh Gujral, Managing Director, Inscol Healthcare Ltd., SCO No.18-19, Sector 34-A, Chandigarh. 3. Sh. P. S. Mann, Inscol Health care Ltd., SCO No.18-19, Sector 34-A, Chandigarh. …Appellants. V e r s u s1. Smt. Inderjit Arora wife of Sh. J. S. Arora resident of #6183, Modern Housing Complex, Manimajra, Chandigarh. 2. Dr. Jayant Banerjee, Inscol Healthcare Ltd., SCO No.18-19, Sector 34-A, Chandigarh. 3. Mrs. Alveena Samson, House No.843, Phase IV, Mohali. 4. United India Insurance Company Limited, SCO No.123-124, Sector 17-B, Chandigarh through its Manager. ….Respondents. Argued by: Ms. Jaishree Thakur, Advocate for the appellants. Sh. Gaurav Chopra, Advocate for respondent No.1. Sh. R. N. Raina, Avocate for respondent No.2. Respondent No.3 already exparte. Sh. D. P. Gupta, Advocate for respondent No.4. PER JAGROOP SINGH MAHAL, MEMBER. 1. The OPs have filed these three appeals under Section 15 of the Consumer Protection Act, 1986 against the order dated 31.12.2009, passed by the learned District Consumer Disputes Redressal Forum-II, U.T., Chandigarh (hereinafter referred to as the District Forum), directing the OPs to refund a sum of Rs.1,01,858/- the expenses incurred by the complainant on her treatment in the Inscol Multi-Speciality Hospital, Chandigarh; Rs.6,91,095/- incurred in Fortis Hospital, Mohali and PGI, Chandigarh and Rs.10,00,000/- as compensation for mental agony and physical harassment suffered by her. The order was directed to be complied with jointly and severally by OPs within one month from the date of receipt of certified copy of the order failing which OPs were made liable to refund the aforesaid total amount of Rs.17,92,953/- to the complainant along with penal interest @ 18% p.a. from the date of filing the complaint i.e. 24.07.2007 till its realization. The liability of the Insurance Company i.e. OP No.6 was limited to the extent of Insurance Policy issued in favour of Dr. Jayant Banerji (OP-3) only. All the three appeals are being disposed of through this order. 2. Briefly stated, the facts are that the complainant was a patient of diabetes for the last 10 years prior to her admission in OP No.1 - Inscol Multi-Specialty Hospital and she was under medical supervision of OP No.3 i.e. Dr. Jayant Banerji. It was averred that on 01.08.2005, the complainant started shivering and felt mild fever accompanied by pain in her left leg, for which at about 4.00 p.m., she visited the clinic of OP No.3 where some preliminary tests were carried out. The complainant was thereafter advised to visit Prime Diagnostic Centre for check up and procedural tests, which was accordingly done by the complainant. Accordingly, High Resolution Harmonic Eco Cardiography test was performed on her at Prime Diagnostic Centre by Dr. U. P. Singh and the report thereof was placed on record as Annexure C-1. Subsequently, OP No.3, after perusing the report of Harmonic Eco Cardiography, advised the complainant to get her checked up from Dr. Sudhir Saxena and the same was accordingly done. After examining the complainant, Dr. Sudhir Saxena gave her some medicines and further advised immediate hospitalization for carrying out certain investigations such as D-Dimer Test, repeat Eco Test and Sprial CT Chest Scan etc. It was alleged by the complainant that Dr. Sudhir Saxena again sent her to OP No.3 for further management of her treatment. At the advice of OP No.3, the complainant got herself admitted in OP No.1-Hospital in the evening of 01.08.05 itself in Intensive Care Unit (ICU) where Ultra Sound Test, Doppler Test were carried out. It was alleged that none of the tests as advised by Dr. Sudhir Saxena was carried out in order to ascertain conclusively that she was suffering from Pulmonary Embolism. As per the complainant, her condition started deteriorating during night and injection namely TPA {Tissue Plasmogim Activator (also known as Actilyse)} was recommended to be administered to her. The case of the complainant was that as per the TPA Instruction Manual as well as Consumer Medicine Information, the said injection was to be administered only after confirmation of Pulmonary Embolism disease and that too by a well qualified physician experienced in the use of Thrombolytic treatment and at a place where all facilities to monitor its use are available as the giving of this injection may result in dangerous side effects, which may need immediate care and treatment. But despite the aforesaid instructions, the said injection was administered without confirming pulmonary embolism on the complainant and by a person who was not competent to administer the said injection. It was next averred that on 02.08.2005, after the administration of the injection, the condition of the complainant deteriorated, she went into shock and breathlessness but no ventilator was made available to her by OP No.1 resultantly, she was moved to Fortis Hospital, Mohali where she remained admitted up to 12.09.2005. As per the complainant, after her discharge from the Fortis Hospital, Mohali on 12.09.2005, her condition again deteriorated, for which she had to be admitted again in the Fortis Hospital from 14.09.2005 to 22.09.2005 and thereafter, she was admitted in the P.G.I. As such, the complainant had to spend a total sum of Rs.8 Lacs on her treatment because of the negligence on the part of OPs. The complainant alleged negligence on the part of OPs while administering her TPA injection with out following the medical norms for administration of the said injection and this, as per the complainant, amounted to deficiency in service on their part. Alleging medical negligence as well as deficiency in service on the part of OPs, the complainant filed the present complaint. 3. In the joint written statement, OPs No.1 and 2 (The Hospital and its Managing Director) admitted the admission of the complainant in Inscol Multi-Speciality Hospital on the evening of 01.08.2005 and that she was discharged on 02.08.05. Their stand is that after her admission, certain tests like Ultra Sound Test, Doppler Test in addition to the tests as advised by Dr. Sudhir Saxena were carried out, which confirmed the complainant suffering from Pulmonary Embolism and therefore, Spiral C.T. Chest was not necessary. As per these OPs, the complainant was not in a fit condition to carry further tests on her as she had already been given number of drips. It was pleaded that her blood pressure remained fluctuating throughout the period of her admission in OP No.1-Hospital. After the confirmation of Pulmonary Embolism and also noticing that her blood pressure was steeply falling, requisite medicines were administered as per the advice of Dr. Jayant Banerji (OP No.3). It was next pleaded that when her condition started deteriorating, it became necessary to administer her TPA injection, the possible side effects of which were told to the complainant and her relatives. The said injection, it was asserted, was administered to the complainant as per the advice of Dr. Sudhir Saxena and all the precautions required for administration of the said injection were duly followed. It was further pleaded that Dr. P. S. Mann who was present at the time of administration of the injection was a duly qualified doctor and he acted as per the instructions of Dr. Sudhir Saxena. As regards the allegation of the complainant relating to the non-availability of ventilator, OPs pleaded that when the need arose for the complainant, the same were already in use by some other patients, which was also duly informed to the complainant and her relatives, who arranged a ventilator in the Fortis Hospital, Mohali. Accordingly, as per these OPs, the complainant was discharged on the request of her relatives and attendants for being taken to Fortis Hospital. Thus, pleading no deficiency in service on their part, these OPs prayed for dismissal of the complaint. 4. OP No.3 – Dr. Jayant Banerji in his reply claimed to be a doctor of great repute practicing as a Diabetologist in Chandigarh. According to him, he passed his MBBS from Christian Medical College, Ludhiana and did his Masters in Internal Medicine from CMC, Ludhiana and FCCS from Society of Critical Care Medicine from USA and had also done the course in Diabetologist from University of New Castle, Australia and since then he is doing active practice at Inscol Tertiary Care Hospital – OP No.1. According to him, on 01.08.05, the complainant visited his clinic, complaining fever, sweating and breathlessness. She had infection on her left shin. He conducted ECG of the complainant, which showed right bundle branch block, which clearly suggested Pulmonary Embolism from the deep vein in her infected left leg and the complainant was advised echo cardiogram. According to him, the report of echocardiogram suggested pulmonary hypertension with normal right ventricular size, suggesting an embolism and as such, he advised the complainant to immediately contact Dr. Sudhir Saxena, Cardiologist. It was pleaded that Dr.Saxena suspected the complainant suffering from Pulmonary Embolism and advised her to get herself admitted in the hospital immediately. The complainant was put on molecular weight heparin therapy and an ultrasound; Doppler and D-Dimer tests were conducted. It was next pleaded that she was treated with antibiotics for infection, insulin for high blood sugar and oxygen for low saturation and along with 1/V fluids were started but due to some medical reasons, her BP started dropping for which inotropes were started. As per Dr. Banerji, being a consultant, he had no absolute control over the patient’s serious condition who was being treated in Inscol Hospital. As per him, the TPA injection was administered in the presence and advice of Dr. Sudhir Saxena and the relatives of the complainant were informed about its side effects before administration. It was asserted that when the B.P. and oxygen level continued to fall, CVP line was put and when CVP was found to be high as per the records, the need of ventilator was felt by Dr. Ashutosh Sharma but at that time, all ventilators were occupied. It was pleaded that the complainant was shifted to Fortis Hospital only on the express consent of her relatives. As per this OP, he had not charged any amount from the complainant and the amount, if any, was charged by OP No.1. It was submitted that the committee constituted by the Punjab Medical Council consisting of well-qualified professionals and experts had already exonerated him. Pleading no deficiency in service or medical negligence on his part, Dr. Jayant Banerji prayed for dismissal of the complaint. 5. OP No.4 Dr. P. S. Mann while adopting the written statement filed by OPs No.1 and 2, pleaded that D-Dimer Test was carried out before administering TPA and the treatment was given as per the directions of the treating doctors. As per Dr. Mann, he possessed the recognized medical qualifications and there was no deficiency in service on his part. As such, Dr. P. S. Mann also prayed for dismissal of the complaint. 6. OP No.5 – Ms. Alveena Samson did not appear despite due service before the learned District Forum and as such, she was proceeded against exparte vide order dated 11.10.2007. 7. OP No.6 - United India Insurance Company in its reply pleaded that only Dr. Jayant Banerji (OP No.3) was insured by it under insurance policy No.082401/46/04/01576 for the period from 05.03.05 to 04.03.06. As per this OP, no treatment was given by OP No.3 to the complainant and as such, no medical negligence could be attributed to OP No.3. As per the Insurance Company, it is only liable to indemnify qua OP No.3. Thus, pleading no negligence on the part of Dr. Jayant Banerji, this OP also prayed for dismissal of the complaint. 8. The parties were given opportunity to lead evidence in support of their contentions. 9. After hearing the learned counsel for the parties and perusing the record, the learned District Forum allowed the complaint vide impugned order dated 31.12.2009 as mentioned in Para No.1 above, which has been challenged by the OPs through these three separate appeals. 10. We have heard the arguments of learned counsel for the parties and have perused the record. 11. The learned counsel for the OPs/appellants have argued that the learned District Forum has referred to the three points in Para No.10 of the impugned order and gave an adverse finding against the OPs with respect to all the three of them. Their contention is that in fact proper and necessary tests were conducted to confirm that the complainant was suffering from pulmonary embolism, that D-Dimer test was conducted, which was positive and that TPA was administered by a qualified physician under the supervision of a qualified doctor and there was no deficiency in post operative procedure and care. It is argued that it was not necessary to keep a ventilator free during the entire treatment of the patient and when they suspected that ventilator may be needed, they told the same to the attendants of the complainant and on their request, she was shifted to Fortis Hospital. It is argued that the findings recorded by the learned District Forum in this respect are liable to be set aside. We do not find any merit in this contention. 12. It is not disputed that the complainant was a patient of Diabetes Mellitus for over seven years and was being earlier treated by Dr. Jayant Banerji (OP No.3). The contention of this OP is that she was not managing herself properly and was not keeping her diabetes under control due to which she was mentioned to be having poor compliance with her treatment. When she came to Dr. Jayant Banerji on 1.8.2005 feeling breathlessness and severe pain in the left leg, shivering with fever, the OP suspected it to be a case of pulmonary embolism and after doing some preliminary tests, advised Eco Cardiography test from Prime Diagnostic Centre. The learned counsel referred to Annexure C-6 showing that Moderate Pulmonary Arterial Hypertension and Moderate Tricuspid Regurgitation were noticed. The doctor then sent her to Dr. Sudhir Saxena who also opined that she might be suffering from DVT, Pulmonary Thrombosis Embolism and Pulmonary Hypertension. He had advised D-Dimer test, repeat Echo Test and Spiral CT Chest Scan, as is evident from Annexure C-2. The learned counsel argued that on its basis, the blood sample was taken and was sent to Fortis Hospital for conducting D-Dimer Test, the report of which is Annexure R-1/B. The OPs moved an application dated 26.7.2010 for additional evidence and the certified copy obtained from the Court of learned Judicial Magistrate First Class, Chandigarh is Exhibit CW-4/C. They also produced a copy of the receipt vide which Rs.1,000/- was charged as investigation fee, which is alleged to have been paid to the Fortis Hospital by the Inscol Hospital. The learned counsel argued that Annexure R-1/B is the copy of this very report and the additional evidence, therefore, fully proves that D-Dimer Test was conducted on 1.8.2005 before further treatment was given to the complainant. The learned counsel for the complainant/respondent has refuted this contention. 13. It is argued by the learned counsel for the complainant that report (Annexure R-1/B) was fabricated subsequently to make out a defence though actually no such test was got conducted before TPA was administered to the complainant. The learned counsel referred to letter (Annexure C-32) received from the Fortis Hospital, vide which, the hospital clarified that only one D-Dimer Test of the complainant was conducted in the Fortis Hospital and that was conducted on 7.8.2005, the report of which is Annexure C-16. Had the D-Dimer Test been conducted on 1.8.2005, the Fortis Hospital would have mentioned the same. It is worthwhile to mention that this information was sought by the counsel for the complainant on 18.12.2007 vide Annexure C-31 and the reply, copy of which is Annexure C-32, was received on 2.1.2008. Till then, Annexure R-1/B did not exist in the records of the Fortis Hospital otherwise, they would have informed the counsel for the complainant through Annexure C-32 that two D-Dimer Tests were conducted on the complainant, one on 1.8.2005 and the other on 7.8.2005. 14. The learned counsel also observed that no charges for conducting the D-Dimer Test were recovered from the complainant and if the OPs had paid Rs.1,000/- towards D-Dimer Test, they would have mentioned the same in the statement of charges prepared in this case. The learned counsel for the OPs on the other hand argued that in fact, Rs.1,000/- as charges for D-Dimer Test was included in the Laboratory investigations as mentioned in the Invoice-cum-Receipt (Annexure C-9) vide which a sum of Rs.2,900/- was mentioned, which included the amount of Rs.1,000/-. This contention was not accepted by the learned District Forum. We are also not inclined to accept the same because there is no such fact mentioned in Annexure C-9 if this payment was made to the Fortis Hospital towards D-Dimer Test. Annexure C-9 shows that separate charges for ABG, ECG, X-Ray, Ultrasound, Doppler Test have been mentioned therein and if any such amount was paid towards D-Dimer Test, then D-Dimer would have been specifically mentioned in the receipt. The OPs claim that several tests were conducted by them when the complainant was admitted in their hospital, therefore, Rs.2,900/- would be for those tests conducted in their own laboratory. No breakup of the charges has been mentioned by the OPs as to how the amount came out to Rs.2,900/-. The OPs are now taking advantage of the vague reference to Laboratory Investigation to include the charges for D-Dimer Test. 15. It is not disputed that the relatives of the complainant had moved a complaint to the Medical Council of India against the appellant – Dr. Jayant Banerji (OP No.3). The appellant submitted a reply and the documents to suggest that they had treated the patient in accordance with the medical standards and there was no professional misconduct on their part. In that complaint also, it was alleged on behalf of the complainant that no such tests were conducted. Had D-Dimer Test been conducted on 1.8.2005, the appellant would have mentioned the same to the Medical Council of India/Punjab but interestingly, no such report of D-Dimer Test was sent to the said Council. They had submitted only one report i.e. Annexure C-30 with respect to the D-Dimer Test conducted on 7.8.2005. There is no explanation given by the appellant as to why the test report dated 1.8.2005, if it existed on that day, was not submitted to prove that TPA was administered by them after confirmation of the diagnosis after getting the D-Dimer Test conducted. This fact also proves that D-Dimer Test had not been conducted on 1.8.2005 and no such report existed till the reply was submitted by the OPs before the Medical Council of India/Punjab. 16. The learned counsel for the complainant argued that the OPs had a direct contact with the Fortis Hospital, both of which existed in the same city and it, therefore, was not difficult for them to manufacture such a report whereby one doctor helps the other to get out of the problem by creating such a report to show that D-Dimer Test was conducted before starting the treatment for pulmonary embolism. Otherwise also, Annexure R-1/B is not proved to be a genuine document. 17. The OPs could prove the D-Dimer Test by producing certain positive evidence on the point as referred to by the learned District Forum in the impugned order. However, the OPs have neither produced the affidavit of the person who took the sample of blood to the Fortis Hospital nor the affidavit of the person who conducted the test in the Fortis Hospital. The report of Fortis Hospital could be proved only by summoning the record from that Hospital and not in its absence. The OPs have not summoned any record from the said Hospital and have either produced their own report, which is alleged to be fabricated or from the court where a complaint is filed by the complainant to take action against the OPs for procuring the said false report, copy of which is CW-4/C. It is argued that the blood samples received for D-Dimer Test would have been prepared and entered in some register maintained by the Fortis Hospital and the reports thereof would also have been entered serial wise, which evidence could have been produced by the OPs to prove that such a sample was received on 1.8.2005 and was analysed by them. However, no such evidence was led by the OPs in this case though they very well knew from the very beginning that the complainant was agitating that D-Dimer Test was not conducted on 1.8.2005 as advised by Dr. Sudhir Saxena. An adverse inference, therefore, requires to be drawn against the OPs in this respect and the mere production of Annexure R-1/B or the duplicate report (CW-4/C) through additional evidence cannot be accepted as correct to hold that D-Dimer Test was conducted before starting the treatment. In the Preliminary Objection No.3 of the reply, OP No.3 stated as follows: - “….As per the knowledge of the answering respondent, the d-dimer test was also reported to be positive….” It shows, even OPs did not see any such report and he was not positive about it but it was reported to him that the result of D-Dimer test was positive. Who told him about it is not mentioned even by OP No.3. 18. It is also argued by the learned counsel for the complainant that presuming for a while, though not admitting, that D-Dimer Test was conducted but it was not the only test advised by Dr. Sudhir Saxena in his prescription (Annexure C-2). He had also advised to repeat Echo Test and Spiral CT Chest Scan. Admittedly, the other two tests were not conducted by the OPs and their contention that the complainant was not in a good condition to be shifted for conducting the said tests was rightly discarded by the learned District Forum by observing that she had been maintaining a stable health during the night when these tests could have been conducted. 19. The learned District Forum in Para No.19 of the impugned order referred to Wikipedia on Pulmonary Embolism. Under the heading, “Combining Tests” into algorithms, it is mentioned, if D-Dimer Test is positive as is alleged in this case, then MDCT is to be obtained. The learned District Forum in Para No.20 also referred to Braunwald’s Heart Disease, a textbook of Cardiovascular Medicine, in which also, it was provided that if D-Dimer Test showed elevated, then Chest CT was to be conducted. In the present case, if according to the OPs, D-Dimer Test was positive, then the next test advised under the medical literature i.e. Chest CT Scan was necessary to be conducted to confirm Pulmonary Embolism but the OPs did not conduct the same for the reasons best known to them. There was, therefore, gross deficiency in service on the part of OPs. 20. Dr. Sudhir Saxena who had advised the test filed his affidavit (Annexure C-13) dated 14.7.2006. His contention was that preliminary observations given by him were subject to confirmation of scientific investigation to be conducted for final diagnosis by Dr. Jayant Banerji and the treatment to be given by him independently. He had referred the patient back to Dr. Jayant Banerji for carrying out scientific investigation to verify and establish accurate diagnosis of physical disorder and for his critical considerations to give adequate medical treatment to the patient immediately. The learned counsel for the complainant argued that scientific investigations related to repeat Echo Test and Spiral CT Chest Scan, as advised by him vide Annexure C-23, which were not conducted. Dr. Jayant Banerji, therefore, failed to proceed in the matter in accordance with the prescribed medical standards even after he was specifically advised by Dr. Sudhir Saxena through Annexure C-2. There is, therefore, sufficient evidence on the record to suggest deficiency in service on the part of OPs. 21. It is clear that in fact the complainant was not suffering from pulmonary embolism. When the complainant was admitted in Fortis Hospital and tests were conducted, it was found that she was suffering from Septic Shock with I.V Fluids and not from pulmonary embolism, as mentioned in Annexure C-12, the Discharge Summary issued by the Fortis Hospital. Annexure C-23 also mentions that she was suffering from Sepsis, Septic Shock and Acute Renal Failure. There is no mention of pulmonary embolism in the diagnosis arrived at by the Fortis Hospital. The administration of TPA injection was, therefore, a grave deficiency in service on the part of OPs. 22. It is admitted by the OPs that TPA was administered to the complainant. The important question would be as to who advised that the TPA injection should be administered. Sh. D. S. Gujral (OP No.2) filed his reply on his own behalf and on behalf of OP-Hospital. In Paras No.8 and 9 of the reply, it was mentioned that the required medicines were administered as per the advice of OP No.3 (Dr. Jayant Banerji). It was mentioned in para No.14 that injection TPA was administered after the conclusion based on required tests as well as on clinical examinations and it was the decision of the treating doctors based on these findings, remedial steps were also taken when called for. Again in Para No.15, it was mentioned that Dr. Saxena (Dr. Sudhir Saxena) had himself attended on the patient in the hospital as is evident from the treatment chart, that he had concurred with the administration of TPA. In Para No.17, it was mentioned that injection TPA was administered only after Dr. Sudhir Saxena had approved it. It was mentioned in Para No.19 that injection TPA was administered as per the advice of Dr. Saxena and process started with his approval. Dr. Sudhir Saxena was alleged to have given it in writing in the activity chart but the OPs did not point out any such writing either in the hand of Dr. Sudhir Saxena or signed by him in approval of the same. Dr. Jayant Banerji in preliminary objection No.3 mentioned that all the possibilities were bring brought to the knowledge of the relatives and it was only after the suggestions put forward by Dr. Sudhir Saxena that he would put on IVC filter if injection will not work. It is mentioned that the injection was administered by the well-qualified staff of OP No.1 on the order of Dr. Saxena (a qualified cardiologist). In Para No.17 of the reply on merits, OP No.3 mentioned that Dr. Sudhir Saxena and Dr. U. P. Singh have confirmed the case of pulmonary embolism (though Dr. Sudhir Saxena denied through his affidavit, if he confirmed any such fact and rather wanted OP No.3 to confirm his opinion through scientific investigations). The OPs did not produce any evidence and did not refer to any such document to suggest that Dr. Sudhir Saxena advised or approved the administration of TPA injection to the complainant. On the other hand, Dr. Sudhir Saxena in his affidavit (Annexure C-13) deposed that the injection Actilyse allegedly administered at Inscol Hospital on 2.8.2005 to Smt. Inderjit Arora was neither given under his supervision nor he was present at the time when the procedure of giving the injection was carried out. Annexure C-13, therefore, falsifies the entire false story built up by the OPs alleging that the injection was given to the complainant at his instance or under his advice or under his supervision. 23. The stand of the OPs in this respect had been changing from time to time. 24. Annexure C-15 is the reply given by Dr. Jayant Banerji to the relatives of the complainant regarding the giving of this injection, which gives a different story. In Para No.5, it was mentioned that clot bursting injection was given by Dr. Sudhir Saxena, a DM Cardiologist after confirming the diagnosis. The OPs had obtained the affidavits of Dr. P. S. Maan and Mrs. Alveena Samson (OPs No.3 and 4), which are Annexures C-18 and C-17 respectively, in which it was mentioned that the said injection was given to the complainant under the supervision of Dr. Sudhir Saxena. However, when Dr. Jayant Banerji found this story to be wrong, he changed the version to say that it was given on his advice. In the entire written reply, Dr. Jayant Banerji did not mention if the injection was given by Dr. Sudhir Saxena. Now the OPs have started saying that Dr. Sudhir Saxena has resiled from his responsibility of advising them to give TPA injection though they have nowhere proved that the said injection was given on his advice. However, Dr. Sudhir Saxena made the matters clear through his letter dated 14.7.2006 that the injection was neither given under his supervision nor he was present at the time when procedure of giving the injection was carried out, OPs changed the story to the one as is being now presented. 25. The learned counsel for the OPs had also taken an objection of non-joinder of Dr. Sudhir Saxena as a party. This objection on the face of it is frivolous. It is nowhere mentioned either by them or by the complainant in their pleadings, if there was any deficiency in service on the part of Dr. Sudhir Saxena. The OPs have even failed to prove, if Dr. Sudhir Saxena was present at the time when the injection was administered, not to say that it was administered under his supervision or on his advice. When Dr. Sudhir Saxena was not treating the complainant, the question of joining Dr. Sudhir Saxena as a party to this complaint did not arise. 26. The learned counsel for the OPs then argued that it was not necessary for them to keep the specialist in attendance at the time when the injection was being administered. Their contention is that it takes about two hours to administer the injection and the presence of a specialist, a consultant or even a doctor during the said period was not necessary. It is also argued by them that the TPA injection could be advised by a Physician experienced in the use of Thrombolytic treatment and the word “use” referred to in Para No.22 of the impugned order does not mean that he should personally administer the injection or should remain present at that time. This contention was not accepted by the learned District Forum. Rightly so because mere advising the TPA without the presence of a Physician experienced in the use of Thrombolytic treatment who could monitor the progress during the period of the injection would not be enough as the very purpose of special warnings and precautions would be defeated. We cannot say that after the TPA injection was advised by a Physician experienced in the use of Thrombolytic treatment, even a nurse would be competent to administer the same and look after and monitor the patient. The special warnings are precautions because general disorders as mentioned by the learned District Forum are common and the same have to be monitored and taken care of if any such eventuality arises such as reaction or side effects of the medicine. Even the evidence produced by the OPs falsify the stand taken by the OPs. Dr. Rajesh Paul in his affidavit (Annexure R-17) deposed in Para No.8 as follows: - “That injection Actilyse is an emergency medicine given to the patient in pulmonary embolism and while administering this medication one has to watch for bleeding and further deterioration and if necessary and inferior vena cava filter can be used.” In their affidavits, the other doctors did not say anything about TPA injection. It was, therefore, necessary that the Physician experienced in the use of Thrombolytic treatment should have been available when the TPA injection was administered. In the instant case, Dr. Sudhir Saxena was not present when the said TPA was administered and Dr. Jayant Banerji himself has wiped his hands off this episode. There was, therefore clear cut deficiency on the part of Ops No.1 and 2 in getting the TPA injection administered in the hospital without a competent Physician being present. 27. As regards the ventilator, the learned counsel for the OPs argued that the availability of a ventilator was not necessary at the time of administration of TPA to the complainant. His contention is that she was in the I.C.U where several ventilators have been installed but at the relevant time, when they felt the need of ventilator, none was free and therefore, they told this fact to the relatives of the patient who offered to shift her to Fortis Hospital where such a ventilator could be arranged. The contention of the learned counsel for the OPs is that the condition that a ventilator should be available is satisfied even if the available ventilator was busy and not free for use by the patient in need of it. We do not find any merit in this argument. It has been provided in the Instruction Manual for use of TPA under the heading “special warnings and precautions” that when Actilyse is administered, standard resuscitation equipment and medication be available in all circumstances. The word “available” means it should be available to the patient during the course of the administration of the injection and thereafter. If none of the ventilators was free when the same was needed by the complainant, we cannot say if resuscitation equipment was available. If no ventilator was free, OPs should not have undertaken to administer the TPA and the patient should have been transferred to some other hospital where such facility/equipment was available. If the complainant had already been admitted in the hospital where the ventilator was available, they should not have admitted any other patient who may require the said ventilator till the complainant ceased to need it. The OPs were, therefore, deficient in rendering service in this respect when they administered TPA knowing fully well that standard resuscitation equipment was not available for her. The problem actually arose when the OPs found that a ventilator would be needed and it was not available due to which they informed the relatives of the complainant who had no other choice but to shift the complainant to Fortis Hospital. The plight of the attendants and relatives in such a situation can well be imagined. The OPs, however, thought it to be a routine matter as if nothing had happened even if they were unable to manage the patient after giving TPA injection thoughtlessly. 28. It is not the only case in which such a problem is being created by the OPs. Dr. Jayant Banerji (OP No.3) mentioned in Preliminary Objection No.5 and Para No.15 on merits that there is chronic shortage of ventilators in the city and many times, the patients have to be shifted to and from one hospital to another. We do not find any merit in this argument. If a patient is admitted in the hospital, when there is no ventilator free, whereas a ventilator is free in the other hospital where he/she is subsequently transferred, it cannot be said if there is any shortage of ventilators. In fact, the hospitals are not considering the problem of the patients and not advising them to get admitted in that hospital where the ventilator is free, they rather admit the patients in their own hospital even if no ventilator is free in the said hospital. Anyway, if a wrong procedure is being adopted by the hospital in this respect, that does not justify the admission, which could have been avoided and the patient would have got admission initially in the hospital in which the ventilator is free. The wrong procedure does not justify the problem created by the OPs in this case in this respect. 29. It is argued by the learned counsel for the OPs that otherwise also, standard resuscitation equipment does not mean ventilator and that even after the complainant was shifted to the Fortis Hospital, the ventilator was not used at all and therefore, there was no deficiency in service on their part. This argument also is devoid of merit. The OPs themselves felt the need of a ventilator as mentioned in Para No.15 of the reply filed by OPs No.1 & 3, Preliminary Objections No.3, 5 and para No.15 of the reply filed by OP No.3, Progress Chart (Annexure C-14) and Para No.6 of the reply (Annexure C-15) given by OP No.3. If ventilator or resuscitation equipment was available with them, they would have used the same and there would have been no need to shift the patient. Their conduct itself shows that it was the ventilator, which was needed to monitor the patient and not any other equipment. Dr. Jayant Banerji in his reply (Annexure C-15) has mentioned that she needed non-invasive ventilation in Fortis Hospital so, the decision to shift was appropriate as their ventilators were occupied. Dr. Deepak Kaur in Para No.8 of his affidavit Annexure RA-9, Dr. N. P. Singh in Para No.7 of his affidavit, Dr. Jagmohan Verma in his affidavit (Annexure RA-10) have mentioned that the need for mechanized ventilation was considered but since all the ventilators were in use, the patient was shifted to other hospital. It is, therefore, clear that a ventilator was needed to monitor the progress of the patient and the contention of the OPs in this respect is wrong. 30. As regards the argument that no ventilator was used in the the Fortis Hospital, that contention is factually incorrect. Annexure C-22 is the case summary in which it is mentioned that when the patient reached the Fortis Hospital, non-invasive ventilation was started, which resulted in normalization of PV status. Annexure C-12 is the Discharge Summary issued by the Fortis Hospital in which also, it is mentioned that she was having persisting Anasarca and Acidosis was started on BiPAP, which resulted in improvement of Respiratory Acidosis. The condition of the patient at the time of discharge is also mentioned to be Afebrile and Hemodynamically stable, Anasarca persisting, on Bipap 5/16 S/T Mode with 10L/MIN 02. There is the discharge on request dated 22.9.2005 in which also, it is mentioned that she was on Non-Invasive Bipap, which resulted in improvement of Respiratory Acidosis. As per the medical terminology, BiPAP stands for Bi-level Positive Airway Pressure and it is a breathing apparatus that helps people get more air into their lungs. The learned counsel for the complainant has argued that BiPAP is the ventilator which is mentioned as Non-Invasive Ventilation in Annexure C-22 by the Fortis Hospital. It shows that ventilator was used by this patient in the Fortis Hospital and the contention of the OPs that ventilator was not needed is factually incorrect. The OPs were, therefore, deficient in service in administering TPA injection without having adequate resuscitation equipment available for the complainant at the relevant time. 31. The learned counsel for the OPs have also argued that since the OPs have been exonerated by the Medical Council of India, this complaint cannot continue against them. The learned District Forum did not agree with this contention and has given sound reasons there for. The decision arrived at by the Medical Council that the OPs were not guilty of professional negligence is falsified from the facts, which emerge in this case. The OPs did not get the proper test conducted and gave the injection without the presence of a Physician experienced in the use of Thrombolytic treatment. When the health of the patient deteriorated, they started blaming each other for administering the said injection. Dr. Jayant Banerji started saying that it was administered at the advice and under the supervision of Dr. Sudhir Saxena. OPs No.1 and 2 also mentioned this fact in their reply filed before the learned District Forum. Dr. Jayant Banerji then alleged that it was on the advice of Dr. Sudhir Saxena but the matter was clarified by Dr. Sudhir Saxena that he was neither associated with the treatment of this patient by the OP Hospital nor he advised the administration of injection nor was it administered in his presence or under his supervision. Annexure RA-12 is the report of Punjab Medical Council, which was based on the reports of Dr. Jagmohan Verma, Dr. Rupinder Singh and Dr. N. P. Singh. This report was obtained by concealing the facts as now emerge and by falsely alleging that TPA was administered on the advice of Dr. Sudhir Saxena, which was factually incorrect. This report was, therefore, rightly discarded by the learned District Forum. 32. There is another aspect of the case, which is bared by the affidavit of Sh. Raj Paul Kapoor who is a Partner in Kapoor and Company from where the TPA injection was purchased. According to him, he received an enquiry on telephone from Inscol Hospital (OP No.1) and on their advice, sent two injections of Actilyse, which were priced at Rs.72,000/- inclusive of sales tax. He was paid only Rs.60,515/- against the Invoice of Rs.72,000/- whereas the complainant was charged Rs.81,600/- for the said injections. In this manner, even by purchasing two injections, the OPs allegedly garnered a sum of Rs.21,085/-. It appears, it was greed for money due to which the injections were administered even without verifying and confirming the diagnosis. These facts find mention in Para No.9 onwards of the complaint. 33. According to Sh. R. P. Kapoor when he reached the hospital for collecting the charges for the above said injections, he noticed that the complainant was not being released to be taken to Fortis Hospital till the remaining medical dues of Inscol Hospital amounting to Rs.71,858/- were paid. He found Sh. Arora expressing his inability to arrange funds in the late evening and offered to give Cheque of ICICI Bank, Sector 9, Chandigarh but Inscol officials headed by Dr. Jayant Banerji were not agreeable to accept the Cheque till some tangible guarantee equivalent to the outstanding amount was given. Sh. R. P. Kapoor found the behaviour of Inscol Hospital officials as inhuman he gave his own guarantee and did not ask for the money on that date. It appears she was allowed to be taken out of OP Hospital on the assurance given by Sh. R. P. Kapoor. The Progress Chart (Annexure C-14) prepared by the OP Hospital confirms that one relative would stay for billing formalities in the Hospital. OP No.3 in Para No.15 of his reply and affidavit admitted that they transferred the patient to Fortis Hospital after a gap of two hours after they felt that the patient needed a ventilator. They, therefore, detained the patient unnecessarily for two hours and did not shift her promptly simply because she did not have money to pay to them. However, the Punjab Medical Council brushed aside that aspect of the case merely by saying that it was a civil dispute and was not under the purview of the Council. They did not find any professional misconduct of Dr. Jayant Banerji or the Inscol Hospital regarding the allegations contained in Para No.5 onwards of his affidavit. 34. There is no dispute about it that Dr. Jayant Banerji (OP No.3) is the Medical Superintendent of OP No.1 Hospital. He is alleged to have employed OP No.4 Dr. P. S. Maan as resident doctor though he is not qualified even to prefix the word ‘Doctor’ before his name. However, in Para No.28 of the reply filed by OPs No.1 and 2, it was mentioned that Dr. P. S. Maan is duly qualified doctor and was acting under the instructions of OP No.3 and Dr. Sudhir Saxena. Dr. P. S. Maan did not file a separate written reply of his own nor submitted any record about his qualifications. OP No.3, who is alleged to have appointed Dr. P. S. Maan as a resident doctor, avoided saying anything on the subject for the reasons best known to him. The Medical Council of India, however, issued a letter (Annexure C-29) to the S.S.P, Chandigarh intimating to him that Dr. P. S. Maan was asked so many times (to produce documents pertaining to his qualifications) and he failed to do so. The S.S.P was requested to constitute enquiry against Dr. Jayant Banerji, Appellant/OP No.3 of Inscol Hospital, Chandigarh for appointing P. S. Maan who is not registered with any State Medical Council to perform as a treating Physician in his set up. It was observed that Dr. P. S. Maan is not registered with any State Medical Council or M.C.I for treating the patients. This is the standard of the OP Hospital for giving treatment to its patients and obviously, where such doctors are appointed, the standard of treatment can well be imagined. 35. The contention of Dr. Jayant Banerji (OP No.3) is that he did not charge any fee from the complainant whereas the same was charged by OP No.1 Hospital and therefore, the complainant was not a consumer qua him. We do not find any merit in this argument. The complainant was admitted in the OP Hospital at the instance of Dr. Jayant Banerji (OP No.3). The complainant was being treated in the OP Hospital by him. The tests were being conducted by Dr. Jayant Banerji and some of the tests, which were to be got conducted as suggested by Dr. Sudhir Saxena were not conducted, again, it was the fault of OP No.3. The TPA injection was administered at his instance though he alleged that it was being advised by Dr. Sudhir Saxena when actually, it was not advised by the latter. OP No.3 is the Medical Superintendent of OP No.1 Hospital and it was his responsibility to take proper care of the patients admitted in the hospital. It was his duty as well of OPs No.1 and 2 to see that resuscitation equipment was present, when TPA injection was given but he did not bother to see the same. Annexure C-9 is the Invoice-cum-Receipt showing that OP Hospital received the consultant charges from the complainant for payment to Dr. Jayant Banerji. It was, therefore, the deficiency not only of OPs No.1 and 2 but of OP No.3 also and he cannot say, if he did not receive any charges for this treatment or the complainant was not his consumer. 36. The learned counsel for the OPs have also argued that they had treated the patient and charged Rs.1,01,858/- but have been directed to pay exorbitant amount i.e. Refund of the aforesaid amount of Rs.1,01,858/- along with Rs.6,58,896/- and Rs.32,199/- alleged to have been spent by the complainant in the Fortis Hospital and the P.G.I and a whopping sum of Rs.10 Lacs as compensation, which according to them, is unwarranted. The OPs have charged a total amount of Rs.1,01,858/- and out of this amount, Rs.81,600/- have been charged for TPA alone but the OPs have been treating the patient on a wrong diagnosis when she was not confirmed to be suffering from pulmonary embolism at all. The OPs by giving a wrong treatment caused the complainant to spent Rs.6,58,896/- in the Fortis Hospital as is clear from In-Patient Bill (Annexure C-26) and Rs.32,199/- in the P.G.I. The entire amount was spent due to the wrong treatment given by the OPs. The amount of Rs.10 Lacs as compensation is not exorbitant, in view of the facts and circumstances of the case and the manner in which a Diabetic patient was treated by the OPs for a wrong disease with which she was not suffering with no resuscitation equipment available and taking her to the brink of death to the chagrin of her relatives and well wishers; putting the entire family into distress; causing them mental and physical harassment, therefore, the amount of Rs.10 Lacs as compensation is just and proper. 37. The learned counsel for the OPs has also argued that Dr. Jayant Banerji (OP No.3) is insured with OP No.6, that the role of each OP should be specified as to what amount of compensation is to be paid by each of them, so that the amount payable by OP No.6 is assessed separately. A perusal of record shows that Dr. Jayant Banerji (OP No.3) was most negligent in rendering proper service to the complainant and every deficiency can be pointed out against him, whether it is regarding the diagnosis, scientific tests to be carried out by him or the administration of TPA even without ascertaining that resuscitation equipment was available in case of necessity. We are, therefore, of the opinion that out of the entire amount ordered by the learned District Forum, 50% shall be paid by Dr. Jayant Banerji (OP No.3 and the Insurance Company – OP No.6) and the remaining 50% shall be paid equally by OPs No.1 and 2. We do not find much against OPs No.4 and 5 to burden them with the liability of paying the compensation. 38. In view of the above discussion, we are of the opinion that there is no merit in any of the appeals and the same are accordingly dismissed with Rs.5,000/- as costs of litigation in each appeal. 39. Copies of this order be sent to the parties free of charge. Pronounced. 6th December 2010. Sd/- [JUSTICE PRITAM PAL] PRESIDENT Sd/- [NEENA SANDHU] MEMBER Sd/- [JAGROOP SINGH MAHAL] MEMBER Ad/-
STATE COMMISSION(Appeal No.48 of 2010) Argued by: Sh. D. P. Gupta, Advocate for the appellant. Sh. Gaurav Chopra, Advocate for respondent No.1. Ms. Jaishree Thakur, Advocate for respondents No.2,3, & 5. Sh. R. N. Raina, Advocate for respondent No.4. Respondent No.6 already exparte. Dated the 6th day of December, 2010. ORDER Vide our detailed order of even date recorded separately, this appeal along with connected appeals bearing No.49 and 50 all of 2010 have been dismissed with costs of Rs.5,000/- in each appeal. (JAGROOP SINGH MAHAL) (JUSTICE PRITAM PAL) (NEENA SAHDHU) MEMBER PRESIDENT MEMBER
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, U.T., CHANDIGARH (Appeal No.49 of 2010) Date of Institution: 03.02.2010 Date of Decision : Dr. Jayant Banerji, the then Medical Superintendent, Inscol Multi Speciality Hospital, Sector 34-A, Chandigarh. …Appellant. V e r s u s1. Smt. Inderjit Arora wife of Sh. J. S. Arora resident of #6183, Modern Housing Complex, Manimajra, Chandigarh. 2. Inscol Multi-Speciality Hospital, Sector 24-A, Chandigarh through its Managing Director Sh. Daljit Singh Gujral. 3. Sh. Daljit Singh Gujral, Managing Director, Inscol Multi-Speciality Hospital, Sector 34-A, Chandigarh. 4. P. S. Mann, Inscol Multi-Speciality Hospital, Sector 34-A, Chandigarh. 5. Mrs. Alveena Samson, Asstt. Nursing, Superintending, Inscol Multi-Speciality Hospital, Sector 34-A, Chandigarh. 6. United India Insurance Company Limited, SCO No.123-124, Sector 17-B, Chandigarh through its Manager. ….Respondents. BEFORE: HON’BLE MR. JUSTICE PRITAM PAL, PRESIDENT. MRS. NEENA SANDHU, MEMBER S. JAGROOP SINGH MAHAL, MEMBER. Argued by: Sh. R. N. Raina, Advocate for the appellant. Sh. Gaurav Chopra, Advocate for respondent No.1. Ms. Jaishree Thakur, Advocate for respondents No.2, 3 & 4. Sh. D. P. Gupta, Advocate for respondent No.5. Respondent No.6 already exparte. PER JAGROOP SINGH MAHAL, MEMBER. 1. For orders, see the orders passed in Appeal No.48 of 2010 titled ‘United India Insurance Company Ltd. Vs. Smt. Inderjit Arora and others’, vide which this appeal has been dismissed with litigation costs of Rs.5,000/-. 2. Copies of this order be sent to the parties free of charge. Pronounced. 6th December 2010. Sd/- [JUSTICE PRITAM PAL] PRESIDENT Sd/- [NEENA SANDHU] MEMBER Sd/- [JAGROOP SINGH MAHAL] MEMBER STATE CONSUMER DISPUTES REDRESSAL COMMISSION, U.T., CHANDIGARH (Appeal No.50 of 2010) Date of Institution: 03.02.2010 Date of Decision : 1. Inscol Hospital, SCO No.18-19, Sector 34-A, Chandigarh through its Director Mr. Daljit Singh. 2. Mr. Daljit Singh Gujral, Managing Director, Inscol Healthcare Ltd., SCO No.18-19, Sector 34-A, Chandigarh. 3. Sh. P. S. Mann, Inscol Health care Ltd., SCO No.18-19, Sector 34-A, Chandigarh. …Appellants. V e r s u s1. Smt. Inderjit Arora wife of Sh. J. S. Arora resident of #6183, Modern Housing Complex, Manimajra, Chandigarh. 2. Dr. Jayant Banerjee, Inscol Healthcare Ltd., SCO No.18-19, Sector 34-A, Chandigarh. 3. Mrs. Alveena Samson, House No.843, Phase IV, Mohali. 4. United India Insurance Company Limited, SCO No.123-124, Sector 17-B, Chandigarh through its Manager. ….Respondents. BEFORE: HON’BLE MR. JUSTICE PRITAM PAL, PRESIDENT. MRS. NEENA SANDHU, MEMBER S. JAGROOP SINGH MAHAL, MEMBER. Argued by: Ms. Jaishree Thakur, Advocate for the appellants. Sh. Gaurav Chopra, Advocate for respondent No.1. Sh. R. N. Raina, Avocate for respondent No.2. Respondent No.3 already exparte. Sh. D. P. Gupta, Advocate for respondent No.4. PER JAGROOP SINGH MAHAL, MEMBER. 1. For orders, see the orders passed in Appeal No.48 of 2010 titled ‘United India Insurance Company Ltd. Vs. Smt. Inderjit Arora and others’, vide which this appeal has been dismissed with litigation costs of Rs.5,000/-. 2. Copies of this order be sent to the parties free of charge. Pronounced. 6th December 2010. Sd/- [JUSTICE PRITAM PAL] PRESIDENT Sd/- [NEENA SANDHU] MEMBER Sd/- [JAGROOP SINGH MAHAL] MEMBER STATE COMMISSIONM.A. No.72(A) of 2010 Argued by: Sh. Gaurav Chopra, Advocate for the applicant/complainant. Ms. Jaishree Thakur, Advocate for Inscol Multi Speciality Hospital. Dated the 29th day of November, 2010. ORDER Since the arguments in the main appeals have been heard and the same are reserved for orders, hence, this application is dismissed being infructuous. Sd/- Sd/- Sd/- (JAGROOP SINGH MAHAL) (JUSTICE PRITAM PAL) (NEENA SAHDHU) MEMBER PRESIDENT MEMBER Ad/-
| | HON'BLE MRS. NEENA SANDHU, MEMBER | HON'BLE MR. JUSTICE PRITAM PAL, PRESIDENT | HON'BLE MR. JAGROOP SINGH MAHAL, MEMBER | |
