Sri. Jacob Stephen (President):
Complainants filed this complaint against the opposite parties for getting a relief from the Forum.
2. The brief facts of this complaint is as follows: The 1st complainant is the wife of late Vinod. 2nd and 3rd complainants are the minor children of the 1st complainant who are represented by the 1st complainant. 4th and 5th complainants are the mother and father of the deceased vinod. About 4 years ago, late Vinod started feeling back pain and he had taken treatment for the same from many hospitals and later he visited at Kottayam Midical College, Hospital. On 13.07.2011 with the advice of the doctor of the Medical College Hospital, Kottayam the deceased Vinod visited the 1st opposite party, Pushpagiri Medical College Hospital, Thiruvalla. The 2nd opposite party of the 1st opposite party hospital diagnosed the cause of ailment as disc prolapse and opined that only a surgery can give total cure to the patient and he was admitted in the hospital for a surgery on 16.07.2011. The patient was told to go for a keyhole surgery and assured that the said procedure was risk free and less painful and requiring fewer days of hospitalization. Accordingly, on 18.07.2011 by about noon the patient was operated by the 2nd opposite party and the patient was shown to the bystanders and later he was admitted in the ICU and by evening the ICU staff asked the bystanders to make available tea and toilet articles for the patient. On the same day by about 8 p.m 2nd opposite party rushed to the patients brother and informed him that the condition of the patient is critical and that a further surgery is to be conducted forthwith to save the life of the patient and obtained papers and forms signed from him. Thereafter by 11.30 p.m the bystanders were told that the patient was put into the ventilator. Being unconvinced, some of the relatives and friends forced into the ICU and they found the patient dead hours ago. Neither the 2nd opposite party nor the hospital staff or anybody cared to disclose the cause of death in a convincing manner, but attempted to project a case of heart failure on the surgery table which could not be accepted and swallowed by the relatives and others as contradictory versions in stammering style were being blurted out from different corners.
3. On the basis of complaints of negligence in the surgery, Thiruvalla Police registered a case as Crime No.1013/11 touching the matter. On the basis of the Crime, body of the deceased was taken to Medical College Hospital, Kottayam and conducted a post-mortem which revealed that abdominal aorta showed a cut 0.5 cm. long, 2 cm. below the origin of inferior mesenteric artery and that a space could be felt between L3 and L4 vertebra seen communicating into abdominal cavity. The Forensic surgeon has found the cause of death as hemorrhage following surgery. The unfortunate death of the deceased was due to the deficiency in service of the opposite parties. The complainants have already paid a sum of Rs.30,000/- towards operation charges, medical and other expenses. The complainants were totally depended upon the income of the deceased as a head load worker who was earning Rs.15,000/- per month. The deceased was the sole bread winner of his family consisting of the complainants. So the complainants are to be compensated adequately for the damages and irreparable loss caused to them due to the deficiency in service committed by the opposite parties. Opposite parties are liable to the complainants for the same. Hence this complaint for the realization of an amount of Rs.15 lakhs as compensation from the opposite parties with interest and costs.
4. Both opposite parties entered appearance and filed separate versions with common contentions. The main contentions are as follows: Opposite parties admitted the treatment of the complainant. According to the opposite parties, the deceased Vinod came to the Neuro Surgery Out patient clinic in the 1st opposite party hospital on 13.07.2011 with complaints of low back pain radiating to both lower limbs of long duration. Detailed clinical evaluation revealed the symptoms suggestive of compression of nerve roots at lumbar level. MRI scan of lumbar spine showed disc prolapse at L3-L4 level causing compression of nerves at that level. A mild type of prolapse was present at L4 and L5 level also. On the basis of the examinations, the patient was diagnosed to have suffering from Cauda Equina Syndrome due to disc prolapse at L3-L4 and L4-L5 vertibral levels. The patient was explained about his ailments and advised Lumbar Microdicectomy which is the preferred surgical treatment for the diagnosed disease. The patient and the 1st complainant were informed about the pros and cons of the said surgical procedure and advised admission to the hospital. Accordingly, the patient got admitted at the hospital on 16.07.2011 and the surgery was posted to 18.07.2011. After complying all of pre-surgical formalities, 2nd opposite party conducted Lumbar Microdiscectomy under general anesthesia at L3-L4 and L4-L5 levels under C-arm guidance on 18.07.2011 with aseptic care and precautious. Intra-operative period was uneventful and the patient was shifted to Neuro Surgery ICU at about 1 p.m and kept under close observation and monitoring. The patient’s general condition was satisfactory till 6 p.m and vitals remained stable except for tachycardia. At about 6 p.m the patient complained pain on left lumbar region and showed features of general distress and restlessness. 2nd opposite party examined the patient and the detailed evaluation of the condition revealed tachycardia and mild guarding of the abdomen. Suspecting the possibility of intra abdominal bleed, 2nd opposite party advised emergency intubation and ventilation and surgical consultation and emergency ultrasonography of abdomen. The USG report showed presence of mild free fluid in perisplenic region and the condition of the patient was explained the relatives. Emergency intulation was done and the patient was connected to ventilator and central line inserted on the left side. Blood transfusion was also done. After fluid resuscitation abdominal USG repeated which revealed significant intra peritoneal free fluid compared to previous scan report. In the consensus opinion of general surgeon and cardiovascular surgeon it was decided to conduct an emergency laparotomy. The situation was explained to the relatives of the patient and after obtaining written informed consent the 2nd opposite party along with other expert doctors conducted laparotomy under all aseptic care and precautions. Intra-operatively there was large retroperitoneal reptured haematoma into the peritoneum at multiple sites. Profuse bleeding was noted from the retroperitoneum. Retroperitoneal blood drained out and retro-peritoneal space explored and pressure packing of retro-peritoneum was done to arrest bleeding and put to tube drain. Post operatively the patient was shifted to post operative ICU and kept on ventilatory support under close monitoring. But in spite of all timely intensive measures the condition of the patient deteriorated further and expired of irreversible shock at 12.30 pm. The cause of death was internal bleeding in spite of timely measures and emergency laparotomy as it is hardly possible to identify exact bleeding site in the intra peritoneal presentation of reptured haematoma at multiple sites with profuse bleed. As the surgery could not be prolonged in view of an already deteriorating condition, a pressure packing of retro-peritoneum was done with a view to arrest bleeding along with tube drain. Thus the 2nd opposite party and other employees of the 1st opposite party had done all possible means and measures to tide over the situation occurred to internal bleeding.
5. Moreover, Microdiscectomy is a complex surgery done with the aid of a post operative microscope and major part of the said surgery is a blind procedure and there is every chance of accidental injury to blood vessels. Major blood vessels like abdominal aorta and inferior vena cave are situated just in front of the disc space in lumbar region and hence there is chance for accidental injury to blood vessals. There was no excessive bleeding during the surgery to suspect aortic injury. Internal bleeding following surgery is a knon complication which was timely detected and all possible corrective and resuscitative measures were taken in consultation with general surgeon and cardio vascular surgeon and exploratory laparotomy was also conducted. Lumbar Microdiscectomy, though involves higher element of risk of aortic injury, was adopted on the basis of a proper disgnosis and on the honest belief of providing greater chance of success for relieving the symptoms of the patient who had been suffering from back pain for the last 4 years and taken treatment from several hospitals for the said period. Just because a professional looking to the gravity of illness has adopted a procedure involves a higher element of risk to redeem the patient out of his sufferings cannot be construed as negligent merely because the procedure did not give the desired results or met with complication involved in the said procedure. 2nd opposite party had acted as per the medical practice and had exercised due skill and expertise as expected from a qualified Neuro Surgeon. The 1st opposite party is a well equipped hospital with qualified experts and other facilities for dealing the cases like the complainants case. The 2nd opposite party is a highly qualified and well experienced Neuro Surgeon and hence the allegation of medical negligence and deficiency in service is baseless. The averments in the complaint are purposely claimed by suppressing the real facts solely for the purpose of undue financial advantage of the complainants. The complainant’s are not entitled to get any relief as prayed for in the complaint as there is no negligence or deficiency in service from the part of the opposite parties. Every averments and allegations in the above complaint that goes against this version are false and hence denied. With the above contentions, opposite parties prays for the dismissal of the complaint with their cost.
6. On the basis of the pleadings of the parties, the only point to be considered is whether this complaint can be allowed or not?
7. The evidence of this complaint consists of the oral testimony of PW1, PW2, DW1 and DW2 and Exts.A1 to A8, B1 and B2. After closure of evidence, both sides filed argument notes and they were heard.
8. The Point:- The complainant’s allegation is that the 1st complainant’s husband was admitted at the 1st opposite party hospital on 16.07.2011 for complaints of back pain. 2nd opposite party examined the patient and advised for Lumbar Microdiscectomy. Accordingly the 2nd opposite party conducted Lumbar Microdiscectomy under general anesthesia at L3-L4 and L4-L5 levels on 18.07.2011. Thereafter the patient was shown to the bystanders and he was admitted in the ICU. Later by the evening the 2nd opposite party informed the bystanders that the condition of the patient is critical and told that another surgery is necessary for saving the life of the patient and he obtained certain signed papers from the brother of the patient. Thereafter, by about 11.30 p.m opposite parties told that the patient was put in ventilator but being unconvinced, relatives and friends of the patient forced into the ICU and found that the patient died hours ago. Nobody from the side of the opposite parties cared to disclose the cause of death of the patient in a convincing manner and they attempted to project a case of heart failure. The contradictory versions regarding the cause of death came from the side of the opposite parties created doubts to the relatives of the patient. So they forced into the ICU and found the patient died hours ago. According to them, the death is due to the negligence of opposite parties and on the basis of the complaint of the relatives Thiruvalla Police registered a Crime as 1013/11. Thereafter the body of the deceased was taken to Kottayam Medical College Hospital and conducted post mortem. In the post mortem, it is revealed that the cause of death of the patient was due to the internal bleeding caused due to the cut injury sustained to the patient’s abdominal aorta during the surgery. The above said cut injury on the abdominal aorta was caused due to the negligence of the 2nd opposite party which resulted in the death of the patient. Due to the death of the patient the complainants lost their income and thereby they are put to irreparable injuries. Since the unexpected death of the deceased was due to the negligent treatment by opposite parties, they are liable to compensate the complainants adequately. Hence they prays for allowing the complaint.
9. In order to prove the case of the complainants, the 1st complainant filed a proof affidavit in lieu of her chief examination for and on behalf of herself and for the other complainants along with certain documents. On the basis of the proof affidavit, the 1st complainant was examined as PW1 and documents produced were marked as Exts.A1 to A6. Apart from PW1, the associate Professor of Forensic Medicine at Medical College Hospital, Kottayam was also examined as PW2 for the complainants and one document marked as Exts.A7 through PW2. Another document is also marked as Ext.A8 for the complainants through DW2. Thus altogether 8 documents were marked in favour of the complainant’s as Exts.A1 to A8. Ext.A1 is the certified copy of FIR and FIS in Crime No.1013/11 registered by Thiruvalla Police in connection with the death of the deceased. Ext.A2 is the certified copy of the post mortem certificate dated 19.07.2011 issued from Medical College Hospital, Kottayam in connection with the post mortem of the deceased. Ext.A3 is the certificate No.even/61/2011-12 dated 23/08/2011 issued by Senior Superintendent of Kerala Head Load Workers Welfare Board, Kattappana showing the average monthly wage of the deceased is Rs.8,905/-. Ext.A4 series (A4-A4(g) are the IP deposit receipts and the medical bills issued from the 1st opposite party hospital in connection with the treatment of the deceased. Ext.A5 is the office copy of the advocate notice dated 27.08.2011 issued against opposite parties 1 and 2 for the complainant. Ext.A6 (1 & 2) are the postal acknowledgment cards of Ext.A5. Ext.A7 is the photocopy of Page No.262 from the text book of Human Anatomy Volume II. Ext.A8 is the photocopy of a picture showing vertebral ligaments Lumbo Sacral Region.
10. The contentions of the opposite parties is that the patient came with complaints of back pain and he was diagnosed Cauda Equina Syndrome due to disc prolapse at L3-L4 and L4-L5 vertibral levels. So he was advised for Lumbar Microdiscectomy which is a complex surgery done with the aid of an operative microscope and the major part of the said surgery is a blind procedure. The risk factors involved in the surgical procedure was explained in detail to the patient and his relatives and after fully conversant with the merits as well as risk factors, the patient and his relatives voluntarily gave written informed consent. Accordingly, under all aseptic care and precautions, the 2nd opposite party conducted the Lumbar Microdiscectomy under general anesthesia at L3-L4 and L4-L5 levels under C-arm guidance on 18.07.2011. Intra operative period was uneventful and the patient was shifted to Neuro surgery ICU at about 1 p.m and kept under close observation and monitoring. The patient’s general condition was satisfactory and vitals remained stable except for tachycardia. At about 6 p.m the patient complained pain on left lumbar region and showed features of general distress and restlessness. So the 2nd opposite party examined the patient and revealed tachycardia and mild guarding of the abdomen. Suspecting the possibility of intra abdominal bleed, emergency intubation and ventilation was given. Blood transfusion was also done. Based on the examinations and evaluations and on the basis of the consensus opinion of general surgeon and cardiovascular surgeon, it was decided to conduct an emergency laparotomy. The critical situation and the need for an emergency laparotomy were explained to the relatives of the patient’s and after obtaining written informed high risk consent, laparotomy was conducted by the general surgeon and Cardio vascular surgeon under all aseptic care and precautious. Retroperitoneal blood drained out and retro peritoneal space explored and pressure packing of retro peritoneum was done to arrest bleeding and put tube drain. Thereafter, the patient was shifted to post operative ICU and kept on ventilatory support under close monitoring. But in spite of all timely intensive resuscitative measures the condition of the patient deteriorated further and expired of irreversible shock at 12.30 p.m. There was no excessive bleeding during Lumbar Microdiscectomy to suspect aortic injury during surgery as any injury will show sudden spurting of blood as the aorta contains blood in high pressure. Since abdominal aorta is situated just in front of the disc space and microdiscectomy is a blind procedure there is every chance for accidental injury. Internal bleeding following surgery is a known complication and the said complication developed in the patient was timely detected and all possible corrective and resuscitative measures were taken and exploratory laparotomy was also conducted. Thus what all treatments given by the opposite parties are proper and medically accepted and hence there is no negligence from the part of the opposite parties. Opposite parties exercised due skill and expertise as expected from a reasonable and well qualified Neuro Surgeon. Opposite parties made all the possible efforts to save the life of the deceased. With the above contention, they prayed for the dismissal of the complaint as they have not committed any negligence or deficiency in service in the treatment of the deceased.
11. In order to prove the contentions of the opposite parties, 2nd opposite party filed a proof affidavit in lieu of his chief examination along with 2 documents. On the basis of the proof affidavit, he was examined as DW1 and the documents produced were marked as Ext.B1 and B2. That apart the Head of the Department and Professor of Neuro Surgery of Govt. Medical College Hospital, Trichur was also examined as DW2 for opposite parties. Ext.B1 is the outpatient treatment records and Ext.B2 is the inpatient treatment records pertaining to the treatment of the deceased at the opposite party hospital.
12. On the basis of the contentions and arguments of the parties and on the basis of the available materials on record, it is seen that the parties have no dispute with regard to the admission, treatments, surgery and death of the deceased. The only dispute between the parties is with regard to the cause of death of the deceased. According to the complainants, the cause of death was due to the negligence committed by the treated doctors. The allegation of the complainants is that during the Lumbar Microdiscectomy and injury was sustained to the abdominal aorta of the deceased which was not noticed by the surgeon who conducted the surgery which resulted in internal bleeding and the death was due to the said internal bleeding and it so happened due to the gross negligence of the treated doctor. But according to the opposite parties, Lumbar Microdiscectomy is a blind procedure and as the abdominal aorta is situated just in front of the disk space in lumbar region there is every chance for accidental injury to the abdominal aorta during Microdiscectomy. Moreover, the said injury was not noticed during the surgery as there was no excessive bleeding to suspect aortic injury. Internal bleeding following surgery is a known complication which was timely detected of possible corrective and resuscitative measures were taken and exploratory laparotomy was also conducted. In spite of all this the patient died. Therefore, the complications developed in the patient cannot be considered as a negligence in the treatment.
13. In view of the issues involved in this case, the only question to be considered is whether the aortic injury sustained to the patient is due to the negligence of the treated doctors. As per Ext.A2 post mortem certificate, abdominal aorta showed a cut 0.5 c.m long, 2 c.m below origin of inferior mesenteric artery. Further, PW2 deposed before this Forum that the diameter of the abdominal aorta is 1.5 c.m to 2 c.m depending upon persons and there will be spurting of blood from injured site and that he had felt a space between L3-L4 vertebra and it is seen communicating into abdominal cavity and the said communication is 2 c.m below the origin of inferior mesenteric artery. This clearly shows that the said aortic injury was caused during the Microdiscectomy. As aorta contains blood in high pressure, there will be spurting of blood, if a 0.5 c.m injury sustains to the aorta. So the contention of opposite parties that there was no excessive bleeding during Lumbar Microdiscectomy to suspect aortic injury during surgery is not sustainable. So it is clear that the aortic injury occurred during the surgery was not noticed by the treated doctor till the completion of the surgery which means that some negligence had occurred in the surgery. If they are vigilant in the surgery, the aortic injury would not have been occurred and the said injury would have been noticed then and there. The argument of the opposite parties is that internal bleeding following surgery is a known complication. But it is not sustainable in view of the following deposition of DW2 which is as follows:- “I never had an occasion to incur an aorta cut in any of my discectomy. I had occasion to conduct more than 350 discectomy in my carrier”. The above deposition of DW2, who is an expert in this field, clearly shows that aortic injury during Microdiscectomy is not a common complication as claimed by the opposite parties. Therefore, we find that the aortic injury sustained to the deceased is due to the negligence of the treated doctors which resulted in the unfortunate death of an young man.
14. It is no doubt, the above said unfortunate death occurred due to the negligence of the opposite parties put the complainants future in darkness and the only way to put some light to the above said darkness can be by giving adequate compensation to the dependents of the deceased. It is true that monitory compensation never make good the loss and sufferings of the dependents particularly to the young widow and the minor children of the deceased. But allowing compensation is the only option in cases like this. Therefore, this complaint is allowable and the complainants are entitled to get adequate compensation.
15. With regard to the quantum of compensation, the age and the income of the deceased and the age and the dependency of the dependents are material. In this case, the deceased is a head load worker died at the age of 35, leaving his aged parents and his wife in her younger age and 2 children below the age of 3 years. The company, care help, comfort, guidance, society, solace, affection and sexual relationship were lost to the widow. Likewise, the minor children also lost everything that can be given by a father. In the circumstances, we are constrained to adopt the guidelines laid down by the Supreme Court of India in Rajesh and other Vs. Rabjin Singh and others reported in 2013 ACJ 1403. Since the said decision was already published, we are not intending to reproduce the reasons considered by the Apex Court for arriving the calculation made for allowing compensation in that case. The calculation in the said case is as follows:
Sl.No. Heads Calculations
(i) Salary Rs. 9520/- p.m.
(ii) 50% of (i) above to be added
as future prospectus Rs.9520+4760 =Rs.14280 p.m.
(iii) 1/4th of (ii) deducted as personal
expenses of the deceased Rs.14280-3570 =Rs.10,710 p.m.
(iv) Compensation after multiplier
of 16 is applied Rs.10710x12x16 = Rs.20,56,320
(v) Loss of consortium Rs.100000/-
(vi) Loss of care and guidance Rs.100000/-
for minor children
(vii) Funeral Expenses Rs. 25000/-
Total compensation awarded Rs.22,81,320/- with 7.5% from the
date of filing of the petition till
realization.
16. If the above calculations are adopted in this case, the following will be the compensation entitled to the petitioners herein.
Sl.No. Heads Calculations
- Income/Wages of the deceased
as per Ext.A3 which is not Rs.8905/- p.m.(Rounded to
challenged by the opposite parties Rs.8900/-)
with cogent evidence
(ii) 50% of (i) above to be added
as future prospectus Rs.8900+ 4450 =Rs.13350/- p.m.
(iii) 1/4th of (ii) deducted as personal
expenses of the deceased Rs.13350-3337.5=Rs.10012/- p.m.
(Rounded to Rs.10000/-)
(iv) Compensation after multiplier
of 16 is applied Rs.10000x12x16 = Rs.19,20,000/-
(v) Loss of consortium Rs.100000/-
(vi) Loss of care and guidance
for 2 minor children Rs.100000/3x2 = 66666/-
(in the reported case there are (Rounded to Rs.66700/-)
3 minor children and in this case
there is only 2 minor children) (vii) Funeral Expenses Rs.25000/-
Total Rs.21,11,700/-
=============
17. Though the compensation is calculated as Rs.21,11,700/- the complainants claim is only 15,00,000/-. But as per the ruling referred above, this Forum can award just, equitable, fair and reasonable compensation, if necessary ignoring the claim made in the application for compensation (Para 19 of the Ruling). But there is a difference between this case and the reported case. In the reported case the deceased is a permanent Govt. Employee whereas the deceased in this case is an Head load worker. The job and the income of an head load worker is not in a permanent nature when compared to the job and income of a permanent Govt. Employee. So the calculations made in the reported case is not squarely applicable to this case. Hence we are calculating the compensation based on the income of the deceased as per Ext.A3 and as such the compensation is assessed as follows:
Sl.No. Heads Calculations
- Income/Wages of the deceased
As per Ext.A3 (rounded) Rs.8900/- p.m.
(ii) 1/4th of (i) deducted as personal
expenses of the deceased Rs.8900-2225=Rs.6,675/-
(iv) Compensation after multiplier
of 16 is applied Rs.6675x12x16 = Rs.12,81,600/-
(v) Loss of consortium Rs.100000/-
(vi) Loss of care and guidance Rs.100000/3x2 = Rs.66666/-
for 2 minor children (Rounded as Rs.66,700/-)
(vii) Funeral Expenses Rs.25000/-
Total compensation Rs.14,73,300/-
============
18. The said amount will carry 7.5% interest from the date of filing of this complaint i.e. from 31.10.2011 till realization. An amount of Rs.10,000/- is also allowed as cost.
19. In the result, this complaint is allowed thereby the complainants are allowed compensation of Rs.14,73,300/- (Rupees Fourteen Lakhs Seventy Three Thousand three hundred only) with interest at the rate of 7.5% from the date of filing of this complaint viz. 31.10.2011 along with cost of Rs.10,000/- (Rupees Ten Thousand only).
20. Out of the total amount entitled to the complainants, the 2nd opposite party is directed to pay Rs.1,00,000/- (Rupees One Lakh only) to the complainants as an alert and waning to the negligent doctors. The remaining amount is to be paid by the 1st opposite party on the basis of the principles of vicarious liability and in the absence of a specific pleading from the part of the 1st opposite party for not applying the principles of vicarious liability in this case. Opposite parties are directed to comply this order by depositing the entire amount before this Forum within 30 days from the date of receipt of this order failing which the complainants are allowed to proceed for the realization of the amount. On deposit of the amount ordered herein above the amount will be dispersed as per the law of succession applicable to the complainants. It is further directed that the amounts entitled to the minor complainants should be deposited in a nationalized bank as fixed deposit in their name, with an attachment to this Forum, till they attains the age of majority and the interest thereon can be utilized for their well being.
Declared in the Open Forum on this the 13th day of November, 2013.
(Sd/-)
Jacob Stephen,
(President)
Smt. K.P. Padmasree (Member) : (Sd/-)
Appendix:
Witness examined on the side of the complainant:
PW1 : Sandhyamol
PW2 : Dr. Zachariah Thomas
Exhibits marked on the side of the complainant:
A1 : Certified copy of FIR and FIS in Crime No.1013/11.
A2 : Certified copy of the post mortem certificate dated 19.07.2011
issued from Medical College Hospital, Kottayam.
A3 : Certificate No.even/61/2011-12 dated 23/08/2011 issued by Senior
Superintendent of Kerala Head Load Workers Welfare Board,
Kattappana.
A4 series (A4-A4(g) : IP deposit receipts and the medical bills issued
by the 1st opposite party hospital.
A5 : Office copy of the advocate notice dated 27.08.2011 issued by the
complainant to opposite parties 1 and 2.
A6 (1 & 2) : Postal acknowledgment cards of Ext.A5.
A7 : Photocopy of Page No.262 from the text book of Human Anatomy
Volume II.
A8 : Photocopy of a picture showing vertebral ligaments Lumbo Sacral
Region.
Witness examined on the side of the opposite parties:
DW1 : Dr. Dominic Anto
DW2 : Dr. P.K. Balakrishnan
Exhibits marked on the side of the opposite parties:
B1 : Outpatient treatment records
B2 : Inpatient treatment records.
(By Order)
Copy to:- (1) Sandhya Mol, W/o. late Vinod, Areekal House,
8 Acre Bagom, Cumbommettu House,
Cumbommettukara, Udumbanchola Taluk.
- The Administrator, Pushpagiri Medical College Hospital,
Thiruvalla.
- Dr. Dominic Anto, Surgeon, Dept. of Surgery,
Pushpagiri Medical College Hospital, Thiruvalla.
(4) The Stock File.
