Tamil Nadu

South Chennai

CC/441/2006

K.Ragukumar - Complainant(s)

Versus

The Chairman & Managing Director. - Opp.Party(s)

M.Kemperaj

24 Aug 2022

ORDER

Date of Complaint Filed : 24.07.2006

Date of Reservation      : 25.07.2022

Date of Order               : 24.08.2022

 

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION,

CHENNAI (SOUTH), CHENNAI-3.

 

PRESENT:    TMT. B. JIJAA, M.L.,                                                 : PRESIDENT

                        THIRU. T.R. SIVAKUMHAR, B.A., B.L.,                :  MEMBER  I 

                        THIRU. S. NANDAGOPALAN., B.Sc., MBA.,         : MEMBER II

 

CONSUMER COMPLAINT No.441 /2006

WEDNESDAY, THE 24^th DAY OF AUGUST 2022

K.Ragukumar,

S/o. N.P.Kuppusamy,

No.74, Malaikoil 1st Cross Street,

Thirukkachur Village,

Chengalpat Taluk,

Kanchepuram District.                                                      ... Complainant                 

 

..Vs..

1.The Chairman & Managing Director,

   Appollo Speciality Hospital,

   Padma Complex,

   No.320, Mount Road,

   Chennai - 35.

 

2.Dr.S.Kalyanaraman,

   Appollo Speciality Hospital,

   Padma Complex,

   No.320, Mount Road,

   Chennai - 35.                                                            ...  Opposite Parties

 

******

Counsel for the Complainant             : M/s. M.Kempraj

Counsel for the Opposite Parties        : M/s. T.M. Pappiah

 

        On perusal of records and after having heard the oral arguments of the Complainant and the Counsel for the Opposite Parties, we delivered the following:

 

ORDER

Pronounced by the President Tmt. B. Jijaa, M.L.,

1.      The Complainant has filed this complaint as against the Opposite Party under section 12 of the Consumer Protection Act, 1986 and prays to pay a sum of Rs.5,00,000/- towards compensation for negligence and mental agony and to pay a sum of Rs.7,05,597/- towards the reimbursement bill amount and to pay a sum of Rs.5000/- towards cost.     

2.     The averments of Complaint in brief are as follows:-

The Complainant’s minor child aged about 3 years and 4 month had developed a sought side walking and his neck was slightly tilted during June 2004. Hence on 07.06.2004 the Complainant had taken the minor child to one Lakshman Neuro Clinic at West Tambaram since the child was unable to talk and walk. On 08.06.2004 he was admitted at Kasturi Hospital as a case of M.R and developed ataxia, and was diagnosed as a case of Brain Demyelination and after treatment he was discharged. On 19.06.2004 he was recommended and referred M.R.I scan at Bharath scan, Chennai and on seeing the scan result on 21.06.2004 the Complainant’s family Doctor L.Shankaranarayanan had given a letter of reference to Professor L.Kalyanaraman, 2^ndOpposite Party who was a senior consultant, Neuro Surgeon and head of the Department of Neuro Surgery and the reference letter had mentioned about acute  paralysis of all four limbs and lesion like tumour in brain. Hence as per the recommendations of the Doctor the minor child was admitted at 1^st Opposite Party for treatment of Brain Tumour after all sequential test and medical diagnosis on 23.06.2004 the child was operated and partial excision of tumour was done at the 1^st Opposite Party and the same was being conducted by the 2^nd Opposite Party. On 25.06.2004, 27.02.2004, 21.07.2004 and 07.08.2004 or the various dates on which the 1^st Opposite Party had committed deficiency on their part. On 29.06.2004 Dr.JanousStumpf, of the 1^st Opposite Party had given a letter stating that the child had High Grade Glioma and the cost of radio therapy at Rs.70,000/-, which the Complainant had paid. On 04.07.2004 the minor child was operated by the 2^nd Opposite Party for shunting from the brain to remove fluid accumulated. Prior to this on 02.07.2004 when the child was in I.C.U the Complainant noticed that the bed was wet and foul smell and odour was emanating. The staff in-charge of I.C.U had falsely stated that the water would have leaked. But the Complainant had identified and deducted that the cathedral which was fixed on the urinal private part of the minor child had deviated and urine was dripping on the bed and had drunched the entire bed and had reached the head of the minor child and dampened and caused infection especially of the part where the surgery was conducted. When the Complainant questioned about this the staff of the 1^st Opposite Party behaved very badly and had sent the Complainant out of I.C.U.  On 02.07.2004 till 09.07.2004 the same incident had taken place and the nurses of the 1^st Opposite Party were given warning. On 14.07.2004 the 2^nd Opposite Party had given a letter stating that the diagnosis for the child was Astrocytoma, Grade-IV which was a type of brain tumour which is a type of cancer which developed slowly in the brain and spread over the spinal body and it was also mentioned that post operatively patient developed fever for which he was being investigated and treated by doctors such as paediatrician and infection disease specialist. On 21.07.2004 that the Complainant visited the I.C.U the same incident taken place which had happened on 02.07.2004. On 06.04.2004 a consolidated bill was prepared by the 1^st Opposite Party for a sum of Rs.7,05,597/- after deducting the sum of Rs.16,860/- thereby a balance of Rs.6,88,737/- being the due payable by the Complainant and a separate bill for Rs.43,350/- was charged towards the Radiation oncology. On 07.08.2004 again the same incident repeated. Meanwhile the child did not regain the consciousness and was not able to fully avoid the dampness for infection or scepticemia which was developed on the head region where the surgery was conducted.  Whenever the Complainant met the Doctor they assured that the child was hale and healthy the Radio Theraphy was given after the surgery. Even though the operation was conducted the post operation care given by the 1^st Opposite Party is bad to the core and has scant the regards for the post operative care and did not follow the norms of the health standard condition which reputed hospital should have offered. On 06.08.2004 the 1^st Opposite Party had issued a certificate stating that the total due of the hospital was Rs.4,30,000/- and after giving credit to the amount of Rs.2,44,500/- being paid the balance of Rs.1,70,000/- still due and payable by the Complainant. Inspite of these best efforts done by the Complainant on 08.09.2004 the minor child age about 4 years had expired. On 09.09.2004 the 1^st Opposite Party had issued a death summary and all the bills were also cleared as the Opposite Party did not permit the Complainant to remove the body of the minor child without the bills being paid. The minor child expired due to the negligence of the 1^st Opposite Party and hence the complaint.

The averments made in the Written Version filed by the 2^ndOpposite Party adopted by the 1^st Opposite party in brief are as follows:-

        The2^nd Opposite Party submitted that he is one of the senior most and experienced Neuro surgeon not only in India and also in the World. He has 47 years of experience in clinical and operative Neuro Surgery. He was a Corresponding Member of the Society of British Neurological surgeons and members of the Editorial Advisory Board of the British Journal of Neurosurgery for ten years. He has been a postgraduate teacher for forty eight years and has been examiner for the postgraduate degree in Neurosurgery in fourteen universities and institutions all over India including the All India Institute of Medical Sciences, Delhi, National Institute of Mental Health and Neuro Sciences, Bangalore and postgraduate Institute of Medical Education and Research, Chandigarh. He was the Head of the Institute of Neurology in the Government General Hospital, Madras for six years before his retirement. The 2^nd Opposite Party stated that he has been the Head of Department of Neurosurgery of Apollo Main Hospital and Apollo Specialty Hospital at Chennai for the past sixteen years. He is a past President of the Neurological Society of, past Vice President of the Asian Australian Society of Neurological surgeons past President of the Indian Society for Pediatric Neurosurgery and past President of the Indian Society for Sterotaxic and Functional Neurosurgery. He is the only Neurosurgeon in india who has been given the prestigious Shanthi Swarup Bhatnagar Award. He is a leading authority on brain tumours and has written the section on Brain Tumours in the Text Book of Surgery published by the Association of Surgeons of India. He has been given the lifetime achievement award by the World Federation for Neuro-rehabilitation International Conference and Neurosciences and Rehabilitation. The Apollo Specialty Hospital has been ISO 9000 certified for maintaining the highest standards in therapy as well as documentation. While so, the above complaint alleging medical negligence against him is malicious, intended to lower his reputation and with the ulteriormotive of extracting money on false allegations and is not Sustainable in law and the same deserved to be dismissed in limine.

The Complainant was referred by Dr. L. Sankara Narayanan, through his letter.  When, the patient was first seen by the 2^ndOpposite Party on 21.6.2004 along with MRI done two days earlier on 19.6.2004, the child had already a large tumor in the pons and cerebellum. It was clearly explained by the Second Opposite Party to the Complainant before admission as follows:

i)The child had a large tumor in the center of the brain.

ii)That the tumor cannot be removed completely by surgery because of its critical location.

iii) That partial removal can be done to know the exact diagnosis so that further appropriate treatment can be llay, given.

iv) That this should be done as early as possible as the tumor was already quite big

v) That the first surgery for the tumor may have to be followed by a second surgery (shunt) if the tumor grew further and produced obstruction to circulation of fluid around the brain.

vi) That the residual tumor after surgery would need further treatment by radiotherapy and/orchemotherapy.

vii) That the immediate outlook as far as the operation and radiotherapy were concerned, was reasonably good although the risk of surgery in such a young child with such a large tumor was considerable.

viii) That the surgery had to be undertaken inspite of the risk as there was no other equally effective way to reduce the brain compression, which may prove fatal within a few days.

ix) That the cost of surgery with other preliminary investigations would be approximately about 1 to 1 1/2 lakhs of Rupees in Apollo Specialty Hospital.

x) That the cost of radiotherapy and chemotherapy would be even more.

XI) That whatever the treatment given (anywhere in the world), the long term outlook was quite bad if the turnor turned out to be a high grade cancer and

XII) That all this treatment could be given free at the Institute of Neurology, Government General Hospital, Madras if the Complainant could not afford treatment in private hospital.

In spite of such advice and instructions, the Complainant instead of going to the Government General Hospital where treatment will be less costly than the Private Hospital, opted for treatment at Apollo Specialty Hospital, the 1^stOpposite Party and told both the Opposite Parties that cost would not matter for him, as his employers would bear the entire cost of the treatment. Thefirst operation was done on 26.6.2004 successfully. Throughout the entire stay of 2½months, the 2^nd Opposite Party visited the child almost twice daily and sometimes 3 or 4 times daily when the child was critically ill and monitored the condition of the child and its progress periodically. The 2^nd Opposite Party reported to theComplainant about the condition of the child periodically to everyday and sometimes twice a day and discussed with him to about the same. The case records of the child reveal (1) that the Wound of the first operation healed very well without any infection, (2) that the operation wounds of the second operation healed very well without any infection and (3) that a number of  chest x-rays taken over a period of several weeks did not show on any chest infection excepting during the terminal stage when thechild, was very critically ill. The daily case notes maintained both the doctors and nurses, of the 1^st Opposite Party with several entries, regarding the condition of the patient, and the treatment given will clearly show that there was no negligence on the part of the Opposite Partiesy. Apart fromthat,  various specialists carried out suggestions regarding treatment advised by the 2nd Opposite Party. It was submitted that in the notes written by the above specialist doctors, there was no any Indication or mention that urine soakage occurred or any indication or mention that the surgical wounds were infected. Hence, the allegations regarding dripping of urine, drenching of the bed and retching of the minor child and causing infection on the part of the surgery and rude behaviour of the staff are not admitted .The 2^nd OppositeParty submitted that soon after the pathology report was available from the specimen taken during the first operation that the tumor was grade IV (advanced cancer), the Complainant was clearly informed by the 2^ndOpposite Party personally that although the patient may respond temporarily to the surgery and radiotherapy the long-term outlook was bad since the tumor was high grade. The 2^ndOpposite Party never gave any assurances to contrary, the Complainant requested the Opposite Parties to give best treatment even if the chances of the child surviving is very ow low.It is the duty of any doctor to give the best possible treatment (surgery or radiotherapy) to every patient with cancer even if the chances of success are quite low. It is always possible to save or cure at least a small percentage of patients undertaking such treatment. The Septicemia (blood infection) was mainly due to the poor condition of the very young patient with advanced cancer who also developed anemia, low blood cell (platelet) count called Thrombocytopenia. All these facts were Informed to the Complainant at every stage and the Complainant is very well aware of the ill health of the child and graveness of the disease and wanted the Opposite Parties to give further  to the child. This Opposite Party totally denied the further allegation that the bed where the child was lying in the ICU was wet and foul smell was emanating and that the urine dripping on the bed had drenched the entire bed and reached the head of the minor child and dampened and caused infection on the part where the Surgery was conducted. The records in the hospital clearly show that the wounds after the operation healed well and not infected at any time. Due care and caution as per the Medical Norms was taken but due to the unfortunate nature of the primary disease, the child died. The patient was given the best possible treatment equal to the standards of the best hospitals in the world, for his extensive High Grade Cancer of the brain. Admittedly the Complainant has read over and signed the Informed Consent letter-dated-23.6.2004 and 29.7.2004 where it is clearly stated the high risk involved. The 2^nd Opposite Party never gave any false hope to the Complainant. There is no cause of action for the complaint. There is no negligence or deficiency in service rendered. Utmost care and proper treatment was given.

There is no negligence on the part of the  Opposite Parties and hence there cannot be any compensation  towards negligence and mental agony. The claim for reimbursement of towards reimbursement of bill amount already paid by the Complainant is not sustainable. The money paid by the Complainant was towards service rendered by the Opposite Parties. The complaint is an abuse of process of law. Hence prayed to dismiss the compliant.

     The Complainant submitted his Proof Affidavit and Written Arguments. On the side of the Complainant, documents Ex.A-1 to Ex.A-14  were marked. The Opposite Parties 1 and 2 submitted his Proof Affidavit and Written Arguments. On the side of the Complainant, documents Ex.B-1 to Ex.A-14  were marked.

Points for Consideration

1. Whether there is deficiency in service on the part of the Opposite Party?

2. Whether the Complainant is entitled for reliefs claimed?

3. To what other reliefs the Complainant is entitled to?

Point No.1:-

Upon perusal of Ex.A-1 it is found that the Complainant’s son Master R.Raghul was admitted to Kasthuri Hospital on 08.06.2004 on complaints that he was unable to walk and talk, he was diagnosed as case of brain stem demyelination and after taking treatment the child was discharged on 14.06.2004. Ex.A-3, MRI scan report dated 19.06.2004 of the chid revealed “ Large, peripherally enhancing space occupying lesion with perilesional edema in left half of pons, extending into left middle cerebellar peduncle and left cerebellar deep white matter” which means a large tumor had developed in the brain. As per Ex.A-4, one Dr.L.Sankara Narayanan had certified  that the child had an acute paralysis of all 4 limbs with in co ordination and as the MRI  revealed a big S.O.L due to cerebro meningeal infection-pyremic abscus or malignancy and considering the emergency situation the child was referred to the 2^nd Opposite Party. On 21.06.2004 the child was admitted in the 1^st Opposite Party Hospital and when it was first seen by the 2^nd Opposite Party the child had already developed a large tumor in the centre of brain, which needed immediate surgery. Hence on 22.06.2004, MRI Spectroscopy was done which indicated brain stem Glioma as found in Ex.B-22,Pg 497.On 23.06.2004 informed consent was obtained for Sub Occipital Craniectomy and excision of as much tumour as safe to the child, followed by Radiotherapy and Chemotherapy if indicatedEx.A-18, Pg.263 @ 264. On 23.06.2004 the first surgery was performed by partial excision of tumour, Sub Occipital Craniectomy (Removal of Bone), Evacuation of the Tumour Cyst (Fluid Collection) and Biopsy (Solid Part) of the lesion was done,Ex.B-10 (Pg.No.141 and 142). On 24.06.2004, HISTOPATHOLOGY, the Surgical Pathology Report indicated Grade IV Astro Cytoma, which is most malignant killing cancer, Ex.B-22,(Pg.299). On 24.06.2004 the 2^nd Opposite Party gave a certificate stating that the patient has been admitted in the 1^st Opposite Party Hospital and that the expenses for treatment including Surgery and Radiotherapy is likely to be about Rs.2 lakhs. The Treatment Chart as found in Ex.B-26, Volume II Pg 1 to 120 would reveal the treatment and care given to the childand continuously monitored by the Opposite Parties. On 02.07.2004, consent for Radiotherapy was obtained from the parent of the child after fully explaining the nature of therapy, its side effects and possible complications. On 02.07.2004, when the child was in ICU, while the Complainant was allowed to see the child, the Complainant had alleged that urine was dripping on the bed, drenched the entire bed and had reached the head of the child causing infection especially on the part where the surgery was conducted. It was also alleged that from 02.07.2004 to 09.07.2004 the same incident had taken place, which was also reported to the 2^nd Opposite Party. The 2^nd Opposite Party had contended that throughout the post operative period child is being attended by nurses day and night. The details of medical treatment, doctors’ finding and nursing care have been entered in the case sheet as found in Volume II of Opposite Parties. On 03.07.2004, it was reported that the operative wound healed fully as found in Pg.37, Vol I. On 21.07.2004 informed consent was obtained from the Complainant for Ventricular Peritoneal Shunt to aid for recovery. On 21.07.2004, the 2^nd operation for Ventricular Peritoneal Shunting from the brain was performed to remove fluid accumulated, which relieves pressure on the brain caused by fluid accumulation. It is pertinent to note that the Complainant on 21.07.2004 had given High Risk Consent for V.P.Shunt surgery after being explained about the condition of the child and the pros and cons of the Neurosurgery and Thrombocytopenia. On knowing the complications involved the Complainant had given consent for surgeryEx.B-6(Pg.81,Vol I). On 07.08.2004, after getting consent, the 3^rd Operation Trachesotomy was done on the child as found in Ex.B-13(Pg.185, Vol I) and thereafter was under continuous treatment. On 15.08.2004, there was blood infection, Septicemia. On 03.09.2004, the child had Bradycardia. On 05.09.2004 the child had respiratory arrest and was shifted to ICU and connected to ventilation. Ex.B-6 Pg.30, Vol I. On 08.09.2004, the child had cardiac arrest and CPR was started. However at 11.45 pm the child was dead due to Grade IV Brain Stem Glioma.

The contention of the Complainant was that, on 02.07.2004 when the child was in I.C.U the Complainant noticed that the bed was wet and foul smell and odour was emanating, the Complainant had identified that the cathedral which was fixed on the urinal private part of the minor child had deviated and urine was dripping on the bed and had drenched the entire bed and had reached the head of the minor child and dampened and caused infection especially on the part where the surgery was conducted. When the Complainant questioned about this the staff of the 1^st Opposite Party behaved very badly and had sent the Complainant out of I.C.U.  On 02.07.2004 till 09.07.2004 the same incident had taken place and the nurses of the 1^st Opposite Party were given warning. Thereafter on 07.08.2004, the same incident which occurred on 02.07.2004 took place. Meanwhile the child did not regain the consciousness due to infection or septicemia which was developed on the head region where the surgery was conducted.Even though the operation was conducted the post operation care given by the 1^st Opposite Party is bad to the core and has scant the regards for the post operative care and did not follow the norms of the health standard condition which reputed hospital should have offered.

 

The contention of the Opposite Parties is that throughout the entire stay of 2½months, the 2^ndOpposite Party visited the child almost twice daily and sometimes 3 or 4 times daily when the child was critically ill and monitored the condition of the child and its progress periodically. The 2^ndOpposite Party reported to theComplainant about the condition of the child periodically with him everyday and sometimes twice a day and discussed with him about the same. The case records of the child reveal (1) that the Wound of the first operation healed very well without any infection, (2) that the operation wounds of the second operation healed very well without any infection and (3) that a number of chest x-rays taken over a period of several weeks did not show on any chest infection excepting during the terminal stage when the child, was very critically ill. The daily case notes maintained both the doctors and nurses, of the First Opposite Party with on several entries, regarding the condition of the child, and the treatment given will clearly show that there was no negligence on the part of the First Opposite Party or their staff members and also by the Second Opposite Party. Apart from-that, the Second Opposite Party periodically examined, carried out suggestions regarding treatment advised by a second neurosurgeon, Dr. K. Ganapathy, a Medical Neurologist, Dr. R. Sridharan, aPaediatric physician, Dr, Andal, a Cardiologist, Dr. M. Ashok Kumar, a Paediatric Haematologist, Dr. Revathy Raj, two Radiation Oncologists, Dr. J. Stumpf and Dr. Ratna Devi, two Infectious Diseases Specialists, Dr. Ramasubramaniam and Dr.  Ram Gopalakrishnan and three Intensive Care Specialists, Dr. Mahendran, Dr. Krishnakumar and Dr. Udayakumar.  None of the notes written by the above specialist doctors, there was any Indication or mention that urine soakage occurred or any indication or mention that the surgical wounds were infected. Hence, the allegations regarding dripping of urine, drenching of the bed and retching of the minor child and causing Infection on the part of the surgery and rude behaviour of the staff are not admitted. The Second Opposite party, soon after the pathology report was available from the specimen taken during the first operation that the tumor was grade IV (advanced cancer), the Complainant was clearly informed by the Second Opposite Party personally that although the child may respond temporarily to the surgery and radiotherapy the long-term outlook was bad since the tumour was high grade. The Second Opposite Party never gave any assurances to contrary, the Complainant requested the Opposite Parties to give best treatment even if the chances of the child surviving is very low. It is the duty of any doctor to give the best possible treatment (surgery or radiotherapy) to every patient with cancer even if the chances of success are quite low. It is always possible to save or cure at least a small percentage of patients undertaking such treatment. The Septicemia (blood infection) was mainly due to the poor condition of the very young patient with advanced cancer who also developed anaemia, low blood cell (platelet) count called Thrombocytopenia. All these facts were informed to the Complainant at every stage and the Complainant is very well aware of the ill health of the child and graveness of the disease and wanted the Opposite Parties to give further treatment to the child.  The further allegation that the bed where the child was lying in the ICU was wet and foul smell was emanating and that the urine dripping on the bed had drenched the entire bed and reached the head of the minor child and dampened and caused infection on the part where the Surgery was conductedareunsustainable, asthe records in the hospital clearly show that the wounds after the operation healed well and not infected at any time. Both the Opposite Parties have done their best with due care and caution as per the Medical Norms and their experience for several years. But due to the unfortunate nature of the primary disease, the child died. The child was given the best possible treatment, for his extensive High Grade Cancer of the brain and the Complainant was clearly informed on several occasions that the chances of success was very low even if the doctors and the hospitals try their best for treating the child.

As regards the contention that the child developed Septicemia (blood infection), the Normal value of platelet count is 1.5 to 4.5 lakhs / cmm and Normal value of Haemoglobin is 13.0 to 18.0 gms%. The Haemogram Report of the child, Ex.B-22 (Pg.307 to 359, Vol I) would reveal that the child had a low platelet count (Thrombocyto-penia) and was severely anaemic. On 13.07.2004Ex.B-22,(Pg.423,Vol I) the blood culture report was negative. Only on 15.08.2004,(Pg.439, Vol I) the blood culture showed positive detecting septicaemia, which is after the patient was shifted to ICU and tracheostomy.

In so far as the relief seeking reimbursement of the bill amount paid by the Complainant to the 1^st Opposite Party, the treatment including  surgery was done by the Opposite Parties on the request of the Complainant who was told about the expenses that would be involved at each stage as seen in Exs.A-6 and A-9 and that he had agreed to bear the expenses and had given consentfor the treatment and surgery, as could be seen from the Exhibits of the Opposite Parties. The Complainant had paid the medical expenses to the Opposite Parties for the services availed from them.The Opposite Parties had given proper care and treatment as found in the documents marked as Exs B-1 to B-30 in three bounded volumes disclosing the line of treatment given to the child.It is evident from the Exhibits marked on the side of Opposite Parties that the patient has been periodically examined by the 2^nd Opposite Party and continuously monitored by other specialists.

If there is no cure, it is not negligence, if there is any mischance it is the common tendency to blame the doctor for negligence. In our considered view the burden of proof in an action for negligence rest primarily on the Complainant, whether there is any act of omission or Commission that is dereliction of duty resulting in the injury. In our view without any element of negligence on the part of the Opposite Parties we refrain from imposing any liability on the Opposite Parties. Accordingly, Point No.1 is answered.      

Point Nos.2 and 3 :-

Therefore on the basis of the foregoing discussion we find that there is no medical negligence or deficiency in service on the part of the Opposite Parties. Hence the complainant is dismissed. No order as to cost.

In the result the complaint is dismissed. No cost.

 

 

 

Dictated to Steno-Typist, transcribed and typed by her, corrected and pronounced by us in the Open Commission, on 24^th of August 2022.  

 

 

S. NANDAGOPALAN               T.R. SIVAKUMHAR                 B.JIJAA

         MEMBER II                       MEMBER I                        PRESIDENT

 

 

 

List of documents filed on the side of the Complainant:-

 

 

Ex.A1	13.02.2001	Date of birth
Ex.A2	08.06.2004	Discharge summary
Ex.A3	19.06.2004	Bharath scan
Ex.A4	21.06.2004	Medical certificate
Ex.A5	29.06.2004	Medical certificate
Ex.A6	29.06.2004	Apollo speciality hospital letter
Ex.A7	14.07.2004	Diagnostic report
Ex.A8	17.07.2004	Apollo speciality hospital certificate
Ex.A9	06.08.2004	Apollo speciality hospital certificate
Ex.A10	08.09.2004	Death summary
Ex.A11	08.09.2004	Death summary
Ex.A12	09.09.2004	In-patient credit bill
Ex.A13	18.10.2004	Representation
Ex.A14	17.06.2006	representation

 

 

 

 

 

 

 

S. NANDAGOPALAN               T.R. SIVAKUMHAR                    B.JIJAA

         MEMBER II                       MEMBER I                         PRESIDENT