KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM.
OP.16/2001
JUDGMENT DATED:07-01-2012
PRESENT:
JUSTICE SHRI. K.R. UDAYABHANU : PRESIDENT
SHRI.S. CHANDRAMOHAN NAIR : MEMBER
Sathyaprabha Sujathan,
Mulavana House,
Karuvattumkuzhi, : COMPLAINANT
Kareelakulangara.P.O,
Alappuzha District.
(By Adv:Sri. Rajeev S.S)
Vs.
1. Venniyil Dr.Sukumara Pillai Memorial Hospital,
Thattarambalam, Mavelikkara-690 103.
Rep. by the Manager.
: OPPOSITE PARTIES
2. Dr.Sunny Varghese.M.S,
ENT Surgeon, V.S.M.Hospital,
Mavelikkara-690 103.
(By Adv:Sri.M.K.George)
JUDGMENT
JUSTICE SHRI.K.R.UDAYABHANU :PRESIDENT
The complainant is the wife of deceased Sujathan aged 41 who allegedly was a qualified Marine Electrical Engineer and was having other qualifications in business administration, sales marketing etc. and having wide range of experience in maintenance of heavy earth moving equipments, generators, cranes , rolling mills etc and had worked as engineer and consultant at many leading companies in India and abroad. He was about to accept a placement in Kuwait Bakery and Floor Mills Ltd, Kuwait as Engineer. He is survived by 3 minor children as well. It is alleged that on 2nd of February, 2000 while taking supper with fish curry he felt severe pain in the throat. On the next day he told that he was having taste of blood and by the evening blood stains were spotted in his saliva while spitting. As the pain and the quantity of blood in the saliva increased he was taken to the first opposite party hospital in the evening of 5th February, 2000. From the casualty he was referred to the E.N.T. department and as advised by the second opposite party E.N.T. Surgeon, X-ray was taken and the same revealed that a fish bone was caught within the left tonsil. E.N.T. Surgeon advised that the fish bone could be removed only through a major surgery by removing the left tonsil itself. The blood samples were taken and tested. Tonsillectomy was conducted on the left tonsil at 11P.M. on 5.2.2000. As the bleeding turned out to be un controllable, he was referred to Medical College Hospital, Kottayam on 7.2.2002 and he was treated therein for 3 days till 11.2.2000 under the supervision of Dr. Prathapan Nair. Blood transfusions were given. The bleeding was controlled and he was referred back to the first opposite party hospital. But he was denied admission therein as he had developed re-bleeding in the throat. He was re admitted at Medical College hospital, Kottayam on the next day ie. on 12.2.2000. It was finally diagnosed as a hereditary bleeding disorder after carrying out various haematology tests. Bleeding was conservatively controlled for 4 days. When it went out of control he was referred to Little Flower Hospital, Angamaly wherein the illness was diagnosed as a case of Haemophilia (A). Eventhough factor replacement and multiple blood transfusions were done, he finally succumbed due to acquired respiratory distress syndrome, which is evaluated as complication of recurrent and prolonged hypo tension. It is alleged that the second opposite party /E.N.T. Surgeon did not take adequate care and proper steps to ensure the prospects of life of a patient suffering from bleeding disorder before performing any kind of surgery on him. The surgeon did not advise to conduct proper blood tests for diagnosing the bleeding disorder before embarking on the surgery. The mandatory tests to be done to detect bleeding disorder before any kind of surgery were not done. The complaint has claimed a sum of Rs.10,50,000/- as compensation altogether.
2. 1st Opposite party, hospital has filed version denying the allegations of negligence. It is pointed out that the second opposite party surgeon is holding M.S. (ENT) degree and having about 15 years of experience. It is contended that the treatment was provided as per well accepted procedures and methods. Neither the patient, nor the complainant or others revealed the history of bleeding disorder in the family. It is pointed out that even in the medical college hospital the same was disclosed only after repeated interrogations. If the history of bleeding disorder was not concealed the treatments would have been different. It is contended that the allegation that he was denied the re-admission is false.
3. The second opposite party/E.N.T. surgeon has filed version admitting that the deceased was brought to the casualty department at 7.45 PM on 5.2.2000. The Casualty Medical Officer informed the surgeon and he examined the patient at 8 P.M. The patient had given the history of accidental fish bone injury in throat while taking food one week back and bleeding from the throat since morning. There was no history of bleeding tendency of the patient in the past. According to the patient, there was no family history of bleeding disorders. On examination there was active bleeding from left tonsillar fossa and no signs of infection over the left tonsil. Right tonsil was normal. The patient was treated conservatively with antibiotics and injection reptilase. X ray neck, AP and lateral was taken and was nil contributory. X ray Films were issued to the patient at the time of reference. All necessary blood investigations including bleeding time, clotting time and platelet count were done and the same were within normal limits. At that time there was massive bleeding from the left tonsil. The pros and cons were discussed with the patient and the complainant and it was decided for exploration under General Anaesthesia. A written informed consent was obtained. Under all aseptic precautions with utmost care and caution the left tonsil of the patient was examined under general anaesthesia. There was no fish bone seen. There was bleeding from the left tonsil. Since conservative methods to control bleeding failed. Control bleeding tonsillectomy and cauterization of the left tonsillar fossa was done. Bleeding was stopped and the patient was shifted to the recovery room at 11 P.M. Post operatively there was no bleeding on 6.2.2000. but the patient developed bleeding from left tonsillar fossa on 7.2.2000 at 6.15 P.M. On examination, there were fresh coats in the left tonsillar fossa. So the patient was referred to Medical College hospital, Kottayam immediately since the surgeon doubted some bleeding disorder. It is denied that the patient was denied re-admission. It is pointed out that when the patient developed re bleeding he was immediately referred to a higher centre for further investigations. The patient had come to the hospital with complaints of bleeding from the mouth. On examination there was active bleeding from left tonsillar fossa. All necessary blood investigations were done. It is re iterated that the surgery was undertaken as the conservative measures failed. It is stressed that in the discharge summary of the Medical College Hospital, Kottayam it is noted that on repeated interrogation, patient revealed family history of bleeding dis order (his brother, sister’s son, his own children also). The family history was revealed only during the time of second admission at Medical College Hospital, Kottayam. It is contended that the first opposite party hospital is a 200 bed hospital with well equipped laboratory and all specialties and major super specialties. It is pointed out that the second opposite party has acted in accordance with the general and approved practice. Mistaken diagnosis is not necessarily a negligent diagnosis. It is contended that the complaint filed is a frivolous and vexatious one and that the same should be dismissed with compensatory costs.
4. The evidence adduced consisted of the testimony of PWs 1 to 3, RW1 and Exts. A1 to A33; B1 to B1(f).
5. PW1 is the complainant/wife of the deceased. PW2 is Dr. Prathapan Nair, the then professor and head of the department of E.N.T. Medical College, Kottayam who treated the complainant at Medical College, Kottayam. PW3 is Dr. Baboos Peter, the haematologist and physician of Little Flower Hospital, Angamaly. Rw1 is the second opposite party, E.N.T. surgeon of the first opposite party hospital. The complainant has produced copies of records with respect to the marriage with the deceased, the death certificate and the service and qualifications of the deceased as well as the offer letter from abroad as mentioned in the complaint and the bills of radiological and blood tests conducted at the opposite party hospital, the bills of paying treatment charges at the opposite party hospital as well as at Medical College Hospital, Kottayam and at Little Flower Hospital, Angamaly. The complainant has also produced the results of laboratory tests while undergoing treatment at Medical College Hospital, Kottayam, discharge summaries with respect to two admissions at Medical college Hospital, Kottayam, Test reports with respect to blood transfusions and the medical certificate issued from Little Flower Hospital, Angamaly consequent to the death of the patient as well as the records with respect to the dues to the Kerala Financial Corporation with respect to the loans availed and the recovery steps taken. It is the case of the complainant that on account of the death of her husband, the family has been put to considerable financial strain. The opposite parties have produced Ext. B1 Patient Record including the medical certificates allegedly issued.
6. The evidence would disclose that the deceased Sujathan, aged 41 years was admitted at the 1st opposite party hospital at 7.45.pm on 5.2.2000 on complaint of impaction of fish bone in the throat when he was taking food with fish curry on 2.2.2000. He was examined at the casualty. He came to the hospital as he was having the blood stains in the saliva. In Ext.B1 case sheet of the opposite party hospital it is noted that he came with a complaint of blood from mouth for one hour and that there is no visible bleeding points. X-ray neck AP and lateral and blood routine was advised. The hemoglobin count and blood group is also noted. At 8 pm as noted in Ext.B1, the ENT Surgeon/OP2 examined the patient. At 8 pm it is mentioned as history of accidental ingestion of fish bone one week back. It is also mentioned as complaint of bleeding from throat since morning. It is further mentioned as active bleeding from left tonsillar fossa. It is further noted as no infection to the tonsil. Suspected granulation over the upper pole left tonsil is mentioned. He underwent emergency tonsillectomy cauterization of left tonsil under general anesthesia. The bleeding was controlled but on 7.2.2000 in the evening he developed uncontrolled bleeding from the same spot and was referred to the Medical College Hospital, Kottayam at 8 pm. From 7.2.02, till 11.2.02 he was an inpatient at Medical College Hospital, Kottayam. After discharge he was sent back to the 1st opposite party hospital. According to the complainants he was refused admission at the 1st opposite party hospital and hence got admitted at Government Hospital, Kayamkulam. On 12.2.2000 he was again readmitted at Medical College Hospital, Kottayam on account of re-bleeding from the left fossa. It was then that it was found on questioning by the doctor that he was having family history of bleeding disorder. Up to 23.2.2000 from 12.2.2000 he was an inpatient at Medical College Hospital, Kottayam. At Medical College Hospital, Kottayam he underwent blood transfusions and explorations of the fossa under general anesthesia twice. As at Medical College Hospital, Kottayam was not having facilities for Haematological work up he was referred to Little Flower Hospital, Angamaly for expert management. On 1.3.2000 he died at Little Flower Hospital, Angamaly on account of Acquired Respiratory Distress Syndrome which is a complication of recurrent and prolonged hypo tension.
7. The allegations of the complainant are that the required mandatory blood tests ie BT, CT, Platelet count and APTT were not done before surgery and that tonsillectomy was not really required and that the same was done in a hasty manner and that no informed consent was taken before the surgery. It is also alleged that there are manipulations in Ext.B1 case sheet. It is pointed out that the case sheet was produced only along with the proof affidavit of DW1, the ENT Surgeon for facilitating manipulations. It is alleged that the notings in Ext.B1 as having BT and CT done are fabricated entries. It is also alleged that the X-ray films and the detailed treatment particulars were not given to the complainant when the patient was taken to the MCH, Kottayam. The contention is that it is only on account of the lapse on the part of the opposite parties in not subjecting the patient to CT, BT tests that has resulted in continued bleeding and consequent death.
8. On the other hand, the opposite parties have contended that CT,BT tests were done prior to the surgery and the same has been noted in Ext.B1 case sheet although, the results of CT,BT tests were omitted to be noted in Ext.B1. It is further stressed that the complainant or the patient did not reveal the family history of bleeding disorder which was detected only at the time of second admission at the MCH, Kottayam. In Ext.A20 discharge summary from MCH it is specifically mentioned that on repeated interrogation the patient revealed family history of bleeding disorder. The patient was having Hemophilia-A and the facilities for detecting the same was available only in Little Flower Hospital, Angamaly at the time. It was at Little Flower Hospital, Angamaly that it was detected that the patient was having Hemophilia-A inspite of having factor replacement and repeated blood transfusions the patient died on account of hemophilia-A. The contention is that the opposite parties had followed the standard protocols whereas, the patient and the bystanders including the complainant concealed the fact of having the family history of bleeding disorder.
9. As pointed out PW2, the head of the Department of ENT at Medical College Hospital, Dr.Prathapan Nair who treated the patient at MCH has testified that before surgery hemoglobin percentage, plate let count, total count, differential count and BT, CT are done. The above is the required protocol is not disputed. PW3, the doctor who treated the deceased at Little Flower Hospital who is the Haematologist and Physician has also agreed to the suggestion that APTT test, Prothrombine test, plate let count, clotting time test are the primary tests for ascertaining bleeding disorders by Surgeons and Physicians. Although the opposite parties have asserted that CT,BT tests were conducted before surgery on 5.2.2000 in the night and that the ENT surgeon had ascertained from the patient that there is no history of previous bleeding tendency. It is pointed out that the same is a fabricated entry as DW1/ENT Surgeon has admitted in the cross-examination at page 10-11 that the above entry is made in a different ink. There is such an admission by DW1. Further the results of BT, CT tests are not noted in Ext.B1, whereas the result of blood routine test is seen noted. It is pointed out that Ext.B1 case sheet was produced subsequently and only at the time of filing proof affidavit by DW1 in August 2003. It is alleged that the retention of the medical records were with the intention to fabricate the treatment records. On the other hand it is contended by the opposite parties that there was no direction or request to produce the case sheet earlier. As there was no direction or request in this regard the opposite parties cannot be blamed in this regard. All the same it is pertinent to note that nowhere the results BT,CT tests are incorporated in the case sheet. In a separate sheet in Ext.B1 case sheet which is marked Ext.B1(d) the results of BT, CT and the platelet count is incorporated. It is brought out in the cross-examination of DW1 that he could not recollect the name of the lab technician who has signed in Ext.B1(d). The signature is also not legible. On the other hand, the lab technician who did blood RE test has signed as ‘Mony Sunny’ and DW1 has also recollected the name. It is admitted by DW1/ENT Surgeon at page 6 of the deposition that results of blood tests has to be mandatorily recorded in the case sheet. Further as pointed out in Et.B1( c ) the result of blood routine test the stamp of having received payment is affixed whereas the same is absent in Ext.B1(d), the result of CT, BT test. The complainant has also produced Ext.A8 bill for the blood routine test. According to the complainant no payment was made for the BTCT test. No counter foils or other records with respect to the payments for BT, CT test was also produced by the opposite parties. It was also to be noted that in the version of the 2nd opposite party/DW1 it is mentioned that the patient told him that there is no family history of bleeding disorder but the same is not noted in Ext.B1.
10. It is pertinent to note that the blood tests results at MCH, Kottayam at different dates as evident from Ext.A15(b), A15(c), A15(d), A17(a), A17(c), A17(f) and A17(g) the abnormality with respect to the clotting time etc is manifest. The same is the case of the blood test result at Little Flower Hospital, Angamaly vide Ext.A22. Hence it is quite unlikely that only in Ext.B1(d) alleged blood test result at the opposite party hospital, the CT,BT was normal, that too at a time when allegedly there was bleeding from the throat. The above would indicate that the case of the opposite parties that the mandatory CT,BT tests were done before doing tonsillectomy is not true.
11. The explanation of DW1, ENT Surgeon for not entering the X-ray findings in Ext.B1 is due to emergency (page 13 of DW1). It is pertinent to note that as per Ext.B1, the complainant was examined by DW1 at 8 pm on 5.2.2000 and X-ray examination was done at the above hospital itself. The patient was taken to the operation theatre only at 9.15.pm vide the nurses beside record. According to DW1 the result of X-ray is nil contributory ie there was no fish bone in the throat. According to DW1 it was an exploratory surgery that was done. On the other hand it is contended by the complainant that DW1 had told that left tonsil is to be removed as there is fish bone in the left tonsil. Ext.A12 and A20 discharge summaries from MCH, Kottayam also mentions as history of fish bone in the throat. The copy of the reference letter is not incorporated in Ext.B1. The case sheet of MCH, Kottayam was also not produced. The above is the lapse on the part of the complainant. The failure to incorporate the copy of the reference letter in Ext.B1 case sheet is a deficiency on the part of the opposite parties. Further according to PW2, Professor of ENT at MCH, Kottayam, tonsillectomy is the treatment for foreign body infaction and he would have done the same in such cases. As according to DW1 as there was no fish bone in the throat the requirement of an emergency tonsillectomy stands not substantiated. Although it is stated by DW1 that he did only an exploratory surgery in the anesthesia notes bleeding from left tonsil and tonsillectomy is noted. Perhaps the same was written subsequent to the surgery.
12. The alleged informed consent is also not reflected in the consent form contained in Ext.B1. The column with respect to the procedure is left blank therein. In the consent for anesthesia it is written in the words of the complainant that the surgery is for stopping the bleeding. Therein also tonsillectomy is not noted. According to DW1, the same was done during the procedure of surgery of exploration and hence the specific consent could not be obtained. But we find in the nurses record at 8.50.pm itself the surgery is mentioned as tonsillectomy left under GA. The patient was sent to operation theatre only at 9.15.pm. Informed consent is not evident from the consent forms got signed and incorporated in Ext.B1.
13. It has also to be noted, as pointed out that the bleeding became uncontrollable bleeding only after the surgery as uncontrollable is not noted earlier in Ext.B1. Of course in the entries at 8 pm on 5.2.2000 it is written as active bleeding from left tonsil fossa whereas at the casualty it is written only as complaint of blood from mouth and no visible bleeding points. Evidently as the left tonsil has been removed there was a larger and deeper injury and bleeding would have become excessive subsequently. The requirement for an emergency surgery without conducting the mandatory blood tests evidences negligence on the part of the 2nd opposite party.
14. It has also to be noted that the case sheet is not a properly maintained one as it contained loose sheets stapled together and results of CT, BT and X-ray are not noted in the case sheet.
15. All the same we find that there is contributory negligence on the part of the patient as well as on the part of the bystanders including the complainant. As the evidence of PW2 the Surgeon of MCH and the statement in Ext.A20 discharge summary from MCH mentions that on 2nd admission at MCH on repeated interrogation the patient revealed family history of bleeding disorder (brother, sister’s son ? his children also). It is the case of the complainant that the deceased was a highly qualified person who had worked abroad. Still he concealed the family history of bleeding disorder. Although PW1, the complainant has testified that there is no such family history and that his children and the relatives were subsequently tested regarding the bleeding disorder and found to be having no such disorder the complainant has not produced any evidence in this regard. The evidence of PW2, the Professor of ENT in this regard has also not been questioned in the cross-examination. Hence we find that after being aware of the family history of bleeding disorder the patient and the complainant ought to have intimated the same to the treating doctor/ENT Surgeon/DW1. We find that there is contributory negligence on the part of the patient and the complainant in this regard. We assess the contribution of negligence as 50%.
16. The deceased was aged 41 years as evident from the treatment records. The complainant has produced the copies of the B Tech Electrical Certificate from the University of Kerala of the deceased issued in November 1980, A4 copy of the certificate of Diploma of Business Management/Administration issued from Cambridge Tutorial College, Ext.A5 the certificate of Diploma in Sales and Modern Marketing Management from the College of Professional Management, Jersey, Britain, Ext.A6 the certificate of having passed Intermediate Examination in Electrical Engineering Practice held in May-June 1970 (sic) from the City of Guilds of London Institute. Ext.A30 and Ext.A31 the intimation document from Carriers World dated:4.5.2000 mentioning that he was selected as an Engineer at M/s Kuwait Bakery and Flour Mills Ltd Company, Kuwait with a basic salary of KD174 + food + accommodation.
17. All the same we find that no objective evidence as to the employment and salary drawn has been furnishing. In the circumstances we find that it would be reasonable to treat his income at the time at Rs.10,000/- per month. After deducting 1 3rd (one third) for the personal expenses, the balance contribution to the family is taken as Rs.6667/-. The multiplier can taken as 8 also in view of the fact that he was suffering from hemophilia-A. Hence the total contribution would work out to Rs.6,40,032/-. A sum of Rs.10,000/- is awarded towards the pain and sufferings undergone and Rs.10,000/- towards the loss of love and affection of the minor children 3 in number, which is not disputed. A sum of Rs.10,000/- is awarded for loss of consortium of the complainant. A sum of Rs.10,000/- is awarded for treatment and ancillary expenses. A sum of Rs.5000/- is awarded for funeral etc expenses. Altogether the amount would workout to Rs.6,85,032/-. With regard to the contributory negligence on the part of the complainant and the deceased 50% of the above sum is reduced. Hence the complainant will be entitled for Rs.3,42,516/-. The complaint was pending before this Commission for more than 10 years. The delay was on account of the lapses on the part of both sides and of the system. Hence we are confining the interest to be paid to 5 years. The complainant will be entitled for interest at 7% for 5 years on the sum of Rs.3,42,516/-. The complainant will also be entitled for cost of Rs.5000/-. The opposite parties would be jointly and severally liable to make the payment. The payment would be made within 3 months from the date of receipt of this order failing which the complainant will be entitled for interest at 12% from 7.1.2012, the date of this order.
JUSTICE K.R. UDAYABHANU: PRESIDENT
S. CHANDRAMOHAN NAIR : MEMBER
APPENDIX
COMPLAINANT’S WITNESS
PW1 : 19.2.2003 Sathya Prabha
PW2 : 9.8.03 Dr.P.Prathapan Nair
PW3 : 9.8.03 Dr.Baboos Peter
COMPLAINANT’S EXHIBITS
Ext.A1 : Marriage certificate datd:31.7.1987.
Ext.A2 : Degree certificate issued by the University of Kerala
Infavour of N.Sujathan dtd:10.8.81.
Ext.A3 : Pass certificate in Marine Engineering issued by Navel Dockyard, Bombay infavour of N.Sujathan.
Ext.A4 : Diploma certificate dtd: 22.11.88.
Ext.A5 :Diploma certificate in sales and Modern Marketing Management dtd:7.2.89.
Ext.A6 : City and Guilds of London Institute Examination result.
Ext.A7(a) : Bill No.5472 dtd: 5.2.2000, X-ray charge issued by the 1st opposite party in favour of Sujathan.
Ext.A7(b) :Bill No.5471 dtd: 5.2.2000, X-ray charge issued by the 1st opposite party in favour of Sujathan.
Ext.A8 : Bill NoLT.13265 dated:5.2.2000 Lab Test (Blood).
Ext.A9(a) : Bill No.5054 dtd:7.2.2000, Inpatient bill issued by 1st opposite party in favour of Sujathan.
Ext.A9(b) : Bill No.24035 dtd:7.2.2000 medicine and equipments issued by 1st opposite party infavour of Sujathan.
Ext.A9(c) : Bill No.23942 dtd:6.2.2000 medicine and equipments issued by 1st opposite party infavour of Sujathan.
Ext.A9(d) : Bill No.8889 dtd:7.2.2000 bill for minor procedures issued by 1st OP infavour of Sujathan.
Ext.A9(e) : Bill No.51697 dtd:7.2.2000 pharmacy bill.
Ext.A9(f) : Bill No.23994 dtd:7.2.2000 pharmacy bill.
Ext.A9(g) : Bill for registration fee dtd:7.2.2000.
Ext.A10 : Bill No.AC000167 dtd:7.2.2000 Ambulance charge.
Ext.A11 :Clinical Pathology Report dtd:8.2.2000 issued by Modern Diagnostic Service, Kottayam.
Ext.A12 :Discharge card from Medical College Hospital dtd:11.2.2000.
Ext.A13(a): Receipt No.21539/216 dtd: 11.2.2000 for the rental charge for Room No.7.
Ext.A13(b): Receipt No.6853 dtd:11.2.2000 acknowledgement of receipt of money issued by Hospital Development Committee, Government Hospital, Kayamkulam.
Ext.A14(a) : Bill No.2258 dtd:17.2.2000 testing charge for blood.
Ext.A14(b) : Bill No.2226 dtd:13.2.2000 testing charges for blood.
Ext.A15(a): Miscellaneous report dtd:12.2.2000.
Ext.A15(b) : Clinical Pathology Report dtd: 13.2.2000.
Ext.A15(c) : Clinical Pathology Report dtd: 14.2.2000.
Ext.A15(d) : Clinical Pathology Report dtd: 15.2.2000.
Ext.A16 : Biochemistry report dtd:21.2.2000.
Ext.A17(a) : Blood test report dtd:16.2.2000.
Ext.A17(b) : Blood test report dtd:16.2.2000.
Ext.A17(c) : Blood test report dtd:17.2.2000.
Ext.A17(d) : Blood test report dtd:17.2.2000.
Ext.A17(e) : Blood test report dtd:18.2.2000.
Ext.A17(f) : Blood test report dtd:18.2.2000.
Ext.A17(g) : Blood test report dtd:18.2.2000.
Ext.A17(h) : Blood test report dtd:19.2.2000.
Ext.A17(i) : Blood test report dtd:21.2.2000.
Ext.A17(j) : Blood test report dtd:23.2.2000.
Ext.A18(a) : Biochemistry test of urine dtd:19.2.2000.
Ext.A18(b) : Haematology test dtd:18.2.2000.
Ext.A18(c) : Biochemistry test of blood dtd:16.2.2000.
Ext.A19 : Test report issued by Modern Diagnostic Centre infavour of Sujathan dtd:14.2.2000.
Ext.A20 : Discharge summary dtd:23.2.2000 from Department of ENT, Medical College Hospital, Kottayam.
Ext.A21 : Bill No.1089 of Ambulance charge dtd:23.2.2000.
Ext.A22 : Clinical report of blood dtd:23.2.2000.
Ext.A23 : Pharmacy sheet of Little Flower Hospital, Angamaly.
Ext.A24 : Medical certificate issued by Dr.Baboos Peter, Haematology at the Little Flower Hospital, Angamaly dtd:15.3.2000.
Ext.A25 : Death Certificate of Sujathan.N issued by Angamaly Municipality dtd:10.3.2000.
Ext.A26 : Ambulance bill issued by Little Flower Hospital, Angamaly dtd:1.3.2000.
Ext.A27(a) : Demand notice dtd:4.10.2001.
Ext.A27(b) : Demand notice dtd:4.10.2001.
Ext.A27(c) : Demand notice dtd:4.10.2001.
Ext.A28 : Copy of notice issued by the Kerala Financial Corporation in favour of Sujathan and the complainant.
Ext.A29 : Photocopy of visa issued infavour oif Sujathan from Kuwait.
Ext.A30 : Telegram sent by Carrers World in favour of Sujathan.
Ext.A31 : Certificate issued by M.K.Aboobacker, Proprietor, Career Worlds Manpower Agency.
Ext.A32(a) : Bill issued by Matha Medicals dtd:14.2.2000.
Ext.A32(b) : Bill dtd:13.2.2000 issued by Medical store, Dhanwanthiri Medicals, Gandhinagar.
Ext.A32(c) : Cash receipts issued by Neethi Medical Store, Gandhinagar.
Ext.A32(d) : Cash receipts issued by Neethi Medical Store, Gandhinagar.
Ext.A33 : Detailed Bill issued by Little Flower Hospital Research Centre, Angamaly.
OPPOSITE PARTIES WITNESS
RW1 : Dated:25.6.2004 Dr.Sunny Varghese.
OPPOSITE PARTIES EXHIBITS
Ext.B1 : Whole out patient Records.
Ext.B1(a) : Out patient record issued by the V.S.M. Hospital, Thattarambalam, Mavelikkara in favour of Sujathan.
Ext.B1(b) : Doctors Orders and programme notes.
Ext.B1(c) :Clinical details, Haematology Department.
Ext.B1(d): Clinical details, Haematology.
Ext.B1(e) : Anaesthetic sheet issued by V.S.M.Hospital, Mavelikkara infavour of Sujathan.
Ext.B1(f) : Treatment certificate issued by V.S.M. Hospital, Mavelikkara in favour of Sujathan dtd:23.11.2000.
JUSTICE K.R. UDAYABHANU: PRESIDENT
S. CHANDRAMOHAN NAIR : MEMBER
VL.
