Compensation ordered Hon’ble Thiru Justice R.SUBBIAH … PRESIDENT C.C. No.55 of 2007 Orders pronounced on: 31.07.2025

Date of filing : 25.09.2007.
IN THE TAMIL NADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI.

Present: Hon’ble Thiru Justice R.SUBBIAH … PRESIDENT

C.C. No.55 of 2007

Orders pronounced on: 31.07.2025

1. A.Bojaiah,
2. B.Ramya (Minor aged about 12 years), 3.B.Diviya (Minor aged about 11 years)
3. B.Lawanya (Minor aged about 8 years)
Complainant Nos.2 to 4, rep. by Father & Natural Guardian the 1st complainant,
all residing at No.60, G4, TNHB Neithal Apartments,
Thiruvalluvar Nagar,
Thiruvanmiyur,
Chennai 600 041. … Complainants

vs.

1.M/s.Vijaya Hospital,
Rep. by General Manager/P&A, No.180, NSK Salai, Chennai 600 026.

2.Dr.C.Satyanarayana Foundation of
Oto Rhino Laryngological Research,
Rep. by Dr.C.Ranga Rao – Medical Director,
A Unit of Vijaya Hospital, No.180, NSK Salai, Chennai 600 026.

3.Dr.C.Ranga Rao,
ENT Surgeon/Medical Director,
Dr.C.Satyanarayana Foundation of
Oto Rhino Laryngological Research,
A Unit of Vijaya Hospital,
No.180, NSK Salai, Chennai 600 026.

4.Dr.M.Jayarami Reddy,
ENT Surgeon/Joint Medical Director,
Dr.C.Satyanarayana Foundation of
Oto Rhino Laryngological Research,
A Unit of Vijaya Hospital, No.180, NSK Salai, Chennai 600 026.

5.Dr.A.Krishnamurthy,
Anesthetist,
M/s.Vijaya Hospital,
No.180, NSK Salai,
Chennai 600 026.
… Opposite Parties.
For Complainant : M/s.Thenmozhi Sivaperumal
For OP No.1 : M/s.J.Dharmarajan
For OP Nos.4 & 5 : M/S.D.Nagasaila
3rd OP, since deceased, case not pressed against him and his Research Foundation/2nd OP.

This Complaint came up for final hearing on 30.08.2023 and, after hearing the arguments of the counsels for the parties and perusing the materials on record and having stood over for consideration till this day, this Commission passes the following:-

O R D E R
R.Subbiah, J. – President.

The complainants herein seek to direct the OPs to pay to them a total sum of Rs.1 crore towards damages, compensation, etc. for the loss of their family member/P.Devendram, who is the wife of the 1st
complainant and the mother of complainant Nos.2 to 4, by alleging that her death was due to the gross medical negligence and service deficiency on the part of the OPs.

2. In brief, the case of the complainants is as
follows:-
Late P.Devendram (hereinafter referred to either as ‘patient’ or ‘deceased’ in terms of the context) had the complaints of nasal blockage and severe type of headache and, at one stage, due to unbearable headache, along with the 1st complainant, she had approached the 4th OP on 06.10.2005. The said OP, after examining her, had advised for nasal endoscopy and asked the patient to come to the 2nd OP-Research Foundation/a Unit of the 1st OP Hospital where the 4th OP was the Joint Medical Director. For the repeated enquiries made by the couple, it was emphatically told by the 4th OP that the procedure was simple in nature and that the relief would also be immediate.
The patient had arrived at the Hospital for endoscopy at 10.30 AM. and at 11 AM., she was admitted and, within few hours, at 1.45 PM., she was wheeled into the Operation Theatre. While so, at 3.15 PM., it was told that the patient had developed some serious problems as her heart was failing and almost she was in a brain dead condition, for which, she was taken straight to the ICU and the consent of the 1st complainant was taken to put her on ventilator. On 12.10.2005, she was declared dead and the complainants fell into shock and trauma upon her death, which was due to the negligence of the OPs, at the young age of 38 while she was keeping good health except for the nasal ailments and, in fact, she had walked by herself into the Hospital at 10.30 AM. and got admitted there at 11 AM but had fallen into some life threatening issues within a short span of 4 hours on the same date/06.10.2005.
From the medical records of the patient, the 1st complainant came to know that his wife had been hurriedly performed the procedure under GA (General Anesthesia) which was not even preceded by pre-operative tests like XRay, CT Scan, etc. It is not known, in the absence of any emergency situation, what was the necessity to perform the procedure/nasal endoscopy surgery, especially when the patient’s Hemoglobin level was 9.2 gms%, which was less than the normal range, that would serve as the main factor for brain death if subjected to surgery under general anesthesia and as to why the 5th OP/Anesthetist failed to advise against GA particularly when the patient’s physical status was admittedly assessed to be ASA2. Also, in spite of the sugar level being at the elevated point of 230 mg/dl, the patient was subjected to the procedure under the pretext that the glucometer test done at 1.45 pm showed 138 mg/dl. Taken over by the above plausible questions that could be easily picked up from the medical records, the 1st OP had sent a legal Notice, for which, the OPs sent replies justifying their actions.
The justification given in the reply notice would in no way be helpful to the defence of the OPs for the reasons that –
➢ As per Medical Literature “Synopsis of Oto rhino Laryngology” by Zakir Hussain & Sasi Kumaran Nair, which deals with the disease, diagnosis and treatment for ‘Ethmoidal Polyposis’, the patient ought to have been subjected to CT Scan and Allergy Test enabling the Doctors to take some good precaution during anaesthesia and to consider alternative methods since patients with limited Ethmoidal Polyp responds well to nasal Steroidal spray.
➢ Negligence at the initial stage is inferable clearly for the reason that there is a failure to admit the patient at least one day before the surgery and that the surgery was admittedly conducted on the same day of admission without keeping
the patient under adequate
Fasting/starvation, as the patient was reported to have had breakfast in the morning.
➢ OP No.5 preferred GA (General
Anesthesia) over local anesthesia which was the better option for the patient who had low Hemoglobin count and more importantly, anesthesia was given to her while her stomach was full.
➢ When the patient had blood sugar at the range of 230 Mg., the OPs ought to have postponed the procedure, however, they proceeded with the surgery without even following the basic clinical protocols of Do’s and Don’ts.
➢ Neither the 1st complainant nor the
patient had ever told that immediate relief was needed, rather, it was the 1st OP that had given the advice to immediately undergo the procedure without even properly pre-assessing the patient’s condition by primarily subjecting her to full-fledged radiological and endoscopic examinations and, straight away, she was made to accept the advice to undergo the endoscopic procedure.
➢ Had the patient been advised rightly by the 1st OP to go for conservative medical treatment instead of surgical procedure, she might have been saved.
By repeating more or less similar allegations in the above segments and by re-stating that the OPs did not act according to the accepted standards of care and the professional conduct expected of them and that the deceased was an unfortunate victim of their gross negligence & deficiency in service at all stages and that records had been prepared/rigged and facts suppressed to efface the trails of negligence, ultimately, the complainants seek to grant the relief, as stated above.

3. Gist of the Written Version filed by the 1st OP/Hospital is as follows:-
The Hospital had nothing to do with the treatment provided to the patient by the independent
consultants/Doctors and the role of the Hospital is restricted to the perspective of providing facilities like nursing care and lab tests and the Consultants shall have to pay for the consultation rooms used by them in the Hospital premises. For any issue relating to the treatment received, the patient can hold the Consultant concerned alone responsible and the said factum is known to the patients since it is so reflected in the conditions mentioned in the Admission Card/Sheet itself. Further, there is no MasterServant or Principal-Agent relationship between this OP and the Specialists/Consultants concerned nor the latter have any contract of service with the Hospital. OP Nos.2 &
3/Foundation had been accommodated in the 1st
OP/Hospital’s premises for using the same as consultation rooms –cum-OT, for which, a sum of Rs.25,000/- per month was paid by them to the Hospital towards maintenance
charges which is exclusive of other amenities they utilized. By stating that no specific allegation is made against this OP anywhere in the complaint and re-stating that the Hospital has no control or authority over the independent professionals from whom the patient had received the treatment and underlining their point that the core averments and allegations reveal that the real grievance of the complainants is only against OP Nos.3 to 5, it is sought that the complaint may have to be dismissed insofar as the 1st OP is concerned by holding no case is made out.

4. It is reported during the course of the proceedings that the 3rd OP is no more and that the complainant is not pressing the case against the said OP and also the 2nd OP-Foundation that was run by him.

5. In his written version, OP No.4 would meet the allegations made against him by stating among other things that the 1st complainant, with some specific averments, had attempted to project as if he had met this OP along with the patient for the first time at the Hospital on 06.10.2005, whereas, the fact remains that, on 28.09.2005 itself, both of them came to him at the 2nd OP complaining that the patient had persistent nasal and sinus related problems and, once again, on 04.10.2005, they both came to him stating that the conservative medical treatment provided by him for the ailments did not give any improvement and seeking remedy through surgical means on 06.10.2005, which date, according to them, was an auspicious day. But, all those facts that are borne out by records have been very conveniently suppressed by the complainants to show as if everything was decided and done hurriedly on the same date/06.10.2005, which is contrary to facts and truth.
In fact, the patient had severe head ache and nasal blockage for about one year and she took treatments with antibiotics, anti-inflammatory/anti-histaminic and steroid drugs from different doctors and, as there was no improvement, on 28.09.2005, she came to the 1st OPHospital that was accredited with the 1st complainant’s employer/BHEL. She was provisionally diagnosed to be suffering from multiple infected ethmoidal polypi at the left side and, for confirmation, she was immediately subjected to nasal endoscopy examination and also radiological test in the form of PNS X-ray which further affirmed the condition.
The endoscopic examination done on 04.10.2005 revealed –
‘a bony spur on the right side with hyperthophied inferior turbinate. Middle meatal region was normal. Multiple ethmoidal polypi were present in the left nostril including mucopus in the middle meatal region’.
After the preliminary examination along with diagnosis and assessment on 28.09.2005 itself, this OP, after explaining the nature of the ailment, had informed that it would be preferable that the patient initially goes through conservative medical treatment/non-surgical course for a few days and, in case the same brings no benefit, the next course of solution would be to undergo a surgery.
Consequently, she was taking the prescribed medicines till 04.10.2015 and, as she had no relief there-from, she expressed her readiness for surgery by stating on
04.10.2015 itself that the procedure could be performed on 06.10.2015 since, according to them, it was an auspicious day and, that being so, it is an absolute falsehood to say that the surgery was not preceded by proper diagnosis & conservative medical method and that it was advised straight away, with a view to extract money.
At no stage, there was any room for lapse or negligence and the allegations of the complainants are rendered absolutely false and absurd for the reasons that – ➢ proper and requisite pre-operative diagnosis was done by this OP by way of repeated PNS X-rays coupled with nasal endoscopic examination on 28.09.2005 and 04.10.2005 which confirmed that the patient had infected Polyposis with sinusitis;
➢ allergy test was not required in the case of the patient whose case is an established nasal polypi with infection for which such test was not mandatory; also, for the further reason that she had no history of asthma and she was not allergic to drugs;
➢ Owing to her past history connected to the diagnosed ailment and different medications she had already taken from other doctors previously, the oral steroids she had would work only against oedema and congestion but the same did not clear the disease and also for the reason that steroid drugs have their own systemic complications, procedure was
advised rightly;
➢ Since the patient was reported to have taken breakfast in the morning, as per ASA
guidelines and as explained in Oxford Book of Anaesthesia – Page No.9, she had been kept under starvation for 6 hours before the surgery;
➢ Similarly, while the initial blood sugar reading revealed elevated level of 230 Mg., the patient who was under monitoring was checked for blood sugar levels at 1.45 PM. and as the reading showed 130 mg and acetone ‘nil’, it was decided to go ahead with the procedure which included standard monitoring that was done with ECG and Pulse Oxymeter;
➢ Also, a mild dip in the HB level was not an obstacle to proceed further since the reading was acceptable for GA and the likely blood loss would not be more than 500 ml. and also, this OP and the 5th OP/Anesthetist, after considering the parameters that the patient was in euglyceamic state and that she was sufficiently starved for 6 hours, were of the joint clinical view that there was no risk factor
from GA. According to the synopsis of Anaesthesia by Lee, HB up to 8 g% may be a safer limit in otherwise fit patients provided the operation not likely to result in a blood loss of more than 500 ml.;
➢ During surgical procedure, there was no issue since the patient was under spontaneous and assisted ventilator support;
➢ Whole period of anesthesia monitoring showed normal vital status;
➢ Ventricular fibrillation developed in the patient at the end of the surgery may be due to subarachnoid hemorrhage that may be due to – ruptured berry aneurysm or co-existing brain tumor that would have bled;
➢ Subarachnoid hemorrhage is not an expected complication of the present procedure as it is only incidental due to co-existing brain tumour and since the complication is not at all produced by the surgery itself, the reason for the death is completely independent of the procedure.
By denying all other allegations and emphasizing that none of the OPs had ever fallen short of any of the duties they owed to the patient and by stating that, since the death was not due to any negligence either at the pre-procedure stage or during the procedure or at the post-procedure stage and it was evidently either due to rupturing of the berry aneurysm or the already existing brain tumor that had bled at that time, in the absence of any expert opinion and, in the face of the obvious failure on the part of the complainants to discharge the primary burden of proof, no liability can be fastened on any of the OPs in particular the 4th OP, who acted diligently and professionally with a sense of care and dedication and hence, the complaint is liable to be dismissed at the threshold.

6. By filing his written version almost in the same and identical lines as that of the 4th OP, the 5th OP sought for dismissal of the complaint.

7. In order to substantiate the claim and counter-
claim, the parties filed their respective proof affidavits and, while on the side of the complainants, 57 documents are marked as Exs.A1 to A57, one document is marked at the instance of OPs-4 and 5 as Ex.B1 and the police/forensic reports are marked as Ex.C1 series.

8. Learned counsel for the complainants firstly deals with OP No.1/Hospital, by stating that it cannot be said that they have no grievance against the 1st OP Hospital, for, it is the said Hospital which failed to co-ordinate with the team of Doctors that had treated the patient. According to
her, the death of the patient was due to the
callous/negligent conduct and lack of professionalism at the 1st OP and, as averred specifically at para No.39 of the complaint, it is the 1st OP that had advised for endoscopic surgical treatment. Secondly, by referring to the following text at para No.74 of the complaint,
“ 74. The
complainant state even a bare
looking at the case sheet maintained by opposite parties Hospital shows that it appears to have been prepared for the
purpose of this case
subsequent to the death of the patient. …”,
she states that, soon after the death of the patient, the records have been prepared by the Hospital in such a way so as to cover up the negligence of the OPs and to suit their escape from any liability and hence, on that score as well, they are liable.
Coming to the other contesting OP Nos.4 and 5, after making detailed submissions that are based on the complaint averments which have already been covered above while narrating the facts from the complaint, learned counsel states that, after the patient was diagnosed for Left Ethmoidal Polyposis, the 4th OP had simply advised for the surgery without even subjecting the patient to a meaningful radiological investigations such as CT Scan or MRI or a proper chest X-ray to rule out ‘other possible causes’ for her symptoms; nor the 4th OP had sought for an evaluation by a Nuero Specialist in order to eliminate other differential diagnosis and identify any underlying condition that may be contributing to her symptoms. Without doing so, the 4th OP proceeded to perform the procedure in such a hurry that, on the same date of admission, the procedure was done while the patient was with full stomach, her Sugar level at the time of admission was 230 mg/dl and her hemoglobin level also was low and any diligent doctor, even if the surgery is minor in nature and ambulatory, would have definitely postponed the procedure to a future date especially in the given negative conditions that stood as a real obstacle on that date. Similarly, the 5th OP, by completely ignoring those negative factors, had rushed to administer general anesthesia for the 4th OP doing the surgery and, in the course of the same, the patient had fallen into a dangerous situation that culminated in loss of her life and hence, the sequence of events themselves are demonstrative in nature to bring home the negligence of the aforesaid OPs, who shall be held liable.
Secondly and very importantly, the post mortem report shows that the deceased died of subarachnoid hemorrhage due to Grade-2 Astrocytoma which means that the patient was already suffering from a sort of brain tumor. Therefore, had the 4th OP ordered a CT or MRI and sought a Neuro Opinion or that of a relevant Specialist, the unfortunate incident might have been avoided. The poor and incomplete diagnosis of the 4th OP and his conduct of proceeding with the surgery along with the 5th OP by ignoring the future complications had ultimately
contributed to the death of the patient.
Thirdly, there is a strong suspicion that the patient was taken only dead to the ICU from the operation theatre after the minor surgery and that is why the Doctors are still not able to explain the underlying condition went through by the patient inside the operation Theatre.
Inasmuch as the facts and records are quite selfspeaking that it was only due to the collective negligence of the Hospital as well as the 5th OP, who remained oblivious to the condition of the patient that was not suitable for giving GA , and also the 4th OP who failed to exhaustively diagnose the patient to assess and detect the underlying condition of the patient, who was already suffering from undiagnosed Astrocytoma of Grade-II, and simply proceeded on and on based on some half-baked diagnosis, there is every justification and reason for fastening liability against all of them, in order to do substantial justice to the complainants by allowing their case in its entirety; learned counsel pleaded ultimately.

9. Learned counsel appearing for the 1st OP Hospital strenuously contends that the attempt to rope in the 1st OP by attributing negligence on the basis of some mistaken facts would in no way be helpful to the case of the complainants for the sole reason that the 1st OP Hospital is in no way associated with the course of treatment the patient had received at the hands of the professionals who occupy the consultation rooms for which they pay charges and also for the various facilities provided by the Hospital like lab testing, nursing/administrative staff assistance, etc. At no point, they report to the Hospital as their Employer or Principal except for availing the facilities regarding the treatment procedure and, that being so, it is not known as to on what basis the complainants allege that the Hospital had gone deficit either in the matter of diagnosis or in giving treatment at the hands of the experts; as such, the allegation is rendered absolutely absurd and bereft of any merit.
Secondly, soon after the death of the patient on 12.10.2005, at the instance of the 1st complainant, a police complaint was filed suspecting that the death was due to the negligence of the OPs, whereupon, the entire case records were taken away by the police authorities and hence, there is no scope for preparing anything new; as such, the argument made in that regard is absolutely unfounded in nature.
Thirdly, after the police complaint, autopsy was done and forensic reports emerged, however, the 1st complainant chose to withhold the same as they sharply stare against his case that is built upon his own figment of feeble imagination and, it is only after the direction of this Commission, those records came to be received and exhibited as Ex.C1 which is demonstrative enough to completely upset and uproot the unfounded case of the complainants.
On merits, it is submitted that, even otherwise, the nexus between the complications and the treatments by the Doctors/OP Nos.4 and 5 is not established which is fatal to their case and claim of the complainants. When the 1st complainant goes on developing his case by vainly broadening the scope of the absurd allegations, he ought to have adduced relevant medical literature or expert evidence or at least taken efforts for cross examination of OP Nos.4 and 5 through question and answer format, however, it appears, he endeavors to succeed with his own guesswork. There being no iota of merit or any sort of good reason to sustain any single allegation of the complainants, this Commission may have to dismiss the case by holding it a vexatious litigation; learned counsel urged finally.

10. Learned counsel appearing for OP Nos.4 and 5, by firstly pointing out that the allegations made against these OPs are mainly two-folded –
i) that no preoperative
assessment/evaluation was done,
particularly in respect of the cardiac condition of the patient or the
malignancy at the cerebral/brain area; and ii) that the surgery being elective in nature and not an emergency one, it could have been postponed till the patient is stabilized in all respects, particularly in terms of her sugar level –
Hemoglobin reading – sufficient emptiness of the stomach, for a
conducive surgical atmosphere,
deals with point No.1 and submits that it is the standard medical practice followed by any diligent medical practitioner that firstly, the cause behind the ailment in terms of the visible symptoms in the patient is examined by way of diagnosis and thereafter, to remedy the malady, the treatment course would be mostly provided by way of medications and, if the ailment is not curable by such course, surgical methods, preferably minimal invasive in nature, would be resorted to as the next step, in order to give a permanent relief. It is in that perspective, the 4th OP had assessed the condition of the patient while she presented on 28.09.2005 with the complaint of relentless head ache and nasal blockage. With all diligence and duty of care owed to the patient, the 4th OP provisionally diagnosed her on 28.09.2005 for left side Nasal Polyposis and, to confirm the condition, he subjected her to PNS Xray and also to endoscopic examination. In the face of it, it was clearly conveyed to the patient that conservative medical treatment being the first option to address the problem, she shall have to take the medications prescribed for a week time and, if there is no improvement gained from that, she may have to undergo the endoscopic sinus surgery which is a day-or-ambulatory surgery, a simple procedure to remove the polypi. All these clinical efforts taken by the 4th OP are borne out by the medical records that have been exhibited by the complainants themselves and hence, cannot be denied. While so, on 04.10.2005, the couple came to the 4th OP stating no improvement and the said OP, by way of abundant caution, once again subjected the patient to radiological examination/PNS X-ray only to detect no appreciable change and to further confirm the previous diagnosis done by him which drove him to suggest for the ambulatory surgery, however, the date and time was fixed only by the couple as 06.10.2005 at 2.30 PM., at the
1st OP under GA. A specific instruction was given by the Doctors that the patient should come on empty stomach since she would be subjected to anaesthesia for the minor surgery. However, the patient had come on that date after taking breakfast/idlys and the pre-procedure investigations indicated elevated level of sugar at 230 mg/dl., whereupon, the 5th OP decided to wait for monitoring/ensuring normal sugar level or else to postpone the procedure for a future date, despite the fact when the patient came readily for the procedure with a view to get solution for her painful condition. She was asked to be under starvation for 6 hours and the Glucose Test done at 1.45 PM. indicated the sugar level as 130 mg/dl. and hence, the allegation of very wild nature that the procedure was taken up with an
elevated sugar level is reduced to dust.
Although by referring to the ENT Textbook of Dr.Hazanka, a point is raised that local anaesthesia is preferred over GA, there are other Researchers who differ from the same and they prefer the latter and, as per the ‘Manual of Endoscopic Sinus Surgery and its Extended Applications’ written by Daniel Simmen and Nick Jones, a detailed discussion of the advantages and disadvantages of both methods is made and, in fact, the advantages of GA are identified as –
a) The surgeon need not worry about discomfort of the patient;
b) It makes it possible to access areas that cannot be accessed with local anesthesia;
c) If there is any bleeding, then it can be sucked out without any disturbance to the patient; and
d) It is difficult to provide local anesthesia in infected cases like acute sinusitis.
In terms of disadvantages, it is stated-
a) The patient is no longer conscious to act as an early warning for anything wrong; and
b) There tends to be more mucosal bleedings when compared to local anesthesia. As such, there are certain advantages and disadvantages associated with either procedure, however, across all Manuals and Handbooks concerning the surgery in question, it is unambiguously stated that the ultimate decision depends upon the choice of the patient and the doctor concerned. Here, the patient herself had consciously wished for GA which was agreed to by the 5th
OP. Further, the patient was starved for 6 hours between her breakfast and surgery which factum is well recorded in the case sheet along with a specific noting that at 1.45 PM, her sugar level was normal with a reading-130 mg/dl and the same belies the blatantly false claim of the complainants that at the time of giving anesthesia, the patient was not adequately fasted, with an elevated sugar
level.
Further, from the blood test results showing 9.2% hemoglobin level and a high total count/TC, the 5th OP could understand, it was due to the presence of infection and hence, he classified the patient to be falling under ASAAmerican Society of Anesthesiologists-II Category since she suffered from multiple infected ethmoidal polypi and left maxillary sinusitis and, in parallel, as a precautionary measure, he had ordered a Unit of B positive Blood to be kept in reserve, in view of the patient’s lowered Blood Count, which demonstrates the degree of care shown to the patient by OP No.5. Had there been any minute negligence in the matter of assessing the condition of the patient and administering anesthesia to her as alleged by the complainants, the patient would have collapsed on the table itself even during the course of giving anesthesia. In the same way, the false allegation that SaO2 readings were fabricated is fiercely rebutted for the reason that SaO2 cannot be recorded when there is low pulse volume and low BP and that is why it could not be recorded after the procedure, between 3.17 and 3.24 pm. during CPR process. All these aspects borne out by records are demonstrative in nature to destroy the false line of allegations that no real pre-operative investigation was done and no proper care given to the patient. As such, any number of allegations hurled in that segment would in no way help or advance the case of the complainant.
Regarding post-operative stage, the patient was handled by a battery of experts like Cardiologist, Neurologist, Nephrologist, etc. and she was also examined by Specialists from Apollo Hospital. At all times, the above OPs were stood alongside the patient and exerted their part attempts to revive her, however, what had destined had ultimately prevailed and, overtaken by the dismay and anguish over the death of his wife which is really a great tragedy to the family and a huge loss, the 1st complainant desultorily turned against the Doctors/OP Nos.4 and 5, who tried their level best to give remedy to the patient and endeavored till the last minute to revive her and he obtusely blamed them with untenable allegations that cannot be sustained in the face of the overwhelming medical records that speak otherwise against the case of the complainants and hence, the complaint deserves no consideration except dismissal, learned counsel voiced
fiercely at the end.

11. From the submissions advanced on behalf of the
parties, the following issues arise for consideration:- 1) Having regard
to the main allegations against the 4th and 5th OPs that are four dimensional – firstly, everything was proceeded and performed
on the same
date/06.10.2005; secondly,
there was no proper diagnosis preceded to
detect the underlying cause for the complications /
ailment; thirdly, conservative medical treatment was not
suggested or provided primarily to test its
working so as to avoid the invasive method however minimal in nature it would be and fourthly, before proceeding with the surgery, both the said OPs were completely oblivious to
the crucial negative
indicators in the patient even against giving GA in the form of elevated sugar level, low HB reading and the crucial aspect that the
patient had come for admission with full stomach after having a good breakfast/idlys, whether a solid case of medical negligence is made out against the said OPs?

2) Can it be said that the 1st OP/Hospital was in any way concerned with or had any control over the treatment provided by 4th and 5th OPs to the patient so as to attribute any sort
of medical negligence
against them and to fasten any liability, consequently?

3) To what relief, the complainants are entitled to?

12. Coming to the first allegation underlined in issue No.1, let us firstly highlight below the following text from the complaint averments:-
“ 4. The complainant submits that his wife
P.Devendram was in GOOD HEALTH. All of a sudden DURING OCTOBER 2005, she was suffering from head ache and nasal block and she was
suffering lot because of the head
ache. … Therefore, the
complainant along with his wife approached the fourth opposite parties on 06.10.2005….”
From the above averments, what could be sensibly
discerned is –
➢ It was only during October, 2005, the patient started having the issues of nasal block causing headaches, which also means, anytime before the said month – to say in November also, she did not have such issues and, in other words, the first time, the patient encountered the issues was during October 2005 only and not before that.
➢ She was having good health all along, except for the headache due to nasal issues;
➢ It was only on 06.10.2005, the couple had actually visited the 4th OP for the purpose of consultation and receiving treatment at his hands.
Having opened up the averments so, it was after the OP Nos.4 and 5 filing the written versions, on the strength of the reply sent by them to the legal notice issued by the complainant and also the medical records of the patient, by stating that the patient was already suffering from those issues, for which, she had visited the 4th OP not for the first time during October but it was much before that – during the month of November itself on 28.09.2005 and it was followed by a proper review on 04.10.2005 as could be seen from Exs.A1 and A2, the complainants changed their tone conveniently in their bulky written arguments that run to 50 pages and admitted the facts, as spoken by the OPs. It is also strange to note that having opened up the averments by conveniently suppressing the core details of the visits made on 28.09.2005 and also on 04.10.2005, which is evident from the medical records, at the end of the complaint, while summing up their case, the complainants would say so bluntly thus:-
“ To sum up the complaint,
a) That is the fact that, when the complainant and along with his deceased wife consulted the opposite parties and visited the hospital of the opposite party on 28.09.2005 itself.” Hence, the allegation that everything was done on the same date/06.10.2005, from examination to surgery, is contrary to the facts as borne out by records and it is also absolutely preposterous in nature.
Coming to the second allegation under issue No.1, the complainant would specifically aver thus at para
No.64:-
“ 64. The complainant
further stated that the opposite parties have not suggested the surgery based on the clinical examination, radiological examination and endoscopic examination. ….”
Once again, this averment-cum-allegation also appears to be a highly self-serving statement for the reason that Ex.A2, dated 28.09.2005, shows that the patient was subjected to Radiological Examination by way of X-ray which confirmed the provisional diagnosis of the 4th OP regarding Polyposis. Apart from that, the said OP subjected the patient once again to PNS X-ray and also an endoscopic examination during the review on 04.10.2005 to further confirm the ailment and it is noted thus in Ex.A47 –
‘a bony spur on the Rt. side
with hyperthophied inferior turbinate …. Multiple ethmoidal polypi were present in the Lt. Nostril including mucopus in the middle meatal region’.
As such, the earliest diagnosis done on 28.09.2005 was further re-affirmed once again on 04.10.2005. Interestingly, the History Sheet under Ex.A5 clearly mentions against the column “Complaints & Duration” that the patient was suffering from the complications for ONE YEAR.
Surprisingly, it is the 1st complainant who exhibited these documents, yet, he consistently avers in vain by stating that only recently, in October-2005, the patient developed the complications. Further, the Histopathology Report of the deceased under Ex.B1 reads ‘features are consistent with inflammatory polyps-ethmoidal Polyposis’ which finding is conclusive enough to endorse the original diagnosis done by OP-4 that the patient was suffering from
Left Ethmoidal Polyposis. Therefore, there is no veracity in the allegation that no proper diagnosis was done before 06.10.2005 in terms of the symptoms that were visible in the patient.
Regarding the third allegation, which is expressed thus at para No.63 of the complaint –
“63. … If the first opposite party advised the complainant’s wife to go for conservative medical treatment (non-surgical treatment), the complainant wife might have saved …..”,
once again, the above text is nothing but a distorted idea projected cleverly by concealing the very cover of the book that the hospital visits and treatment began at the end of November, 2005 itself and, as could be seen from Ex.A1 onwards, the patient was diagnosed for the ailment of Polyposis, re-confirmation was done with further examinations on 04.10.2005, medications were already prescribed on 28.09.2005 itself for alleviating the complications as could be seen from Ex.A1 and, when the patient had turned up for review on 04.10.2005 which is evident from Ex.A3, once again, she was subjected to diagnosis despite the fact when she expressed no improvement in order to find out the effect of the conservative medical treatment and, only after ascertaining her condition that there was no improvement from the medications, as the next step, minor or minimal invasive surgery/nasal endoscopy for polypi removal was advised, for which, the date and timing was opted by the couple themselves and obviously, the 1st complainant does not deny or dispute the same.
Therefore, having undergone conservative medical treatment as the first course, to say that such course was never suggested at the 1st OP or by the 4th OP is nothing but a falsehood and it is a very hard pill to swallow.
Having dealt with major portion of the allegations which are found to be unsubstantiated, it is now time to deal with the remaining allegation connected to the main episode of surgery proceedings. According to the complainants, it was clearly conveyed to the Doctors/OP Nos.4 and 5 that the patient had taken idlys as breakfast 2 hours before she was subjected to sugar test that was done around 11.30 AM. and hence, she was on a full stomach at that time. However, by being completely heedless to the said vital fact, the surgery was performed even without subjecting her to sufficient starvation particularly when it was a surgery after GA. The records reveal that the patient was not sufficiently starved enough for the clinically minimum mandatory duration of 6 to 8 hours and such willful negligence turned out to be a vital factor to trigger fatal consequences in the whole system to which the cerebral area having an undiagnosed tumor in the form of Grade-II Astrocytoma is also a part, to the extent of taking away the life of the patient and hence, the Forensic Reports especially the Post Mortem Report, which is limited to the cause of death, would in no way be helpful to sustain the defence of the said OPs against the formidable point of negligence in this particular segment. It must be appreciated that it was not a great deal of surgery but only a very minimal invasive procedure to remove the Polypi endoscopically and it is for the reason that the surgery was performed after General Anesthesia which type of sedation compulsorily requires the patient to be on starvation or empty stomach after taking solid foods like idlys at least for 6 to 8 hours, the patient immediately suffered the implications in the form of subarachnoid hemorrhage and hence, causal link between the negligence in giving anesthesia before surgery while the patient was not fully starved enough and the sudden/immediate cardiac issue that arose from such negligence immediately at the end of the surgery would undoubtedly establish the case of negligence against the 4th and 5th OPs. Also, the sugar level was 230 mg. at time of initial examination and considering the fact that the patient had no diabetic issues anytime before that except on the date of surgery, with all caution and diligence, the procedure could have been postponed to a future date at least to examine the reason behind the sudden elevation in sugar levels on that particular date. Apart from that, as could be seen from the Anesthesia
Chart/Ex.A16, the Hemoglobin level of the patient was 9.2 gms.%, which was a real cautioning pointer against administering GA. Therefore, all these glaring lapses which exhibit negligence on the part of OP Nos.4 and 5 are sufficient to fasten liability upon them and to do substantial justice to the victim’s family which has not yet come out of the pangs of the tragedy that had taken away their most affectionate and beloved member.
In this regard, it is the defence of OPs/Doctors that it was only due to the infection from systemic
disease/multiple infected ethmoidal polypi, the patient had the hemoglobin reading of 9.2 gms. which is only a ‘moderate anemia’ and to manage any emergency situation during the procedure, which is not likely to involve much blood loss, by way of precaution, the 5th OP had already secured sufficient unit of blood in reserve. Further, as per
Medical Literature/Lee’s Synopsis of Anaesthesia, 11th Edition, written by R.S.Atkinson and others, if a patient is otherwise fit and there is unlikely that the surgery will result in loss of blood of more than 500 ml. then doctors may go ahead with the surgery even when a person has less than 10 g/ml. In the present case, the 5th OP, after taking note of the moderate anemia and classifying the patient’s anesthetic risk as American Society of Anesthesiologists Risk Scale – II, assessed the relevant parameters that did not indicate any abnormality to preclude the proposed endoscopic procedure and suggested to go ahead in the light of the situation that all precautionary steps in the real sense had been taken to counter any eventuality. The said explanation having not been demonstrated by the complainants to be wrong or incorrect by way of adducing any expert opinion, we do not find any good point in favour of the complainants, in that segment.
In respect of the empty stomach issue, it is a very serious point that would go to the root of the case either way, depending upon the outcome from a careful
verification of the records. It is the basic and commonly well known fact based on “2-6 Rule in medical terminology” that while adult patients can drink clear fluids like water, black tea/coffee without milk or juices
without pulp upto 2 hours before induction of anesthesia, for a patient, who had taken solid food or even
cow milk, 6/six hour duration is the minimum starvation time before induction of General Anesthesia. In this regard, the OPs themselves would admit at page No.23 of their written submissions at page
No.23:-
“ iii. …. Anaesthesia,
as per all medical literature is to be administered only after the patient has fasted so as to
prevent the pulmonary
aspiration of gastric contents.
The allegation of the complainant is that the
anaesthesia was provided to the patient when she had a full stomach which was a negligent act on the part of OP-5.
iv. In the Oxford
Handbook of Anaesthesia, edited
by Keith G Alman and H Wilson, on Page 9, they have discussed fasting. They state that the preoperative fasting period is dependent upon the type of fluid and food consumed. We have already noted earlier that the patient was admitted in the hospital at about 10.30 am. on 06.10.2005. She had eaten her breakfast at around
9.00 am. The surgery was to be conducted at 2.30 pm. The patient did not eat anything in the hours between her breakfast and her surgery.”
As such, it is not even denied by the 4th and 5th OPs themselves that fasting duration is a mandatory clinical protocol in any surgery by way of GA and that any lapse in adherence to adequate fasting would lead to pulmonary aspiration of gastric contents which means due to
inadequate fasting, if solid food particles are aspirated, it may cause immediate physical obstruction of the airways leading to potential death.
Admittedly, the present case does not pertain to emergency surgery but it is only an elective procedure wherein strict fasting guidelines are/must be followed to ensure that no solid food or milk is taken minimum 6 hours before induction of anesthesia or preferably 8 hours before that, in order to ensure patient’s safety and prevent aspiration. As already stated, only a proper fasting interval in an elective surgery would ensure that stomach is as empty as possible before anesthesia, for, once anesthesia is administered, the protective airway reflexes are suppressed and if there is food or fluid in the stomach, there is a great risk of the stomach contents coming back that would lead to aspiration/inhaling those contents into lungs which would lead to serious complications.
Now, coming to the sequence of events – the following entry made in Ex.A15/1st OP Hospital’s P.O.
Nursing Chart is relevant to be mentioned:-
“ Admitted today at 11 am… checked and assessed.
today posted for surgery.”
As such, the patient appeared to have been admitted at 11 am. in the morning and, in the same document, although BP reading recorded at 11 am. and 1.45 pm. is mentioned, there is no detail entered in respect of sugar levels or the fasting status. In their written versions, at para No.24, OP
Nos.4 and 5 would state thus:-
“ 24. …. since the
patient had had her breakfast at around 9 am. he opined that before finally deciding on surgery, he would repeat the blood sugar test to verify her sugar level at fasting. ….” However, in Ex.A14 which has an entry stating that ‘patient had 3 idly’, there is nothing mentioned specifically that the timing of breakfast was 9 am. as claimed by OP Nos.4 and 5 in their written version. In fact, at Para No.56 of their written versions, these OPs further develop their case in terms of the breakfast timing by advancing it to 8.30 am. although they stated at other places consistently that it was at 9 am, thus:-
“ 56. … Patient was on fasting from 8.30 am. ….”
If that is so, there is no difficulty for them to prove the said timing from the patient’s medical records, however, as already stated, except the entry in Ex.A14 bearing the detail that the patient took the breakfast, no specific timing is written and from Ex.A15, which says that the admission was done at 11 AM. which means, the probability is, the sugar test would have been done around 11.30 AM. As per the statement of the complainants, the sugar test was done 2 hours after the breakfast; therefore, the factual probability is, the patient might have had her breakfast at or around 9.30 AM. Even according to OP Nos.4 and 5, the minimum fasting interval should be a 6 hour duration which is mentioned thus at para No.44 of their written versions:-
“ 44. … According to
‘ASA Fasting Guidelines’ this includes: (i) Light meals-
minimum fasting
period of 6 hrs. (Oxford
book of Anaesthesia page no.9)
(ii) Food should be with held for
6 hrs. Drinks for 4 hrs.
preceding the operation….”
When even according to the above OPs, the minimum mandatory fasting interval is 6 hours, for the sake of argument, even if 9 AM. is taken to be the breakfast time, the mandatory clinical duration of 6 hours was not over by 2.30 PM., when the surgery was taken up. As such, in a situation where admittedly the patient had come to the
Doctor revealing that she had taken some solid food, which means along with idly she would have taken some side dishes, any prudent and diligent doctor would first pose a question to the patient regarding the exact timing of the breakfast as every single minute would have its own significance to count the compulsory minimum fasting duration of 6 hours, in order to prevent the patient’s exposure to aspiration issues that would be devastating in nature, especially when she had an undiagnosed brain tumor of serious nature. But, the recording of clinical events on the crucial aspect of the timing of breakfast itself was not done properly which means, the Doctors had no proper focus in that perspective. The doctors must be knowing well that it was only an elective surgery and postponing the procedure for the safety of the patient, who had taken a good breakfast and who had a sudden spike in sugar level on that date without any previous history of diabetes, for a few hours or even after one or two days would not make the heavens fall as it is not an emergency surgery. The issue gets aggravated further in noticing the following bald nature of entry recorded in Ex.A22 to the following effect:-
“ Starvation: Checked. Patient has been starved for 6 hours prior to Anaesthesia and surgery.”
The said convenient entry without mentioning the starting and ending point of time is nothing but a conscious and deliberate wrong noting intended to show as if the fasting rule was adhered to, which cannot be true, for the reason that, either by going the breakfast timing of 9 AM. as consistently stated by the OPs or the most probable timing derivable from the facts and records to be 9.30 AM., the minimum fasting duration of 6 hours was not even complete at 2.30 PM. Admittedly, the surgery had commenced at 2.30 PM.; if that is so, anesthesia procedure would have taken place 5 to 10 minutes before that by 2.15 or 2.20 PM. which once again means, there is a deliberate sort of negligence and a glaring lapse, nay, professional lacking on the part of OP Nos.4 and 5 in complying with the mandatory clinical protocol regarding adequate fasting duration and non-adherence to which would pose risk to the life of the patient. As such, this is a case where, in utter disregard to the mandatory fasting rule, OP Nos.4 and 5 deliberately and consciously preplaced their action well knowing the outcome that such action by them on a patient, who had admittedly taken some solid breakfast, to undergo GA, would push her into aspiration issues that may be disastrous. Given the condition of undiagnosed brain tumor, aspiration triggered by such conduct would affect the whole system to which the cerebral area where the patient was having an undiagnosed Grade-II
Astrocytoma is also a part. May be the diagnosis in respect of the symptomatic complications would have been rightly done and may be, even the surgery been rightly performed, but those right actions would go diluted and washed away by the professional failure of the above OPs in having remained oblivious to the factor regarding starvation rule. It is not known as to why that much of urgency was shown by the 4th and 5th OPs by not waiting at least for a few hours to have a meaningful satisfaction about the emptiness of the stomach. Normally, in these types of cases, either the Doctor Notes or Nurse’s Notes would bear clear details with exact timings particularly in respect of breakfast, starting time of observation regarding starvation and exact completion of the 6 hour duration, but, that recording ethics is completely invisible here, leaving the waters in a much-troubled condition from which, the OPs/Doctors cannot be allowed to fish anything, as they are not laymen but qualified & certified professionals. In fact, the above OPs struggled a lot in their new written submissions to meet this particular point and, to the extent possible, they attempted to fade it away with some blunt and half-baked narrations to such an extent that the minimum starvation period of 6 hours as mentioned in the handbook by Keith G Alman and Iain H. Wilson is not even brought to surface, in order to dilute such a formidable point menacing their defence, despite the same is clearly spelt out in their written versions. In our careful assessment of the facts in the light of the records, there is no difficulty at all to hold that the clinically mandatory fasting duration was not even complete and, most probably, about 45 minutes to 1 hour before completion of the fasting time, hurriedly, both the OPs commenced their respective proceedings almost in a condition the patient did not adequately fast as per the established medical rule governing the surgeries that are done under GA. One another aspect is, once again, an element of negligence is visible in doing the sugar test on
Glucometer instead of regular lab blood test which is Gold Standard for Accuracy, reliable and based on a comprehensive analysis, especially for the purpose of monitoring the sugar reading at the time of surgeries. As already stated, this being an elective surgery, the best method of lab blood testing could have been pursued instead of the testing that was done on Glucometer and such exercise would have also given some time space to cover the starvation interval. On this score also, there is a lapse coupled with hastiness on the part of the OPs. In the given factual scenario, the medical records adduced by the complainants are demonstrative enough to discern
negligence on the part of OP Nos.4 and 5 to the extent that they professionally failed in following the well known medical protocol regarding the fasting condition of the patient for the minimum prescribed period of 6 hours and also, there is a lapse on their part in casually monitoring the sugar level on Glucometer instead of doing a comprehensive analysis by way of proper Lab Blood Test and, in those segments, they are liable to be held negligent. At this juncture, it must also be adverted to that the endeavor of the OPs to solidify their defence from the Post Mortem Report under Ex.C1 series stating that the death was due to Grade-II Astrocytoma (natural cause) would in no way help them to dilute the formidable factor of negligence and the obvious reason is, the Post Mortem Report, in the present factual sense, is limited in scope to understand the cause of death and it is not prepared in a broad dimension covering those aspects that would be helpful to fathom the underlying issue of negligence as pinpointed above. Similarly, the said Report also cannot be wielded by the complainants to broaden the horizon of negligence or to introduce a new case by stating that had MRI or CT been ordered at the first instance, even the brain tumour issue/Astrocytoma could have been detected for giving a comprehensive treatment. It is already pointed out by us that the patient presented with the symptom of headache due to nasal block that was not substantially potential for the clinical mind to pick up the issue of tumour and also, the symptom-based-diagnosis clearly revealed Polyposis as the reason behind the headaches and thereby, there was no further scope to suspect beyond what was diagnosed. That is why this Commission is mindful to record in a calculative manner that the effect of GA administered without subjecting the patient to the minimum interval of full 6 hour fasting period would have caused disastrous implication that would consequentially affected the whole system without exception to the cerebral area where the patient was having an undiagnosed tumor in the form of Grade-II Astrocytoma. At any rate, in the absence of any expert opinion to show that, despite the PNS X-ray and endoscopic report, there was then a clinical necessity even in the light of the limited symptoms, to suspect Astrocytoma, for ordering an MRI or a CT which the 4th OP failed to do, the complainants cannot press anything more. Ultimately, the arguments revolving around the post mortem report would enure to the benefit of none. To sum up –
➢ Facts and records render the case and defence of OP Nos.4 and 5 devoid of substance and reveal on the contrary that there is no compliance by those OPs of the mandatory clinical
requirement to ensure fasting of the patient for a minimum duration of 6
hours and it means GA was
administered while remnants of food particles were present in the patient’s
stomach that would produce
aspiration issues and may result in fatal complications to take away the life in a patient who was already having an undiagnosed brain tumour;

➢ There is a lapse on the part of the said OPs to do the sugar test by lab means and they so casually checked it on glucometer which is not generally used for the monitoring in surgical procedures, especially where the patient, who had no previous diabetic history, had encountered a sudden
spike in sugar levels on that date ;

➢ The factum that fatal
consequences/complications like subarachnoid hemorrhage leading to cardiac failure would never result from the minimal invasive procedure militates much against the defence of the OPs, for, it has the potentials to establish a direct causal link in between the negligence in not ensuring adequate starvation of the patient and the absolutely unexpected sudden fatal complications that arose resultantly in the form of
subarachnoid hemorrhage which led to heart failure of the patient and such an established causal link would lead any prudent mind to draw a probable inference that those complications had also impacted the undiagnosed condition of Astrocytoma to rupture or bleed, ultimately
resulting in the patient’s death. Accordingly, issue No.1 is answered in favour of the complainants and against OP Nos.4 and 5 holding the latter liable for medical negligence to the extent that they failed to comply with standard and mandatory medical protocol regarding the patient’s adequate starvation interval before giving GA and in not ordering a proper lab blood test to check the blood sugar level.

13. Regarding issue No.2, although it is not
disputed that the 1st OP did not share any principal-agent or employer-employee relationship with the 4th and 5th OPs and there is no substantive proof to infer any sort of medical negligence so as to fasten any liability on the said OP, as a paneled hospital for the BHEL whose employee is the 1st complainant, once the case history and clinical proceedings are recorded in their own papers bearing the name of the Hospital, they have the moral responsibility to ensure that such recordings are informative and precise with clarity in all aspects, particularly in respect of the timings, as mentioned above. Although it is alleged by the complainants that the 1st OP too had provided treatment, the records show otherwise that it was not so and also, the 1st OP is represented by the General Manager and not by any medical practitioner whereas the surgery proceedings took place at the hands of OP Nos.4 and 5, who are said to have used the consultation rooms and other facilities in the Hospital for their profession by paying charges which aspect is not disputed and that being so, for their independent acts of omission and commission, the 1st OP cannot be roped in. It is also alleged by the complainants that the 1st OP had fabricated the records and, in our view, such allegation is only absurd in nature for the reason that, soon after the police complaint, the papers were taken away by the police for investigation which factum is not denied by the complainants. One another allegation that the patient was taken dead body, as could be seen from the additional written arguments of the complainants, on 06.10.2005 itself immediately after the surgery, is falsified by the records produced by the complainants themselves that she was subjected during the relevant dates to various tests and examinations like MRI, lab tests, etc. and the forensic records/Ex.C1 also stares against such theory. Obviously, no other Specialists who dealt with the patient after the endoscopy surgery are added as parties. As such, this Commission does not find any rhyme or reason to hold the 1st OP liable for any negligence much less medical negligence. Accordingly, the issue is answered in favour of the 1st OP and against the complainants.

14. Regarding issue No.3 connected to relief, the same shall be proportionate to the degree of proved negligence on the part of OP Nos.4 and 5 as discussed and held above and, in our considered opinion, directing the said OPs to jointly and severally pay to the complainants a total sum of Rs.10 lakh, would meet the ends of justice.

15. In the result, the complaint is allowed in part as against OP Nos.4 and 5 alone, who shall have to jointly and severally pay a sum of Rs.10,00,000/- (Rupees ten lakh only) to the complainants by way of compensation for the medical negligence on their part, besides a sum of Rs.50,000/- (Rupees fifty thousand only) towards litigation expenses, and the said sums shall have to be paid within a period of 8 weeks from the date of receipt of a copy of this order, failing which, the amount shall carry interest @ 9% p.a. from the date of the complaint till the date of
realization.
Complaint stands dismissed against the 1st OP/Hospital and not pressed against OP No.3, who died during the pendency of the proceedings and OP
No.2/Foundation that was run by him.
Sd/-
R.SUBBIAH, J.
PRESIDENT.

LIST OF DOCUMENTS MARKED ON THE SIDE OF THE COMPLAINANT
Sl.No.
Date Description of Documents
Ex.A1 28.09.2005 Copy of Prescription Tablets
Ex.A2 28.09.2005 Copy of X-Ray Report
Ex.A3 04.10.2005 Copy of X-Ray Report
Ex.A4 06.10.2005 Copy of Admission Slip
Ex.A5 06.10.2005 Copy of Patient History Sheet
Ex.A6 06.10.2005
to
12.10.2005 Copy of Clinical Chart
Ex.A7 06.10.2005
to
12.10.2005 Copy of Nurses Chart Report
Ex.A8 06.10.2005
to
12.10.2005 Copy of Diabetics Chart
Ex.A9 06.10.2005 Copy of Lab Reports (3 Nos.)
Ex.A10 06.10.2005 Copy of X-Ray Report

Ex.A11 06.10.2005 Copy of Consent Form
Ex.A12 06.10.2005 Copy of Pre-operative Check List
Ex.A13 06.10.2005 Copy of Graphic Chart
Ex.A14 06.10.2005 Copy of Post Operative Drug and Fluid Order
Ex.A15 06.10.2005 Copy of Post Operative Nursing Chart
Ex.A16 06.10.2005 Copy of Anaesthesia Chart
Ex.A17 06.10.2005 Copy of Operative Record
Ex.A18 06.10.2005 Copy of Risk Factor Profile
Ex.A19 06.10.2005
to
12.10.2005 Copy of Progress Sheet and Doctors order
Ex.A20 06.10.2005 Copy of I.P. Case Sheet
Ex.A21 06.10.2005 Copy of Results of Investigation
Ex.A22 06.10.2005 Copy of Anaesthelogist Report
Ex.A23 06.10.2005 Copy of E.C.G. Chart (2)
Ex.A24 06.10.2005 Copy of Intensive Care and post operative Care Treatment
Ex.A25 07.10.2005 Copy of Blood Test Result
Ex.A26 07.10.2005 Copy of X-Ray Report
Ex.A27 07.10.2005 Culture and sensitive Report – Original
Ex.A28 07.10.2005 Haemotology Report – Original
Ex.A29 07.10.2005 Bio Chemistry Lab Reports (9) – Original
Ex.A30 07.10.2005 Copy of Report given by the Neuro Diagonostic Lab
Ex.A31 07.10.2005 Copy of E.C.G. Chart
Ex.A32 08.10.2005 Copy of X-Ray Report

Ex.A33 08.10.2005 Bio Chemistry Lab Reports (2) – Original
Ex.A34 08.10.2005 Haemotology Report – Original
Ex.A35 08.10.2005 Copy of C.T. Report
Ex.A36 08.10.2005 Copy of E.C.G. Chart
Ex.A37 08.10.2005 Copy of X-Ray Report
Ex.A38 09.10.2005 Copy of X-Ray Report
Ex.A39 09.10.2005 Lab Reports (Bio Chemistry /
Haematology / Chemical Pathology) – Originals
Ex.A40 10.10.2005 Copy of M.R. Scan Report
Ex.A41 10.10.2005 Copy of X-Ray Report
Ex.A42 11.10.2005 E.C.G. Chart – Original
Ex.A43 11.10.2005 Copy of X-Ray Report
Ex.A44 12.10.2005 Copy of E.C.G. Chart
Ex.A45 12.10.2005 Copy of X-Ray Report
Ex.A46 12.10.2007 Copy of E.E.C. Report
Ex.A47 12.10.2005 Copy of Report given by Dr.
Sathyanarayana Foundation
Ex.A48 12.10.2005 Copy of Report given by Vijaya Hospital
Ex.A49 13.10.2005 Copy of Post Mortem Certificate
Ex.A50 23.02.2006 Legal notice by the complainantOffice copy
Ex.A51 11.03.2006 Reply notice by the opposite parties – Original
Ex.A52 13.04.2006 Reply notice – Original
Ex.A53 19.03.2007 Copy of Health Care Information by University of Missouri
Ex.A54 17.05.2007 Copy of Paper publication – Thinathanthi
Ex.A55 04.10.2005 Copy of advice given by the 4th respondent
Ex.A56 20.05.2005 Copy of Transport Taxi Bill
Ex.A57 20.05.2005 Copy of Ambulance bill

LIST OF DOCUMENTS MARKED ON THE SIDE OF THE 1st Ops

NIL

LIST OF DOCUMENTS MARKED ON THE SIDE OF THE Ops 4 & 5
Sl.No. Date Description of Documents
Ex.B1 22.11.2005

COURT EXHIBITS:
Copy of the Biopsy Report of Smt. Devendram by Dr. I. Sundari M.D.,
DCR., Vijaya Health Centre
Sl.No. Date Description of Documents
Ex.C1 21.02.2013
Certain Documents obtained from the Director & Superintendent of the Institute of Non-communicable Diseases & Govt. Royapettah
Hospital, Chennai – 14.

Sd/-
R. SUBBIAH, J.
PRESIDENT.

ISM/TNSCDRC/Chennai/Orders/JULY/2025.