State Consumer Disputes Redressal Commission
P.Joy Bell M vs Christian Medical College & ... on 14 October, 2015
IN THE TAMILNADU STATE CONSUMER DISPUTES REDRESSAL
COMMISSION, MADURAI BENCH.
Present: Thiru.A.K.ANNAMALAI, M.A.M.L.,M.Phil., Presiding Judicial Member
Thiru.M.MURUGESAN, B.Sc.,B.Ed., Member
C.C.No.03/2012
(C.C.No.18/2007 on the file of State Consumer Disputes
Redressal Commission, Chennai.)
THE 14th DAY OF OCTOBER 2015.
Date of complaint filed : 14.02.2007
Date of order pronounced: 14.10.2015
P. JOY BELL,
W/o. R. Jeyam Julius,
50/73, Rajamaniyapuram,
Arumuganeri,
Thoothukudi District. Complainant
Vs
Christian Medical College and Hospital,
Through its Medical Superintendent,
Ida Scudder Road,
Vellore - 632 004. Opposite Party
Counsel for Complainant : Mr.M. Ilango, Advocate.
Counsel for Opposite Party : Mr.Sundar Pandian Dass, Advocate.
This complaint coming before us for final hearing on 14.09.2015
and on hearing the arguments of both sides and on perusing the material
records, this Commission made the following:
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ORDER
THIRU. A.K. ANNAMALAI, PRESIDING JUDICIAL MEMBER.
The complaint under section 17(1) (a) (i) of the Consumer Protection Act, 1986 claiming direction against the opposite party alleging medical negligence and deficiency in service in giving treatment to her which caused mental agony and continuation of further treatment claiming compensation of Rs.22,67,102/- and for costs.
1. The gist of the complaint in brief is as follows: The complainant aged about 43 years, during the year 1994 was diagnosed that she was suffering from SLE (Systemic Lupus Erythematosus) with morphea and later on 03.11.1997, further diagnosed that the complainant is suffering from SLE with small vessel vasculitis which needs regular follow-up treatment for life long and also necessary drugs. The doctor who treated her in the hospital abandoned the follow-up treatment and putting her on off drugs by prescribing a vitamin Tab.B plex Forte alone which resulted in the SLE again in an aggravated form and under compelling circumstances, without valid consent, warnings and disclosers they administered steroids and Tab. Cyclophasphamide, which ultimately resulted in early menopause at the age of 36. The opposite party started Hormone Replacement Therapy for early menopause under the threat of fracture of bones and continued the same for a long term (more than 5 ¼ years) without consent, warnings, precautions and important disclosures and without any periodical evaluations such as mammogram, Pap smear, MRI of breasts etc.,. 3 which resulted in breast cancer. She was under treatment with the opposite party during the year 2001, 2002, 2003 and 2004 and on 09.03.2004, she came to know that the opposite party administered H.R.T. to the complainant only on oral basis and not on any evaluation and they have not furnished the medical records and only after filing the Writ Petitions by the complainant on 04.04.2006 which was furnished by fabricated records with intention to substantiate the opposite party's false representation in his reply dated 22.09.2005 and stated that the complainant appeared at the opposite party's hospital's O.G. Unit for evaluation after 4 years from the year 2000 and neither suggested mammogram or informed the complainant of the consequences of cancer because of the failure to give proper treatment for her diseases under gross negligence which ultimately resulted in infiltrating duct carcinoma Grade-II in her right breast and she was forced to get the medical records only through the direction of the Writ Petitions continuing of H.R.T. after 2 - 3 years without any presentation of evaluation the opposite party committed gross negligence to her treatment and thereby they are liable to pay compensation to the complainant and the consumer complaint came to be filed after issuing legal notice to the opposite party claiming the reliefs as above.
2. The opposite party denied the allegations admitting the statement given to the complainant for the diagnosis of SLE in the year 1994 and she was started on Chloroquine. On 13.12.1995 since there was an improvement and after consultation, Dermatologist advised her to stop Chloroquine from the 4 Dermatology point of view and she was compelled to come for follow-up on the test she had given to the Medicine doctor and asked for medical report in the report dated 22.12.1995, Beflex forte (vitamin) was advised for 3 months and at no stage she was advised abandonment of follow-up either verbally or by medical report. The patient abandoned follow up action on her own accord and the nature of treatment of SLE she made aware of this during her admission in August 1994. In 1997, she came back for treatment with deep ulcers which had not responded to treatment by the local doctors and biopsy of the ulcers showed necrotizing vasculitis she was prescribed Cyclophosphamide and Prednisolone which resulted in full healing of the ulcer. During this period the complainant was referred to OG for amenorrhoea and had started Hormone Replacement Therapy for premature menopause in April 2000. After stopping earlier medicines and subsequently it was stopped because of drop in blood counts (which was monitored regularly on this treatment) when SLE itself is an important cause for premature menopause which includes her medication. In medical report of 2004, the medicine II doctors had advised maintenance treatment for SLE and Vasculitis with low dose steroids and the rest as advised by OG thereby implying H.R.T. treatment and in August 2004 her SLE Vasculitis was under control and she was advised to continue the same treatment and also ordered mammography and pap smear for her. But, she had failed to do mammography as advised and had mammography only in February 2005 after 7 months and in March 2005 her breast cancer was detected which has not normally caused by 5 HRT as breast cancer type for infiltrating duct cancer and not lobular type which is caused due to HRT. The opposite party further stated that the disease SLE itself is an important cause for premature menopause. It is not mandatory or medical compulsion that pap smear and mammogram should be done to all HRT patients in an interval and there is no nexus between the absence of pap smear and mammogram test with any injury suffered by the complainant. This is only an optional. According to medical norms mammogram is performed once in every 2 years after HRT. Her breast was examined and recorded to be normal on 03.05.2001 only after three years on 27.08.2004; she visited the O.G. OPD and had mammogram only on 09.02.2005 even though it was ordered on 27.08.2004. On getting medical report on 01.03.2005, the HRT was stopped. The complainant attended OG only on 2 occasions after HRT was started. The second visit was after 4 years when mammogram was ordered. Therefore, the opposite party cannot be made responsible for the absence of patient in reporting before the concerned department for proper treatment though denied that there is duty bound to make patient on HRT to have mammogram compulsorily done in every year to rule out breast cancer. The complainant was treated only by stages adequately, optimally and scientifically and her incidental breast cancer is unrelated to HRT which was also detected early and at a curable stage and she was given treatment for that also and cured still takes follow up in opposite party hospital even on 14.10.2005 and there is no negligence or deficiency in service on their part. The complainant also filed Writ Petitions to 6 furnish the medical records praying for continuing the treatment with free facilities which was denied in the Writ Petitions and medical records were furnished and she filed a complaint before the Medical Council of India and other State Authorities and on the basis of opposite parties proper medical records and reports further action was taken. The complainant also filed criminal complaints before the Police against all the 7 medical professionals who had given treatment to the complainant which are still pending and hence the complaint to be dismissed.
3. Both sides have filed their proof affidavits and on the side of the complainant, documents Exhibits A1 to A38 and on the side of the opposite party Exhibits B1 to B25 series are marked.
4. The following are the points for consideration (1) Whether there was any deficiency in service or negligence as alleged by the complainant by the opposite party in giving treatment to the complainant?
(2) Whether the complainant is entitled for a sum of Rs.22,67,102/-
as compensation ?
(3) To what relief the complainant is entitled?
5. Point No.1: In this complaint enquiry, it is the admitted case of both sides that the complainant was having treatment in various departments in the opposite party's hospital from the year 1999 till 2005. The main allegation of the complainant is that she was given treatment for SLE and subsequently 7 underwent HRT and belated mammogram which lead to breast cancer and removal of right side breast due to that and alleged negligence and deficiency in service in wrong advice to be off drugs and abandonment of follow-up treatment (which resulted in escalation of SLE), prescribing dangerous drugs like Cyclophophamide and steroid drugs Wysoloen without consent which lead to early menopause, starting HRT treatment without obtaining consent or explaining it would cause cancer or other dangerous diseases, failure to advise mammogram with the follow-up test, continuing HRT for a long duration of more than 5 years and refusing to furnish medical records. In her contentions, the complainant alleged that because of wrong treatment and negligence, the opposite party even failed to issue medical records which is subsequently received through the orders of the Hon'ble High Court of Madras by way of Writ Petitions as per exhibits B-18 and B-19 and it is also alleged that the complainant has given criminal complaint against the some medical officers alleging negligence in giving treatment as per FIR under Ex A-36 and statements of witnesses relating to the criminal case in STC No.224 of 2008 on the file of Judicial Magistrate No. IV. Vellore in which she has relied the doctors' statement under section 161 Cr.PC to support the negligence of the opposite party hospital. While considering these aspects the criminal complaint as against the 6 medical officers and some other doctors under section 304-A of IPC against whom the alleged 161 statements were obtained from the Government doctors viz., Dr.R. Maheswari, M.D., D.G.O., and Dr.V. Thirunavukkarasu, M.D., D.D.,. The 161 8 statements relating to the doctors who are not parties in this complaint and only the Superintendent of Hospital, Christian Medical College and Hospital is alone being the opposite party and on the basis of vicarious liability the complaint was filed in the absence of some parties against whom 161 statements were recorded to be relied upon cannot be accepted. Further 161 Cr.PC statements are recorded by Police Officers and not signed by the concerned deponents and so it should be proved that the contents and veracity of the statements through the criminal courts by way of chief examination, cross-examination and further examination of Police Officers who have recorded these statements under section 161 of Cr.PC which are unless and until proved through the criminal court of law which cannot be accepted or fixing deficiency in service or negligence against the persons concerned on that basis alone.
6. In this case, the complainant also relied on a text book of surgery for the purpose of breast cancer management alleging because of prolonged treatment of HRT for more than 5 years under Exhibits A-38 series and A-39 which are relating to the medical literature for Mammogram and also relied on the following rulings which are as follows:
1) Jacob Mathew - Vs - State of Punjab and another, Reported in 2005 SCC (Crl) 1369.
2) Nizam Institute of Medical Science - Vs - Prasanth S. Dhananka & others Reported in 2009 (7) MLJ 596 (SC)
3) Samira Kohli- Vs - Dr. Prabha Manchanda and another, Reported in (2008)2 MLJ 662 (SC) 9
4) Post Graduate Institute of Medical Education and Research, Chandigarh
- Vs - Jaspalsingh and others Reported in (2009) SCC (Crl) 399.
5) Malaykumar Ganguly - Vs - Dr. Sukumar Mukherjee and others With Kunal Saha (Dr) - Vs - Dr. Sukumar Mukherjee and Others.
6) Kharti and others - Vs - State of Bihar and others Reported in AIR 1981 1068
7) Malakala Surya Rao and others - Vs - Gundapuneedi Janakamma Reported in AIR 1964 AP 198.
8) Ravi Kapur - Vs - State of Rajasthan Reported in (2012) 3 Supreme Court Cases (Cri) (2012) 9 Supreme Court Cases 284.
9) Unreported judgment of Hon'ble Supreme Court, dated 1 July 2015 in the case V. Krishnakumar - Vs - State of Tamil Nadu & Ors.
and thereby relying the above judgements to elicit that the complainant is entitled to file the complaint against the hospital and also to establish the negligence and deficiency in service against the treatment given to the complainant.
7. The complainant's side also filed the proof affidavits of 2 doctors, one Dr.C. Vetrivel and another Dr. M. Lakshmi Narayanan apart from her own affidavit. While considering the affidavits of Dr.C. Vetrivel, and Dr. M. Lakshmi Narayanan, Dr.C. Vetrivel is having M.B.B.S., degree with diploma in D.Ch., Paediatrics practising from 1975 and stating that being the family doctor of the complainant, on perusal of records of the complainant, the complainant had been taking HRT from the year 1999 she was advised Mammogram only on 01.03.2005 and having treatment for more than 5 years and the opposite party states that there is no report of HRT causing breast cancer in women with 10 premature menopause is baseless and the opposite parties have not done mammogram while giving HRT to be given at least once in six months interval. Likewise, in the affidavit of Dr.M. Lakshmi Narayanan who is also having M.B.B.S. and M.S. degree working as Assistant Surgeon, Government Rajaji Hospital in Madurai, on perusal of complainant's medical records states that SLE is life long disease and the dropping of follow-up treatment not correct she was under
compulsion to take Tab. Cychlophosphamide and Tab. Wysolone to control the raised limits of SLE which caused early menopause and she was given HRT continuously. Having Mammogram test which was done for the first time only in 2005 showing speculated mass lesion of size 4 x 2.5 cm with internal clustered pleoymorphic micro classifications in right breast upper and outer quadrant S/o. malignant lesion. Nodes detected clinically in both auxiliary region which is the drainage area of breast and she was advised to stop HRT only on 01.03.2005 after more than five long years and prescribed protocol in the administration of HRT not followed because of loss of her right breast she has sustained permanent disability and she must be kept in observation life long since it is advanced carcinoma Breast.
8. Whereas the opposite party alleging that the complainant had undergone for treatment with SLE skin disease from the year 1994 having a disease from 1992 and subsequently it was disclosed that she was having the same for more than 13 years and she was advised with proper medicines to Cyclophosphamide (Steroid) during the year 1998 and she was referred to O.G. 11 (Obstetrics and Genecology) and also for amenorrhoea (stoppage of menstruation cycles) and started with HRT (Hormone Replacement Therapy) for pre-menopause in April 2000 and subsequently defaulted for follow-up treatment with Gynaecologist for a period of 4 years and only on 27.08.2004 Obstetrics and Gynaecology unit II found that her breasts were normal and advised for Mammogram evaluation and pap smear for deciding for further continuance of HRT and she had undergone Mammogram on 01.03.2005, after 7 months and it was found that she was having infiltrating duct carcinoma (Breast Cancer) and she had alleged that the breast cancer was due to prolonged continuation of HRT without having annual evaluation of Mammogram. But, the alleged breast cancer cannot be HRT related breast cancer, in this case, the breast cancer is relating to infiltrating duct carcinoma and she had failed to produce the copies of medical records and also prayed for continuation of medical treatment with the opposite party if so really had grievances against the opposite party she should not have prayed for continuation of treatment with the opposite party hospital and still she is having continuation of treatment even after filing this complaint and as far as the allegations are concerned, the opposite party had consulted with the specialist Prof. Ramnath Misra M.D., FRCP, Professor & Head, Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Science, to obtain the expert opinion and the opinion was marked as Ex B-25 in which at page No.3, it is observed narrating the history of the complainant's case and the 12 treatments given in paragraph 1 to 12 and on the basis of the above his remarks are made as follows:
a) The decision to treat with cyclophosphamide was appropriate as per the current line of management of SLE with vasculitis which was proved without doubt. The adverse effects have been explained to the patient and her husband, which they had understood.
b) She was treated y qualified Rheumatologist and Immunologist for SLE and it was he who sent her again to OG after he saw the patient after a gap of 4 years.
c) She had amenorrhoea/premature menopause subsequent to cyclophosphamide, but it cannot be concluded that it was solewly responsible. SLE alone can cause premature menopause. The doctors had taken great care to explain the side effects and under the circumstances, the risk/benefit ration strongly favoured use of Cytotoxic agents like Cyclophosphamide.
d) The decision to start and monitor her hormone replacement therapy HRT for amenorrhoea is by he gynaecologist and not by physicians.
It is evident that the patient has defaulted on her follow up visits with the gynaecologists. The physicians of Medicine II had referred the patient time an again to Obstetrics and Gynaecology department for treatment of amenorrhoea. The rheumatologist is only responsible for the medicines that he/she prescribe and when a repeat medications is advised it means the medicines prescribed for SLE and would not include HRT in this circumstance.
e) The women's health initiative study which showed and increased risk of cancer on HRT for more than five years was done in women between the age of 50 and 80 and not on SLE patient. At that age the risk of all cancers are normally high and therefore, the result of that study is not applicable to this patient who received HRT between 13 38 and 40 years of age. Further, infiltrating duct carcinoma which this patient had, is not the usual morphological type of breast cancer after HRT. HRT related breast cancer is usually of lobular type and therefore it remains to be proven that her breast cancer was due to HRT.
f) To minimize the risk of adverse events, it is the joint responsibility of the doctors and patients. It is as much of patients responsibility to come for regular follow ups and abide by the physicians advise. Clearly, the patient defaulted on her regular follow up with the gynaecologists and reported for mammography 7 month after it was advised.
and in that document he had also furnished bio-data details regarding his qualification as M.B.B.S., M.D.,(Medicine), Registrar in Rheumatology, current position as Professor, Clinical Immunology, Department of Immunology, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, U.P. and having various appointments from the year August 1989 to June 2000, the Senior Research Officer in Clinical Immunology and Research Fellow of the Arthritis Research Council and also having teaching and training activities and editorial activities and publications., etc.,. From this expert opinion, it is seen that the expert who is in the field of Immunology which is more relevant to decide the allegation of complainant regarding prolonged treatment in HRT has considered all the documents of the treatment records relating to the complainant during the year from 1994 to 2005 and came to the conclusion that the treatment was given having no deficiency and negligence.
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9. While considering complainant's side two doctors' affidavit, as far as the Dr.C. Vetrivel affidavit is concerned, he had admitted that he is a family doctor of the complainant having only general qualifications in medicines with diploma in Paediatrics cannot be expected to have certified the complainant's treatment at opposite party's hospital in various departments during the period from 1994 to 2005 especially relating to the treatment of HRT alleged to have been undergone from 2001 to 2005 when the opposite party alleged after 2000 she did not come for follow-up management till 2004 and only on the basis of records furnished by the complainant the affidavit of Dr.C. Vetrivel could not be taken as considered proof to prove the case of the complainant. Likewise while considering the affidavit of Dr.M. Lakshmi Narayanan, had repeated the details as per the affidavit of Dr.Vetrivel as pointed earlier without seeing the patient and on the basis of medical records supplied by the complainant is relating to SLE and Cychlophosphamide and the treatment relating to HRT also cannot be accepted as proved. Whereas the opposite party when relied on the expert opinion obtained in Ex B-25 series, one Dr.Ramnath Misra, M.D., FRCP who is attached to reputed medical institution of Sanjay Gandhi Post Graduate Institute of Medical Science. Lucknow, Utter Pradesh run by Government of India with deep knowledge concerned in Immunology related to the treatment given to the complainant on HRT and cancers subject to Mammogram and his expert opinion cannot be considered as biased one in view of the detailed explanation with details in his report which could be preferred that the two other doctors opinion 15 relied upon the complainant. Further when the opposite parties alleged that as far as the treatment given at OG II she was firstly advised for HRT during the year 2000 and subsequently she came only after 4 years in 2004 when she was advised for Mammogram on 27.08.2004 as per Ex B12 and it was taken only on 01.03.2005 after seven months and for this contention the complainant alleged that she had been undergone HRT for more than 5 years continuously as per the opposite party's advice during the period in between 2000-2005 and the opposite party alleged that she had visited Gynaecologist only after 4 years and defaulted for follow-up visits till 27.08.2004 and further it is alleged by the opposite parties that HRT related breast cancer is usually of lobular type and in this case the complainant had breast cancer due to infiltrating duct carcinoma it may not be due to HRT. Even though the complainant relied on medical literature which would show that the possibility of breast cancer for prolonged treatment under HRT for more than 5 years and in this case even as per the records she had such treatment only for 5¼ years as stated by the complainant with berating period in between 2000-2005, there may not be possibility of continuous treatment for 5 years which only caused the alleged breast cancer and the complainant is having history of various diseases from the year 1997 to 2004 and more than 13 years of skin diseases with ulcer having diahorria more than 10 years and other complications. It cannot be proved for early menopause except for allegations that it was only due to continuous treatment of Cyclophosphamide and Wysolone and HRT.
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10. The learned counsel for the opposite party also relied on the rulings reported in 2006 (2) CPR 14 (NC) wherein, in the case of Dr.Kunal Saha - Vs - Dr. Sukumar Mukherjee & Ors, the Hon'ble National Commission has observed as follows: -
" Consumer Protection Act, 1986 - Sections 2(1)(g), 14 - Indian Penal Code, 1860 - Section 304-A - Medical negligence - Jurisdiction of Courts or Consumer For a to sit in appeal against the decision taken by expert doctors with regard to administration of a particular dose of medicine - Tests for determining deficiency in medical service - Whether the Courts or the Consumer Fora can sit in appeal against the decision taken by the expert doctors with regard to9 administrati9on of a particular dose of medicine - (No) - Jurisdiction of Consumer Fora would be limited in case of apparent deficiency in prescribing dose of medicine ".
Further, the learned counsel for the opposite party relied on a rulings reported in Supreme Court Cases (2009) 3 SCC in support of his contention, wherein in the case of MARTIN F. D' SOUZA - Vs - MOHD. ISHFAQ, the Hon'ble Supreme Court has held as follows: -
Simply because a patient has not favourably responded to a treatment given by a doctor or a surgery has failed, the doctor cannot be held straightaway liable for medical negligence e by applying the doctrine of res ipasa loquitur. No sensible professional would intentionally commit an act or omission which would result in harm or injury to the patient since the professional reputation of the professional would be at stake. A single failure may cost him dear in his lapse."17
In those circumstances, we have come to the conclusion that the complainant has not proved her case regarding the negligence or deficiency in service against the opposite party in giving treatment to her through their doctors in this regard and thereby the point is answered accordingly.
11. Point Nos.2 & 3: In view of the findings adverse against the complainant in point No.1, the complainant is not entitled for any claim as prayed for in the complaint and thereby the complaint is liable to be dismissed as devoid of merits.
12. In the result, the complaint is dismissed. However, each party do bear their own costs.
Sd/-xxxxxxxx Sd/-xxxxxxxxx
M. MURUGESAN, A.K. ANNAMALAI,
MEMBER. PRESIDING JUDICIAL MEMBER.
ANNEXURE
Documents filed on the side of the complainant.
Ex A1 04.04.2006 Annexure I-A of the Medical records pertaining to the
treatment of the complainant furnished by the OP.
Ex A2 04.04.2006 Annexure I-B of the Medical records pertaining to the
treatment of the complainant furnished by the OP.
Ex A3 04.04.2006 Annexure II of the Medical records pertaining to the
treatment of the complainant furnished by the OP.
Ex A4 04.04.2006 Annexure III of the Medical records pertaining to the
treatment of the complainant furnished by the OP.
Ex A5 04.04.2006 Annexure IV of the Medical records pertaining to the
treatment of the complainant furnished by the OP.
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Ex A6 09.05.2005 Xerox copy of the letter by the complainant to OP
demanding compensation
Ex A7 08.07.2005 Xerox copy of the letter by the complainant to OP
demanding compensation and medical records
\
Ex A8 26.07.2005 Xerox copy of the letter by the complainant to OP
demanding medical records in the light of MCI,
Regulations 2002.
Ex A9 03.09.2005 Xerox copy of remind letter from the complainant to OP
for providing medical care
Ex A10 17.09.2005 Xerox copy of the letter from the complainant to OP demanding further treatment Ex A11 09.07.2005 Attested Xerox copy of letter of acknowledgement for complainant's letter EX A12 12.07.2005 Attested Xerox copy of opposite party's refusal letter Ex A13 22.09.2005 Attested Xerox copy of reply from the OP to the complainant Ex A14 01.03.2006 Xerox copy of order in W.A. No.113 of 2006 Ex A15 21.03.2006 Xerox copy of the letter from the complainant to the OP to furnish all the medical records Ex A16 04.04.2006 Attested copy of the letter of the OP to the complainant Ex A17 11.04.2006 Xerox copy of the letter from the complainant to OP to furnish medical records without any suppression and fabrication Ex A18 25.04.2006 Attested Xerox copy of the OP's letter to the complainant Ex A19 03.05.2006 Xerox copy of the letter from the complainant to the OP to furnish medical records as per the order in W.A.No.113 of 2006 Ex A20 13.06.2006 Attested copy of OP's Advocate notice Ex A21 20.06.2006 Copy of the notice sent by complainant to OP 19 Ex A22 13.11.1997 Attested Xerox copy of prescription given by OP Ex A23 30.09.1999 Attested copy of cash receipt issued by OP hospital Ex A24 28.10.1999 Attested copy of cash receipt issued by OP hospital Ex A25 Nov' 1999 Attested Xerox copy of prescription given by OP Ex A26 08.02.2011 Attested Xerox copy of prescription given by OP Ex A27 03.05.2001 Attested Xerox copy of prescription given by OP Ex A28 27.08.2004 Attested copy of cash receipt issued by OP hospital Ex A29 17th Edition Xerox copy of Pages 884 and 885 from Sebastian's test book of surgery Ex A30 Year2005 Copy of co-operative funeral care-HRT and Menopause by Dr.David Delvin/Retirement Matters Ltd, Ex A31 08.01.2003 Copy of article Estrogens and Estrogens with Therapies Ex A32 Year 2005 Copy of article Ennis and Ennis, P.A. about HRT side effects published on website Ex A33 Dec 2004 Copy of article Menopause and Hormone Replacement Study, published by the Royan College of OG , UK.
Ex A34 08.08.2003 Copy of article Advice of chair of Expert Advisory Group on HRT for Members EX A35 11.05.2004 Copy of article HRT for the Primary prevention of Chronic diseases Ex A36 26.02.2007 Xerox copy of FIR in Cr.No.73 of 2007 against the OP and others Ex A37 12.06.2008 Attested copy of letter by Addl. Superintendent of Police, Vellore along with statements of Govt. Doctors for further investigation Ex A38 List of documents filed in Exhibit A 37 series 20 Documents filed on the side of the opposite party Ex B1 22.08.1994 Out patient record Ex B2 13.12.1995 Out patient records Ex B3 22.12.1995 Medical Report Ex B4 30.08.1994 Discharge Summary EX B5 03.11.1997 Out-patient record Ex B6 30.04.2000 Out patient record Ex B7 03.05.2001 Out patient record Ex B8 06.08.2001 Out patient record Ex B9 10.03.2004 Out patient record Ex B10 10.03.2004 Medical Report Ex B11 26.08.2004 Medical Report Ex B12 27.08.2004 Out patient record Ex B13 19.03.2005 Histopathology report Ex B14 14.12.1995 Out-patient report Ex B15 30.08.2004 Out-patient record Ex B16 27.08.2004 Out-patient record Ex B17 14.10.2005 Out patient record\ Ex B18 06.01.2006 Order in W.P.No.448/2006 Ex B19 01.03.2006 Order in W.P.No.113/2006 Ex B20 13.09.2010 Letter from Medical council of India along the minutes of the ethics committee meeting 21 Ex B21 08.11.2010 Letter received from medical council of India regarding list of members of ethics committee Ex B22 16.06.2008 Ethics Committee proceedings Ex B23 24.01.2007 Order in Crl.O.P.No.19634/2006 Ex B24 12.04.2010 Order in Crl.O.P.No.20443/2008\ Ex B25 14.10.2010 Series Expert opinion given by Prof.Ramnath Misra, M.D.FRCP, Department of Immunology Sd/-xxxxxxxx Sd/-xxxxxxxxx M. MURUGESAN, A.K. ANNAMALAI, MEMBER. PRESIDING JUDICIAL MEMBER.
TCM/Order/Mdu Bench/Oct-2015