State Consumer Disputes Redressal Commission
Smt.Syamala vs Dr.D.Vijaya Devi on 20 December, 2011
Daily Order
Kerala State Consumer Disputes Redressal Commission Vazhuthacaud,Thiruvananthapuram Complaint Case No. CC/02/41 1. Syamala Palakkad House,Pongummodu,Tvpm BEFORE: HONARABLE MR. JUSTICE SHRI.K.R.UDAYABHANU PRESIDENT PRESENT: ORDER
KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAD, THIRUVANANTHAPURAM
OP.41/02
JUDGMENT DATED:20..12..2011
PRESENT
JUSTICE SRI.K.R.UDAYABHANU :PRESIDENT
SRI.S.CHANDRAMOHAN NAIR : MEMBER
Smt.Syamala, aged 50 years, : COMPLAINANT
Residing at Palakkad House,
Pongummodu,
Thiruvananthapuram.
(By Adv.R.S.Kalkura)
Vs.
1. Dr.D.Vijaya Devi, aged 50 years, :OPPOSITE PARTIES
Professor and Head of Department,
Department of Anesthesiology,
Medical College Hospital,
Thiruvananthapuram.
2. Dr.Achan M.Alex, aged 55 years,
Professor in the department of
Orthopaedics,
Medical College Hospital,
Thiruvananthapuram.
(By Adv.K.Murlidharan Nair,
counsel for OP 1 and 2))
3. The Superintendent,
Medical College Hospital,
Thiurvananthpauram.
4. State of Kerala, rep.by its
Chief Secretary, Secretariat,
Thiurvananthapuram.
(By Adv.N.C.Priyan. Addl.Govt.Pleader,
counsel for OPs 3 and 4))
JUDGMENT
JUSTICE SRI.K.R.UDAYABHANU :PRESIDENT The complainant is the mother of the deceased Shaji aged 28 who allegedly died on account of the carelessness and negligence of the doctors of the Medical College Hospital, Thiruvananthpauram. The recitals of the complainant is as follows:- On 3.3.2001 Mr.shaji had sustained a fracture of the right humerus as a result of fall at the temple at Sreekariyam and was taken to the Medical College Hospital wherein his arm was bandaged and was placed in observation. He was discharged on the next day on 4.3.01. He went to the house of the 2nd opposite party the Professor in the department of Orthopaedics, Medical college hospital (mentioned hereafter as MCH) and as per his direction attended the out patient treatment of the hospital on 9.3.01. As directed by the 2nd opposite party he was admitted as an inpatient. As directed by 2nd opposite party and the junior doctors of OP2 certain articles for surgery were purchased. At 8PM he was taken to the operation theatre. After the surgery started it was found the staff become agitated and on enquiries told the bystanders that the deceased developed certain complications of anesthesia and that he has been taken to ICU and later put on the ventilator. The doctors gave conflicting answers. Complaint was made to the 3rd opposite party the Superintendent of the hospital who was totally indifferent and was more interested in his trip to New Delhi on the next day. Shaji never regained consciousness and on 25.3.01 he died. The postmartum revealed that death was due to multi organ failure occurring as a complication of general anesthesia. The 1st opposite party the anesthesiologist was responsible to ensure that the surgery was duly performed. She was negligent in her duties. The deceased died due to the negligence of opposite parties 1 to 3. The 4th opposite party the government is vicariously liable. It is also alleged that the surgery was done hastily in circumstances that did not require a hasty operation. In response to the lawyer notice the 2nd opposite party has admitted the whole affairs. Complainant has stated that the deceased was the sole bread winner for the family. The future of her daughters have been blighted on account of the dreadful tragedy. The deceased was the only son she has claimed Rs.15 lakhs as compensation.
2. The complaint was subsequently amended incorporating that 4th opposite party/government had ordered an enquiry in the matter. The members of the enquiry committee was Dr.Thomas Koshy, Associate. Professor in anesthesiology, Sree Chithira Thirunal Institute of Medical Science and Technology, Thiruvananthapuram, Dr.P.S.John, Professor and Head of Department of Orthopaedics, Medical College Hospital, Kottayan, Dr.J.Nelsun, Professor and Head of Department of Forensic medicine, Medical College Hospital, Alappuzha. The committee has submitted its report to the Government. The above report has been deliberately suppressed by the 4th opposite party in the version filed. The enquiry committee had reported that the death of Shaji was on account of insufficient monitoring that resulted in the anesthetic mortality and that there was not even a single working pulse oximeter or capnograph in any of the operating rooms in the Medical College Hospital inspite of hundreds of critical and non critical cases were being operated every day and night. The fact of the above inadequate facilities were never informed or disclosed to the complainant or bystanders. Had it been disclosed the complainant would not have ventured to get the operation done in the Medical College Hospital and would have taken him to some other hospital as he was the only son and sole bread winner of the family. It is also alleged that the opposite parties failed to exercise reasonable and competent degree of skill in conducting the surgery. The 2nd opposite party had given the impression that he himself will be operating the deceased whereas the operation was conducted by junior doctors. The 2nd opposite party was all along assuring that he himself will be conducting the operation. The Surgery was conducted in the absence of the 2nd opposite party. The findings of the enquiry committee as such is not entirely correct as the same was prepared by the committee members to exonerate their colleagues and put the blame on lack of facilities etc. The only possible cause of death is the over dose of anesthesia. The 4th opposite party/the Government has attempted to cover up the matter by not disclosing the fact of the enquiry conducted in the version filed.
3. The opposite parties 1 and 2 the Professor and head of department of Anesthesiology and the Professor of Orthopedics, MCH respectively have filed a joint version denying the allegations. It is pointed out that the income of the deceased is mentioned as Rs.300/- at the time of the admission in the MCH. The patient was seen in the OP with the complaints of pain and swelling of right upper arm following history of fall. X-ray showed oblique fracture at the surgical neck of right humerus. Closed manipulative reduction(CMR) was done and arm chest strapping given. Medicines were also administered. On 4.3.01 he was discharged with advise to come for review on 8.3.01. On 9.3.01 he reported at the OP and got admitted. He was advised emergency surgery. The required blood examinations, X-ray chest etc were done. He was posted for emergency surgery at night for open reduction and internal fixation (ORIF). Pre anesthetic evaluation was conducted. The patient was ASA Gr.I E. The general condition was good and other systems were within normal limits. Informed consent of the patient was obtained. The procedure started to 11.10.PM on the emergency table. The pre medication of pethedine 25Mg, phenergan 10mg, , glycopyrrolate 0.2mg was given per IV. General anesthesia was started by duty anesthetists at 11.10PM. Till 1.15AM everything was normal. However blood loss was more severe than excepted and blood already arranged was transfused. The patient developed hypotension and bradycardia within 5 minutes of transfusion. Immediately blood was stopped and nitrous oxide cut off and IPPV with 100% Oxygen was continued There was profound fall in BP. Even cartoids were not palpable. Surgery was stopped and CPCR started. Adrenaline IV and defibrillation was given. At 1.27AM the heart picked up. QRS complex appeared heart rate 140/mt regular cartoids palpable, so also peripheral pulses. BP 160/80mm of hg hydrocortisone 200mg and mannitol 20 ml was given. At 1.35. Surgery was restarted and it was over by 3AM and during the period the condition was stable with good urine output. At the end of the surgery, residual paralysis reversed and respiration was found to be inadequate and the patient was transferred to CCU for elective ventilation. The patient's condition was briefed to the relatives. He was put on ventilator on 10..3.01 and was given supportive treatment upto 25.3.01 with the condition progressively worsening . Despite the attention given by various specialties including neurologist he passed away on 25.3.01 at 9.30AM. The postmortem was conducted. The 1st opposite party did not attend the patient prior to the operation or during the operation. There are a number of qualified and competent anesthesiologists in the department. Anesthesiology team in the matter consisted of one Lecturer(PSC), a PG student on stay duty and a qualified anesthesiologist(MD anesthesia) on call. The three of them managed the case when the decision of elective ventilation was taken. A team of anesthesiologists managed the CCU. The head of the department of anesthesia only supervise and coordinates all the activities in the department of anesthesia and CCU. The 2nd opposite party as the Prof. and HOD has under him a number of qualified Orthopedic surgeons. The duty Orthopedic surgeon had operated upon the patient on 3.3.01(sic). The 2nd opposite party has only over all control and supervision over the surgeons under him. It is contended that the 1st and 2nd opposite parties are unnecessary parties. It is denied there was any negligence. It is also contended that compensation claimed is excessive.
4. The opposite parties 1 and 2 had filed an additional version subsequent to the amendment of the complaint. It is pointed out that the enquiry report has not reported that the death was on account of insufficient monitoring. It is mentioned in the report that the non monitoring might or might not have changed the outcome of the patient and that he suffered an anesthetic accident. It is mentioned in the report that with available facilities the doctors had performed diligently and that all pre and post anesthetic preparations were correct and in accordance with the accepted lines of management. The averment resulting the fact that there was not even a single working pulse oximeter in the hospital is not admitted. MCH is one of the largest hospitals in the State with the most modern equipments. The doctors working in the hospital are the most qualified and most experienced doctors in their respective fields. The opposite parties have no control over the equipments in the hospital or their procurement. There are all the necessary equipments for conducting surgeries. It is denied that the 2nd opposite party has assured that he himself will be conducting surgery. It is denied that the complainant's son died due to over dose of anesthesia.
5. Opposite parties 3 and 4, superintendent of MCH and the State of Kerala respectively have filed a joint version denying the allegations as to the negligence of the doctors.
6. The 3rd opposite party has filed an additional version pointing out that the enquiry committee has revealed that there was no medical negligence on the part of the opposite party. The opposite party had provided all available equipments and instruments in the operation theatre. There were sufficient staff and facilities in the hospital. All the available facilities of the MCH was provided to the deceased. While treatment at CCU it was detected that the deceased had mitral valve prolapse which has lead to cardiac arrest. It is pointed out that the surgery of the deceased was an emergency one and more over a total of 5 operations were conducted in that unit on that day. It is denied that there was any negligence on the part of the opposite parties.
7. The evidence adduced consisted of the testimony of PWs 1 to 4, DWs 1 and 2; Exts.P1 to P10, X1 to X5.
8. On behalf of the complainant who is the mother of the deceased, PW1/complainant herself has testified. PW2 is the son-in law of the complainant who was the bystander. PW3 is the doctor who conducted postmortem. PW4 is the doctor who headed the enquiry committee appointed by the Government to enquire into the matter. At the instance of the opposite parties DW1 the Professor and head of the department of the anesthesiology of the Medical College Hospital and DW2 the present Superintendent of the Medical college Hospital who is the 3rd opposite party were examined. The documents produced at the instance of the complainant includes cash bills, postmortem certificate, the lawyer notice and the reply notice received from the opposite parties 1 and 2/the doctors and Exts.X1 to X5 including the case sheets, the reports submitted by the investigating officer of the Kerala State Human Rights Commission. The preliminary investigation report by a senior doctor of the Medical College Hospital as appointed by the Government and the enquiry report by a committee of doctors.
9. The points stressed by the counsel for the complainant includes that there was no requirement to conduct an emergency surgery in the night as the matter required only an elective surgery. It is also alleged that the surgery was conducted by junior doctors although it was assured that the 2nd opposite party/Professor in the department of Orthopedics who is known to the husband of the complainant had assured that he himself would be conducting the surgery. The junior doctors conducted the surgery in the absence of any supervision by the 2nd opposite party who was the unit head. It is also contended that the deceased who was having a displaced fracture in the surgical neck of humerus was discharged on the next day with only a chest strap. He ought to have been retained in the hospital and subjected to open reduction and internal fixation(ORIF). It is also contended that the opposite parties ought to have informed the deceased or the bystanders that the essential life saving equipments are not available for the hospital as has been found by the enquiry committee appointed by the government and that it would be the junior doctors who would be conducting the surgery. If the same was informed the deceased being the only son of the complainant would not have been made to under go surgery at the Medical college Hospital and that he would have been taken to some other hospital where the facilities are available. It is also pointed out that no doctors who conducted the surgery or anesthesia was examined. It is pointed out that in such circumstances the opposite parties ought to have got examined the doctors who conducted the surgery and administered anesthesia. It is also stressed that the 2nd opposite party, the Professor, Orthopedics against whom specific allegations are made did not testify.
10. We find that in Ext.X1 case sheet the injury sustained is mentioned as oblique fracture of surgical neck of humerus (right )and that the injury was sustained due to a fall on 3.3.01. Closed manipulative reduction (CMR) was done and arm and chest strapping given. Subsequently he has been discharged on the next day with direction to appear for review on 8.3.01. Subsequently he got admitted on 9.3.01. It is explained by PW2, the brother in law of the deceased that the 2nd opposite party asked him to come on 9.3.01 and got admitted and that he was not directed to appear for review on 8.3.01. It is his case that the deceased and himself had met the 2nd opposite party at his house.
11. The fact that the complainant had sustained the displaced fracture of humerus is mentioned in Ext.P9 reply notice send by the 2nd opposite party only. It appears that for a displaced fracture at the surgical neck of humerus discharging the patient on the next day with chest arm strap was not proper as pointed out by the counsel for the complainant. As pointed out ORIF should have been done at the earliest. The same is also evident from the fact noted in X1 case sheet that at the time of admission on 9.3.01 there was complaint and deformity and tenderness as well as edema plus. For about one week the deceased was permitted to be away from the hospital with a displaced fracture and only closed manipulative reduction done and with chest strap. As to why such a treatment was given is not explained by the 2nd opposite party and he has not testified also.
12. It is the case of PW2 that himself and the deceased met the 2nd opposite party to the house of 2nd opposite party and that it is at the instruction of the 2nd opposite party that the deceased was admitted on 9.3.01 for surgery. He was under the impression that the 2nd opposite party would conduct the surgery. It is also the case of the complainant that the 2nd opposite party had given impression that it was only a minor surgery. PW2 has also deposed accordingly. The deceased was aged 28 years. It is not noted in Ext.X1 case sheet that he was admitted for undergoing emergency surgery. No reasons for conducting the emergency surgery is also mentioned in Ext.X1. Only in anesthesia notes it is mentioned as surgery emergency and ASA Gr.I. The deceased had no other ailments. The surgery commenced on 11.10PM of 9.3.01 and ended at 2.50AM of 10.3.01. It is also noted in another portion of the case sheet that the surgery was completed at 3AM. The general anesthesia was administered by Dr.Sunil, Lecturer in anesthesia and Dr.Chandrika 2nd year DA student and a senior lecturer in anesthesia was on call. The surgery was done by Dr.Nigil Lal, Provisional lecturer in Orthopedics and Dr.Subin, 2nd year D Ortho student and Dr.Sasikumar, M.S Ortho student. During the surgery blood loss was noted and one unit of O-ve blood was transfused. During the transfusion at about 1.15AM the patient developed bradycardia and hypotension at about five minutes after transfusion. Emergency measurers to resuscitate was done and the patient reached normally. Surgery restarted at 1.35AM and finished by 2.50.AM. Anesthesia was reversed and there was spontaneous breathing but not regained consciousness. The patient was put on ventilator. Subsequently he developed multi organ failure and died at 9.30AM on 25.3.01. He was in ventilator for about 16 days in an unconscious state. Ext.X3 requisition mentions with respect to the compatibility of the blood transfused and the same was recosmatched and found to be having no negative factors. According to PW1 the doctors told him that the blood got from blood bank is not fresh and asked him directed him to obtain fresh blood and that he went to the blood bank and obtained fresh blood.
13. According to PW1 the blood bank staff told him that there is nothing wrong that the blood provided. Although it is contended by the opposite parties that one pint of blood was prearranged the evidence of PW2 is to the contra. DW1, the 1st opposite party/Professor and Head of the department of anesthesiology has testified that the deceased was given the necessary attention and adequate care and anesthesia was administered as per protocol and that the deceased happened to have a known complication of anesthesia. The head of the department only co-ordinate and supervises the unit. The doctors who administered the anesthesia was fully competent. According to him the expert committees, final conclusion is that the non monitoring on account of the availability of the suggested equipments might or might not have changed the outcome of the patient who suffered an anesthetic accident.
14. DW2 the present Superintendent of the Medical College Hospital has testified as to the facts noted by him from the records. It is asserted that the hospital is having the most modern equipments and experienced doctors. According to him pulse oxi meter and capnograph was not available in 2001 period . Capnograph is a very modern instrument although pulse oxi meter was in use earlier also. In the case of the instant patient it was blood gas analyser that was used. It is also admitted that the nurses record is not seen incorporated in X1 case sheet and that in case sheets in ICU the nurses record is kept as separate and as not part of case sheet. It is also stated that the anesthesia team is the same for 24 hours.
15. DW1 the 1st opposite party, Professor of Anesthesia has admitted in the cross examination that there is no indication in the case sheet about the requirements of an immediate operation. It is also stated there is no nerve injury or masculine injury. It is pointed out by the counsel that only in such cases emergency surgery was not necessitated. She has also stated that the Medical college Hospital was not having capnograph at the time in the emergency operation theatre. Pulse oxi meter was also not available in that day in the emergency operation theatre. According to her the above equipments are not mandatory but was desirable items. Indian Society of Anesthesiologist had also considered the same as desirable only in the year 1999. The mandatory items were anesthetic equipments, ECG monitoring along with other para meters. She has also stated that the transfusion was stopped by about 5 to 10 minutes. She has admitted that it is noted in Ext.X1 as severe blood loss and that transfusion was stopped suspecting reaction of the blood transfused; and thereafter managed with IV fluid. Severe blood loss is recorded at 10.30AM. Blood transfusion started at 1.15AM. As to why the blood transfusion was started late there is no explanation. The above time lag would indicate that blood was not arranged already as is contended by the opposite parties. She has also admitted that the absence of pulse oxi meter and capnograph was not informed to the bystanders. She has disagreed to a certain extent with the suggestion that during monitoring by the ECG the changes will be recorded delayed than if monitored by pulse oximeter and capnograph. According to her heart rate can be noted in the ECG faster.
16. PW4 is an Addl.Professor of Anesthesia, Sree Chithira Thirunal Institute of Medical Science, Thiruvananthapuram who headed by the committee appointed by the government to enquire into the matter. The report is Ext.X3. The expert committee consisted of apart from PW4, Professor and Head of Department of Orthopedics, MCH, Kottayam, and Professor and Head of Department of Forensic Medicines , MCH, Alappuzha. It is noted in Ext.X3 that there were 5 emergency surgeries in the particular operation theatre on that date and the deceased was the last one. The delay was on account of the other 4 surgeries done earlier. The doctors examined by the committee included Ops 2 and 3 and the doctors who actually did the surgery and administered anesthesia and on call Sr.Lecturer in anesthesia, the Professor and Head of the department of Neurology, Professor and Head of the department of Nephrology who conducted the preliminary enquiry, Professor and head of blood bank, Professor and head of forensic medicines/PW3 who conducted postmortem and Senior Lecturer in Cardiology. It is the finding of the committee that the only monitoring which was available in the operation theatre was an ECG monitor and that the evidence of complications as happened in the case of the deceased produced ECG changes very late. Monitoring with pulse oximeter could have given early warning of bradycardia and hypo tension. The presence of capnograph would have given other early evidence of impending disaster. It is noted that the doctors who administered anesthesia are experienced doctors and the doctor who did the surgery is a qualified Orthopedic surgeon with 2 years experience after post graduation. The Committee has noted the inadequacy of staff in the department of anesthesia and the absence of an anesthesia technician. The patient sustained cardiac arrest during the surgery and that it is an anesthetic accident. Some additional monitoring might have given an early warning of the impending disaster which might or might not have made any change in the outcome. It is also noted that the incidents of anesthesia cardiac arrest is six times more likely during emergency as against elective surgery. He has also reported that in the current period no anesthesia is given without pulse oximeter and capnograph. He has also stated that in the case of the deceased from the available evidence insufficient monitoring(absence of pulse oximeter and capnograph) seems to be a reason for the anesthetic mortality. It is also mentioned that the Committee has observed that there was not even a single working pulse oximeter or capnograph in any of operating rooms in the Medical College Hospital. The Committee has justified the role played by the doctors that with available facilities in the operative room which included a rusted operating table. It is mentioned that they have performed their duties diligently. The Committee has recommended installation of modern standard of monitoring like ECG pulse oximeter and capnograph in all operating rooms to reduce future unfortunate incidents like the present one. PW4 has stated in his deposition that to assess the reason of cardiac arrest there was insufficiency monitoring in the operation theatre. The monitoring items required are ECG, pulse oxi meter and capnograph in addition to blood pressure monitoring and hand on the pulse. Capnograph measures the carbon dioxide level of the exhaled breath and gives an idea about the respiratory system and the cardiac output. He has also asserted that his hospital(SCTIMST) without the above equipments the operations are not done and that the above basic equipments are mandatory. The ET tube is fixed to the mouth with a plaster and if it all if comes out the monitor will show it.
17. We find that vide Ext.X3 report by the Committee that consisted of 2 heads of departments of MCH in the State and headed by PW4 of Sree Chithira Thirunal Institute has regularly blamed the authorities of the Medical College for not having the mandatory equipments to monitor and forewarn the anesthetic complications. It is admitted that the patient or the bystanders were not intimated of the inadequacy of the facilities so that they could have avoided the particular institution. Hence there is lapse on the part of the treating doctors in this regard. The absence of the doctors who conducted the surgery and administered anesthesia from testifying and explaining the circumstances is also relevant. The 2nd opposite party has admitted in Ext.P9 reply notice that the deceased had sustained displaced fracture at the surgical neck of humerus. He also has not testified. He should not have abstained from tendering evidence especially as there are specific allegations as to the lack of responsibility and carelessness on his side especially that he had given the impression that he himself will be conducting the surgery. There is no proper explanation as to the fact that the reasons. For emergency surgery is not mentioned in the case sheet. It is also pertinent to note the fact that it was a displaced fracture is not mentioned in the case sheet. The reason for discharging the deceased with a chest strap also ought to have been explained by 2nd opposite party. All the same in view of the fact it was not OP1 or OP2 who administered the anesthesia and conducted the surgery we find that it would not be proper to hold that they are liable. As already noted above the case of having made arrangement for storage of blood for transfusion if required appears incorrect. The case of the complainant that if the by standers of the patient were told about the lack of facilities they would have opted for another hospital is something that has to be considered. In the circumstance we find that there is deficiency in service on the part of the 2nd opposite party, 3rd opposite party, the then superintendent of Medical College Hospital and the Government.
18. The case of the complainant is that the deceased was aged 28 years and was working as an electrician. The deceased was her only son. Her husband died shortly thereafter. The deceased was a bachelor. PW1 is mentioned as aged 51 years. It is the case of PW1 that it was the deceased who was looking after the family consisting of two daughters also. In the circumstances we assess the compensation as follows. The average monthly income of the deceased can be reasonably taken as Rs.5000/-. After deduction 1/3 of his personal expenses the balance would work out to Rs.3333/-.
Being a bachelor he would have made the contribution of the above amount to the family atleast for the remaining 4 years till the likely marriage. Thereafter his contribution is taken as 1/3 of Rs.5000/- ie Rs.1667/-. The amount of contribution for the 4 years would workout to Rs.1,59,984/- and thereafter for 8 years the amount at the rate of Rs.1667 would work out to Rs.1,60,032/-. Multiplier adopted is 12 considering the age of PW1 the mother. A sum of Rs.10000/-awarded pain and suffering and negligence by the deceased. The sum of Rs.10000/- is awarded for loss of estate of the deceased. A sum of Rs.7500/- is awarded towards treatment expenses and ancillary expenses. A sum of Rs.2500/- is awarded for funeral expenses etc. Altogether the compensation would workout to Rs.3,50,016/-. The complainant also would be entitled for the interest at 7% per annum from the date of complaint ie 20.5.02. The complainant will also be entitled for cost of Rs.7500/-. The opposite parties 3 and 4 are directed to make the payment within three months from the date of receipt of this order.
In the result the complaint is allowed as above.
JUSTICE K.R.UDAYABHANU :PRESIDENT
S.CHANDRAMOHAN NAIR : MEMBER
APPENDIX
Complainants Witness:-
PW1 - Syamala
PW2 - Rajeev.C.R
PW3 - Dr.G.Sugathan
PW4 - Dr.Thomas Koshy
Opposite parties Witness:-
DW1 - Dr.Nizamudeen.A
DW2 - Dr.Vijaya Devi
Complainants Exibits:-
P1 - Cash bill from J&J Surgicals to Rajeev.C.R
P 2 - Requesition for blood transfusion
P 3 series - cash receipts
P4 - Coupons from Hospital Development Authority to the name of Shaji
P5 - Attested copy of PostMortem certificate dtd. 26.3.01
P6 - Attested copy of PostMortem certificate dtd. 1.6.01
P7 - Lawyer notice
P8 - Acknowledgment card
P9 - Letter dated 7.5.02 from 2nd opposite party to Adv.V.Suresh
P10 - Letter from Dr.Vijaya devi to Adv.V.Suresh dtd. 16.3.02
Opposite party's Exibits:-
X1 - Case sheet
X2 - Letter dtd. 20.4.06 of KSHRC
X2(a )- Investigation report
X3 - Report of enquiry committee
X3(a) A portion of X3
X4 - Attested copy of Blood Bank register
X5 - Attested copy of Operation Theatre Register
JUSTICE K.R.UDAYABHANU : PRESIDENT
S.CHANDRAMOHAN NAIR : MEMBER
ps
[HONARABLE MR. JUSTICE SHRI.K.R.UDAYABHANU] PRESIDENT