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State Consumer Disputes Redressal Commission

Babita Agrawal vs Suyash Hospital on 28 March, 2023

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foi{khx.k ds fy, Jh ,l-ds-O;kl] Jh vfu:) xks[kys] Jh ;'k nhf{kr ,oa lqJh usgk ;kno vf/koDrkx.kA ¼ fnukad 28@03@2023 dks ikfjr ½ ekuuh; lnL; Jh Mh0ds0 JhokLro vuqlkj %& 1- ;g ifjokn miHkksDrk laj{k.k vf/kfu;e 1986 dh /kkjk 17 ds vUrxZr e`rd fnyhi vxzoky ds Øe'k% iRuh] cPpksa ,oa ekrk&firk ds }kjk] fnukad 19-05- 2003 dks jkf= djhc 10-40 cts vxzoky uxj] c`t/kke dkyksuh] bUnkSj esa gqbZ ywV dh ?kVuk esa yqVsjksa ls Jherh mek xqIrk dks cpkus dk iz;kl djus ij] yqVsjksa }kjk fnyhi vxzoky¼e`rd½ dks pkdw¼Nqjh½ ls mlds isV esa pksV igqapkus ds QyLo:i lq;'k gkfLiVy izk-fy- bUnkSj esa mlh fnu ?kfVr ?kVuk ds rRdky ckn HkrhZ djus ij] tgka mldk bykt fd;k x;k] ijUrq fnukad 05-06-2003 dks fnyhi vxzoky dh mDr vLirky esa bykt ds nkSjku e`R;q gks tkus ij foi{khx.k ds }kjk fnyhi vxzoky dk bykt ,oa vkijs'ku esa vlko/kkuh] ykijokgh ,oa mis{kkiwoZd mldk bykt djus ds rF; dks vk{ksfir djrs gq,] ifjoknhx.k ds }kjk vkadfyr dh x;h {kfr ckcr~ lEiw.kZ {kfriwfrZ jkf'k :i;s 62-02 yk[k foi{khx.k ls mUgsa fnyk;s tkus gsrq izLrqr fd;k x;k gSA 2- ifjokn ds rF; la{ksi esa bl izdkj gSa fd fnyhi vxzoky fnukad 19- 05-2003 dks jkf= djhc 10-40 cts vxzoky uxj] c`t/kke dkyksuh] bUnkSj esa Fkk] rHkh mlds }kjk 'kksj lqudj ywV dh ?kVuk] tks fd Jherh mek xqIrk ds lkFk yqVsjksa }kjk dh tk jgh Fkh] rFkk mlls igus gq, tsojkrksa dks ywVk tk jgk Fkk] ogka fnyhi vxzoky }kjk yqVsjksa dks dkcw esa djrs le;] yqVsjksa ds }kjk pkdw¼Nqjh½ ls fnyhi vxzoky ds isV esa pksVsa igaqpk;h x;hA rRi'pkr~ mDr nq?kZVuk gksus ds 15 fefuV ds vUnj gh -3- fnyhi vxzoky dks dkj ls ykdj lq;'k gkfLiVy] bUnkSj esa HkrhZ djk;k x;k tgka ij foi{kh Ø-2 MkW- th-,l-ekyikuh ,oa foi{kh Ø-3 MkW- vfuy c{kh] foi{kh Ø-1 vLirky esa ekStwn Fks] ftUgksua s fnyhi vxzoky dh pksVksa dk ijh{k.k dj ;g O;Dr fd;k fd fnyhi vxzoky dks vkbZ pksV cgqr lk/kkj.k izd`fr dh gS rFkk fpark dh dksbZ Hkh ckr ugha gS] fdUrq pksV fdruh xgjh gS\ ,oa vanj ?kko ugha jg tk,] ;g ns[kus ds fy, NksVk lk vkijs'ku djuk iM+x s k A rRi'pkr~ ifjoknhx.k ds }kjk Qhl tek djkdj fnyhi vxzoky dk mDr vLirky esa bykt izkjaHk fd;k x;k tgka ij fnyhi vxzoky dk vkijs'ku MkW- vfuy c{kh¼foi{kh Ø-3½ ds }kjk fd;k x;k] ijUrq muds }kjk vkijs'ku ,oa bykt esa vlko/kkuh] ykijokgh ,oa mis{kk dh x;h] ftlds ifj.kkeLo:i fnukad 05-06-2003 dks fnyhi vxzoky dh mDr vLirky esa e`R;q gks x;hA 3- ifjokn esa vkxs ;g crk;k gS fd fnukad 19-05-2003 dks fnyhi vxzoky iw.kZr% LoLFk Fkk rFkk mls ?kVuk esa vkbZ isV dh ,d pksV ds vfrfjDr] mldh vU; lHkh tkap fjiksVZ lkekU; FkhA foi{khx.k ds }kjk fnyhi vxzoky dks nh x;h nokbZ;ksa esa Ceftrixone, tks fd Cephalosporin dh nok ftldk okLrfod uke Oframax gS] ftls vkijs'ku ds ckn 1&1 xzke rhu ckj] bl izdkj 24 ?k.Vs esa 4 xzke o 34 ?k.Vs esa 5 xzke Mkst fn;k x;k rFkk nwljk batsD'ku Amikasian 500m.g. dk Hkh vkijs'ku ds ckn 11 fnu rd yxkrkj] fcuk fdlh vko';drk ds mls yxk;k x;k] ftlds dkj.k fnyhi vxzoky dks usÝksVkDlhVh dkfjr gqbZ rFkk fnukad 19-05-2003 dks fd;s x;s vkijs'ku ds dkj.k fnyhi vxzoky ds isV dh NksVh vkar esa fLFkr tstque esa ,d Nsn 1 x 0-25 cm dks gksuk rFkk 50 cc CyM dsfoVh esa ik;k x;k Fkk] tcfd Ceftrixone(Oframax) batsD'ku] isV ds vkijs'ku ds igys ,oa ckn esa fl)kar% ugha fn;k tkuk pkfg, Fkk] ftlds dkj.k e`rd dks gkbZ Mkst ,aVhck;ksfVd nsus ds dkj.k gh fnyhi vxzoky dks Mªx VkDlhVh ,oa vU; chekfj;ka mRiUu gqbZ rFkk mldk nwljk vkijs'ku Hkh djuk iM+kA mDr nokvksa ds -4- dkj.k fdMuh dh dk;Ziz.kkyh fcxM+ x;h vkSj var esa og ;wjse h;k ls ihfM+r gks x;k ftlds dkj.k mldh e`R;q gks x;hA 4- ifjokn dk vU; vk/kkj ;g Hkh jgk gS fd e`rd fnyhi vxzoky dks gkbZ Mkst batsD'ku nsus ds ifj.kkeLo:i fnukad 21-05-2003 dks] fnyhi vxzoky dh fdMuh dh dk;Ziz.kkyh fcxM+ x;h Fkh rFkk mDr fnukad dks nksigj rd mls ew= dk fu"dklu ugha gqvk Fkk] fQj Hkh foi{khx.k ds }kjk mls fujUrj ykijokghiwoZd Q~ywM p<+k;k tkrk jgk rFkk mls 24 ?k.Vs esa 6000 fe-yh- Q~ywM nsus ij dsoy 1200 fe- yh- ew= vkmV&iqV :d&:d dj gqvkA bl izdkj fdMuh esa Toxic iSnk gqvk rFkk mDr vksoj yksM Q~ywM ds dkj.k] mlds vU; vaxksa ij ncko cuk rFkk QsQM+s dh dsfoVh esa Q~ywM Hkj x;k] tks fd i'pkr~orhZ fLFkfr esa fnukad 22-05-2003 dks 600 fe-yh- Q~ywM fnyhi ds QsQM+s dh dsfoVh ls fudkyk x;k rFkk mlds ;wjhu esa Hkh CyM vkus yxk FkkA fnukad 21-05-2003 dks fnyhi dh rfc;r vf/kd [kjkc gksus ij mls fn;k tk jgk gkbZMkst Ceftrixone batsD'ku can fd;k x;k rFkk fnukad 21- 05-2003 dks Tazact batsD'ku pkyw fd;k x;k vkSj mlds dqy 9 batsD'ku yxk;s x;sA bl izdkj foi{kh Ø- 3 ,oa 4 yxk;r 7 dks ,aVhck;ksfVd dk vuqHko ugha gksus ds dkj.k] fnyhi vxzoky dh chekjh] mUgsa le> esa ugha vkbZ rFkk mDr fn;s x;s batsD'ku ds dkj.k fnyhi vxzoky dks lkbM bQsDV gksus yxk rFkk mlds dkj.k mls CyM ;wfj;k ,oa ØsfVfuu esa o`f) gksus yxhA i'pkr~orhZ fLFkfr esa mls Meropenam 1 xzke] izR;sd 6 ?k.Vs esa o ckn esa 3 ?k.Vs ds vUrjky esa fn;k x;k] tcfd baVjuy esfMlhu fl)kar ds vuqlkj tc rd chekjh dh tkap ugha gks tkrh] rc rd Emprical Therapy dh tkuk pkfg, Fkh rFkk fnyhi vxzoky dks nq?kZVuk esa vkbZ pksV ds vkijs'ku ds igys mlss Surgical Prophylaxis Antibiotic Cephalosporin fn;k tkuk pkfg, FkkA -5- 5- ifjokn ds vuqlkj i'pkr~orhZ fLFkfr esa fnukad 23-05-2003 dh 'kke dks foi{kh Ø-3 ds }kjk ifjoknhx.k dks ;g crk;k x;k fd fnyhi ds QsQM+s dk ikuh fudky fn;k x;k gS] ijUrq mlds isV esa ikuh Hkj x;k gS] mls fudkyus ds fy, mldk vkijs'ku djuk iM+sxkA rRi'pkr~ ifjoknhx.k ds }kjk fnyhi vxzoky dh fLFkfr ds lanHkZ esa iwNk x;k rFkk mlds QsQM+s esa ikuh Hkjus dk dkj.k Hkh iwNk x;k rFkk mls bankSj ;k eqEcbZ ds vU; vLirky esa ys tkus gsrq dgk x;k] ijUrq muds }kjk dgk x;k fd os ofj"B ltZu foi{kh Ø-5 MkW- v'kksd yM~Mk ls fnyhi dk vkijs'ku djok dj isV dk ikuh fudyok;saxs rFkk og Bhd gks tkosxk vkSj bl izdkj foi{kh Ø-2 }kjk vius vLirky dh cnukeh ds Mj ls okLrfodrk dks fNikdj nwljk vkijs'ku vius vLirky esa gh fnukad 24-05-2003 dks djk;k x;k rFkk mls nwljs vLirky esa LFkkarfjr ugha djus fn;k x;kA foi{kh Ø-2 o 3 ds }kjk fnyhi vxzoky ds isV ds ikuh dks fudkyus ds fy, nwljh ltZjh djus dh lgefr] mlds ifjtuksa ls diViwoZd ,oa /kks[kk nsdj yh x;h Fkh] tcfd fnyhi dk dksyksLVkeh vkijs'ku fd;k x;k Fkk rFkk foi{kh Ø-5 MkW- MkW- v'kksd yM~Mk ds }kjk fnyhi dk dksyksLVkeh vkijs'ku fd;k x;k Fkk o mldh vkar dks dkVdj mldk eqag dksyksLVkeh csx esa Mkyk x;k o mDr cSx dks fnyhi ds isV ij yxk;k x;kA bl izdkj isV dk ikuh fudkyus dk dgrs gq,] diViwoZd dksyksLVkeh vkijs'ku fd;k x;k rFkk dksyksLVkeh cSx yxk;s tkus o fQLVqyk ds laca/k esa rF;ksa dks fNik;k x;k rFkk dksyksLVkeh vkijs'ku ds ckjs esa fnyhi vxzoky ds ifjokjtu dks vkijs'ku ds iwoZ o vkijs'ku ds nkSjku dksbZ Hkh tkudkjh ugha nh x;hA i'pkr~orhZ fLFkfr esa mPp 'kfDr dh ,aVhck;ksfVd fn;s tkus ds dkj.k] fnyhi vxzoky ds isV dh dsfoVh esa 250 fe-yh- Bile Hkj x;k o Bile Peritonitis ,oa Enterocutaneous Biliary Fistula rFkk A Calculas Cholecysitis o iwoZ esa fd;k x;k vkijs'ku fyad gks x;k] ftlds dkj.k vf/kd ,aVhck;ksfVd nsus ds dkj.k fnyhi vxzoky dks usÝksVkDlhVh ,oa Mªx VkDlhVh gqbZA -6- 6- ifjokn ds vuqlkj foi{kh Ø- 2 o 3 ds }kjk f}rh; ltZjh ds igys vkijsfVo VsLV ugha fd;k x;k rFkk fnyhi vxzoky ds isV dk ,Dljk] lhVh Ldsu ;k lksuksxzkQh ugha dh x;h] tks fd ltZjh ds iwoZ fd;s tkus pkfg, FksA fnyhi vxzoky dks Cholecysitis vkijs'ku ds laHkkfor [krjs dh tkudkjh Hkh mlds ifjokjtuksa dks ugha nh x;h] mDr tkudkjh foi{kh Ø-2 o 3 ds }kjk vkijs'ku ds iwoZ nh tkrh] rks fnyhi vxzoky dh nwljh ltZjh foi{kh Ø-1 vLirky esa ugha djk;h tkrhA f}rh; ltZjh ds ifj.kke Lo:i fnyhi dks cgqr lh dfBukbZ;ka mRiUu gks x;h] ckbZy] CyM vkfn fujarj cgrk jgk rFkk mls 10&11 ckWVy CyM IykTek p<+k;k x;k rFkk uflaZx LVkQ }kjk ykijokgh dj dksyksLVkeh cSx esa D;k vkmV&iqV gks jgk gS] nks fnu rd CyM o ckbZy fy[kus ds ckn mldk fy[kuk can dj fn;k x;k rFkk uflZax LVkQ ds }kjk vkijs'ku ds i'pkr~ izR;sd 2 ?k.Vs esa iksLVvkijsfVo jk;y V~;wc ,Lisjs'ku RTA djuk Fkk] fdUrq uflZax LVkQ ds }kjk mDr vkns'k dk ikyu ugha fd;k x;k rFkk vkijs'ku esa fjis;j fd;k x;k ijQksjs'ku fyad gks x;k rFkk ,Lik;js'ku nsjh ls fd;s tkus ds dkj.k fMdEizsl ugha gksus ds dkj.k yxk;s x;s Vkads <hys gks tkrs gSa] ftlds QyLo:i isfjVksukbfVl ,oa lsQ~Vhlhfe;k gks x;k Fkk] ftlds dkj.k fnyhi vxzoky dh e`R;q gks x;hA 7- ifjokn ds vuqlkj ;g rF; Hkh jgk gS fd foi{khx.k dks fnukad 21- 05-2003 dks gh ;g irk yx x;k Fkk fd fnyhi dk igyk vkijs'ku Qsy gks x;k gS fQj Hkh mUgksaus] mDr rF; dks fnyhi vxzoky ds ifjtuksa ls fNik;k x;k] ftlds dkj.k mldh fcekjh c<+rh pyh x;h rFkk ;fn rRdky gh fnyhi vxzoky dk nwljk vkijs'ku dj fn;k tkrk rks mldh e`R;q ugha gksrhA fnyhi vxzoky dk LokLF; fcxM+us ij mldk ijh{k.k ofj"B fpfdRld MkW- vkj-,l-esgrk ds }kjk fd;k x;k Fkk] ftUgksua s fnyhi dks nh tkus okyh FkMZ tujs'ku dh ,aVhck;ksfVd nok;sa cUn djus dh lykg nh x;h Fkh vkSj bl izdkj xyr bykt ds dkj.k gh fnyhi vxzoky dks Mªx VDlhVh gqbZ vkSj mldh fdMuh Qsy gks x;h rFkk MDV ds dkj.k isfjVksukbZfVl] -7- dksyhlkbZfVVhl] fQLrqyk gqvk rFkk dksyksLVkeh vkijs'ku ds dkaIyhds'ku gq,] ftlds ifj.kkeLo:i mldh e`R;q gqbZ gSA bl izdkj fnyhi vxzoky dk bykt ,oa vkijs'ku djus esa foi{khx.k ds }kjk ykijokgh dh x;h gS rFkk foi{khx.k ds }kjk dq'kyrkiwoZd fpfdRlk u djrs gq, muds }kjk vius drZO; dk Hkax fd;k x;k gSA foi{khx.k dk mDr d`R; fpfdRlh; ykijokgh mis{kk ,oa mrkoysiu ls bykt djus dk jgk gS rFkk muds }kjk vkijs'ku ds mijkUr i'pkr~orhZ mfpr ns[kHkky ugha djus ds ifj.kke ds fy, foi{khx.k gh mRrjnk;h gSaA fnyhi vxzoky dh vk;q mldh eR;q ds le; ek= 35 o"kZ Fkh rFkk og 90 o"kZ dh mez rd thfor jgdj vius ifjokj dk Hkj.kiks"k.k djus gsrq vkthfodk gsrq dekbZ djrkA ,slh n'kk esa mldh e`R;q gksus ds dkj.k ifjoknh Ø-1] tks fd fnyhi vxzoky dh iRuh jgh gS] og vius ifr ds izse] Lusg ,oa oSokfgd lq[k ls oafpr gks x;h gS rFkk ifjokjtuksa dks fnyhi vxzoky dh eR;q ds ifj.kkeLo:i vR;f/kd ekufld d"V ls xqtjuk iM+k gS] QyLo:i laiw.kZ 'kh"kZdksa dh {kfriwfrZ ds vUrxZr] muds }kjk fnyhi vxzoky dh e`R;q ds dkj.k dkfjr gqbZ {kfr :i;s 62-02 yk[k vkadfyr djrs gq,] mldh izfriwfrZ gsrq foi{khx.k dks la;qDrr% ,oa i`Fkdr% mRrjnk;h gksuk O;Dr djrs gq,] ifjoknhx.k dks mijksDrkuqlkj vkadfyr dh x;h {kfriwfrZ jkf'k rFkk ml ij] fnyhi vxzoky dh e`R;q frfFk ls 18 izfr'kr okf"kZd dh nj ls C;kt ,oa ifjokn O;; fnyk;s tkus dh izkFkZuk dh x;h gSA 8- foi{khx.k dh vksj ls vius tokc nkos esa] e`rd fnyhi vxzoky dks lk/kkj.k izd`fr dh pksV gksus ls badkj fd;k x;k gS rFkk ;g O;Dr fd;k x;k gS fd fnyhi vxzoky dh e`R;q dk dkj.k] mlds Åij gR;kRed] vkØked pksVsa Fkha tks fd yqVsjksa ds }kjk igqapkbZ x;h Fkh] mlh dk ifj.kke jgk gS] tc og yqVsjksa ds }kjk ,d efgyk ls ywV djus ds nkSjku] mlds }kjk gLr{ksi fd;k x;k Fkk rc mls pkdw ls isV esa la/kkfrd pksV dkfjr dh x;h FkhA e`rd fnyhi vxzoky ,d lkglh ,oa fu%LokFkhZ O;fDr Fkk rFkk mlds mDr ohjksfpr dk;Z dks jkT; ljdkj ds }kjk Hkh ekU;rk nh x;h gS vkSj mls Hkkjr ljdkj j{kk foHkkx ds }kjk ej.kksijkar 'kkS;Z pØ ls Hkkjr ds egkeghe jk"Vªifr ds }kjk lEekfur fd;k x;k gS rFkk mls ohjrk iqjLdkj -8- Hkh e/;izns'k 'kklu ds }kjk fn;k x;k gSA ifjokn esa fnyhi vxzoky dh mYysf[kr e`R;q dk dkj.k tks ifjoknhx.k ds }kjk tks crk;k x;k gS] mlesa ek= mldh e`R;q gksus dk rF; gh Lohd`r gS] ijUrq vU; rF; tks ifjokn esa mYysf[kr fd;s x;s gSa] og lR; ugha gSaA 9- foi{khx.k ds vuqlkj fnyhi vxzoky dks ifjoknhx.k }kjk vo'; gh foi{kh Ø-1 vLirky esa fnukad 19-05-2003 dks jkf= 10-40 cts HkrhZ fd;k x;k Fkk rFkk ogka mldk bykt Hkh fd;k x;k Fkk] ijUrq foi{kh Ø- 2 o 3 ds }kjk ifjoknhx.k ls dHkh ;g ugha dgk x;k fd fnyhi dks vkbZ pksVsa vR;ar lk/kkj.k izd`fr dh gSaA mlds foijhr foi{kh Ø-2 o 3 ds }kjk ejht fnyhi vxzoky ds ifjtuksa dks ;g lwfpr dj fn;k x;k Fkk fd ftl le; mls gkfLiVy esa vkgr voLFkk esa yk;k x;k Fkk rks mldh pksV vR;f/kd xaHkhj Fkh rFkk ;g Hkh crk fn;k x;k Fkk fd mDr pksV dk ;fn rRdky bykt ugha fd;k x;k rks og ?kkrd (Fatal) Hkh gks ldrk gSA foi{khx.k ds }kjk e`rd fnyhi vxzoky ds ifjtuksa dks ;g Hkh crk fn;k x;k Fkk fd fnyhi vxzoky dh 'kY;fØ;k rRdky dh tkosxh] ftlls ;g irk py lds fd mldh NksVh vkar rFkk vU; vkarfjd vaxksa esa dksbZ Hkh {kfr dkfjr gqbZ gS vFkok ugha\ foi{khx.k ds }kjk ;g rF; Hkh Li"V dj fn;k x;k Fkk fd e`rd dh 'kY;fØ;k esa lq/kkjkRed dk;Zokgh djus rFkk mls laØe.k eqDr djus ds fy, isfjVksfu;y esEcjsu dsfoVh dh 'kY;fØ;k djuh gksxh] tks fd fnyhi vxzoky dks Stabing ¼?kksia k gqvk½ ?kko xans pkdw¼Nqjh½ ls dkfjr fd;k x;k gSA mDr ?kko ls vkbZ pksV dh ejEer dh tk lds rFkk vkarfjd vaxksa dks cpkus gsrq ekud fu/kkZfjr 'kY; izfØ;k viuk;h x;h Fkh rFkk tks Hkh fuokjd mik; ¼ Prophylactic measure½ fd;s tkus Fks] os lHkh fd;s x;s Fks rFkk tks Hkh nok,a ejht dks nh x;h Fkh og lc mlds mfpr bykt ds mn~ns'; ls gh nh x;h FkhA -9- 10- foi{khx.k ds }kjk iw.kZ :i ls ;g iz;kl fd;k x;k Fkk fd ejht dh chekjh ,oa laØe.k c<+us ugha ik;s rFkk tks nok;sa laØe.k dks jksdus ds fy, vko';d Fkha ogh ejht dks iznku dh x;h Fkh] ijarq laØe.k ;qDr Nqjh ls ?kko dkfjr gksus ds dkj.k iwoZ ls gh] mlds 'kjhj esa laØe.k ekStwn Fkk] D;ksfa d mlds isV esa tks Hkh pksV igaqpk;h x;h Fkh og xank ,oa ekspkZ ;qDr pkdw ls dkfjr dh x;h FkhA bl izdkj laØe.k dh fLFkfr esa ejht esa pkdw yxus ds 'kh?kz mijkUr gh laØe.k izkjaHk gks x;k Fkk] blfy, mls mijksDr nok;sa nh x;h] ftlls fd mlds laØe.k dks jksdk tk lds rFkk mlds laØe.k ds dkj.k mRiUu gksus okyh tfVyrkvksa ls ejht dks cpk;k tk ldsA foi{khx.k ds }kjk bl rF; ls fo'ks"k :i ls badkj fd;k x;k gS fd ejht dks ,fedkflu batsD'ku 500 ,eth dk fn;k x;k Fkk rFkk bl rF; ls Hkh badkj fd;k x;k gS fd Ceftrixone batsD'ku ls fnyhi vxzoky dks usÝksVkDlhVh dkfjr gqbZ gSA ,fedkflu¼Amikasian½ batsD'ku esa tks nok gksrh gS tks fd Crftrixone ,oa vU; ,aVhck;ksfVd ds lkFk nh tkrh gSA mDr nok blfy, nh xbZ gS fd ejht ds 'kjhj esa cSDVhfj;k dh tks o`f) mls laØe.k ds dkj.k gks x;h Fkh mls jksdk tk lds rFkk cSDVhfj;k ds QSyko dks lkekU; cuk;k tk ldsA ,fedkflu ,oa lsQ~Vªh tksu ds dkachus'ku dks cSDVhfj;k ds laØe.k dks jksdus ds fy, ,d Lohd`r izfØ;k gS] tks fd ejht dks nh tkrh gSA rnuqlkj gh fnukad 20-05-2003 ls fnukad 29-05-2003 rd mDr nokvksa dk iz;ksx] ejht fnyhi vxzoky ij fd;k x;k gS vkSj mlds ckn mls cUn fd;k x;k gSA 11- foi{khx.k }kjk ejht ds xqnZs dh dk;Ziz.kkyh ,oa ;qfj;k ,oa fØfVfuu dks fu;fer :i ls ekuhVj fd;k x;k gS rFkk mldh tks Hkh tkap fjiksVZ jgh gS] og lHkh lkekU; jst a esa gh pkjksa VkbZe dh x;h tkap ds le; ik;h x;h gS] tks ;g nf'kZr djrk gS fd mldh fdMuh] ,aVhck;ksfVd nokvksa ds dkj.k izHkkfor ugha gqbZ Fkh] vfirq mDr nokvksa dk izHkko ejht ij gks jgk FkkA ejht fnyhi vxzoky dk ØsfVukbu VsLV Hkh fnukad 28-05-2003 dks fd;k x;k Fkk] tks ;g nf'kZr djrk gS fd mldh

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fdMuh LoLFk fLFkfr esa Fkh] ftlds lanHkZ esa PRINCIPLES OF Internal Medicine ys[kd gjhlu dh iqLrd 254@4 ist 1611 ^vusDtj vkj&1^ gSA mlesa mDr rF;ksa dk mYys[k gSA foi{khx.k ds }kjk le;&le; ij ejht fnyhi vxzoky dks nh x;h nokvksa dk izHkko Hkh ml ij izdV gks jgk Fkk rFkk mldk mn~ns'; ek= lsIll¼Cepsis½ dks de djuk FkkA fnyhi vxzoky ds vkijs'ku ds nkSjku mlds laca/kh MkW- izdk'k xxZ] ,e-Mh- ,oa mlds nksLr MkW- MCY;w- vkj- xt/kj] ,e-,l- Hkh iwjh 'kY; fØ;k ds nkSjku ekStwn Fks rFkk 'kY; fØ;k] tks viuk;h x;h gS] og Hkh muds iw.kZ laKku esa jgh gSA 12- bl izdkj] ifjokn esa mYysf[kr foi{khx.k ds }kjk tks mis{kk vFkok mrkoysiu ls bykt djus rFkk ejht fnyhi vxzoky ds bykt esa ykijokgh djus dk tks vk{ksi yxk;k x;k gS] mlls foi{khx.k ds }kjk iw.kZr% badkj fd;k x;k gS] vfirq ;g Hkh O;Dr fd;k x;k gS fd tks fnyhi vxzoky dks vkbZ pksVksa ds lanHkZ esa ] loksZRre bykt] mldh tku cpkus gsrq fd;k tk ldrk Fkk] og foi{khx.k ds }kjk fd;k x;k gS vkSj ifjoknhx.k ds }kjk tks vius ifjokn esa vk{ksi yxk;s x;s gSa og feF;k gSaA fnukad 30-05-2003 dks MkW- vkj-lh- esgrk ds }kjk Hkh ejht fnyhi vxzoky dks ns[kk x;k Fkk rFkk mudh jk; ds vuqlkj r`rh; ih<+h+ dh ,aVhck;ksfVd dks i'pkr~orhZ fLFkfr esa ejht dks ugha fn;k x;k gS] tcfd r`rh; ih<+h dh ,aVhck;ksfVd dks ejht fnyhi vxzoky dks fnukad 21-05-2003 ls gh nsuk cUn dj fn;k x;k Fkk rFkk vkbZ-oh- baVªkosul Q~ywM ejht fnyhi vxzoky dks fMgkbZMªs'ku ls cpkus ds fy, fn;k x;k gS rFkk ejht dk ;wjhu vkmV&iqV Hkh 400 ,e-,y- fnukad 03-06-2003 dks Hkh FkkA e`rd dh e`R;q dk dkj.k mldh g`n;xfr dk :d tkuk jgk gS] tks fd mlds isV esa vkbZ pksVksa ls mRiUu tfVyrkvksa ds dkj.k mRiUu gksuk izdV gS] tSlk fd iksLVekVZe fjiksVZ es]a i`"B 142 ij ys[k gSA

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13- foi{khx.k ds vuqlkj ejht fnyhi vxzoky] xaHkhj :i ls lsIVhlhfe;k ls ihfM+r gks x;k FkkA foi{kh Ø-3 ,oa 4 ds fo:) ifjoknhx.k ds }kjk feF;k vk{ksi ifjokn esa yxk;s x;s gSa] tcfd foi{kh Ø-3 MkW- vfuy c{kh ,e-ch-ch-,l- ,oa ,e-,l- tujy ltZjh esa ojh;rk izkIr ;ksX; fpfdRld jgs gSa rFkk esfMdy dkWyst mn;iqj ls muds }kjk v/;;u fd;k x;k gS rFkk jkW;y dkyst vkWQ ltZu ,fMucxZ ls o"kZ 1992 esa mUgsa ,Q-vkj-lh-,l- fMxzh vokMZ fd;k x;k vkSj muds }kjk vius lsokdky esa yxHkx 4000 vkWijs'ku fd;s x;s gSaA blh izdkj ls foi{kh Ø-4 MkW- iz'kkar vxzoky ftUgksua s foi{kh Ø-3 dh lgk;rk fnyhi vxzoky dh 'kY; fØ;k ds nkSjku dh x;h Fkh] og Hkh mPp ;ksX;rk izkIr 'kY; fpfdRld gSa] tks fd tujy ltZjh esa ekLVj vkWQ ltZu o"kZ 1997 esa xka/kh esfMdy dkyst] jhok ls ikl fd;k x;k gS vkSj vius lsok dky esa muds }kjk yxHkx 900 ls vf/kd vkijs'ku fd;s x;s gSaA blh izdkj ls foi{kh Ø-7 MkW- egsUnz vxzoky Hkh ,usLFkhfl;ksykWth esa ,e-Mh- jgs gSa rFkk muds }kjk Hkh yxHkx 20000 vkWijs'ku djus esa fgLlk fy;k x;k gSA bl izdkj] tks 'kY; fØ;k laca/kh dq'kyrk ugha gksus dk vk{ksi yxk;k x;k gS] og iw.kZr% feF;k vk/kkj gS] vfirq foi{kh Ø- 3] 4 ,oa 7 iw.kZ fo'ks"kKrk izkIr fpfdRld jgs gSa] rnuqlkj gh muds }kjk ejht fnyhi vxzoky dk bykt fd;k x;k gSA 14- izLrqr ekeys esa fpfdRldksa dh mis{kk dk rF; dks dfBu lcwr ds lkFk lkfcr djuk vko';d gksrk gS rFkk izLrqr ekeys esa jsl bZIlk yksD;qVj dk fl)kar ykxw ugha gksxk] D;ksfa d ejht dh e`R;q izkd`frd dkj.kksa ls ?kfVr gqbZ ?kVuk ds dkj.k gh gqbZ gSA foi{kh vLirky ds fpfdRldksa dh ykijokgh ls fnyhi vxzoky dh e`R;q ugha gqbZ gS] QyLo:i ifjoknh x.k ds ifjokn dks fujLr djus dh izkFkZ uk dh x;h gSA 15- mHk;i{k ds fo}ku vf/koDrkx.k ds rdZ Jo.k fd;s x;sA ifjokn i= ,oa tokc ds vfHkopuksa] mHk;i{k dh vksj ls izLrqr 'kiFk i= ,oa nLrkostksa dk Hkh voyksdu fd;k x;kA fopkj fd;k x;kA

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16- mHk;i{k ds vfHkopu ,oa ifjokn esa vk{ksfir rF;ksa ds vkyksd esa fuEufyf[kr fopkj.kh; iz'u mifLFkr gksrs gSa %& 1- D;k foi{khx.k ds }kjk fnyhi vxzoky dks tks fd fnukad 19-05-2003 dks jkf= 11 ih-,e- cts foi{kh Ø-1 vLirky esa HkrhZ gqvk Fkk mldk foi{khkx.k ds }kjk mis{kk vFkok mrkoysiu ls vFkok ykijokghiwoZd bykt fd;k x;k gS\ 2- D;k ifjoknhx.k] foi{khx.k ls :i;s 62]02]000@& dh {kfriwfrZ jkf'k vFkok vU; dksbZ Hkh {kfriwfrZ] jkf'k izkIr djus ds vf/kdkjh gSa\ 17- izdj.k esa ;g rF; vfookfnr jgk gS fd iwoZ esa izLrqr ifjokn dk fujkdj.k] fnukad 03-09-2007 dks e0iz0jkT; miHkksDrk fookn izfrrks"k.k vk;ksx] Hkksiky ds }kjk djrs gq, ifjoknhx.k ds ifjokn dks foi{kh vLirky ,oa mlds fpfdRldksa ds fo:) e`rd fnyhi vxzoky ds bykt esa fpfdRlh; mis{kk vFkok ykijokgh ugha ikrs gq, ifjokn dks fujLr fd;k x;k Fkk] ftlds fo:) ifjoknhx.k ds }kjk eku~uh; jk"Vªh; miHkksDrk vk;ksx esa vihy Øekad 599@2007 izLrqr dh x;h Fkh] tgka ls fnukad 26-10-2016 dks mDr vihy izdj.k esa ikfjr vkns'k ds }kjk jkT; vk;ksx ds }kjk ikfjr vkns'k fnukad 03-09-2007 dks vikLr djrs gq,] izdj.k dk iqu% fujkdj.k djus gsrq jkT; vk;ksx dks izfrizsf"kr fd;k x;k Fkk rFkk jkT; vk;ksx dks ;g funsZf'kr fd;k x;k gS fd muds }kjk foi{kh Ø-1 vLirky esa] mlds fpfdRldksa dh vksj ls tks ifjoknh ds vkosnu ij fpfdRldksa dh fo'ks"kK desVh lsB th-,l- esfMdy dkWyst ,oa KEM vLirky eqEcbZ dh xfBr dh x;h Fkh] mu fo'ks"kK fpfdRldksa dk izfrijh{k.k foi{kh vLirky ds fpfdRldksa dh vksj ls fd;s tkus gsrq mUgsa volj fn;k tkdj] rFkk foi{kh Ø-1 vLirky ,oa mlds fpfdRldksa ds }kjk ;fn dksbZ] [k.Mu Lo:i lk{; izLrqr djuk pkgrs gSa rks mls Hkh izLrqr djus dk mUgsa volj nsrs gq,] ifjoknhx.k dks Hkh vU; dksbZ lk{; izLrqr djus dh Lora=rk

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nsrs gq,] iqu% mHk;i{kksa dks lquokbZ dk volj nsrs gq,] ifjokn dk fof/klaxr fujkdj.k djus gsrq vknsf'kr fd;k x;k gSA 18- foi{khx.k dh vksj ls lsB th-,l-esfMdy dkyst ,oa ds-bZ-,e- gkfLiVy] eqEcbZ dh ,DliVZ desVh ds }kjk nh x;h fjiksVZ fnukad 14-05-2008 ds lanHkZ esa eku~uh; jk"Vªh; vk;ksx ds }kjk izFke vihy Øekad 599@2007 cchrk vxzoky ,oa vU; fo:) lq;'k gkfLiVy izk-fy- ,oa vU; esa ikfjr vkns'k fnukad 02-01-2008 ds ikyu esa fjiksVZ nsus okys] fo'ks"kK fpfdRldksa dh lfefr ds lnL; MkW- Jherh yrk lquhy fcfpys] MkW- cyoar fnxacj lkear dk izfrijh{k.k fnukad 05-08-2017 dks rFkk MkW- jktho jatuhukFk lkrksldj dk izfrijh{k.k fnukad 06-08-2017 dks e0iz0 jkT; miHkksDrk vk;ksx ds }kjk fu;qDr dfe'uj ds ek/;e ls fjdkMZ fd;k x;k FkkA 19- ,DliVZ desVh ds }kjk tks foi{kh Ø-1 vLirky ,oa mlds fpfdRldksa ds }kjk fd;s x;s bykt lac/a kh nLrkost jgs gSa] mUgsa ifjoknhx.k dh vksj ls iSjoh djus okys vf/koDrk Jh ikjl tSu ds }kjk mUgsa lHkh bykt ds isilZ vfxze rkSj ij miyC/k djk;k x;k gS rFkk fjiksVZ nsus ds iwoZ fo'ks"kK fpfdRldksa dh xfBr desVh ds le{k ifjoknhx.k ds ekeys ds laca/k esa muds }kjk laf{kIr :ijs[kk izLrqr dh x;h FkhA rRi'pkr~ fo'ks"kKksa ds }kjk fnukad 14-05-2008 dks fo'ks"kK desVh dh fjiksVZ izLrqr dh x;h FkhA 20- fnukad 14-05-2008 dh fo'ks"kK desVh dh fjiksVZ esa] foi{kh Ø-1 vLirky ,oa mlds fpfdRldksa ds }kjk e`rd fnyhi vxzoky dks foi{kh Ø-1 vLirky esa fnukad 19-05-2003 dks 23-15 ih-,e- ij HkrhZ gksuk rFkk mlds iwoZ fnukad 19-05- 2003 dks 10-40 ih-,e- ij vxzoky uxj] c`t/kke dkyksuh] bUnkSj esa ywVdrkZx.k ls ,d efgyk dks cpkrs gq, ywVdrkZvksa ds }kjk fnyhi vxzoky ds isV esa pkdw ?kksia us ls mDr ?kksia s gq, ?kko¼stab wound½ ls ihfM+r gksdj lq;'k vLirky bUnkSj esa bykt gsrq HkrhZ gksus dk rF; vfookfnr jgk gSA

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21- foi{kh Ø-1 vLirky ,oa mlds fpfdRldksa dh fnyhi vxzoky ds bykt esa mis{kk vFkok mrkoysiu ls bykt fd;s tkus laca/kh rF; dks fo'ks"kK fpfdRldksa ds }kjk vius izfrosnu fnukad 14-05-2008 esa fuEu vk/kkjksa O;Dr fd;k x;k gS %& 1- ejht fnyhi vxzoky dks] tks bykt dh vof/k esa ,aVhck;ksfVDl nh x;h Fkh] og mlds lsIVhlhfe;k dks de u djrs gq,] mudk foijhr izHkko fnyhi vxzoky ds 'kjhj ds eeZ vaxksa ij iM+k] ftlds dkj.k mlds 'kjhj ds eq[; vax fdMuh] g`n;] QsQM+s bR;kfn dk;Z'khy ugha jg x;s Fks\ 2- fnyhi vxzoky dk izFke vkijs'ku fnukad 20-05-2003 dks jkr 1 ,-,e- cts fd;s tkus dk rF; fpfdRlh; nLrkostksa ls izdV gqvk gS rFkk mlds vkijs'ku ls ;g izdV gqvk gS fd ftl pkdw ls fnyhi vxzoky ds isV esa izgkj fd;k x;k Fkk] mlds dkj.k fnyhi vxzoky dh NksVh vkar dh isfjVksfu;e dsfoVh esa djhc 50 lh-lh- CyM rFkk twtsue esa] tstquy ijQksjs'ku 1 lh-,e- yEck ik;k x;k gS] ftls mlds }kjk Øksfed dSVxV ds }kjk fjis;j fd;k x;k Fkk] ijUrq mDr vkijs'ku ds nkSjku foi{kh Ø-2 ,oa 3 }kjk ?kqyu'khy lwplZ dk mi;ksx gksuk] tcfd mlds LFkku ij flYd lwplZ dk mi;ksx gksuk pkfg, Fkk] ftlds dkj.k iQksZjs'ku ,oa fyadst ls laHkkfor fjlko dks cpk;k tk ldrk FkkA 3- rhljk vk/kkj ;g fy;k x;k gS fd ejht fnyhi ds 'kjhj esa baVªkosul Q~ywM] mlds ;wjhu ds vkmV&iqV dh vis{kk vf/kd p<+k;k x;k gS] ftlds dkj.k NksVh vkar ls] tks izFke vkijs'ku fd;k x;k Fkk] mlesa fydst gqvk] ftlls fudys vin`O;ksa ds dkj.k ejht fnyhi vxzoky dks lsIVhlhfe;k dh chekjh gqbZ FkhA 4- ejht ds mRrdksa esa esdsfud izfØ;k ls vkDlhtu dh de vkiwfrZ ds dkj.k mlds 'kkjhfjd vaxksa dks izHkkfor gksus dk rF; izdV fd;k x;k gSA

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22- vc mDr lanHkZ esa mHk;i{kksa dh lk{; ij fopkj fd;k tk jgk gS \ mDr lanHkZ esa ;g fcUnq orZeku izdj.k esa ;g rF; fookfnr ugha gS fd fnukad 19- 05-2003 dks djhc 10-40 ih-,e- ij 35 o"khZ; fnyhi vxzoky dks ftl pkdw ls pksV igqapkbZ x;h Fkh] og pkdw lftZdy pkdw u gksdj vfirq ek= lkekU :i ls okLrqvksa dks dkVus esa iz;ksx gksus okyk pkdw jgk gS rFkk ejht dks mDr ?kVuk ds ckn fnukad 19-05-2003 dks 23-15 ih-,e- ij lq;'k vLirky esa HkrhZ fd;k x;k] tgka mldk fnukad 20-05-2003 dks jkf= 1 ih-,e- ct] mlds isV esa tks ?kksaik gqvk ?kko Fkk] mldk izFke vkijs'ku fd;k x;k Fkk rFkk NksVh vkar esa isjhVksfu;e dsfoVh esa jDr tek gksuk rFkk tstque dks cs/krs gq,] NksVh vkar esa ?kko gksuk] ftls izFke vkijs'ku ds }kjk fjis;j fd;k x;k FkkA 23- izFke vk{ksi ejht fnyhi dks bykt ds nkSjku nh tkus okyh ,aVhck;ksfVDl ds lac/a k esa jgk gS\ bl lanHkZ esa ejht fnyhi vxzoky ds bykt laca/kh fpfdRlh; nlrkost ^izn'kZ lh&1 yxk;r lh&7^ izLrqr fd;s x;s gSa] tks fd ifjoknh dh isij cqd ds i`"B 32 yxk;r 167 ij layXu gSa] ftudk voyksdu fd;k x;kA 24- ejht fnyhi vxzoky] vk;q 35 o"kZ dh e`R;q fnukad 05-06-2003 dks jkr djhc 9-30 ih-,e- ij gksus dk rF; bykt ds ipksZa ds i`"B 87 ds vuqlkj gksuk izdV gks jgk gS] ftlesa ;g rF; mYysf[kr gS fd ejht dh lHkh laHko dkfMZ;ks iYeksujh jhlsfsa l;sfVo estj¼Resuscitative measures½ viuk;s tkus ds ckotwn Hkh] ejht dks iquthZfor ugha fd;k tk ldk rFkk mls fnukad 05-06-2003 dks jkf= 9-30 cts e`r ?kksf"kr fd;k x;kA 25- izdj.k esa e`rd dh iksLVekVZe fjiksVZ] ifjoknh dh isij cqd ds i`"B 142 ij layXu gS] mlesa e`rd fnyhi vxzoky dh e`R;q dk dkj.k] mldk g`n;

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'okalkojks/k gksuk rFkk mlds ikfj.kkfed dkj.k] tks e`rd ds isV esa migfr;ka dkfjr gqbZ Fkh mlds dkj.k mls isfjVksukbfVl ,oa tstque ds nwljs vkijs'ku ds nkSjku fFkjSI;qfVd bUVjos'a ku] ds dkj.k gksus dk rF; mYysf[kr gSA 26- vc iz'u ;g gS fd ejht fnyhi vxzoky dks fnukad 20-05-2003 dks mlds izFke vkijs'ku ds le;] tks Hkh ,aVhck;ksfVDl fpfdRldksa ds }kjk nh x;h Fkh] mlds dkj.k D;k mlds 'kjhj ds eeZ vaxksa ij foijhr izHkko iM+k\ ftlds ifj.kkeLo:i fnyhi vxzoky dh fnukad 05-06-2003 dks mldh e`R;q gks tkuk jgk gS\ 27- mDr lanHkZ esa fopkj djrs gq, ;g ik;k tkrk gS fd ifjoknhx.k ds }kjk ;g rF; foi{kh vLirky esa mlds fpfdRldksa ij vk{ksfir fd;k x;k gS fd muds }kjk vuqHkotU; fpfdRlk baisfjuy Fksjsih dks ugha viukbZ xbZ rFkk fnyhi vxzoky ds vkijs'ku ds mijkar izksQkbZysfVd ,aVhck;ksfVd lsQ~Vªh;ktksu vksÝkesDl] tks fd CEPHALOSPORIN r`rh; ih<+h dh nok jgh gS] og iznku dh x;h] tcfd mls igyh ih<+h dh nok lsQktksfyu nsuk pkfg, FkkA bl lanHkZ esa fpfdRlk lkfgR; dk voyksdu djus ij ;g lwpuk izkIr gksrh gS fd eq[; nok lsQkyks Liksfju dks 4 ihf<+;ksa esa foHkkftr fd;k x;k gSA izFke ih<+h esa lsQktksfyu] tcfd rhljh ih<+h esa lsfQ~Vª;kDtksu@lsDVh;u dks j[kk x;k gSA mDr nokvksa dk izHkko xzke ikthfVo ,oa xzke fuxsfVo oSDVhfj;k ij gksrk gSA ifjoknhx.k ds vuqlkj ejht fnyhi vxzoky dks 2 xzke lsfDVª;ktksu vkisj'ku ds igys fn;k x;k Fkk rFkk 1 xzke vkijs'ku ds mijkar 1 xzke lqcg ,oa 1 xzke 'kke dks fn;k tk jgk FkkA ifjoknhx.k ds vuqlkj mDr fu/kkZj.k =qfViw.kZ jgk gS] D;ksafd mDr ,aVhck;ksfVDl ds dkj.k gh fiRr Bile sludge dkfjr gqvk gS rFkk bl lanHkZ esa esfMdy VsDLV cqd esa ys[k fuEukuqlkj mYysf[kr gS %&

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"Ceftriaxone because of extremely high concentrations in the bile, can cause "sludging" in the gall bladder and occasionally produces symptoms compatible with acute cholecystitis"- (Harrisons- Principles of Internal Medicine, 16th Ed, Pg808) The same book, in Table 118-8 states that in Dirty(traumatic wound) Cefazoline should be given, before and for 3-5 days after trauma as a prophylaxis.
28- foi{khx.k ds }kjk mDr rF;ksa dks badkj djrs gq, ;g crk;k x;k gS fd tks Hkh nok;sa ejht fnyhi vxzoky dks mlds bykt ds fy, nh x;h Fkh] og vuqHkotU; fpfdRlk¼Emprical Therapy½ ij vk/kkfjr ugha jgh gS] vfirq ;g O;Dr fd;k x;k gS fd mDr lHkh nok;sa lq/kkjkRed rjhds gsrq ejht dks nh x;h Fkh rFkk vkgr fnyhi vxzoky tks HkrhZ gqvk Fkk] mlds 'kjhj esa laØe.k mlh le; gks x;k Fkk] tc mls pksV] tks fd xans ,oa tax yxs pkdw ds }kjk igqapk;h x;h FkhA lsfQ~fVª;kDtksu baVªkosul batsD'ku] mDr laØe.k dk bykt djus gsrq fn;k x;k Fkk] tks fd ejht ds isV esa vkbZ pksVksa dk ifj.kke jgh gS vkSj foi{khx.k ds }kjk Hkh fpfdRlh; lkfgR; vius rdZ ds leFkZu esa izLrqr fd;k x;k gS] mlds vuqlkj %& "Ceftriaxone- The distinguishing feature of this cephalosporin is its longer duration of action(1, 1/2, 8hr) per mitting once or at the most twice daily dosing. It has good CSF penetration, and is eliminated equally in urine and bile" (Esentials of Medical Pharmacolgy by K.D. Tripathi 5th Ed, Pg 665)."

29- mDr lanHkZ esa fpfdRlh; lkfgR; dk voyksdu djus ij ;g Hkh nf'kZr gksrk gS fd mlesa ;g er oSfHkUurk jgh gS fd ,aVhck;ksfVDl cephalosporin dk

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dksbZ rhljh ih<+h dh nok dk mi;ksx ejht dh fLFkfr dks lq/kkjus gsrq fd;k tkos rFkk ;g ejht] nj ejht dh fLFkfr ,oa mlds ?kko dh izd`fr rFkk ejht dk ?kko fdl LVst ij gS\ fdl izdkj dk laØe.k gS\ rFkk pksV okys LFkku esa fdruk tksf[ke vkPNkfnr gS\ mu lHkh dkjdksa ij fuHkZj gksuk crk;k x;k gS rFkk vafre fu.kZ; bykt djus okys fpfdRld ds }kjk vius Kku vkSj vuqHko ds vk/kkj ij gh vkadfyr fd;k tkrk gS fd mDr ifjfLFkfr esa dkSu lh nokbZ ejht ds fy, vko';d gS rFkk mldh fdruh ek=k fn;k tkuk mi;qDr gksxk\ ejht dks nh tkus okyh nok dk tks lkbM bQsDV gksrk gS] ml ij Hkh fpfdRldksa ds }kjk fopkj djrs gq, gh] ejht dh nok fu/kkZfjr dh tkrh gS] D;ksafd ;g bykt djus okys fpfdRld ij gh fuHkZj gksrk gS fd og ejht dh fLFkfr ds vuqlkj] mDr ekeys esa dkSu ls Lrj dh nok dks mi;qDr le>rk gSA 30- izLrqr ekeys esa ejht dh vkar esa pksV Fkh rFkk NksVh vkar eas tks inkFkZ ekStwn Fks] mudk Nydko (Spillage) izdV gks jgk Fkk] tks fd vkar dh isjhVksfu;e dSfoVh esa bdV~Bk gqvk FkkA bl lanHkZ esa fpfdRldksa ds }kjk tks fu.kZ; ejht dh vkar ds laØe.k dks c<+us ds volj dks ns[krs gq, rFkk lsfQ~Vlhfe;k] c<+us ds volj dks ns[krs gq, mls jksdus gsrq muds }kjk lsQkyksLiksfju ,aVh ck;ksfVdDl dh rhljh ih<+h dh nok lsfQ~Vª;kDtksu dk pquko fd;k x;k gS] og fpfdRlh; lkfgR; ls vuqeU; gksuk nf'kZr gks jgk gSA 31- mDr lanHkZ esa tks ifjoknh ds vkosnu ij] eku~uh; jk"Vªh; mHkksDrk vk;ksx ds }kjk fo'ks"kK fpfdRldksa dh desVh dk xBu gqvk Fkk] ftuds }kjk fnukad 14-05-2008 dks desVh dh fjiksVZ eku~uh; jk"Vªh; vk;ksx esa izLrqr dh x;h Fkh] ;|fi ml le; foi{kh Ø-1 vLirky ,oa mlds fpfdRldksa dh vksj ls muds vfHkHkk"kd] mDr ekeys esa foi{khx.k dk i{k j[kus ds fy, mifLFkr ugha Fks] vfirq ek= ifjoknh ds vfHkHkk"kd }kjk ekeys ls lacaf/kr nLrkostksa dks] muds }kjk ifjoknhx.k ds i{k esa fo'ks"kK desVh ds lnL;ksa ds le{k izLrqr djus ds mijkUr gh mDr fjiksVZ nh x;h

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Fkh] ijUrq i'pkr~orhZ fLFkfr esa MkW- cyoar fnxacj lkear] tks fd lsB esfMdy dkyst ,oa ds-bZ-,e- gkfLiVy eqEcbZ esa QkeZdksykWth ds foHkkxk/;{k@izksQslj jgs gSa muds }kjk foi{khx.k dh vksj ls fd;s x;s izfrijh{k.k dh dafMdk 2 fnukad 05-08-2007 dks iwNs x;s izFke iz'u ds mRrj esa] fuEukuqlkj mYys[k fd;k x;k gS ckcr~ "It is correct to say that the antibiotics given to Mr. Dilip Agarwal were in consonance with the prescribed standards and established practice prevalent in the country at that point of time."

32- ifjoknhx.k dh vksj ls izLrqr vkosnu ij eku~uh; jk"Vªh; vk;ksx }kjk gh xfBr mDr fo'ks"kK desVh ds fo'ks"kK fpfdRld dh vksj ls ] tks mDr ejht ds bykt ds ipksZa dk voyksdu djus ds mijkUr rF;ksa dks izdV fd;k x;k gS] mlls] gekjs er esa vU;Fkk fHkUu jk; xzg.k djus dk dksbZ dkj.k ugha jg tkrk gS rFkk fpfdRlh; nLrkostksa dk voyksdu djus ij ;g ik;k tkrk gS fd batsD'ku Amikasian 500mg, tks ejht dks yxHkx bykt ds nkSjku 11 fnuksa rd fu;fer :i ls lsfQ~Vª;kDtksu ds lkFk fn;k x;k gS] ftlls gh] ifjoknhx.k dk vk{ksi ;g jgk gS fd ejht dks Mªx VkfDlVh dkfjr gqbZ gS] ijUrq mDr lanHkZ esa] tks fnyhi vxzoky dh iSFkkykWftdy tkap fjiksVZ jgh gS¼ifjoknh dh isijcqd ds ist 88 yxk;r 135 rd½] mlds vuqlkj ek= fnukad 27-05-2003 dks gh CyM ;wfj;k lkekU; jst a ls vf/kd 102 ,eth@Mh,y rFkk lhje ØsfVukbu 2 ,eth@Mh,y mYysf[kr fd;k x;k gS] mlds iwoZ CyM ;wfj;k ,oa lhje ØsfVukbu lkekU; jst a esa gh gksuk nf'kZr gks jgk gSA 33- ,slh n'kk esa] tks ifjoknhx.k dh vksj ls ;g vk{ksi yxk;k x;k gS fd ejht fnyhi vxzoky dks ,aVhck;ksfVd lsQkyksLiksfju dh rhljh ih<+h dh nok CEFTRIXONE nsus ls ejht fnyhi vxzoky ds 'kjhj ds eeZ vaxksa dks izHkkfor

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gksuk rFkk mlds dkj.k mldh e`R;q gksus ds rF; dks vk{ksfir fd;k x;k gS] og rF;] Lohdkj ;ksX; ugha ik;k tkrk gSA 34- mDr fcUnq ij fo'ks"kK desVh ds lnL; MkW- Jherh yrk lquhy fcfpys us viuh fjiksVZ dh dafMdk 9 esa] ;g rF; O;Dr fd;k x;k gS fd il dYpj fjiksVZ ;g nf'kZr dj jgh Fkh LVQyksdksdl xzke ikthfVo Fkk rFkk og lsQksVkfDle] lsQkyksfjMkbu esxusDl ,oa vksQyksDlkflu ,aVhck;ksfVDl ds izfr laosnu'khy Fkk rFkk ;g O;Dr fd;k x;k gS fd tks ejht ds bykt dk rF; mlds bZykt'khV ds i`"B 10 ij vafdr gS] mlesa dYpj fjiksVZ dks udkjkRed crk;k x;k gS] ogha mijksDr dYpj fjiksVZ fojks/kkHkk"kh jgh gS] ijUrq mDr lanHkZ esa] mDr lk{kh us vius izfrijh{k.k dh dafMdk 2 esa ;g O;Dr fd;k x;k gS fd desVh dh fjiksVZ ds isjkxzkQ 2] 5] 6 ,oa 7] tks fd ejht dks nh x;h nokvksa ls lacfa /kr gSa] og muds }kjk viuk fu"d"kZ fn;k x;k gS rFkk muds }kjk ;g Lohdkj fd;k x;k gS fd desVh dh tks fjiksVZ fnukad 14-05-2008 dks nh x;h gS] mlesa ifjoknh ds vfHkHkk"kd ds }kjk mUgsa 1 ekg igys ejht fnyhi vxzoky dh dsl fgLVªh ls lacfa /kr vfHkys[k ns fn;s x;s Fks rFkk ifjoknh ds vfHkHkk"kd ds }kjk viuk iwjk ekeyk Hkh desVh ds lkeus izLrqr fd;k x;k FkkA vkxs mDr lk{kh MkW- Jherh yrk lquhy fcfpys us vius izfrijh{k.k esa ;g Hkh Lohdkj fd;k gS fd fnukad 30-03-2003 dks ejht dks vkbZ-lh-;w- vflLVsM vkWDlhtu fn;k tkuk jksdk x;k Fkk] ml le; baVsd 3600 rFkk vkmV&iqV 2300 Fkk rFkk tks ejht dk VsphdkfMZ;k Fkk] og fnukad 21-05-2003 dks fLFkj gksdj lkekU; LVst ij vk x;k FkkA 35- mDr lanHkZ esa foi{kh vLirky ,oa bykt djus okys fpfdRldksa esa ls ifjoknhx.k ds fo}ku vfHkHkk"kd Jh tSu ds }kjk] ejht dk vkijs'ku djus okys MkW- vfuy c{kh rFkk mls ,usLFkhfl;k nsus okys MkW- egsUnz vxzoky rFkk mijksDr ejht dks i'pkr~orhZ fLFkfr esa ns[kus okys MkW- v'kksd yM~Mk] MkW- jkts'k Hkkjk.kh] MkW- v'kksd oktis;h] MkW- cdhmj jgeku xt/kj dk izfrijh{k.k fd;k x;k gS] ftlesa ejht dk

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vkijs'ku djus okys MkW- vfuy c{kh ls iwNs x;s iz'u Ø-12 ,oa 13 ds mRrj esa fuEufyf[kr mRrj fn;k x;k gS %& "The choice of antibiotic and its dosage in potentially contaminated abdominal trauma is always of a Broad Spectrum Agents like Ceftriaxone and an aminoglycoside like Amikacin along with Tinidzaol/Metronidazol As regards the dosage quantity. the same would depend on the age. physical condition extent of injury and contamination,but not exceeding 4gms a day of Ceftriaxone. 1 gm a day of Amikacin and 1200 mg a day of Metronidazol." rFkk mDr lanHkZ esa MkW- v'kksd yM~Mk ds }kjk iz'u Ø-25 dk mRrj fuEukuqlkj fn;k x;k gS %& "25. The choice of Antibiotic and its dosage in potentially contaminated abdominal trauma is always of a Broad Spectrum Agents like ceftriaxone and an aminoglycoside like Amikacin along with Tinidazol/Metronidazol. As regards the dosage quantity, the same would depend on the age, physical condition, extent of injury and contamination, but not exceeding 4gms a day of ceftriaxone, 1 gm a day of Amikacin and 1200 mgm a day of Metronidazol."

36- mDr lHkh rF;ksa ij fopkj djus ds mijkUr rFkk fo'ks"kK desVh ds fpfdRldksa MkW- cyoar fnxacj lkear ds }kjk izfrijh{k.k ds iz'u Øekad 1 ds mRrj esa gh ;g Lohdkj fd;k x;k gS fd fnyhi vxzoky dks tks ,aVhck;ksfVDl] mlds bykt ds nkSjku foi{kh Ø-1 vLirky ds fpfdRldksa ds }kjk nh x;h Fkh] og fu/kkZfjr ekud ds vuqlkj gh Fkh rFkk mlh rjg dh izsfDVl rRlac/a kh le; esa Hkkjr ns'k esa izpyu'khy Fkh] ftl le; ejht fnukad 19-05-2003 dks lq;'k vLirky esa LVSc batwjh¼Stab Injury½ ls ihfM+r gksdj HkrhZ gqvk Fkk tSls gh mls ,slk pkdw¼Nqjh½ ls

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tks fd lftZdy pkdw ugha Fkk] og tSls gh] mldh vkar esa ?kksia k gqvk ?kko dkfjr fd;k x;k] mlh {k.k ls lsIVhlhfe;k izkjaHk gks x;k FkkA ,slh n'kk esa tks ifjoknhx.k ds }kjk ejht fnyhi vxzoky dks ,aVhck;ksfVDl esa mPp 'kfDr dh nok,a nsus ls] mldh fdMuh dks Qsy gksuk crk;k x;k gS] og rF; Lohdkj ;ksX; ugha ik;k tkrk gSA 37- ifjoknhx.k }kjk foi{kh vLirky ,oa fpfdRld dh mis{kk crkus ds fy, vU; vk/kkj ;g Hkh fy;k x;k gS fd ejht dk izFke vkijs'ku] tks fd fnukad 20-05-2003 dks jkr djhc 1 cts fd;k x;k gS] ml nkSjku mldh NksVh vkar esa tks pksVsa¼Stab Injury½ Fkh] mlesa flykbZ gsrq tks ?kqyu'khy Vkadk¼CROMIC catgut½ vkar ds nksuksa fljksa dks tksM+us ds fy, iz;ksx fd;k x;k Fkk] og ?kqyu'khy gksus ds dkj.k 'kh?kz xy x;k] ftlls vkar ls vUnj ds inkFkZ dk fjlko ¼spillage½ gqvk vkSj mlds dkj.k ejht fnyhi vxzoky dks lsIVhlhfe;k iSnk gks x;k FkkA 38- mDr lanHkZ esa fo'ks"kK desVh ds ,d fpfdRld MkW- jktho jtuhukFk lkrksldj us viuh fjiksVZ fnukad 14-05-2008 dh dafMdk 11 esa fuEukuqlkj rF; mYysf[kr fd;k gS %& "11. It is observed that the deceased Mr. Dilip Agarwal had traumatic jejunal perforation which was sutured with absorbable suture material 2-0 chromic catgut. The current practice of repairing the bowel perforation is that with non- absorbable silk. The suturing of bowel with CROMIC cat-gut is not in practice since last 15-20 years. The chances of leak are higher with absorbable suture material than with non-absorbable silk."

39- mDr lanHkZ esa fo'ks"kK lfefr dh fjiksVZ fnukad 14-05-2008esa eq[; :i ls] foi{kh Ø-1 vLirky ,oa ;gka dk;Zjr fpfdRldksa ds }kjk vkijs'ku esa] fpfdRlh;

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mis{kk dk nwljk vk/kkj ;g fy;k x;k gS fd ¼iSjkxzkQ 11½ e`rd fnyhi vxzoky dks VªesfVd tstquy iQkZsjs'ku ds dkj.k] mlds vkijs'ku esa ?kqyu'khy lwplZ eVsfj;y 2- 0 Øksfed dSVxV dk iz;ksx fd;k tkuk crk;k x;k gS rFkk ;g ys[k fd;k x;k gS fd ekStwnk le; esa ckosy iQksZjs'ku dks ejEer djus ds fy, v?kqyu'khy flYd lwplZ dk bLrseky gksuk pkfg, rFkk isV ds vkijs'ku esa iz;ksx fd;s tkus okys ?kqyu'khy lwplZ ¼CROMIC Catgut½ dk iz;ksx fiNys 15&20 lkyksa ls izpyu'khy ugha jgk gS] D;ksfa d ?kqyu'khy lwplZ dk iz;ksx djus ls yhdst dh laHkkouk] v?kqyu'khy lwplZ dh vis{kk vf/kd gksrh gSA 40- bl lanHkZ esa fo'ks"kK lfefr ds MkW- jktho lkrksldj us vius izfrijh{k.k esa viuh lk{; ds iz'u Øekad 64 ds mRrj esa ;g Lohdkj fd;k x;k gS fd lfefr dh fjiksVZ esa tks iSjkxzkQ 11& lwplZ ds laca/k esa fy[kk x;k gS] og mudh O;fDrxr jk; ij vk/kkfjr gS rFkk mUgksua s tks ^^djsaV izsfDVl^^ dk mYys[k fd;k x;k gS] mldk eryc fiNys 20 o"kZ ls ckosy vkijs'ku esa ?kqyu'khy Vkadksa dk bLrseky ugha fd;k tkrk gS rFkk vkxs mUgksua as bl rF; ls badkj fd;k gS fd mUgksaus viuh jk;] mDr vk'k; dh blfy, nh gS] D;ksafd ejht ds lkFk ?kVuk o"kZ 2003 esa ?kfVr gqbZ Fkh rFkk muds }kjk viuh jk; o"kZ 2008 esa nh x;h gS] ijUrq mUgksaus mDr lanHkZ esa dksbZ Hkh MkVk vius izfrosnu ds leFkZu esa ugha fn;k gS vkSj u gh fdlh VsDLV cqd ls viuh jk; ds leFkZu esa dksbZ m)j.k is'k fd;k x;k gSA 41- foi{khx.k ds fo}ku vf/koDrk us mudk /;ku ltZjh dh ekud iqLrd Bailey & Love's SHORT PRACTICE OF SURGERY 24 oka laLdj.k dh vksj vkdf"kZr djkdj] iz'u iwNk x;k gS rFkk ftlesa mUgksua s ;g er O;Dr fd;k gS fd ?kqyu'khy lwplZ dk eryc ,sls lwplZ ls gksrk gS] tks ,d fu'p; le;kof/k ds mijkar vo'kksf"kr gks tkrk gS rFkk Øksfed dSVxV dks ?kqyu'khy inkFkZ ls fufeZr gksus rFkk mls yxkus ds 7 ls 10&12 fnu ds vUnj mldh 'kfDr de gks tkuk]

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D;ksfa d og ?kqyu'khy gksus dk rF; vk/kkfjr fd;k x;k gS] ijUrq bl lanHkZ esa mudk /;ku Bailey & Love's dh iqLrd ftlds ^^,^^ ls ^^,^^ Hkkx esa 'kh"kZd dSVxV ,ukLVkseksfll¼izn'kZ Mh,bZ&6½ ds i`"B 850 ds ^^ch^^ ls ^^ch^^ Hkkx dh vksj /;ku vkfdf"kZr djk;k x;k gS] ftlesa nks rjg ds dSVxV crk;s x;s gSa] igyk Iysu dSVxV rFkk nwljk Øksfed dSVxj rFkk dSVxV dks ØksekslkbM blfy, fd;k tkrk gS] D;ksfa d og etcwr cu lds rFkk foyEc ls ,CtkoZ gks lds rFkk mDr iqLrd esa ;g rF; Hkh ys[k fd;k x;k gS fd ckosy iQksZjs'ku dh ejEer djrs le; flYd dSVxV dk mi;ksx djus ls euk fd;k x;k Fkk] D;ksafd mldh izfØ;k] mRrdks¼a Tissues½ ij xaHkhj :i ls gksrh gS] tcfd mldh vis{kk flaFksfVd] uku ,DtkscZy lwplZ dks mDr vkijs'ku esa ojh;rk nsus dk rF; mYysf[kr gSA 42- bl izdkj mDr iqLrd ds m)j.k ls ;g izdV gS fd vkijs'ku okys LFkku ds nksuksa fljksa dks tksM+us gsrq Anastomosis Vw&ys;j dSVxV] tks fd ?kqyu'khy gksrk gS] mlh dk iz;ksx djus ds rF; dks vk/kkfjr fd;k x;k gSA ;|fi mDr lk{kh MkW- jktho jatuhukFk lkrksldj ds }kjk tks fo'ks"kK fjiksVZ esa] flYd lwplZ dk iz;ksx djus dk tks rF; mYysf[kr fd;k x;k gS] ml lanHkZ esa foi{kh vLirky ds fo}ku vf/koDrk ds }kjk mDr fpfdRld dks fn;k x;k bl lq>ko ls fd] flYd lwplZ dk] mRrdks¼a Tissues½ ij foijhr izHkko iM+us ls flYd lwplZ dk iz;ksx vc izsfDVl esa ugha gS rFkk og ekU; fpfdRlh; fl)karksa ds vuq:i mUgksau]s izfrosnu ys[k ugha fd;k x;k gS rFkk bl lanHkZ esa fo}ku vf/koDrk ds }kjk lacfa /kr lk{kh dk /;ku fpfdRlh; lkfgR; VsDLV cqd vkWQ vkijsfVo ltZjh ck; QjX;q'kal 8oka laLdj.k ds ftls ^^,^^ ls ^^,^^ Hkkx ls fpfUgr fd;k x;k gS ^^izn'kZ Mh&,bZ& 8 dh vksj /;ku vkdf"kZr djk;k x;k gS] ijUrq bl lanHkZ esa] mDr lk{kh MkW- lkrksldj ds }kjk ;g O;Dr fd;k x;k gS fd mDr lkfgR; esa ysEcVZ lwplZ dk vuU; :i ls iz;ksx djus dk rF; fy[kk gqvk gSA ;|fi mDr lk{kh Jh MkW - jktho jatuhukFk lkrksldj ds }kjk ;g Lohdkj ugha fd;k x;k gS fd Øksfed dSVxV dk iz;ksx fiNys

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15&20 lkyksa ls ckosy ltZjh esa fpfdRldksa }kjk iz;ksx fd;k tk jgk gSA bl lanHkZ esa mudk /;ku ,fFkdkWu ckm.M Dykstj eSU;qvy ¼izn'kZ Mh&,bZ 9½ dh vksj Hkh fo}ku vf/koDrk }kjk vkdf"kZr djk;k x;k gS rFkk mUgksua s viuh lgefr Hkh mDr ys[k ij O;Dr dh gS] ijUrq ;g Hkh O;Dr fd;k x;k gS fd bl izdkj ds dSVxV] nksuksa vusLVkseksfll esa] ,d lkFk iz;ksx fd;k tk ldrk gS vFkok ugha\ ijUrq mDr iqLrd tks Leky bUVsLVkbu esa ^^ch^^ ls ^^ch^^ Hkkx rd] ;g rF; fy[kk gqvk gS fd ?kqyu'khy Vkads djhc 14 fnuksa ds mijkUr gh ,CtkoZ gksrs gSa] mlls mUgksaus viuh lgefr Hkh O;Dr dh x;h gSA 43- bl izdkj mDr lk{; ls] tks fd mDr lk{kh ds }kjk iz'u Øekad 75 yxk;r 81 ds mRrj esa crk;k x;k gS vUrr% fpfdRlh; lkfgR; ds vk/kkj ij ;g rks Lohdkj fd;k x;k gS fd ckosy iQksZjs'ku fjis;j esa ?kqyu'khy lwplZ dk gh iz;ksx fd;k tkrk gS] ijUrq Lo;a ds }kjk ds-bZ-,e- gkfLiVy eqEcbZ esa dk;Zjr jgus ds nkSjku flYd lwplZ dk iz;ksx djus dk rF; vo'; gh O;Dr fd;k x;k gS] ijUrq muds }kjk iz'u Øekad 78 esa bl lq>ko ls badkj fd;k x;k gS fd muds }kjk }s"kiw.kZ ,oa feF;k :i ls ?kqyu'khy dSVxV¼chromic catgut½ ds bLrseky ds rF; dks viuh fjiksVZ esa xyr :i ls crk;k x;k gSA 44- mDr lanHkZ esa foi{kh Ø-1 vLirky dh vksj ls MkW- vfuy c{kh ds }kjk iz'u Ø-8 dk mRrj fuEukuqlkj fn;k x;k gS %& "A Proper repair of the perforation was performed as mentioned in the operation notes though the number of sutures are not noted, but looking to the nature of injury. two to three sutures in two layers were applied."

45- mDr lanHkZ esa ETHICON dh iqLrd WOUND CLOSURE MANUAL esa tks SMALL INTESTINE vkSj vkijs'ku esa ABDOMINAL

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WALL CAVITY esa of.kZr fLFkfr dks iz;ksx fd;s tkus dk rF; fuEukuqlkj fy[kk x;k gS %& "Once inside, the type of suture selected will depend upon the nature of the operation and the surgeon's technique."

46- vc gekjs le{k iz'u ;g mRiUu gksrk gS fd MkW- jktho jatuukFk lkrksldj ds }kjk] e`rd fnyhi vxzoky ds vkijs'ku ds nkSjku tks ?kko ds fljksa dks tksM+us@flykbZ djus gsrq tks Øksfed dSVxV dk mi;ksx fd;k x;k Fkk] mlds mi;ksx dks D;ksa vuqfpr crk;k x;k gS\ vkSj mlds vk/kkj ij foi{kh vLirky ds fpfdRldksa }kjk fnyhi vxzoky dk bykt fd;s tkus dk rF; viuh fo'ks"kK desVh dh fjiksVZ esa ys[k fd;k x;k gS] bl fcUnq ij fopkj djrs gq,] ge ;g ikrs gSa fd ifjoknh ds }kjk eku~uh; jk"Vªh; vk;ksx ds le{k ^izn'kZ vkj MCY;w ,l@3^ dk fnukad 26-12- 2007 dks] muds vfHkHkk"kd ds }kjk vkosnu nsdj] izksQslj MkW0 jktho vkj- lkrksldj] dks muds i{k esa fo'ks"kK jk; nsus gsrq izlUurkiwoZd viuh dh lgefr nsuk crk;k x;k gS] ;|fi eku~uh; jk"Vªh; vk;ksx ds }kjk izFke vihy Øekad 599@2007 esa ikfjr vkns'k fnukad 02-01-2008 ^izn'kZ vkjMCY;w 5@4^ esa fdlh fo'ks"kK fpfdRld ds uke ij] viuh vkifRr O;Dr dh gS] ijUrq ;g O;Dr fd;k x;k gS fd lacfa /kr fpfdRld laLFkk ,oa vLirky ds funs'kd ls gh ;g fuosnu fd;k x;k gS fd muds }kjk gh fo'ks"kKksa dh lfefr dks viuk izfrosnu nsus gsrq xfBr dh tkos] blfy, bl lHakkouk ls badkj ugha fd;k tk ldrk gS fd i'pkr~orhZ fLFkfr esa MkW - jktho vkj- lkrksldj] tks fd fo'ks"kK lfefr ds ,d lnL; jgs gSa] muds }kjk tks fnukad 14- 05-2008 dks viuh fjiksVZ nh x;h gS] ftlesa fpfdRldksa dh mis{kk dk fu"d"kZ fudkyus ds fy,] ?kko ds fljksa dks tksM+us ds fy,] foi{kh vLirky ds fpfdRldksa ds }kjk Øksfed dSVxV ds mi;ksx dks muds }kjk xyr ,oa vlko/kkuhiw.kZ d`R; crk;k x;k gS] og ekU; fpfdRlh; lkfgR; tks fd izdj.k esa izLrqr gS] mlds vuqlkj ?kqyu'khy dSVsxV dk gh iz;ksx fnyhi ds vkar ds vkisj'ku esa visf{kr jgk gS] blfy, tks fnukad 14-05-2008 dks fo'ks"kK lfefr ds }kjk] mDr vk/kkj ij fpfdRldksa dh mis{kk

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dks f}rh; vkijs'ku ds nkSjku fd;s tkus dk vk/kkj fy;k x;k gS] og Lohdkj ;ksX; ugha ik;k tkrk gS] ml n'kk esa vkSj Hkh] tc Lo;a MkW- lkrksldj us vius izfrijh{k.k esa iz'u Øekad 63 ds mRrj esa fnyhi vxzoky ds isV esa 6 bap xgjk pkdw dk ?kko gksuk Lohdkj fd;k x;k gS rFkk pkdw Hkh ukWu lftZdy gksuk crk;k x;k gSA 47- ifjoknhx.k ds }kjk e`rd fnyhi vxzoky dh e`R;q dk dkj.k fpfdRlh; mis{kk es]a bl rF; dks Hkh vk/kkfjr fd;k x;k gS fd mls vko';drk ls vf/kd vkbZ- Ogh- Q~ywM p<+k;k x;k Fkk] ftlds vuqlkj rqyukRed :i ls mlds }kjk ew= dk mRltZu¼excretion½ vuqikfrd :i ls de jgk gS] tks i'pkr~orhZ fLFkfr esa fdMuh QsY;ksj dk dkj.k fufeZr gqvk gSA 48- bl lanHkZ esa ifjoknhx.k dh vksj ls lk{kh ifjoknh Ø-1 cchrk vxzoky] tks fd e`rd fnyhi vxzoky dh iRuh jgh gS] mldk 'kiFk i= fnukad 23-01-2005] e`rd ds pkpk vkseizdk'k vxzoky] e`rd dh eka Jherh panzdyk vxzoky] e`rd ds firk jkeizdk'k vxzoky] vt; xks;y] ,oa ckcwyky vxzoky ds 'kiFki= izLrqr fd;s x;s gSa] ftuesa ;g rF; mYysf[kr gS fd fnyhi vxzoky dks MkW - vfuy c{kh ds }kjk ykijokghiwoZd xyr nok;sa fn;s tkus ds dkj.k rFkk mlds isV esa ikuh Hkj tkus ds dkj.k fdMuh dh dk;Ziz.kkyh izHkkfor gqbZ] ftlds dkj.k fnyhi vxzoky dk nwljk vkijs'ku djuk iM+k] ijUrq fnyhi vxzoky dk dksyksLVkeh vkijs'ku MkW- v'kksd yM~Mk ds }kjk fd;k tkuk] muds }kjk isV ls ikuh fudky nsus rFkk dksyksLVkeh cSx yxk;s tkus dk rF; crk;k tkuk O;Dr fd;k x;k gSA 49- bl lanHkZ esa fnukad 14-05-2008 dks fo'ks"kK desVh dh fjiksVZ dh dafMdk 5] 12] 15 ,oa 16 esa ¼i`"B 68] 70 ,oa 71½ fuEukuqlkj mYys[k fd;k x;k gS %&

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"5. On 21.05.2003 patient's urine output started falling. Patient had tachycardia. Patient was then examined by Dr. A. Bandi as per the case records and Dr. Parag Agarwal Cordiologist. At. 21.00 hours patient was started on Injection Tazact. From the observed I/O charts shown to the committee, patients B.P. had fallen to94/70 mmHg. Patient was then started on injection Dopamine at 23 hours on 21.05.2003.
On 21.05.2003 blood gases showed deterioration of Po2 68.1mm of Hg & PCo2 of 36.3 of Hg.
On 21.05.03 X-ray chest and USG was done which revealed left pleural effusion,about 600ml of pleural fluid was aspirated on 22.05.03.
On 22.05.2003 spiral C.T. chest revealed consolidations both lungs. Blood gases showed deterioration on 23.05.2003 with PO2 57.5 mm of Hg ad PCO2 39 mm of Hg.
12. On 21.05.2003 during first 12 hours of post operative period patient received excess fluids - 4 liters. Patient passed only 1200 C.C. of urine during this period.
15. At re-cxploration bile was noticed in peritoneal cavity duc to leak of the sutured perforation. The observed finding of leak at the second operation explained the septicemia after the first operation. The committee therefore is of the view that the perforation had leaked after the first operation giving
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rise to Bacterial Peritonitis and the patient therefore was in sepsis during the period from first to second operation.
16. The HR C-T on 22-05-2003 shows large consolidation involving the posterior basal segment of the both L L (LT>RT) and reactionary pleural effusion on Rt. Side X-ray chest and USG showed pleural fluid and on tapping there was 600ml of fluid in chest on Lt side. All these findings along with persistent hypoxia on serial blood gas reports suggest acute respiratory distress syndrome a known outcome of septicemia."

50- mDr rF;ksa ds vkyksd esa ;g O;Dr fd;k x;k gS fd ejht fnyhi vxzoky dks lsIVhlhfe;k ,oa tstquksVkeh dk tks nwljk vkijs'ku fd;k x;k gS] og vlQy jgk gS rFkk e`rd fnyhi vxzoky dks lsIVhlhfe;k ds dkj.k cSDVsfj;y isfjVksukbfVl gqvk gS vkSj mlds dkj.k gh mls acute respiratory distress syndrome.(ARDS) ¼i`"B71½ mRiUu gqvk vkSj mldh e`R;q gqbZ gS %& bl laca/k esa fo'ks"kK lfefr dh lnL; MkW- yrk lqfuy fcfpys dks] fo'ks"kK lfefr dh fjiksVZ ds iSjkxzkQ 12 ij] mudk /;ku foi{khx.k ds vf/koDrk }kjk vkdf"kZr djus ij] muds }kjk crk;k x;k gS fd %& "The fluid appears excess as subsequently the patient went into ARDS with hypo tension.

I conider Harison's Principles of Internal Medicines as Geeta for us. The witness referred. Harrison's Principles of Internal Medicines 16th Edition at page 1606 wherein the last paragraph it is stated 'The primary goal...1 to 2 hour' I agree to the proposition laid

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down. After refering the record. The witness states that infusion 4 ltrs. Of fluids that is administered there is no mention of time or duration over which this 4 ltrs. Fluids is infused to the patient. foi{khx.k ds vf/koDrk }kjk iz'u iwNk x;k fd %& Q. I put it to you that the infusion of 4 ltrs. Of fluid was primarily done to avoid hypo tension?" ftl ij mDr fo'ks"kK lk{kh }kjk mRrj esa "I Agree" dFku fd;k x;k gSA 51- mDr lanHkZ esa fopkj djrs gq, ;g ik;k tkrk gS fd MkW- vfuy c{kh ftuds }kjk fnyhi vxzoky dk izFke vkijs'ku fd;k x;k Fkk] mudk izfrijh{k.k ifjoknh ds fo}ku vf/koDrk ds }kjk Hkh fd;k x;k gS ftlesa muds }kjk iz'u Ø-24 ,oa 25 ds mRrj esa fuEukuqlkj O;Dr fd;k x;k gS %& "24. The I.V.fluids given in present situation were essential for the treatment of septic shock and not for planned routine surgery. This has already been elaborated in para 8 of my reply.

25. This is denide in want of more information."...

52- bl lanHkZ esa iwjh fpfdRlh; fjiksVZ dk v/;;u djus ds mijkUr fo"ks"kK desVh ds lnL; MkW- cyoar fnxacj lkear ds }kjk iz'u Ø-2 ds mRrj esa ;g crk;k x;k gS fd fnyhi vxzoky dks tks Hkh ,aVhck;ksfVd bR;kfn nh x;h gS ] og fu/kkZfjr ekud ds vuqlkj gh jgh gS rFkk mUgkaus s viuh lk{; esa ;g Hkh Lohdkj fd;k gS fd fnyhi vxzoky dks mlh {k.k lsIVhlhfe;k izkjaHk gks x;k Fkk] tc pkdw ls mldh vkar dks pksVsa igqapkdj] ?kko }kjk mls fonh.kZ fd;k x;k Fkk rFkk mDr pkdw tks fd lftZdy pkdw Hkh ugha FkkA mlls laØe.k izkjaHk ls gh dkfjr gksuk ,d LokHkkfod ifjfLFkfr nf'kZr gks jgh gSA

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53- ifjoknhx.k dh vksj ls ;g Hkh rF; vk{ksfir fd;k x;k gS fd ejht fnyhi vxzoky dks vLirky esa HkrhZ jgus ds nkSjku] mlds 'kjhj esa vkDlhtu dh ek=k dks fu;fer ¼Meintained½ ugha j[kk x;k gS rFkk bl lanHkZ esa fo'ks"kK lfefr dh fjiksVZ fnukad 14-05-2008 ds isjk 14 ist&70 fuEukuqlkj gS %& "14. Patient's oxygenation was not being maintained in spite of oxygen by mask and it is observed that the patient was not given any mechanical ventilatory support during this time in spite of falling oxygenation."

54- mDr lanHkZ esa fo'ks"kK lfefr dh lnL; MkW- Jherh yrk lquhy fcfpys ds }kjk vius izfrijh{k.k esa ¼i`"B 83½ iz'u Øekad 23 ds mRrj esa ;g crk;k x;k gS fd ejht dks eSdsfudy osaVhysVj liksZV] ftlds ek/;e ls ejht esa 'okal ysus dh {kerk vkDlhtu dh lar`Irrk¼Sachuration½ osaVhyVj ds ek/;e ls cuk;h tkrh gS rFkk ;g Lohdkj fd;k x;k gS fd ejht lqlaxr le; esa lrr~ baVsfa lo ds;j ;wfuV esa MkWDVjksa ds vkCtosZ'ku esa jgk gS rFkk mls uscqykbZts'ku ,oa fQft;ksFksjsih Hkh nh x;h gS rFkk ;g O;Dr fd;k x;k gS fd ejht dh 'olu xfr 36 Fkh u fd 56] rFkk ;g Hkh Lohdkj fd;k x;k gS fd esdsfudy osaVhysVj dk Hkh lkbM bQsDV gksrk gS] ijUrq ;g O;Dr fd;k x;k gS fd ejht dks thfor jgus gsrq esdfs udy osaVhysVj ,d izHkkoh ek/;e gS] ijUrq ;g Lohdkj fd;k x;k gS fd ejht dk fnukad 24-05-2003 dk SPO2/94 Fkk ¼ist 85½ rFkk tks fd vlkekU; ugha Fkk rFkk ejht lHkh funsZ'kksa dk ikyu dj jgk FkkA bl lanHkZ esa fo}ku vf/koDrk ds }kjk gSfjlu dh fy[kh gq, iqLrd fizalhiy vkQ baVjuy esfMlhu dk 16oka ikVZ 1 ds fgLls dks lacaf/kr lk{kh dks fn[kkdj iwNs tkus ij] muds }kjk ;g Lohdkj fd;k x;k gS fd izLrqr ekeys esa ejht dks esdsfudy osaVhysVj liksVZ dh vko';drk ugha Fkh rFkk tks Hkh bfPNr ifj.kke ,oa izHkko izkIr djus dh izR;k'kk Fkh] og uscqykbts'ku ,oa izkd`frd vkDlhtu

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,oa fQft;ksFksjsih jslik;jsDVªh V;wc ds ek/;e ls izkIr dj yh x;h FkhA bl izdkj mijksDr lk{; ls] tks ifjoknhx.k ds }kjk ;g rF; vk/kkfjr fd;k x;k Fkk fd ejht fnyhi vxzoky dks mlds bykt ds nkSjku i;kZIr vkDlhtu dh ek=k dks ejht ds jDr esa fu;fer ugha j[kk x;k Fkk] ;g rF; Hkh vlR; ik;k tkrk gS rFkk mDr dkj.kksa ls tks foi{kh vLirky ,oa mlds fpfdRldksa dh mis{kk dk vk/kkj fy;k x;k gS] mls Hkh Lohdkj ;ksX; ugha ik;k tkrk gSA 55- ifjoknh cchrk vxzoky ,oa ifjoknh ds vU; lkf{k;ksa ds }kjk vius ifjokn i= ,oa 'kiFk i=ksa esa ;g rF; Hkh vk/kkfjr fd;k x;k gS fd fpfdRldksa ds }kjk nwljs vkijs'ku dh ifjfLFkfr crk;s tkus ij] fnyhi vxzoky ds isV esa ikuh Hkj tkuk rFkk vkijs'ku dj ikuh fudky nsx a s] mls ;g crk;k x;k Fkk] ijUrq muds }kjk fnukad 20-05-2003 dks 10 ?k.Vs dh nsjh ls fnyhi vxzoky dk RTA fd;s tkus ds dkj.k mls isfjVksukbZfVl is:Vqy lsIVhlhfe;k gksus ds rF; dks fNikdj dsoy isV ls ikuh fudkyus gsrq] muls vkijs'ku dh lgefr fy;k tkuk] ijUrq fnyhi vxzoky dk dksysLVkeh vkijs'ku fd;s tkus dk rF; O;Dr fd;k x;k gSA 56- bl lanHkZ esa fopkj djrs gq, ;g ik;k tkrk gS fd ejht fnyhi vxzoky dk nwljk vkijs'ku djus okys fpfdRld MkW- v'kksd yM~Mk us vius izfrijh{k.k ds iz'u 26] 27] 28] ,oa 29 dk fuEukuqlkj mRrj fn;k x;k gS %& "26. The provisional diagnosis of Enterocutaneous Fistula was made in view of the grievous injury to the intestine inflicted by stabbing for which the first surgery was performed. In view of the worsening septicemia and this provisional diagnosis, decision to re-explore the abdomen was taken and explained to the relatives.

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27. Enterocutaneous biliary fistula means leaking of intestinal{Enteric} contents from damaged and perforated intestine. jejunum in the present case, and as the jejunum contains bile hence it is termed as Enterocutaneous Biliary Fistula. It dose not have a length. It was not from the colon, in which case it is called a Colo-cutaneous fistula.

28. ... I did not perform any colostomy operations, as it was not at all indicated.; The operations notes are true and comprehensive as per the norms of principles of Good Surgery. The operation notes written on the Post-operative sheet are as below :

Exploration done thru previous incision with upward extension. Bilious collection about 250 ml. Leak from previous jejunal perforation. In view of peritonitis, same perforation was brought out as jejunostomy Loop. Lavage done. Drain left in splenic recess. Tension sutures. Closure in single layer with 1'0' Lolp Nylon. Skin with 2'0' Nylon. patient stood surgery well.
The Colostomy bag is a plastic bag used to collect secretions, coming out of the intestine, which has been brought out. It is not necessary for the said bag to be used only for the colon.
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29 The Bile peritonitis was the result of leakage from the damaged intestine and not the cause of damage to the intestine. The operations notes are true description of my operative findings and procedure performed."

57- MkW- v'kksd yM~Mk ds }kjk muds izfrijh{k.k ds iz'u Ø-30 ds nkSjku ;g crk;k x;k gS fd ejht }kjk fnukad 24-05-2003 dks vkijs'ku ds ckn gYdk Hkkstu ysuk izkjaHk fd;k x;k Fkk rFkk mldh e`R;q ds 1 fnu iwoZ og gYdk Hkkstu Hkh] mlds fpfdRlh; fjdkMZ ds vuqlkj ys jgk FkkA tgka rd ejht dh ;qjhu esa [kwu vkus rFkk mls fdMuh Qsy gksus ds laca/k esa] mDr fpfdRld ds }kjk iz'u Øekad 34 ds mRrj esa ;g crk;k x;k gS fd ejht dks ;qjhu ikl djus gsrq dSFksVj yxk;k x;k Fkk] ftlesa [kwu ds dqN jslst] ew= esa ns[ks x;s Fks vkSj mldk dkj.k ;g gS fd dSFksVj yxkrs le; ekbuj batwjh vkuk laHko gS] ijUrq mlds dkj.k fdMuh Qsy gksuk ugha ekuk tk ldrk gS vkSj CyM ;qfj;k esa] rFkk ØsVsukbZu ds Lrj esa dksbZ c<+ksRrjh ugha gqbZ FkhA ,slh n'kk esa mDr lk{kh ds vuqlkj ejht esa vkijs'ku ds nkSjku vkDlhtu dk Lrj fu;fer ugha j[kus dk rFkk fdMuh Qsy gks tkus dk tks Hkh vk/kkj foi{kh vLirky ,oa mlds fpfdRldksa dh mis{kk ds rF; dks crkus ds lac/a k esa] fnyhi vxzoky ds bykt ds nkSjku cjrs tkus dk vk/kkj fy;k x;k gS] mls Hkh Lohdkj ;ksX;

ugha ik;k tkrk gSA


58-            ifjoknhx.k     }kjk    ¼314½     PHARMACOLOGY                  AND

PHARMACO THERAPEUTICS Fksjsih dh iqLrd 18oka laLdj.k ys[kd MkW- vkj-,l- lkrksldj dh iqLrd dk m)j.k nsdj] laØe.k ds laca/k esa ;g rdZ fd;k x;k gS fd fnyhi vxzoky dk tks Hkh vkijs'ku gqvk] mleas foi{kh fpfdRldksa dh ykijokgh ls gh] izFke vkijs'ku ds Vkads <hys gksus ls] mlesa ls vkar ls fQdy eVsfj;y dk fjlko gqvk] ftlds dkj.k fnyhi vxzoky dks lsIVhlhfe;k dkfjr gqvk

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rFkk tks Hkh ,aVhck;ksfVd dk iz;ksx gqvk gS og izHkko'khy ugha jgk gS] vfirq muds dkj.k ejht ds vaxksa dks izHkkfor fd;k x;k gS rFkk bl lanHkZ esa muds }kjk Bailey & Love's 'kY; fpfdRlk ds lanHkZ esa 24oka laLdj.k dh iqLrd ds m)j.k dks Hkh izLrqr fd;k x;k gS rFkk MsfoMlu dh iqLrd ¼i`"V 365½ Principles and Practice of Medicine 18oka laLdj.k dk m)j.k Hkh izLrqr fd;k x;k gS] ijUrq bl lanHkZ esa tks fo'ks"kK lfefr fu;qDr jgh gS] mlds lnL; MkW- cyoar fnxacj lkear ds }kjk viuh izfrijh{k.k lk{; esa e`rd fnyhi vxzoky ds bykt ds nkSjku] tks izfØ;k ,oa ,aVhck;ksfVd bR;kfn mls fu/kkZfjr fd;k x;k Fkk] mls rR;e; izpfyr fu/kkZfjr ekudksa ds vuqlkj gh gksuk crk;k x;k gS rFkk ;g Hkh Lohdkj fd;k x;k gS fd ftl {k.k fnyhi vxzoky dks pkdw ?kksaik x;k Fkk] mlh {k.k ls mls lsIVhlhfe;k dh 'kq:vkr gqbZ Fkh rFkk mldh vkar dks pkdw ls pksV igqapkdj fonh.kZ fd;k x;k rFkk tks pkdw pksV igaqpkus esa mi;ksx fd;k x;k Fkk] tks ejht fnyhi vxzoky ds 'kjhj esa ?kksaik x;k Fkk] mlls gh igqaph pksV dks ejht fnyhi vxzoky dh e`R;q dk dkj.k crk;k tk jgk gS] og laØe.k mls HkrhZ gksrs le; gh] fodflr gksuk izkjaHk gks x;k FkkA 59- foi{kh Ø-1 vLirky dh vksj ls fo}ku vfHkHkk"kd ds }kjk U;k; n`"Vkar Hkxokunkl ,oa vU; fo:) LVsV vkQ jktLFkku ,-vkbZ-vkj 1957¼lq-dks-½ 589 ¼dafMdk&13½] izrki feJk ,oa vU; fo:) LVsV vkWQ mM+hlk ,-vkbZ-vkj- 1977¼lq-dks½ 1307 dk ¼isjk&5½] dqlk ,oa vU; fo:) LVsV vkWQ mM+hlk ,-vkbZ-vkj- 1980¼lq-dks½ 559 dk ¼isjk 8½] larks"k dqekj flag fo:) LVsV }kjk lh-ch-vkbZ- 2011 ,-vkbZ-vkj- ,l-lh-MCY;w- 3647 dk ¼isjk 14½] ds izLrqr dj ;g rdZ fd;k x;k gS fd fpfdRlh; lkfgR; ds m)j.k dks lacfa /kr fpfdRlh; lk{kh ds le{k ijh{k.k ds nkSjku j[kdj] ;fn mldk lkeuk fpfdRld ls djkdj] mlds fo"k; esa mldh jk; izkIr ugha dh x;h gks] rks U;k;ky; Lo;eso fpfdRlh; lkfgR; dk iz;ksx djrs gq, dksbZ Hkh fu"d"kZ

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ugha fudky ldrk gS] D;ksfa d oSKkfud lk{; vR;ar rduhdh fo"k; gksrk gS rFkk ml ij fo'ks"kK dh jk; gh egRoiw.kZ gksrh gSA 60- bl lanHkZ esa gekjs le{k izLrqr ekeys esa eku~uh; jk"Vªh; vk;ksx }kjk xfBr fo'ks"kK lfefr ds fpfdRldksa dh jk; vo'; gh] foi{kh vLirky ,oa mlesa ls e`rd fnyhi vxzoky dk bykt esa la;qDr jg pqds fpfdRldksa dks ftUgsa foi{kh i{kdkj ds :i esa la;ksftr fd;k x;k gS] muds le{k fpfdRlh; lkfgR; dks j[kdj mudk izfrijh{k.k vo'; gh ugha fd;k x;k gS] ijUrq ftu fo"k;ksa dks ifjoknhx.k ds }kjk ifjokn esa mBk;k x;k gS rFkk mDr lanHkZ esa ifjoknhx.k ds fo}ku vf/koDrk ds }kjk] foi{kh vLirky ds fpfdRldksa ls mudk izfr ijh{k.k Hkh fd;k x;k gS] blfy, mDr U;k; n`"Vkarksa ds lanHkZ esa izfrikfnr fd;s x;s U;k; fl)kar ds izfr iw.kZ lEeku O;Dr djrs gq,] mudk ;gh fu"d"kZ fudyrk gS fd fpfdRlh; lkfgR; ds vk/kkj ij gh foi{kh vLirky ,oa mlds fpfdRldksa ds }kjk] tks fd fnyhi vxzoky dh fpfdRlk esa layXu jgs gSa] muds }kjk mis{kkiw.kZ rjhds ls fnyhi vxzoky dh fpfdRlk] fnukad 19-05-2003 ls mldh e`R;q ds iwoZ fnukad 05-06-2003 ds e/; rd] fd;s tkus dk dksbZ Hkh fu"d"kZ ugha fn;k tk ldrk gSA 61- foi{khx.k dh vksj ls vU; U;k; n`"Vkar Antonio Dias Caldeira v/s Frederick Augustus Gray Air 1935(PC) 154 dk Hkh izLrqr fd;k x;k gS] ftlesa fpfdRlh; lk{; ds lanHkZ esa] ek= vVdyksa ds vk/kkj ij rFkk ek= fl)karksa ds vk/kkj ij Li"V fu"d"kZ ugha fudkyk tkuk pkfg,] vfirq tks Hkh lk{; O;kogkfjd :i ls] mDr ifjfLFkfr fo'ks"k esa miyC/k gksxh mlh ij fopkj djrs gq, U;k;ky; dks viu fu"d"kZ ys[k djus dk U;k; fl)kar izfrikfnr fd;k x;k gS rFkk U;k; n`"Vkar tsdc eSF;w fo:) LVsV vkWQ iatkc ,oa vU; fØfeuy vihy uacj 144&145@2004 fu.kZ; fnukad 05-08-2005 dk Hkh izLrqr fd;k x;k gS] ftlesa fpfdRldksa dh mis{kk ds lanHkZ esa ;gh U;k; fl)kar izfrikfnr fd;k x;k gS fd fcuk

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fo'ks"kK dh lk{; ds lk/kkj.kr% fpfdRldksa dh mis{kk] ejht ds bykt ds laca/k esa gksus dk fu"d"kZ ugha fudkyuk pkfg,] D;ksfa d fpfdRld ,d ;ksX; O;fDr gksrk gS rFkk mlds }kjk Hkjld iz;Ru] vius ejht ds fy, LokLF; ykHk izkIr djus gsrq iz;kl fd;k gh tkrk gSA 62- blh izdkj ls U;k; n`"Vkar Ms. Ins. Malhotra v/s Dr. A. Kriplani & ors. flfoy vihy uacj 1386@2001 fu.kZ; fnukad 24-03-2009 dk Hkh izLrqr fd;k x;k gS] ftlesa isV esa tyu ds dkj.k ,- eYgks=k dks fnukad 24-08- 2003 dks ckEcs gkfLiVy esa HkrhZ fd;k x;k] tgka i'pkr~orhZ fLFkfr esa bykt ds nkSjku mldh e`R;q gks x;h Fkh] ftl ij fpfdRldksa ds }kjk fiz;k eYgks=k dks fizVksukbZfVl dh chekjh ds lkFk mldh fdMuh dks Qsy gks tkus dk fu"d"kZ fn;k x;k FkkA ftlesa fiz;k eYgks=k] tc vLirky esa HkrhZ gqbZ Fkh] rks mls mYVh ,oa nLr ls ihfM+r gksus ds dkj.k HkrhZ gksus ds 4 ?k.Vs iwoZ ls gh Fks] ,slh n'kk esa fpfdRldksa dh mis{kk ds dkj.k mldh e`R;q gksus dk rF; lkfcr ugha ekuk x;k gS rFkk vU; U;k; n`"Vkar dqlqe 'kekZ ,oa vU; fo:) c=k gkfLiVy ,.M esfMdy fjlpZ lsVa j ,oa vU; flfoy vihy uacj 1385@2001 fu.kZ; fnukad 10-02-2010¼lq-dks-½ dk Hkh izLrqr fd;k x;k gS] ftlesa Hkh eku~uh; loksZPp U;k;ky; us ;g U;k; fl)kar izfrikfnr fd;k gS fd fpfdRldksa ds }kjk vius drZO;ksa dk mfpr :i ls ikyu fd;k x;k gks] rFkk viuh O;kolkf;d dq'kyrk ,oa iw.kZ ;ksX;rk ds lkFk ejht dk bykt fd;k x;k gks ] rks mls vuisf{kr ifj.kke vkus ds vk/kkj ij] fpfdRlh; mis{kk dk nks"kh ugha ekuk tkuk pkfg,A 63- foi{kh dh vksj ls ,d vU; U;k; n`"Vkar vpqrjko gfjHkkm [kksnok fo:) LVsV vkQ egkjk"V ,oa vU; 1996 ,l-lh-lh-¼2½ 634 fu.kZ; fnukad 20-02- 1996 dk Hkh izLrqr fd;k x;k gS] ftlesa Hkh eku~uh; loksZPp U;k;ky; ds }kjk ifjoknh vpqrksjko gfjHkkm [kksnok dh iRuh pafnzdk ckbZ dh ulcanh vkijs'ku ds nkSjku e`R;q gks tkus ij] mDr izdj.k ds rF;ksa ij fopkj djrs gq, pafnzdk ckbZ dk vkijs'ku ds

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nkSjku mlds isV esa eki NwV tkus ds dkj.k pafnzdk ckbZ ds isV esa fizVksukbfVl fodflr gqvk] ftlds i'pkr~ mldh e`R;q gks x;h rFkk og vLirky ls thfor ugha cp ik;h rFkk e`frdk pafnzdk ckbZ ds isV esa eki dh ekStwnxh ds lac/a k esa foi{kh fpfdRldksa }kjk dksbZ larks"ktud Li"Vhdj.k ugha nsus ds dkj.k gh mDr ekeys esa foi{kh vLirky ,oa mlds deZpkjh fpfdRld MkW0 nhoku dh mis{kk ls gh] e`frdk pafnzdk ckbZ dks fizVksukbZfVl mRiUu gksuk rFkk mlds bykt ds nkSjku mldh e`R;q gks tkus ls mDr fpfdRld ds lkFk&lkFk mlds fu;kstd egkjk"Vª jkT; dks Hkh] mDr fpfdRld dh mis{kk gsrq mRrjnk;h ekurs gq, fopkj.k U;k;ky; ds fu.kZ; dh iqf"V dh x;h FkhA 64- ekuuh; loksZPp U;k;ky; us vius ,d vU; fu.kZ; ckEcs gkLihVy ,.M esfMdy fjlpZ lsaVj fo:) vk'kh"k tSloky] ,-vkbZ-vkj- 2022¼lq-dks-½ 204 ds ekeys esa ;g U;k; fl)kar izfrikfnr fd;k x;k gS fd fpfdRldksa ls ;g vis{kk gksrh gS fd os mfpr ns[kHkky vius ejht dh djsaxs] ijUrq dksbZ Hkh fpfdRlh; is'ksoj ds }kjk] vius ejht dks ;g fuf'pr vk'oklu ugha fn;k tk ldrk gS fd] og vkijs'ku dh 'kY; fØ;k ds mijkUr] Bhd gh gks tkosxk rFkk ek= bl vk/kkj ij fd 'kY; fØ;k mijkUr] ejht ds bykt ds lanHkZ esa visf{kr ifj.kke dks izkIr ugha fd;k tk ldk Fkk rFkk ejht dh e`R;q gks x;hA ,slh n'kk esa e`R;q dk dkj.k] ,d ek= fpfdRlh; mis{kk dks ekU; ugha fd;k tk ldrk gS] ;fn fpfdRld ds }kjk vius O;kolkf;d dq'kyrk ls ejht dk bykt fd;k x;k gksA 65- izLrqr ekeys esa Hkh] ejht fnyhi vxzoky fnukad 19-05-2003 dks foi{kh Ø-1 vLirky esa HkrhZ gqvk Fkk tgka fd foi{kh vLirky ds fpfdRldksa ds }kjk mldh 'kY; fØ;k djrs gq,] mldh vkar esa igqaph gqbZ pksV dk vkijs'ku dj] vkar ds ?kko dks fjis;j fd;k x;k Fkk] ijUrq nqHkkZX;o'k dkykarj esa fnyhi vxzoky dh e`R;q] bykt ds nkSjku gh fnukad 05-06-2003 dks gks x;h FkhA ftlds lanHkZ esa foi{kh vLirky ,oa mlds fpfdRldksa ds fo:) fnyhi vxzoky ds bykt esa fpfdRlh; mis{kk dk vk{ksi]

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ifjoknhx.k ds }kjk yxk;k x;k gS] ijUrq ftu vk/kkjksa ij mDr vk{ksi] foi{kh vLirky ,oa mlds fpfdRldksa ds fo:) vk/kkfjr fd;k x;k gS] ds lHkh vk/kkj mijksDr foospuk ds vkyksd esa lkfcr ughas ik;s tkrs gSaA 66- tgka rd mlh ?kVuk esa] ,d vU; vkgr euh"k vxzoky dks Hkh tks batwjh¼pksV½ igqaph Fkh] ftldk Hkh bykt xksdqynkl vLirky] bUnkSj esa gqvk Fkk rFkk mldk Hkh vkijs'ku fnukad 22-05-2003 dks gqvk Fkk rFkk og Bhd gks x;k Fkk] ijUrq ml lanHkZ esa euh"k vxzoky dk fMLpktZ fVfdV ^izn'kZ lh&8^ ¼i`"B 168½ vo'; gh izLrqr fd;k x;k gS] ftlesa mlds isV esa iQksZjs'ku] fpfdRldksa }kjk crk;k x;k Fkk] ijUrq ^izn'kZ lh&8^ esa tks euh"k vxzoky dh pksVsa Fkh] mlesa mlds isjhVksfu;e esEcjsu dks QVus dk rF; izdV ugha gks jgk gS] tcfd ejht fnyhi vxzoky dh vkar esa tqtsue ds ikl Nsn ;qDr ?kko¼iQksZjs'ku½ gksuk fpfdRlh; nLrkostksa ls izdV gks jgk gSA ek= blh dkj.k ls euh"k vxzoky dks vkbZ pksV dk bykt xksdqynkl vLirky] bUnkSj esa gksus ls mldk thou cp x;k gS] ijUrq mlh ?kVuk esa fnyhi vxzoky dks tgka pksV ds dkj.k tks foi{kh Ø-1 vLirky esa bykt ds nkSjku mldh e`R;q gks x;h rks] mldk dkj.k ;g ugha ekuk tk ldrk gS fd fnyhi vxzoky ds bykt esa foi{kh Ø-1 vLirky ,oa mlesa dk;Zjr foi{khx.k fpfdRldksa ds }kjk bykt esa mis{kk ,oa mrkoysiu vFkok ykijokgh ls dk;Z fd;k x;k gSA 67- ;gka ;g mYys[k djuk fo"k;karj ugha gksxk fd fnyhi vxzoky dks tks Hkh pksVs]a ywV dh ?kVuk esa yqVsjksa }kjk Jherh mek xqIrk dh yqVsjksa }kjk psu [khapus ds nkSjku] e`rd fnyhi vxzoky ,oa euh"k vxzoky ds }kjk chp cpko djus rFkk yqVsjksa dks idM+us ds Øe esa] yqVsjks }kjk mlds isV esa pkdw ls pksV dkfjr fd;k x;k Fkk] ftlds lanHkZ esa iqfyl Fkkuk la;ksfxrk xat] bUnkSj e-iz- esa pksV igqapk;s tkus okys O;fDr;ksa@yqVsjksa ds fo:) ntZ vijk/k] ftlesa yqVsjksa }kjk mek xqIrk ds lkeku dh j{kk djrs le; fnyhi vxzoky ,oa euh"k vxzoky dks pksVsa vo'; gh vkbZ Fkh] rFkk dkykarj esa iqfyl Fkkuk la;ksfxrkxat esa fnyhi vxzoky dk bykt djus okys

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fpfdRld MkW- vfuy c{kh ,oa MkW- th-,l- ekyikuh foi{khx.k fpfdRldksa rFkk LVkQ ds fo:) iqfyl Fkkuk la;ksfxrkxat] ftyk bankSj esa vijk/k Øekad 482@2003 /kkjk 304¼,½ Hkk-na-la- ds varxZr] vijk/k iathc) fd;k x;k gS] ftlesa mDr fpfdRldksa dh mis{kk vFkok mrkoysiu ls fnyhi vxzoky dk mipkj djus ds vk/kkj ij ?kVuk fnukad 19-05-2003 ds mijkar fnukad 05-06-2003 dks vFkkZr 16 fnu ckn e`R;q gks tkus dk rF; mYysf[kr fd;k x;k gS ;|fi mDr lanHkZ esa dksbZ vafre fjiksVZ iqfyl ds }kjk vUos"k.k mijkUr izLrqr fd;k x;k gks og gekjs le{k izLrqr ugha gS] ijUrq izLrqr ekeys esa tks fpfdRldksa dh fnyhi ds bykt esa fpfdRlh; mis{kk dk fu"d"kZ fudkys tkus gsrq] vfHkys[k mHk;i{k dh vksj ls izLrqr fd;k x;k gS] mldh lE;d foospuk mijkUr ;gh fu"d"kZ fudyrk gS fd foi{kh vLirky ,oa mlds fpfdRldksa foi{kh Ø-2 yxk;r 8 ds }kjk] e`rd fnyhi vxzoky dh fpfdRlk esa vius drZO;ksa dk lE;d :i ls fuokZg fd;k x;k gS rFkk miyC/k lk{; ds vk/kkj ij foi{khx.k dh mis{kk vFkok mrkoy siu ls bykt fd;s tkus dk fu"d"kZ fudkyk tkuk] fof/klEer ugha ik;k tkrk gSA 68- ;gka ;g Hkh mYysf[kr fd;k tkuk fo"k;karj ugha gksxk fd e`rd fnyhi vxzoky ds }kjk dks mek xqIrk dh yqVsjksa ls j{kk djus ds nkSjku] vius izk.kksa dh vkgqfr nsus ds dkj.k] mls Hkkjr ljdkj] j{kk ea=ky; }kjk ej.kksijkUr ^^'kkS;Z pØ^^ fn;k x;k gS] ftldks e`rd fnyhi vxzoky dh iRuh }kjk izkIr fd;k x;k gS rFkk e/;izns'k jkT; ds }kjk Hkh mls cgknqjh iqjLdkj esa] Lo.kZ ind ls lEekfur fd;k x;k gS rFkk vlkekftd rRoksa ls mek xqIrk dh j{kk ds fy, viuh tku dh vkgqfr nsus dk rF; Hkh mYysf[kr gSA 69- ,slh n'kk esa fu'p; gh] fnyhi vxzoky ds }kjk ,d ohjksfpr dk;Z djrs gq, og yqVsjksa }kjk vkgr gqvk gS] blfy, fu'p; gh og lEeku dk gdnkj vo'; jgk gS] ijUrq ek= fnyhi vxzoky dh nq?kZVuk esa dkfjr pksVksa ds dkj.k] mldh e`R;q gks tkus ds QyLo:i] foi{kh vLirky ,oa mlds fpfdRldksa dh mis{kk dk

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fu"d"kZ fudkyk tkuk] izdj.k esa miyC/k lk{; ds vkyksd esa fof/kiw.kZ ugha ik;k tkrk gS] QyLo:i ifjoknhx.k dk ;g ifjokn iks"k.kh; ugha ikrs gq, vfirq fujLr fd;s tkus ;ksX; gksuk ik;k tkrk gSA 70- mijksDr foospuk ds vkyksd esa ifjoknhx.k dk ;g ifjokn Lohdkj ;ksX; ugha ikrs gq, vfirq fujLr fd;s tkus ;ksX; ik;s tkus ls rnuqlkj ifjokn dks fujLr fd;k tkrk gSA 71- izdj.k dh lai.w kZ ifjfLFkfr;ksa ij fopkj djrs gq, ifjokn dk O;; mHk;i{k viuk&viuk Lo;a ogu djsaxs] ;g vknsf'kr fd;k tkrk gS ¼MkW0 JhdkUr ik.Ms;½ ¼Mh0ds0 JhokLro½ ihBklhu lnL; lnL;

ikjs

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ifjokn Ø- 01@2005 cchrk vxzoky o vU; 05 fo:) lq;'k gkfLiVy] }kjkizca/kd lapkyd o vU; 07 fopkjkFkZ ¼Jh Mh0ds0 JhokLro½ lnL; 

ekuuh; MkW0 JhdkUr ik.Ms;              % ihBklhu lnL;




                            ¼fnukad          @03@2023 dks fu;r½


                                         ¼MkW0 JhdkUr ik.Ms;½
                                          ihBklhu lnL;
                                        - 43 -




72-          Hkxokunkl ,oa vU; fo:) LVsV vkQ jktLFkku ,-vkbZ-vkj 1957¼lq-
dks-½ 589 dafMdk&13 fuEukuqlkj gS %&

13. The learned Sessions judge w as of the opinion that the evidence of the doctor P.W. II made the story that Shivlal could walk for a little distance up to the Khala of H-----------