State Consumer Disputes Redressal Commission
Shilpa Datla vs 1. Smt. Dr. A. Pranathi Reddy on 20 April, 2023
1
BEFORE THE TELANGANA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION:HYDERABAD
(ADDITIONAL BENCH)
C.C.77/2016
Between :
Shilpa Datla , W/o.Ashwin Datla,
Aged: 33 years, Occ:Business,
R/o.102, Serenity,
Plot no.415, Road No.22,
Jubilee hills,
Hyderabad - 500 033. ...Complainant
And
1.Smt Dr.A.Pranathi Reddy, Aged : Major, Occ:Doctor, C/o.Rainbow Hospitals, Children's Hospital & Perinatal Care, 22, Road No.4, ( Old road no.10) Banjara Hills, Hyderabad - 500 034.
2. Rainbow Hospitals, Children's Hospital & Perinatal Care, 22, Road No.4, ( Old road no.10) Karvy Lanes, Banjara Hills, Hyderabad - 500 034. ... Opposite parties.
Counsel for the Complainants : M/s.M.Papa Reddy Counsel for the Opposite Parties : M/s.D.Narendar Naik CORAM : Hon'ble Sri V.V.Seshubabu, M ember (J), And Hon'ble Smt.R.S.Rajeshree, M ember (NJ).
THURSDAY, THE TW ENTIETH DAY OF APRIL, TW O THOUSAND TW ENTY THREE .
Order : (Hon'ble Sri V.V.Seshubabu, M ember (J), *****
01). The complaint is filed on 30.4.2016 u/s.17(1)(a)(i) of the Consumer Protection Act, 1986 claiming Rs.1 crore towards damages i.e. for the expenses incurred for the treatment and for mental agony of the deceased Smt.K.Durga Devi with joint and several liability against opposite parties 1 & 2.
02). The brief averment of the complaint are that the opposite party no.1 is a doctor working in the oppositie party no.2 hospital;
2that mother of complainant by name Smt.Durga Devi took treatment under opposite party no.1 from 2009 to 2012 for her gynic problem (hereinafter will be referred as deceased); that the deceased was born on 17.2.1961 and had a history of living healthy life till her menopause reached in the year 2007-2008; that she visited opposite party no.2 hospital in the year 2009 for the post menopausal problems and was referred to opposite party no.1; that on 1.4.2009 she complained of experiencing post menopausal bleeding, leukorrhea since 4 months and pain in left iliac fossa on and off for two months; that opposite parties recorded their observations in the Out Patient Card and she was subjected to series of tests like Gynaecology ultrasound scan; that it is revealed that the uterus had a thick endometrium of 1.3 cm., and upon speculum examination it was found that there was bleeding through Ostium; that basing on the tests, the deceased was advised to undergo hysteroscopy and an endometrial biopsy and while undergoing tests polyp was removed; that the specimens of endometrial currettings and polyp were sent for biopsy, but not revealed any malignancy; that on 24.7.2009 in the post operative checkups , it was found that the uterus' endometrial thickness was 0.7 cm. and was subjected to 'pap smear' test in the first week of October,2009; that on 13.10.2009 the opposite party no.1 found no further bleeding; that papsmear test conducted on 14.10.2009 showed negative results for malignancy, however report revealed "smears show superficial, intermediate parabasal cells along with plenty of endocervical cell clusters, metaplastic squamous cells against moderate inflammation in the background" indicating that the specimen was moderately inflamed; that during the period 2009-2012 the deceased several times approached opposite party as she was not comfortable and continued to experience pain; that as an abundant precaution, the deceased had undergone a full body checkup on 19.3.2010 and this time endometrial thickness was of 10 mm. as against the normal range of 4 mm.; that the report also showed "Mild Hepatomegaly with mild fatty infiltration and Small Left Renal Cortical Cyst"; that the urine examination shows abnormal range of Leucocytes; that the Thyroid Profile and Lipid Profile results also showed abnormal results; that the deceased consulted opposite parties on 24.4.2010 and enquired about the abnormalities, but they have conducted tests of their 3 own and this time endometrial thickness of the uterus was 5 mm. and she was assured that there was nothing to worry; that the deceased bonafidely believed the opposite parties and reposed utmost trust, faith on them and their advice; that on 9.3.2011 she approached opposite parties complaining of tenderness and soreness around the breasts coupled with a regular sensation before her estimated cycles which lasted for a duration of 3-4 days; that a speculum examination was done and it was noted that the endometrial thickness was 7 mm.; that the deceased was subjected to Mammogram and Follicle Stimulating Hormone Test (FSH) and prescribed an ointment for temporary relief; that despite there being abnormality in the FSH Test, the opposite parties did not raise an alarm; that on 19.12.2012 the deceased consulted the opposite parties about post menopausal bleeding and also post coital bleeding which she noted on 6 or 7 occasions prior thereto; that the deceased was subjected to Ultra Sound Scanning of abdomen and Papsmear Test but this time also ointment and gel were prescribed without further investigation; that it is not out of place to mention that the opposite party ought to have been cautious in attending the patient and should have taken a serious note of the repeated complaints with regard to post-menopausal bleeding, coital bleeding, variance in the endometrial thickness and should have advised the deceased to consult an Oncologist in view of the symptoms shown by her indicating cancerous malignancy; that on 23.3.2013 the deceased approached Dr.Mohan Vamsy, Oncologist in the Omega Hospital who enquired about her gynaecological history and after preliminary investigation, made her to admit in the hospital, as she was found to be not normal; that on further diagnosis made on 27.3.2013 she was found with Cervicitis with Adenomyosis and hence was subjected to Hysterectomy; that at the time of operation, a sample was sent for biopsy and on conducting frozen biopsy, the histopathology it was revealed that she had Carcinoma of Cervix and it reached last stage; that during the hysterectomy operation as her lymph nodes could not be removed she was immediately to undergo radiation treatment in May- June,2013 with subsequent cycles; that she was subjected to radiation treatment at New York Presbyterian, the University Hospital of Columbia and Cornell; that the deceased was made to 4 incur huge expenditure; that the deceased continued to complain pain in the abdomen region and non bilious vomiting coupled with vaginal bleeding in June,2014 and she was diagnosed as a patient of advanced Carcinoma Cervix; that the deceased has taken treatment in Basavatarakam Indo - American Cancer Hospital & Research Institute for multiple tumours resulting in another surgery for removal of urinary tract and rectum in July,2014 and she has also taken treatment in Mediciti Hospital on 8.8.2014 and as she suffered heavy bleeding from vulvo - vaginal area as there is signs of pseudoaneurysm and ultimately succumbed on 18.1.2015; that if the opposite parties properly treated and diagnosed the problem at the earliest she would have survived for another 10 years; that as the acts of opposite parties amounts to clear negligence and they have committed deficiency in service and the complainant is being subjected to immense and untold mental agony and trauma due to the demise of her mother; that towards expenditure for treatment, Rs.50 lakhs was claimed and for mental agony and trauma another Rs.50 lakhs was claimed; hence the complaint.
03). The opposite party no.1 filed written version and the same is adopted by opposite party no.2.
The brief averments of the written version are that the complaint is not maintainable either on facts or on law; that the deceased approached opposite party no.1 on 1.4.2009 with a complaint of post menopausal bleeding along with mild leucorrehea and oft recurring pain in left iliac fossa; that on thorough examination endometrial thickness was found to be 1.3 cm. and she was subjected to hysteroscopy, polypectomy with endometrial biopsy to investigate the nature of the extra growth in the endometrial cavity, but the result clearly establishes absence of any cancer; that the patient returned for following check-ups conducted in July 2009 and October 2009, the deceased not stated about previous complaints and her endometrial thickness was reduced to 7 mm. and the Pap-smear test and trans-vaginal ultrasound scans were normal and endometrial thickness reduced to 5 mm.; that other pelvic organs remained asymptomatic of abnormal bleeding; that on 9.3.2011 the deceased complained of nipple soreness and again through 5 clinical examination of the cervix, vagina and uterus and transvaginal scan were done and they presented no signs of cancer additionally mammogram was advised to screen for breast cancer; that the patient experienced cessation of periods at the age of 46 as against the average age of Indian women of 51 years; that she was advised to undergo FSH (Follicle Stimulating Hormone) which is an indication of true menopause; that FSH levels were not truly that of a menopausal woman infact the variation in endometrial thickness is reflective of patient's hormonal status; that in December, the deceased approached with a complaint of post coital bleeding due to vagina being atropic (dry) owing to diminished estrogen level which had caused frictional bleeding after coitus; that clinical examination did reveal any overt cancer additionally pap-smear sample was taken and result shows normal; that at every stage, the opposite party no.1 performed thorough clinical examination keeping in mind appropriate differential diagnosis and ordered all relevant investigations all of which were normal without the remotest indication of cancer or pre-cancer existing; that the patient subsequently took treatment at another hospital and even there diagnosis of cervical cancer was never made and patient underwent surgery for adenomyosis and cervicitis and not cervical cancer; that the frozen section was performed and it shows surgery was halted and the specimen was sent to histopathology in view of some inadvertent findings and only an intra operative consultation alone could confirm the presence of the cancer and no diagnosis to that effect was made prior to the surgery; that the allegations against opposite party no.1 are defamatory in nature and made with the irresponsible approach; that the opposite party no.1 is highly qualified and experienced doctor who took all appropriate steps; that hidden cancer was elusive to the naked eye, imaging and histology; that the complainant is put to strict proof of all the averments made in the complaint except those that are admitted. It is to be submitted that the opposite party no.1 is highly qualified doctor having more than 25 years experience in the field of Gynaecology, having obtained MD from the renowned PGIMER, Chandigarh and she was currently registered with Indian Medical Council and Telangana Medical Council and that she is a Member of the Prestigious Royal College of Obstetricians and 6 Gynaecologists (RCOG), London and gained experience abroad at the University of Michigan, USA; that she remains academically active with current changes in her field; that opposite party no.1 gets invited as guest faculty to several scientific conferences, has numerous scientific publications to her credit; that the claim amount is exorbitant and there is no negligence at all in providing treatment. With these pleas requested to dismiss the complaint.
04). To prove the complaint, the complainant filed evidence affidavit as PW.1 and got marked Exs.A1 to A38. The opposite party no.1 in support of her pleadings filed evidence affidavit as DW.1, but no document is marked on her behalf.
The documents though filed on 30.4.2016 not reflected on the docket. Therefore, they were marked on 20.3.2023, but this time also docket dt.20.3.2023 by mistakenly not reflected the marking of documents.
05). Heard the arguments on both sides. The complainant counsel filed synopsis of written submissions besides the case law and the medical literature; so also opposite parties.
06). Now the point for determination are:
i. Whether the opposite parties are at negligent
in providing the treatment to the deceased
Smt.K.Durga Devi?
ii. Whether the complainant is entitled for the
amounts as claimed, if so to what amount?
iii. Relief?
07). Basing on the pleadings, documents, evidence and
arguments, the above points are answered like hereunder.
For the sake of convenience, the deceased Smt.K.Durga Devi will be addressed as deceased and parties will be addressed as arrayed in the complaint. It is needless to observe that complainant/PW.1 was not cross examined, so also opposite party no.1/DW.1.
08). Ex.A1 is the Death Certificate of the deceased and as per the same she died in Indo American Cancer Hospital, Banjara Hills, Hyderabad on 18.1.2015. Ex.A2 is the Passport of PW.1 in which she is mentioned as the daughter of the deceased and her father's 7 name is mentioned as Ravi and her date of birth was mentioned as 25.4.1982. With the help of Ex.A2, PW.1 proved her relationship with the deceased. In the case on hand, there is no dispute at all regarding the several approaches made by the deceased with the opposite parties and line of treatment/diagnosis made by them to the issues suffered by the deceased. It is also to be observed that the deceased took treatment from the opposite parties during the years 2009-2012 for her gynic problem viz:
i). experiencing post menopausal bleeding;
ii). leukorrhea since 4 months and pain in left iliac fossa on and off for two months (it was her first complaint when she visited opposite party no.1 on 1.4.2009). The deceased was subjected to various tests and no malignancy was surfaced in those tests.
iii). on 24.7.2009 the deceased once again approached the opposite parties for post operative checkups as she was subjected to hysterectomy and endometrial biopsy;
iv). on 19.3.2010 the deceased undergone full body checkup with whole abdomen ultrasound scan;
v). on 9.3.2011 the deceased approached opposite party with tenderness and soreness around the breasts coupled with regular sensation before her estimated cycles. This time she was subjected to Mammogram and FSH Test (Follicle Stimulating Hormone Test) and nothing abnormal was found;
vi). on 19.12.2012 the deceased approached
opposite party with a complaint of post
menopausal bleeding and also post coital bleeding which she witnessed 6-7 occasions prior thereto. This time she was subjected to ultra sound scanning of whole abdomen and pap smear test.
Except the results showing 'mature superficial intermediate squamous epithelial cells along with clusters of endocervical cells in a fluid and mucoid background showing few neutrophils' nothing abnormal was found.
809). PW.1 is accepting results of all these tests. However, it is her contention that when the deceased is complaining of problems from 2009 to 2012, the opposite parties ought to have been cautious in attending to the deceased and should have taken serious note of the repeated complaint in respect of post menopausal bleeding, coital bleeding, variance in endometrial thickness which are nothing but indication of cancerous malignancy. It may as it be there.
10). On 23.3.2013 the deceased approached Dr.Mohan Vamsi, Oncologist at Omega Hospital for the regular breast check-up as there was no positive result for the treatment given by the opposite party. Dr.Mohan Vamsi enquired about the gynaecological history and medical treatment given by the opposite parties; that after preliminary investigation they have immediately concluded that the condition of the deceased was not normal and she was made to admit in the hospital for further diagnosis; that after the admission she was thoroughly investigated and diagnosed with cervicitis with adenomyosis and hence underwent hysterectomy. While conducting operation sample was taken and sent for biopsy and on conducting frozen biopsy histopathology revealed that the deceased has carcinoma of cervix and the carcinoma has reached its last stage. Here, it is to be observed that while performing hysterectomy only biopsy was taken and a frozen biopsy was conducted in which it was found that the deceased has carcinoma of cervix. DW.1 is also contending that till the operation is performed that too during the year 2013, and only after frozen biopsy was done even the Oncologist failed to observe that the patient had carcinoma of cervix. So, it is the contention of the opposite parties that the frozen section means surgery was halted and specimen was taken and sent to histopathology in view of some inadvertent findings and only an intra operative consultation alone could confirm the presence of cancer for which diagnosis was not made prior to surgery. It is the line of contention of DW.1 that unfortunately patient had hidden cancer, which is elusive to naked eye, imaging and histology and for this reason, opposite party need not be blamed. The argument of the opposite party is having sound logic.
911). It is to be observed that in para 12 of the written version at page 8, DW.1 claimed herself as highly qualified doctor having more than 25 years experience in the field of Gynaecology having obtained MD from the renowned PGIMER, Chandigarh and she was currently registered with Indian Medical Council and Telangana Medical Council and that she is a Member of the Prestigious Royal College of Obstetricians and Gynaecologists (RCOG), London and gained experience abroad at the University of Michigan, USA; that often invited as a guest faculty to several science conferences and made numerous scientific publications to her credit and was responsible for conducting pre exam MRCOG training courses.
This all goes to show that DW.1 is having lot of experience in the field and in nutshell she can be considered as uptodate with all the developments in her field.
12). Admittedly, the deceased had post menopausal bleeding and it is not disputed by the opposite party and on the other hand the deceased subjected to have reached menopause during the years 2007-2008 as per the complaint. She approached DW.1 in the year 2009 i.e. nearly one year after she reached the stage of menopause. From 2009 to 2012, the deceased continuously complaining about the post menopausal bleeding. It shows that inspite of medication, problem was not solved and it is recurring and most of the times the opposite parties subjected the deceased for test like papsmear, Mammogram and other pathological tests but they have not given any clue for the cancer. When the deceased is repeatedly coming with the same problem, DW.1 should have thought of other tests to weed out the possibility of cancer or could have referred the patient to Oncologist. For the reasons better known to DW.1 she did neither.
13). WHO Guidelines on "Comprehensive Cervical Cancer Control" : A Guide to Essential Practice at page 81 under Head Chapter 4 Screening for Cervical Cancer goes to show that :
"Screening is testing of all women at risk of cervical cancer, most of whom will be without symptoms;
Screening aims to detect precancerous changes, which, if not treated , may lead to cancer;10
Screening is only effective if there is a well organized system for follow-up and treatment; Women who are found to have abnormalities on screening need follow up, diagnosis and possibly treatment, in order to prevent the development of cancer or to treat cancer at an early stage; Several tests can be used in screening for cervical cancer. The Pap smear (cytology ) is the only test that has been used in large populations and that has been shown to reduce cervical cancer incidence and mortality. Other tests (VIA, VIL, HPV) show promise but there is as yet to comparable evidence on their effectiveness. Large studies are still under way".
The above material goes to show that even in the year 2006 the tests like VIA, VILI and HPV are prevailing in the medical field. When the deceased had been repeatedly coming with the same problem, DW.1 should have prescribed those tests like VIA, VILI, HPV atleast as an alternative, to weed out the possibility of cancer. DW.1 given more stress on the findings of 2006 WHO recommendations to the effect that all those tests are not effective and for that reason she had not prescribed. It is also contended that WHO guidelines for screening and treatment of pre cancerous lesions for cervical cancer, 2013 states that using HPV test is only suggestion and not recommendation. It is also argued that even though recommendations were made in the year 2013, but during the said period, when the deceased took treatment under DW.1 it was only from 2009 to 2012. So, it is contended that, DW.1 cannot be found fault with for not prescribing those tests on the deceased.
14). The opposite party counsel relied upon case law reported in 2019 (3) ALD 1 (SC) in Arun Kumar Manglik vs.Chirayu Health and Medicare Pvt.Ltd. and another. Basing on the above case law it is argued that even the HPV Test is not available in most of the hospitals and not suggesting the test cannot be considered as negligence on the part of DW.1.
It is important to note that as per the above case law , the standard of reasonableness is implicit in Bolam test which imposes duty on medical professional to take into account advances in medical science and ensure that the patient centric approach is to be adopted.
11So, it is argued by the complainant counsel that the above case law infact supports the version of the complainant. The standard of care expected from a professional is a reasonable one but cannot be high degree of standard. It is important to note that the standard of skill expected from a doctor depends upon case to case and facts involved in the particular case. In the case on hand as already repeatedly said the deceased has been approaching DW.1 for about 3 years with the same problem and there was no clue for the same and it is still subsisting . Over and above the same DW.1 claimed herself as a reputed doctor with uptodate knowledge on the subject. Reputation and knowledge of a docor will attract large number of patients. Then the standard of care attached to the said reputed doctor will certainly be more than any other doctor on the subject with a reasonable degree of skill. In other words the same yardstick applied to any other doctor, is not a comparative factor to apply the principle to a well reputed doctor who is having knowledge of all the medical developments on the subject. The National Cancer Grid (NCG) of India Tata Memorial Center published an article on 'Consensus Evidence Based Resource Stratified Guidelines on Secondary Prevention of Cervical, Breast & Oral Cancers', given a Table 1 which shows 'Summary of the Resource - Stratified Clinical Practice Guideline for Secondary Prevention of Cervical Cancer' . It goes to show that primary screening methods are :visual inspection with acetic acid (VIA)- (essential/limited resource), Human Papillomavirus (HPV)DNA-(optional/enhanced resource) and Human Papillomavirus (HPV) DNA - ( optional/ high resource).
So, DW.1 cannot contend that she has no knowledge about VIA, HPV, DNA tests etc., when these tests are prevailing in the medical field in the year 2006 itself, though came into limelight as most effective one in the year 2013.
15). It is further argued for the opposite parties that WHO recommendations of 2013 and 2021 were introduced only in 2020- 21 and it was made as a mandatory practice. Therefore, those recommendations cannot be applicable retrospectively, when the deceased took treatment under DW.1. Applicability of the guidelines is not an yardstick when those tests are available in the medical field. We are reiterating at the cost of repetition that due 12 to continuous problem of the deceased, DW.1 should have gone for other tests or should have referred the patient to an Oncologist.
The complainant counsel relied upon the following citations :
i. Hemminger vs.LeMay , 2014 IL App (3rd) 120392 . It is discussed in the case that the early detection of the problem by a doctor would give more chances of recovery to patient and on that concept evolved lost chance theory of recovery. If timely diagnosis is not made, the doctor was made liable. In the said case, the other cases are relied upon to arrive at the conclusion.
ii. In the case between Rajiv Gandhi Cancer Institute & Research Centre and others vs. Zile Singh Dahiya ;
in para 28 it is observed that delay in diagnosis and the resultant delay in the treatment in a reputed institute are the grounds to found fault with the treatment part.
iii. In Coody vs. Barraza -No.47,732-CA, DT.6.3.2013 Court of Appeal of Lousiana , Second Circuit. at para 11 relating to 'Damages', it is observed that " In the determination of general damages, the discretion vested in the trier of fact is "great" and even vast, so that an appellate court should rarely disturb an award of general damages".
It is also observed in several cases that the judgements of the foreign courts are not binding on the Indian Courts, but they are having persuasive value if facts and circumstances were similar which is clearly observed in Google India Private Limited vs. Visaka Industries Limited and Ors. by High Court of Judicature at Hyderabad for the State of Telangana and the State of Andhra Pradesh, dt.18.11.2016.
16). Taking all these aspects and facts into consideration, we are of the view that DW.1 not made any efforts with all seriousness to diagnose the issues of the deceased i.e. post menopausal bleeding, post coital bleeding etc. In view of the knowledge that can be imputable to DW.1, one can safely conclude that she was at negligence and it amounts to deficiency in service.
Even though one cannot assess if the problem is detected earlier how long the deceased might have survived, still 'lost chance theory' to cure or to survive long years was denied to the deceased. Even though it is claimed in the complaint that Rs.50 13 lakhs was spent for the treatment, no documentary evidence is placed to match the claimed amount. Exs.A1 to A31 goes to show that in total 50,000 $ was paid for the treatment of the deceased at NewYork-Presbyterian , The University Hospital of Columbia and Cornell on 21.5.2013 . It is not translated into Indian Currency. Ex.A33 goes to show that in Global Hospitals, Hyderabad Rs.65,041/- was paid for the treatment of the deceased. Ex.A36 goes to show that Rs.6,37,377/- was paid in Basavatarakam Indo
- American Cancer Hospital & Research Institute for the treatment of the deceased on different dates. No expert evidence is adduced to show that in case of early detection of problem it could have completely eradicated without any recurrence. Therefore , even in case of early detection the deceased might have survived for some more years, if not months still has to incur expenditure for the cancer treatment. Therefore, we are of the view that the entire amount spent on the deceased cannot be automatically granted as damages. We are of the view that a sum of Rs.10 lakhs can be awarded as compensation for the negligence of opposite parties and also for the deficiency in service. For the mental agony undergone by the deceased, PW.1 who is her daughter cannot be compensated. What all the mental agony undergone by PW.1 shall be assessed and given as compensation. Therefore, we are of the view that a sum of Rs.2 lakhs can be awarded as compensation to PW.1. So, the points are answered accordingly.
17). In the result, complaint is partly allowed directing opposite parties 1 & 2 to pay with joint and several liability in all Rs.12 lakhs to the complainant besides costs of Rs.25,000/- . Time for compliance is one month. In case of failure to comply with the ordered amount, it will carry interest @ 9% p.a. from the date of failure, till the date of payment.
(Dictated to Steno, transcribed and typed by her, corrected and pronounced by us in the open Court on this 20th day of April, 2023.) Sd/- Sd/-
MEMBER (J) MEMBER(NJ)
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Dated : 20.4.2023 14 APPENDIX OF EVIDENCE W itnesses Examined For the complainant For the opposite parties Evidence aff. of complainant Opposite party no.1 filed Evidence as PW.1 Aff. as DW.1 Exhibits marked on behalf of the complainant:
Ex.A1 : Copy of Death Certificate of K.Durga Devi dt.31.1.2015.
Ex.A2 : Photostat copy of passport of complainant. Ex.A3 : Photostat copy of passport of K.Durga Devi. Ex.A4 : Original Gynaecology Record of Smt.K.Durga Devi issued by Rainbow Hospital( dt.1.4.2009 to 13.10.2009). Ex.A5 : Original medical prescription dt. 2.4.2009 issued by Opp. parties.
Ex.A6 : Photostat copy of Gynecology Ultrasound Scan Report Dated : 1.4.2009.
Ex.A7 : Original Discharge Summary of Mrs.K.Durga Devi issued by opposite parties.
Ex.A8 : Copy of Test report of Mrs.K.Durga Devi issued by Global Hospital.
Ex.A9 : Copy of Findings of Ultrasound Whole Abdomen of Mrs.K.Durga Devi, dt.19.3.2010 .
Ex.A10: Copy of Complete Urine Examination (CUE) Report issued by Elbit Medical Diagnostics Ltd.,dt.19.3.2010. Ex.A11: Copy of test report of Mrs.K.Durga Devi with regard to Post Prandial Plasma Glucose, dt.19.3.2010. Ex.A12 : Copy of Test Report of Fasting Plasma Glucose issued by Elbit Medical Diagnostics Ltd.,dt.19.3.2010. Ex.A13 : Copy of Test Report of Complete Blood Picture ( CBP) of Mrs.K.Durga Devi issued by Elbit Medical Diagnostics Ltd.,dt.19.3.2010.
Ex.A14 : Copy of Test Report- Thyroid Profile of Mrs.K.Durga Devi issued by Elibit Medical Diagnostics Ltd.,dt.19.3.2010. Ex.A15 : Copy of Test Report- Lipid Profile of Mrs.K.Durga Devi issued by Elbit Medical Diagnostics Ltd.,dt.19.3.2010. Ex.A16 : Original report - Total body bone density of Mr.K.Durga Devi issued by Elbit Medical Diagnostics, dt.19.3.2010. Ex.A17 : Copy of Echo Cardiography Report of Mrs.K.Durga Devi issued by Elbit Medical Diagnostics, dt.23.3.2010. Ex.A18 : Original Out Patient Card Cum Receipt dt.24.4.2010 issued by opposite parties on behalf of Mrs.K.Durga Devi. Ex.A19 : Original Gynaecology Record of Mrs.K.Durga Devi issued by Opposite party.
Ex.A20 : Original Out Patient Card cum Receipt dt. 9.3.2011 issued by opposite parties on behalf Mrs.K.Durga Devi Ex.A21: Original Out Patient Card cum Receipt dt. 10.3.2011 issued by opposite parties on behalf Mrs.K.Durga Devi. Ex.A22 : Original FSH report of Mrs.K.Durga Devi issued by Opposite party.
Ex.A23 : Original Gynaecology Record of Mrs.K.Durga Devi issued by Opposite party dt.19.12.2012.
Ex.A24 : Original report of Ultra Sound Scanning of whole Abdomen of Mrs.K.Durga Devi issued by Focus Diagnostics .
Ex.A25 : Original Test report of Mrs.K.Durga Devi issued issued by Global Hospitals Dt.21.12.2012. Ex.A26 : Original Histopathology Report of Mrs.K.Durga Devi 15 Dt.28.3.2013 issued by Omega Hospitals. Ex.A27 : Original Discharge Summary of Mrs.K. Durga Devi Dt.30.3.2013 issued by Omega Hospitals. Ex.A28 to 31 : Photostat copies of Patient Payment Receipt dt.21.5.2023 issued by NewYork -Presbyterian - The University Hospital of Columbia and Cornell. Ex.A32 : Original Discharge Summary of Mrs.K. Durga Devi issued by Global Hospitals.
Ex.A33 : Copy of In-patient Cash Bill issued by Global Hospitals. Ex.A34 : Copy of Findings of Whole Body PET-CT Scan issued by Basavatarakam Indo American Cancer Hospital & Research Institution.
Ex.A35 : Copy of Discharge Summary dt.16.7.2014 of Mrs.K. Durga Devi issued by Basavatarakam Indo American Cancer Hospital & Research Institution. Ex.A36 : Copy of Discharge bill dt.29.6.2014 issued by Basavatarakam Indo American Cancer Hospital & Research Institution.
Ex.A37 : Original Discharge summary of Mrs.Durga Devi issued by Medicity Hospitals, dt. 8.8.2014. Ex.A38 : Copies of medical bills dt.8.8.2014.
Exhibits marked on behalf of the opposite parties : Nil Sd/- Sd/-
MEMBER (J) MEMBER(NJ)
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Dated : 20.4.2023