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Defense:

The OPs resisted the complaint and submitted that there was no negligence on their part.
          Defense of Dr.Manoj Khanna OP-1:
2.      The patient suffered cardiac arrest prior to the commencement of the surgery. The complainants' allegations are wrong. It is further submitted that, the patient was obese and obesity itself can cause bradycardia followed by hypoxia. It was a coincidence that the patient suffered cardiac arrest while he was in the OT for the procedure of liposuction. The patient did not disclose that he was suffering from thyroid. His weight was 92 kg, since 10 years, and with exercise and diet control, he reduced the weight to 74 kg. Dr. Konika Banerjee, a Dietician, advised the patient for liposuction, after consultation and laboratory investigations. After explaining the procedure and the risks involved the decision to undergo liposuction was taken. Thyroid is not a contraindication for the procedure. On 20.12.1999, the patient came along with his son to OP3 for the procedure. The detailed history and examination was done by OP1 & OP2 before taking the patient to OT. The allergic test for anaesthetic reagent was also done.  OP1 prepared in OT three litres of tumescent fluid using standard formula that: 1 litre of "Ringer lactate";     1 cc of Adrenaline; 15 cc of Xylocaine. Thus, three litres of tumescent would contain 3 cc of Adrenaline; and 45 cc of Xylocaine (this equals to 4.5 mg of Xylocaine). Since OP 1 had infused 1.5 litre of tumescent fluid, the correct figure of Xylocaine infused would be 22.5 cc which would equal to 2.25 mg. Therefore, (i) it was a minimal dose. Maximum dose of Xylocaine could go up to from 35 mg to 55 mg per kg weight of the deceased; (ii) Adrenaline and Xylocaine act and react against each other. Former increases pulse rate and the latter decreases the pulse rate; (iii) Xylocaine test was done twice, once by OP 2 and second time by OP 1. It is no body's case that the procedure could have commenced without use of Xylocaine. In this context, OP placed the medical text from "Chapter 24- Liposuction-A comprehend review of Techniques and Safety".
   

20.    References from Medical text books, journals, research articles:

Under chapter 24 - liposuction "a comprehensive review of techniques and safety" We have gone through several reference books and some extracts are reproduced as below:         
Liposuction patients often present with a variety of expectations, concerns, and/or complaints.  In order to achieve optimal contour with liposuction, appropriate patient selection is imperative.  As a general rule, liposuction is performed in healthy patients who maintain realistic goals and expectations.

22.    Failure of OP-1 selecting patient for liposuction:

Proper patient selection is essential. As a general rule, the best candidates for liposuction are those who have maintained a stable weight for at least six months, whatever their size.
The operating surgeon needs to obtain thorough medical history including, body mass index (BMI), diet, life-style, exercise, medication history, quality of skin and smoking. A commonly overlooked aspect is skeletal deformity of spine, which can result in apparent asymmetry. Acquiring pre-operative photographs is also an important aspect of the pre-operative assessment. It is also important to discuss the limitations of liposuction, as it cannot be used as a panacea for all contour deformities. Assessment of patients' expectations is also essential to ensure that they have realistic and achievable expectations.  For our consideration, reference to anaesthetic notes of OP 3 and the AIIMS report are sufficient to raise issues of fact, as to whether OP-1 failed to select the patient for liposuction. In this context, we have referred to medical texts and research articles, from:
 (http://www.nordesthetics.com/en/articles/BMI-liposuction) BMI and Liposuction:
BMI stands for body mass index and is determined using the ratio of height compared to weight. Depending on your BMI, you can be categorized on a predetermined scale that ranges from underweight to obese. Although, some doctors dispute the accuracy of the BMI scale because it doesn't account for the fact that muscle weighs more than fat, BMI is often used by medical professionals to determine, whether or not a person is at a "normal" weight .If a person has a very low BMI, then the chances are that you won't need liposuction, as it means that they need to put on weight, not lose it. On the flipside, if a person's BMI is very high, then liposuction may not be a suitable treatment for them, as liposuction is not an obesity treatment and there is a limit to the amount of fat that can safely be removed from the body.