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2.                For the sake of convenience, the parties are referred to as arrayed in the complaint.

3.                The case of the complainant, in brief, is that the complainant was admitted in opposite party no.1 hospital on 28.08.2007  with the complaint of abdomen pain.  After examining by Dr.A.Deepak Das it was found that there were stones in the right gallbladder and conservative treatment was given to the complainant and she was discharged on 01.09.2007.  The complainant due to abdominal pain again on 29.07.2008 was admitted in the opposite partyno.1 hospital and the opposite party no.2 suggested to undergo laparoscopic surgery.  On 11.08.2008 the opposite partyno.2 performed laparoscopic cholecystectomy.  During the course of operation, opposite party no.2 converted the laparoscopic surgery into open surgery but the opposite party no.2 did not inform what type of surgery is conducted and the complainant had a biliary leak from the day on of the operation from the drain as well as from the wound.  After three days endoscopy test was done, the bile leak was stopped after 10 days. The complainant was discharged from the hospital on 06.09.2008.  Again on 13.09.2008 the complainant visited the opposite party hospital for follow up treatment then opposite party no.2 informed that the operation was successful and that the complainant would be free from abdomen pain. Thereafter as the complainant noticed jaundice, she on the advice of Dr.T.Ravi Shankar undergone ultrasound scan of abdomen wherein it was diagnosed as "moderately dilated intra hepatic biliary radicals due to stricture at confluence of hepatic ducts at the proximal level".  The complainant came back to Hyderabad and visited KIMS Hospital wherein the complainant was undergone MRI choliangiopancreatogrphy test on 15.04.2009.  The said test gave an impression " status post Cholecystectomy. Abrupt cut-off of common hepatic duct just beyond the confluence with dilated right and left hepatic duct and intrahepatic biliary dilation".  As per the reports at the time of performing Cholecystectomy by oppsotie party no.2, the common hepatic duct just beyond the confluence was abruptly cut-ff.  Due to the said fault on the part of opposite party no.2 the biliary hepatic structure developed and the jaundice was also developed. 

14.              The main allegation of the complainant is that as the complainant developed the symptoms of jaundice, pruritus and fever, she visited her daughter where she consulted Dr.T.Ravi Sankar who after performing ultrasound scan it gave an impression "moderately dilated intra hepatic biliary radicals due to stricture at confluence of hepatic ducts at the proximal level".  The complainant came back to Hyderabad and consulted Dr.Prasad Behra at Poulomi Spuper Specialty Hospital where Dr.Prasad diagnosed that the complainant developed obstructive jaundice with symptoms at times nagging and that the LFT showed a raised ALP with mild Hyper Bilurubinaemia and that the US abdomen showed a stricture at confluence with proximal dilation.   The complainant visited KIMS, Secunderabad wherein Dr.Y.Nagarjuna refrrd the complainant to undergo MR Choliangiopancreatography test on 15.04.2009.  The said test gave an impression " Status Post Choecystectomy Abrupt  cut-off of common hepatic duct just beyond the confluence with dilated right and left hepatic duct and intrahepatic biliary dilation".  It means at the time of performing Cholecystectomy by opposite partyno.2 the common hepatic duct just beyond the confluence was abruptly cut-off.  Due to the said fault on the part of opposite party no.2 the biliary hepatic stricture developed and the jaundice was also developed.     The opposite partyno.2 committed mistake while performing Laparoscopic Cholecystectomy on 11.08.2008 by cutting the common hepatic duct just beyond the confluence due to the said reason the opposite partyno.2 in the middle of laparoscopic surgery converted it into open surgery.  Because of the improper surgery, it resulted into bile-leak, hepatic duct stricture, development of jaundice, necessitating second surgery Hepato-jejunaustomy at NIMS on 4.5.2009. 

17.              The basic point for consideration in the present case is, whether there was any negligence on the part of OP-1 hospital and OP-2 and OP-3 doctors in the treatment of the patient,   when she approached them for the said surgery. From the facts and circumstances on  record, it is made out that following her surgery  at OP-1 hospital after examination by OP-2 and OP-3 doctors, the complainant still had to go to the other  hospitals for her further intensive treatment, which gives rise to safe presumption that the patient was in bad condition, after the treatment at OP-1 hospital. There is statement of Dr. T.Ravishanker, Consultant Gastroenterologist & Endoscopist, Coimbatore referring the complainant to Dr.Venkat  as the complainant is a case of stricture common hepatic duct for favour of ERCP.  , After conducting ultrasound Scan of Abdomen dated 28.01.2009 in Best Scan Centre it was found    it was found " moderately dilated intra hepatic biliary radicals due to stricture at confluence of hepatic ducts at the proximal level".    She consulted Poulomi Super Specialty Hospital, Secunderabad where she was diagnosed that she developed obstructive jaundice with symptoms at times nagging and that the LFT showed a raised ALP with mild Hyper Bilurubinaemia and that the US abdomen showed  a stricture at confluence with primal dilation.  She visited KIMS Hospital where Dr.Y.Nagarjuna referred the complainant to undergo MR Choliangiopancreatogography test which gave an impression " status post Cholecystectomy Abrupt cut-ff of common hepatic duct just beyond the confluence with dilated right and left hepatic duct and intrahepatic biliary dilation.   It means at the time of performing cholecystectomy by oppsoti eparty no.2 the common hepatic duct was cut off due to the said fault the biliary hepatic stricture developed and the jaundice was also developed.  Thereafter the complainant was admitted at NIMS where Dr.N.Beerappa performed hepato-jejonostomy and relieved of all the complications created by the opposite parties.   

18.              In nut-shell, the defence taken by the OPs says that complication could occur during the procedure performed on the complainant and hence, the allegation of medical negligence  against them was not true. However, this version of the opposite parties stand belied from the facts stated by them in the written statement. It has been categorically stated that both the doctors opposite party no.2 and opposite party no.3 found the patient to be in a stable, comfortable condition and hence,  they decided to discharge her on 01.09.2007 itself. It cannot be believed by any stretch of imagination that if the condition of the patient was stable and comfortable,  then how she had to pass through the subsequent events  and then get admitted in the various hospitals, where further surgery was done. It is very clear, therefore, that the opposite parties  miserably failed to manage the condition of the patient, following the operation done by them for the removal of stones from the gallbladder or the gallbladder itself.    It has been held in a number of landmark judgments made by the Hon'ble Supreme Court of India and this Commission that in the cases involving medical negligence, the standard of care expected from medical professionals has to be that of ordinary persons, possessing ordinary skills, in reported in (2005) 6 SCC 1; their lordships carried out a detailed analysis of the doctrine of negligence in the context of medical profession. They also referred to the principle of res ipsa loquitur in the said case.  In the facts and circumstance of the present case also, applying the principle of res ipsa loquitur, it is very clear that the patient was discharged by the OP-1 Hospital, even when her condition was not stable and she had to be admitted almost immediately in the other hospital for further treatment. The said hospital detected, after carrying out certain tests that there was negligence by the OPs, as the complainant was suffering from Benign Biliary Stricture (Type-II) post cholecystectomy .  Benign strictures develop due to damage to the bile ducts during surgery or trauma to the abdomen; a recurring condition, such as pancreatitis or bile duct stones; or a chronic disease, such as primary sclerosing cholangitis (PSC).