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2.       The facts in brief are that the Complainant's wife namely, Rajini Srikande (hereinafter referred to as "the Patient") visited the Hospital on 05.08.2013 with the Complaint of pain in the Right Flank since two days coupled with fever and vomiting.  It was stated that she was admitted in the Hospital at about 9.30 p.m. and paid an amount of ₹10,000/-.  It was averred that as per the record got from Vijaya Diagnostic Centre dated 05.08.2013, the Patient had a Calculus measuring 12mm noted in Proximal Ureter causing moderate dilation of Pelvicalycal system of Right Kidney.  A Complete urine examination was done and Protein was noticed in the urine.   At the time of admission, her Hemoglobin was found to be 9.3gm% and total WBC count was at 26,800 cells/cumm as against the normal range of 4-11000 cells/cumm and she was diagnosed to have Right Upper Ureteric Calculus and was admitted for surgery.  After preoperative work up and after pre-anesthetic checkup she was taken up for Right URS+DJ Stenting on 06.08.2013.  But unfortunately,  she expired on 07.08.2013 at about 1.45 am.  It was averred that  the surgery was not properly conducted and instead of local Anesthesia the Patient was administered general Anesthesia. 

5.       The Hospital and the treating Doctor filed their common Written Version stating that a minimum risk of Bradycardia and hypotension are also associated with any kind of Anesthesia and unfortunately the Patient developed Bradycardia and hypotension and expired.  It was denied that the Patient died on account of general Anesthesia.  It was stated that after pre-operative work up and pre-anesthetic check-up she was taken up for Right URS + DJ stenting on 06-08-2013. Her WBC count preoperatively was 13500. She was admitted in the Hospital in the evening prior to the surgery and started on broad - spectrum antibiotics. Cystoscopy and ureteroscopy revealed that she had 9 mm Right Upper Ureteric impacted Calculus. On dis-impacting the Calculus, cloudy and purulent urine was noticed. It was decided to abandon the stone breaking procedure and to insert a DJ stent instead to clear the infection. While performing DJ stenting unfortunately she developed sudden Bradycardia with Hypotension and had Cardiac Arrest. She was immediately shifted to Critical Care Unit and was put on a ventilator and inotropic support. Left radial cannulation was also done. She had wide fluctuations in blood pressure even with inotropic support. The Complainant was apprised of the situation and critical condition of the Patient. Unfortunately the Patient died. It was further stated that the Hospital and the treating Doctor were not negligent as standard and reasonable care was given by them and there is no evidence on record that a total DRS was done instead of graduated DRS can be construed as medical negligence.

6.       The State Commission while dismissing the Complaint observed as follows:

 "17. The complainant no.1 in his proof affidavit, reiterating the allegations in the complaint, based upon certain literatures, had attempted to find fault, in the procedure adopted by the opposite parties. It is the specific case of the opposite parties, that  generally spinal anesthesia is administered for abdominal and lower limb surgeries and general anesthesia for any surgery.  Opposite party no. 2 and the anesthesialogy team at opposite party no.1 hospital explained to the deceased that either general anesthesia or spinal anesthesia could be given to her and advised spinal anesthesia as it is a surgery for abdomen.  But the deceased opted for general anesthesia and insisted that she be given general anesthesia only.  Accordingly she was given general anesthesia.  This does not imply that general anesthesia is not safe.  It is an accepted medical practice to administer general anesthesia or spinal anesthesia for surgeries    throughout the world and generally they are safe.  However, a very minimal risk of bradycardia and hypotension is always associates with any kind of anesthesia.  Unfortunately the diseased developed bradycardia and hypotension and died.   Moreover the deceased having understood about the risks involved in administering the general anesthesia or spinal anesthesia had given consent for the surgery under general anesthesia.  Ex.A3 is the copy of consent form wherein the deceased had given her consent for administering the general anesthesia.  It was also written on the consent form that patient insisted for General Anesthesia in spite of explaining the advantages and post-operative analgesia of spinal anesthesia.  Therefore, it is apparent on the face of the record that there is no negligence on the part of the opposite parties in administering the general anesthesia to the deceased.  It is on the insistence of the deceased only the opposite parties had administered general anesthesia though the opposite parties explained about the advantages of administering spinal anesthesia. 

11.     In the instant case, the Patient had a history of hypotension and had come to the Hospital on 05.08.2013, with an Impacted Calculus and Cystoscopy Right URS was done on 06.08.2003, with Ureteric Catheter, which revealed 9mm Right Upper Ureteric impacted Calculus. It is an admitted fact that while performing the DJ stenting, the Patient developed sudden Bradycardia with Hypotension and had cardiac arrest and died on the very next day i.e. 07.08.2013. The surgical Patient record shows that there was positive ST. depression.  There is no hospital record to evidence that this condition was treated and the Patient was stabilized cardiacally prior to administration of general Anesthesia for the purpose of Righ URS and DJ Stenting.  There are no reasons given for the Patient having developed sudden Bradycardia with hypotension during the process of conduction of DJ stenting.  In the treatment record dated 06.08.2013 lung consolidation was noted on the chart.  The contention of the learned Counsel appearing for the Respondent is that in a 36 year old Patient, this ST depression is nothing specific and therefore has no nexus. The onus of explaining the reasons for the sudden development of Bradycardia with hypotension is not explained or supported by any documentary evidence.  The entire treatment record does not show whether any cardiac evaluation was done though ST depression+ was noted specifically when the Patient was admittedly a known hypertensive and the same was recorded in the discharge summary. To reiterate, proper pre-operative evaluation by the cardiologist was not done prior to administration of general Anesthesia, when the Respondents themselves admitted in their written arguments that Bradycardia and hypotension are common complications of general Anesthesia.  It is observed from the record that serum creatine was normal and hydronephrosis with normal creatine kidney and the ultrasound report shows that the other kidney had no issues and we are of the considered view that proceeding with the surgery without taking appropriate preoperative safety measures with respect to pre-investigative tests, stabilizing the Patient first as he also had infection with pus, especially  in the light of fact that the Patient  had a history of hypotension as can be seen in the discharge summary, does not amount to 'Duty of reasonable Care',  a professional of reasonable expertise, ought to have exercised in those circumstances.