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2.     The Complainants' son Anmitra, about 6 years of age (hereinafter referred to as the 'patient') for his squint eyes was taken to Chennai at Sankara Nethralaya (hereinafter referred to as the 'OP-1 - Hospital'). Dr. (Mrs.) S. Agarkar examined the child on 12.06.2000 and advised minor surgery to correct the squint. She proposed the name of Senior Surgeon - Dr. T. S. Surendran for the operation to be done on 14.06.2000.  The preoperative investigations, blood and urine tests were conducted. On 13.06.2000, Dr. Sujatha clinically examined the child and noticed faint functional systolic 'murmur'   and chest wall abnormality. The same was brought to the notice of Dr. S. Bhaskaran, a Senior Cardiologist, who further examined the child with some exercises and concluded about no murmur and he also ruled out further need for any tests like ECG, ECHO or Chest X-ray etc. He declared the child "Fit for General Anesthesia". The surgery was fixed on 14.06.2000. As advised, the Complainants took their child on empty stomach to the hospital at 9.00 a.m., but the bed to the child was allotted at around 2.00 p.m. The child was administered three injections and at about 3.00 p.m., he was taken to Operation Theatre. At about 6.00 p.m. the Complainants were given shocking news by Dr. J. Biswas that their child expired on the operation table. It was further alleged that the hospital issued patient's case summary after two days i.e. on 16.06.2000. The discharge summary was vague without details of Cardio Pulmonary Resuscitation (CPR) and the happenings in the operation theatre. Despite repeated requests, the OPs failed to provide complete medical record. Therefore, they approached the Prime Minister's Office and, finally after six months (11.12.2000) entire medical record including Post mortem report was handed to the Complainants.
5.     Thereafter, Ms. Latha Suresh, the Head of Surgery fixing center, gave the date of 14.06.2000 for surgery. The Physician, Dr. S. Sujatha examined the patient on 13.06.2000 and requested the Cardiologist - Dr. Bhaskaran, to see the patient since she felt a questionable faint murmur. Dr. Bhaskaran reviewed the case sheet and lab investigation reports, took the history and further ascertained that the child was able to play games and climb three storied stairs without any difficulty. Dr. Bhaskaran put the child to various positions and exercise, and auscultated. He concluded no cardiac problem to undergo surgery under General Anesthesia (GA). It was submitted that as per medical guidelines, routine pre-operative ECG, ECHO and X-ray were not necessary for children and persons below the age of 40 years accept medically warranted. 
6.     The OP-1 hospital submitted that for squint surgery the infrastructure and operation theatre (OT) is fully equipped with monitor, centralized Oxygen and all facilities for administering GA or any type of anesthesia.  The patient was taken to the OT for surgery at 3.10 p.m. The Anesthetist In-charge of the case - Dr. Kannan, (OP-3) and operating surgeon Dr. T.S. Surendran, (OP-2) were present in the OT.  The OP-3 connected the patient to ECG, NIBP and Pulse Monitor. Before surgery, he scrutinized all the systems in OT which found everything in order. It was further submitted that the child did not co-operate to place IV drip in OT, therefore, the child was reassured and asked to breathe through a mask by which 50% Oxygen(O2) with 50% Nitrous Oxide (N2O) was administered. Then, Halothane was administered in the gas mixture using fluotec vaporizer, with starting concentration of 1% and gradually increased to 3% over a period of 1 to 3 minutes. Then IV line for 5% Dextrose started. Thereafter, the mask was removed and child was successfully intubated. At 3.20 pm, the Anesthetist  noticed that the ECG Monitor was showing steady drop in the heart rate to a sinus bradycardia of 50 per minute. However, the oxygen saturation was 99%. Immediately IV Injection Atropine 0.3 mg was administered. ECG showed gradual and steady rise in pulse rate to 140 -150.  Then the rhythm changed from Sinus Rhythm to Ventricular Tachycardia of around 200 which progressed to Verntricular fibrillation.

20.    The Tracheal intubation is a standard technique used during GA.  Local anesthesia was not resorted to as it requires the co-operation of the child. The mask anesthesia was not resorted to in any head and neck surgery which also obstructs the surgical field of eyes. Tracheal Intubation may be done under deep inhalation anesthesia (Halothane) or with the use of other muscle relaxants. In the Instant case, as the vocal cord was anterior, it was not possible to intubate the patient in the first attempt. It is not clear from the record that Scoline was administered before first intubation, as such the possibility cannot be ruled out.