SMT. RAVI SUSHA  : PRESIDENT:

     The complainant filed by this  complaint U/S 12 of the Consumer Protection Act 1986 alleging medical negligence and deficiency  in service on the part of the 1^st opposite party in treating her at 2^nd OP hospital.

     The fact of the case is that the complainant visited the 1^st OP on 29/3/2017 at 2^nd OP hospital for a stomach ache and after examination, she was diagnosed with an ectopic pregnancy. The complainant was informed that an immediate operation was necessary to  save her life.  Consequently, the complainant and her husband  were constrained  to give consent to the surgery.  After the operation, the removed fetus was not shown to the complainant and her husband.  She was discharged on 5//4/2017, and experienced severe stomach ache  two weeks later.  The complainant sought help from the 1^st OP again, who prescribed some medication  for gas trouble but her symptoms worsened.  When she visited the 1^st OP again, she was  again told that the problem was due to gastric disorders and advised to see a surgeon at the hospital.  The surgeon also diagnosed the problem as gas trouble.  When the complainant stopped taking the medication prescribed by the 1^st OP.  She felt relief but experienced nausea and a swollen lower abdomen.  Upon self examination, she realized she was pregnant.  Further submitted that on 28/4/2017, the complainant met Dr.Remadevi at Koyili hospital , who confirmed that she was pregnant.  As advised by  doctor, the complainant took folic acid for two weeks, but even after that, if the fetus did not show growth, she would need to undergo an abortion.  On 3/5/2017, she was admitted to Koyili hospital and after a scan it was discovered that the fetus was not growing as required.  The doctor advised that a normal abortion should occur within two weeks, and if not, a medicinal abortion could be performed.  On 20/5/2017 the complainant returned to Koyili hospital, where it was determined that the  fetus had not survived, and it was subsequently removed at the hospital. The complainant submits that  without proper examination, the 1^st OP diagnosed her with an ectopic pregnancy and removed it through surgery.  The complainant claims that during the surgery, the 1^st OP failed to realize she was pregnant.  Furthermore, the complainant alleges that her right ovary was removed during the surgery, preventing her from conceiving in the future.  After the surgery, the complainant has been suffering from backaches and requires ongoing medication due to the 1^st OP’s irresponsible actions. Hence complainant seeks compensation of Rs.7,50,000/- from the OPs.

     During the pendency of the case, after the version filed by OPs 1&2, the complainant has filed an impleading petition to implead 3^rd OP Dr.Gopinathan as an additional 3^rd OP.  Which was allowed and Dr.Gopinathan  has been impleaded as additional 3^rd OP.

   After receiving notices OPs 1 to 3 filed separate versions.

  1^st OP contended that  during 2017 1^st OP was working as Senior resident medical officer in OB&G Department in the 2^nd OP ‘s hospital.  While she was attending her out patient duty on 29/3/2017 she was called to attend the complainant brought to the casualty as a referred case from outside hospital.  1^st OP immediately reached the casualty and attended the patient.  She was brought with a complaint of lower abdominal pain and had an ultra sound scan done from Modern Multi Speciality hospital Pappinssery, which was done  on 28/3/2017. The USG from Pappinissery showed complex cyst right ovary  and evidence of moderate free fluid in the pouch of Douglas and investigation reports, Unine pregnancy test-weekly positive and serum Beta HCG test  also positive.  On clinical examination the  complainant was found to  have features suggestive of internal bleeding with lower abdominal tenderness, guarding and mild shifting dullness.  Based on clinical  examination findings, investigation reports, she suspected possibility of ruptured ectopic pregnancy  as there was evidence of internal bleeding with a positive pregnancy test in the serum.  If she has to wait for another ultra sound and serum Beta HCG result, the patient may bleed more internally leading to shock.  The patient  has to be managed as emergency to find out the source of bleeding and also to stop the bleeding.  It is the duty of attending doctor to explain the nature of the disease and it’s severity to the bystander of the patient.  Hence she explained the condition to the bystander of the complainant.  As she  felt the emergency informed the duty doctor in ward, the  3^rd OP and  as advised by him she was admitted to the ward for management. The diagnosis, further managements, operation was done by  3^rd OP who was the duty doctor in the ward.  The surgery was not done by her and she was not even present in the theatre. As per working arrangement in the hospital in the absence of the treating doctor, 1^st OP had to attend the complainant  in the OPD after discharge.  The complainant came with gas trouble and lower abdominal discomfort.  After examination 1^st OP prescribed medicines for her symptoms and advised to see the treating 3^rd OP  doctor  for further evaluation.  She had no severe complaints warranting  admissions or emergency management at that time.  The complainant lost further follow up and 1^st OP was unaware of further modality of treatment.

     2^nd OP  admitted  that the complainant came to their  hospital  as referred from another  hospital for better treatment. After thorough examination it was diagnose that the patient is having ruptured ectopic pregnancy  and the condition being a surgical emergency   she was removed to operation theatre and surgery was conducted by 3^rd OP.  All required measures were taken to save the patient.  This OP has no vicarious liability to compensate the complainant since there is no deficiency in service on  their part.  Hence prayed for  dismissal of the complaint.

     3^rd OP has stated that the complainant a second gravid came to the  casualty department at the 2^nd OP’s hospital on 29/3/2017  with complaint of abdominal  pain and missed period.  The casuality medical officer had attended the patient and based on clinical history, investigation and examination, the patient was referred to  Obstretics & Gynaecology Department for  further evaluation. On evaluation of Ultrasound findings, clinical symptoms and based  on examination confirmed the diagnosis of ruptured ectopic pregnancy which had a surgical  emergency.  So emergency laparotomy was done, otherwise the patient may bleed more internally leading to shock. Necessary surgical preparations and pre-anesthetic evaluations and arrangement for blood were done.  After pre-anesthetic evaluation the patient was shifted to the operation theatre and surgery was started  at  10.25 am.  On opening the abdominal cavity altered blood was found coming out . Intra operative findings was (1) blood in the peritoneal cavity(2) Bleeding from Fimbrial end of right fallopian tube and right ovary (3) clots in the POD,  4) left tube and ovary found to be normal . Clamp applied over the right tube and ovarian  ligament and bleeding was arrested. Portion of the tube and ovary with haematoma were removed and the stump legated.  Post operatively the condition of the patient remained  stable and she was discharged on 5/4/2017 without any complaint and advised review after one month or earlier if there was any problems Thus 3^rd OP had exercised reasonable skill and care in the  diagnosis and treatment of the patient in strict  regard to standard and accepted medical practice and protocol.  3^rd OP submitted that the excised tube  and ovary  were shown to the  complainant’s husband and the same  was sent for histopathology examination to confirm the  clinical diagnosis.  Further  the features of congestion and hemorrhage of  fallopian tube evidenced  an histopathology unequivocally  establish the fact that decision to proceed with emergency laparoctomy was apt and proper and complications due to ruptured ectopic pregnancy could be evaded by timely decision. The 3^rd OP is having qualification of MBBS,DGO and  having 34 years experience as consultant Gynecologist both in government and private hospitals.  There is no negligence or  deficiency in service on their part , hence prayed for dismissal of the complaint.

     Both sides led evidence.  The complainant in  proof of her case filed her affidavit evidence and got the documents marked as  Exts.A1 to A15.  One more witness was examined from the side of  complainant as expert  witness. While the 3^rd  OP filed the affidavit evidence and  marked the case record of  complainant as Ext.B1.  The 1^st OP filed her affidavit evidence and was examine d as DW2.  All the witness were cross examined  by 2^nd OP.  After that the learned counsel of complainant and  OPs 1& 3 made oral argument.  The learned counsel of OPs 1&3 filed written  argument note also with  number of citations of Apex court.

       At the time of hearing, learned counsel for the complainant, narrated the facts of the case as given in the complaint and stated that without proper  examination and test,  the 1^st OP diagnosed the complainant with an ectopic pregnancy and  removed portion of  the  right side fallopian tube and right side ovary through surgery.  Further, it has been stated that during the surgery, 1^st OP failed to realize that the complainant was pregnant.  Further stated that due to the removal of her right ovary during the surgery, preventing her from conceiving in the future and after the surgery she has been suffering from back aches and  requires  continuous  treatment.  Further stated that when the patient had consulted the Gynecologist at Koyili Hospital, she  was diagnosed as pregnant and on USG report taken from Koyili hospital the impression  shows  Early intrauterine pregnancy of 5 weeks.  Complainant alleged that as 1^st OP has  done  surgery without proper diagnosis and test, was the reason  for the death of  featus in the womb, which leads to conduct  D&C on the complainant on 23/5/2017 at Koyili Hospital.

      On the other hand, the learned counsel of OPs argued that  during 2017 1^st OP was working as Senior resident medical officer in OB&G Department in the 2^nd OP ‘s hospital.  While she was attending her out patient duty on 29/3/2017, she was called to attend the complainant brought to the casualty as a referred case from outside hospital.  1^st OP immediately reached the casualty and attended the patient.  She was brought with a complaint of lower abdominal pain and had an ultra sound scan done from Modern Multi Speciality hospital Pappinssery, which was done  on 28/3/2017. The USG from Pappinissery showed complex cyst right ovary  and evidence of moderate free fluid in the pouch of Douglas and investigation reports, Unine pregnancy test-weekly positive and serum Beta HCG test  also positive.  On clinical examination the  complainant was found to  have features suggestive of internal bleeding with lower abdominal tenderness, guarding and mild shifting dullness.  Based on clinical  examination findings, investigation reports, she suspected possibility of ruptured ectopic pregnancy  as there was evidence of internal bleeding with a positive pregnancy test in the serum.  If she has to wait for another ultra sound and serum Beta HCG result, the patient may bleed more internally leading to shock.  The patient  has to be managed as emergency to find out the source of bleeding and also to stop the bleeding.  It is the duty of attending doctor to explain the nature of the disease and it’s severity to the bystander of the patient.  Hence she explained the condition to the bystander of the complainant.  As she  felt the emergency informed the duty doctor in ward, the  3^rd OP and  as advised by him she was admitted to the ward for management.

         1^st OP contended that surgery  was done by 3^rd OP and the intra operative findings was (1) blood in the peritoneal cavity(2) Bleeding from Fimbrial end of right fallopian tube and right ovary (3) clots in the POD, so portion of the tube and ovary with haematoma were removed and the stump legated.  Post operatively the condition of the patient remained  stable and she was discharged on 5/4/2017 without any complaint and advised review after one month or earlier if there was any problems.  According  to 3^rd OP on evaluation of Ultrasound findings, clinical symptoms and based  on examination confirmed the diagnosis of ruptured ectopic pregnancy which had a surgical  emergency.  So emergency laparotomy was done, otherwise the patient may bleed more internally leading to shock.  Thus 3^rd OP had exercised reasonable skill and care in the  diagnosis and treatment of the patient in strict  regard to standard and accepted medical practice and protocol.  Further contended that there was on the basis of the allegation that either 1^st OP or 3^rd OP was guilty  of deficiency in service /Medical negligence.  OPs  stated that the excised tube  and ovary  were shown to the  complainant’s husband and the same  was sent for histopathology examination to confirm the  clinical diagnosis.  Further  the features of  congestion and hemorrhage of  fallopian tube evidenced  an histopathology unequivocally  establish the fact that decision to proceed with emergency laparoctomy was apt and proper and complications due to ruptured ectopic pregnancy could be evaded by timely decision.

      We note that there is a histopathology report dtd. 12/4/2017 from OP hospital of the complainant referred by 3^rd OP (marked as Ext.A3). Clinical details shows  Ectopic pregnancy.  Nature of specimen shows: Right ovary and small part of fallopian tube description of specimen shows: ovary- yellowish areas and  multiple cysts.  Fallopian tube appears dilated, C/S:lumen obliterated.  Microscopy: ovary shows corpus luteum and follicle cysts, fallopian tube shows congestion of blood vessels and hemorrhage.  Lumen shows thrombi.   The features are suggestive of   congestion and hemorrhage.

 Here it is to be noted that the complainant has no objection in the findings stated in the  Ext.A3 report.  At the  evidence  time complainant has deposed that she has no  complaint  about the removal of  the ectopic pregnancy.  Her main allegation is about not recognizing an intra uterine pregnancy at the time of the operation.

   On this point , opinion of Expert doctor, as cited by complainant is to be looked into.  The expert doctor is examined as PW2, who is the treating doctor of complainant at Koiyili Hospital,Kannur from where she availed treatment subsequent to OP hospital.  At Koyili hospital PW2 suggested to take USG of uterus and the USG report dtd.28/4/2017 is marked as Ext.A5.  The impression in Ext.A5 shows “early intrauterine  pregnancy of 5 weeks”.  Further no evidence of foetal pole.

   From Ext.A5 it is clear that the intra uterine pregnancy  on the  date of  29/3/2017  conducting surgery at OP hospital was of 1 week.

   PW2 deposed as ectopic pregnancy സർജറി നടത്തുമ്പോൾ  ഗർഭപാത്രത്തിൽ മറ്റൊരു ഭ്രൂണം വളരുന്നുണ്ടോ എന്ന് പരിശോധിക്കേണ്ടത് ആവശ്യമാണോ? അതിനാണ് സ്കാൻ ചെയ്യുന്നത്. ഓവറിയും fallopian tube ഉം റിമൂവ് ചെയ്യുന്ന സമയം യൂട്രസിലുള്ള ഓരാഴ്ച മാത്രം പ്രായമായിട്ടുള്ള ഭ്രൂണത്തെ കണ്ടു മനസ്സിലാക്കാൻ സാധിക്കുമോ? ഇല്ല. Ext.A1 റിപ്പോർട്ടിലും intra uterine pregnancy ഉള്ളതായി പറഞ്ഞിട്ടില്ല? കാരണം ഒരാഴ്ച പ്രായമായ ഭ്രൂണത്തെ വഴി കണ്ടുപിടിക്കാൻ സാധിക്കില്ല .സർജറി ടൈമിൽ intra uterine pregnancy ഉണ്ട് എന്ന് കണ്ടാലും ഈ കേസിൽ ഓവറി നീക്കം ചെയ്തെ പറ്റുള്ളൂ കാരണം  life saving ആണ് പ്രധാനം.

   In Ext.A1 USG report also featus in the womb was not detected.  As per the evidence of PW2, we can realize that even if intra uterine pregnancy was found, the ectopic pregnancy should be removed as life saving measure as done in this case.

   The legal position on  medical negligence that it is well established that it is sufficient if he exercises the ordinary skill of an ordinary competent man excising  that particular act.

  In Jacob Mathew vs. State of Punjab, Hon’ble Supreme Court held that the Medical Practitioner should have  such an awareness as an  ordinarily competent practitioner would have.

     Here from the expert’s opinion, it is seen that the OP doctors had exercised reasonable skill  and care in the diagnosis and  treatment of the patient in strict regard to standard and accepted medical practice and protocol.

   The complainant’s another allegation is  when she  approached 1^st OP after two weeks from the surgery with complaint of stomach ache, the 1^st OP evaluated as complaint  of gas trouble and given  medicine for  gas trouble.  1^st OP submitted  that the  complainant came to her with  complaint of gas  trouble and  lower abdominal discomfort and after examination  prescribed medicines for her symptoms and advised to see the treating  doctor Dr.Gopinathan(3^rd OP) for further  evaluation.  According to 1^st OP, she had no severe complaints  warranting  admissions or emergency management at that time.  The complainant lost further follow up.  1^st OP denied that the complainant again met her  2^nd time and  repeat the medicine again .  The learned counsel of OP submitted that the complainant did not produce any documents to show that  she met  1^st OP again and that 1^st OP prescribed medications.  According to 1^st OP, since it was an  outpatient consultation, this can be  proved only by producing  prescriptions and  bills but  the complainant has not provided any such  documents.  Further submitted that since complainant has not produced  any OP card about the 2^nd visit, the allegation of complainant cannot be believed.

    Further 1^st OP contended that the complainant has not submitted the treatment records from the MM Hospital from where the complainant availed treatment prior to OP hospital.  The learned counsel of OP argued that the consultation records to show the opinion of  Gynecologist in the M M hospital records is an important records, but the complainant failed   neither produced the said prescription nor examined the said Gynecologist to establish the allegation  of complainant that the gynecologist in the MM hospital had not advised to conduct urgent surgery.  The learned counsel further submits that the complainant in this case has failed the allegations with cogent  evidence.  Further submits that an allegation of medical negligence cannot be presumed, it should be proved with the  evidence.  The learned counsel submits a citation of Hon’ble Supreme Court  post graduate institute case(2009(7)SCC 330) held that in medical negligence actions , the burden  is on the claimant to prove breach of duty, injury and causation.  In another  case the Hon’ble Apex court held that to prove the negligence of  a doctor, the medical evidence of an expert in the field is required(Dr.SK Jhunjhu wala 2019(2)SCC 282).

     Here complainant has failed to establish the above said two allegations either through treatment records or through examining  the Gynecologist of MM hospital to prove second allegation as stated above.  Hence the above said two allegations raised by the learned counsel of complainant cannot be believed.   

     The another allegation of complainant that due to the unnecessary removal of the right ovary during the surgery, preventing her  from conceiving in the future.

      About the said fact PW2 the expert Doctor opinioned during chief examination by complainant page No.3 രണ്ടു ovary ഉള്ള ഒരു സ്ത്രീയുടെ അതേ  status ആണോ ഒരു ovary നീക്കം ചെയ്ത സ്ത്രീയുടെ അവസ്ഥ? അല്ല.  അതുകൊണ്ട് ഗർഭധാരണത്തിനുള്ള സാധ്യതയും കുറവാണ്?(A).  അങ്ങനെയില്ല.  ഞാൻ പറയുന്നു, രണ്ടു  ovary ഉള്ള സ്ത്രീയേക്കാളും ഒരു ovary ഉളള സ്ത്രീക്ക് ഗർഭധാരണത്തിനുള്ള സാധ്യത കുറവാണ് എന്ന് പറയുന്നു?(A) ശരിയല്ല.  So from the  evidence of expert doctor, the said allegation of complainant also cannot be proved.

   The expert doctor(PW2) further opinioned that Ectopic surgery നടത്തിയത് വഴി uterus നകത്തുള്ള ഭ്രൂണത്തിന്ർറെ ജീവൻ നഷ്ടപ്പെടുവാൻ സാധ്യത ഉണ്ട്? (A) നഷ്ടപ്പെടും,  ഈ patient  ന്ർറെ       uterus ലെ ഭ്രൂണം നഷ്ടപ്പെട്ടത്  ovary നീക്കം ചെയ്തതുകൊണ്ടാണോ എന്ന് എനിക്ക് പറയുവാൻ  പറ്റില്ല.  On analysis of PW2’s evidence she has deposed that യൂട്രസിൽ ഒരാഴ്ച വളർച്ചയുള്ള  ഭ്രൂണം ഉണ്ടെങ്കിൽ ആയത് സ്കാനിൽ ബോധ്യപ്പെടുമോ ഭ്രൂണത്തെ കാണില്ല. പക്ഷെ യൂട്രസിന്ർറെ ഇന്നർ ലയറിൽ തടിപ്പുള്ളതായി കാണാം. അങ്ങനെ തടിപ്പ് കണ്ടാൽ ഗർഭിണിയാണ് എന്ന് ബോധ്യപ്പെടും. പക്ഷെ ആയത്  എവിടെയാണ് എന്ന് മനസ്സിലാക്കുവാൻ സാധിക്കില്ല. ഗർഭാശയത്തിനു പുറത്ത് ഗർഭധാരണം സംഭവിച്ചാലും ഈ തടിപ്പ് ഉണ്ടാവും.  ഓവറി ട്യൂബിൽ ectopic pregnancy നടന്നാൽ യൂട്രസിൽ അകത്ത് ഇത്തരം തടിപ്പ് ഉണ്ടാവും.

   Further Ext.A1 report ലും intra uterine pregnancy ഉള്ളതായി പറഞ്ഞിട്ടില്ല.  കാരണം ഒരാഴ്ച പ്രായമായ ഭ്രൂണത്തെUSG വഴി കണ്ടുപിടിക്കാൻ സാധിക്കില്ല.  സർജറി ടൈമിൽ intra uterine pregnancy  ഉണ്ട് എന്നു കണ്ടാലും ഈ കേസിൽ ഓവറി നീക്കം ചെയ്തെ പറ്റുള്ളൂ.  കാരണം life saving  ആണ് പ്രധാനം.  Further stated that Ext.A2(Histopathology report) ൽ peritoneal cavity യിൽ blood ഉം clot ഉം ഉണ്ടായിരുന്നു. ട്യൂബിൽ നിന്നും ബ്ലീഡിംഗും right ovary യിൽ നിന്നും ബ്ലീഡിംഗും ഉണ്ടായിരുന്നു. Ext.A2 പരിശോധിച്ചാൽ ഈ case ൽ ovary remove  ചെയ്തത് ശരിയായ treatment ആണ്.

   Here we can  realize that complainant does not have a case that Exts.A1&A2 report are not correct.  Hence from the evidence of expert opinion, we cannot find any medical negligence on the part of  1^st OP or 3^rd OP  in treating  the patient.  The complainant’s firm averment is that the surgery and treatment on her was done by 1^st OP.  But the medical record Ext.B1 clearly shows that the treatment and surgery was done by 3^rd OP alone.  Here in the complaint and  during evidence time complainant does not even  arised any complaint against 3^rd OP.  Complainant further alleged that Ext.B1 record is a forged document.  The said allegation was denied by 1^st OP during cross-examination.  Here  also there is no evidence before us to come to a decision that Ext.B1 is a concoted document.  From the medical records produced by the complainant and Ext.B1 clearly shows that the treating doctor and  surgery conducted  doctor was 3^rd OP.

     OP.No.3 was examined as DW1.  During cross examination of DW1, by 2^nd OP, has stated that ഞാൻ രണ്ടാം എതിർകക്ഷി ആശുപത്രിയിൽ 2009 മുതൽ 2020 ജൂൺ വരെ ജോലി ചെയ്തിരുന്നു.  നിങ്ങൾ പരാതിക്കാരിയെ പരിശോധിച്ച് സർജറി നടത്തിയിരുന്നോ? നടത്തിയിരുന്നു.  ഒന്നാം എതിർകക്ഷി കാഷ്വാലിറ്റിയിൽ വെച്ച് കണ്ടതിന് ശേഷം  റഫർചെയ്തിട്ടാണ് നിങ്ങളുടെ അടുത്തേക്ക് വന്നത്? അതെ.  നിങ്ങളുടെ മുന്നിലേക്ക് ഹാജരാക്കി തന്ന investigation report raptured ectopic pregnancy  ആണ് എന്ന് ഡയഗ്നോസ് ചെയ്തിട്ടു്ണ്ട്? അതെ. നിങ്ങളുടെ examination ലും prehistory  യിലും investigation report കൊണ്ടും diagnose  ചെയ്തത് ശരിയാണ് എന്ന് ബോധ്യപ്പെട്ടോ? ബോധ്യപ്പെട്ടു. raptured ectopic pregnancy  എന്നത് സർജിക്കൽ എമർജൻസി ആണ്. raptured ആകുന്പോൾ ഓരോ സെക്കണ്ടിലും ബ്ലീഡിംഗ് കൂടികൊണ്ടേയിരിക്കും.  സമയം വൈകുന്തോറും patient ന്ർറെ life നെ ബാധിക്കും .  എമർജൻസി ആയതുകൊണ്ട് വേറൊരു  സ്കാൻ ചെയ്യേണ്ടുന്ന ആവശ്യം ഇല്ലായിരുന്നു.  ഒരു ഗർഭിണിയിൽ ഭ്രൂണത്തിന്ർറെ വളർച്ച സ്കാൻ ഇമേജിൽ കാണണമെങ്കിൽ ചുരുങ്ങിയത് എത്ര ആഴ്ചത്തെ വളർച്ച വേണം? 6 ആഴ്ച. Pregnancy simultaneous ആയി inside ലും out side ലും വരാം.  ഓവറിയിൽ ബ്ലീഡിംഗ് ഉണ്ടെങ്കിൽ നിലനിർത്താൻ പറ്റില്ല. Bleeding profuse ആയെങ്കിൽ remedy എന്താണ്? clamp ഇട്ടതിന് ശേഷം പുറത്ത് ബ്ലീഡിംഗ് ഉള്ള ഭാഗം കട്ട് ചെയ്ത് കളയുക.

    Though complainant has cross-examined 3^rd OP, nothing has  elicitated  against the version given by 3^rd OP.  3^rd OP stated that he had evaluated the Ultra sound findings in Ext.A1, clinical symptoms and based on the examination, confirmed the diagnosis of ruptured ectopic pregnancy and decided to conduct an emergency laparotomy in order to save the patient from going into a state of hemorrhagic shock .

   The learned counsel OP submitted certain citation of Hon’ble Supreme court  in Jacob Mathew case(2005)6SCC1, 2005 SCC(Cri) 1369) the court observed that the onus to prove medical negligence lies largely on the claimant and that this onus can be  discharged  by leading cogent evidence.  A mere averment in a complaint  which is denied by the  other side can, by no stretch of imagination, be said to be evidence by which the case of the complainant can be said to be proved. It is the  obligation of the  complainant to  provide the facia probanda as well as the facta probantia. C.P.Sreekumar(Dr.)MS Ortho vs.Ramanujam (2009 7 SCC 130.  The commission cannot presume that the allegations in the complaint are inviolable truth even though they remained unsupported by any evidence(R.Singh vs. Shabana,2022 3CPR 82 Del).  A mere averment in a complaint which is  denied by the other side can , by no stretch of imagination, be said to be proved. It is the  obligation of the  complainant to  provide the facia probanda as well as the facta probantia . C.P.Sreekumar vs.Ramanujam 2009 )Supreme(UK) 218, 2009 2UAD 232 SC , 2010 1 UC 303 SC .  Further submit that direct  causation (causa causans) is one of the factors to be considered.(2014(2) CPR (NC) 351) in negligence  cases, one must prove that there was a duty, that duty was breached, and the breach of that duty caused damages. Vishnu Priya Giri(deceased) vs. G.M Modi Hospital Research centre for Medical  science,2022 3 CPR (NC) 198.  To succeed in any medical negligence claim, the  complainant must demonstrate that four essential ingredients of medical negligence are “4 D namely 1) duty of care(2) Dereliction(breach) of duty 30 Direct causation and 4) damage proximate to the breach. Manjulata Garg vs R.C Mishra,2022 4 CPR (NC) 169).

      On considering the entire facts, circumstances, medical records available, and also from  the view of Apex court , we cannot come into a conclusion that there is medical negligence and deficiency in service in treating  complainant by OPs 1&3 at 2^nd OP’s hospital.  Therefore there is no medical negligence on the part of OPs.

   In the result complaint fails and hence the same is dismissed.  No order as to cost.

Exts;

A1- Ultra sound scan report dtd.28/3/2017

A2- Discharge summary issued by 2^nd OP dtd.5/4/2017

A3- Histopathology report

A4&A9-OP registration sheet from Koyily hospital

A5&AA7-USG report and filim  from Koyili hospital dtd.28/4/17,4/5/17

A6&A8-Discharge summary   -do-

A10 series- Medical Bills 80 Nos. from KMC Kannur

A11(series)0Medical bills from Koyili Hospital

A12- OP card from  District Ayurveda hospital

A13- lawyer notice

A14&A15- returned lawyer notice  of OPs 1&2

B1- Medical records of PW1

PW1-Jiji.P- complainant

PW2-Dr.P.Ramadevi-witness of PW1

DW1-Dr.P.Gopinathan- 3^rd OP

DW2-Dr.Philomina George.K-1^st OP

Sd/                                                             Sd/                                                   Sd/

PRESIDENT                                             MEMBER                                               MEMBER

Ravi Susha                                       Molykutty Mathew                                    Sajeesh K.P

eva           

                                                                        /Forwarded by Order/

                                                                   ASSISTANT REGISTRAR