SMT. RAVI SUSHA: PRESIDENT

This complaint has been filed for getting an order directing opposite parties to pay Rs.20,00,000/- and costs to the complainant alleging medical negligence on the part of opposite party No.1 and deficiency in service on the part of opposite party No.2.

            Brief facts of complainant’s case are that the complainant admitted before Taluk Govt. Head Quarters Hospital in Taliparamba for her 2^nd delivery. On 19/11/2016 at 3.32 pm she delivered a female child. OP No.1 attended the delivery as the medical officer on duty at that time.  After getting pain also the delivery was delayed.  OP No.1 dragged out the newborn by holding the head with forceps, resulting in the child suffering injuries to the nervous system causing immobility to left hand.  Previously complainant was consulting OP No.1 among your during the period of pregnancy.  As advised by OP No.1 complainant had under gone various tests and obstetric scan.   On 01/10/2016 after scanning OP No.2 reported that everything was normal, and her expected delivery date was 25/11/2016.   OP No.1 had informed the complainant’s husband that the weight of the child is on the higher side.  In such cases OP No.1 ought to have resorted to cesarean.    But instead of that the OP No.1 dragged out child giving scope for severe damages to this new born.  After discharging the child was shown at neuro Hospital at Mangalore for further management.  Now the child is being given physiotherapy treatment at Lourd Hospital, Taliparamba.  The immobility of the entire left hand to the child continues as shall even now.  Complainant has to spent Rs.500/- per day for physiotherapy.  OP No.2 wrongly reported that the weight of the baby is 1.960 K.grams. OP2 did not make a correct assessment as to have weight of the fetus.  So there is deficiency in service on the part of both OP No.1 and 2.  OP No.3 is also liable since OP No.1 is a Government servant.   On 25/04/2017 the complainant had issued a lawyer notice to the OPs demanding the above said amount of Rs.25,00,000/-.  OP No.1 had received the notice on 29/04/2017 and OP No.2 &3 had received the notice on 26/04/2017 .  The OP did not pay the above said amount so far.  OPs had sent reply to the lawyer notice with false contentions.  For permanent disability, for treatment expenses, for mental and physical pain complainant demands the above said amount as compensation from all OPs are jointly and severally.  Hence filed this complaint.

            After receiving notices by OPs 1 to 2 filed version. OP No.1 contended that the complainant a 2^nd gravid with expected date of delivery on 24/11/2016 was under the antenatal care of the 1^st OP.  She was diagnosed to have gestational diabetics mellitus (GDM) and started on insulin.  The 1^st OP had attended the complainant with due care and advised proper medication and periodical ultra sound scanning as per protocol. The complainant underwent obstetric scanning on 01/10/2016 and as per scan report the estimated foetal weight was 1960+/- 137gms which was appropriate corresponding to gestational age.  Volume of amniotic fluid was found slightly increased and biophysical profile was normal.  As per scanning there was no foetal abnormality and the complainant was continued insulin for glycaemic control.  Complainant got admitted to Govt. Taluk Head Quarters hospital on 16/11/2016.  The 1^st OP had counseled the complainant about possible risk factors in trial labour likelihood of foetal weight gain due to gestational diabetes complicating vaginal delivery.  OP contended that during 2^nd stage of labour the complainant did not strain herself and for poor maternal pushing efforts delivery was effected by using outlet forceps with aseptic care and precautions.  There was slight difficulty in delivering the shoulder which was diagnosed as shoulder dystocia and it was managed as per MacRobert’s maneuver with adequate supra pubic pressure as per accepted medical protocol.  The baby had birth weight       4.530 Kg. and diagnosed to have Erb’s Palsy and referred for pediatric and orthopedic consultation.  Further management of the baby was done as per advice of the pediatrician.  The 1^st OP had attended and treated the complainant in strict regard to standard and accepted practice and protocol.  Shoulder dystocia is an unpredictable event diagnosed when after delivery of the foetal head, further expulsion is prevented by impaction of the foetal shoulder within maternal pelvis.  Brachial plexus injury is an accepted complication of shoulder dystocia developed due to factors beyond the control of the attending gynecologist.  There was no contra indications for trial vaginal delivery in the case of the complainant as per clinical history and radiological evaluation. There was no negligence or carelessness on the part of the 1^st OP in the management of delivery of the complainant he is not liable to compensate the complainant either jointly or severally and prayed for the dismissal of complaint against OP1.

            OP No.2 has stated in the version that the complainant reported to the Lourde Scanning Centre on 01/10/2016 for obstetric scanning as per reference from the Govt. Hospital.   Here reported last menstrual period was on 18/02/2016 and the calculated gestational age of foetus as per LMP was 32 weeks 2 days and expected date of confinement on 24/11/2016.  The 2^nd OP conducted scanning with due diligence and care and found a single live intrauterine foetus in cephalic presentation.  The estimated foetal weight as per radiological assessment was 1960+/-137 gm which was appropriate corresponding to gestational age.  The gestational age as per scanning showed only one day difference with gestational age as per LMP and the same was also noted in the report.  Volume of amniotic fluid was found slightly increase and biophysical profile was normal.  The complainant did not bring her previous scan report if any for comparative study.  On the basis of proper evaluation of ultrasound scan images the 2^nd OP issued a report and in view of increased liquor volume, the complainant was advised repeat scan and recorded the suggestion for follow up scan in the report.  But the complainant did not turn up for further scanning and she lost follow up.  OP submitted that in the scan report issued to the complainant after proper evaluation and study of images the 2^nd OP recorded the correct findings.  Ultra sound creates a two dimensional image of a three dimensional baby and in prenatal testing ultra sound results cannot be relied as 100% accurate in any circumstances.  It is a medically accepted fact that ultra sound scanning is not 100% fool proof diagnostic device and its findings need to be correlated with clinical findings and in case of difference of Opinion, reassessment with related necessary investigations are required for diagnosis.  The second OP had exercised reasonable skill and care in conducting ultra sound scanning for the complainant and in the examination, analysis and evaluation of the radiological images and hence not liable to compensate the complainant.  There was no deficiency in service on the part of the 2^nd OP and prayed for the dismissal of the complaint with cost.

            OP No.3 has pleaded that The Taluk Head Quarters Hospital, Taliparmba is a Govt.  Hospital giving treatment to the deserving patients free of cost.  As such the complainant herein is not a consumer as far as the OP No.3 is concerned.  OP3 submitted that the OP No.1 Dr.Remashan CK was working as Junior Medical consultant in Govt. Taluk Head Quarters Hospital at Taliparamba.  The complainant was admitted in the said hospital in 16/11/2016 as IP No.8602.  She was taking insulin for diabetic pregnancy.  She delivered a female child on 19/11/2016 at 3.32 PM.  The child was having a weight of 4.5 Kg.  Since the weight of the child was too high, power of the complainant to deliver the child was seen decreasing.  The OP No.1 reported to be attended the delivery by causing delivery with the help of forceps.  After delivery, the child was referred to orthopedic specialist since the child shown immovability on left hand.  The mother and child were discharged from hospital on 22/11/2016.  In fact the OP No.1 reported to be done all possible efforts to help the complainant for the delivery.  No negligence was reported as against the OP No.1 from any corner.  As such compensation claimed against this OP is not at all maintainable.

            Complainant was examined as Pw1 and Ext.A1 to A15 marked.  OP No.1 was examined as Dw1 and OP No.2 was examined as Dw2.  The case record form Taliparamba Municipality Taluk Head Quarters Hospital was marked as Ext.X1.

            The 1^st contention raised by the learned counsel of OPs No.1 and 2 is that complainant is not a consumer within the meaning of s.2(1) (d) of the consumer Protection Act 1986 in as much the complainant was rendered services by the OP No.1 without any charge.  Further submitted that the complainant was also bad in law due to non-jointer of necessary and proper parties ie. complainant’s case is that she had availed service of OP No.1 at Taluk Govt. Head Quarters hospital in Taliparamba.  But the hospital was not impleaded as a party in this OP array.

            In support of the arguments, OP1 relied upon the rulings IMA Vs VP Shantha 1995(6) SCC 651, Niveditha Singh Vs.Dr.Asha Bharti in 2022 (1) KLJ 864 in which the Hon’ble court held the “A medical officer employed in a hospital provides services on behalf of the hospital administration.  If the service rendered by the hospital is free of charge and does not fall within the scope of sec. 2(1) (o) of the act, then the service rendered by the medical officer employed in the hospital, who receives a salary, cannot be considered as service under section 2 (1) (O).  Govt. hospitals would not be within the purview of the Act.

            Here, the case of the complainant is that during her 2^nd pregnancy, she was under the antenatal care of the OP No.1.   As advised by OP No.1, complainant had undergone various tests and obstetric-scan.  Accordingly on 01/10/2016 complainant underwent the USG Scan from OP No.2.  After scanning OP No.2 reported that everything was normal.  As per the scan report given by OP No.2, the expected date of delivery was 25/11/2016.  Complainant alleged that OP No.2 had wrongly reported that the weight of the child is only 1.960 K.gms.  OP No.2 did not make correct assessment as to the weight of the fetus.  Complainant gave birth to a child on 19/11/2016.  Complainant alleged that at the time of delivery oPNo.1 had dragged out the child by holding the head with forceps.  In the process there were injuries to the nervous system causing immobility to left hand of the new born.  Further, alleged that OP No.2 wrongly reported that the weight of the baby was              1.960 Kilograms, whereas at the time of birth, the baby weighed 4.530 kilograms.  OP2 did not make a correct assessment of the baby’s weight.

            For substantiating the allegations, complainant herself has given evidence and submitted her treatment records.   In the complaint she alleged that Right side shoulder dystoua was suffered to the child due to the stretching of nerves at the time of delivery as a result of vigorously and rashly pulling the body of the child.  If OP No.1 had taken the required care expected from a doctor, the injury on the newborn child could have been avoided.  Further, alleged that, if the weight of the baby was above the normal rate, OP1 ought to have opted cesarean.  The complainant alleged that the child has permanent disability and has to spent Rs.500/- per day for physiotherapy.  According to complainant, OP No.2 wrongly reported on 01/10/2016 in the scan report  that the weight of the baby is 1.960 K.grams where as at the time of birth, the baby weighed 4.530gm. OP2 did not make a correct assessment as to have weight of the baby.

            During cross-examination time, Pw1 deposed that കുട്ടിയുടെ തല forcep ഉപയോഗിച്ച് വലിച്ചെടുക്കുകയായിരുന്നു.  കുട്ടിക്ക് പ്രസവത്തോടെ കയ്യുടെ നരമ്പിനാണ് അസുഖം വന്നത്.  കയ്യുടെ നരമ്പിന് അസുഖം വന്നത് forcep ഉപയോഗിച്ച് ഷോൾഡർ  വലിച്ച് എടുത്തതുകൊണ്ടാണ്. കുട്ടിയുടെ തല forcep ഉപയോഗിച്ച് ഷോൾഡർ  വലിച്ച് എടുത്തതുകൊണ്ടാണ് കയ്യുടെ നരമ്പിന് അസുഖം വന്നതെന്ന് ഡോ. ബട്ട് അശോകയിലെയും മംഗലാപുരം ഡോ. രാജേഷ് ഷെട്ടിയും പറഞ്ഞിട്ടുണ്ട്. 2-ാം എതൃകക്ഷി സ്ക്കാൻ ചെയ്ത് തെറ്റായ റിപ്പോർട്ട്  കൊടുത്തതുകൊണ്ടാണ് 1-ാം എതൃകക്ഷിക്ക് കുട്ടിയുടെ weight കൃത്യമായി  മനസ്സിലാകാതിരുന്നതെന്ന് പറയുന്നു. എന്നതാണ് നിങ്ങളുടെ പരാതി? ശരിയാണ്.  2-ാം എതൃകക്ഷി സ്ക്കാൻ റിപ്പോർട്ടിൽ കാണിച്ച ഭാരം എന്നുള്ളത് മറ്റാരെക്കൊണ്ടും വീണ്ടും സ്ക്കാൻ ചെയ്യിച്ചിട്ടില്ല.  ആയതുകൊണ്ടുതന്നെ 2-ാം എതൃകക്ഷി ചെയ്ത സ്ക്കാനിംഗ് തെറ്റാണെന്ന് പറയാൻ പറ്റില്ല എന്ന് പറയുന്നു?  ശരിയല്ല.  During re-examination Pw1 deposed that forceps deliveryയിൽ കുട്ടയുടെ തല പിടിച്ച് വലിച്ചതുകൊണ്ടാണ് പ്രാകൃത രീതിയാണെന്ന് പറഞ്ഞത്.  Maternal pushing കുറവ്കൊണ്ടാണ് ഡലിവറിക്ക് പ്രശ്നമായതെന്ന് 1^st OP പറഞ്ഞിട്ടില്ല.

            OP No.1 pleaded that on 16/11/2016, complainant was admitted in the OP hospital.  She was taking insulin for diabetic pregnancy.  On 19/11/2016 she delivered a female child having a weight of 4.5 Kg.  Since the weight of the child was too high, power of the complainant to deliver the child was seen decreasing.  So OP No.1 attended the delivery by causing delivery with the help of forceps.  Since the child shown immovability on left hand, the child was referred to orthopedic specialist.  OP NO.1 contended that he had attended the complainant with due care and advised proper medication and periodical ultra sound scanning as per protocol.  Further stated that during delivery there was slight difficult in delivering the shoulder which was diagnosed a shoulder dystocia and the baby was referred for pediatric and orthopedic consultation.  There was no negligence or carelessness on his part in compensate the complainant.

OP No.1 contended that negligence on the part of OP1 doctor must be established by the complainant through expert opinion.  OP1 pleaded that negligence cannot be presumed.  Further contended that   the doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by responsible body of medical men skilled in that particular art.

            The learned counsel of OP 1 relied upon the ruling Baba Saheb Ambedkar Memorial Hospital Vs.Manjeri Sinha 2017(4) CPR (NC) 822(similar to the present case) in which it is held by the Hon’ble appellant commission that it is an admitted position that the child delivered by the complainant had birth injuries in the form of shoulder dystocia.   She is also stated to have birth injuries in the form of left brachial plexus with honor’s syndrome.  However, there is no expert opinion produced before the State Commission to prove that the aforesaid injures happened only on account of negligence on the part of the appellant NO.2 in performing the delivery procedure.  There is no expert opinion to prove that but for a negligence, the child would have been born without the aforesaid injuries.

The learned counsel of OP 1 submitted another Judgment of Hon’ble Appellate commission having similar facts as that of the present case. M/s Sinhgal Maternity and Medical Centre & Anr. – Appellants versus Master Nishant Verma & Ors –Respondent 2014 2 CPJ NC 441 OPs contention was after delivery of the head, shoulder impaction occurred because of poor maternal effort on the part of complainant No.3 leading to shoulder dystocia and known complication, namely, brachial plexus injury.  It is medically well established that both these are unpredictable events and can occur despite perfect obstetrical management, as in the instant case.  On detecting this condition, OP No.2 acted as per standard protocols by using Mc Roberts maneuver, widening of episiotomy and applying supra public pressure.  Following delivery both complainant No.1 and complainant No.3 received the best possible medical care and attention from a number of specialists, including a Pediatrician and a Neurologist.  Under the circumstances, the complaint of medical negligence and deficiency in serviced is not maintainable and deserves to be dismissed.  Counsel for the OPs cited extensively from medical literature, including  Williams*, to prove that in most of the cases shoulder dystocia cannot be  predicted or prevented because there are no accurate methods and it can occur in both normal weight and also large weight babies.  Further when shoulder dystocia was noticed, the standard protocol/procedure to deal with such cases was undertaken.   The State Commission wrongly concluded that the McRoberts maneuver was not used merely because it was not specifically mentioned in the discharge certificate to use forceps instead of vacuum suction apparatus, from the medical literature on the subject, we note that both procedures ie. Forceps delivery and vacuum suction apparatus delivery have their pros and cons and, under the circumstances, the decision of which procedure to adopt is best left to the professional judgment of the doctor conducting the delivery.  As per medical literature on the subject, these are two separate procedures.  The McRoberts maneuver alone is believed to relive more than 40% of shoulder dystocias and when combined with suprapubic pressure relieves more than 50 % of shoulder dystocias.  The Hon’ble Commission held that to sum up, so far as First Appeals No.217 of 2007 and 391 of 2007 filed by OPs No.1 & 2 and OP No.4 / Insurance Company respectively are concerned, we agree with the ORDER of the State Commission that there was medical negligence on the part of OPs NO. 1 & 2 in not conducting the required and important ante natal tests as peer the standard protocols, which had unfortunate repercussions, and also in failing to use Mc Roberts maneuver in handling shoulder dystocia.  However, we are unable to conclude as discussed in the foregoing paragraphs that medical care and treatment of complainant No.1.  Accordingly, the above 1^st appeals are dismissed and the order of the State Commission is upheld with the above mentioned modification.  Minor Harsh Amit Kumar Sheth and Ors. – Appellants versus Sheth Hospital and Maternity Home and Ors. – Respondents 2012 (4) CPJ NC 350 in which contention of OP that the injury caused to the infant was not as a result of the fall but had occurred at the time of birth due to shoulder dystocia.  In this connection, it was pointed out that during delivery as is natural, the head of the baby comes out first and thereafter the shoulder which are wider.   Sometimes, as has happened in this case, the shoulder gets trapped and it is by pulling out the remaining portion of the body from the womb that the child is delivered.  Sometimes during this procedure an injury can occur which is described as shoulder dystocia.  However, if the infant is not forcibly pulled out after the head has appeared, its life can be seriously endangered.  In the instant case, the child’s head came out normally but the portion  of is shoulder being broad, dystocia had occurred and even though an episiotomy was done, it became necessary to use forceps for pulling the shoulder of the child so as not to endanger his life.  This is a complication which can occur without any earlier symptoms or forewarning and in such case injury to the bronchial plexus cannot be ruled out but one has to select between the two devils a side risk of hypoxia or risk of injury to branchial plexus.  Doctors invariably choose the lesser riskie of causing brachial plexus injury.  This does not imply that her is any medical negligence, particularly, in the instant case where as stated above, due care and precaution was taken right from the time of the pregnancy till the delivery and thereafter.

Here from the entire facts and circumstances, the decision taken by the Hon’ble Appellate commission and also from the medical literature, our considered view no reliable evidence and substantial reason have been submitted by the complainant to come to a conclusion that there was medical negligence on that the part of OP No.1 that no adequate pre-natal care was taken in adopting the method of delivery on the complainant and also remained unattended prior and after the delivery to the complainant.  Hence we are of the view that there was no medical negligence on the part of OP No.1 doctor.

            With regard to OPNo.3, District collector Kannur is an unnecessary party in connection with the facts of this case.  Hence OP No.3 is exonerated from the liability.

      As far as OP No.2, Dr.Sneha Mathew, consultant radiologist, is concerned, complainant’s allegation is that OP No.2 did not make correct assessment as to the weight of the foetus and had wrongly reported weight of the baby as only 1.960Kg.   According to OP No.2 she had rightly estimated foetal weight as per accepted guidelines which was corresponding to gestational age at 32 weeks and simply based on baby’s birth weight it cannot be termed as wrong.  The complainant had uncontrolled gestational diabetes mellitus and her abnormal foetal weight gain was due to her condition of GDM.  Even in normal patients (without GDM) maximum weight gain of the foetus during the last eight weeks of pregnancy.  So in a patient with GDM the foetus weight gain after  32 weeks can go up to many folds.  There was no error or fault on her part in the assessment of foetal parameters and estimated foetal weight recorded by OP2 was correct and the same cannot be presumed as wrong merely on the basis of actual birth weight.  There was no deficiency in service of my part.  So OP2 is not liable to pay any compensation to the complainant.

            The question to be decided is whether OP No.2 issued scan report negligently?

            During cross-examination of OP No.2 as Dw2, she has deposed that കുട്ടിയുടെ വളർച്ച സാധാരണ ഗതിയിൽ എത്ര ആഴ്ച കൂടുമ്പോൾ എത്ര കിലോഗ്രാം കൂടും?  32  ആഴ്ചയ്ക്ക് ശേഷം 200 ഗ്രാം കൂടാം അല്ലെങ്കിൽ  കുറയാം. This was an answer given by the OP2 when she was cross examined.  This testimony was not challenged.  So this is the evidence available before this Hon’ble commission. 18,20 ആഴ്ചയിൽ 20 മുതൽ    50 ഗ്രാം വരെ കൂടാം.   Ext.A5 32 മത്തെ   ആഴ്ചയിൽ ചെയ്ത സ്ക്കാൻ റിപ്പോർട്ട്  ആണ്. ഡെലിവറി ആയത് 38 ആഴ്ചയ്ക്ക് ശേഷമാണ്. Amniotic fluid quantity    കൂടിയത്കൊണ്ടാണ് വീണ്ടും സ്ക്കാൻ ചെയ്യണമെന്ന് suggest ചെയ്തത്.

            OP No.2 has pleaded that, she analyzed the USG image and reported the baby’s weight correctly.  It is argued by the learned counsel of OP2 that as there was no second report taken from any other center, it is not possible to say that Ext.A5 scan report dated 01/10/2016 is a wrong report.  Further submitted that there may be an unexpected increase in the baby’s weight just before delivery, which is a scientific fact.  According to OP No.2 as the consultant radiologist conducted scanning with due diligence and care and found a single live intrauterine foetus in cephalic presentation.  The estimated foetal weight as per radiological assessment was 1960+/-gm which was appropriate corresponding to gestational age.  As per the text book on Ultrasonography in Obstetrics and Gynecology by Callenfoetal growth at 32 weeks the estimated foetal weight is 1953 gms (page 136).    On scanning the OP.2 found the weight proportion to the normal required weight.  But at that time amniotic fluid was found slightly increased and biophysical profile was normal.  On the basis of proper evaluation of ultra sound scan images the OP2 issued the report.  It was also advised for follow up.  The OP2 denied the allegation that she did not make correct assessment at the weight of fetus and had wrongly reported the weight of child as only 1.960 Kg only.  The OP pleaded that even in normal patient (without GDM) maximum weight gain of fetus during the last 8 weeks of pregnancy there may be maximum weight gain of fetus.  In patient with GDM the fetus weight gain after 32 weeks can go up to many folds.  So there is no basis in alleging that the report of the OP No.2 was not correct.

            It is an admitted fact that USG was taken by OP No.2 at 32 weeks of pregnancy and the delivery happened at 38 weeks ie. after 6 weeks from taking USG Scanning Dw2( OP2) deposed that the weight of foetus will increase or decrease 200 gms. each after 38 weeks.  Here as per Ext.A5, dated 01/10/2016 the weight of baby at 32 weeks was 1.96Kgm.  At the delivery ie after 6 weeks on 19/11/2016 the weight of the baby was 4.53gm.  As per the opinion made by OP No.2 the weight of the baby would have been maximum 3.16 Kgm.  OP No.2 claimed that since there was amniotic fluid slightly increase, the weight may vary.  But for that contention no expert evidence has been adduced by OPs.  Further for the pleading that increase weight 200gm per week after 32 weeks also has no expert evidence.  Opinion of OP No.2 cannot be taken as expert opinion.   Though considered the evidence of OP No.2, there was increase of more than 1.37 gm increase.  OP No.2 contended that there is no other report taken subsequently to Ext.A5 report.  Since there was no advise from the side of treating doctor (OP No.1) to take another USG Scan, we cannot blame the complainant for submitting another scan report to counter Ext. A5 report.  OP No.1 pleaded that from Ext.A5 report there was no reason to suspect abnormal foetal weight gain as Ext.A5 scan report shows normal.  From the evidence available, we are of the view that all the anomaly on the child happened due to the incorrect report to OP No.2.  There is no dispute that the complainant has taken scanning form OP No.2’s scanning centre after paying fee.  So no doubt, complainant is a consumer of OP No.2.  Hence complainant is entitled to get relief from OP No.2, Dr. Sneha Mathew consultant Radiologist Ext.A16 shows Loco motor disability  Erbs palsy (L) 40%.  Complainant has also submits documents to show that physiotherapy was doing on the child.

            In the result complaint is allowed.  Opposite party No.2 is directed to pay Rs.5,00,000/- to the complainant towards compensation and Rs.25,000/- towards cost of the proceedings of this case.  The 2^nd OP shall comply the order within 45 days from the date of receipt of the certified copy this order.  Failing which the amount Rs.5 lakhs carries interest @ 9% per annum from the date of order till realization.  Complainant can execute the order as per provision of Consumer Protection Act 2019.

Exts.

A1- Prescription dated 11/08/2016

A2- Discharge card

A3- Discharge card dated 28/10/2016

A4- Prescription dated 07/05/2016

A5- Scan report dated 01/10/2016

A6(2 in No.)- Laboratory report dated 17/11/2016(2 in numbers)

A7- Prescription dated 23/11/2016

A8- Consultation bill dated 19/12/2016

A9- Physiotherapy card

A10- Cash bill  dated 20/09/2021

A11- Discharge card dated 28/01/2020

A12- Medical bill (13 in Nos.) Rs.55,889/-

A13- Prescription dated 17/04/2022

A14- MRI Referral Form

A15- Certificate issued by Lourde hosptial dated 13/05/2022

A16-Copy of Disability certificate

X1-The case record from Taliparamba Municipality Taluk Head Quarters Hospital

Pw1-Complainant

Dw1-OP1

Dw2-OP2

      Sd/                                                                                 Sd/                                                         Sd/

PRESIDENT                                                                 MEMBER                                               MEMBER

Ravi Susha                                                               Molykutty Mathew                                     Sajeesh K.P

(mnp)

/Forward by order/

Assistant Registrar