M Pundalika Shenoy vs Ramaiah Institute Of Cardiology

1.ONE Sri Pundalika Shenoy had filed this complaint against M/s. M.S. Ramaiah Institute of Cardiology and Gokula Education Foundation (Hospital) and its 3 Doctors praying for the direction to them to pay compensation of Rs. 19,82,853.00 along with interest @ 24% p.a. from the date of receipt of Notice dated 21.11.1996 and such other relief deemed fit. During the proceedings, the complainant died and his Legal Representative are brought in record. O.P. 3 Dr. Nityananda Shetty expired and deleted from the complaint under the Order dated 18.11.2004. The brief facts of the case are that the deceased Pundalika Shenoy was admitted into the O.P. 1 Hospital on 17.2.1996 with pain in the left leg. It was diagnosed as Deep Vein Thrombosis of the left lower limb. He was an in -patient from 17.2.1996 to 24.2.1996, and he was advised to take oral anti -coagulants. Discharge summary was given to him at the time of discharge. Later on, he developed breathlessness and as immediate measure, was admitted to local Hospital near his residence at Vijayanagar, and thereafter shifted to O.P. 1 Hospital on 21.5.1996. There, he was taken as in -patient. He was treated for some time, and advised by O.P. 4 Dr. Nagaraj Desai to undergo implantation of IVC Filter to cure his ailment. At the time of advice, he did not care to inform complainant or his two younger brothers Sri Vithoba Shenoy and Sri. Damodar Shenoy who had accompanied him, as to the pros and cons of the same. But, peremptory opinion given by him to them was that unless the said implantation was not done, patient could not get any relief. O.P. 4 asked for an advance of Rs. 14,321 towards implantation, and after depositing the same, he proceeded to conduct the implantation. The complainant agreed to undergo the said implantation without demur, in view of the advice of O.P. 4 that filter implantation was the only curative and life saving measure for deep vein thrombosis. It was done on 30.5.1996 by a team of Medical Experts headed by O.P. 4, and including O.Ps. 3 to 5 who were attached to the O.P. 1 Hospital in their professional capacities. The said implantation was done through the Right Internal Jugular Vein Cannulation. The entire process was visibly projected on Image Intensifier, and patient was watching it. It was conducted by O.P. 4 and assisted by other Doctors including O.Ps. 3 and 5. After about half an hour, the said process had commenced, the complainant suddenly suffered from a piercing ache and internal slab pain, at around the region of heart and chest, and lost consciousness. When he recovered, he was given to understand by the O.Ps. 3 to 5, that the said implantation was successfully performed and that while doing so, there had been certain incidental complication i.e., there was a tear in the Right Ventricle, and they were required to perform Median Sternotomy, a operation for the closure of the right ventricle tear which was of a common nature associated with such implantation. The said surgery was done as an emergency for close of right ventricle tear. The tear had been caused due to cardiac perforation which had led to tamponade, as told by them. The patient believed it, as there was no reason to disbelieve at that time. He was in the Intensive Care Unit and treated there till 12.6.1996 when he was discharged, with the discharge summary. He had to spend Rs. 1,05,000 being the cost of implantation including professional charges, cost of IVC Filters and expenses for pre and post implantation treatments, Hospitalization charges, cost of expenses incurred for the surgery of Median Sternotomy and other miscellaneous, incidental charges and expenses covering post operation also. Thereafter, the patient has advised by O.Ps. 3 to 5 at the time of discharge, to visit the O.P.1 Hospital for treatment and dressing, which was done. He was also asked to visit for a post operation observation, which he did. He developed acute pain after the said operation which continued even after discharge. When he complained to the O.Ps. 3 to 5, they went on consoling him by stating that pains were normal and usual and in due course of time, it will subside. He not only believed them, but also bore with the chest pain which increased considerably and steadily, and it started radiating all over the chest and back, instead of subsiding. The patient had reasons to doubt about the efficaciousness of the implantation treatment, and the operation conducted by the O.Ps. When pain became totally unbearable, complainant who had by the said time had lost faith in the O.Ps., got himself admitted in the Vital Mallya Hospital on 6.8.1996, where it was diagnosed as wound infection of Sternotomy, which was due to the perforation of R.A.I.R.V. coupled with massive pericardial effusion. After the surgery of Median Sternotomy by O.Ps., there was a drainage of effusion from chest wound and causing radiating pain all over the chest. The said infection pericardial effusion and radiating pain had all been caused due to the negligent and carelessness with which the said Median Sternotomy operation was conducted by O.Ps. on 30.5.1996. The patient was advised to undergo operation for Sternal Wound Exploration, wire removal of right coastal cartilage excision. The said wire had been inserted by the O.Ps. at the time of Median Sternotomy surgery which was required to be removed after the operation, which they never took care to do so. The patient had no option to undergo the surgical operation at the Mallya Hospital, as otherwise, it would have become fatal. He had to remain there as inpatient from 6.8.96 to 10.8.96 and had to spend about Rs. 19,500 being the pre -operation, laboratory and other tests, hospitalization charges, operation charges, medicines, for treatment, other incidental and miscellaneous expenses including post operation medical expenses. Discharge summary was issued to him at the time of discharge on 10.8.1996 produced. Even after the discharge from the Mallaya Hospital, the patient did not get well, due to infection and abysses of XIPHISTERNUM adjoining the 8th and 9th coastal cartilage and Osteomyclitis of lower end sternum which was the result of the negligence of the O.Ps. in conducting the medians sternotomy surgery. The patient had to undergo yet another operation at Mallaya Hospital which was solely necessitated on account of the negligence of the O.Ps. as stated above. Again he had to spend Rs. 25,000 being the cost for laboratory and other tests, hospitalization charges, operation charges etc. Discharge summary in that regard is produced. In view of the subsequent surgical operation at Mallaya Hospital and after making inquiries with the persons in medical field, he learnt, as an utter shock that there was no necessity whatsoever for filter implantation and the said process which was never understood the process in the medical field as being a curative one, much less the life saving measure. O.P. 4 claims to be expert in field of implantation has taken a risk to study the implantation process at the cost of patients life. The other O.Ps. are the parties to conspiracy in experimenting the same on the life of the complainant who are also aware that the said process is unusual one and rarely advised by the medical experts throughout the world, and knowingly well that the same was not life saving or curative one. The O.Ps. had been totally careless and negligent even while performing IVC implantation, which was not at all necessary. The filter implantation was even monitored through the image intensifier screen and entire process could be watched. Pig Tail Catheter inserted through the jugular vein, went astray due to their negligence and carelessness and it got inserted into right ventricle causing tear, and the O.Ps. negligent attitude thereafter too is apparent, they could have pulled the same and redirected properly. Fact speaks to itself as could be seen from the nature of the tear caused to the right ventricle that no such care and diligence was exercised. It could not have normally occurred except by excess assertion of force while inserting the same which indicates their negligent and carelessness and lack of experience while performing the implantation. The general medical opinion is such tear never occur and very rare. The chances of deflection of the applicator capsule into the right ventricle is generally overcome by applying the torque to the inserting catheter using appropriate method or by turning the patient. The O.Ps. have not taken any precautionary steps of using appropriate method or by turning the patient. They have not even taken the steps to overcome such eventuality of deflection which could have been foreseen and lack of it resulted in the tear of the right ventricle. The median Sternotomy operation had not been conducted in the manner it was required to be done by the O.Ps. The very fact it led to wound infection and pericardial effusion and draining of the same necessitating further operation and treatment at Mallaya Hospital to over come it, shows that the O.Ps. had either during the said operation or earlier thereto in implantation have not taken any care and caution much less the least minimum care and caution expected while performing such implantation. All the O.Ps. have played fraud and practised deception of the complainant, as they never care to inform the exact nature of the operation conducted by them on 30.5.1996, when the complainant had fallen unconsciousness. They did not care to inform correct state of affairs, lest the complainant would then have taken action against them before they could have suppressed the traces of their negligent acts. They have further played deception as they neither informed the complications that had further arising after the said operation, nor had taken any post operative care after the median sternotomy conducted by them. Their act and conduct do not behove the Nobel Medical profession who are required to be honest and sincere, and as such O.Ps. have violated ethics of the medical profession. The complainant has issued legal notice on 21.11.1996 to O.Ps. highlighting the above factors for which they have replied on 16.12.1996 denying their liability and raising series of false, reckless, frivolous excuses to overcome their negligence and carelessness.

THE patient prior to the said operation, was working on the sales side headquartered at Bangalore and he was last employed as Sales Officer of M/s. Bharath Trading Company, Rajajinagar, Bangalore. He had put in 24 years of service involving vigorous travelling and canvassing for various products. He had been a very energetic person, after the implantation and operation conducted by the O.Ps., he has become a total recluse. He has been undergoing treatment regularly and he has advised to continue for indefinite period, but at the same time without much hope of improvement. The negligence and carelessness by O.Ps. has effected his health and mortality apart from depriving sources of livelihood. He cannot exert himself in any manner and has become burden to the family of wife and 2 young daughters, which has caused severe mental tension. He has to undergo Psychiatric treatment for Pschomatic Fobic disorder (still undergoing), caused on account of above facts. He has been advised to stay indoors till further advice, till he gets strength to move about. He requires the assistance of 3rd parties for his daily cores. This has caused serious apprehension whether he could lead normal life discharging marital obligations. He was earning Rs. 65,000 p.a. before he was hospitalized. He had bright future, but for the negligence of O.Ps., he would have not only continued to earn the said amount and would have gain more during the subsequent periods considering the normal increments, till the age of 60 years. He was likely to be promoted and would have earned considerably more amount than expected to be earned by him in the course of time. He has reasonably expected to leave beyond 60 years as generally, his family elders lived fairly longer period, and lived healthily. He would have been continued to be employed gainfully. His average gaining as per modest estimate to be Rs. 65,000 per year and making provisions for the increments, he would have earned not less than Rs. 1,10,000 on 60th year. In all, for the period from 1997 to 2009 (16 years) he would have earned not less than Rs. 12.50 lakhs. Considering all the above facts, the patient has claimed global sum of Rs. 19,82,853 as damages. The claim in the complaint is under 5 heads -For the reimbursement of charges and treatment, Rs. 1,05,000 in the O.P. Hospital, Rs. 44,520 Mallya Hospital Expenses, and loss due to earnings, 2/3 of Rs. 12,50,000 i.e., Rs. 8,33,333, and compensation for pain and agony and future medical expenses Rs. 10.00 lakh. Version of O.Ps. 1 to 5 is that the facts and circumstances of the case requires elaborate oral and documentary evidence to decide the issues raised by the complainant, which is not suitable for adjudication in a time -bound proceedings under the Consumer Protection Act. It involves complicated questions of disputed facts in medical science and jurisprudence, which can be decided only after elaborate trial and scrutiny of various documents based on the expert opinion. This is a fit case to be decided by way of ordinary civil suit. They have admitted the complainant having admitted himself in the O.P. 1 Hospital with the complaint of pain in the left leg on 17.2.1996, and it was diagnosed as deep Venous Thrombosis of the left lower limb. He was in -patient from 17.2.1996 to 24.2.1996 and was discharged with the advice to take oral anti -coagulants. The fact of admission of the patient to a local hospital near his residence after he developed breathlessness at Vijayanagar and later on shifted to O.P. 1 Hospital on 21.5.1996 is admitted. The cause of breathlessness is on account of the complainant not following the medical advice at the time of discharge from the O.P. 1 Hospital at the first instance. The deceased complainant was admitted for the second time to the O.P. 1 Hospital on account of his utter carelessness, laches and negligence of not following the medical advice at the time of discharge from O.P. 1 Hospital. He developed breathlessness and also Haemoptysis. On observation, he had recurrent deep Venous Thrombosis and Pulmonary Embolism. Initial conservative treatment given was rest and elevation. He was started on heparin streptokinase and other resuscitative measures. In spite of this, he had recurrent episode of Pulmonary Embolism. After consultation and informing the complainant and his relatives about the advantages and disadvantages of the procedure of IVC Filter Implantation, besides the risks involved, the deceased was offered an insertion of IVC Filter Implantation to prevent fatal pulmonary embolism due to the recurrent attacks only as a life saving measure, and not as a cure in Deep Venous Thrombosis. Deceased consented for the said implantation offered by the O.Ps. and made part payment towards the cost and surgery for the said implantation, was performed on 30.5.1996. The IVC filter was inserted through the right internal jugular route, it is admitted. The process of implantation was projected on image intensifier. While performing the said procedure, deceased had cardiac tamponade and as an emergency was treated by the surgical exploration as it was the only chance of saving the deceaseds life at that stage, it is a known complication during the said procedure and if not diagnosed in time and operated upon i.e., Median Sternotomy Operation, the deceased complainant would have ended up in fatality. The cardiac tamponade is rare one. After the operation sternotomy was closed using sternal wires and the patient had complete healed median sternotomy wound at the time of discharge on 12.6.1996. He was asked to follow up for the some time as the pain in the region of operation in the normal course would last from few weeks to a few months till the bone union takes place, at the time of discharge. Except for the hospital charges for the said implantation treatment collected from deceased complainant, they are not aware of any other expenses incurred by him. Rs. 1,05,000 mentioned is exorbitant and excessive. The complainant did not follow up any post operation treatment as advised and for reason best known to him and did not visit the hospital regularly after his discharge on 12.6.1996. There is no reason for the deceased complainant to doubt about the efficaciousness of the O.Ps. 3 to 5 since they are doctors of repute and the whole exercise in their efforts was done with due care and caution as a life saving measure with a bona fide intention to save the deceased complainant. In case of median sternotomy operation, the pain in the region may last for a few weeks to a few months. The post operative complications put forth in the complaint were not brought to their knowledge, besides no follow -up treatment was taken by the deceased complainant, as advised. After the sternotomy operation which was closed using sternal wire and the removal of the said wires is postponed for 8 -10 weeks to prevent sternotomy dehiscence failing which it will lead to yet another emergency. The operation at Mallya Hospital is as a result of negligence and lapses for not taking follow -up treatment regularly as advised to the deceased patient. The very fact that the complainant is still suffering and did not recover despite the treatment at Mallya Hospital, goes to show that the complications developed by the complainant are for the reasons beyond the control of the O.Ps., and the same are despite the best diligent efforts of the O.Ps. and maximum use of their knowledge, skill and expertise. The said post operative complications are unpredictable since medical science is empirical, and in the normal course none can foresee development of such complications since human body is complex and subjective. The suffering of the deceased complainant after discharge from Mallya Hospital cannot be attributed to the negligence of the O.Ps. in conducting the median sternotomy operation, which was done with due care and caution.

THE procedure does not involve using Pig Tail Catheter in the operation and deceased patient was ill -advised in the matter and has made wild allegations without proper verification, authenticity of facts on medical field only to make a case to suit his convenience. There is no evidence of pericardial effusion as per para 14 of the complaint. Paras 13 and 14 of the complaint requires to be strictly proved. It is objectionable that deceased complainant has used defamatory and derogatory words such as fraud, deception, suppression. Requisite care and caution were taken by O.Ps. subsequent to the median sternotomy operation. O.Ps. have appropriately replied the legal notice dated 21.1.1996 highlighting the true facts. Basis arrived at for making the claim are false, motivated and imaginary. The claim is unrighteous, unjustifiable and without precedents, and against the well established cannons of law and medical literature. There is no logic or rational for such claims under various heads. The huge amount of claim manifests the dishonest intention to make a wrongful gain. The deceased complainant exaggerated the claim of Rs. 19,82,853 under various heads, has got a potential to create mischief and deter doctors undertaking risky surgical operations lowering their morale. By making false allegations, the deceased complainant is trying to cover up his own lapses and laches. The complainants are not entitled for any compensation and interest on the claim amount.

THE O.Ps. 2 to 5 are doctors of repute and are experienced. O.Ps Hospital is also one of the reputed hospitals in Bangalore City catering to the needs of the public and with necessary infrastructure and experienced team of doctors known for the professional integrity and honesty. The O.Ps. Hospital does not experiment on any patient in the field of medical science. O.Ps. have strictly adhered to the medical ethics and ettiquates for saving life of the deceased patient complications while inserting IVC filter. The known complication documented in medical science literature and text book, though it is there. O.Ps. are not liable to pay any compensation either jointly or individually. They have sought for the dismissal of the complaint. The complainants have relied on Exts. C1 to C9 and filed the affidavit of deceased Pundalika Shenoy, patient and that of his wife Sumana P. Shenoy after his death. The complainant No. 1 Sumana P. Shenoy is cross examined as C.W. 1. On behalf of O.Ps., they have relied on Exts. R1 to R34 and filed the affidavit for O.P. 1 and O.P. 2, Director Dr. K. Balasaraswathi of O.P. 1 along with O.Ps. 3 to 5. O.P. 4 Dr. Nagaraj Desai is cross examined by the complainant as R.W. 1. We have heard both sides. The learned Counsel for the complainant has produced the medical literature under the heading inferior vina kevo filter indications safety and effectiveness and human physiology chart and short note about the medical aspects of the case and diagram of the heart pumping action. A synopsis is also filed by the said Counsel along with notes of arguments. We have heard the oral arguments of both the sides. The learned Counsel for the complainant has argued that the deceased Pundalika Shenoy aged about 47 years had approached O.P. 1 with the pain in the left leg and after examination and investigation the O.Ps 2 to 4 as team have conducted the operation of IVC Implantation. It was recklessly done and the procedure adopted by them was not proper and the lack of post operative care, as a result of which his heart was affected. There was a blood clotting in the left leg of the patient, and it was diagnosed as Deep Vein Thrombosis (DVT). There was a deflection with the tear, puncture and it was not properly monitored, and how it was caused is not made known to the patient and the relatives. The pros and cons of this operation were not explained either to the patient or to his relatives. The deceased patient Pundalika Shenoy has suffered lot after operation as a result of which he committed suicide. The evidence on record points out the condition of the deceased patient throughout. Post operative care was not at all taken. The complainants have produced the Bills regarding the medical expenses. The discharge summary speaks for itself about the history of the patient. The defence of the O.Ps that their action is life saving device cannot be upheld. The medical literature produced shows that the O.Ps have not properly conducted procedure as required to be done. The defence of unexpected complications cannot be accepted. The deceased was working, and prior to the admission to the O.P.s Hospital, he was in good health and he was getting salary of Rs. 5,000 per month with bonus, in a private Company - Bharat Trading Corporation, as a Sales Officer. But, for this ailment and medical treatment, he would have survived for another as least 25 years looking to the family history that his ancestors had long life. The compensation claimed in the case is justifiable. The deficiency in service and negligence on the part of O.Ps. in treating the patient and in not taking proper care, and their follow -up to meet the situation after the operation and their failure in not removing the wire which was inserted in the course of operation, which has resulted in complication of the wound due to which health of the patient deteriorated, and he was not in a position to look after himself in his day -to -day life, and deprived of the income, and became a burden to the family.

THE learned Counsel for the O.Ps has argued that the case of the deceased Pundalika Shenoy is one of the Deep Vein Thrombosis and pulmonary embolism for which anti -coagulants were given and due to the irregular intake by the patient, and in not following the medical advice after the operation, he developed heart attack and breathlessness. To save the life of the patient, IVC filter had to be implemented through the catheter, to prevent the clot and blood going to the heart. The procedure to be followed was explained to the patient and his brothers and relatives and have agreed to the same. Patient has seen over the screen, and had watched entire procedure. The procedure of Deep Vein Thrombosis was successfully completed and uneventful. There was control in the BP and puncture in the heart. Pin was not seen in the imager, operation was continued. Defect was not rectified in it. Insertion and non -removal of the wire was not done. To avoid, future care was not taken. Paras 18 and 19 of the Affidavit of O.Ps shows all precautions were taken in the operation theatre. In the case of insertion of catheter, development of complication is inevitable. It has to pass through right ventrical. Tear or puncture is common. Paras 26 and 27 of the Affidavit shows that it is inevitable. The complainants could have produced the evidence of an expert which is essential to the case. To meet the complications, all precautions were taken and everything was arranged. Tear or puncture was closed in the operation. There was no negligence on the part of O.Ps. There was infection, and before post -operative treating, the patient went to Mallya Hospital, where ribs were cut during operation by negligence. For pain, antibiotics were given. The lab test shows that there was no infection. Pros and cons were explained to the complainant. Ext. C8 note is made after death. There is no link to pain and suicide. The patients suffering was not due to the negligence of O.P. There are no supporting materials regarding the income of the deceased patient to fix the compensation.

THE points for consideration are whether - 1. O.Ps 3 to 5 have committed negligence and rendered deficiency in service while treating the deceased Pundalika Shenoy for Deep Vein Thrombosis and Median Sternotomy, and operation was not properly conducted, which resulted in the infection and abscess (collection of pus) at the Xiphisternium (lower segment sternum) adjoining the 8th and 9th coastal cartilage and Ostomyeletries of lower end sternum (brist bone) which had to be operated at Mallya Hospital at a cost of Rs. 44,520? 2. The patient suffered severe pain and helplessness due to negligence on the part of the O.Ps? 3. The complainants are entitled for the compensation for the above deficiency in service and negligence? 4. What Order? We answer it in the - (1) Affirmative (2) Affirmative, (3) Affirmative, (4) See operative portion. Discussions

We have perused the complaint, versions, and the affidavits of the deceased Pundalika Shenoy, and Complainant No. 1 Smt. Sumana P. Shenoy and her cross examination as C.W. 1, and also Exts. C1 to C9. We have also perused Exts. R1 to R34 and the affidavit of Dr. K. Balasaraswathi for the O.P. 1 & 2, and O.Ps. 3 to 5. O.P. 4 is cross examined as R.W. 1, which is also considered. We have taken note of contention of both the sides, and also the medical literature, and synopses and notes of arguments of the complainant. The medical literature under Review Medical Inferior Vena Cava Filters, Indications, Safety, Effectiveness by Danial M. Becker M.D., MPH; John T. Philbrick, MD; J. Bayne Selby, MD at Page 1985 has stated that preventing pulmonary embolization by preventing vena cava flow has been attempted since 1893. Vena Cava (IVC Filters) have been available and accordingly there are 5 Filters commercially in the United States (Greenfield filter, Titanium field filter, Simon -Nitinol filter, Birds Nest filter). Filter complications were common but rarely life threatening; four (0.16%) deaths from filter complications were noted among the reviewed studies. Under the heading conclusion, it is stated that inferior Vena Kava Filter appears to be effective in preventing the recurrent pulmonary embolism. While there is no ideal filter, some situations call for specific filters. Filter selection and insertion require experience, modern angiography technique and collaborations between clinicians caring for patients and interventional radiologists or surgeons inserting the device (Arch Intern Med. 1992:152:1985 -1994. In Page 1989, under the heading ''how often do fatal complications of IVC Filters occur?'' Among 2557 patients described in the reviewed studies, only 3 deaths (0.12%) could be attributed to the Filter complications. These deaths involved misplacement of Greenfield filter during insertion hypotension and cardiac arrest minutes after insertion, after Greenfield filter and cephalad migration of an early version of the Birds Nest Filter to the pulmonary artery.

THE medical aspects of the case as per the complainant is, the ailment was diagnosed to be Deep Vein Thrombosis of the left leg. Thrombosis is a condition in which blood clots form in the vein of the lower portion of their left limb which migrates into the circulatory system from the vein and cause pulmonary embolism, which is a blockage of blood vessel by an obstruction called an embolis, usually a blood clot. Pulmonary embolism is a condition in which blood clot becomes lodged in the lungs, after migrating from the blood circulatory system from the lower vein in the lower limbs. Deep Vein Thrombosis was treated by the process intravenous Caval filter implantation which is a small metal device about an inch long, shaped spokes of an umbrella. The Filter is placed in the vena kava which is the large vein in the abdomen which brings the blood from lower half of the body. It is positioned at the infra renal in the inferior vena cava. These Filters trap blood clot from Deep Vein Thrombosis in the left leg and prevent them from travelling lungs to cause pulmonary embolism. Filters are used only when the patient cannot tolerate blood thinning medication because of major bleeding or other severe complication from the drugs, allergies to anti -coagulants or failure of seemingly adequate blood thinning to prevent further embolism. The actual process of IVC Filter implantation is being done by inserting the filter by means of a catheter and applicator capsule into the inferior Vena Cava through the jugular vein. The Filter is inserted by means of guide wire passing through the jugular vein and passing a superior vena cava, it goes to the inferior vena cava via right atrium and wherein filter is implanted. The catheter and applicator capsule are withdrawn after the filter is implanted.

BEFORE considering the documents available on record, it is necessary to consider the affidavit and cross examinations of the deponents. Affidavit filed in the case on behalf of both parties are repetition of their respective pleadings namely complaint and version and Notice and Reply. C.W. 1 Smt. Sumana P. Shenoy in her examination, has spoken about the death of her husband on 8.4.2000, who was working as a Sales Manager in Bharat Trading Company, but was not attending work for the last 4 years prior to the death. She has spoken about the admission on 17.12.1996 with injury to the left leg, and was an in -patient for a week and was given treatment. The pain in the leg was reduced after taking rest. He attended the work for 2 -3 months. She has supported the complaint allegations about the breathlessness in May 1996, and taking the patient to Gayathri Hospital near to House where he was in -patient for one day, and on the advice of the said Hospital; he was shifted to O.P. 1 Hospital. He was kept in ICU for a long time and treated, as a result of which the breathlessness problem was reduced. He was to be discharged in 2 days. O.P. 4 Dr. Nagaraj Desai told the patient that IVC Filter has to be fixed to save the life of the patient. She has spoken about the operation in that regard on 30.5.1996 at 8.00 a.m. Doctor had told that operation will be over within half an hour, and there will be no problem. The patient was conscious during operation. When he was seeing the imager, while performing the operation, he felt a severe injury and lost consciousness. Doctor came and told them that it is natural occurrence, and told immediately different operation was to be done. It was just like an open heart surgery. The said operation was done, and he was in the Hospital as in -patient till 12.6.1996. After discharge, when he returned home, the pain did not subside. He had pain in the left side of the chest and the back. He could not walk. He was attending the check -up in the O.P. Hospital frequently. Doctors use to advise that pain will gradually reduce. When the pain increased, on examination they were told that pus has formed in the chest. After removing it, it was bandaged and patient was sent home. Even then, the pain did not reduce. Out of fear, they lost confidence in the Doctors O.P. 1 and 2. Her husband was taken to Mallya Hospital. They were told that the injury is not yet dried, and bandaged, the bone is not removed, and it requires one more operation and accordingly it was done and sutures are removed. Within one month pain started for which another operation was done but pain did not subside. In April 2000, her husband went to Mangalore as his father had died on April 8, 2000, he could not bear the pain and committed suicide leaving a letter in his pocket. Due to carelessness in the O.P. 1 Hospital, all these things have happened and she has produced all the documents i.e., discharge summary at Exts. C1, C2 and the Discharge Summary from Mallya Hospital at C3 and C4 and copy of the Legal Notice to O.P. 1 at Ext. C5, and the reply to the O.Ps at Ext. C6 and Death Certificate of her husband at C7, F.I.R., of Mangalore Police at Ext. C8, and the note written by husband at Ext. C9. Due to these incidents, it is difficult to live, she has sought for compensation claimed in the complaint. Except the salary of the husband, there was no sources for the family. In the cross examination, she has stated that her husband studied up to SSLC and joined as Sales Manager before her marriage and his monthly salary was Rs. 8,000. No salary slip was issued. Prior to admission of her husband to O.P. 1 Hospital on 17.12.1996 with the complaint of pain in leg, he had not visited any other Hospital. She has deposed more about the job of her deceased husband and its nature and the salary of her husband. Further, she has identified her husbands handwriting in the paper dated. 9.4.2000 at Ext. C8. She has denied the suggestion that she has fabricated it, on the blank paper signed by her husband, and produced the same. She has also denied the suggestion that in collusion with the Police, she got prepared the police report and that her husband committed suicide for different reasons. Regarding the treatment of her husband, she has admitted that she took her husband to O.P. 1 Hospital at the first instance for admission. She has not given any consent for admission at that time. Her husband was an in -patient for 8 days in the Hospital, and he was given injection and tablets, and Doctor used to come and examine him. He complained of pain, which gradually subsided, and he was fully recovered at the time of the discharge. Tablets were prescribed to him at the time of discharge. But 2 -3 months after the discharge, he attended the job and afterwards, they did not go for check -up to the O.P. 1 Hospital as he was all right. He was taking tablets daily. She was bringing medicines and collecting the receipts for the purchase from the Stores which are produced in this case. Her husband used to tie bandage for his left leg while walking. Her husband had not gone to Mangalore on business, before his admission to Ramaiah Hospital for the second time. He did not take any Ayurvedic treatment while he was taking tablets. He had swelling in the legs when he was admitted first time in O.P. 1 Hospital. At that time, he had no breathing problems. When he had breathing problem for the second time, he was admitted to Gayathri Nursing Home on 25.5.1996. He suffered breathing problem badly and were advised to go to O.P. 1 Hospital in that night itself. They took him to O.P. 1 Hospital on 26.5.1996. Ext. R1 is the admission record dated. 24.2.1996 at the time of admission for the first time and has identified her signature thereon at Ext. R1(A), which is dated 17.2.1996. On examination of her husband, Doctor told that there was a blood clot in the left leg and he was given injection and tablets. They were told by the Doctor to continue the tablets after going home, and there is no problem to come back to the Hospital. After 3 or 4 months, he had breathing problem and he was brought to O.P. 1 Hospital from Gayathri Nursing Home on 21.5.1996 by his mother and brother Mr. Vittoba Shenoy. She identifies the signature of Damodar Shenoy, brother of her husband in Exts. R2 at R2 A. Her husband was under observations after his admission on 21.5.1996 for some days. He was given tablets and injection and treated during that period. Her husbands brother was present on 30.5.1996 when the Doctor suggested for operation when there was a sudden breathing problem to her husband. She has admitted that the Doctor informed them that the blood clot in the left leg has to be arrested by IVC Filter implantation. He might have told that if it is not done, there will be a danger to his life. After taking their consent, Doctor performed the operation of Filter implantation on 30.5.1996. O.Ps. 3 to 5 were in the Operation Theatre during the operation. After the completion of filter implantation, catheter was removed and Doctors found there was a puncture in the heart. They cut opened the Median Sternum and arrested the tamponade. If it was not done, her husbands life was in danger. After operation, her husband was shifted to the ward and stayed there till 12.6.1996. There was no problem to her husband after the operation. After discharge from the Ramaiah Hospital, her husband was going for check -up along with his brother Vittoba Shenoy to O.P. 1 hospital for 5 -6 times. He was taking medicines after discharge. After the discharge, pus was formed in the operation portion and her husband was having pain. He was going to the same Doctor in the O.P. 1 Hospital and nothing was got done by them for the formation of the pus. Then, they went to Mallya Hospital voluntarily after 1 1/2 months. Her elder brother and her husbands brother took her husband there. Discharge summary is given both by the O.P. 1 Hospital and Mallya Hospital. Her brother and husbands brother know about the treatment given in Mallya Hospital. After discharge from Mallya Hospital, her husband was all right for 1 to 1 1/2 months and thereafter pain started. Again pus was formed after 1 1/2 months after returning from Mallya Hospital. Her husband was admitted again by her elder brother and husbands brother and another operation was done in Mallya Hospital, where he stayed for 4 days and then discharged. They were told in Mallya Hospital that her husband was all right and he can go back to their house after discharge. Her husband was taking tablets after discharge from 1st admission. He might have gone to Mallya Hospital for follow -up checkup after the second operation and she does not remember it, and she was not aware whether her husband was advised by Mallya Hospital to come for follow -up. Her husband was taking tablets regularly without any gap. She does not know the Doctors who performed the operation in Mallya Hospital. They did not go to Doctors and meet them when her husband was taking tablets after the operation. After discharge, his pain was not subsided. They did not got to Mallya Hospital and asked the Doctor about the further treatment to the pain after second operation to her husband. They were told in Mallya Hospital that because of the carelessness of the Doctors in O.P. 1 Hospital in treating her husband, the second operation was necessary. She does not know that the Doctors, who told them, are working in Mallya Hospital and can give evidence. She has pleaded ignorance that because of the negligence of the Doctors in Mallya Hospital in performing the first operation, second operation became necessary. No amount was received from medical insurance. She has denied the suggestion of the O.Ps in cross examination. From the above evidence of C.W. 1, it is evident that there are vital admission in the cross examination which goes contrary to the complaint allegations, regarding the consent giving in the O.P. 1 Hospital, and the improvement in the health of her husband after treatment in the O.P. 1 Hospital, and also in Mallya Hospital. The evidence of this witness does not help much in proving the alleged omissions of the O.Ps in treating the patient and performing the operation, as pointed out in the complaint. On the other hand, her evidence discloses that the Doctors in Mallya Hospital told them that because of the carelessness of the Doctors in O.P. 1 Hospital in treating her husband, second operation was necessary. The name of the Doctors who told them are not mentioned. She is not aware whether they are available to give evidence. So, to this extent, case of the complainant has got corroborative materials. But the complainants have not chosen to get that evidence and no reason is assigned for the same. Except evidence of C.W. 1, there is no other evidence except documents at Exts. C1 to C9, out of which the Discharge Summary at Exts. C1 to C4 are material. In this background, they require to be considered. Ext. C1 is the Discharge Summary with the faculty of O.P. 3 Dr. Srinivasan and Dr. Hariprasad of the O.P. 1 Hospital for the treatment given to the deceased patient between 17.2.1996 and 24.2.1996. According to which, the final diagnosis Deep Vein Thrombosis - Left lower limb. The patient came with the pain in the left leg for past 8 days extending from hip upto the foot, and more on waling and relieved during rest and no other similar complaint in the past. The above is a non -smoker and non -alcoholic, moderately build and nourished and no pallor, no icterus, no cyanoses, no clubbing pitting oedema +, and no generalized lymphadenopathy, swelling of (L) calf and thigh. Calf tenderness +. Homan sign +. Pluse, BP S1 & S2 N (RSPA) are recorded and showing normalcy and no murmur in the heart and air entry satisfactory on both sides. The treatment given was Doppler Ultrasound done elsewhere, confirmed the diagnosis. CXR on admission showed clear lung fields. The patient was started on regimen of rest and leg elevation. Heparin Injection 3 times daily, initially changed to low molecular weight. Heparin and finally oral anti -coagulants. Leg and thigh swelling and pain gradually subsided. The patient was made ambulatory with elastic crape bandage application anti -coagulants recommended for 3 months. Summary of investigation is shown as PT control 14", patient 15" and chest X -ray dated 18.2.1996 shows CXR PA view - clear lung fields. Activities normal and at the time of discharge Flexon PRN, Acitrom 4mg/2mg alternate days, and Alprax 0.25 mg HS PRN tablets were prescribed. The patient was given special instructions to avoid long period of standing/sitting. Elastic crape bandage upto the knee day times, watch for signs of bleeding viz., easy browsing, epitaxis, severe headack, etc., and report immediately. Review in CTVS O.P.D after 15 days with PT Report. Ext. C2 is another discharge summary for the period 21.5.1996 to 12.6.1996 of the patient with the faculty of O.P. 3 to O.P. 5 and Dr. Srinivas. The final diagnosis is recurrent pulmonary emboli (R) lower lobe segmental infarction - old DVT (L) leg. Post IVC Filter implantation - cardiac perforation - tamponade. Operation - Emergency Median Sternotomy - closure of RV tear. The known patient of DVT (L) leg previous admission February 1996 complaining of discontinuing acitron tablet. Presenting with acute onset of breathlessness and moderate hemoptysis -3 days duration. O/E: Febrile. Mild tachypnea +. Swelling of (L) calf and thigh. Calf tenderness +. Mild Pallor +. PR. Pulse 72/min. regular, BP 120/90 MMHG. Lungs (R) Basal crackles. Heart S1 S2 (N) S3 PA NAD. The details of treatment given in the Hospital are CXR on admission showed (R) lower zone opacity. Patient was mildly breathless. He was started on injection Heparin 5000 IU IV tablet Cifran and intermittent oxygen inhalation. Echo on admission shows normal RA.RV size. Normal LV and RV function. PA systolic pressure was 40 mm Hg. Patients breathlessness was slowly worsening and was shifted to CCU. On 24.5.1996 decided to thrombolise and STK 2.5 lakh units IVS Dose was given followed by 1 lakh unit infusion hourly for 36 hours. Patients symptoms improved considerably. CT Scan of abdomen showed normal IVC. In view of symptoms it was decided to implant an IVC filter. On 30.5.1996 through (R) internal Jugular vein cannulation, IVC gram done and IVC filter deployed just below renal veins immediate post -procedure patient developed hypotension. Echo revealed tamponade. Percadiocentesis was done about 100 ml blood evacuated. Pressures improved and patient was immediately shifted to O.T. At operation found cardiac tamponade with dark coloured blood in pericardial cavity. Heart had arrested/bradycardia. There was active bleeding from a 1/2 cm. Tear in RA, RV junction posteriorly. Heart picked up immediately after pericardium was opened and tamponade relieved. A pledgeted 30'' prolene suture was used to close the tear and bleeding promptly arrested. Post op. recovery was uneventful. At the time of discharge patient is ampulant. Wound healing is satisfactory. Patient is maintaining satisfactory. PT with 4 mg. Acitrom daily. The investigation summary of haemoglobin ESR, TC, DC, BT, CT, blood groups are noted. Urine, routine of sugar and protein -Nil. 10.6.96 -PT test 18" control 14" platelets 4.5 lakh/mm3. Urea 16 mg/dl. 301.05.96 -Creatinine 0.8 mg/dl on the same day. On 22.5.96, reading recorded Bilirubin T as 1.0 S. Protein, 6.7 S. Alb, 4.5 AST, 69 ALT, 73 S.Alk Phos: 156. Chest X -ray dated 22.5.1996 shows, ill -defined patch (R) base -CTR 15:28. Echo Summary is recorded on admission, RA, RV, size normal and LV RV function normal. Any other special investigation and consultations are recorded and anti cardiolipin IqA antibody (Elisa) Borderline positive. Test value 22.7 APL. Advice repeate test after few weeks. APG SAT PH PCO2 PO2 HCO3 B and SAT recorded. Abdominal CT Scan dated 27.5.1996 No. 3633. No IVC Thrombosis, ultra -sound of the abdomen on 21.5.1996 normal state. Normal diet and activities. Tables are prescribed and special instructions were given that in view of oral anti -coagulants watch for signs of excessive bleeding in Epistaxis, easy bruising bleeding from gums. Severe headache, etc., and report to physician immediately. Review in CTVS O.P.D, after one week. This is signed for O.P.3. Ext. C3 Discharge Summary issued by the Consultant Dr. Nagendra Prakash (Cardiothorasic Surgeon) of Mallya Hospital shows that final diagnosis was done for Sternotomy Wound Infection. Operation done for sternal wound exploration, wire removal and Rt coastal cartilage excision on 7.8.1996. H/o Chest pain since 2 months. The pain started after surgery which was performed in May. The pain progressively increased. The pain used to decrease on taking analergics. The pain radiated all over the chest, radiating to back also. The pain of dull acing type. PH -patient gives H/o injury to leg about 7 months and had DVT and later adopt 2 cms. had acute onset of breathlessness. He was diagnosed to have pulmonary embolism. IVC filter was put on Ramaiah Hospital, he even at time of insertion the patient developed hypotension. The sternum was opened. There was perforation of RAIRV with massive pericardial effusion. After surgery, there was drainage from chest wound and pain. Rs: sounds heard equally both sides, respiratory sounds not heard well. No added sounds. After surgery there was drainage from chest wound and pain radiating all over chest. No H/o hypertension/Diabetic Milletus. No H/o smoking/consumption of alcohol, mixed diet. On examination, pallor - ve, Icterus - ve/cyanosis - ve, oedema (+ve left leg), CVS S1 S2 heard. No added sounds. The treatment given was tablet Acitrom 4 mg at 6 p.m./Tablet Desprin 0 - 1/2 -0/Tablet Nimultid 1 -0 -1/tablet Brufen 200 mg 1 -0 -1/Tab Paraxin 500 mg 1 -0 -1. Investigations - HB 10.5/PCV 33.4[B[G A+ve/RBC 5.4/RBC 5.4/WBC 9000/DC N 72/E 03/B 00/L 25/M 00/HIV, HBsAg:Negative/Pus culture:No growth after 48 hrs. incubation/PC 3,91,000/PT 27.5/PTT 53.2/RBS 77/BUN 17/Creatinine 0.9. The course in Hospital, the patient came to Hospital with H/o chest pain having slight discharge from the sternal wound. After necessary pre -operative investigation, posted for Sternotomy, sternal wire removal and RT coastal cartilage was excised. The patient was shifted to the wards on the same day and post operative period was uneventful. Patient was completely ambulatory prior to discharge. Post Operative investigations were PT 34.2 sec. Advised on discharge, Tablet Ritampicin 450 mg 1 -0 -0 x 7 days, Cap. Tramazac 1 -1 -1, Tab. Acitron 2 mg at 6.00 p.m. daily and to come after 10 days for suture removal. Ext. C4 is the discharge summary issued by Dr. Nagendra Prakash for the final diagnosis of Infection and Abscess of Xiphisternum adjoining 8th and 9th coastal cartilage and Osteomyelitis of lower and sternum. The patient underwent sternal wound exploration, wire removal and right coastal cartilate excision on 7.8.1996, it was diagnosed as Sternotomy wound infection. Patient now c/o chest pain and has been posted for excision of 8th and 9th coastal cartilage and Xiphisternum. Patient is not a hypertensive or diabetic. No H/o smoking or alcohol consumption, Patient takes mixed diet. Had not passed motion since 10 days and had constipation for seven days. Micturation no disturbances. Patient had H/o injury to leg about 7 months back and developed deep vein thrombosis, he was diagnosed to have pulmonary embolism. IVC filter was put in Ramaiah Hospital, patient developed hypotension during procedure, and his sternum was opened. There was perforation of RA RV with pericardial effusion. After surgery there was drainage from wound. On examination - middle aged male, moderately build and nourished, Pulse: 84/min., BP: 120/80m of Hg, Temp: afebrile, No cyanosis, No pallor, RS: Air entry good BS - Sternotomy scar seen, CVS: S1 S2 ± No murmur, PA: Soft - Tenderness + epigastric region, No organomegaly, BS + and CT Test done. Pre -operative investigations - Hb%: 12.1 Sec., PVC: 9.7 gm%, PT: 17.0 Sec., RBC: 4.9 mill/cumm, P.I. 73.5, WBC 8800/cumm, Platelet count: 2,36,000, N - 70, E - 00f, B - 00, L - 30, M - 00. Course in the Hospital, patient was admitted to hospital on 2.9.96 with H/o chest pain. There was slight discharge from lower end of sternum. He was posted for excision of 8th and 9th coastal cartilage and sinus exploration. The operation was uneventful. He was shifted to wards on same day. Cartilagenous tissue was taken from the chest and sent for culture and sensitivity. Culture revealed the organism to be methicdillin resistant staphylococeal. Thereby he was put on tabl. Cifran 500 mg and Injection Amikacin to which the organism was sensitive. The patient was ambulatory and wound had healed prior to discharge. Discharged from the sternal wound after the procedure. Advised on discharge, Tabl. Cifran 500 mg TID x 10 days, Inj. Amikacin 250 mg 23D x 10 days, Tab. Acetrom 2 mg daily once at 6 p.m. From the above material, and the legal notice and the reply at Exts. C5 and C6, the case of the complainant is corroborative. But, as already discussed above, evidence of CW 1 has shown the admission by her regarding the improvement in the condition of the patient after the treatment by the O.Ps. differing from the complaint allegations. As already discussed above, the corroborative evidence of an expert is waiting in this case to support the allegations in the complaint about the lacunae in diagnosis, operation, and post operative care by the O.Ps. The doctors at Mallya Hospital who have opined in support of the complaint are the best supporting evidence, which is not availed. Exts. C1 to C4 do not support allegations of the complaint. But, discloses the existing state of affairs in the condition of the deceased patient at the time of discharge from the respective Hospitals. Discharge summary of Mallya Hospital nowhere states that the sternal wound exploration and excision of 8th and 9th coastal cartilage and sinus exploration are the result of the implantation of the IVC filter done on 30.5.1996 in the O.P. 1 Hospital. The evidence of CW 1 is not supported by any corroborative material in that regard, such as the presence of the persons when the doctors at Mallya Hospital commented on the implantation of IVC Filter, and its after effects in the O.P. 1 Hospital. Under these circumstances, the complainants have not substantiated their case.

IT is necessary to consider the evidence of the O.Ps to find out whether there is an admission by them supporting the complaint allegations. O.P. 4 Nagaraj Desai has filed his counter affidavit on behalf of all the O.Ps. and he subjected himself to cross examination as RW 1. In paras 10, 11, 12, 14, 16, 19 and 20 of the affidavit, he has sworn that the complication arose during insertion of IVC filter were recognized immediately, and were promptly attended to without delay. Proper remedial measures were instituted immediately and the patient was not only saved of his life but it also prevented from recurrent attacks of pulmonary embolism. Twice his life was saved. Firstly, by arresting the clot by deployment of a filter like mechanism to prevent frequent and fatal pulmonary embolism and secondly, while performing the same the cardiac tear was immediately detected and after cutting open of the sternum of the deceased complainant as an emergency measure, tamponade was relieved and cardiac arrest was tackled. Even slightest negligence by them in that time could have eventually resulted in instantaneous death of the patient. He was clinically dead and was brought back to life by relieving the cardiac tamponade. Operation done by them was successful. The very fact that a team of doctors specialized in different branches was present at the time of the operation as put forth by complainant itself goes to prove that while insertion of IVC filter, O.Ps. were prepared for such an eventuality or complications arising thereof and abundant care was taken and precaution to meet any such emergencies resulting in fatality. The complainant had healed sternotomy at the time of discharge. The alleged infection could have been avoided if he had visited O.P. Hospital regularly after discharge as advised. During stay of complainant in their Hospital, he did not have any signs of infection or visible discharge of wound or inflammation and he never complained of acute and intolerable pain. The alleged infection or wound discharge is after lapse of 1 1/2 months from the date of discharge from the O.P. 1 Hospital. This infection of inner skin effecting cartilages and not related to the treatment for Deep Vein Thrombosis and relieving of cardiac tamponade and reversing cardiac arrest which could have resulted in instantaneous death. Infection could be autogenic due to taking of prolong anti -coagulants for which they cannot be blamed. The complainant is permanently relieved from the Deep Vein Thrombosis for which purpose he was treated. The effect of implantation of the IVC filter is that the free clots which are in circulation of blood travels via the heart (i.e., RA/RV) to the lungs and blocks the pulmonary vessels leading to the breathlessness and to the patient suddenly collapsing for which he had to be treated urgently by offering IVC filter to arrest the clot with image intensifier which is a latest procedure and a modern approach without involving major surgery. It was done by O.P. 3 assisted by O.P. 4 in a cathlab. A surgical team was stand -by and the operation theatre, blood, lab facilities, special equipments were kept ready to meet any kind of complication and emergencies that might occur while performing such procedure i.e., implantation of IVC filter. While conducting such procedure with the help of catheter, there was tear in the RA/RV junction resulting tamponade and cardiac arrest, which is detected immediately, and as an emergency measure, complainants sternum was cut open to have a entry to the head to relieving the tamponade reverse the cardiac arrest and delay of few seconds in that situation would have ended up in fatality. cutting open of the sternum of the complainant patient was consequential as there is no way to reach the heart to relieving the tamponade and save the life of the complainant. Sternal wire is normally not removed unless if it results in infection to the sternum, in the normal course, removal of such wires are usually postponed for 8 to 10 weeks after the operation to prevent sternal dehince failing which it will lead to cut another emergency. Since the complainant did not visit them as advised, they had no occasion or chances to examine the complaint of alleging pain due to infection and removal of sternal wires. The complication which arose during the insertion of IVC filter resulting in cardiac tamponade is a known complication and beyond their control. They may occur despite due care and caution and in spite of knowledge, skill and expertise, while handling such procedures with the best of hands.

O .P. 4 in his cross -examination as RW 1 has stated that deceased Sri. Pundalika Shenoy who was treated from 17.2.1996 to 24.2.1996 for Deep Vein Thrombosis was all right for 3 months, and he developed breathlessness and admitted to a Nursing Home in Vijayanagar, who referred him to the O.P. 1 Hospital. At the time of discharge, he was prescribed anti -coagulant medicines and is supposed to have not taken it as per the records. After treating the patient for some time, he became stable. Himself and O.Ps. 3 and 5 advised him for IVC filter (Inferior Vena Cava Implantation) because he had a clot in leg in the past and he approached them with breathing difficulty and blood coughing (hemoptysis). They have informed the patient and relatives about details of IVC Implantation before doing it, which they do 3 or 4 times in a year, and it was not the first time. The risk, consequences, and the benefits of the procedure have been explained to the patient. To save his life, it was necessary. He was given local anaesthesia and the procedure was done through right internal and jugular vein and approach using X -ray Image Intensifier. He was also watching the procedure. As the procedure was finished, the patient was noticed of dropping blood pressure, and low blood pressure with altered sensorium, which is due to collection of blood around the heart (cardiac tamponade). This was immediately treated by taking the blood from pericardial cavity with improvement. It was a puncture. After opening the chest and pericardial cavity, it was found that there was collection of blood and there was an opening/tear in the right ventricle arterial junction and blood was drained and the tear was repaired and the patient was stabilized and shifted to surgical ICU for subsequent treatment. The reasons of this tear in the right ventricle was possibly because of the catheter touching the thin right ventricle valve. Median Sternotomy was required to this patient to take care of his emergency cardiac tamponade, otherwise it would have been impossible to save him. The patient has kept in the ICU till 12.6.1996. He appeared for follow -up treatment on 12.6.96, 14.6.96 and 24.7.96. After discharge, O.P. 3 Dr. Nithyananda Shetty was treating him in Medinova, where he was working. The patient might have had sternal pain for a long period after the operation. When the patient was diacharged, he was in a stable condition. Normally this sternal wire is not removed and it will remain there forever, unless it is required to remove after 3 or 4 months of the operation. He has denied the suggestion that the tear happened because of the unusual force in inserting the catheter, and there was a wound infection in the sternal and it was not told to the patient, and there was negligence of the team of doctors in doing IVC Implantation procedure, and because of unbearable pain, the patient wanted to end his life. From the above evidence of O.P. 4, it is apparent that while doing the procedure tear has occurred in the right ventricle arterial junction with a bleeding which he terms as a puncture, and later admits as tear. They have taken steps to stabilize it. The reasons for this tear is catheter touching the thin right ventricle valve, which supports the suggestion that it has happened because of the use of the unusual force in inserting the catheter. This has resulted in cardiac tamponade and Median Sternotomy was resulted. This is mainly due to not taking of necessary precaution while inserting the catheter, to avoid the touching of the thin right ventricle valve. While conducting IVC Implantation procedure with the help of the catheter there was tear in RA/RV junction resulting in tamponade and cardiac arrest and as an emergency measure, the sternum of the patient was cut open to have an entry to the heart to relive the tamponade and reverse the cardiac arrest and during that situation the cut open of the sternum of the patient was consequential, and there was no way out to reach the heart to relive the tamponade. O.P. 2 a cardiac surgeon was involved in the management of the patient to meet any kind of emergencies from the start to the finish. The sternum was closed using sternal wires and the patient was discharged on 12.6.1996 with a healed median sternotomy wound. The patient had to be operated in the Mallya Hospital for the same reason and wire had to be removed, in view of the development of the complications after the surgery, which the O.Ps. call it as inevitable and beyond their control. This contention cannot be accepted, because the team of specialists with all preparations have treated the patient, in the course of the procedure, and also thereafter. They were prepared to face any situation, but these two factors could not be over -come by them. In support of the say of the O.P. 4 in his Affidavit and the cross examination, with development of complication, and saving of the patient is natural, no supporting material like any medical science is pointed out and produced by them. In the absence of it, mere say of the O.P. 4 cannot be upheld when there was serious allegations against them in the complaint. Even though, no expert evidence is available on behalf of the complainant, the version and affidavit and cross examination of the O.P. 4 and other O.Ps. make out the case of deficiency in service by them to the patient resulting in his death, after development of complications, which could not be got over by the O.Ps. in spite of the best treatment as claimed by them. Under these circumstances, the above material supports the case of the complainant. Point Nos. 1 and 2 are answered in the affirmative.

POINT No. 3 -The facts in the complaint and discharge summary of the O.P. 1 Hospital, discloses that brief history and clinical examination show that the patient is a non -smoker and non -alcoholic and moderately built and nourished and he had no other complaints except the pain in the left leg for the last 8 days. Prior to 17.2.1996, he was having good health. The Chest X -ray shows clear lung fields. Even after the first visit to the O.P. 1 Hospital, he was able to attend the work for 3 months. So, from these materials, it is clear that deceased Pundalika Shenoy was a normal healthy man at the time of first visit to the hospital of O.P. 1. Because of the procedure and drugs administered, the patient developed unexpected complications and was made to suffer pain throughout, which he could not bear. As per Ext. C7, that has resulted in his suicide. The suggestion is made to wife of the patient that she got it prepared in collusion of the police and it is denied. Looking to the facts and circumstances of the case, it is clear that throughout, the patient has suffered a lot and he was not relieved of the pain in spite of the treatments in the O.P. Hospital, and Mallya Hospital and performing sternotomy wound infection operation and Absces Xiphisternum. Ext. C4 is the discharge summary of the Mallya Hospital shows that the patient underwent sternal wound exploration wire removal, and right coastal cartilage excision which was diagnosed sternotomy wound infection and there was a complaint of chest pain of the patient and so excision 8th and 9th cartilage and Xiphisternum procedure was posted. It is also noted in it that the patient is not a hypotensive or diabetic. No complaint of smoking or alcohol consumption. It is observed that patient had injury, about 7 months back and developed Deep Vein Thrombosis and IVC filter was put in O.P. 1 Hospital, developed Hypotension during procedure and his sternum was opened and there was perforation of RA/RV with pericardial effusion and after surgery there was drainage from wound. He was weighing 59 kgs., BP was 120/80, pulse was 84/min., CT Scan of chest shows bilateral informatory pericardial swelling and fluid collection adjacent to the Xiphisternomy. Under the heading, course in Hospital, it is mentioned that patient was admitted on 2.9.1996 with a complaint of chest pain and slight discharge from the lower end of his sternum. He was posted for excision of 8th and 9th coastal cartilage and sinus exploration. The operation was uneventful. So, these materials support the above conclusion about perfect health of the patient before approaching the O.P. 1 Hospital for the first time. Such a person, after undertaking this procedure of treatment by the O.P. 1 Hospital, has reached the stage of series of complications as pointed above which resulted in further procedures in the Mallya Hospital. In spite of all these things, he could not regain to his original health. So, all these circumstances naturally made the patient disgusted, and ended in the death by committing suicide, which is a pathetic one. The wife and children of complainant are brought on record after his death in the course of this proceedings, and they have continued the case. Naturally, the wife and children have attended to the illness and treatment of the deceased Pundalika Shenoy throughout and they have also suffered along with him in the course of the treatment both mentally and physically, and lost the bread winner. Even though the claim of compensation for the deficiency in service is personal right of the patient, the wife and children of the deceased Pundalika Shenoy are the beneficiaries under him, who was the head of the family and they were purely depending upon him for their living. The very fact that they are allowed to pursue the case after the death of the patient Pundalika Shenoy clearly makes out that they are eligible to get the compensation for the loss of the life of the head of the family, and mental suffering throughout his treatment by the whole family. The records of the O.P. Hospital show that complainants and deceased patient have paid the hospital charges and purchased drugs. They have produced Xerox copies of the receipts and bills in support of that. Considering the above materials, and also the facts and circumstances of the case, we feel the complainants are entitled to global compen -sation of Rs. 2,00,000 (Rupees two lakh only) from the O.Ps. Point No. 3 is answered in the affirmative. We pass the following order: ORDER Complaint is allowed in part. Complainants are entitled to the compensation of Rs. 2,00,000 (Rupees two lakh only) from the O.Ps. 1, 2, 4 and 5. Accordingly, they are directed to pay the said amount jointly or severally to the complainants within 6 weeks from the date of receipt of the order, failing which, to pay interest @ 12% p.a. thereon from the date of complaint till realisation. They shall also pay the cost of Rs. 2,000 (Rupees two thousand only) to the complainants. Complaint partly allowed.