SR.

Date Particulars EXHIBITS

NO.

1. 10th May, 2007 Mrs. Mandakini Ramrao PAtil, the wfe of the complainant(hereinafter
6 45 pm refered to as the patient) visited OP No. 2- Karandikar Hospital to get a
Laproscopic Tubal Litigation(Family Planning Operation) done. She met
OP No. 3 who explained and counselled the patient about the procedures,
important instructions prior, during, and after the surgery, the risks
involved and the consequences thereon. All doubts regarding the
procedure were clarified at length and important instructions including
that the patient has to be Nil by Mouth at least 6 hours prior were orally
given to the patient. The OP No. 3 also specifically informed that the
surgery would be carried out by OP No. 4 – Dr. Kawde and also that this
surgery would be carried out under general anesthesia. The patient also
disclosed to OP No. 3 that she had undergone a Gastroscopy on that same
morning i.e. 10th May 2007 at Dr. Prakash Joshi’s clinic. The two came
for consultation to OP No. 3 in the consulting rooms at OP No. 2 hospital.
The patients OPD No. is 3208 and they paid a fees of Rs. 150/- for the
consultation. All medical investigations were carried out that day itself
and more importantly, the patient went for the Gastroscopy Nil by Mouth
as well. The patient underwent the Gastroscopy at Dr. Prakash Joshi’s
consulting rooms on 10th May, 2007. The patient also carried out the
necessary medical investigations for gastroscopy including blood tests,
urine routine, and other requisite tests at Indumati Laboratory on the same
day as they were recommended by Dr. Joshi. This important material fact
has been hidden from this Hon’able Court in order to mislead the Court.

11th May, 2007 . Mrs. Mandakini Kishore Patil was brought to the OPD of OP No. 2, EXHIBIT A
7 30 am
Karandikar Hospital and research centre owned and run by OP No. 3 for

laparoscopic tubal litigation under general anaesthesia. It can be implied

that she came Nil by Mouth before the surgery since she had been clearly

instructed to do so on 10th May 2007. The staff had strict instructions, oral as

well as written to cross check the patients required to be admitted Nil by

Mouth in order to avoid any complications during or after the surgery. The

instructions given to the staff about reconfirming that the patient was Nil
 by Mouth were misconstrued by the complainant as the complainant

wrongly assumed that the staff of OP No. 2 informed the patient only 2

hours prior to the surgery that the patient was supposed to be Nil By Mouth.

The admission records of this OP hospital are annexed hereto and marked

as Exhibit A

3. The patient was explicitly asked by the staff around 7:30i.e. at least 2 hours EXHIBIT B

before the scheduled operation whether she was Nil by Mouth, and it was

only after the affirmation of the patient that the Consent form was given. It

can be clearly seen that that the patient had more than two hours to refuse

surgery or clear any doubts still in mind. It is thus clear on the face that the

Opposite Parties were not at fault at all. The copy of the form which clearly

instructs of being NIL BY MOUTH atleast 6 hours before the surgery has

been hereto annexed and marked EXHIBIT B

4. Dr. Sangeeta Kotkar and an employee of OP No. 2 was a witness on the EXHIBIT C

part of the Hospital to ensure that all the compliances are met before the EXHIBIT D

surgery. Dr. Sangeeta Kotkar read out all the contents of the Consent

formto the Patient. Further, the pre anesthesia form was duly collected by

Dr. Archana. Hereto annexed and marked EXHIBIT C is the copy of the

consent form and other related documents . The patient was also informed

that Dr. Gauri Karandikar – OP No. 3 and Dr. Vasant Kawde – OP No. 4

with the help of other specialist doctors would be performing the surgery.

Hereto annexed and marked as EXHIBIT D is the copy of the names of the

doctors. The Consent form presented was in Marathi, a language

 understood by the patient. The saidf consent form is a document certified

and approved by the Nashik Obstetrivc and Gynaecological Society. The

procedure followed in presentation of the Consent form clearly shows the

high standard of care taken by OP No. 2 in terms of the consent being taken

of the Patient in an adequate and prescribed manner.

4. 10 30 am The surgery began at 10:30 am in the presence of OP No. 1,3 and 4. The

surgery performed was successful but the patient did not regain

consciousness. Due care was taken by OP No. 1 while administering the

right amount of anesthesia to the patient, using standard recommended

drugs and was present throughout the surgery. All thre necessary apparatus

required during the Surgery were present, including a Cardiac Monitor,

Pulse Oximeter to check the pulse, blood pressure, E.C.G and Oxygen

content of the body and r5ecords for the same were present and in good

working condition. After the successful completion of the surgery, the

patient had inadequate emergence from anesthesia. The OP No. 1 continued

monitoring and gave the necessary medications to the patient.

5. 11 45 am The Opposition parties sensed the complexities of the situation at 11:45 am EXHIBIT E

and immediately informed the relatives of the patient about her condition.

Hereto annexed sand marked as EXHIBIT E is the copy of the DAILY

ORDER SHEET, time 11:45 and 2:00 pm. At the same time, an oral

consent from the relatives of the Patient was taken at the time to call upon

a senior Anesthesiologist in view of Inadequate Emergence from

Anesthesia. The relatives of the patient were in fact informed about the
 condition of the patient from time to time throughout the day. The calling

of the senior specialist was done as a “Principle of Abundant Precaution.”

These material facts have not been disclosed to this Hon’able Court by the

Complainant.

6 The Opposition Parties realized that this situation was not a normal one.

Some patients take more than the normal time to come out of anesthesia,

therefore the OP No. 1 was under the bonafide belief that the Patient shall

revive in some hours, thus shifted the Patient on a life support system, a

usual practice given to the Patients who take more than the normal time to

come out of anesthesia. The patient’s condition was monitored

continuously by a competent team of doctors.

7 Dr. Gandhi was called upon to check on the patient in the afternoon. She EXHIBIT F

suspected Hypoxic Encephalopathy. She suggested that the patient be

observed for the next few hours and that the treatment prescribed by OP

No. 1 was correct. The complainant was explained by OP No. 1 and 3 that

the patient was improving but also suggested that the patient be moved to

Life Line Hospital for tertiary care. The complainant and relatives wanted

to shift the patient to a hospital in Mumbai. The Opposite parties tried

explain to them that there was no ambulance in Nasik with adequate

ventilator back up having a 4 hour batter back up and that the patient was

in a feeble state and that it was not advisable to make this shift but the

complainant was adamant. Op No. 1 and 3 being prudent medical

 practitioners then suggested that the patient be shifted to Life Line Hospital

and then to a Hospital in Mumbai after th3e adequate provisions are put

into place since the complainant was so adamant. Hereto annexed and

marked as EXHIBIT F is the copy of the Transfer summary of OP No. 2.

8 Hence it is not wrong to say that the discharge of the patient was mad4e in

a hasty manner against medical advice.

9 The OP No 2 did not have an in house ambulance facility thus they did not

waste any time in calling for an ambulance from Life Line Hospital and

waited till it arrived to ensure that it had the needed infrastructure. Two

hours were wasted by the complainant due to his callous and ignorant

behavior. The complainant was adamant that the patient be shift to Mumbai

thus two more hours were wasted in waiting for another ambulance which

too, was ill-equipped to take the Patient to Mumbai. Both Op No. 1 and 3

were present all through. They reasoned that it was extremely risky to shift

the Patient to Mumbai and finally shifted the patient to Life Line Hospital

to ensure minimum discomfort caused to the patient. This material fact was

concealed from this Hon’ble court.

10 12 00 am It is pertinent to note that the patient was kept at Life Line Hospital only

for one night and it was only due to diligence of OP No. 3 that an external

ambulance was called upon and the patient was duly shifted to Life Line

Hospital.
11 It was later discovered that the complainant shifted the patient callously

from Nasik to Mumbai, Hinduja Hospital after spending one night in Life

Line hospital for which the ambulance was called for from Mumbai.

Looking at the feeble and delicate state of the patient, it is pertinent to note

what the patient would have gone through in those four hours of the journey

from Nasik to Mumbai without knowing the conditions of the lifesaving

apparatus in the ambulance. The signs of improvement and positive effects

seen in the patients due to the efforts of the all the earlier doctors including

the Opposite Parties would have in fact been negated because of this

journey.

12 12th May, 2007 The patient was admitted to Hinduja Hospital.

13 22nd May, 2007 The patient died at Hinduja Hospital. Hinduja Hospital informed the Police

since this was a medico legal case and the routine protocol and procedures

were carried out by the Police and other authorities. Accordingly, a post

mortem was done at J.J. Hospital, Mumbai and the report ment6ioned

Hypoxic Ischemic Brain Damage with Hemorrhage in Brain and Adrenal

with Sever Pulmonary Oedema with Lymphocytic Thyroiditis in case of

Laproscopic Sterilization under general Anesthesia. (UNNATURAL)

14 The complainant further filed a police complaint with the Nasik Police and

as per the procedure in a medico legal case, a committee was formulated to

investigate the episode. The role of the committee was to look for any prima

facie case of negligence without drawing any inference that the conclusions
drawn by the committee do not deduce or conclude the existence of any

kind of negligence.