Judgment :- K.A. Mohamed Shaft, J. This appeal is directed against the judgment passed by the Sub Court, Thodupuzha dated 27.6.88 in Q.S.108/86. Defendants 2 and 3 are the appellants. The suit was filed by the plaintiff-respondent herein claimed damages of Rs. 3,50,000/- from the defendants. The Lower Court after trial decreed the suit against defendants 2 and 3 for Rs.1 lakh with interest thereon at 6% per annum from the date of decree, by the impugned decree and judgment Hence defendants 2 and 3 have preferred this appeal. 2. The plaintiff claimed damages on the following allegations. On 18.10.84 at about 4p.m. while carrying a bucket of water the plaintiff stumbled and fell down and experienced sprain on her right foot, while developed in to severe pain with inflamation. On 18.10. S4 itself she went to the Mercy Hospital, owned and run by the 1 st defendant where the 3rd defendant had been working as a doctor. The 3rd defendant examined her and gave medicines. Though she consumed medicines as prescribed by the 3rd defendant, the pain did not subside. On23.10.84 at about7a.m. she went to the hospital and met the 3rd defendant. She was admitted in the hospital and got X-rayed her right foot The 3rd defendant told her that there is fracture and on 24.10.84 plaster cast was applied below the right knee excluding the toes. On 25.10.84 the toes showed discolouration and there was swelling below the knee. The 3rd defendant was called and he gave an injection. Blisters were developed at the root of the middle two toes of the right foot and the 3rd defendant performed surgery on the blisters. But the pain continued and the 3rd defendant removed the plaster on 29.10.84. Then it was found that the entire foot became septic and ulcers formed on both sides. All toes had become black in colour. Though the plaintiff sought for discharge, the 3rd defendant told her that there is no need for any anxiety and her condition was improving. On 2.11.84 the 3rd defendant brought a surgeon from the Medical College Hospital, Alleppey, who examined the plaintiff and said that the tissues were damaged incurably and the toes should be amputated. She was removed to the Medical College Hospital, Kottayam on 2.11.1984 and found that amputation of part of her foot was necessary. On 7.11.1984 half of her foot was amputated. She was removed to the Medical College Hospital, Kottayam on 2.11.1984 and found that amputation of part of her foot was necessary. On 7.11.1984 half of her foot was amputated. Skin grafting was also conducted. There was absolutely no need to put her leg in plaster cast. Due to the plaster the nerves were pressed and damaged. It was due to the negligent handling by 3rd defendant her foot had to be amputed. The plaintiff was aged only 24 years and unmarried at that time. The prospects for her marriage has become dim and she also lost her brilliant academic career. She had to suffer unbearable mental pain and agony apart from permanent disability and disfiguration. She had to spend large amount towards expenses for her treatment All these loss and sufferings were caused to her due to the negligence of the 3rd defendant Therefore, she is entitled to damages for Rs. 3,50,000/-. 3. The defendants contested the suit by filing separate written statements. The 1st defendant contended that he had nothing to do with the hospital its ownership or management or control and as such not liable for the claim made by the plaintiff. 4. The 2nd defendant has contended that the plaintiff was admitted in the hospital with suspected gangrene and the 3rd defendant started treating her for the same disease. It is also contended that the 3rd defendant has given proper treatment to the plaintiff and defendant is not liable to pay any damages to the plaintiff 5. The 3rd defendant filed a detailed written statement contesting me suit, He contended that when the plaintiff alleged that the pain is not subsided after the administration of medicines prescribed by him on 18.10.84, she was admitted in the hospital. X-ray was taken on 23,10.84 and found that ti ere was no fracture of the foe:, According to him, the right foot of the plaintiff was put on plaster cast for one day o immobilize that foot in order to relieve her from pain and it was removed the next ay and she continued to be in-patient in the hospital. According to him, the portion of the limb was protected and proper medicines were given to her. But when signs if discolouration of the skin was noticed, an expert doctor, a retire f surgeon from the Alleppey Medical College was called on 2.11,84 and consulted for second opinion. According to him, the portion of the limb was protected and proper medicines were given to her. But when signs if discolouration of the skin was noticed, an expert doctor, a retire f surgeon from the Alleppey Medical College was called on 2.11,84 and consulted for second opinion. As he pointed that three toes will have to be amputated, the plaints f was immediately removed to the Medical College Hospital, Kottayam. According to him, he has given the best medical treatment and attention to the plaintiff and there was absolutely no negligence on his part and as such the plaintiff is not entitled to any relief in the suit. 6 After trial the lower court found that the 3rd respondent was negligent in this case and therefore, decreed the suit against defendants 2 and 3 for damages of Rs.1 lakh. 20. In the book "Bailey & Love's Short Practice of Surgery' the learned authors have observed at page 353 that Sprains of the lateral ligaments should be treated by compression bandaging, early mobilisation within the limits of pain and swelling, and co-ordination exercises. Therefore, it is clear from the medical evidence from the text book as well as experts available in this case that complete immobijisation in plaster was not essential in this case and depending upon the injury elastic bandage was sufficient. 21. It is submitted by the counsel for the respondent that this is a fit case wherein the principle of res ipsa loquitur applies. According to him, since the professional skill of the appellant is under consideration, it is up to him to explain how the accident could have been happened without negligence on his part. In support of this contention the counsel for the respondent relies upon the observations made by the learned authors Salmond and Heuston on the Law of Torts, 19th Edition at page 270 wherein the learned authors have observed as follows: "If the accident is proved to have happened in such a way that prima facie it could not have happened without negligence on the part of the defendants, then it is for the defendants to explain how the accident could have happened without neglience." 22. The argument advanced by the counsel for the appellants that the principle of res ipsa loquitur will apply only in cases where the court is not able to decide the reason for the inquiry in the accident, is not sustainable. In this case the 2nd appellant has no contention that gangrene has set in due to any unforeseen reasons. But his definite case is that gangrene has set in due to the sprain due to the fall of the respondent. Though he noticed symptoms of gangrene on 23.10.84 itself as there was reduction in blood supply to the limb and subsequently confirmed by him on 27.10.84 on the removal of the plaster casts he has no taken any remedial measures to improve the blood supply and prevent gangrene. He put plaster cast even after noticing reduction in blood apply to the limb of the respondent. Therefore, in this case there is negligence on the part of the 2nd appellant due to commission as well as omission. Hence the principle of resi psa loquitur as stated above is applicable in this case since the professional skill in the treatment of the respondent is a matter for consideration. 23. The counsel for the appellants vehemently submitted that the evidence to be adduced and the standard of proof in an action for medical negligence against a doctor is very high and the patient should prove the negligence. According to him, the medical practitioner should act in accordance with the prevailing medical practice and it is up to the respondent to prove that the doctor has acted negligently with cogent and acceptable evidence. He relies upon the decision of a Division Bench of the Bombay High Court in Philips India v. Kunju Punnu (AIR 1975 Bombay 306) wherein it is held that the standard of care and skill to satisfy the duty in tort is that of the ordinary competent medical practitioner exercising the ordinary degree of professional skill. In that judgment the Division Bench has observed as follows: "26. In that judgment the Division Bench has observed as follows: "26. It is therefore, clear that in an action for negligence against a doctor, as in any other action for negligence, the plaintiff has to prove: (1) that the defendant was under a duty to take a reasonable care towards the plaintiff to avoid the damage complained of or not to cause damage to the plaintiff by failure to use reasonable care: (2) that there was a breach of duty on the part of the defendant and (3) that the breach of duty was the legal cause of the damage complained of and such damage was reasonably foreseeable". 24. But in the decision in Laxman v. Trimhqk (AIR 1969 SC 128) the Supreme Court has observed as follows: 11. The duties which a doctor owes to his patient are clear. A person who hold himself out ready to give medical advice and treatment impliedly undertakes that he i possessed of skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties, vix, a duty of care in deciding whether to undertake the care, a duty of case in deciding what treatment to give or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the practicular circumstances of each case is what the law requires". Hence the above dictum laid by the apex court has to be followed by this Court. 25. In the decision in Achutrao Haribhau Khodwa v. State of Maharashtra (1996) 2 SCC 634, the apex court has observed as follows: "14. The sill of medical practitioners differs from doctor to doctor. The very nature of the profession is such that there may be more than one course of treatment which may be advisable for treating a patient. Courts would indeed be slow in attributing negligence on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution. The very nature of the profession is such that there may be more than one course of treatment which may be advisable for treating a patient. Courts would indeed be slow in attributing negligence on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution. Medical opinion may differ with regard to the course of action to be taken by a doctor treating a patient, but as song as a doctor acts in a manner which is acceptable to the medical profession and the court finds that he has attended on the patient with due care, skill and diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold the doctor to be guilty of negligence. 15. In case where the doctors act carelessly and in a manner which is not expected of a medical practitioner, then in such a case an action in torts would be maintainable. As held in Laxman case by this Court, a medical practitioner has various duties towards his patient and he must act with a reasonable degree of skill and knowledge and must exercise z reasonable degree of care. This is the least which a patient expects from a doctor". 26. applying the principles laid down in the above decisions of the apex court to the facts and circumstances of this case, it is clear that the 2nd appellant has not exercised the due skill, care and caution expected of him while treating the respondent The 2nd appellant after knowing that there was no fracture of the bone or the ligament, after taking X-ray put the right limb of the respondent in full plaster cast fully realising the hazards of a tight plaster cast even after noticing that there was reduction in blood supply to the limb. He did not take any steps to treat the respondent either to augment the blood supply or to prevent the setting in or advancement of gangrene in spite of the fact that even according to him, he had suspected the setting in of gangrene on 23.10.84 itself and found that gangrene has set in at least on 27.10.84. He did not take any effective steps for treatment for gangrene thereafter and he in fact sought the second opinion only on 2.11.84. He did not take any effective steps for treatment for gangrene thereafter and he in fact sought the second opinion only on 2.11.84. Under the circumstances it is clear that the appellant in this case did not exercise reasonable skill, knowledge and care in the treatment of the respondent. Therefore, he is liable to pay damages for negligence in the treatment of the respondent. 27. The counsel for the appellants argued that the reliefs sought for by the respondent-plaintiff cannot be based outside the pleadings and the case pleaded should be proved by the respondent. He argued that the negligence pleaded by the respondent that he has put plaster cast for six days even though there was no fracture of her leg is disproved in evidence since the plaster cast was removed the next day. So according to him, the respondent is not entitled to a decree in the suit. In support of the contention that the case pleaded should be proved, the counsel for the appellants relies upon the decision in Trojan & Co. v. Nagappa (AIR 1953 SC 235). The dictum that the case pleaded should be proved admits of no doubt, but it is not helpful to the appellants in this case. 28. In this case, there is sufficient and satisfactory evidence on record to establish that the setting in and advancement of gangrene resulting in amputation of a portion of the foot of the respondent was due to the negligence of the appellant. It i s also clear from the evidence on record that gangrene has set in due to the tight plaster cast put by the appellant on the right foot of the respondent. Though the respondent had pleaded that her leg was put in plaster cast from 14,10.84 to 29.10.84 and that too done by the appellant informing her that there is fracture of her leg, that contention with regard to the fracture of the leg and the duration of the plaster cast i s found to be incorrect by the lower court. But the fact remains that gangrene has set in due to the tight plaster cast put by the appellant without exercising proper care and professional skill in the matter. But the fact remains that gangrene has set in due to the tight plaster cast put by the appellant without exercising proper care and professional skill in the matter. Moreover, in the written statement the 2nd defendant 1 st appellant has admitted that the respondent was admitted in the hospital with suspected gangrene and the 3rd defendant started treating for the same disease. Therefore the core of the contention of the respondent that due to the negligence on the part of the appellant in putting her limb in tight plaster cast, a portion of her foot happened to be amputated, is established. Therefore, it cannot be said that the case pleaded by the respondent is not proved in this case, though the details with regard to the allegations of negligence made by the respondent are found to be incorrect. It has to be noted that in a case of this nature regarding negligence of an expert in the field of science, the allegations with regard to the details of negligence alleged by the plaintiff who is a layman absolutely inexperienced about the professional skill, care and intricacies in the field, cannot be magnified and blown out of the proportions to contend that the case pleaded by the plaintiff is not proved. Therefore, we find that the case pleaded by the respondent regarding negligence of the 2nd appellant is proved in this case. 29. Though the respondent had claimed Rs. 3.5 lakhs being damages from the appellants, the lower court after considering the entire facts and circumstances awarded Rs.1 lakh being damages to the respondent. We find considering the fact that the respondent was a young unmarried lady had to undergo amputation of a portion of her right foot and she had to suffer unbearable mental and physical pain apart from incurring large amounts for her treatment, the award of damages of Rs.1 lakh by the lower court is only moderate and reasonable in this case. We find absolutely no ground to interfere with the quantum of damages awarded by the lower court in this case. In view of what is stated above, we find that the appeal is devoid of any merits and the judgment and decree passed by the lower court are liable to be confirmed. Hence this appeal is dismissed confirming the judgment and decree passed by the lower Court. In view of what is stated above, we find that the appeal is devoid of any merits and the judgment and decree passed by the lower court are liable to be confirmed. Hence this appeal is dismissed confirming the judgment and decree passed by the lower Court. Under the circumstances of the case we direct the parties to bear their respective costs.