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2007 DIGILAW 742 (KAR)

NARAYANA K. SWAMY v. A. NAZIR AHAMED KHAN

2007-11-14

V.JAGANNATHAN

body2007
JUDGMENT V. Jagannathan, J. 1. These two appeals arise out of one and the same judgment rendered by the trial court in O.S. No. 7691/91. The appellants herein were the defendants 3 and 4 respectively before the trial court. The suit filed by the plaintiff claiming damages following the death of plaintiff’s wife Smt. Khateeja Yasmeen on account of negligence of the appellants came to be allowed and the trial court awarded a compensation of Rs. 1,00,000/- and put the liability jointly and severally on the appellants. 2. The facts briefly stated are to the effect that the plaintiffs who are the husband and minor children of deceased Khateeja Yasmeen filed the suit in question claiming compensation of Rs. 4,00,000/- on the ground that Khateeja Yasmeen died while she was under treatment in the third respondent’s hospital and it is the case of the plaintiff that the deceased was taken to the hospital on 31.3.1988 with severe bursting headache and vomiting. The first plaintiff-husband was asked to get a CAT and Contrast Scan done immediately in a private nursing home as the duty doctor was not available on account of general holiday. The husband agreed to the said suggestion, but he was not provided with ambulance though requested by him. Nevertheless, the patient was taken to Jubilee Nursing Home and was then brought back to NIMHANS. The 4th defen dant who is one of the appellants herein was in-charge of the patient and had dire-cted that angiogram teat has to be condu-cted. But no such angiogram test was conducted for various reasons to which reference would be made at a later stage. 3. However, lumber puncture test was carried out and it revealed the presence of disease known as SAH (Subarachnoid haemmorrhage). The patient was put under lumber puncture on more than one occasion and in fact, three times lumber puncture was carried out and the presence of SAH was noted. Thus, according to the plaintiff, though lumber puncture is not conducted within short intervals, the patient was put under the said test three times, whereas angiogram test was to be conducted at the earliest, but the said test was not done. This according to the plaintiff led to the patient going into coma stage with other complications and right from the date the patient was admitted to the hospital, till 5.4.1988, no angiogram test was conducted. 4. This according to the plaintiff led to the patient going into coma stage with other complications and right from the date the patient was admitted to the hospital, till 5.4.1988, no angiogram test was conducted. 4. Finally, the first plaintiff’s wife Khateeja Yasmeen breathed her last on 9.4.1988. The plaintiff, therefore, filed the suit in question putting the blame entirely on the third and fourth defendants and it is on account of their negligence, the patient’s life was lost and it to also an unfortunate fact that when Khateeja Yasmeen was taken to the hospital, she was a pregnant of 24 weeks. Hence, the suit, was filed claming damages from the appellants who were primarily responsible for the loss of life of the first plaintiff’s wife. 5. On behalf of the defendants, written statement was filed by the third defendant and the stand taken was that, adequate care and required treatment was given to the patient and as the repeated lumber puncture did not confirm the presence of SAH, angiogram was postponed and therefore, all the attentions made by the plaintiffs concerning negligence, improper treatment etc., were not admitted by the third defendant. The 4th defendant who happened to be the in-charge doctor of the patient in question, denied any negligence in the treatment of the patient and his defence was that the angiogram test was postponed because of non-availability of the radiologist on one occasion and because of the repeated lumber puncture test carried. Therefore, the 4th defendant denied the allegations of negligence, improper care and denial of adequate facilities. 6. The pleadings of the parties gave rise to the following issue being framed by the trial court: i) Whether the plaintiffs prove that Smt. Khateeja Yasmeen died due to negligence in treatment at D3? ii) Whether D3 proves that death was due to unusual signs of Smt. Khateeja Yasmeen? iii) Whether the plaintiffs are entitled for the compensation claimed? iv) What decree or order? 7. On appreciating the evidence let in by the parties and upon hearing the learned Counsel for the parties to the suit, the trial judge answered the issues 1 and 3 in favour of the plaintiffs and issue No. 2 was answered against the third defendant and consequent to the said findings, the suit of the plaintiff came to be decreed by awarding Rs. 1,00,000/- as compensation for the negligent act and omission on the part of the third and fourth defendants (appellants herein) in the treatment of the deceased Khateeja Yasmeen. The appellants were held jointly and a severally liable to pay the damages of Rs. 1,00,000/- with interest thereon. It is this judgment of the trial court that has prompted the appellants to prefer these two appeals. 8. I have heard the learned Counsel Sri. N.B. Bhat for the appellants and learned Counsel Sri. R.B. Sadashivappa for the respondents-plaintiffs. I have also carefully perused the entire material on record. 9. Learned Counsel Sri. N.B. Bhat submitted that the trial court had come to a conclusion that the cause of death of Khateeja Yasmeen though was on account of SAH, yet, it was on account of the negligent act and omission on the part of the 4th defendant in not performing the angiogram test on the deceased, that has led to the death of Smt. Khateeja Yasmeen. Therefore, it was contended that the said finding of the trial court is totally erroneous and the failure to conduct angiogram test could not be viewed as the real cause for the death of Khateeja Yasmeen. Since it is not in dispute that Khateeja Yasmeen died on account of she having been affected by SAH, non-performance of angiogram test could not have been held to be fatal. In this regard, learned Counsel took me through the evidence on record and sought to drive home the point that the trial court was in error in coming to the conclusion that the appellants herein were responsible by their negligent act of not conducting the angiogram test and it was submitted that angiogram test is one of the various tests that is conducted in the hospital in order to find out the condition of health of a patient and therefore, the trial court could not have put much emphasis on failure to conduct the angiogram test in order to find out what would be the cause for the death of Khateeja Yasmeen. 10. It is the further submission of the learned Counsel Sri N.B. Bhat that, since the death took place on account of the disease viz., SAH, even if angiogram test had been conducted, that would not have made any difference insofar as the treat ment given to the patient is concerned. 10. It is the further submission of the learned Counsel Sri N.B. Bhat that, since the death took place on account of the disease viz., SAH, even if angiogram test had been conducted, that would not have made any difference insofar as the treat ment given to the patient is concerned. As such, the approach of the trial court was erroneous and the finding that the appellants herein were negligent, there-fore, cannot be sustained in law. In this regard, he also drew my attention to the written statement filed by the 4th defendant and submitted that the reasons for not conducting the angiogram test having been clearly stated in para 4 of the written statement filed on behalf of the 4th defendant, no negligence could have been attributed to the 4th defendant and hence, the finding of the trial court on the issues framed by it requires to be interfered with and consequently, the appeal also requires to be allowed by setting aside the judgment by the trial court. 11. Sri. R.B. Sadashivappa learned Counsel for the respondents- plaintiffs opposing the above submissions, submitted that not only the appellants herein were negligent in the treatment of Khateeja Yasmeen, but even according to the sole witness DW1 examined on behalf of the appellants, conducting angiogram test was the surest method to ensure the presence of SAH in the patient and in view of the other admissions by the witness DW1, it is not open to the appellants now to contend that there was no negligence on their part. In fact, referring to the time taken by the appellants to file their written statement before the trial court, learned Counsel submitted that the negligence did not stop with the manner in which the patient Khateeja Yasmeen was treated leading to her death, but the negligence/indifference continued even in the filing of the written statement inasmuch as the third defendant filed the written statement almost after six years of filing of the suit and the 4th defendant viz., Dr. K.S. Narayanaswamy in-charge of the patient filed his written statement much later i.e. in the year 1997 after a gap of 8 long years. K.S. Narayanaswamy in-charge of the patient filed his written statement much later i.e. in the year 1997 after a gap of 8 long years. As if these factors were not enough to prove the negligence of the 4th defendant, it is submitted by the learned Counsel, that the 4th defendant who is one of the appellant herein also did not enter the witness box to support the stand taken by him in his written statement. Therefore, the pleadings of the 4th defendant which is unsupported by the evidence cannot be looked into. 12. As far as the merits of the case is concerned, it is submitted that though the plaintiffs got examined number of witnesses, 2 of the 3 witnesses were doctors by profession and they have deposed in regard to the negligent manner in which the patient was treated in the hospital and they also happened to be the brothers of the deceased. The 4th defendant refused to act upon the opinion by the neurosurgeon of U.S. Dr. Shahin the brother of the deceased, conveyed through Dr. Amin and the evidence of the said witnesses clearly go to establish the negligence with which the appellants herein treated the deceased. At the same time, though the defendants got exami ned only one witness i.e., DW1 who is Dr. K.V.R. Shastry, the said witness has clearly admitted in his evidence that the angio gram test was suggested by Dr. Narayana swamy and the same test was the surest way of finding out the presence of SAH. 13. Therefore, by referring to the evi dence of DW1, it was pointed out that the admission made by DW1 is sufficient to come to the conclusion that there was negligence on the part of the appellants herein in not treating the deceased properly and apart from that, it was pointed out by the learned Counsel that the evidence of DW1 also reveals the manner in which the deceased was treated and to what extent the reports of the third defendant-hospital can be considered as credit worthy. That apart, learned Counsel also referred to the reasons given by the trial court in the course of its judgment to submits that the learned judge of the trial court has left no stone unturned in arriving at the findings by referring not only to the pleadings and evidence of the parties, but also to various text books on the disease in question and therefore, no fault can be found with the reasoning given by the trial court for allowing the suit of the plaintiff. 14. As far as the quantum of damages is concerned, learned Counsel Sri. Sadashivappa submitted that though the plaintiffs have not preferred any appeal against the quantum of damages awarded in a sum of Rs. 1,00,000/- as against their claim of Rs. 4,00,000/-, yet, one should not lose sight of the fact that the plaintiffs have been deprived of love and affection of the deceased. It was submitted that the deceased was in her thirties (36 years) and was a double graduate and the first plaintiff-her husband is also a professor and three minor children are left behind by the deceased and considering all these factors, the damages awarded cannot be treated as too high, but the said damages of RS. 1,00,000/- is far too low considering the loss caused to the plaintiff. Never-theless, it was submitted by the learned Counsel that any amount of money cannot compensate for the loss of the deceased wife of the first plaintiff, but the plaintiffs are much more pained by the manner in which the deceased was treated that too by a hospital which in known to be a reputed hospital. As such, learned Counsel for the respondents-plaintiffs submitted that though the quantum of damages, awarded is on the lower side, the plaintiffs will get solace by getting justice at the hands of the court and precisely, the trial court has rendered justice to the case of the plaintiffs. 15. In the light of the submissions made as above by the learned Counsel for the parties, the only question that requires to be considered is, as to whether the trial court was justified in recording a findings of negligence as against the third and fourth defendants (appellants herein) for the death of the deceased. 16. It is not in dispute that the cause of death of the deceased is on account of Subarachnoid haemorrhage (SAH). 16. It is not in dispute that the cause of death of the deceased is on account of Subarachnoid haemorrhage (SAH). Wikipedia, “Free encyclopedia on internet” gives the following information about (SAH). Subarachnoid hemorrhage (SAH) is bleeding into the Subarachnoid space surrounding the brain, i.e., the area between the arachnoids membrane and the pia mater. It may arise due to trauma or spontaneously, and is a medical emergency which can lead to death or severe disability even if recognized and treated in an early stage. Treatment is with close observation, medication and early neurosurgical investigations and treatments. Subarachnoid hemorrhage causes 5% of all strokes. 10-15% die before arriving in hospital, and average survival is 50%. Signs and symptoms The classic symptom of subarachnoid hemorrhage is thunderclap headache (“most severe ever” headache developing over seconds to minutes). 10% of all people with that symptom turn out to have a subarachnoid hemorrhage, and is the only symptom in about a third of all SAH patients. Other presenting features may be vomiting (non-specific), seizures (1 in 14) and meningism. Confusion, decreased level of consciousness or coma may be present. Intraocular hemorrhage (bleeding into the eyeball) may occur. Subhyaloid haemorrhage may be visible on fundoscopy (the hyaloid membrane envelopes the vitreous body). In a patient with thunderclap headache, none of the signs mentioned are helpful in confirming or ruling out hemorrhage, although a seizure makes bleeding from an aneurysm more likely. Oculomotor nerve abnormalities (affected eye looking downward and outward, pupil widened and less responsive to light) may indicate a bleed at the posterior inferior cerebellar artery. As a result of the bleeding, blood pressure often rises rapidly, together with a release of adrenaline and similar hormones. As a result, substantial strain is put on the heart, and neurogenic, pulmonary edema, cardiac arrhythmias, electrocardiographic changes (some resembling a heart attack) and cardiac arrest (3%) may occur rapidly after the onset of haemorrhage. Bleeding in the subarachnoid space may occur as a result of injury or trauma. SAH in a trauma patient is often detected when a patient who has been involved in an accident becomes less responsive or develops hemiparesis (one-sided weakness) or changed pupillary reflexes, and Glasgow Coma Score calculations deteriorate. Headache is not necessarily present. Risk factors for subarachnoid hemorrhage are smoking, hypertension (high blood pressure) and excessive alcohol intake; all are associated with a doubled risk for SAH. Headache is not necessarily present. Risk factors for subarachnoid hemorrhage are smoking, hypertension (high blood pressure) and excessive alcohol intake; all are associated with a doubled risk for SAH. Some protection of uncertain significance is conferred by Caucasian Ethnicity hormone replacement therapy, a higher than normal cholesterol and the presence of diabetes mellitus. Diagnosis The initial steps in a case of possible subarachnoid hemorrhage are obtaining a medical history and performing a physical examination; these are aimed at assessing the likelihood of the condition, and identifying other potential, causes of the symptoms. Neck stiffness and other signs of meningism may be present, as well as a reduced level of consciousness. The diagnosis of subarachnoid haemorrhage cannot be made on clinical grounds alone. Medical imaging is usually required to confirm or exclude bleeding. The modality of choice is computed tomographty (CT/CAT) of the brain. This has a high sensitivity (it will correctly identify 95% of the cases), especially on the first day after the onset of bleeding. Some date suggests that magnetic reson-ance imaging (MRI) may be more sensitive after several days. In those where the CT/MRI scan is normal lumber puncture (removal of cerebrospinal fluid/CSF with a needle from the lumber sac under local anesthetic) will identify another 3% of the cases by demonstrating xanthochromia (yellow appearance of centrifugated fluid) or bilirubin (a breakdown product of hemoglobin) in the CSF. Once a subarachnoid hemorrhage is confirmed, the next question is about its origin. CT angiography (using radiocontrast) to identify aneurysms is generally the first step, as invasive angiography (injecting radiocontrast through a catheter advanced to the brain arteries) has a small rate of complications but is useful if there are plans to obliterate the source of bleeding, such as an ancuryam, at the same time”. 17. Haemorrhage is defined in the Chambers 21st Century Dictionary as to mean escape of profuse amount of blood especially from a ruptured blood vessel. In the book Abram’s Angigraphy Vascular and interventional Ragiology III Edition by Herberyt L. Abrams Volume I at page 285 and 286, it is stated thus: CT findings on the other hand, do not preclude angiography, unless, the cause of haemorrhage is evident (e.g. a known tumor or trauma), angiography will be needed to reveal the etology of the bleedings or to degine the source so as to guide treatment. Angiography is the procedure of choice for the diagnosis of and definition of cerebral aneurysms. Most aneurysms are treated by surgically clamping or ligating the proximal portion of the aneurysm. Therefore angiography must delineate the origin and configuration of the aneurysm and its orientation to the surrounding vessels. The relationship of aneurysms of the distal internal carotid to dura (i.e., whether the aneurysms are intradural or extradural) must be determined. Both CT and angiography are helpful in predicting local clot, whereas the exact site of rupture from the aneurysm dome is more easily deducted from angiography. Arterial spasm frequently occurs several days after a subarachnoid haemorrhage. In view of this, angiography is the best performed early in the course; also, early angiography allows for a definitive diagnose and treatment directed more specifically towards the cause of the haemorrhage. 18. It is, therefore, clear from the above observations that Angiography is the best performed early in the course. In the instant case, it is not disputed by the parties that no angiogram test was conducted despite the doctors opinion that such a teat is imperative. In fact, DW1 the only witness examined on behalf of the appellants and who also happened to be a professor and Head of the Department of Neurology has stated in his evidence that at paragraph No. 11 thus: Conducting Angiogram will be the surest method to find out the clues pertaining to the presence of SAH. As per the records perused by me, no angiogram test was conducted on the patient right from the day one till the date of her death. (witness volunteers that as per records on 1.4.1988, the doctor has made a note that the patient was planned for angiogram to the coming days. Records show that on 5.4.88 the patient was taken to the Angiogram room. But because of the development of new sign and symptom, the angiogram test was postponed. Records do not disclose that from 31.3.88 to 5.4.88, the patient was taken to the angiogram test. The duty doctor has mentioned in the admission chart that the patient had the clues of the presence of SAH. A Resident Doctor by name Guptha has written a note that it is a case to be admitted under Dr. K.S. Narayana Swamy. It is true that Dr. Narayana Swamy was looking after the patient”. 19. Apart from these, the 4th defendant Dr. A Resident Doctor by name Guptha has written a note that it is a case to be admitted under Dr. K.S. Narayana Swamy. It is true that Dr. Narayana Swamy was looking after the patient”. 19. Apart from these, the 4th defendant Dr. Narayanaswamy himself had opined to conduct angiogram test and it was, he alone who was competent to suggest such a test. Incidentally, DW1 also had been associated in the preparation of a book by name “Subarachnoid Haemorrhage” by Sen Gupta and C.L. Mcallister. Therefore, when a witness having such profound knowledge of SAH, deposes before the court that conducting the angiogram will be the surest method to find out the clues pertaining to the presence of SAH, it was not only obligatory, but was inevitable on the part of the 4th defendant to have conducted the angiogram test on the deceased. Unfort unately, as could be seen from the evid ence of this witness, not only no such angi ogram test was conducted, but on the other hand, the test which ought not to have been conducted repeatedly within a short duration viz., lumber puncture test was conducted on the deceased. This is clear from the very evidence of DW1 who has stated to the effect that they will not conduct the lumber puncture test repeatedly if the first test itself conclusively indicate presence of SAH, but in the instant case it has been conducted, thrice. The evidence of DW1 also reveals that on the very first day when the deceased was taken to the hospital, the presence of SAH was noted. Despite this, three lumber puncture tests were conducted which were not required to be conducted as per the evidence of DW1. At page 141 of the paper book and in paragraph 10 DW1 has stated that the lumber puncture was also done to the patient and CT scan was also conducted on the first day of the admission of the patient. The patient underwent the lumber puncture test on 31.3.1988, 4.4.1988 and again on 8.4.1988. There fore, the very evidence of DW1 is also an indication of the negligent manner in which the deceased was treated at the third defendants hospital. 20. In the book “Diagnostic Radiology”, Volume-II. Section 9, under the title “Central Nervous System”, the obser vations at pages-1977 and 1978 are also worth recalling at this juncture. There fore, the very evidence of DW1 is also an indication of the negligent manner in which the deceased was treated at the third defendants hospital. 20. In the book “Diagnostic Radiology”, Volume-II. Section 9, under the title “Central Nervous System”, the obser vations at pages-1977 and 1978 are also worth recalling at this juncture. They are: “Intra-arterial angiography is the cornerstone in the diagnosis and treatment of the large majority of intracranial aneurysms and other causes of subarachnoid haemorrhage as soon as the latter is confirmed by lumbar puncture. CT or MRI: indeed, this remains one of the few incontestable indications for angiography. Intravenous DSA is unreliable for the detection of small aneurysms. Timing of angiography in relation to the bleed varies in different departments, but the study is usually obtained as soon as the general condition of the patient permits surgery, whose aim is exclusion of the aneurysm from the circulation before further, possibly fatal, bleeding occurs”. 21. Therefore, non-conducting of the angiogram test will have to be seen as a fatal omission on the part of the appellants herein and unfortunately, the reasons given for the failure to conduct angiogram test also does not go well with the reputation for which the third defendant-hospital is known. It has been pointed out from the evidence on record and which is also not in dispute viz., that the angiogram test was not conducted because of the non-availability of the Radiologist, who was on leave. 22. It is rather strange that in a hospital of such repute as the one headed by the third defendant, it was not able to provide a Radiologist for conducting angiogram test having regard to the serious complications with which the deceased was brought to the hospital for treatment. To compound this is the manner in which the treatment was given to the deceased. Though the deceased was suffering from SAH and as there was a blood-clot in her brain, she was put on tablets, which are generally called as Paracetamol tablets. 23. It has also come in the evidence of P.W.1 that even the deceased was deprived of the facility of being carried on a stretcher, but she was physically lifted from one place to another and the learned trial judge has referred to this aspect in paragraph-16 of his judgment (page 66 of the paperbook). 23. It has also come in the evidence of P.W.1 that even the deceased was deprived of the facility of being carried on a stretcher, but she was physically lifted from one place to another and the learned trial judge has referred to this aspect in paragraph-16 of his judgment (page 66 of the paperbook). Further, the learned trial judge, after referring to the various authorities on the disease SAH, has observed in paragraph-26 of the judgment that from a perusal of the literature placed before the trial court, for finding out the blood-clot in the brain, lumbar puncture test is followed by angiography. The court has further observed that defendant-4, being in charge of the deceased, ought to have taken reasonable care in the circumstances of the case to get angiogram test conducted at the earliest point of time. Postponing of the angiogram test for more than a week, therefore, will have to be considered as an act of negligence on the part of defendant-4. The trial court has also observed that the reason for postponing the angiogram test could be linked to the absence of the Radiologist and the court has, therefore, rightly observed that defendants-3 and 4 could have hired the services of a Radiologist instead of postponing the crucial angiogram test. 24. As far as the deceased being found to be pregnant at the time of treatment is concerned, the learned trial judge has also referred to the observations in “Gynaecology and Obstetrics”, Volume -3, by Scirra, and the said author has opined that at all ages approximately one third of spontaneous subarachnoid haemorrhage are due to other causes, including bleeding disorders, vasculitie, subacute bacterial endocarditis, sickle cell anemia and matastatic choriocarcinoma. Having thus referred to the said opinion, the learned judge has observed that, in the instant case, as the deceased was 24 weeks pregnant and aged about 32 years and she having had three issues born earlier, the evidence revealed that the deceased had no gynecological problems and, therefore, under such circumstances, it is ununderstandable as to why defendants-3 and 4 did not carry out the angiogram test soon after the first lumber puncture test was done which suggested the clues of the presence of SAH. 25. 25. In fact, as the matter concerns medical negligence on the part of defendants-3 and 4, the trial court also has examined the evidence meticulously keeping this in perspective and noted several defects and they are to be found at paragraph-30 of the trial court’s Judgment which, in my view, is worth being reproduced at this juncture: 30. The approach of the court must be extra-cautious while dealing with the alleged medical negligence. On a meticulous examination of the evidence on record and after a perusal of the literature on Neurology produced by the learned Counsel on both the sides, the conclusions that can be drawn are: (a) the first lumbar puncture test conducted on the deceased on the first day of her admission to the hospital on 31.3.1988 suggested the clues of the presence of SAH; (b) intra-arterial angiography is the corner stone in the diagnosis and treatment of a large majority of intracranical aneurysms and other causes of subarachnoid haemorrhage as soon as the latter is confirmed by lumbar puncture; (c) though four vessels angiogram was recommended by the 4th defendant it was not administered soon after the first lumbar puncture test suggesting the clues of the presence of SAH; (d) there is an unexplained delay from 31.3.1988 to 5.4.1988 for non-conducting of the angiogram test, though consecutive lumbar puncture tests suggests the clues of SAH. The said delay proved fatal. The 4th defendant in particular and other doctors of neurology and neurosurgery department of the 3rd defendant are squarely liable for their negligence in handling the case of the deceased. 26. Apart from these, the position in law as regards medical negligence also will have to be kept in view. Medical negligence basically means, such negligence resulting from the failure on the part of the doctor to act in accordance with the medical standards in vogue which are being practiced by an ordinarily and reasonable competent man in practicing the same art. As far as the importance of proper diagnosis is concerned, in the case of Cosmopolitan Hospitals Vs. Medical negligence basically means, such negligence resulting from the failure on the part of the doctor to act in accordance with the medical standards in vogue which are being practiced by an ordinarily and reasonable competent man in practicing the same art. As far as the importance of proper diagnosis is concerned, in the case of Cosmopolitan Hospitals Vs. Vasantha P. Nair I (1992) CRJ 303 (NC), it has been held that where the disease of a patient was initially diagnosed as tuberculosis and treatment was given and later, the ailment was diagnosed as jaundice on the basis of other symptoms the National Commission confirmed the finding of the State Commission with regard to the complaint being maintainable. 27. In the case of Dr. Laxman Balakrishna Joshi Vs. Dr. Trimbak Bapu Godbole AIR 1996 SC 128, it was found on facts that a young boy of 20 years suffered an overlapping fracture of femur and it required ‘pin traction’. He was given injections of Morphia and Hyoscine at an hour’s interval. But, the doctors did not take care to perform the essential preliminary examination of the boy before starting the treatment. The boy died as he was not put on ‘pin traction’, but he was treated under general anaesthesia. The Apex Court held that the death was due to the shock resulting from reduction of the fracture attempted by thus doctor without taking the elementary caution of giving anaesthesia to the patient. 28. In the case on hand also, despite the necessity of conducting the angiogram test as opined by the doctors themselves, defendant-4 being in charge of the deceased, did not ensure that angiogram test was in fact conducted on the deceased, but it was not to be. 29. The trial court also found the findings of the enquiry officer (Ex.D-4) were in direct conflict with the evidence of D.W.1 and the other defects to which the trial court has referred to are those concerning the creditworthiness of the reports. D.W.1 has stated in his evidence that as per the records, the deceased was said to have been taken to have angiogram test. It is nobody’s case that angiogram test was conducted on the deceased. There is further admission by D.W.1 in his evidence that the summary death report observation is not in conformity with the laboratory report. Another factor is, D.W.1 has admitted in his cross-examination that Dr. It is nobody’s case that angiogram test was conducted on the deceased. There is further admission by D.W.1 in his evidence that the summary death report observation is not in conformity with the laboratory report. Another factor is, D.W.1 has admitted in his cross-examination that Dr. T.G. Suresh has given his opinion on 6.4.1988 without referring to the case file. 30. All these lapses on the part of the hospital authorities also speak volumes about the manner in which the reports are given in the instant case. I, therefore, find enough force in the submission made by the learned Counsel for the respondent-plaintiffs that negligence aspect has not been confined only to the failure to conduct angiogram test, but it continued to encompass the other areas as well, including the time taken by the appellants to file their written statement in the present suit and defendant-4, who was in charge of the patient and against whom negligence had been alleged by the plaintiffs, not coming before the court to give his evidence as a witness. 31. Mere filing of the written statement by defendant-4 will not be sufficient in a case of this nature and it was incumbent on the part of defendant-4 to have entered the witness box to support the stand taken by him in his pleadings. If there was no negligence at all on the part of defendant-4, nothing prevented him from coming before the court and given evidence particularly in view of he being a professional doctor and any finding against him was also likely to affect his professional career. It is rather inexplicable as to how defendant-4 chose not to defend himself in a case of this nature where professional negligence is attributed to him. Silence on his part, therefore, also gives weightage to the evidence placed by the plaintiffs. 32. Having thus examined the evidence let in before the trial court and its appreciation by the learned judge and the reasons given by the trial judge for his findings, I am of the view that the appellants herein cannot escape from being found negligent in the treatment of deceased Khateeja Yasmeen. There has been several lapses in the instant case to which I have already made reference above. There has been several lapses in the instant case to which I have already made reference above. All these lapses cumulatively and more importantly the fatal omission in not conducting the angiogram test on the deceased have led to the loss of a precious life. 33. There is a popular saying in English which paraphrased can be put thus: “For want of a shoe, the horse was lost and for want of the horse, the battle was lost”. In the instant case, right from the beginning, there have been several lapses one after another. (i) First, the husband of the deceased was driven by the third defendant-hospital to go to a private nursing home and get a CT scan done. (ii) The second and the very unfortunate one is that the husband was even deprived of having an ambulance to carry his wife to the nursing home for test. (iii) The third one is the absence of non-availability of the Radiologist, who was said to be on leave. This led to the angiogram test being postponed and this finally led to the death of Katheeja Yasmeen. (iv) One other factor which also has to be mentioned is that the report of the hospital itself has not been shown to be creditworthy even according to the evidence of D.W.1 and (v) the unfortunate patient, who died, also did not have the elementary facility of being carried on a stretcher from one room to the other in the hospital, but was literally lifted from place to place, an inhuman way of treating a pregnant woman, with serious complications. 34. This Court is really shocked to find such a state of affair prevailing in a reputed hospital like NIMHANS. The hospital authorities will have to keep in view that the entire hospital, the staff included, is meant to serve the patients who come for treatment. If a patient is deprived of elementary facilities and certain tests are not conducted which are crucial to diagnose further and to give proper course of treatment, these lapses coupled with the absence of essential staff like Radiologist, all will ultimately lead to patient’s succumbing to the disease, not because the disease was a fatal one, but because of lack of proper treatment and adequate assistance and help. 35. 35. Therefore, though this Court has agreed with all the findings given by the trial court and so also the reasoning given in support of the said findings, it is necessary to once again reiterate the importance of medical services to a common man and generally to every patient. It is said that the medical profession is one among the three noble professions of the world. Therefore, it is needless to say that utmost importance is given to every patient, who comes to the hospital for treatment and every effort is made to enable the patient to get back to his/her normal health and best treatment should be given to every patient and there should be no lapses of the nature which we have found in the instant case and, therefore, I am constrained to observe at this juncture that a copy of this judgment also be sent to the Indian Medical Council for taking necessary steps and for giving suitable directions to all the hospitals which come under its purview to ensure that lapses of such nature as had happened in this case will not recur in future. It is with this fond hope that I proceed to pass the following order: 36. Both the appeals are dismissed. The quantum of damages awarded by the trial court is confirmed since the plaintiffs have not seriously contested the same. No costs. The amount in deposit made in R.F.A.No. 788/2006 is permitted to be withdrawn by the appellant. As far as the security furnished in R.F.A.No. 945/2002 is concerned, in view of the appeals being dismissed, the security furnished be returned to the plaintiffs.