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Madhya Pradesh High Court · body

2012 DIGILAW 1308 (MP)

Mohar Singh v. State of M. P.

2012-12-21

G.D.Saxena, S.K.Gangele

body2012
JUDGMENT Heard on I.A.No.9790/2012, an application for temporary suspension of sentence of the appellant Mohar Singh on medical ground. It is submitted that the appellant Mohar Singh has been suffering from pain in left lower limb and he is unable to walk. Earlier MRI, ultrasound and CT Scan of the appellant was conducted and it was diagnosed that there were mild degenerative changes affecting lumbar spine and disc bulge-herniation at L4-5 & L5-S1 levels with right lateral recess compromise at L5-S1 level. The illness of the appellant is serious in nature and if proper treatment i.e. surgery is not conducted, then there would be paralysis of lower part of the body. This court vide order dt.27.7.2012 granted interim bail to the appellant for treatment for a period of four weeks. Against the aforesaid order, an SLP was filed before the Hon'ble Supreme Court. In pursuance to the directions of the Hon'ble Supreme Court, the appellant was examined by the medical board and as per the report of the medical board dt.28.8.2012, the appellant needs surgery and hospitalization. Hon'ble Supreme Court vide order dt. 3.9.2012, disposed of the SLP with the following directions : “Heard counsel on either side. This special leave petition has been preferred by the complainant against the order passed by the High Court releasing the accused for a period of thirty days on temporary suspension of his sentence. Learned counsel for the State Government has made available a report of the Medical Board dated 28.8.2012 which shows that the accused needs surgery and hospitalization. On the other hand counsel for the complainant submits, even if treatment is needed, facilities are available in the nearby hospitals. We express no opinion on the rival contentions since we are relegating the matter to the High Court. The High Court will consider all aspects and will take appropriate decision in accordance with law. The counsel for the complainant, if so desires, can assist the public prosecutor. The special leave petition is accordingly, disposed of without expressing any opinion on the merits of the case.” After the directions of the Hon'ble Supreme Court, the Medical Board of J.A.H. Gwalior, consisting Prof. The counsel for the complainant, if so desires, can assist the public prosecutor. The special leave petition is accordingly, disposed of without expressing any opinion on the merits of the case.” After the directions of the Hon'ble Supreme Court, the Medical Board of J.A.H. Gwalior, consisting Prof. Dr.S.N. Iyengar, Dr.Avinash Sharma and Dr.Avdhesh Shukla, submitted the following report : “2) On examination following were the findings -Patient is obese -General physical examination is normal -Spine – No spinal tenderness was found No spinal stiffness was noted -SLR – Patient resisted limb elevation at hip, however on knee flexion hip could be flexed up to 90 degree. -Cross leg raising test didn't elicit any pain -There was no local tenderness at hip -Dorsiflexion of left foot felt weak. All Deep Tendon reflexes were normal -Plantars were flexors. -There was no sensory defecit Patient's MRT was done on 25.2.12 revealed diffuse disc bulge at L4-5 level with no significant thecal compression, left side L5 root was compressed. Lumbar spine shows evidence of degeneration. MRI done on 7.08.12 showed no significant change from 25.02.12 MRI. OPINION 1) Patient complaints of pain in left lower limb; there is no radicular pattern. 2) Cross leg elevation test is negative. 3) Weakness is dorsiflexion of left foot noted. 4) MRI shows left L5 root compression with small central disc at L4-5 ADVICE 1) In view of atypical presentation patient needs second opinion at higher centre. Committee suggest AAIMS Delhi Neurosurgery Department. 2) Patient needs fresh MRI of lumbo sacral MRI on 3 Tesla MRI and MRI of sacroiliac joint and both hips to rule out any pelvic pathology. 3) Patient needs an opinion from orthopaedician to rule out any pelvic pathology. 4) He needs six weeks absolute bed rest under supervision of Jail authorities jail hospital with strong analegesics and antispasmolytics. 5) He should reduce the weight at least by 15-20 kgs. 6) Needs reevaluation at the end of these. Patient's presentation is atypical. If after repeat MRI, Orthopaedician's opinion (if it is negative for pelvic pathology), weight reduction, absolute bed rest, he doesn't improve then it can be concluded that this atypical presentation is due to disc disease and then he can be considered for surgery.” This court vide order dt. 23.11.2012 further ordered that a second opinion be also obtained from Department of Neurosurgery and Ortho, Hamidia Medical College, Bhopal. 23.11.2012 further ordered that a second opinion be also obtained from Department of Neurosurgery and Ortho, Hamidia Medical College, Bhopal. In pursuance to the order passed by this court, the appellant was examined by the Medical Board of Department of Surgery, Gandhi Medical College, Bhopal, consisting following Members : 1. Dr.A.K.Chaurasia, Asstt. Prof. Neuro Surgery Deptt. 2. Dr.I.D. Chaurasia, Asstt. Prof. Neuro Surgery Deptt. 3. Dr.Rahul Verma, Asstt. Prof. Orthopedics Deptt. The Medical Board has submitted the following report : “2-On examination following were the findings Patient is obese General Physical examination is normal -SLR – 90 degree on Rt.Side Ltd.sided SLR is 30 degree -Cross leg raising test didn't elicit any pain on Rt. Side. -There was no local tenderness at hip and sacroiliac joint. -Dorsiflexion of left foot felt weak with weakness of Lt EHL and EDL. -Sensory deficit in L5-S1 dermatomes on Lt. Side about 25-30% (not co operative for sensory examination) Patient's MRI was done on 25.2.12 revealed diffuse disc bulge at L4-5 level with no significant thecal compression, left side L5 root was compressed. Lumbar spine shows evidence of degeneration. MRI done on 7.08.12 showed no significant change from 25.02.12 MRI. MRI done on 5-12-12 suggestive of significant spinal canal stenosis at L4-5 level manifested by disc herniation causing indentation of thecal sac with compression of Bilateral existing nerve roots more on Lt. side. X-ray pelvis with both hips shows normal hip joint on Lt. side and normal SI joint on both sides & Rt. Proximal femur showing callus formation at the tip of greater trochanter. OPINION 1) Patient complaints of pain in left lower limb; 2) Cross leg elevation test is negative on Rt. Side and SLR is 30 on Lt. side. 3) Weakness is dorsiflexion of left foot noted with EHL and EDL weakness. 4) Fresh MRI shows Bilateral L5 root compression, more on Lt. side with central disc Herniation at L40-5 and canal stenosis at L4-5 level. ADVICE 1) Clinically and Radiologically both sacroiliac joints and both hip do not show any gross pathology. 2. Physiotherapy with special reference to back exercise for about 4 weeks alongwith rest and analgesic and muscle relaxants. 3. Avoid forward bending, lifting heavy weight and squatting. 4. In the meantime further opinion can be taken from higher centre i.e. AIIMS New Delhi. 5. 2. Physiotherapy with special reference to back exercise for about 4 weeks alongwith rest and analgesic and muscle relaxants. 3. Avoid forward bending, lifting heavy weight and squatting. 4. In the meantime further opinion can be taken from higher centre i.e. AIIMS New Delhi. 5. If patient not improves in four weeks, Surgery for L4-5 disc is advisable.” The Medical Board has specifically observed that surgery of L4-5 is advisable and further opinion from AIIMS can be taken. Learned senior counsel appearing on behalf of the appellant has contended that Dr.N.K.Singh, Fortis Hospital, New Delhi is the specialist of such type of surgeries and the appellant wants to get treatment from Fortis Hospital, New Delhi. He further submitted that the appellant shall also make arrangement for treatment at AIIMS, New Delhi. Learned senior counel submits that the surgery is complicated one and this kind of surgery is not possible at J.A.H. Gwalior. Learned Public Prosecutor and the learned counsel for the complainant contended that although there is ailment to the appellant, but it is not serious in nature and looking to the nature of the case, the appellant is not entitled to be released on medical ground. Learned counsel further admitted the fact sentence of another co accused has been suspended. In the present case, earlier this court rejected the applicant for suspension of sentence of the appellant on merits. The appellant has a serious problem of diffuse disc bulge at L4-5 level with no significant thecal compression, left side L5 root was compressed and lumber spine shows evidence of degeneration. Both the Medical Boards i.e. J.A.H. Gwalior and Gandhi Medical College, Bhopal, opined that further opinion of AIIMS New Delhi be obtained. Hon'ble Supreme Court has also observed that the appellant needs surgery and hospitalization. In this view of the matter, the application is allowed and it is directed that execution of jail sentence of the appellant shall remain suspended temporarily and he be released on bail temporarily for a period of thirty days only from the date of his release, on his furnishing a personal bond in the sum of Rs.2,00,000/-(Rupees Two Lac only) with two solvent sureties of Rs.1,00,000/-each to the satisfaction of the CJM Gwalior, and the learned CJM Gwalior shall fix a date for surrender of the appellant on completion of the aforesaid period of thirty days. The appellant shall surrender immediately after expiry of the aforesaid period of thirty days from the date of his release. A copy of the order be sent to the concerning court for necessary compliance. Certified copy as per rules.