JUDGMENT : An young lady by name Sabeera, wife of one Mohammed Tariq, died on 22.4.2007 while undergoing treatment at Al Shifa Hospital, Perinthalmanna. The plaintiffs, her legal heirs and legal representatives have filed a suit against the management and the Consultant Gynecologist of Savera Hospital, Tirur as O.S No. 61 of 2012 for damages as she was under prenatal treatment before the said hospital. The suit was dismissed by a judgment and decree dated 18.10.2012. Feeling aggrieved, the appeal has been filed by plaintiffs 2, 4 and 5/the appellants. 2. For the sake of convenience, the parties are referred to as per their ranking before the trial court in the suit. 3. Shorn of unnecessary details, the facts of the case are as under: Deceased Sabeera was the wife of the second plaintiff. When she was pregnant for the 2nd time, she was under prenatal care and treatment of the 4th defendant, the consultant gynecologist of the first defendant hospital since 14.9.2006. On the first visit itself, she had complained to the gynecologist about recurrent severe headache, persistent excessive vomiting, drowsiness and swelling on feet and hand, dizziness, fever, intermittent incidents of double vision, blurred vision and acute pain in stomach. But it was not taken care of in the proper sense by the gynecologist saying that such symptoms were quite common among pregnant women. Sabreea had developed edema on her face and legs on 16.4.2007, but her blood pressure was not checked though she consulted the gynecologist on 17.4.2007. On 20.4.2007 she was admitted in the 1st defendant Hospital as an inpatient and as her condition was worse, she was referred for better treatment and thus she was admitted in Al Shifa Hospital, Perinthalmanna on 21.4.2007 at about 1.30 a.m. But on the next day i.e. on 22.4.2004 by about 1.30 a.m. she died. Her death was due to the negligence on the side of the defendants. Though she had symptoms of pre-eclampsia, a serious complication of pregnancy it was not diagnosed properly and proper care and attention was not given by the gynecologist and the hospital authorities and thus she lost her life at the young age of 23 years. Hence, the suit was filed for realization of an amount of Rs.10,00,000/-as damages from the defendants. 4. Hence, the suit was filed for realization of an amount of Rs.10,00,000/-as damages from the defendants. 4. The defendants resisted the claim inter alia contending that there was absolutely no negligence on the side of the hospital authorities as well on the side of the 4th defendant/the Gynecologist, who attended her in the hospital. Her LMP was on 1.8.2006. The fourth defendant had treated her with reasonable care and skill. During antenatal check up, all routine investigations including immunization were given to the patient. But on 20.4.2007, she came to the hospital with complaints of severe epigastric pain and headache. As she had a raised blood pressure the fourth defendant admitted her to manage the situation. Impending eclampsia was doubted in diagnosis. So, necessary investigations were advised and requisite treatment were given and the physician was also consulted and as her blood pressure was not reducing, termination of pregnancy was decided to be done by conducting an emergency Cesarean section. But it was advised by the anesthetist that it was better to have the surgery in a hospital where ventilation facility and blood bank were available. Therefore, the patient was referred to PVS Hospital, Calicut having excellent facilities. Since eclampsia was doubted, the doctor had given all kinds of treatment possible in that hospital and referred the patient to a higher center having more facilities for treatment. There was absolutely no negligence on the part of the defendants in providing treatment to Sabeera. There was no negligence or deficiency of service and hence the plaintiffs are not entitled to realize any amount as compensation from the defendants. 5. Before the court below, PWs 1 to 4 were examined and Exts.A1 to A24 were marked for the plaintiffs. For the defendants, DW1 was examined and Exts. B1 to B5 were marked and Exts. X1 series were also marked. The court below after appreciation of the evidence found that the death of Sabeera was not due to any negligence on the side of the defendants and therefore, there was no medical negligence which led to the death of Sabeera and on the said finding the suit was dismissed. X1 series were also marked. The court below after appreciation of the evidence found that the death of Sabeera was not due to any negligence on the side of the defendants and therefore, there was no medical negligence which led to the death of Sabeera and on the said finding the suit was dismissed. Aggrieved by the dismissal of the suit for compensation, the plaintiffs 2, 4 and 5 filed this appeal, contending that the finding of the court below was absolutely wrong and the court below had erred in finding that proper medical treatment was provided to the deceased by the defendants and there was no negligence on their side. 6. Heard Sri. Ajayakumar G, the learned counsel for plaintiffs 2, 4 and 5/appellants, Sri. Sheji P. Abraham, the learned counsel for defendants 1 to 4/respondents 1 to 4, and Sri. M.R. Sarin Panicker, the learned counsel for plaintiffs 1 and 3/respondents 5 and 6. 7. Admittedly, the deceased Sabeera was an young lady aged only 23 years at the time of her death. Though her parents were in the party array while filing the suit as plaintiffs, they did not join the appellants to challenge the judgment and decree of the trial court in this appeal. So, the appeal is preferred by the husband of the deceased, who is the second plaintiff and the children of the second plaintiff and Sabeera. It is not in dispute that the deceased was undergoing prenatal treatment in connection with her second pregnancy in the defendants' hospital and she was consulting the fourth defendant, gynecologist. The unfortunate part of this case is that the child born to her in the 2nd delivery, who lost her mother on birth is also before the court as the third appellant/fifth plaintiff claiming damages on the death of her mother. When the suit was filed, she was only 7 months old. 8. It is also not in dispute that Sabeera had her consultation in the defendants' hospital when she conceived for the second time from 14.9.2006 as her last LMP was on 31.7.2006. Admittedly, she was treating as an out patient till her admission in the defendants' hospital on 20.4.2007 and she was under the treatment of DW4, the consultant gynecologist. 8. It is also not in dispute that Sabeera had her consultation in the defendants' hospital when she conceived for the second time from 14.9.2006 as her last LMP was on 31.7.2006. Admittedly, she was treating as an out patient till her admission in the defendants' hospital on 20.4.2007 and she was under the treatment of DW4, the consultant gynecologist. As medical negligence is alleged against the doctor who treated her, the question to be looked into is whether there was any failure to exercise due care and skill, that is expected from a doctor/gynecologist. It is the settled law that in case of Medical Professionals, negligence means failure to act with the standards of reasonably competent medical professional at relevant time. Doubtless that a doctor owes a duty to the patient to use diligence, care, skill and caution in administering the treatment. If normal skill, care and protection as demanded from the side of a gynecologist were provided to the patient, then it will not be possible to conclude that the doctor had committed any breach of duty so as to hold her liable for negligence. As referred above, she was admitted in the hospital on 20.4.2007. But she was referred to PVS Hospital, Kozhikode a higher centre on 21.4.2007. Though she was referred to PVS Hospital, Kozhikode, by 1.30 a.m. on 21.4.2007, she was taken to Al Shifa Hospital, Perinthalmanna, and cesarean operation was conducted but unfortunately her death occurred on 22.4.2007 at 1.30 a.m. as evidenced by Ext.A24. The treatment records of Al Shifa hospital were not made available except Ext.A24. By Ext X1 it was informed by the hospital authorities that original records were misplaced and they could not trace out the records. 9. Ext.A1 to A3 are the prescriptions issued by the fourth defendant who was examined as DW1. The question mooted for consideration is whether there was negligence on the side of the fourth defendant doctor (hereinafter referred to as DW1) in administering the treatment to the patient. Before going into the details, I think that it is better to have a reference on the decisions of the Apex Court which laid down the guidelines to decide the liability of the doctors in death cases arising out of medical negligence. Before going into the details, I think that it is better to have a reference on the decisions of the Apex Court which laid down the guidelines to decide the liability of the doctors in death cases arising out of medical negligence. A Three Judges Bench in Jacob Mathew v. State of Punjab and another ( AIR 2005 SC 3180 ) has dealt with medical negligence in the case of death in a detailed manner and held that negligence in the context of medical profession necessarily calls for a treatment with a difference. To infer rashness or negligence on the part of a professional, in particular a doctor, additional considerations apply. A simple lack of care, an error of judgment or an accident etc are not proof of negligence on the part of a medical professional. In paragraph 27 it was held as follows: “27. No sensible professional would intentionally commit an act or omission which would result in loss or injury to the patient as the professional reputation of the person is at stake. A single failure may cost him dear in his career. Even in civil jurisdiction, the rule of resipsa loquitur is not of universal application and has to be applied with extreme care and caution to the cases of professional negligence and in particular that of the doctors. Else it would be counter-productive. Simply because a patient has not favourably responded to a treatment given by a physician or a surgery has failed, the doctor cannot be held liable per se by applying the doctrine of resipsaloquitur.” It was further observed in para 29 that a medical practitioner faced with an emergency ordinarily tries his best to redeem the patient out of his suffering. He does not gain anything by acting with negligence or by omitting to do an act. It was finally concluded in para 49 as follows: “49. We sum up our conclusions as under: (I) Negligence is the breach of a duty caused by omission to do something which a reasonable man guided by those considerations which ordinarily regulate the conduct of human affairs would do, or doing something which a prudent and reasonable man would not do. The definition of negligence as given in Law of Torts, Ratanlal & Dhirajlal (edited by Justice G.P. Singh), referred to hereinabove, holds good. The definition of negligence as given in Law of Torts, Ratanlal & Dhirajlal (edited by Justice G.P. Singh), referred to hereinabove, holds good. Negligence becomes actionable on account of injury resulting from the act or omission amounting to negligence attributable to the person sued. The essential components of negligence are three: “duty”, “breach” and “resulting damage”. (2) Negligence in the context of the medical profession necessarily calls for a treatment with a difference. To infer rashness or negligence on the part of a professional, in particular a doctor, additional considerations apply. A case of occupational negligence is different from one of professional negligence. A simple lack of care, an error of judgment or an accident, is not proof of negligence on the part of a medical professional. So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alternative course or method of treatment was also available or simply because a more skilled doctor would not have chosen to follow or resort to that practice or procedure which the accused followed. When it comes to the failure of taking precautions, what has to be seen is whether those precautions were taken which the ordinary experience of men has found to be sufficient; a failure to use special or extraordinary precautions which might have prevented the particular happening cannot be the standard for judging the alleged negligence. So also, the standard of care, while assessing the practice as adopted, is judged in the light of knowledge available at the time of the incident, and not at the date of trial. Similarly, when the charge of negligence arises out of failure to use some particular equipment, the charge would fail if the equipment was not generally available at that particular time (that is, the time of the incident) at which it is suggested it should have been used. (3) A professional may be held liable for negligence on one of the two findings: either he was not possessed of the requisite skill which he professed to have possessed, or, he did not exercise, with reasonable competence in the given case, the skill which he did possess. The standard to be applied for judging, whether the person charged has been negligent or not, would be that of an ordinary competent person exercising ordinary skill in that profession. The standard to be applied for judging, whether the person charged has been negligent or not, would be that of an ordinary competent person exercising ordinary skill in that profession. It is not possible for every professional to possess the highest level of expertise or skills in that branch which he practices. A highly skilled professional may be possessed of better qualities, but that cannot be made the basis or the yardstick for judging the performance of the professional proceeded against on indictment of negligence. (4) The test for determining medical negligence as laid down in Bolam case (1957) WLR 582, 586 holds good in its applicability in India. (5) The jurisprudential concept of negligence differs in civil and criminal law. What may be negligence in civil law may not necessarily be negligence in criminal law. For negligence to amount to an offence, the element of mens rea must be shown to exist. For an act to amount to criminal negligence, the degree of negligence should be much higher i.e. gross or of a very high degree. Negligence which is neither gross nor of a higher degree may provide a ground for action in civil law but cannot form the basis for prosecution. (6) …..... (7) …..... (8) Res ipsa loquitur is only a rule of evidence and operates in the domain of civil law, specially in cases of torts and helps in determining the onus of proof in actions relating to negligence. It cannot be pressed in service for determining persethe liability for negligence within the domain of criminal law. Resipsaloquiturhas, if at all, a limited application in trial on a charge of criminal negligence.” In Dr. Suresh Gupta v. Government of NCT of Delhi and Another ( (2004) 6 SCC 422 ) it was held as follows: “This act attributed to the doctor, even if accepted to be true, can be described as negligent act as there was lack of due care and precaution. Suresh Gupta v. Government of NCT of Delhi and Another ( (2004) 6 SCC 422 ) it was held as follows: “This act attributed to the doctor, even if accepted to be true, can be described as negligent act as there was lack of due care and precaution. For this act of negligence he may be liable in tort but his carelessness or want of due attention and skill cannot be described to be so reckless or grossly negligent as to make him criminally liable.” The Supreme Court again in Kusum Sharma and Others v. Batra Hospital and Medical research Centre and Others ( (2010) 3 SCC 480 ) after exhaustive analysis of the English and Indian judgments culled out the principle to be followed for judging negligence especially medical negligence. The important points relevant to the facts of this case are ; “I. Negligence is the breach of a duty exercised by omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable man would not do. II. …....... III. The medical professional is expected to bring 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 particular circumstances of each case is what the law requires. IV. A medical practitioner would be liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field. V. …..... VI. The medical professional is often called upon to adopt a procedure which involves higher element of risk, but which he honestly believes as providing greater chances of success for the patient rather than a procedure involving lesser risk but higher chances of failure. Just because a professional looking to the gravity of illness has taken higher element of risk to redeem the patient out of his/her suffering which did not yield the desired result may not amount to negligence. VII. Negligence cannot be attributed to a doctor so long as he performs his duties with reasonable skill and competence. Just because a professional looking to the gravity of illness has taken higher element of risk to redeem the patient out of his/her suffering which did not yield the desired result may not amount to negligence. VII. Negligence cannot be attributed to a doctor so long as he performs his duties with reasonable skill and competence. Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him was acceptable to the medical profession. VIII. …....... IX. …....... X. …....... XI. ….......” 10. Therefore, to fasten liability on a medical practitioner the court has to ascertain whether there was intentional act or omission or failure on his/her side in administering treatment to one's patient. If only there was breach or failure to follow the practice acceptable on the part of medical professional and reasonable care, attention and requisite skill expected from an expert, were not provided to save a patient from acute emergency, negligence can be attributed against a doctor. A doctor who is treating a patient may only think to relieve him/her from the sufferings and the well being of the patient will be the only aim of the doctor and normally with all care and skill the doctors will try their level best to save the patient. Normally, a doctor will be taking the effort and risk even in cases where hard and risk factors are involved with the ultimate aim to save the patient and he will be satisfied only if the best treatment is provided to the patient. But, unfortunately an error or wrong judgment may happen in rare cases. It is well settled that a mere error or a mistake in identifying the disease or lack of high skill may not amount to negligence. If requisite skill, reasonable attention and reasonable care are provided to a patient, a doctor can not be said to be negligent in his activities. Coming to the facts of the case, DW1 who treated the patient till 20.4.2007 had deposed that when complication was noted by her, she had referred the patient to PVS Hospital where more facilities were available. Coming to the facts of the case, DW1 who treated the patient till 20.4.2007 had deposed that when complication was noted by her, she had referred the patient to PVS Hospital where more facilities were available. She had further deposed that during the ante natal visit of the patient on various days, she had checked her blood pressure and weight and proper care and treatment was provided and entered in the prescriptions and in the treatment records. She has also testified that when blood pressure of Sabeera was found fluctuating during her antenatal check up, on 20.4.2007 she advised admission and thus, she was admitted on 20.4.2007 itself. The entries in Ext.B3 would show that careful monitoring was done in the hospital by checking her blood pressure and pulse and administered medicines. As blood pressure was not coming normal, DW1 suspected it as a case of impending eclampsia. According to DW1 requisite treatment was provided and investigations were advised and consultation of physician was made immediately. But as the blood pressure was not reducing it was decided to terminate the pregnancy by an emergency cesarean operation. But the anesthetist advised to have the cesarean section in a hospital where ventilation facilities were available, thus the patient was referred to PVS Hospital, Kozhikode, a higher center. But, it was evident from the records that she was shifted to Al Shifa Hospital where she was attended by PW4. PW4, who treated the patient at Al Shifa Hospital has also deposed that the patient had impending eclampsia and high blood pressure, and the test results of the patient was different from the normal level which was not under control, cesarean was done at 3.25 a.m on 21.4.2007 as they could not control the blood pressure. A perusal of the deposition of PW4 would show that she did not depose anything against the doctor who treated Sabeera and negligence was not suspected from the side of the doctor who treated her previously. 11. Of course, the plaintiffs have examined PW3, a Gynecologist of the Medical College Hospital, Kozhikode with 23 years of experience. A perusal of her evidence would reveal that she had given evidence on the basis of her general information and knowledge about the treatment that too on the basis of the prescriptions of DW1. She has no case that the deceased had consulted her at any point of time. A perusal of her evidence would reveal that she had given evidence on the basis of her general information and knowledge about the treatment that too on the basis of the prescriptions of DW1. She has no case that the deceased had consulted her at any point of time. She too has not given evidence to support the case of the plaintiffs. Nothing was brought out in evidence to show that there was omission or recklessness in the treatment administered in the defendants' hospital. It is significant to note that according to her as the death was on the next day after surgery it was not possible to say what was the complication which resulted in her death. It was because of the absence of treatment records of Al Shifa hospital where the patient had undergone treatment for more than 24 hours immediately before death. 12. The most important piece of evidence which is lacking in this case is the absence of a postmortem report. A postmortem report assumes importance in this case because the death was not in the hospital of the defendants and it was after the surgery by the doctors of Al Shifa hospital. Though the plaintiffs are claiming compensation/damages alleging medical negligence on the part of the defendants, especially alleging deficiency in treatment and failure to identify the disease in the hospital run by the defendants, and that the death occurred at Al Shifa where the deceased had the cesarean operation, the absence of a postmortem examination and report are definitely fatal to the case of the plaintiffs. As referred to above, the patient died on 22.4.2007 while undergoing treatment in Al Shifa Hospital. She was admitted in Al Shifa Hospital on 21.4.2007 at 1.30 a.m. and she had undergone cesarean operation on the very same night. But her death was on 22.4.2007 at 1.30 a.m., that is after 24 hours. The hospital authorities or the doctor who attended the patient immediately before her death were not made as defendants in the suit, of course no allegation was raised against them. Negligence was not alleged against the doctor and the hospital where the patient died that too, after the surgery. It is also to be noted that the child born in that surgery was alive and the doctors have saved the baby. Negligence was not alleged against the doctor and the hospital where the patient died that too, after the surgery. It is also to be noted that the child born in that surgery was alive and the doctors have saved the baby. Such being the case, how the death occurred is a crucial aspect to be decided so as to fasten liability upon the doctor and the hospital authorities where the deceased had undergone treatment before shifting to the higher center. No explanation is forthcoming for the absence of a postmortem examination, though medical negligence is alleged against the defendants. Medical records are not available to visualize the situation. May be because no doubt was expressed by the relatives at that point of time. Postmortem examination is being conducted to find out the cause of death. A postmortem examination/autopsy is a surgical procedure conducted by the experts in the field which consists of a thorough examination of a corpse by dissection of each and every part to determine the cause and manner of death and to evaluate and find out the disease or injuries which resulted in the death of the person. When untimely death occurs, a postmortem examination will help the investigators of a crime to find out the cause of death, to rule out the various possibilities of death, to clear off the doubts of dear and near of the deceased as well the society, and all the more unnecessary prosecution or predicament of medical professionals, other stakeholders etc. could be avoided. But, sadly here there is no postmortem report indicating the reason/cause of the death of the deceased. When the plaintiffs had doubt that the death of the deceased was because of the negligence in the treatment imparted by the defendants they ought to have sought for a postmortem examination on the body of the deceased to find out the actual cause of death. It is significant to note that the plaintiffs have filed the suit only against the defendants where the deceased had pre natal examination right from 14.9.2006 to 20.4.2007. Admittedly, she died on 22.4.2007 after her cesarean section on 21.4.2007. It is significant to note that the plaintiffs have filed the suit only against the defendants where the deceased had pre natal examination right from 14.9.2006 to 20.4.2007. Admittedly, she died on 22.4.2007 after her cesarean section on 21.4.2007. The baby was taken alive at Al Shifa Hospital where she had undergone the surgery and after one day of the surgery, her death occurred and in the absence of a postmortem report indicating the cause of death, it is not possible to infer that there was negligence on the side of the defendants and there was failure to provide treatment to her for eclampsia. It is well settled mere allegation in a suit, when denied, cannot be said to be evidence by which the case of the plaintiffs can be proved. The importance of expert having experience in the field is absolutely necessary as the death was after the surgery. Many complications could develop in a surgery therefore a postmortem report is an important piece of evidence to decide the crucial aspect especially when treatment records were not produced before the court. The explanation of Al Shifa hospital in Ext.X1 that the treatment records were misplaced and so unable to submit before the court is not a sound reason to accept. On the other hand the defendants produced their treatment records. There is no allegation of fabrication or that the document was concocted by the defendants. It reveals that as eclampsia was suspected all required treatment was administered and emergent cesarean delivery was decided and all preparations including consent of the patient were obtained but as the hospital had no ventilation facilities and blood bank, the anesthetist suggested to have the surgery in a higher centre with all facilities and she was immediately referred to a higher centre without wasting time. It is evident that seeing the condition of the patient, a decision for urgent cesarean section was taken by the 4th defendant, to save her and the child. So, she exercised reasonable care and skill in the matter, though she doubted pre-eclampsia. In 'D C Dutta's Textbook of Obstetrics, 'Preeclampsia (PE)' is defined as follows : “It is a multisystem disorder of unknown etiology characterized by development of hypertension to the extent of 140/90 mm Hg or more with proteinuria after the 20th week in a previously normotensive and nonproteinuric woman. In 'D C Dutta's Textbook of Obstetrics, 'Preeclampsia (PE)' is defined as follows : “It is a multisystem disorder of unknown etiology characterized by development of hypertension to the extent of 140/90 mm Hg or more with proteinuria after the 20th week in a previously normotensive and nonproteinuric woman. Some amount of edema is common in a normal pregnancy. Edema has been excluded from the diagnostic criteria unless it is pathological. The pre-eclamptic features may appear even before the 20th week as in cases of hydatidiform mole and acute polyhydramnios.” “Eclampsia :-The term eclampsia is derived from a Greek word, meaning 'like a flash of lightening'. It may occur quite abruptly, without any warning manifestations. In majority (over 80%), however, the disease is preceded by features of severe pre-eclampsia. Pre-eclampsia when complicated with grand mal seizures (generalized tonic-clonic convulsions) and/or coma is called eclampsia. Thus, it may occur in patients with preeclampsia or in patients who have pre-eclampsia superimposed on essential hypertension or chronic nephritis.” “Prediction and Prevention: In majority of cases, eclampsia is preceded by severe pre-eclampsia. Thus the prevention of eclampsia rests on early detection and effective institutional treatment with judicious termination of pregnancy during pre-eclampsia. However, eclampsia can occur bypassing the pre-eclamptic state (20-40%) and as such, it is not always a preventable condition. Eclampsia may present in atypical ways; hence it is at times difficult to predict.” 13. Therefore, Pre-eclampsia is an abnormal or complicated condition of pregnancy in which there will be high blood pressure and other complications, which may occur before, during or after delivery like a flash of lightening. It is stated in Mosby's Medical Dictionary, 2nd Edition as follows: “Pre-eclampsia is classified as mild or severe. Mild preeclampsia is diagnosed if one or more of the following signs develop after the twenty-fourth week of gestation: systolic blood pressure of 140 mm Hg or more or a rise of 30mm or more above the woman's usual systolic blood pressure; diastolic blood pressure of 90 mm Hg or more or a rise of 15 mm or more above the woman's usual diastolic blood pressure; proteinuria; edema. Severe preeclampsia is diagnosed if one or more of the following is present: systolic blood pressure of 160 mm Hg or more or a diastolic blood pressure of 110 mm Hg or more on two occasions 6 hours apart with the woman at bed rest; proteinuria of 5 g or more in 24 hours; oliguria of less than 400 ml in 24 hours; ocular or cerebral vascular disorders; cyanosis or pulmonary edema. Preeclampsia commonly causes abnormal metabolic function, including negative nitrogen balance, increased central nervous system irritability, hyperactive reflexes, compromised renal function, hemoconcentration, and alterations of fluid and electrolyte balance.” 14. Though it is a complication which occurs during pregnancy and even after delivery, which is at times difficult to predict, in the absence of a postmortem report, it is not possible to find out the exact cause of death in the present case as the death occurred not in the hospital of the defendants, but in the other hospital almost after 2 days of discharge and that too after delivery through cesarean. As referred above, the entire treatment records pertaining to the treatment of the deceased while she was admitted in Al Shifa Hospital from 20.4.2007 to 22.4.2007 till her death and the condition of the patient when she was treated as inpatient were also not available for perusal. In fact, there was no attempt on the side of the plaintiffs to bring forth those materials on record. As 'Eclampsia' is a complicated and severe condition which may occur in a pregnant woman abruptly without any warning manifestations with high blood pressure even convulsion, coma, cerebral hemorrhage, cardiac failure and causing a threat to health of mother and baby, in the absence of an expert opinion regarding the cause of death, it is not possible to conclude that the death of the deceased was just because there was no proper diagnosis or proper treatment received from the defendants. 15. Sri. Sheji, the learned counsel for the defendants would point out that it is well settled that for establishing negligence, or deficiency in treatment by a doctor, sufficient evidence must be produced by the party to prove that reasonable care and treatment were not provided to the patient by the doctor; here the plaintiffs miserably failed to do so and the complications in the pregnancy were not due to any negligence on the part of the defendants. In Jacob Mathew's case (supra), it has been held that a professional can be held liable for negligence if there is one of the two findings, i.e., either he was not possessed requisite skill which he is professed to have possessed, or that he did not exercise with reasonable competence and skill which he did possess. Here, when the facts of the case are evaluated meticulously, there is nothing on record to show that the fourth defendant did not possess the requisite skill or competence. She is a well qualified gynecologist. Whether she had taken reasonable care and exercised reasonable competence have to be judged on the basis of the evidence on record. It is true that she was giving pre natal treatment to the deceased from 14.9.2006. Ext.A1 series would show that the periodical checkup by the doctor was followed as usual and all kinds of investigation were seen done on the patient as evident from the entries. Blood pressure recorded was normal and weight was also normal and there was no state of edema. Absence of previous history of high blood pressure, edema or overweight as evident from Exts. A1 to A3 prescriptions, indicate the fact that the diagnosis was in the correct line and she had a normal pregnancy till it turned as a doubtful case on 20.4.2007. When pre-eclampsia was noted with high blood pressure, the patient was immediately admitted in the hospital on 20.4.2007 for close monitoring. As referred above, it was revealed from the deposition of DW1 that she made preparations to have a cesarean operation to save the patient as she was having eclampsia. But, it is further revealed that the hospital was not having all kinds of facilities including ventilation, and other facilities to save the life of the mother and baby in case of crisis. It is evident that as ventilation facility was not available, the anesthetist was not keen to take the risk and hence she was referred to a higher center where more facilities are available. The evidence of DW1 would indicate that ventilation facility was absolutely necessary for the mother as well for the child, to save the precious life in case of cesarean operation, therefore she was referred to PVS Hospital, Kozhikode. The evidence of DW1 would indicate that ventilation facility was absolutely necessary for the mother as well for the child, to save the precious life in case of cesarean operation, therefore she was referred to PVS Hospital, Kozhikode. So that part of the conduct of DW 1 itself would show that reasonable care was taken by her and she had referred the patient to a better center where the facilities were available since she could not undertake the surgery in the absence of ventilation. So, it is amply clear that the DW1 had given reasonable care and exercised her expertise to save the life of the deceased. Despite the exercise of reasonable skill and care, the unfortunate incident happened. When the doctor had acted with sufficient care and skill, the death of the patient on 22.4.2007 after delivery, that too, in another hospital, will not show that she was negligent in discharging her duty. Merely the fact that the patient died on 22.4.2007 is not sufficient to conclude that there was failure on the side of the doctor in identifying the complication and diagnosing it in the proper way and providing adequate treatment to her. When the facts of the case are evaluated with the guidelines laid down by the Apex Court in Jacob Mathew's case (supra), Kusum Sharma's case (supra) and Dr. Suresh Gupta's case (supra), I am of the firm opinion that evidence are not sufficient to conclude that there was any kind of omission or negligence on the part of the doctor and the hospital management in dealing with the case of the deceased. Of course, an unfortunate incident has taken place in this case as the life of an young lady was lost at the age of 23 years. It is true that she left this world leaving behind the new born baby as well as her elder child aged only 4-5 years. But the hospital management and the doctor who treated her can be found guilty of professional negligence only if there is definite and concrete evidence to prove that reasonable skill, care, treatment and attention were not provided to the patient by the doctor concerned and the hospital authorities that was expected from a professional. But the hospital management and the doctor who treated her can be found guilty of professional negligence only if there is definite and concrete evidence to prove that reasonable skill, care, treatment and attention were not provided to the patient by the doctor concerned and the hospital authorities that was expected from a professional. On the other hand, I find that the usual treatment with maximum care and protection and skill were given by DW1 to the patient to save her pregnancy and the child. Normally, no doctors or professionals in the field will think that their patient should die or suffer from their treatment. Doctors are rendering a service to humanity. So the main aim and desire of all the doctors who are imparting treatment especially to a pregnant lady will be to protect and save the mother and the new born child. They will take special care of their patients by providing proper treatment. Some unfortunate incidents like this may result in death of the patient which is beyond the control of the doctor as in this case as eclempsia is a serious complication which may occur rarely to pregnant ladies; which may sometimes not possible to predict as it is like a flash of lightening. The medical records would establish that DW1 had taken maximum care to reduce the high blood pressure of the deceased and tried maximum to give reasonable care. Hence, it is not possible to conclude that she had failed in diagnosing the disease at the proper time. The medical records disclose that medicine was administered to the patient and the investigation was done with close monitoring to manage the situation. When all the materials available on record is evaluated meticulously, it could correctly be concluded that the plaintiffs, who approached the court complaining negligence on the part of the doctor and hospital, could not successfully prove that there was lack of care and diligence or failure to exercise reasonable skill on the side of DW1. On the other hand the defendants have proved satisfactorily that there was no lack of care or diligence in giving treatment to the patient and there was no negligence at all by the defendants hence I find that there is absolutely no justifiable ground to interfere with the finding entered by the court below. On the other hand the defendants have proved satisfactorily that there was no lack of care or diligence in giving treatment to the patient and there was no negligence at all by the defendants hence I find that there is absolutely no justifiable ground to interfere with the finding entered by the court below. Therefore, I find that this appeal is without any merits and hence liable to be dismissed and I do so. Accordingly, the judgment and decree under challenge are hereby confirmed and the appeal is dismissed leaving the parties to suffer their costs.