Col. Shrawan Kumar Jaipuriyar filed this Complaint under Section 21(a)(i) of the Consumer Protection Act, 1986 for the award of compensation of Rupees Two Crores against the OP No. 1, Commandant, Base Hospital and Rupees One Crore against the OP-2, Commandant, Army Hospital(R & R) for then being deficient in rendering service to the wife of the Complainant resulting in paraplegia (paralysis of her body waist downwards) and for the award for the mental agony. The Complainant, a retired Col. from Army also an Orthopedic Surgeon served as a professor, his wife Dr. Mrs. Shanti Prasad aged about 64 years         (herein referred as “Patient”) was a retired CMO cum Civil Surgeon, Araria (Bihar). In July 2004, she was operated for carcinoma right breast at OP-2 hospital; she took chemotherapy, radiotherapy and hormone therapy. She was also a Diabetic (DM Type-II) & hypertensive. In the first week of October 2010 she suffered fever and was empirically treated at Patna, thereafter, -1- 1. 1. the Complainant decided to take her to the Army Hospital R R (OP-2) at Delhi Cantt., for further investigations and management. Accordingly, he contacted the Deputy Commandant of OP-2, on telephone and requested him for assistance in bringing the patient from Patna to Delhi, for hospitalization. Because of Postural Hypotension of his wife, he could not bring her by air, hence on 11.10.2010, both travelled to New Delhi from Patna by Sampoorna Kranti Express Train.  Due to road jams in Delhi during Common Wealth Games with great difficulty he reached OP-2 around 2:00 p.m. on 12.10.2010. Complainant alleged that, the OP-2 just neglected her to admit in ICU and behaved casually. There were no specialists at the instance and after great pursuance of Deputy Commandant of OP-2, Lieutenant Col. Srivastava, a Physician examined her, who after investigations diagnosed her as Hyponatramia (Low Sodium levels). After completing the admission formalities, the patient was denied admission for non-availability of bed due to heavy rush. Finally the doctors at OP-2 advised the Complainant to take the patient at OP-1, Base Hospital, where he had served. Therefore, the complainant alleged that, the patient was literally thrown out of the hospital in such critical state; it was just a death warrant. The golden hour of patient’s care was lost, the condition of the patient went on deteriorated further. Thus, no alternative, he took the patient to OP-1, and as per telephonic instructions of Commandant Maj. Gen. Chopra, the patient was admitted in ICU at 04:33 p.m. on 12.10.20120, under Dangerously Ill health List (DIL). She was treated with IV fluids, antibiotics and other supportive measures. On the same night somebody performed Lumber Puncture (LP) without consent of either patient or the complainant. Thereafter, on 16.10.2010, the Complainant noticed that the patient could not move her lower limbs and was senseless, i.e. she developed sudden paraplegia. Further, she lost her bladder sensation, hence, she was put on continuous urinary catheterization. Due to damage to the nerves by LP, she developed “Lower Motor Neurone Type of Paralysis” it was suggestive of “Cauda Equina Syndrome”. On 20.10.2010, the patient was discharged from Base Hospital in moribund state of health with the advised to approach ECHS empanelled hospital for Radiotherapy treatment under an Oncologist. Thus, the Complainant took the patient to AIIMS. It was alleged that, at AIIMS, she was examined on OPD basis, and just to pass the bucks MRI of Dorsolumbar spine was done on 22.10.2010. AIIMS ignored the MRI Dorso Lumbar spine which was done at Base Hospital, just 4 days before i.e. on 18.10.2010, thus it caused inconvenience to the patient (who was paraplegic and immuno compromised). AIIMS made a diagnosis of Leptomeningeal carcinomatosis vide investigation no. N 002999/10 dated 20.10.2010. Thereafter, she was advised radio therapy, which was agreed by the Oncologist Army Hospital (R & R) Delhi Cantt. Col. S. Bhatnagar and permission by the Commandant OP-2 Hospital (R&R) was granted as OPD procedure on 01.11.2010. But, unfortunately, on

01.11.2010 patient was running fever, she was not fit to undergo radio therapy. Therefore, on 01.11.2010 the patient was admitted in emergency ward in Mata Chanan Devi Hospital and remained in ICU till 07.11.2010. To ascertain the diagnosis, whether it was extension of Malignancy (Metastasis) and Infective pathology, the PET CT Scan was performed at Army Hospital (OP-2) which revealed no metastasis. Then, the patient was referred to Neuro-phycisian for the treatment. Brig. Shashi Johari, Consultant (Neurologists) who advised (enhanced MRI) of whole spine and also advised for consultation of Urologists for incontinence of urine. Further, on 29.01.2011 a ‘Contrast MRI’ of Whole Spine was performed after 3 months at Focus Imaging and Research Centre Pvt. Ltd. (Annexure V) which did not reveal metastasis. Also the whole body PET CT Scan did not show metastasis, but it was suggestive of infective lesion. She continued to take Hormonal 1. 1. 1. 1. 1. therapy by Tab. Letozol 2.5 mg/OD. Subsequently she was reviewed on 27/8/2011, Dr. A. K. Dhar, VSM Consultant in Medicine and Oncology, changed to Tab. Exemestane 2.5 mg OD (Annexure II). Therefore, there were no metastases in the spine. Complainant alleged that, the Base Hospital (OP-1) and AIIMS made a wrong and negligent diagnosis in haste showing that the patient had extension of cancer (metastasis) in the spine. He further alleged that, the death of his wife was directly attributable to the grave medical negligence committed by OP-1 in doing the Lumbar Puncture without any justification; it was done negligently, without consent of patient or complainant. Therefore she suffered infection and developed paraplegia She was wrongly treated for cancer by the . OPs. Thereafter, she survived for 2 years,8 months and died  with severe agony. The complainant filed this complaint and prayed for compensation of 3 Crores under different heads. Defense: The OPs did not file written version within stipulated time, as per Section 13 of the Consumer Protection Act. The right to file written version was forfeited. As this is a case of alleged medical negligence; in the interest of justice we have allowed the OPs to file medical treatment documents from the hospitals (OP-1 and 2) and the relevant medical literatures. : Submissions The complainant furnished written arguments, also argued himself in person. He reiterated the facts mentioned in his complaint. He drew our attention to the clinical notes that, the LP was performed without his consent, when he was available round the clock in the hospital premises and OP doctors could have been called him over the cell phone. He   came to know about LP only after four days, i.e., on 16.10.2010, when he noticed that the patient could not move her lower limbs. Hence, it was the act of the OP-1 doing LP without the express and written consent of the Complainant which constitutes grave medical negligence. Complainant further argued that, the oral consent of patient was not a valid consent, because   the patient was in altered sensorium, he was uninformed till the discharge of the Patient after 10 days. Hence, the OP-1 is manifestly guilty of suppressio veri and The Complainant has produced expert opinion from Dr. Kaushal Kishore suggestio falsi. Professor and HOD Medicine ,  Santosh Medical Collage, Ghaziabad, (U.P.) and medical literature Buzzle (An. 11), Post Lumbar Puncture spinal subarachnoid hematoma causing paraplegia. Complainant further argued that, in the ‘Clinical Notes’ charts, there is not a syllable, or a whisper of the fact that, three Consultants ever suspected Meningitis, which is stated to be 1. 1. 1. 1. the reason due to  Lumbar Puncture. The record does not show any follow up treatment or review after the LP, which, is monumental proof of grave negligence of the ipso facto, OP-1. The record supplied is ominously reticent on these vital points, which are germane to the case. The OP-1 has not filed the ‘Nurses Reports’ which contain all the details as to the Doctor’s visits, who attended the patient, the investigations done, treatment given etc. Thus, the ‘Nurses’ Reports can throw ample light on these vital facts, which have been concealed by the OP-1 with the malafide intention to cover up their negligence. Complainant further submitted that, LP was not an absolute necessity; due to  electrolyte imbalance (Hyponatramia- Low Sodium levels) the patient had altered sensorium, The Expert opinion Annexure-X clearly indicates  the flawed Lumbar Puncture, which resulted into paraplegia. The dates in progress sheets subsequent to 12.10.2010, till her discharge on 21.10.2010, nothing was mentioned about the onset of paraplegia. Hence, OP-1 tried to conceal it’s negligence. Complainant vehemently denied that the patient suffered from Metastasis, because, thereafter, the patient survived for more than 2½ years. He argued that, the PET CT and MRI  of Dorsolumbar Spine done at Focus Imaging and Research Centre, support his views that, there was no evidence of Metastasis in the spine. The patient suffered “ ” due to damage of nerves in the Lumbosacral region Cauda Equina Syndrome due to wrong LP. The OP had not made available CFS report. It was a deliberate concealment; thus it was Iatrogenic (mistake of the doctor) paraplegia due to LP done by an unexperienced Operator with repeated punctures to draw fluid, causing nerve injury. There was no express consent for the procedure of LP. The Counsel for OPs argued at length. The doctor from OP-1 Dr. Sharad Srivastava was also present; he made submissions on the basis of medical records. We have specifically asked the OP-doctor about the informed consent, whether taken or not He has admitted that, written informed consent was not taken, but oral consent was taken. The LP was performed as an emergency to rule out possibility of meningitis, it was done  in good faith of patient. As, patient herself was a doctor, she was orally explained and informed about the decision of performing LP. Therefore, he denied any malfide intention or any negligence while performing LP. It was performed in ICU by a qualified resident, as per standard protocol, by using sterile instruments. The OP-1 hospital possess sophisticated and high infrastructure. He has put reliance upon the medical literature in subject of neurology. Findings and Reasons: We have carefully observed the case sheet of both the OP hospitals. It is revealed that; initially, the patient reported to Army Hospital (R & R) - OP-1, on 12.10.2010, she was examined by a Medical Specialist Dr. Sharad Srivastava MD (Med). The entries in case sheet( page73) are reproduced as below: 1. 1. i. ii. iii. Impression: Fever with altered sensorium, CA breast (Optd,POCT,RT),HTN,Type II DM. Advised investigations X-ray chest(urgent),NCCT head followed by CSF study, CBC and LFT, Na, K, RFT, Blood sugar F & PP. Further, advised for required admission, but regrets that shortage of beds at this hospital was advised to get admitted in the hospital. However, the patient could not be admitted as no bed was available. Thereafter, on the same day at 4.33 pm,the patient was shifted to Base Hospital (OP-1) on admission ,patient was examined, by Dr. N. Thirumoorthi, Resident Medicine and the clinical findings and advise were same as OP-2, patient was admitted in ICU on DIL. He has advised additional blood tests like Dengue, PBS for MP, Widal and started treatment. She was further examined by the senior R. Anandam diagnosed as Cerebral Mets Malaria Pneumonitis He further advised for CT/MRI brain, Oncology and Neuro-physician’s opinion. The patient was further examined by Col R. Khaduja (Med & Nephrology) Sr. Adv., and Col M S Sandhu Sr. Adv. (Med & Cardiology)the investigations revealed Serum Sodium (Na+) was 113, i.e. Hyponatremia. Therefore, accordingly, correction of Na+ abnormality was planned, as per Adrogue Medias Formula, along with other medications were continued. She was again advised for review by Onco-Surgeon to rule out possible metastasis in brain. We have noted that the patient was examined on 15-16 /10/2010 by Dr. R. Anadane, Neurologist who noticed the weakness with inability to move both lower limbs, and his clinical notes mentioned as, In view of sudden onset of paraplegia with sensory loss with a definite sensor below umbilicus likely post ineffective myeloneouropathy  Therefore, it was planned for MRI spine to rule out compressive etiology and advised for treatment with IV immunoglobulin(IV Ig 2 gm/kg) along with oral Prednisolone and DVT prophylaxis.  She was finally managed as a case of fever with hyponatremia. She was discharged on 21.10.2010. We have perused the ICU progress and treatment charts which reveal details of treatment, administration of medicines. The investigation chart reveal blood investigations, and noting of CSF report, the cytology revealed RBCs 250 , WBC 5. Dengue positive.  We have noted the medical case sheet of MH Danapur Cantt, where the patient was diagnosed as Pneumonitis-Immuno compromised, DM, Ca Breast (Operated). After going through entire records on file and our thoughtful consideration, we find that, the main allegations by the complainant are on three points that, the OP failed to take informed consent, the paraplegia was due to infection caused by  negligence of OP-1 doctors  performing the LP and the patient was wrongly diagnosed and advised treatment for cancer metastasis. 1. 2. It was an admitted fact that, the patient was a doctor, on 12.10.2010 she was diagnosed as a case of hyponatremia at OP-2 but not admitted due to shortage of beds in ICU., thus she was admitted in OP-1on same day. The medical records revealed that, the patient was examined by senior residents and the Senior consultants, who arrived to the diagnosis of fever with altered sensorium due to Hyponatramia. The physician and also the neurologist have advised the Lumbar Puncture to rule out meningitis. As per medical texts, for signs and symptoms of altered sensorium, the LP is an essential investigation to rule out Central Nervous System (CNS) pathology. The LP was done after doing Non-Contrast CT Scan (NCCT) of the brain. Thus, we agree with submission of OP doctor that, since the patient herself was conscious and she being a qualified doctor, she was duly informed regarding the conduct of the procedure and a verbal consent was obtained before she was subjected to LP. It was performed in good faith of patient, as on emergency basis as the patient was in ICU. We disagree with the complainant that, he was not informed about LP. It is surprising that, the complainant is one of the senior and retired doctors from OP-1, who served as a Head of Department in Orthopaedics, there.  It is unbelievable, the OP-1 doctors kept him in dark about the patient’s diagnosis, mode of treatment and investigations advised. It is pertinent to note that, the complainant is not a layman, he himself being a senior doctor, can read the case sheet, can understand and also there was every scope for him to discuss about the modality of treatment with the concerned doctors at OP-1. There is nothing on record to show that, the hospital authority denied any access to him to go through the case paper, or to meet/ discuss with the doctors. The medical records showed that, the LP was advised at OP-2 itself at first instance. Also, at the OP-1, on admission to ICU, the CSF study was advised. The submission of complainant itself shows that, the doctors were receptive at OP-1 and 2. Team of doctors visited the patient regularly, blood and radiological investigations were performed, further, the patient was treated for correction of hyponatramia as per standard protocol. Patient was administered higher antibiotic, immunoglobulins and steroids, as needed. No doubt, it was the OP-1 doctors who suspected a case of infective Myelorediculopathy. Medical literature revealed that, there are several causes for it. The complainant vehemently contended that the LP was performed by an inexperienced doctor and by unsterilized instruments. It is unacceptable, because the Army Hospital is a referral hospital; there is a duty of care, which follow the Standard Operating procedures. LP is to draw CSF; it is a routine procedure and is unlikely to cause spinal cord injury. LP is done at L-3 & L-4 and cannot lead to a complication of paraplegia as the Spinal Cord extends only till L1 vertebra. The LP report shows few RBCs, otherwise it is normal only. It was not frankly traumatic. Thus, the infective etiology was not due to the procedural lapses of LP, but it appears to be due to inherent disease of the patient which she was suffering. The medical literature produced by the complainant, is also not “About.com Neurology” supportive for his case. The relevant para is reproduced as below: Can I be paralysed from having a spinal tap What complications do I need to worry about The spinal cord ends a few inches above the spot where the needle is inserted. Nerves branching off the spinal cord dangle loosely down through the thecal sac in what is called the cauda equine (horse’s tall). Because the needle is inserted well below where the cord ends, there is almost no chance of cord damage or paralysis. Sometimes, the needle may brush against one of the nerves in the cauda equine, but this only causes damage in about 1 out of More commonly you feel a brief electric twinge that 1,000 people and usually heals with time. goes down your leg. 1. 1. 1. 1. 1. 1. Expert Opinion: The complainant in his support produced an expert opinion from             Dr. Kaushal Kishore, Professor and HOD Medicine, Santosh Medical Collage, Ghaziabad, (U.P.). For our confirmation, we have taken an expert opinion  from AIIMS. . The Expert Opinion given by Medical Board constituted at AIIMS, on 1.4.2014 It is reproduced as below: MRI spine dated 18-10-2010: Findings – Intradural, extramedullary enhancing soft tissue in dorso-lumbar spine; Signal alteration in the distal spinal cord; Degenerative changes in the cervical and lumbo sacral spine. Report found correct. MRI spine dated 29-01-2011: Findings- Same as above, with no significant radiological change from the previous imaging. Differential diagnosis for enhancing intradural, extra medullary soft tissue includes both leptomeningeal carcinomatosis and arachnoiditis. In the setting of previous history of carcinoma breast the findings are more likely to be due to metastatic disease; however a definitive diagnosis cannot be given on MRI alone. CT dated 13-10-2010 on CD, study date 12-10-2010 done at base hospital. No report attached. Findings right old lacunar infarct, small calcified granuloma, bifrontal atrophy. PET Scan CD does not have DICom original data only one MSV (rotating image). So no opinion can be made with the given CD. The patient Shanti Prasad (64yrs/F) as per records was suffering from carcinoma of breast, hypertension and diabetes mellitus with recurrent urinary tract infection and septicemia. She was admitted multiple times with infection and encephalopathy. 1. 1. During one admission in October, 2010 she has been reported to have developed paraperesis, while being investigated for fever and encephalopathy. Her MRI scanning and lumbar spine puncture carried out then, revealed intradural extra-medullary deposits over dorsal and lumbar spinal cord. In view of the above mentioned details it is not possible to comment on the temporal and/or causal relationship of the paraperesis to lumbar puncture. The Complainant has produced expert opinion from Dr. Kaushal Kishore Professor and , HOD Medicine, Santosh Medical Collage, Ghaziabad (U.P.). The opinion is : reproduced as below

“I have gone through the literature and the standard textbooks and I am of the opinion that the cause of the dreaded Morbidity of Paraplegia, incontinence of Urine and Stool is because of Trauma to the nerves while doing Lumbar Puncture at base Hospital, Delhi Cantt.. Further it will be a futile effort to subject the well-stabilised patient for unnecessary invasive investigations which will cause inconvenience to the patient and family members and it may prove to be fatal for the patient.”

It should be borne in mind that, the expert has a duty to opine only, not to favour or give a biased opinion. The interests of the public and the medical profession are best served when scientifically sound and unbiased expert witness testimony is readily available to the Patient/Complainant and the Doctor/OP in medical negligence cases. On bare perusal of, the 2 para from the opinion of Dr. Koushal Kishore appears to be as a nd directive in nature. It is the domain of the Court (Judges) to analyse and arrive to the proper conclusion. The courts are not bound to accept an expert report in totality.  Also, it is apparent that, Dr. Koushal is a physician who was not a neurologist. He is from a Private Medical College, not from any Government institute or Govt authority. Therefore, we rely upon the opinion of experts given by the Medical Board of AIIMS, which bears every details and it was given by a team of specialist from various departments in AIIMS like Neurology, Surgery, and Radio diagnosis. In this context,   (2010) 5 SCC 513 in V. KISHAN RAO . NIKHIL SUPER SPECIALITY, v , para 54 of the judgment, the Hon’ble Supreme Court exhaustively discussed about expert witness.  The Bolam’s Principle, which has been accepted in English law as applying to both treatment and diagnosis in the cases of (1981) 1 All ER 267 Whitehouse vs. Jordan and (1985) 1 All ER 635. The law of medical Maynard vs. West Midland Health Authority negligence and disclosure of risk in England was developed further in Bolitho vs. City and (1997) 4 All ER 771 In this case Browne Wilkinson, L.J., in his Hackrey Health Authority . judgment said: 1. 1. In the vast majority of cases the fact that distinguished experts in the field are of a particular opinion will demonstrate the reasonableness of that opinion. In particular, where there are questions of assessment of the relative risks and benefits of adopting a particular medical practice, a reasonable view necessarily presupposes that the relative risks and benefits have been weighed by the experts in forming their opinions. But if, in a rare case, it can be demonstrated that the professional opinion is not capable of withstanding logical analysis, the judge is entitled to hold that the body of opinion is not reasonable or responsible. Consent - It was the allegation of complainant that, the Informed Consent was not taken by OP doctors, for the Lumbar Puncture procedure, therefore patient suffered paraplegia.  Not taking consent , is , but we don’t want to exaggerate it, because, the LP per se negligence was done in good faith of patient. It was indeed necessary to do CSF investigation, for proper diagnosis and treatment of the patient.  The patient herself and her husband were doctors, we believe that, at least informed oral consent should be there. Therefore, in our opinion, absence of written consent was not a very serious deficiency or lapse on the part of  OPs. In this context, we have perused an article

“ Informed Consent and Disclosure of Risk in published in the Cochin University Law Review Medical Treatment: Recent Developments”

,Vol XXXIV, Sep-Dec 2010. This article has discussed elaborately on the subject of Consent and about  the  decisions of courts in India and in the other countries. The leading authority is Samira AIR 2008 SC 1385 in which the Hon’ble Supreme Court after referring to two Kohli’s Case, , different schools of thought, has preferred the ‘real consent’ followed in the UK over ‘informed consent’, followed in America. In this case, the Supreme Court expressed the views in the following terms: We are of the view that to nurture the doctor-patient relationship on the basis of trust, the extent and nature of information to be given by doctors should continue to be governed by the Bolam test rather than the ‘reasonably prudent patient’ test evolved in Cantebury. It is for the doctor to decide, with reference to the condition of the patient, the nature of illness, and the prevailing established practices, how much information regarding risks and consequences should be given to the patients, and how they should be couched, having the best interests of the patient. A doctor cannot be held negligent either in regard to diagnosis or treatment or in disclosing the risks involved in a particular surgical procedure or treatment. If the doctor has acted with normal care, in accordance with recognised practice accepted as proper by a responsible body of medical men skilled in that particular field, even though there may be a body of opinion that takes a contrary view. However, the most important part of Samira Kohli’s decision, is the reason given by the court of preferring ‘real consent’ over ‘informed consent’: In India, majority of citizens requiring medical care and treatment fall below the poverty line. Most of them are illiterate or semi-literate. They cannot comprehend medical terms, 1. 1. 2. concepts and treatment, procedures. They cannot understand the functions of various organs or the effect of removal of such organs. They do not have access to effective but costly diagnostic procedures. Poor patients lying in the corridors of hospital after admission for want of beds or patients waiting for days on the roadside for an admission or a more examination is a common right. For them any treatment with reference to rough and ready diagnosis based on their outward symptoms and the doctor’s experience or institution is acceptable and welcome so long as it is free or cheap, and whatever the doctor decides as being in their interest, is usually unquestionably accepted. They are passive, ignorant, and uninvolved in treatment procedures. British Law on informed consent does not require as high a standard of disclosure as under American and Canadian Law. The Legal standard was laid down in the celebrated case of (1957) 2 All ER 118 McNair, J., Bolam vs. Friern Hospital Management Committee, said that the test for negligence ‘in the case of a medical man means failure to act in accordance with the standard of reasonably competent medical man at the time.’ Further it was stated that reasonably professionals may differ in opinion and that a doctor cannot be held liable in negligence merely because he has a difference of opinion with another reasonable or responsible doctor. Hence a doctor will not be liable in negligence for failure to disclose risk as long as the doctor acted in accordance with a practice accepted by a responsible body of medical men. It matters not either if the responsible body in question represents a minority opinion. According to ,  medical negligence requires that the plaintiff Black’s Law Dictionary establish the following elements: 1) the existence of the physician’s duty to the plaintiff, usually based on the existence of the physician-patient relationship; 2) the applicable standard of care and its violation; 3) damages (a compensable injury); and 4) a causal connection between the violation of the standard of care and the harm complained of. The Hon’ble Supreme Court held in catena of judgments discussed the Medical Negligence. In a key decision on this matter in the case of Dr. Laxman Balkrishna Joshi v Dr. , (1996) 1 SCR 206, held that if a doctor has adopted a practice Trimbak Bapu Godbole that is considered “proper” by a reasonable body of medical professionals who are skilled in that particular field, he or she will not be held negligent only because something went wrong. Doctors must exercise an ordinary degree of skill. In Achutrao Haribahau (1996) 2 SCC 634 , he Khodwa and Ors. Vs. State of Maharashtra and Ors., t Hon’ble Supreme Court noticed that in the very nature of medical profession, skills differ from doctor to doctor and more than one alternative course of treatment is available, all admissible. Negligence cannot be attributed to a doctor so long as he is performing his duties to the best of his ability and with due care and caution. 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. In Hucks v. (1968) 118 New LJ 469, Lord Denning observed that a medical practitioner would be Cole liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field. 1. 1. Therefore, we are of considered view that, the doctors at OP-1 and 2 have performed their duty reasonably during the diagnosis, treatment of the patient. There was no deviation in Standard of medical treatment to the said patient of altered sensorium. Patient was properly investigated by CT, MRI, PET and CT, thereafter,  treated  with antibiotics, immunoglobulins etc.  No doubt, there was no informed consent for LP, it was a breach of duty, but the paraplegia of the patient was not due to the Lumbar Puncture. Thus, there was no casual relation to the breach of duty by the OPs.  There are many other causes of paraplegia in such debilitated patient. The expert report from the AIIMS Medical Board and the MRI findings are suggestive of Carcinomatosis leptomenigitis, and the PET CT was not conclusive. Even the thickening which revealed in MRI  on the extra-medullary   soft tissue in dorso-lumbar spine was mainly due to metastasis; such thickening will not be possible  within short duration of 2-4 days due to infection after LP. Ideally, expert witnesses should be unbiased conveyers of information. The pivotal factor in the medical negligence   is the integrity of the expert witness testimony. It should be reliable, objective, and accurate and provide a truthful analysis of the standard of care. Regrettably, not all medical experts testify within these boundaries. Therefore, we don’t accept the expert report issued by Dr. Koushal Kishore. It is pertinent to note that, there are some lapses on the part of OPs, because they have not maintained the medical records properly. The relevant entries of Lumbar Puncture are conspicuously missing from the case sheet. The medical record is silent about who, when and how the LP was performed But, the report from Medical Board of AIIMS and the relevant medical literature; does not establish that Lumbar Puncture was the cause of Paraplagia in this patient. Therefore, complainant failed to prove negligence of OPs, we don’t find any negligence in diagnosis and treatment of patient. Considering entirety of facts and relying upon several judgments of Hon’ble Apex Court, we dismiss this complaint. The parties are directed to bear their own costs. ......................J J.M. MALIK PRESIDING MEMBER ...................... DR. S.M. KANTIKAR MEMBER