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Tuesday, April 17, 2018

How is should a doctor explain to a patient

http://www.thehindu.com/news/cities/Delhi/consumer-panel-orders-hospital-to-pay-5-lakh-for-medical-negligence/article23497338.ece Consumer panel orders hospital to pay ₹5 lakh for medical negligence Commission says ‘informed consent’ to proposed treatment mandatory The State Consumer Disputes Redressal Commission in Delhi has directed Indraprastha Apollo Hospitals to pay ₹5 lakh as compensation to a petitioner for alleged medical negligence. Directing the hospital and the treating doctor to jointly pay the sum, the commission held that “informed consent [to proposed treatment] is mandatory”, which the hospital failed to do. The petitioner, challenging a district forum order that held the hospital guilty of “deficiency in services and not medical negligence”, had sought compensation of ₹50 lakh. The petitioner said that his 23-year-old daughter was admitted to the hospital in 2004 after a severe bout of diarrhoea but was diagnosed with an autoimmune disease, where healthy tissues are mistakenly attacked by the immune system, four days later. In the complaint against the hospital, the petitioner alleged that his daughter died after the hospital carried out a blood transfusion despite the “patient being in good condition”. ‘Overdose of steroids’ “The complainant levelled allegations that transfusion of blood to the patient resulted in an overdose of steroids. The complainant further submitted that the patient was absolutely fit when he requested the doctors to discharge her. Contention of the complainant is that further transfusion of blood led to unconsciousness from which the patient never recovered,” read the allegations as noted by the State commission. Complicated case Contending allegations that the hospital had tried to “grab money”, the respondents, including the doctor who treated the patient, argued that “it was a complicated disease and could not have an on-spot diagnosis without referring to a stringent battery of tests. There was no contradiction to blood transfusion. Her condition warranted life-saving measures and steroids needed to be given”. Referring to the report submitted by an expert committee, which spoke of a “communication gap between the hospital and the petitioner”, the State Consumer Disputes Redressal Commission held: “No record shows whether the patient or her attendants were disclosed information related to diagnosis of the disease, nature of proposed treatment, potential risk of the treatment and consequences of the patient refusing the suggested line of treatment. All these things are fundamental requirement of law.”

Thursday, April 12, 2018

Eye Surgeon Punished for No Fault of his

1 (FA/14/59) STATE CONSUMER DISPUTES REDRESSAL COMMISSION MAHARASHTRA, MUMBAI FIRST APPEAL NO.FA/14/59 (Arisen out of Judgment and order dated 27/08/2013 passed by Ld. Addl.Mumbai Suburban District in consumer complaint No.531 of 2006) Shri.Gopal Joshi R/at-Jeevaram bhawan, 4 th floor, B/46, R.R.T Road, Mulund (W), Mumbai 400 080. Appellant(s) Versus 1.Dr.Ashlesha Gala Netra Jyot, Eye Care Centre, 206, Jai Commercial Complex, At the Junction of M.G.Road & S.L.Road, Opp.Hotel Gurukrupa, Mulund (W), Mumbai 400 081. 2.Dr.Hemant Thakkar 1 st Navghar Lane, Mulund (E), Mumbai 400 081. Respondent(s) BEFORE: Hon’ble Mr.Justice A.P.Bhangale, President Hon’ble Dr.S.K.Kakade, Member PRESENT: For the Appellant(s): Advocate Shri.T.S.Shilotri is present with authority letter from Advocate Shri.Mangesh D.Nalavade For the Respondent(e) : Advocate Shri.Ajay Pawar is present for respondent No.1. None present for respondent No.2. ORDER Per: Hon’ble Mr.Justice A.P.Bhangale, President [1] Heard submissions. By present appeal, appellant has challenged validity and legality of the impugned Judgment and Order dated 27/08/2013 2 (FA/14/59) passed by Ld. Addl. Mumbai Suburban District in consumer complaint No.531 of 2006 whereby the consumer complaint was dismissed. Brief facts appears as underThe complainant is resident of Jeevram Bhavan, 4th floor, B/46, R.R.T.Road, Mulund (W), Mumbai 400 080 had approached his family doctor, Dr.Hemant Thakkar due to problem in his eye. According to Dr.Thakkar complainant need to undergo Cataract operation. He advised him to approach Dr.A.M. Gala who at Netrajyot Eye Care Centre, 206, Jai Commercial Complex, Mulund (W), Mumbai 400 080. Thus, on 09/08/2005 Dr.Gala had advised the complainant to undergo Cataract operation. He was initially examined and it was decided to hold operation on 12/08/2005 at 8 a.m. The eye operation was conducted and the patient was discharged at evening on the same day. The complainant thereafter complained of cornea swelling to his left eye and ultimately lost his eye sight of left eye. Though the complainant had used eye drops as prescribed he was referred to Dr.Nikunj Shah and Dr.Nikhil Gokhale by Dr.Gala. The two doctors to whom patient was referred opined that there was injury to retina of the complainant and complainant had to undergo another operation on left eye on 02/09/2005. According to the complainant, the operation had failed and complainant lost his eye sight of left eye. Further according to complainant Dr.Gala ought not to have referred the complainant to Dr.Nikunj Shah and Dr.Vatsal Parekh. Complainant alleged that there was medical negligence by Dr.Gala and Dr.Thakkar as well. [2] According to opponent No.1-Dr.Gala, patient had undergone operation at the hands of Dr.Parekh regarding injury to cornea and therefore he is not concerned with that operation. He also disputed his liability about the cataract operation or failure thereof. According to Dr.Gala it was a minor operation and was performed successfully and later on when injury to 3 (FA/14/59) cornea was complained of he had referred the patient to the competent doctors. [3] We have considered the reasons stated by the Ld.Forum below in details regarding the observations as to the facts and medical negligence including the ruling of Hon’ble Supreme Court in Civil Appeal No.3541 of Martin F. D' Souza vs Mohd. Ishfaq on 17 February, 2009 2009 CPJ page 32 (SC. [4] It is true that medical practitioner would fail below the standard of his reasonable competency conduct if there are want of precautions to perform the operation or surgery. In the present case, we do not find any evidence from the opponent No.1 i.e. Dr.Gala as to his initial observation of the patient (complainant). Standard of reasonable care and precaution on the part of surgeon before performing operation necessarily and ought to be supported by documents such as Fitness Certificate of the patient to undergo surgery or operation and Consent Form at pre-operative stage indicating that the patient had given his free consent for undergoing the surgery. If according to Dr.Gala Cataract surgery was minor operation he should have taken precaution that patient is advised preliminary medical examination indicating that patient did not suffer from ailments like high B/P, Diabetes etc. or if he is suffering the necessary medical test to be performed and it ought to be ensured from the competent examining doctor that the patient is fit for undergoing surgery as contemplated in the case of complainant. We do not find any evidence in this regard nor we find that Ld.District Forum performed its duty to enquire as to whether surgeon concerned had insisted upon Fitness Certificate of the patient or whether patient had given his free consent to undergo the surgical operation. Apart from this, considering the judicial precedent relied upon on behalf of the opponent in First Appeal No.956 of 2006 decided by the State Consumer Disputes Redressal Commission, Rajasthan, Jaipur between Mrs.Damayanti Devi v/s. 4 (FA/14/59) Dr.Indu Arora decided on 05/06/2009 and the principles of medical negligence, we are not questioning the requisite professional skill of Dr.Gala nor we impute professional negligence upon him on account of performance of operation in the facts of the case as he is post graduate in surgery and experienced Ophthalmologist. Our observations are limited to failure to take precautions on account of not insisting upon Fitness Certificate or Consent Form in writing from the patient at pre-operative stage since in the present case patient had approached Dr.Gala on 09/08/2005 and was called on 12/08/2005 at 8 a.m. for operation of the cataract. There was sufficient time gap during which complainant could have been medially examined in respect of ailments which he suffered and regarding fitness of the complainant to undergo the surgical operation in respect of cataract of his left eye. In our view, had these precautions been taken by Dr.Gala then he may have been exonerated from the liability. In absence of these precautions Ld.District Forum failed in its duty to address itself on these questions and simply considering the other facts proceeded to dismiss the complaint. Our attention is also invited to the Article -‘Medical tests before eye surgery- when you need them – and when you don’t ’ published by American Academy of Ophthalmology in the year 2017 in the periodical ‘Choosing wisely (an initiative of the ABIM Foundation). It cannot be disputed that cataract surgery in modern days is low risk eye surgery as it is usually done with local anesthesia to numb the eye and then medicines are prescribed for relaxation of the patient. However, observation is mentioned as, ‘Even though eye surgery is very low risk, many healthy people get a routine set of tests before their surgery. In these cases, the tests don’t change the surgery or make it safer.’ The article further reads as, ‘You may need an EKG if you have heart disease or symptoms such as chest pain or shortness of breath. If you have diabetes, you will probably need a blood test to make sure it is under control.’ These observations are clearly indicative of precautions that need to be taken before any eye 5 (FA/14/59) surgery is performed in cases of patient suffering from ailments such as hypertension or diabetes. Necessary medical tests are necessary so that the competent doctor examining can certify that patient is fit for surgery. Furthermore, surgeon shall also take precaution to obtain free consent of the patient or close relative in writing before he can be subjected to surgery. For want of these precautions only we partly allow this appeal irrespective of the failure of the surgery. We direct the appellant Dr.Ashlesh M.Gala to pay sum of Rs.25,000/-(Rupees Twenty Five Thousand only) as compensation inclusive of charges for surgery to be refunded in the sum of Rs.15,000/- (Rupees Fifteen Thousand only). We also direct litigation costs in the sum of Rs.5000/- (Rupees Five Thousand only) shall be paid to the complainant. The amount shall be paid within one month from the date of this order failing which it shall carry interest @ 9% p.a. from the date of order till realization. Impugned order is set aside. Appeal is partly allowed accordingly. Certified copy of this order be supplied to both the parties. Pronounced on 23 rd March, 2018. [JUSTICE A.P.BHANGALE] PRESIDENT [Dr.S.K.KAKADE] MEMBER rsc --

http://www.dnaindia.com/mumbai/report-doctor-penalised-for-improper-eye-surgery-2602557 The Maharashtra Consumer Dispute Redressal Commission has recently pulled up a Mulund-based ophthalmologist, Dr Ashlesh Gala, for a botched up cataract surgery which resulted in the loss of vision for one of his patient. The forum held that the doctor failed to take the preliminary precautions of conducting the mandatory medical tests for the consumer which resulted in vision-loss in one eye. The commission has asked the doctor to pay a penalty amount of Rs 45,000 toward the complainant for his mistake. However, the patient, Gopal Joshi, is unhappy with the order and has decided to take the matter to the National Commission. The commision's order read,"It cannot be disputed that the cataract surgery in modern day is a low-risk eye surgery as it is usually done with local anesthesia to numb the eye and then medicines are prescribed for relaxation of the patient. However, even though eye surgery has very low risk, many healthy people get a routine set of tests done before the surgey is conducted. In these cases, the tests don't change or make it safer but helps controlling blood pressure and sugar during the time of the surgery." Meanwhile, Joshi's lawyer, Mangesh Nalawade, while speaking to DNA said, "Our plea was on the grounds of negligence as the medical papers say that there was a cornea tear of my client which lead to loss of his vision in one eye. But, the aspect of negligence was not considered by the Commission. We are definitely approaching the National Consumer Dispute Redressal Commission and filing an appeal." -- http://www.choosingwisely.org/patient-resources/medical-tests-before-eye-surgery/ If you’re going to have cataract surgery or another eye surgery, you may be given some medical tests first. For example, you may have an electrocardiogram (EKG) to check your heart, or a complete blood count (CBC) to check for anemia, a low amount of red blood cells. These tests may make surgery safer. For example, they may find medical problems that lead to a delay or change in your surgery. But most people don’t need these tests before eye surgery. Here’s why: The tests usually aren’t helpful for low-risk surgery. Generally, cataract and other eye surgeries have very low risks of complications or problems, such as heart attacks. There really isn’t anything doctors can do to lower the risk any further. Eye surgeries do not take long, and they use only a local anesthetic to numb the eye, often with a medicine to relax you. Even so, many healthy people get a routine set of tests before eye surgery. In these cases, the tests don’t change the surgery or make it safer. They can lead to more tests. The tests themselves are very safe, but they can cause false alarms. This can lead to anxiety and more tests. And they can needlessly delay your sur­gery. For example, one test may be followed up with a repeat test, an ultrasound, a biopsy, or a test that exposes you to radiation, such as an X-ray or CT scan. The costs can add up. Your health plan may not pay for the tests if you do not have a specific medical need for them. If this happens, you may need to pay for them. It could cost between $25 and $50 per test, according to HealthcareBlueBook.com. So when are the tests needed? You may need the tests if you have certain kinds of health conditions or illnesses. For example, you may need an EKG if you have heart disease or symptoms such as chest pain or shortness of breath. If you have diabetes, you will probably need a blood test to make sure it is under control. Based on the test results, your doctor may need to change your surgery or anesthesia. You may need special care during or after the surgery. Or you may need to postpone the surgery until the problem is treated or controlled. This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk. © 2013 Consumer Reports. Developed in cooperation with the American Academy of Ophthalmology. 04/2013

Tuesday, March 27, 2018

PGI Chandigarh: doctors told to summon security before announcing patient's death

From https://www.nyoooz.com/news/chandigarh/1066322/chandigarh-pgi-doctors-told-to-summon-security-before-announcing-patients-dea/ Taking strict note of manhandling of doctors at its emergency wing, Post-Graduate Institute of Medical Education and Research (PGIMER) director has told resident doctors to inform security personnel first before breaking the news of a patient’s death to attendants. Dr Jagat Ram has also ordered a quick-response team (QRT) of 12 security guards to keep an eye on untoward incidents threatening the safety of doctors in the emergency wing. “Next week a meeting of resident doctors, representatives of hospital administration and security wing will be called to finalise the new measures,” a senior administrative officer, not wishing to be named, said. The child died on Wednesday night, following which his family started hurling abuses at the female doctor and broke a machine,” said Dr Sandeep Tula, vice-president, Association of Resident Doctors (ARD). We have filed a police complaint against the family.”“For their safety, I have told all resident doctors working in the emergency to inform the QRT before informing attendants about the death of a patient. Taking strict note of manhandling of doctors at its emergency wing, Post-Graduate Institute of Medical Education and Research (PGIMER) director has told resident doctors to inform security personnel first before breaking the news of a patient’s death to attendants. Dr Jagat Ram has also ordered a quick-response team (QRT) of 12 security guards to keep an eye on untoward incidents threatening the safety of doctors in the emergency wing. This team will be in addition to the 40-odd security guards posted in the ward. On the night of March 21, attendants of a 13-year-old critically ill boy created ruckus inside the emergency, hurled abuses at a female doctor and broke a dialysis machine costing Rs 21 lakh, after the doctors could not save the child. “The boy had end-stage cancer. For three days, the doctors had been informing the father that bone marrow transplant was the only solution, but his family could not afford the expenses. The child died on Wednesday night, following which his family started hurling abuses at the female doctor and broke a machine,” said Dr Sandeep Tula, vice-president, Association of Resident Doctors (ARD). Attacks on doctors March 21: Attendants hurled abuses, threatened a resident doctor after she could not save a child suffering from end-stage blood cancer May 2017: A resident doctor was slapped by a patient’s attendant in the emergency medical OPD as the doctor failed to save the patient August 2016: A resident doctor was manhandled by a patient’s attendant in emergency Dr Jagat Ram said, “This behaviour is highly inappropriate and will not be tolerated. The doctors give their best to save lives and do not deserve this treatment by attendants.

Friday, January 22, 2016

Court Fined Doctors Rs. 40 Lakhs for Conservative Management

If Doctor wants to try non surgical methods, but if patient develops complications, Consumer Courts Fine Doctors
All those who say that doctors are operating without waiting, please read this 
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உடனடியாக அறுவை சிகிச்சை செய்யாமல், நோயாளிக்கு பிரச்சனை வந்தால் நுகர்வோர் நீதிமன்றங்கள் மருத்துவருக்கு 40 லட்சம் அபராதம் விதிக்கின்றன
மருத்துவர்கள் தேவையில்லாமல் அறுவை சிகிச்சை செய்கிறார்கள் என்று கூறுபவர்களின் பணிவான கவனத்திற்கு 
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The Delay in diagnosis and treatment made the patient to lose her life, which in turn costed Doctors and Hospital hefty sum of Rs.25 lakhs towards compensation + Rs.15 lakhs towards mental pain & agony, totalling to Rs.40 lakhs with interest !!!
The commission gave an interesting example to explain the issue of 1 % risk of serious harm.
“suppose that, an aeroplane on a long-haul flight developed engine trouble while in mid-air, this gave rise to a one percent risk that the plane would crash and that risk would not increase for the next 12 hours but remain constant”.
“A reasonable pilot, knowing this, would not wait for 12 hours to expire but would land his plane as soon as reasonably practicable.”
(MRS.) MANIKA ROY & ANR V/s. DR. B.L. CHITLANGRA, Bombay Hospital & ors. CC no.42/2003, decided on 5th January, 2016, by the National Commission.
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Facts in nutshell:
Ms. Kaberi Roy, 29, (since deceased, referred herein as a “patient”), daughter of complainants was initially diagnosed by their family physician as the patient of ‘acute appendicitis’ and advised her for immediate surgery and therefore the complainants admitted her in Bombay Hospital at 10.30 PM 0n 27.06.2002.The casualty Medical Officer examined her and diagnosed it as a case of acute appendicitis. The routine check-up also indicated severity of appendicitis and possibility of perforation (leucocytes count (17700 per cmm). The Neutrophils were 87%). It was alleged by the Complainants that the Opponent Doctors, senior surgeons failed in their duty to examine the patient immediately during emergency as Doctors came to examine the patient on next day i.e. 28.06.2002 at 11 AM. I.e. almost after more than twelve hours of her emergency admission. The Surgery turned to not fruitful and it was alleged that the no proper surgical procedure was selected, there was septicaemia, no post-iop proper treatment and as a result patient died within two days of hospitalization, and within 36 hours of her operation.
Court Fined Doctors Rs. 40 Lakhs for Delay in Patient Diagnosis and Treatment
The Commission heard the parties at length, studied the medical records and medical literature…
The commission found discrepancy in Medical Record and the statements of Doctors especially regarding removal of Gangrenous fluid. It further observed that the departures of the Opp. Doctors individually and together in the treatment and diagnosis of the patient led to a delay in the patient’s surgery, and were a proximate cause or substantial cause contributing to the septic emic shock and death. The patient was admitted in late night, thus emergency USG scan should have been sought on an urgent basis to rule out the causes of acute abdomen. The opponent Hospital is one of tertiary care hospital and the highest care is expected than from other hospitals & had the USG scan been obtained and interpreted promptly, these complications might have been avoided. If that had happened, patient could have been operated expeditiously as an emergency basis, further observed by the commission. It also held that an appropriate standard of care had not been met as surgery took place after 17 hours.
Court Fined Doctors Rs. 40 Lakhs for Delay in Patient Diagnosis and Treatment
IT relied by the Landmark judgment of Apex court of Dr. Laxman Balakrishna Joshi Vs. Dr. Trimbak Bapu Godbole AIR 1969 SC 128, which laid down that a doctor when consulted by a patient, owes him certain duties, namely,
(a) a duty of care in deciding whether to undertake the case;
(b) a duty of care in deciding what treatment to give; and
(c) a duty of care in the administration of that treatment. A breach of any of these duties gives a cause of action for negligence to the patient.
Court Fined Doctors Rs. 40 Lakhs for Delay in Patient Diagnosis and Treatment
This may be the first case of this year wherein the Doctors and Hospital were held negligent and ordered to pay such heavy compensation!! To learn from the mistakes of others, is the crux of this case!!

http://desimedicos.com/court-fined-rs-40-lakhs-for/
https://www.facebook.com/spine.brain.surgeon/posts/10153949284609828

Sunday, January 10, 2016

Define Medical Negligence


From https://www.facebook.com/spine.brain.surgeon/posts/10153919623829828 << "What I think is that the ambit and scope of term 'medical negligence' should be defined properly. Complications are inherent to the science of medicine also, as it's not a 100 per cent fool-proof science," Dr Mundada said adding that inability to make the patient well is not and should not be made equivalent to medical negligence. >> http://www.newindianexpress.com/nation/Eyebrows-Raised-Over-NHRC-Hearing-on-Medical-Negligence-Cases/2016/01/07/article3216077.ece

Sunday, November 16, 2014

Medical officer gets jail over waste disposal

From http://www.asianage.com/india/ex-medical-officer-gets-jail-over-waste-disposal-005 In a landmark judgment, the sub-divisional judicial magistrate court Jagatsinghpur on Wednesday awarded six-month imprisonment to former additional district medical officer Nityananda Panda for failure in disposal of hospital waste and violation of Environment (Protection) Act, 1986. In his verdict on Tuesday, the SDJM Alekh Kumar Pradhan also imposed a penalty of `50,000 on Panda and further one-month in prison in case he fails to deposit the penalty. Besides, the court also slapped a penalty of `50,000 on the authorities of the district headquarters hospital. The directive of the court came at the end of hearing in a criminal case filed by the Orissa State Pollution Control Board against Dr Panda. It may be mentioned that the Orissa high court in 2009 had asked the OSPCB to register criminal cases against the medical authorities for improper waste disposal management in gross violation of Environment (Protection) Rules. Acting on the directive of the court, the board had given provisional authorisation for one year to the Jagatsinghpur hospital for disposal of waste. However, the board during its inspection of the hospital on April 4, 2010, found gross irregularities in waste management by the hospital authorities. Taking strong exception to the lackadaisical attitude of the hospital authorities, the board had issued a show cause notice to them on May 1, 2010.

Private college hospitals can do autopsies, says court

http://www.deccanchronicle.com/141102/nation-current-affairs/article/private-college-hospitals-can-do-autopsies-says-court Chennai: The Madras high court has suggested to the state government to explore the feasibility of permitting private medical college hospitals to perform autopsies on unidentified bodies, which will relieve the congestion in mortuaries in government hospitals. A division bench comprising Justices S. Rajeswaran and P. N. Prakash gave the suggestion while issuing a set of directions to authorities relating to man missing cases and unidentified bodies. Citing an order of the Karnataka government relating to conducting of post-mortem, the bench said, “Due to paucity of post-mortem doctors in government hospitals, post-mortem on unidentified bodies is not done immediately and preference is given only to murder cases, accident cases and in cases where the body is identified. In our opinion, a solution to this problem can be found, if private medical college hospitals in the state are given permission to conduct post-mortem as done in the state of Karnataka”. In Tamil Nadu, there were 19 government medical colleges and 26 private medical colleges, of which 11 were deemed universities. At present, students studying in these private medical colleges were sent to the government medical college hospitals for getting training in autopsy, the bench pointed out. To begin with, on a trial basis, if the government grants permission to these private medical colleges to perform autopsies on unidentified bodies, it will relieve the congestion in the mortuaries in the government hospitals. The orthodox may raise their eyebrows and ask anxiously “Will not these private doctors become amenable to influence and issue bogus post-mortem certificates?” But, the situation seems no better in the government hospitals either. “If videography of all post-mortems, whether done in government hospital or private hospital is made compulsory, such misadventures can be curtailed”, the bench added. The bench said an apprehension was voiced that the state will not be able to take any action against a doctor of a private medical college, if the post-mortem certificate given by him was found to be bogus. It cited various sections under the Indian Penal Code dealing with furnishing false information and causing disappearance of evidence, among others that are to prosecute the doctor. The legislature can also bring in an amendment to the definition of “public servant” found in section 21 of IPC and in section 2 © of the Prevention of Corruption Act, by including “The doctors who perform autopsy at the request of a police officer” so that the doctor can be prosecuted even under the Prevention of Corruption Act, the bench added.

Tuesday, September 23, 2014

Penalised for Not Giving Doc Rural Service Marks

From http://m.newindianexpress.com/tamil-nadu/369689

MADURAI:

Pulling up the State Health Secretary and the Secretary of the Medical Selection Committee for not awarding marks to a young doctor for her rural service, thereby denying her an opportunity to pursue postgraduate specialisation course, the Madras High Court bench here imposed a fine of `1 lakh on each of them.

The doctor J Mercy Rumya Florence, an assistant surgeon, was temporarily appointed at a primary health centre in Thulukarapatti in Tirunelveli where she worked for two years and four months. Later, she appeared for an entrance exam in 2012-13, for pursuing postgraduate degree course and scored 63.36 marks. As per the prospectus she was eligible to be awarded one mark for each completed year of Compulsory Rotatory Residential Internship (CRRI) in rural area. However, she was not given the marks on the grounds that it is awarded only for doctors who are in regular service. Justice S Nagamuthu said that due to the careless attitude of the respondents, the petitioner had lost her right to acquire a PG seat and she deserved to be compensated for it.