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Saturday, October 26, 2013

Rs.6,08,00,550/ crores compensation to N.R.I. for the death of his wife = Medical Negligence – Compensation was fixed based on principles and theories of M.V. ACT = Dr. Balram Prasad … Appellant Vs. Dr. Kunal Saha & Ors. … Respondents= http://judis.nic.in/supremecourt/imgst.aspx?filename=40897

       Rs.6,08,00,550/ crores compensation to N.R.I. for the death of his wife  =  Medical Negligence – Compensation was fixed based on principles and theories of M.V. ACT =
 The  patients irrespective of their social, cultural  and  economic  background  are entitled to be  treated  with  dignity  which  not  only  forms  their fundamental right but also their human right

We, therefore, hope  and trust that this decision acts as a deterrent and a reminder  to  those doctors,  Hospitals,   the   Nursing   Homes   and   other   connected establishments who do not take their responsibility seriously.=
injection Depomedrol used at the rate of 80 mg twice daily by  Dr.Sukumar Mukherjee was in clear  violation  of  the  manufacturer’s  warning  and  recommendation  and  admittedly,   the   instruction  regarding direction for use of the medicine had not been  followed in the instant case. 
          This Court has also made it  clear  that  the
         excessive use of the medicine by  the  doctor  was  out  of  sheer
         ignorance of basic hazards relating to the use of steroids as also
         lack of judgment.
        No doctor has the right to use the  drug  beyond  the maximum recommended dose.

1)   Whether the claim of  the  claimant  for  enhancement  of
                 compensation in his appeal is justified.  If it is so,  for
                 what compensation he is entitled to?
              2)   While making additional claim by way of affidavit  before
                 the National Commission when amending the  claim  petition,
                 whether the claimant is entitled for  compensation  on  the
                 enhanced claim preferred before the National Commission?


3(a)  Whether  the  claimant  seeking  to  amend  the  claim  of
           compensation under certain heads in the original claim  petition
           has forfeited his right of claim under Order II Rule 2 of CPC as
           pleaded by the AMRI Hospital?
           3(b)  Whether the claimant is justified in  claiming  additional
           amount for compensation under different heads without  following
           the procedure contemplated under the provisions of the  Consumer
           Protection         Act          and          the          Rules?


4.   Whether the National Commission is  justified  in  adopting
              the multiplier method to determine the  compensation  and  to
              award the compensation in favour of the claimant?
           5.   Whether the claimant is entitled to pecuniary damages under
              the heads of loss of employment, loss of his property and his
              traveling expenses  from  U.S.A.  to  India  to  conduct  the
              proceedings in his claim petition?
           6. Whether the claimant is  entitled  to  the  interest  on  the
              compensation that would be awarded?
           7.  Whether the compensation awarded in  the  impugned  judgment
           and the apportionment of the compensation amount  fastened  upon
           the doctors and the hospital requires interference  and  whether
           the claimant is liable for contributory negligence and deduction
           of compensation under this head?
           8.  To what Order and Award the claimant is entitled to in these
           appeals?

   In summary, the details of compensation  under  different  heads
      are presented hereunder:


           |Loss of income of the deceased   |Rs.5,72,00,550/-              |
|For Medical treatment in Kolkata |Rs.7,00,000/-                 |
|and Mumbai                       |                              |
|Travel and Hotel expenses at     |Rs.6,50,000/-                 |
|Mumbai                           |                              |
|Loss of consortium               |Rs.1,00,000/-                 |
|Pain and suffering               |Rs.10,00,000/-                |
|Cost of litigation               |Rs.11,50,000/-                |


      147.   Therefore,  a  total  amount  of   Rs.6,08,00,550/-    is   the
      compensation awarded in this appeal to the claimant Dr. Kunal Saha  by
      partly modifying the award granted by the  National  Commission  under
      different  heads  with  6%  interest  per  annum  from  the  date   of
      application till the date of payment.

Accordingly, the Civil Appeal No. 2867/2012 filed by  Dr.  Balram
      Prasad, Civil Appeal No. 858/2012 filed by Dr. Sukumar  Mukherjee  and
      Civil Appeal No. 731/2012 filed by Dr. Baidyanath  Haldar  are  partly
      allowed by modifying the judgment and order of the National Commission
      in so far as the amount fastened upon them to be paid to the  claimant
      as mentioned below. 
Dr. Sukumar Mukherjee and  Dr.  Baidyanath  Haldar
      are liable to pay compensation to the tune of Rs.10 lakhs each and Dr.
      Balram Prasad is held liable to pay compensation of Rs.5 lakhs to  the
      claimant. 
Since,  the  appellant-doctors  have  paid  compensation  in
      excess of what they have been made liable to by  this  judgment,  they
      are entitled for reimbursement from the appellant-AMRI Hospital and it
      is directed to reimburse the same to the above  doctors  within  eight
      weeks.


152. The  Civil  Appeal  No.  692/2012  filed  by  the  appellant-AMRI
      Hospital is dismissed and it is liable to pay compensation as  awarded
      in this judgment in favour of the claimant after deducting the  amount
      fastened upon the doctors in this judgment  with  interest  @  6%  per
      annum.



153. The Civil Appeal No. 2866/2012  filed  by  the  claimant-Dr.Kunal
      Saha is also partly allowed and the finding on contributory negligence
      by the National Commission on the part of the claimant is  set  aside.
      The direction of the National Commission to deduct 10% of the  awarded
      amount of compensation on account of contributory negligence  is  also
      set aside by  enhancing  the  compensation  from  Rs.1,34,66,000/-  to Rs.6,08,00,550/- with 6% interest per  annum  from  the  date  of  the complaint to the date of the payment to the claimant.



154. The AMRI Hospital is directed to comply  with  this  judgment  by
      sending demand draft of the compensation awarded in this appeal to the
      extent of liability imposed on it after deducting the amount, if  any,
      already paid to the  claimant,  within  eight  weeks  and  submit  the
      compliance report.

                         REPORTABLE

                        IN THE SUPREME COURT OF INDIA
                        CIVIL APPELLATE JURISDICTION

                        CIVIL APPEAL NO.2867 OF 2012


      Dr. Balram Prasad                             … Appellant

                                   Vs.

    Dr. Kunal Saha & Ors.                  … Respondents


                                    WITH

                         CIVIL APPEAL No.692 of 2012

      Advanced Medicare & Research
      Institute Ltd.                         … Appellant

                                   Vs.

    Dr. Kunal Saha & Ors.                  … Respondents


                                    WITH

                        CIVIL APPEAL No.2866 of 2012

    Dr. Kunal Saha                                  …Appellant

                                  Vs.

    Dr. Sukumar Mukherjee & Ors.           … Respondents



                                    WITH

                   CIVIL APPEAL No.731 of 2012


      Dr. Baidyanath Haldar                      …  Appellant

                                  Vs.

    Dr. Kunal Saha & Ors.                  …  Respondents

                                     AND


                         CIVIL APPEAL No.858 of 2012

      Dr. Sukumar Mukherjee                   … Appellant

                                   Vs.

     Dr. Kunal Saha & Ors.                  … Respondents










                               J U D G M E N T




    V. Gopala Gowda, J.

           The Civil Appeal Nos.2867, 731 and 858 of 2012 are filed by  the
      appellant-doctors, Civil Appeal No.  692  of  2012  is  filed  by  the
      appellant-AMRI Hospital and Civil Appeal No. 2866 of 2012 is filed  by
      the claimant-appellant – Dr. Kunal Saha (hereinafter  referred  to  as
      ‘the claimant’), questioning the correctness of the impugned  judgment
      and order dated 21.10.2011 passed by the  National  Consumer  Disputes
      Redressal  Commission  (hereinafter  referred  to  as  the   ‘National
      Commission’) in Original Petition No.240 of 1999.


     2. The appellant-doctors are aggrieved by the quantum of  compensation
        awarded by the National Commission and the liability fastened  upon
        them for the negligence on their part and have prayed to set  aside
        the same by allowing their appeals. In so far as the appellant-AMRI
        Hospital is concerned,  it  has  also  questioned  the  quantum  of
        compensation awarded and has prayed to reduce the same by  awarding
        just and reasonable  compensation  by  modifying  the  judgment  by
        allowing its appeal.


           So far as the claimant is concerned, he is aggrieved by the said
      judgment and the compensation awarded  which,  according  to  him,  is
      inadequate, as the same is contrary to the admitted facts and law laid
      down  by  this  Court  in  catena  of  cases  regarding  awarding   of
      compensation in relation to the  proved  medical  negligence  for  the
      death of his wife  Anuradha  Saha  (hereinafter  referred  to  as  the
      ‘deceased’).


     3. The brief relevant facts and the grounds urged  on  behalf  of  the
        appellant-doctors, AMRI Hospital and the claimant in  seriatim  are
        adverted to in this common judgment for the  purpose  of  examining
        the correctness of their  respective  legal  contentions  urged  in
        their respective appeals with a view to pass  common  judgment  and
        award.


     4.  Brief  necessary  and  relevant  facts  of  the  case  are  stated
        hereunder:
            The  claimant  filed  Original  Petition  No.  240  of  1999  on
      09.03.1999 before the National Commission  claiming  compensation  for
      Rs.77,07,45,000/- and later the same was amended by  claiming  another
      sum of Rs.20,00,00,000/-.  After the case of Malay Kumar  Ganguly  Vs.
      Dr. Sukumar Mukherjee[1] was remanded by this Court  to  the  National
      Commission to award just and reasonable compensation to  the  claimant
      by answering  the  points  framed  in  the  said  case,  the  National
      Commission held  the  doctors  and  the  AMRI  Hospital  negligent  in
      treating the wife of the  claimant  on  account  of  which  she  died.
      Therefore, this Court directed the National  Commission  to  determine
      just and reasonable compensation payable to the claimant. However, the
      claimant, the appellant-Hospital and the doctors were aggrieved by the
      amount of compensation awarded by the National Commission and also the
      manner in which liability was apportioned amongst each of them.  While
      the claimant was aggrieved by the inadequate amount  of  compensation,
      the  appellant-doctors  and  the  Hospital  found  the  amount  to  be
      excessive and too harsh. They further claimed that the  proportion  of
      liability ascertained on each of  them  is  unreasonable.  Since,  the
      appellant-Hospital and the doctors raised similar  issues  before  the
      Court; we intend to produce their contentions in brief as under:


      On granting the quantum of compensation based on  the  income  of  the
      deceased:




     5. It is the claim of the learned counsel on behalf of the  appellant-
        doctors and the Hospital that there is no pleading in the  petition
        of the claimant that the deceased had a  stable  job  or  a  stable
        income, except in paragraph 2A of the petition  which  states  that
        the deceased was a Post-Graduate student and she had submitted  her
        thesis. The only certificate produced by the  claimant  shows  that
        she was just a graduate in Arts (English).  Further, it is urged by
        the learned counsel that the document produced by the claimant -  a
        computer generated sheet,  does  not  explain  for  what  work  the
        remuneration, if at all was received by the deceased. Also, whether
        the same was a  onetime  payment  of  stipend  or  payment  towards
        voluntary work, is not explained by the claimant.  Further,  it  is
        stated by the learned counsel that there  is  no  averment  in  the
        petition of the claimant as to on what account the said payment was
        received by the deceased and whether she has received it as a Child
        Psychologist as claimed by the claimant or otherwise.

     6. It is also the case of the appellant-doctors and the Hospital  that
        the claimant had not led any  oral  evidence  with  regard  to  the
        income of the deceased and further he has not explained why just  a
        single document discloses the payment made sometime in the month of
        June 1988 in support of the income of the deceased when admittedly,
        the couple came  to  India  in  the  month  of  March-April,  1998.
        Therefore, the learned counsel for the  appellant-doctors  and  the
        Hospital have urged that the said document is a vague document  and
        no reliance could have been placed by the  National  Commission  on
        the same to come to the conclusion that the deceased  in  fact  had
        such an income to determine and award the compensation as has  been
        awarded in the impugned judgment and order. From a perusal  of  the
        said document, it could be ascertained that it shows just one  time
        payment received for some odd jobs.  Therefore, it is contended  by
        the appellant-doctors and the Hospital that the  claimant  has  not
        been able to discharge his onus by adducing any  positive  evidence
        in this regard before the National Commission.


     7. It is further contended by the learned counsel that  the  assertion
        of the claimant in the petition and  in  his  evidence  before  the
        National Commission that the income of the deceased was $30,000 per
        annum  is  not  substantiated  by  producing  cogent  evidence.  No
        appointment letter of the deceased to show that she was employed in
        any organization in whatsoever capacity had been produced  nor  has
        the claimant  produced  any  income  certificate/salary  sheet.  No
        evidence is produced by the claimant in support of  the  fact  that
        the deceased was engaged on  any  permanent  work.  No  Income  Tax
        Return has been produced by the claimant to show that she had  been
        paying tax or had any income in U.S.A.


     8. It is further submitted that even if it is assumed that the  annual
        income of the deceased was $30,000 per annum, apart from  deduction
        on account of tax, it is also essential for the National Commission
        to ascertain the personal living expenses of the deceased which was
        required to be deducted out of the annual income to  determine  the
        compensation payable to the claimant.   The National Commission was
        required to first ascertain the style of living  of  the  deceased-
        whether it was Spartan or Bohemian to arrive the income  figure  of
        $30,000 per annum.  In India, on account of style and  standard  of
        living of a person, one–third of the gross income is required to be
        deducted out of the annual income as laid down in the  decision  of
        this Court in the case  of  Oriental  Insurance  Company  Ltd.  Vs.
        Jashuben & Ors[2].

           It is further contended by the learned counsel for the appellant-
      doctors and the Hospital that no  yardstick  is  available  about  the
      expenditure of the deceased in the U.S.A. The claimant has not adduced
      any evidence in this regard.  The  evidence  given  by  the  so-called
      expert, Prof. John F. Burke Jr. also does not  say  anything  on  this
      score.

           Even if it is assumed that the annual income of the deceased was
      $30,000 per annum for which there  is  no  evidence,  25%  thereof  is
      required to be deducted towards tax.  The deduction  of  tax  is  much
      more as is apparent from the case reported in United  India  Insurance
      Co. Ltd. & Others Vs. Patricia Jean Mahajan & Ors[3].   In  fact,  the
      claimant has neither adduced any evidence in this regard  nor  has  he
      produced the  relevant  statute  from  which  the  percentage  of  tax
      deduction can be ascertained.


           The claimant was last examined by video  conferencing  conducted
      under the supervision of Justice Lokeshwar Prasad  (retired  Judge  of
      Delhi  High  Court)  as  local  Commissioner.   The   AMRI   Hospital-
      appellant’s witness Mr. Satyabrata Upadhyay was cross-examined by  the
      claimant.


      9.    The claimant filed M.A. No.1327  of  2009  before  the  National
      Commission after remand order was passed by this Court in the case  of
      Malay Kumar Ganguly (supra). The claimant now claimed  enhancement  of
      compensation at Rs.78,14,00,000/- under the heads of pecuniary damages
      and non-pecuniary damages.


            The prayer made in the application was to admit  the  claim  for
      compensation along with supporting documents including the opinions of
      the foreign experts and further prayed for issuing  direction  to  the
      appellant-doctors and the Hospital to arrange for cross-examination of
      the foreign experts, if they wish, through video conferencing at their
      expenses as directed by this Court in the remand order in Malay  Kumar
      Ganguly’s case (supra) and for fixing the matter for a  final  hearing
      as soon as possible on a firm and fixed date as the  claimant  himself
      want to argue his petition as was done before this Court, as he  being
      the permanent resident of U.S.A.


      10.  The learned senior counsel appearing for the claimant on 9.2.2010
      prayed for withdrawal of the application stating that  he  would  file
      another appropriate application. Thereafter, on 22.2.2010 the claimant
      filed M.A. No.200 of 2010 seeking direction to the National Commission
      to permit him to produce affidavit of four foreign experts  and  their
      reports. The National Commission dismissed the same vide  order  dated
      26.4.2010 against which special leave petition No.15070/2010 was filed
      before this Court which was withdrawn later on.  Again,  the  claimant
      filed  M.A.  No.594  of  2010  before  the  National  Commission   for
      examination of four foreign experts to substantiate his claim  through
      video conferencing at the expense of  the  appellant-doctors  and  the
      Hospital. The National Commission vide order dated 6.9.2010  dismissed
      the application of the claimant for examining foreign experts. Against
      this order, the claimant preferred SLP (C) No.3173 of 2011 before this
      Court praying for permission to examine two foreign  experts,  namely,
      Prof. John F.  Burke  Jr.  and  Prof.  John  Broughton  through  video
      conferencing  and  he  undertook  to  bear  the  expenses   for   such
      examination. The claimant  had  given  up  examination  of  other  two
      foreign experts, namely, D. Joe Griffith and Ms.  Angela  Hill.  Prof.
      John F. Burke Jr. was examined on 26.4.2011 as an Economics Expert  to
      prove the loss of income of the deceased and the claimant relied  upon
      an affidavit dated 21.9.2009 and his report dated  18.12.2009  wherein
      he has stated that if the deceased would have  been  employed  through
      the age of 70, her net  income  could  have  been  $3,750,213.00.   In
      addition, the loss of service  from  a  domestic  prospective  was  an
      additional  amount  of  $1,258,421.00.  The  said  witness  was  cross
      examined by the learned counsel for the  doctors  and  AMRI  Hospital.
      The learned Counsel for the appellant-doctors placed reliance upon the
      following questions and answers  elicited  from  the  above  Economics
      Expert witness, which are extracted  hereunder:-
           “Q.16. Can you tell me what was the wages of Anuradha in 1997?


           A.16. May I check my file (permitted).  I don’t know.


           Q.17. Are you aware whether Anuradha was an income tax payee  or
           not?


           A.17. Anu and her husband were filing joint return.


           Q.18. Did Anu have any individual income?


           A.18. I don’t know.


           Q.19. Did Kunal  Saha  provide  you  the  earning  statement  of
           Anuradha Saha, wherein her gross monthly pay was shown as $ 1060
           as on 16.1.1998?


           A.19. I don’t believe that I have that information.
           …
           Q.21. What documents have you taken into consideration of  Anu’s
           income for giving your opinion?


           A.21.  None.


           Q.22. Whether Anu was employed at the time of her death?


           A.22. I don’t think so; I don’t believe so.”



      11. The claimant on the other hand, had placed  strong  reliance  upon
      the evidence of the Economics Expert Prof. John F. Burke to prove  the
      income of the deceased as on the date of her death and  actual  income
      if she would have lived up to the age of  70  years  as  he  had  also
      examined Prof. John Broughton in justification of his claim.
            The learned counsel for  the  appellant-doctors  contended  that
      Prof. John F. Burke, who was examined through  video  conferencing  in
      the presence of the Local Commissioner, has estimated  the  life  time
      income of the deceased to be 5 million and  125  thousand  US  dollars
      without any supporting material.  The said foreign expert witness  did
      not know whether the deceased had any individual income.  He  did  not
      know about the earning statement  of  the  deceased  produced  by  the
      claimant.  He has also stated that the deceased was  not  employed  at
      the time of her death.

      12.  The learned counsel for the appellant-doctors also submitted that
      the earning statement issued  by  Catholic  Home  Bureau  stating  the
      income of the deceased at $1060.72 for the period ending 15th January,
      1998 cannot be relied upon for the following reasons :-
              a) The earning statement was not proved in accordance with law
                 since only the affidavit of claimant was exhibited and  not
                 the documents before  Justice  Lokeshwar  Prasad  (Retired)
                 i.e. the Local Commissioner on 5.12.2003 during the  cross-
                 examination.


              b) There is nothing to  show  that  Anuradha  Saha  was  under
                 employment at Catholic Home Bureau.


              c) Letter of appointment has not been annexed.


              d) Federal Tax record has not been  produced.   The  Economics
                 expert has stated  that  Anuradha  and  the  claimant  were
                 filing joint tax return.

              e) It does not show weekly income of the deceased as has  been
                 treated by NCDRC.

              f) Nature of appointment,  even  if  presumed,  has  not  been
                 stated,  i.e.,  whether  it  was  temporary  or  permanent,
                 contractual or casual and period of employment.




           It is further submitted by the learned counsel that the evidence
      of Prof. John F. Burke, Jr. has not been relied upon to prove the loss
      of income of the deceased as it shows that the deceased was not paying
      income tax.  Therefore, the National Commission has  erred  in  partly
      allowing the claim of the claimant while computing the compensation on
      the basis of the earning of the deceased.


      On awarding compensation under the head of ‘loss of consortium’:


      13.  The learned senior counsel and other counsel for  the  appellant-
      doctors submitted that the National Commission has erred  in  awarding
      Rs.10,00,000/- towards loss of  consortium.   This  Court  in  various
      following decisions has  awarded  Rs.5,000/-  to  Rs.25,000/-  on  the
      aforesaid account:-
|CASE LAW                                       |AMOUNT          |
|1. Santosh Devi v. National Insurance Co. Ltd.,|Rs.10,000       |
|(2012) 6 SCC 421                               |                |
|2. New India Assurance Company Limited v.      |Rs.10,000       |
|Yogesh Devi, (2012) 3 SCC 613                  |                |
|3. National Insurance Company Limited v.       |Rs.5,000        |
|Sinitha, (2012) 2 SCC 356                      |                |
|4. Sunil Sharma v. Bachitar Singh, (2011) 11   |Rs.25,000       |
|SCC 425                                        |                |
|5. Pushpa v. Shakuntala, (2011) 2 SCC 240      |Rs.10,000       |
|6. Arun Kumar Agrawal v. National Insurance    |Rs.15,000       |
|Company Limited, (2010) 9 SCC 218              |                |
|7. Shyamwati Sharma v. Karam Singh, (2010) 12  |Rs.5,000        |
|SCC 378                                        |                |
|8. Reshma Kumari v. Madan Mohan, (2009) 13 SCC |Rs.15,000       |
|422 in Sarla Dixit v. Balwant Yadav            |                |
|9. Raj Rani v. Oriental Insurance Company      |Rs.7,000        |
|Limited, (2009) 13 SCC 654                     |                |
|10. Sarla Verma v. Delhi Transport Corporation,|Rs.10,000       |
|(2009) 6 SCC 121                               |                |
|11. Rani Gupta v. United India Insurance       |Rs.25,000       |
|Company Limited, (2009) 13 SCC 498             |                |
|12. National Insurance Company Limited v.      |Rs.10,000       |
|Meghji Naran Soratiya, (2009) 12 SCC 796       |                |
|13. Oriental Insurance Company Limited v. Angad|Rs.10,000       |
|Kol, (2009) 11 SCC 356                         |                |
|14. Usha Rajkhowa v. Paramount Industries,     |Rs.5,000        |
|(2009) 14 SCC 71                               |                |
|15.  Laxmi Devi v. Mohammad. Tabbar, (2008) 12 |Rs.5,000        |
|SCC 165                                        |                |
|16. Andhra Pradesh State Road Transport        |Rs.5,000        |
|Corporation v. M. Ramadevi, (2008) 3 SCC 379   |                |
|17. State of Punjab v. Jalour Singh, (2008) 2  |Rs.5,000        |
|SCC 660                                        |                |
|18. Abati Bezbaruah v. Dy. Director General,   |Rs.3,000        |
|Geological Survey of India, (2003) 3 SCC 148   |                |
|19. Oriental Insurance Co. Ltd. v. Hansrajbhai |Rs.5,000        |
|V. Kodala, (2001) 5 SCC 175                    |                |
|20. Sarla Dixit v. Balwant Yadav, (1996) 3 SCC |Rs.15,000       |
|179                                            |                |
|21. G.M., Kerala SRTC v. Susamma Thomas, (1994)|Rs.15,000       |
|2 SCC 176                                      |                |
|22. National Insurance Co. Ltd. v. Swaranlata  |Rs.7,500        |
|Das, 1993 Supp (2) SCC 743                     |                |

    14.  Further, the senior counsel and other counsel for  the  appellant-
    doctors contended that the case of Nizam Institute of Medical  Sciences
    Vs. Prasanth S. Dhananka & Ors.[4]  relied  upon  by  the  claimant  is
    misconceived as that case relates to the continuous pain and  suffering
    of the victim, who had lost control over his lower  limb  and  required
    continuous physiotherapy for rest of his life. It was  not  the  amount
    for loss of consortium by the husband or wife. Hence, it  is  submitted
    by them that the National Commission  erred  in  granting  Rs.10  lakhs
    under the head of ‘loss of consortium’.

    On the objective and pattern of payment of compensation cases:


    15.  It is further contended by the learned counsel for the  appellant-
    doctors that the compensation awarded by the National Commission should
    be meant to restore the claimant to the pre-accidental position and  in
    judging whether the compensation  is  adequate,  reasonable  and  just,
    monetary compensation is required to be arrived at on the principle  of
    restitutio-in-integram.  The National Commission while calculating  the
    just monetary compensation, the earnings of the claimant who himself is
    a doctor, is also required to be taken  into  consideration.  Regarding
    the contention of  the  claimant  that  in  allowing  compensation  the
    American standard is required to be applied, it has not been  disclosed
    before the Commission as to what  is  the  American  standard.  On  the
    contrary, the  National  Commission  was  directed  by  this  Court  to
    calculate the compensation in the case as referred to  in  Malay  Kumar
    Ganguly’s case (supra) and on the basis of the principles laid-down  by
    this Hon’ble Court in various other judgments. The two judgments  which
    have been referred  to  in  Malay  Kumar  Ganguly’s  case  (supra)  are
    Oriental Insurance Company Ltd. Vs. Jashuben & Ors.  (supra)  and  R.K.
    Malik Vs. Kiran Pal[5], where this Court has not directed assessment of
    compensation according to American standard.  Therefore, the contention
    of the claimant that compensation  has  to  be  assessed  according  to
    American standard is wholly untenable in law and the same is liable  to
    be rejected.

    16.  Further, it is contended by the senior counsel and  other  counsel
    for the appellant-doctors and Hospital that the reliance placed by  the
    claimant upon the decision of this  Court  reported  in  Patricia  Jean
    Mahajan’s  case  (supra)  clearly  shows  that  the  multiplier  method
    applicable to claim cases in India was applied  after  taking  note  of
    contribution by the deceased for his dependants. The  said  case  is  a
    clear pointer to the fact that even if a foreigner dies in  India,  the
    basis of calculation has to be applied according to Indian Standard and
    not the American method as claimed by the claimant.

    17.  Further, the word ‘reasonable’ implies that the  appellant-doctors
    and AMRI Hospital cannot  be  saddled  with  an  exorbitant  amount  as
    damages - which cannot either be  treated  as  an  obvious  or  natural
    though not foreseeable consequence of negligence.


    18.  Further, the learned senior counsel has  placed  reliance  on  the
    judgment of this Court in Nizam Institute of Medical  Sciences  (supra)
    wherein this Court enhanced the original compensation  awarded  to  the
    claimant-victim who had been paralyzed due to medical  negligence  from
    waist down, under the heads: requirement  of  nursing  care;  need  for
    driver-cum-attendant, as he was confined  to  a  wheel  chair;  and  he
    needed physiotherapy.
            In the present case, the negligence complained  of  is  against
    the doctors and the Hospital which had resulted in  the  death  of  the
    wife of the claimant. In that case, the extent of liability ought to be
    restricted  to  those  damages  and  expenses  incurred  as  a   direct
    consequence of the facts complained of, while setting apart the  amount
    to be awarded under the head ‘loss of dependency’. The relevant portion
    of the aforesaid judgment of this Court in  the  Nizam’s  Institute  of
    Medical Sciences is quoted hereunder:

          “…………. The adequate compensation that we speak of,  must  to  some
          extent, be a rule of thumb measure, and as a  balance  has  to  be
          struck,  it  would  be  difficult  to  satisfy  all  the   parties
          concerned.” (paragraph 88)




    19.  It is further contended by the learned senior  counsel  and  other
    counsel for the appellant-doctors that the claimant failed  to  produce
    any document by taking recourse to Order XLI Rule 27 of Code  of  Civil
    Procedure and Order LVII of Supreme Court Rules to justify  his  claims
    of approximately an additional amount of  Rs.20  crores  including  the
    cost of  filing  of  the  claim  for  compensation  to  the  amount  of
    compensation demanded for medical negligence  which  is  a  far-fetched
    theory and every negative happening in the claimant’s  life  post-death
    of his wife Anuradha Saha cannot be attributed as the  consequence  due
    to medical negligence. Therefore, the enhancement  of  compensation  as
    prayed for by the claimant  stood  rightly  rejected  by  the  National
    Commission by recording reasons. Therefore, this Court need not examine
    the claim again.

    On the use of multiplier method for determining compensation :




    20. It is contended by the senior counsel and  other  counsel  for  the
    appellants that the multiplier method has enabled the courts  to  bring
    about  consistency  in  determining  the  loss   of   dependency   more
    particularly, in cases of death of victims of negligence, it  would  be
    important for the courts to harmoniously construct  the  aforesaid  two
    principles to determine the amount of  compensation  under  the  heads:
    expenses, special damages, pain and suffering.

    21. In Sarla Verma’s case (supra), this Court, at Paragraphs 13 to  19,
    held that the multiplier method is  the  proper  and  best  method  for
    computation of compensation as there will be uniformity and consistency
    in the decisions.  The said view has been reaffirmed by this  Court  in
    Reshma Kumari & Ors. Vs. Madan Mohan & Anr., Civil  Appeal  No.4646  of
    2009 decided on April 2, 2013.

    22. It is further submitted by the learned counsel that in capitalizing
        the pecuniary loss, a lesser multiplier is required to  be  applied
        inasmuch as the deceased had no  dependants.   In  support  of  his
        contention, reliance is placed upon  the  decision  of  this  Court
        reported in Patricia Mahajan’s case (supra)  in  which  this  Court
        having found a person who died as a bachelor, held  that  a  lesser
        multiplier is required to be applied to quantify the compensation.


    23. It is further contended by the senior counsel and other counsel for
        the appellant-doctors that in Susamma Thomas (supra) this Court has
        observed that “in fatal accident cases, the measure  of  damage  is
        the pecuniary loss suffered and is likely to be  suffered  by  each
        dependant as a result of the death”.  This  means  that  the  court
        while awarding damages in a fatal accident case took  into  account
        the pecuniary loss already suffered as a result of  the  negligence
        complained  of,  and  the  loss  of   dependency   based   on   the
        contributions made by the deceased to the claimant until her death.
        While the former may be easily ascertainable, the latter  has  been
        determined by the  National  Commission  by  using  the  multiplier
        method and in respect of the use of the multiplier method  for  the
        purpose of calculating the loss of dependency of the  claimant,  in
        paragraph No. 16 of  the  aforesaid  judgment  this  Hon’ble  Court
        observed as follows:

           “16. It is necessary to reiterate that the multiplier method  is
           logically sound and legally  well-established.  There  are  some
           cases which have proceeded to determine the compensation on  the
           basis of aggregating the entire future  earnings  for  over  the
           period the life expectancy was lost, deducted a percentage there
           from  towards  uncertainties  of  future  life  and  award   the
           resulting sum as compensation. This is clearly unscientific….”


     24. In Sarla Verma’s case (supra) this  Court  sought  to  define  the
         expression ‘just compensation’ and opined as under:
            “16.….Just Compensation” is adequate compensation which is fair
           and equitable, on the facts and circumstances of  the  case,  to
           make good the loss suffered as a result of the wrong, as far  as
           money  can  do  so,  by  applying  the  well-settled  principles
           relating to award of compensation. It is not intended  to  be  a
           bonanza, largesse or source of profit.


           17.  Assessment  of  compensation   though   involving   certain
           hypothetical considerations should  nevertheless  be  objective.
           Justice  and  justness  emanate  from  equality  in   treatment,
           consistency and thoroughness in adjudication, and  fairness  and
           uniformity in the decision-making  process  and  the  decisions.
           While it may not be possible to have mathematical  precision  or
           identical awards in  assessing  compensation,  same  or  similar
           facts should  lead  to  awards  in  the  same  range.  When  the
           factors/inputs are the same, and  the  formula/legal  principles
           are the same, consistency and uniformity, and not divergence and
           freakiness, should be the result of adjudication  to  arrive  at
           just compensation.”
                            (Emphasis laid by this Court)


     25. It was also contended by the learned counsel  for  the  appellant-
         doctors that apart from accident cases under  the  Motor  Vehicles
         Act, 1988, the multiplier method was followed  in  Lata  Wadhwa  &
         Ors. Vs. State of Bihar[6] by a three Judge Bench of  this  Court,
         which is a case where devastating fire took  place  at  Jamshedpur
         while celebrating the birth anniversary  of  Sir  Jamshedji  Tata.
         Even in M.S. Grewal & Anr. Vs. Deep Chand Sood  and  Ors.[7],  the
         multiplier  method  was  followed  wherein  school  children  were
         drowned due to negligence of school teachers.   In  the  Municipal
         Corporation of Delhi Vs.  Uphaar  Tragedy  Victims  Association  &
         Ors.[8]  the multiplier method was once again followed where death
         of 59 persons took place in a cinema hall and 109 persons suffered
         injury.

     26. Therefore, it is contended by the senior counsel and other counsel
         for the appellant-doctors that multiplier method  should  be  used
         while awarding compensation to the victims  because  it  leads  to
         consistency and avoids arbitrariness.

      On contributory negligence by the claimant

     27. The learned senior counsel and other counsel  for  the  appellant-
         doctors submitted that the National  Commission  in  the  impugned
         judgment should have  deducted  25%  of  the  compensation  amount
         towards contributory negligence of  the  claimant  caused  by  his
         interference in  the  treatment  of  the  deceased.  Instead,  the
         National Commission  has  deducted  only  10%  towards  the  same.
         According to the learned senior counsel and other counsel for  the
         appellants, the National Commission erred in not adhering  to  the
         tenor set by this Court while remanding the case back  to  it  for
         determining the compensation to arrive at an adequate amount which
         would also imply an aspect of contributory negligence,  individual
         role and liability of the Hospital and the doctors held negligent.
         Therefore, this Court is required  to  consider  this  aspect  and
         deduct the remaining 15% out of the compensation  awarded  by  the
         National Commission towards negligence by the claimant.

      On enhancement of compensation claimed by the claimant :



     28. The learned senior counsel and other counsel  for  the  appellant-
         doctors and the Hospital contended  that  enhanced  claim  of  the
         claimant in his appeal is without any amendment to  the  pleadings
         and therefore, is not maintainable in law.  The  claimant  in  his
         written submission filed during the course of arguments  in  July,
         2011 before  the  National  Commission,  has  made  his  claim  of
         Rs.97,56,07,000/-  which  the  National  Commission  has   rightly
         rejected in the impugned judgment  holding  that  it  was  legally
         impermissible for it to consider that part of the  evidence  which
         is strictly not in conformity with the pleadings in order to award
         a higher compensation as claimed by the claimant. In justification
         of the said conclusion and finding of the National Commission, the
         learned counsel have placed reliance upon the principle  analogous
         to Order II Rule 2 of C.P.C., 1908 and further contended that  the
         claimant who had abandoned his claim now cannot  make  new  claims
         under different heads.  Further, it  is  submitted  by  Mr.  Vijay
         Hansaria, the learned senior counsel on behalf  of  AMRI  Hospital
         that though the claimant had filed an application on 9.11.2009  in
         M.A. No.1327 of 2009 for additional claim;  the  said  application
         was withdrawn by  him  on  9.2.2010.   Therefore,  his  claim  for
         enhancing compensation is not tenable in law. In  support  of  the
         said contention, he has placed reliance upon the judgment of  this
         Court  in  National  Textile  Corporation  Ltd.  Vs.   Nareshkumar
         Badrikumar Jagad[9], wherein it is stated by this Court  that  the
         pleadings and particulars are necessary to  enable  the  court  to
         decide the rights of the parties in the trial.

           In support of the said proposition of  law,  reliance  was  also
      placed upon other judgment of this Court in Maria  Margarida  Sequeria
      Fernandes Vs. Erasmo Jack de  Sequeria[10],  wherein  this  Court,  at
      paragraph 61, has held that :-
             “in  civil  cases,  pleadings  are  extremely   important   for
             ascertaining title and possession of the property in question.”


      The said view of this Court was reiterated in A. Shanmugam  Vs.  Ariya
      Kshatriya Rajakula Vamsathu Madalaya Nandavana Paripalanai Sangam[11],

     29. Further, the learned  senior counsel for the appellant-doctors and
         AMRI Hospital placed reliance upon the provisions of the  Consumer
         Protection Act, 1986 and the Motor Vehicles Act, 1988 to urge that
         though  the  Consumer  Courts  have  pecuniary  jurisdiction   for
         deciding  the  matters  filed  before  it  whereby  the  pecuniary
         jurisdiction  of  the  District  Forum  is  Rs.20   lakhs,   State
         Commission is from Rs.20 lakhs to Rs.1 crore, whereas for National
         Commission, it is above Rs.1 crore,   the  Motor  Accident  Claims
         Tribunal have unlimited jurisdiction. In the  Consumer  Protection
         Act, 1986 there is a provision  for  limitation  of  2  years  for
         filing of complaint under Section 24-A of the Act and there is  no
         limitation prescribed in the Motor Vehicles Act, 1988.

     30. Sections 12 and 13 of the Consumer Protection Act, 1986 provide as
         to how the complaint has to  be  made  and  the  procedure  to  be
         followed by the claimant for filing the complaint.  Rule 14(c)  of
         the Consumer Protection Rules, 1987 and  the  Consumer  Protection
         Regulations, 2005 require the complainant to  specify  the  relief
         which he claims. The filing of  the  complaint/appeal/revision  is
         dealt with Consumer Protection Regulations, 2005.  Under the Motor
         Vehicles Act, 1988, a victim or  deceased’s  legal  representative
         does not have to specify the amount claimed as held by this  Court
         in the case of Nagappa Vs. Gurudayal Singh[12].


     31. Under Section 158(6) of the Motor Vehicles Act, 1988,  the  report
         forwarded to the Claims Tribunal can be treated as an  application
         for compensation even though no claim is made or specified  amount
         is claimed whereas under the Consumer Protection  Act,  a  written
         complaint  specifying  the  claim  to  be  preferred  before   the
         appropriate forum within the period of limitation prescribed under
         the provision of the Act is a must.

     32. Under Section 163-A of the Motor Vehicles Act, 1988 a claimant  is
         entitled to compensation under the structured formula even without
         negligence whereas no such provision  exists  under  the  Consumer
         Protection Act.

     33. In this regard, the learned senior counsel and other  counsel  for
         the  appellant-doctors  and  Hospital  placed  reliance  upon  the
         judgment of this Court in the case of Ibrahim  Vs.  Raju.[13]  and
         submitted that the said case does not apply to the fact  situation
         for two reasons, namely, it was a case under  the  Motor  Vehicles
         Act, 1988, whereas this case involves the Consumer Protection Act.
         Secondly,  this  Court  in  the  previous   case,   enhanced   the
         compensation  observing  that  due  to  financial  incapacity  the
         claimant could not avail the services  of  the  competent  lawyer,
         which is not the case in hand, in as  much  as  the  claimant  had
         hired the services of  an  advocate  who  is  Bar-at-Law  and  the
         President of the Supreme Court Bar Association.

     34. Further, the learned  counsel  for  the  appellant-doctors  placed
         reliance upon the judgment of this Court in  the  case  of  Sanjay
         Batham Vs. Munnalal Parihar[14], which is a case under  the  Motor
         Vehicles  Act,  1988.   This  Court  enhanced   the   compensation
         following the judgment in  Nagappa’s  case  (supra).  The  learned
         counsel also placed reliance upon the judgment of  this  Court  in
         Nizam Institute’s case (supra) where the complainant  had  made  a
         claim of Rs.7.50 crores.  This  Court  enhanced  the  compensation
         from Rs.15.50 lakhs to Rs.1 crore.   But,  the  Nizam  Institute’s
         case is not a case for the proposition  that  a  claimant  can  be
         awarded compensation beyond what is claimed by him.  On the  other
         hand, it was a case of peculiar facts and circumstances since  the
         claimant had permanent disability which required constant  medical
         attention,  medicines,  services  of  attendant  and  driver   for
         himself.  The cases referred to by the claimant regarding  medical
         negligence in his written submission are distinguishable from  the
         present case and in none of these cases upon  which  reliance  has
         been placed by the claimant, this Court has  awarded  compensation
         beyond what is claimed. Therefore, the reliance  placed  upon  the
         aforesaid judgments by the claimant does not support his claim and
         this Court need not accept the same and enhance  the  compensation
         as has been claimed by him since he is not entitled to the same.

      Death of the claimant’s wife due to cumulative effect of negligence :


     35. This Court vide its judgment in Malay Kumar Ganguly’s case (supra)
         has held that:

              “186. A patient would feel the deficiency in  service  having
              regard  to  the  cumulative  effect  of  negligence  of   all
              concerned. Negligence on the part of  each  of  the  treating
              doctors as also the hospital may have been  the  contributing
              factors to the ultimate death of the patient. But, then in  a
              case  of  this  nature,  the  court  must   deal   with   the
              consequences  the  patient  faced,  keeping   in   view   the
              cumulative effect. In the instant case, negligent action  has
              been noticed with respect to  more  than  one  respondent.  A
              cumulative incidence, therefore, has led to the death of  the
              patient.”



      The two words  “may”  and  “cumulative  incidence”  in  the  abovesaid
      observations  of  this  Court  is   relevant   for   determining   the
      quantification of compensation. It is submitted  that  this  Court  is
      also not sure that the negligence solely has contributed to the  death
      of the claimant’s wife. At the most, this Court is of  the  view  that
      the negligence may have contributed to the  death  of  the  claimant’s
      wife. The incidences leading to or contributing to the  death  of  the
      deceased are:
              i) Disease TEN itself is a fatal disease which has  very  high
                 mortality rate.
             ii) TEN itself produces septicemic shock and deceased  Anuradha
                 died because of such consequence.
            iii) No direct treatment or treatment protocol for TEN.
             iv) Negligence of many in treating deceased Anuradha.
              v) Contributory negligence on the part of  Dr.Kunal  Saha  and
                 his brother.



           Furthermore, it is observed factually that lethal combination of
      Cisapride and Fluconazole had been used for a number of days at Breach
      Candy  Hospital  during  her  stay  which  leads  to  cardiac  arrest.
      Therefore, the National Commission ought to have considered  different
      incidences as aforesaid leading to the death of the claimant’s wife so
      as to correctly apportion the individual liability of the doctors  and
      the AMRI Hospital in causing the death of the wife of the claimant.

     36. Further, with regard to the liability of each of the  doctors  and
         the  AMRI Hospital, individual submissions have  been  made  which
         are presented hereunder:


      Civil Appeal No. 692/2012

     37. It is the case of the appellant-AMRI Hospital  that  the  National
         Commission should have taken note of the fact  that  the  deceased
         was initially examined by Dr. Sukumar Mukherjee  and  the  alleged
         medical negligence resulting in the death of the deceased was  due
         to his wrong medication (overdose  of  steroid).   Therefore,  the
         Hospital has little or  minimal  responsibility  in  this  regard,
         particularly, when after admission of the deceased in the Hospital
         there was correct  diagnosis  and  she  was  given  best  possible
         treatment. The  National  Commission  erred  in  apportioning  the
         liability on the Hospital to the extent of 25% of the total award.
          This Court in the earlier round of litigation held that there  is
         no  medical  negligence  by  Dr.  Kaushik  Nandy,   the   original
         respondent No.6 in the complaint, who was also  a  doctor  in  the
         appellant-Hospital.

     38.  Further,  the  learned  senior  counsel  for  the  AMRI  Hospital
         submitted that the arguments advanced on behalf of the appellants-
         doctors Dr. Balram  Prasad   in  C.A.  No.2867/2012,  Dr.  Sukumar
         Mukherjee in C.A. No.858/2012 and Dr. Baidyanath  Haldar  in  C.A.
         731/2012 with regard to percentage, on the basis of costs  imposed
         in  paragraph  196  of  the  judgment  in  the  earlier  round  of
         litigation is without any basis and further submitted  that  under
         the heading – ‘Individual Liability of  Doctors’  findings  as  to
         what was the negligence of the  doctors  and  the  appellant  AMRI
         Hospital is not stated. If  the  said  findings  of  the  National
         Commission are considered, then  it  cannot  be  argued  that  the
         appellant AMRI  Hospital  should  pay  the  highest  compensation.
         Further, the learned senior counsel rebutted the submission of the
         claimant contending that since  he  had  himself  claimed  special
         damages against the appellant-doctors, the Hospital and Dr.  Abani
         Roy Choudhary in the complaint  before  the  National  Commission,
         therefore, he cannot now contend  contrary  to  the  same  in  the
         appeal before this Court.

      CIVIL APPEAL NO. 858 OF 2012

     39. It is the case of the appellant- Dr. Sukumar  Mukherjee  that  the
         National  Commission  while  apportioning  the  liability  of  the
         appellant, has wrongly observed that :
              “Supreme Court has primarily found Dr.Sukumar  Mukherjee  and
              AMRI hospital guilty of negligence and deficient  in  service
              on several counts.  Therefore, going by the said findings and
              observations of Supreme Court we consider it  appropriate  to
              apportion the liability of Dr.  Sukumar  Mukherjee  and  AMRI
              hospital in equal proportion, i.e. each should pay  25%  i.e.
              38,90,000/- of the awarded amount of 1,55,60,000/-.”



     40.  It is submitted by the learned counsel for the  appellant  -  Dr.
         Sukumar Mukherjee that scrutiny of the  judgment  in  Malay  Kumar
         Ganguly’s case (supra) will show that at no place did the  Hon’ble
         Supreme Court made any observation or recorded  any  finding  that
         the  appellant  Dr.  Mukherjee  and  the  Hospital  are  primarily
         responsible. On the contrary, under the heading “Cumulative Effect
         of Negligence” under paras 186 and 187,  this  Hon’ble  Court  has
         held as under:
              “186. A patient would feel the deficiency in  service  having
              regard  to  the  cumulative  effect  of  negligence  of   all
              concerned.  Negligence on the part of each  of  the  treating
              doctors as also  the  hospital  may  have  been  contributing
              factors to the ultimate death of the patient.  But, then in a
              case  of  this  nature,  the  court  must   deal   with   the
              consequences the patient faced keeping in view the cumulative
              effect. In  the  instant  case,  negligent  action  has  been
              noticed  with  respect  to  more  than  one  respondent.    A
              cumulative incidence, therefore, has led to the death of  the
              patient.


              187. It is to be noted that doctrine of cumulative effect  is
              not available in criminal law.  The complexities involved  in
              the instant case  as  also  differing  nature  of  negligence
              exercised by various actors, make it very difficult to distil
              individual extent of negligence with respect to each  of  the
              respondent.  In such a scenario finding of medical negligence
              under Section 304-A cannot be objectively determined.”



     41.  It is further submitted by the learned counsel for the appellant-
         Dr. Sukumar Mukherjee that the wife of the claimant was  suffering
         from rash/fever from April 1998, she was seen  by  the  appellant-
         Dr.Sukumar Mukherjee only  on  three  occasions  before  his  pre-
         planned visit to the U.S.A. for  attending  a  medical  conference
         i.e. on 26.4.1998, 7.5.1998 and on the night of 11.5.1998 and then
         the appellant-Dr.Mukherjee left India for USA  and  returned  much
         after the demise of the claimant’s wife.  On her first examination
         on 26.4.1998  the  appellant  suggested  a  host  of  pathological
         tests. The patient was requested to visit the  Doctor  with  these
         reports. No drugs were prescribed by the appellant-Dr.Mukherjee at
         this examination. On  7.5.1998,  Anuradha  Saha  walked  into  the
         clinic of the appellant-Dr.Mukherjee at  9.30  p.m.  and  reported
         that she was  uncomfortable  because  she  had  consumed  food  of
         Chinese cuisine. The appellant-Dr.Mukherjee noticed that there was
         a definite change  in  the  nature  of  the  rash.  Based  on  the
         information furnished and the status and condition of the patient,
         she was diagnosed to be suffering from allergic vasculitis and the
         appellant-Dr.Mukherjee  commenced  treating   the   patient   with
         Depomedrol, which is a drug belonging to the family  of  steroids.
         The appellant-Dr.Mukherjee recommended Depomedrol 80  mg.IM  twice
         daily for 3 days  to  be  reconsidered  after  Anuradha  Saha  was
         subject to further review. Depomedrol is very  much  indicated  in
         Vasculitis (USPDI 1994): “Depomedrol is  anti-inflammatory,  anti-
         allergic drug. Therefore, it  is  Doctor’s  judgment  to  use  the
         drug.” The appellant-Dr.Mukherjee administered  one  injection  of
         Depomedrol on the night of 7.5.1998. He  did  not  administer  any
         other  injections  to  the  deceased  thereafter.  It  is  further
         submitted  that  much  higher  dose  of   Depomedrol   have   been
         recommended  in  USPDI  1994  and  CDRom  Harisons  Principles  of
         Medicine 1998 in by pass skin  diseases  like  multiple  sclerosis
         with a dose of 177.7 mg daily for 1 week and 71 mg on every  other
         day for one month.

     42. On 11.5.1998 when  the  appellant-Dr.Mukherjee  examined  Anuradha
         Saha at the AMRI Hospital prior to his  departure  to  U.S.A.,  he
         prescribed a whole line of treatment and  organized  reference  to
         different   specialists/consultants.   He   recommended    further
         pathological tests because on examining the patient at  the  AMRI,
         he noticed that she had some blisters which were not  peeled  off.
         There was no detachment of skin  at  all.  He  also  requested  in
         writing the treating  consultant  physician  of  AMRI  Dr.  Balram
         Prasad, MD  to  organize  all  these  including  referral  to  all
         specialists. The appellant-Dr.Mukherjee suspected continuation  of
         allergic Vasculitis in aggravated form and prescribed steroids  in
         a tapering dose on 11.5.1998 and  advised  other  tests  to  check
         infection and any immuno abnormalities.  It  is  stated  that  the
         appellant-Dr.Mukherjee did not examine the patient thereafter  and
         as aforementioned, he left on a pre-arranged visit to U.S.A. for a
         medical  conference.  No  fees  were  charged  by  the  appellant-
         Dr.Mukherjee. It is further submitted that before  the  appellant-
         Dr.Mukherjee started the  treatment  of  the  deceased,  Dr.Sanjoy
         Ghose on 6.5.1998 treated her and during the period  of  treatment
         of the appellant-Dr. Mukherjee  from  7.5.1998  to  11.5.1998,  on
         9.5.1998 Dr.Ashok Ghosal (Dermatologist)  treated  Anuradha  Saha.
         These  facts  were  not  stated  in  the  complaint  petition  and
         concealed by the claimant. To this aspect, even this Hon’ble Court
         has also recorded a finding in the case referred to supra that the
         patient was also examined by two consultant dermatologists Dr.A.K.
         Ghosal and Dr. S. Ghosh who diagnosed the disease to be a case  of
         vasculitis.

     43. It is further submitted by the learned counsel for the  appellant-
         Dr. Mukherjee that the cause of death as  recorded  in  the  death
         certificate of the deceased is “septicemic shock with multi system
         organ failure in a case  of  TEN  leading  to  cardio  respiratory
         arrest”.  Blood culture was negative prior to death.  There was no
         autopsy to confirm the diagnosis at Breach Candy Hospital, Mumbai.
          Dr. Udwadia observed on 27.5.1998 that the patient has  developed
         SIRS in absence of infection  in  TEN.   The  patient  expired  on
         28.5.1998 and the death certificate was written by a junior doctor
         without the comments of Dr.  Udwadia.   It  is  submitted  by  the
         learned counsel that there  is  neither  any  allegation  nor  any
         finding by this Court that the doctors of the  AMRI  Hospital  had
         contributed to septicemia.  The mere finding that the patient  was
         not properly dressed at AMRI Hospital where she stayed for only  6
         days of early evocation of the disease do not justify contribution
         to septicemic shock of the deceased.  Further, there is no  record
         to show that at AMRI Hospital the skin of the patient  had  peeled
         out thereby leading to chance of  developing  septicemia.  On  the
         other hand, it is a fact borne out from record  that  the  patient
         was taken in a chartered flight to Breach Candy  Hospital,  Bombay
         against the advice of the doctors at Kolkata and  further  nothing
         is borne out from the records as what precaution were taken by the
         claimant while  shifting  the  patient  by  Air  to  Breach  Candy
         Hospital thereby leading to the conclusion that during the  travel
         by chartered flight she might have  contracted  infection  of  the
         skin leading to septicemia. It is further submitted by the learned
         counsel for the appellant- Dr. Sukumar  Mukherjee  that  the  fact
         that the  disease TEN requires higher degree of care  since  there
         is no definite  treatment,  such  high  degree  of  care  will  be
         relatable  to  comfort  but  not  definitely  to  septicemia  that
         occurred at Breach Candy Hospital. Hence,  negligence  has  to  be
         assessed for damages for failure to provide comfort to the patient
         and not  a  contributory  to  septicemia  shock  suffered  by  the
         deceased.

     44. It is submitted by the learned counsel for  appellant-Dr.  Sukumar
         Mukherjee that there is no finding or  allegation  that  the  drug
         Depomedrol prescribed by  the  appellant-Dr.Mukherjee  caused  the
         disease TEN.  The appellant advised a number  of  blood  tests  on
         11.5.98 in AMRI  Hospital  to  detect  any  infection  and  immune
         abnormality due to steroids and to  foresee  consequences.  It  is
         further submitted that Breach Candy Hospital records show that the
         patient was haemo-dynamically stable.  Even Dr.Udwadia  of  Breach
         Candy Hospital on 17.5.1998  doubted  with  regard  to  the  exact
         disease and recorded the disease as TEN or Steven Johnson Syndrom.

           Therefore, the National  Commission  ought  to  have  considered
      different  incidences  as  aforesaid  leading  to  the  death  of  the
      claimant’s wife and the quantum of damages shall have  to  be  divided
      into five  parts  and  only  one  part  shall  be  attributed  to  the
      negligence of the appellant-Dr.Mukherjee.


      Civil Appeal No. 2867 of 2012

     45. It is the case of Dr. Balram Prasad-appellant in Civil Appeal  No.
         2867 of 2012 that on 11.05.1998,  Dr.  Sukumar  Mukherjee,  before
         leaving for U.S.A., attended the patient at the AMRI  Hospital  at
         2.15 p.m. and after examining the deceased, issued the second  and
         last  prescription  on  the  aforesaid  date  without  prescribing
         anything different but re-assured the patient that  she  would  be
         fine in a few  weeks’  time  and  most  confidently  and  strongly
         advised her to continue with the said injection for at least  four
         more  days.  This  was  also  recorded  in  the   aforesaid   last
         prescription of the said date. Further, it is stated that  without
         disclosing that he would be out of India from 12.05.1998, he asked
         the deceased to consult the named Dermotologist,  Dr.  B.Haldar  @
         Baidyanath Haldar, the appellant in Civil Appeal No. 731 of  2012,
         and the physician Dr. Abani Roy Chowdhury in his last prescription
         on the last visit of the deceased. Most culpably, he did not  even
         prescribe I.V. Fluid and adequate nutritional  support  which  was
         mandatory in that condition.  Dr. Haldar took over  the  treatment
         of the  deceased  as  a  Dermatologist  Head  and  Dr.  Abani  Roy
         Chowdhury as Head of the Medical Management from  12.05.1998  with
         the positive knowledge and treatment background that  the  patient
         by then already had clear intake of 880 mg of Depomedrol injection
         as would be evident from AMRI’s treatment sheet dated 11.05.1998.

     46. It is further stated by  the  claimant  in  the  complaint  lodged
         before National Commission that it contained specific averments of
         negligence against the appellant-doctors.  The  only  averment  of
         alleged negligence was contained in paragraph 44 of the  complaint
         which reads as under:


              “44. That Dr. Balram Prasad as attending  physician  at  AMRI
              did do nothing better.  He did  not  take  any  part  in  the
              treatment of the patient although  he  stood  like  a  second
              fiddle to the main team headed by the opposite  party  No.  2
              and 3.   He never suggested even faintly that AMRI is not  an
              ideal place for treatment of TEN patient; on the converse, he
              was full of praise  for  AMRI  as  an  ideal  place  for  the
              treatment of TEN patients knowing nothing how a  TEN  patient
              should be treated.”




     47. The claimant has also placed strong reliance upon the answer given
         by him to question No. 26 in his  cross  examination  which  reads
         thus:


                 “Q.No.26. Dr. Prasad says that Depomedrol dose according to
                 the treatment  sheet  of  the  AMRI  Hospital,  he  made  a
                 specific suggestion that the dose should be limited to that
                 particular day only. Is it correct?


                 Ans.  It is all matter of record. Yeah, he said one day  in
                 AMRI record.”




     48. Though,  the  appellant-Dr.  Balram  Prasad  was  accused  in  the
         criminal complaint lodged by the claimant he was neither proceeded
         against as an accused in the criminal  complaint  nor  before  the
         West Bengal Medical Council but was named as a witness.   Further,
         it is stated by the claimant that he  urged  before  the  National
         Commission as well as before this Court in unequivocal terms  that
         the bulk of the compensation awarded  would  have  to  be  in  the
         proportion of 80%  on  the  AMRI  Hospital,  15%  on  Dr.  Sukumar
         Mukherjee and balance between  the  rest.  Despite  the  aforesaid
         submission before the National  Commission,  the  claimant  claims
         that it has erred in awarding  the  proportion  of  the  liability
         against each of the appellant-doctors in a manner mentioned in the
         table which is provided hereunder:
| NAME OF THE PARTY            |AMOUNT TO BE PAID                   |
|Dr. Sukumar Mukherjee         |Compensation:Rs.38,90,000           |
|                              |Cost of litigation:1,50,000         |
|Dr. Baidyanath Haldar         |Compensation:Rs.25,93,000           |
|                              |Cost of litigation: Rs.1,00,000     |
|Dr. Abani Roy Chowdhury (since|Compensation: 25,00,000             |
|deceased) (claim foregone)    |                                    |
|AMRI Hospital                 |Compensation: Rs.38,90,000          |
|                              |Cost of litigation: Rs.1,50,000     |
|Dr. Balram Prasad             |Compensation: Rs.25,93,000          |
|                              |Cost of litigation: Rs.1,00,000     |


     49. The appellant-Dr.  Balram  Prasad  in  Civil  Appeal  No.2867/2012
         contends that he was the junior most attending physician  attached
         to the Hospital, he was not called upon to prescribe medicines but
         was  only  required  to  continue  and/or  monitor  the  medicines
         prescribed by the specialist in the discipline.  But realizing the
         seriousness of the patient, the appellant had himself referred the
         patient  to  the  three  specialists  and   also   suggested   for
         undertaking a skin biopsy. The duty of care ordinarily expected of
         a  junior  doctor  had  been  discharged  with  diligence  by  the
         appellant. It is further contended that in  his  cross-examination
         before the National Commission  in  the  enquiry  proceeding,  the
         claimant himself has admitted that the basic fallacy was committed
         by three physicians, namely, Dr. Mukherjee, Dr. Haldar and Dr. Roy
         Chowdhury. The above facts would clearly show that the role played
         by the appellant-Doctors in the treatment of the deceased was only
         secondary and the same had been discharged with reasonable and due
         care expected of an attending physician in  the  given  facts  and
         circumstances of the instant case.

     50. In the light of the above facts and circumstances, the  contention
         of the claimant that the death of the claimant’s wife was  neither
         directly nor contributorily relatable to the alleged negligent act
         of the appellant- Dr.  Balram  Prasad,  it  is  most  respectfully
         submitted that  the  National  Commission  was  not  justified  in
         apportioning the damages in the manner as has  been  done  by  the
         National Commission to place the appellant on the same footing  as
         that of Dr. Baidyanath Haldar, who was a senior  doctor  in-charge
         of the management/treatment of the deceased.

     51. The learned senior counsel for  the  appellant-Dr.  Balram  Prasad
         further urged that the National Commission has also erred  in  not
         taking into account the submissions of the claimant  that  80%  of
         the damages ought to have been levied on the Hospital, 15% on  Dr.
         Sukumar Mukherjee and the balance between the rest.  It  is  urged
         that the proportion of the  compensation  amount  awarded  on  the
         appellant is excessive and unreasonable which is beyond  the  case
         of the claimant himself.

      CIVIL APPEAL NO. 731 OF 2012


     52. The learned counsel Mr. Ranjan Mukherjee appearing  on  behalf  of
         the appellant in this appeal has filed the written submissions  on
         15.4.2013. He has reiterated his  submission  in  support  of  his
         appeal filed by the said doctor and has also adopted the arguments
         made in support of the written submissions filed on behalf of  the
         other doctors and AMRI Hospital by way of  reply  to  the  written
         submissions of the claimant.  Further, he has submitted  that  the
         appellant Dr. Baidyanath Haldar is about 80 years  and  is  ailing
         with heart disease and no more in active practice.  Therefore,  he
         requested to set  aside  the  liability  of  compensation  awarded
         against him by allowing his appeal.
           All the doctors and the Hospital urged more  or  less  the  same
      grounds.


      Civil Appeal No. 2866 of 2012


     53.  This appeal has been filed by the claimant. It is  the  grievance
         of the claimant that the National Commission  rejected  more  than
         98% of the total  original  claim  of  Rs.77.7  crores  which  was
         modified to Rs.97.5 crores later on by  adding  “special  damages”
         due to further economic loss, loss of employment, bankruptcy  etc.
         suffered by the claimant in the course of 15-year  long  trial  in
         relation to  the  proceedings  in  question  before  the  National
         Commission and this Court.   The  National  Commission  eventually
         awarded compensation of only Rs.1.3 crores after reducing from the
         total award of Rs.1.72 crores on the ground that the claimant  had
         “interfered” in the treatment of his wife and  since  one  of  the
         guilty doctors had already expired, his share of compensation  was
         also denied.

     54. Therefore, the present appeal  is  filed  claiming  the  just  and
         reasonable compensation urging the following grounds:
           a) The National Commission has failed to consider the pecuniary,
              non-pecuniary and special damages as extracted hereinbefore.

           b)  The  National  Commission  has  made   blatant   errors   in
              mathematical calculation while  awarding  compensation  using
              the multiplier method which is not the correct approach.

           c) The National Commission has erroneously used  the  multiplier
              method to determine compensation for the first time in Indian
              legal history  for  the  wrongful  death  caused  by  medical
              negligence of the appellant-doctors and the AMRI Hospital.

           d) The National Commission has reinvestigated  the  entire  case
              about medical negligence and  went  beyond  the  observations
              made by this Court in Malay Kumar Ganguly’s case  (supra)  by
              holding that the claimant  is  also  guilty  for  his  wife’s
              death.

           e) The National Commission has failed to grant any  interest  on
              the compensation though the litigation has taken more than 15
              years to determine and award compensation.

           f)  The  National  Commission  has  failed   to   consider   the
              devaluation of money as a result of “inflation” for  awarding
              higher compensation that was sought for in 1998.

           g) It is also vehemently contended  by  the  claimant  that  the
              National  Commission  has  made  blatant  and   irresponsible
              comment on him stating that he was trying to “make a  fortune
              out of a misfortune.”  The said remark must be expunged.

     55. The appellant-doctors and the AMRI  Hospital  contended  that  the
         compensation claimed by the claimant  is  an  enormously  fabulous
         amount and should  not  be  granted  to  the  claimant  under  any
         condition. This contention ought  to  have  been  noticed  by  the
         National Commission that it is wholly untenable in law in view  of
         the Constitution Bench decision of  this  Court  in  the  case  of
         Indian Medical Association Vs. V.P.  Shantha  &  Ors[15],  wherein
         this Court has categorically disagreed on this specific  point  in
         another case wherein “medical negligence” was  involved.   In  the
         said decision, it has been held at paragraph 53  that  to  deny  a
         legitimate claim or to restrict arbitrarily the size of  an  award
         would amount to substantial injustice to the claimant.

     56. Further, in a three Judge Bench decision of this  Court  in  Nizam
         Institute’s case(supra) it has been held that if a  case  is  made
         out by the claimant, the court  must  not  be  chary  of  awarding
         adequate compensation.  Further, the claimant contends  that  this
         Court has recently refused to quash the defamation  claim  to  the
         tune of Rs.100 crores in Times Global Broadcasting Co. Ltd. & Anr.
         Vs. Parshuram Babaram Sawant [SLP (Civil) No(s) 29979/2011 decided
         on 14-11-2011], suggesting that in  appropriate  cases,  seemingly
         large amount of compensation is justified.

     57. The claimant further urged that this is the fundamental  principle
         for awarding “just compensation” and this Court has  categorically
         stated while remanding the case back to  the  National  Commission
         that the principle of just compensation is based on “restitutio in
         integrum”, i.e. the claimant must receive the sum of  money  which
         would put him in the same position as he would have been if he had
         not sustained  the  wrong.   It  is  further  contended  that  the
         claimant had  made  a  claim  referred  to  supra  under  specific
         headings in great detail with justification for each of the heads.
         Unfortunately, despite referring to judicial notice and  the  said
         claim-table in its final judgment,  the  National  Commission  has
         rejected the entire claim  on  the  sole  ground  that  since  the
         additional claim was not pleaded earlier, none of the claims  made
         by the  claimant  can  be  considered.   Therefore,  the  National
         Commission was wrong in rejecting  different  claims  without  any
         consideration and in assuming that the claims made by the claimant
         before the Tribunal cannot be changed or  modified  without  prior
         pleadings under any other condition. The said view of the National
         Commission is contrary to the numerous following decisions of this
         Court which have opined otherwise:-

      Ningamma and Anr. Vs. United India Insurance Company  Ltd.[16],  Malay
      Kumar  Ganguly’s  case  referred  to  supra,  Nizam  Institute’s  case
      (supra), Oriental Insurance Company Ltd. Vs. Jashuben & Ors.  (supra),
      R.D. Hattangadi Vs. Pest Control (India) Pvt.  Ltd.  &  Ors[17],   Raj
      Rani & Ors Vs. Oriental Insurance Company Ltd. &  Ors[18].,  Laxman  @
      Laxman Mourya Vs. Divisional Manager Vs. Oriental  Insurance Co.  Ltd.
      & Anr.[19] and Ibrahim Vs. Raju & Ors. (supra).

     58. The claimant has further argued that  the  just  compensation  for
         prospective loss of income of  a  student  should  be  taken  into
         consideration by the National Commission.  In this regard, he  has
         contended that this Court while remanding the  case  back  to  the
         National  Commission  only  for  determination   of   quantum   of
         compensation, has made categorical observations that  compensation
         for the loss of wife to a husband must depend on her  “educational
         qualification, her own upbringing, status, husband’s income, etc.”
          In this regard,  in  the  case  of  R.K.  Malik  &  Anr.  (supra)
         (paragraphs 30-32) this Court has also expressed similar view that
         status, future prospects and  educational  qualification  must  be
         judged for deciding adequate compensation. It is contended by  the
         claimant that it is an undisputed fact that  the  claimant’s  wife
         was a recent graduate in Psychology from a highly prestigious  Ivy
         League School in New York who had a brilliant future ahead of her.
          Unfortunately, the National Commission has calculated the  entire
         compensation and prospective loss of income solely based on a  pay
         receipt of the victim showing a paltry income of  only   $  30,000
         per year, which she was earning as a graduate student.   This  was
         a grave error on the part of the National Commission,  especially,
         in view of the observations made by this  Court  in  the  case  of
         Arvind Kumar Mishra Vs. New India Assurance Co.[20],  wherein this
         Court has calculated quantum of compensation based on ‘reasonable’
         assumption about  prospective loss as to how much  an  Engineering
         student from BIT might have earned in future even in  the  absence
         of any expert’s opinion (paragraphs  13,14).   The  principles  of
         this case were followed in many other cases namely, Raj Kumar  Vs.
         Ajay Kumar & Anr.[21], Govind Yadav Vs. New  India  Insurance  Co.
         Ltd.[22], Sri Ramachandrappa Vs. Manager, Royal Sundaram  Alliance
         Insurance[23],     Ibrahim Vs. Raju & Ors. (supra),Laxman @ Laxman
         Mourya Vs. Divisional Manager, Oriental Insurance Co. Ltd. (supra)
         and Kavita Vs. Dipak & Ors.[24]

     59. In view of the above said decisions of this Court, the prospective
         loss of income for the wrongful death of claimant’s wife  must  be
         reasonably judged based on her future potential in the U.S.A. that
         has also been calculated scientifically by economic expert,  Prof.
         John F. Burke.

     60. It  is  further  the  case  of  the  claimant  that  the  National
         Commission has completely failed to award “just compensation”  due
         to non consideration of all the following critical factors:
              1) The Guidelines provided by Supreme Court:  This  Court  has
                 provided guidelines  as  to  how  the  National  Commission
                 should  arrive  at   an   “adequate   compensation”   after
                 consideration of the unique nature of the case.
              2) Status and qualification of the victim and her husband.
              3) Income and standard of living in the U.S.A.:  As  both  the
                 deceased and the claimant   were  citizens  of  U.S.A.  and
                 permanently settled as  a  “child  psychologist”  and  AIDs
                 researcher, respectively, the compensation in  the  instant
                 case must be calculated in terms of the status and standard
                 of  living  in  the  U.S.A..  In  Patricia  Mahajan’s  case
                 (supra), where a 48 year old US  citizen  died  in  a  road
                 accident in India, this Court has awarded a compensation of
                 more than Rs. 16 crores after holding that the compensation
                 in such cases must consider the high status and standard of
                 living in the country where the victim  and  the  dependent
                 live.
              4) Economic expert from the U.S.A.:
           The claimant initially filed a  complaint  before  the  National
           Commission soon after the wrongful death of  his  wife  in  1998
           with a total claim of  Rs.77.7  crores  against  the  appellant-
           doctors and AMRI Hospital which  was  rejected  and  this  Court
           remanded  this   matter   to   the   National   Commission   for
           determination of the quantum of  compensation  with  a  specific
           direction in  the  final  sentence  of  judgment  that  “foreign
           experts” may be examined through video conferencing.
              5) Scientific calculation of loss  of  income:   The  National
                 Commission  should   have   made   scientific   calculation
                 regarding  the  loss  of  income  of  the  claimant.   This
                 direction has been given by  this  Court  in  a  number  of
                 cases.  Further, he has contended that the  claimant  moved
                 this Court for video conferencing.  The  claimant  examined
                 Prof.  John  F.  Burke,  a  U.S.A.   based   Economist   of
                 international repute, in May-June, 2011. Prof John F. Burke
                 was also cross-examined by the  appellant-doctors  and  the
                 AMRI Hospital. Prof. Burke  scientifically  calculated  and
                 testified himself under direct as well as cross-examination
                 as to how he came to  calculate  the  prospective  loss  of
                 income  for  a  similarly  situated  person  in  U.S.A.  as
                 Anuradha, the deceased and categorically  stated  that  the
                 direct loss of income for Anuradha’s premature death  would
                 amount to “5 million and 125 thousand dollars”.  This  loss
                 of income was calculated after deduction of  1/3rd  of  the
                 amount for her personal expenses. 1/3rd deduction of income
                 for personal  expenses  has  also  been  recommended  in  a
                 judgment of this Court in the case of Sarla Verma  (supra).
                 Prof. Burke has also explained how he calculated  the  loss
                 of income due  to  the  premature  death  of  Anuradha  and
                 further  testified  that  his  calculation  for   loss   of
                 Anuradha’s income was a “very  conservative  forecast”  and
                 that to some other estimates, the  damages  for  Anuradha’s
                 death could be “9 to 10 million dollars.  While the loss of
                 income would be multi million dollars as  direct  loss  for
                 wrongful death of Anuradha, it may  appear  as  a  fabulous
                 amount in the context of  India.  This  is  undoubtedly  an
                 average and legitimate claim in the context of the  instant
                 case.  And further, it may be noted that far bigger amounts
                 of compensation are routinely  awarded  by  the  courts  in
                 medical negligence cases in the U.S.A.  In this regard this
                 Court also made very clear observation  in  Indian  Medical
                 Association Vs. V.P. Shanta & Ors.(supra), that to  deny  a
                 legitimate claim or to restrict arbitrarily the size of  an
                 award would amount to substantial injustice.
              6) Loss of income of claimant:
           The National Commission has ignored the loss of  income  of  the
           claimant  though  this  Court  has  categorically  stated  while
           remanding the case to the National Commission that pecuniary and
           non-pecuniary losses and future losses “up to the date of trial”
           must be considered for the quantum of compensation. The claimant
           had incurred a huge amount of expenses in the course of the more
           than 15 years long trial in the  instant  case.  These  expenses
           include the enormous cost for legal expenses as well as expenses
           for the numerous trips between India and  the  U.S.A.  over  the
           past more than 12 years. In addition to that  the  claimant  has
           also suffered huge losses during this period, both  direct  loss
           of income from his job in U.S.A. as well as  indirect  loss  for
           pain and intense mental agony for tenure denial and  termination
           of his employment at Ohio State University  (OSU)  which  was  a
           direct result of the wrongful death  of  Anuradha  in  India  as
           would be evident from the judgment passed by the Court of Claims
           in Ohio which was filed by the AMRI Hospital on July  18,  2011.
           The claimant also submitted an  affidavit  as  directed  by  the
           National Commission in which the detailed description about  the
           loss that he suffered in his personal as  well  as  professional
           career in U.S.A. over the past 12 years for the  wrongful  death
           of Anuradha, has been mentioned.  Needless  to  say  that  these
           additional  damages  and  financial  losses  the  claimant   has
           suffered since he  filed  the  original  complaint  against  the
           appellant-doctors could not possibly be a part of  the  original
           claim filed by him 15 years ago.


     61. In view of the circumstances  narrated  above,  the  claimant  has
         referred a revised quantum of claim which also includes a detailed
         break-up of the individual items of  the  total  claim  in  proper
         perspective under separate headings of  pecuniary,  non-pecuniary,
         punitive and special damages.  The individual items of claim  have
         also been justified with  appropriate  references  and  supporting
         materials as needed. The total quantum of claim for  the  wrongful
         death of the  claimant’s  wife  now  stands  at  Rs.97,56,07,000/-
         including pecuniary damages of  Rs.34,56,07,000/-,  non  pecuniary
         damages of Rs.31,50,00,000/-, special damages of US $  1,000,000/-
         for loss of job in Ohio and punitive damages of US  $  1,000,000/.
         This updated break-up of the total claim has  been  shown  in  the
         claim-table referred to in the later part  of  the  judgment.  The
         claimant respectfully submits that the National Commission  should
         have considered this total claim in conjunction with the affidavit
         filed by him during the course  of  making  final  arguments.  The
         National Commission also should have taken into consideration  the
         legal principles laid down in the case of Nizam Institute  (supra)
         wherein this Court allowed the claim  of  compensation  which  was
         substantially higher than the original  claim  that  he  initially
         filed in the court. Further, the National Commission ought to have
         taken into consideration the observations made in the remand order
         passed by this Court while determining the quantum of compensation
         and the legitimate expectation for the wrongful death of a patient
         ‘after  factoring in the position  and  stature   of  the  doctors
         concerned  as also the Hospital’. This Court also  held  in  Malay
         Kumar Ganguly’s  case  (supra)  that  AMRI  is  one  of  the  best
         Hospitals in Calcutta, and that the doctors were the best  doctors
         available. Therefore, the compensation in the instant case may  be
         enhanced in view of the specific observations made by this Court.

     62. Appellant-doctors Dr. Sukumar Mukherjee and Dr. Baidyanath  Haldar
         have attempted to claim in  their  respective  appeals  that  they
         cannot be penalized with compensation because they did not  charge
         any fee for treatment of the deceased.  Such a claim has no  legal
         basis as in view of the  categorical  observations  made  by  this
         Court in Savita Garg Vs. Director,  National  Heart  Institute[25]
         and in Malay Kumar Ganguly’s case (supra) wherein this  Court  has
         categorically stated that the aforesaid principle in Savita Garg’s
         case  applies to the present case also insofar as it  answers  the
         contentions raised before us that the three senior doctors did not
         charge any professional fees.

     63. Further, it is contended by the claimant that  from  a  moral  and
         ethical perspective, a doctor cannot escape liability for  causing
         death of a patient from medical negligence on the ground  that  he
         did not charge any fee.  If that was true, poor patients  who  are
         sometimes  treated  for  free  and  patients  in  many  charitable
         Hospitals would be killed with impunity  by  errant  and  reckless
         doctors. It is urged that the National Commission  ought  to  have
         considered the claim made for prospective loss of  income  of  the
         appellant’s wife and has committed error in rejecting the same and
         it has also rejected the amount of the pecuniary  losses  of  this
         claimant under separate headings which are mentioned in the  table
         referred to  supra  including  expenses  that  were  paid  at  the
         direction of the National Commission, namely, expenses relating to
         video-conferencing or payment for the Court  Commissioners.   Most
         of these direct losses were suffered by the claimant as  a  result
         of the wrongful death of his wife in the long  quest  for  justice
         over the past 15 years as a result of the wrongful  death  of  his
         wife. The National Commission did not provide any reason as to why
         the said claims were denied to him, as per this  Court’s  decision
         in Charan Singh Vs. Healing Touch Hospital[26].

     64. It is further urged by the claimant that the National  Commission,
         in applying the  multiplier  method  as  provided  in  the  Second
         Schedule under Section  163  A  of  the  Motor  Vehicles  Act,  is
         erroneous to calculate compensation in relation to  death  due  to
         medical negligence.

     65. Further, the claimant has taken support from the following medical
         negligence cases decided by this Court. It was  contended  by  the
         claimant that out of these cases not a single case was decided  by
         using the multiplier method, such as,  Indian  Medical  Assn.  Vs.
         V.P. Shanta & Ors.(supra),  Spring  Meadows  Hospital  &  Anr  Vs.
         Harjol Ahluwalia[27], Charan Singh  Vs. Healing Touch Hospital and
         Ors.(supra), J.J. Merchants & Ors. Vs. Srinath Chaturbedi (supra),
         Savita Garg Vs. Director National Heart Institute  (supra),  State
         of  Punjab Vs. Shiv Ram  &  Ors.(supra),   Samira  Kohli  Vs.  Dr.
         Prabha Manchanda & Anr.(supra), P.G. Institute of Medical Sciences
         Vs. Jaspal Singh & Ors.,  (supra)  Nizam   Institute  Vs.  Prasant
         Dhananka (supra) Malay Kumar Ganguly Vs. Sukumar Mukherjee &  Ors.
         (supra) and V. Kishan Rao Vs. Nikhil  Superspeciality  Hospital  &
         Anr. (supra).

     66. In fact, the National Commission or any other  consumer  court  in
         India have never used the multiplier system to calculate  adequate
         compensation for death or injury caused due to medical  negligence
         except when the National Commission decided  the  claimant’s  case
         after it was remanded back by this Court.   Reliance   was  placed
         upon Sarla Verma’s case  (supra)  at  paragraph  37,  wherein  the
         principle laid down for determining compensation using  multiplier
         method does not apply even in accident cases under Section 166  of
         the MV Act.  In contrast to death from road or other accident,  it
         is urged that death or permanent injury to a patient  caused  from
         medical   negligence   is   undoubtedly   a   reprehensible   act.
         Compensation for death of a patient from medical negligence cannot
         and should not be  compensated  simply  by  using  the  multiplier
         method. In support of this contention he has placed reliance  upon
         the Nizam Institute’s case (supra) at paragraph  92,  wherein  the
         Court has rejected the specific claim made by the guilty  Hospital
         that multiplier should be used to calculate compensation  as  this
         Court has held  that such a  claim has absolutely no merit.

     67. The multiplier method was  provided  for  convenience  and  speedy
         disposal of no fault motor accident cases.  Therefore,  obviously,
         a “no fault” motor vehicle accident should not  be  compared  with
         the case of death from medical negligence under any condition. The
         aforesaid approach in adopting the multiplier method to  determine
         the just compensation would be damaging for society for the reason
         that the rules for using the multiplier  method  to  the  notional
         income  of  only  Rs.15,000/-  per  year  would  be  taken  as   a
         multiplicand. In case, the victim has no income then a  multiplier
         of 18 is the  highest  multiplier  used  under  the  provision  of
         Sections 163 A of the Motor Vehicles  act  read  with  the  Second
         Schedule. Therefore, if a child, housewife  or  other  non-working
         person fall  victim  to  reckless  medical  treatment  by  wayward
         doctors, the maximum pecuniary damages that the unfortunate victim
         may collect would be only Rs.1.8 lakh. It is stated in view of the
         aforesaid reasons that in today’s India, Hospitals, Nursing  Homes
         and doctors make lakhs and crores of rupees on  a  regular  basis.
         Under such scenario, allowing the multiplier method to be used  to
         determine compensation in medical negligence cases would not  have
         any deterrent effect on them for their medical negligence  but  in
         contrast,  this  would  encourage  more   incidents   of   medical
         negligence in India bringing even greater danger for  the  society
         at large.

     68. It is further urged by the claimant that the  National  Commission
         has failed to award any compensation  for  the  intense  pain  and
         suffering that the claimant’s  wife  had  to  suffer  due  to  the
         negligent treatment by doctors and AMRI Hospital but the  National
         Commission had made a paltry award equivalent to $ 20,000 for  the
         enormous and life-long pain, suffering, loss of companionship  and
         amenities that the unfortunate claimant has  been  put  throughout
         his life by  the  negligent  act  of  the  doctors  and  the  AMRI
         Hospital.

     69. The claimant further contended that  he  is  entitled  to  special
         damages for losses that he suffered upto the date of trial as held
         by this Court while remanding this matter in Malay Kumar Ganguly’s
         case back to the National Commission.  Thus, the claimant filed  a
         legitimate claim for special damages for the losses  sustained  by
         him in the course of 15 years long trial including the loss of his
         employment at the Ohio State University and resultant position  of
         bankruptcy and home foreclosure. The National Commission  did  not
         provide any reason for  rejecting  the  said  claim  which  is  in
         violation of the observations made in Charan Singh’s case (supra).

     70.  Further,  this  Court  has  affirmed  the   principle   regarding
         determination of just compensation in  the  following  cases  that
         inflation  should  be  considered  while   deciding   quantum   of
         compensation: Reshma Kumari & Ors. Vs. Madan Mohan & Anr. (supra),
         Govind Yadav Vs. New Indian Insurance Co. Ltd. (supra)and  Ibrahim
         Vs. Raju & Ors. (supra).

     71.  Using the cost of inflation index (in short C.I.I.) as  published
         by the Govt. of India, the original claim of Rs.77.7  crores  made
         by the claimant in 1998   would be equivalent to  Rs.188.6  crores
         as of 2012-2013. The mathematical calculation in this  regard  has
         been presented in the short note submitted by the claimant.  Thus,
         the compensation payable for the wrongful death of claimant’s wife
         would stand today at Rs.188.6 crores and  not  Rs.77.7  crores  as
         originally  claimed  by  him   in   1998   without   taking   into
         consideration the various relevant aspects referred to  supra  and
         proper guidance and advice in the matter.

     72. Further, it is urged by  the  claimant  that  he  is  entitled  to
         interest on the compensation at reasonable rate  as  the  National
         Commission has awarded interest @ 12% but only in case of  default
         by the appellant-  doctors  and  the  AMRI  Hospital  to  pay  the
         compensation within 8 weeks after the judgment which was delivered
         on October 21, 2011.  That means, the National Commission did  not
         grant any interest for the  last  15  years  long  period  on  the
         compensation awarded in favour of the claimant as  this  case  was
         pending before the judicial system in India for which the claimant
         is not responsible.  The said act is contrary to the  decision  of
         this Court in Thazhathe Purayil Sarabi & Ors. Vs. Union of India &
         Anr.[28].

     73.  He has also placed reliance upon in justification of his claim of
         exemplary or punitive damages.  A  claim  of  US  $  1,000,000  as
         punitive damages has been made against the AMRI Hospital  and  Dr.
         Sukumar Mukherjee as provided in the table.  In  support  of  this
         contention he placed strong reliance  on  Landgraf  Vs.  USI  Film
         Prods[29] and this Court’s decision in Destruction of  Public  and
         Private Properties Vs. State of A.P.[30], wherein it is held  that
         punitive or exemplary damages have been justifiably awarded  as  a
         deterrent in the future for outrageous and  reprehensible  act  on
         the part of the accused. In fact punitive  damages  are  routinely
         awarded in medical  negligence  cases  in  western  countries  for
         reckless and reprehensible act by  the  doctors  or  Hospitals  in
         order to send a deterrent message to other members of the  medical
         community. In a similar  case,  the  Court  of  Appeals  in  South
         Carolina in Welch Vs. Epstein[31]  held  that  a  neurosurgeon  is
         guilty for  reckless  therapy  after  he  used  a  drug  in  clear
         disregard to the warning given by the  drug  manufacturer  causing
         the death of a patient. This Court has categorically held that the
         injection Depomedrol used at the rate of 80 mg twice daily by  Dr.
         Sukumar Mukherjee was in clear  violation  of  the  manufacturer’s
         warning  and  recommendation  and  admittedly,   the   instruction
         regarding direction for use of the medicine had not been  followed
         in the instant case. This Court has also made it  clear  that  the
         excessive use of the medicine by  the  doctor  was  out  of  sheer
         ignorance of basic hazards relating to the use of steroids as also
         lack of judgment. No doctor has the right to use the  drug  beyond
         the maximum recommended dose.


     74. The Supreme Court of Ohio  in  Dardinger  Vs.  Anthem  Blue  Cross
         Shield et al[32]. had judged that  since  $  49  million  punitive
         damages was excessive  it still awarded US $19 million in  a  case
         of medical negligence.   The aforesaid judgments from  the  U.S.A.
         clearly show that punitive damages usually are many  times  bigger
         than the compensatory damages.  A nominal amount of US $ 1,000,000
         has been claimed as punitive damages in the instant case to send a
         deterrent message to the reckless doctors in India keeping in view
         the major difference in the standard of living between  India  and
         U.S.A. In fact, this Court in a well-known  case  of  Lata  Wadhwa
         (supra) in which a number of  children  and  women  died  from  an
         accidental fire,  awarded  punitive  damages  to  send  a  message
         against the unsafe condition kept by some greedy organizations  or
         companies in the common public places in India.

     75. It was further contended by the claimant that this Court  remanded
         the case back to the National Commission for determination of  the
         quantum of compensation only but the National Commission in  clear
         disregard to the direction issued by this Court,  has  re-examined
         the issues involved for medical  negligence.   Further,  in  Malay
         Kumar Ganguly’s case, this Court has rejected the  assertion  made
         by the doctors of the Hospital that the  claimant  had  interfered
         with the treatment of his wife or that other doctors and/  or  the
         Hospital i.e. Breach Candy Hospital in Bombay should also be  made
         a party in this case.

     76. It  is  further  contended  by  the  claimant  that  the  National
         Commission  has  wrongfully  apportioned  the  total   amount   of
         compensation by losing sight of  the  observations  made  by  this
         Court while remanding the case back to it for determination of the
         quantum of compensation. This Court did not make  any  observation
         as to how the compensation should be divided, as  awarded  by  the
         National  Commission.  Except  for   the   appellant-Dr.   Sukumar
         Mukherjee who was imposed with a cost of Rs.5,00,000/- this  Court
         did not impose cost against  any other  doctors  even  though  the
         Court  found  other  appellant-doctors  also  guilty  for  medical
         negligence.

     77. It is further contended  that  the  National  Commission  on  31st
         March, 2010 in S.P. Aggarwal Vs. Sanjay Gandhi P.G. Institute  (FA
         No.478/2005) held that “in view of the fact that  several  doctors
         and paramedical staff of the appellant institute were involved, it
         is the appellant institute which has to be held vicariously liable
         to compensate the complainant to the above extent.”

     78. It is further urged that in Nizam Institute’s  case  (supra)  this
         Court imposed the entire compensation against the Hospital despite
         holding several doctors responsible for causing  permanent  injury
         to the patient. While remanding back the issue of quantifying  the
         quantum of compensation to the National Commission, this Court has
         observed that the standard of medical nursing  care  at  the  AMRI
         Hospital was abysmal. It is further  submitted  that  80%  of  the
         total compensation should be imposed against the AMRI Hospital and
         20% against Dr. Sukumar Mukherjee. The claimant  has  claimed  the
         damages as under :-

|PECUNIARY DAMAGES:                                                      |
|A  Cost associated  with the victim, Anuradha Saha                      |
|1    |Loss of prospective/future earning upto to|Rs.9,25,00,000/-        |
|     |70 years                                  |                        |
|2    |Loss of US Social Security income up  to  |Rs.1,44,00,000/-        |
|     |82 years                                  |                        |
|3    |Paid for treatment at AMRI/Breach Candy   |Rs.12,00,000/-          |
|     |Hospital                                  |                        |
|4    |Paid for chartered flight to transfer     |Rs. 9,00,000/-          |
|     |Anuradha                                  |                        |
|5    |Travel/hotel/other expenses during        |Rs. 7,00,000/-          |
|     |Anuradha’s  treatment in Mumbai/ Kolkata  |                        |
|     |in 1998                                   |                        |
|6    |Paid for court proceedings including video|Rs.11,57,000/-          |
|     |conferencing from U.S.A.                  |                        |
|B Cost associated with Anuradha’s husband, Dr. Kunal Saha               |
|1    |Loss of  income for missed work           |Rs.1,12,50,000/-        |
|2    |Travel expenses over the past 12 years    |Rs.70,00,000/-          |
|C  Legal expenses                                                       |
|1    |Advocate fees                             |Rs.1,50,00,000/-        |
|2    |other legal expenses                      |Rs.15,00,000/-          |
|Total pecuniary damages              Rs.34,56,07,000/-                  |
| Non-Pecuniary Special Damages                                          |
|1    |Loss of companionship and life amenities  |Rs.13,50,00,000/-       |
|2    |Emotional distress, pain and suffering for|Rs.50,00,000/-          |
|     |husband                                   |                        |
|3    |Pain/suffering endured by the victim      |Rs.4,50,00,000/-        |
|     |during therapy                            |                        |
|Total non pecuniary damages          Rs.31,50,00,000/-                  |
|D    |PUNITIVE/EXEMPLARY DAMAGES                |Rs.13,50,00,000/-       |
|E    |SPECIAL DAMAGES                           |Rs.18,00,00,000/-       |
|  Total                              Rs.97,56,07,000/-                  |

      Therefore, the claimant has prayed for allowing his appeal by awarding
      just and reasonable compensation under various  heads  as  claimed  by
      him.

     79. On the basis of the rival legal factual and  contentions urged  on
         behalf of  the  respective  doctor-appellants,  Hospital  and  the
         claimant, the following points would arise  for  consideration  of
         this Court:-
              1)   Whether the claim of  the  claimant  for  enhancement  of
                 compensation in his appeal is justified.  If it is so,  for
                 what compensation he is entitled to?
              2)   While making additional claim by way of affidavit  before
                 the National Commission when amending the  claim  petition,
                 whether the claimant is entitled for  compensation  on  the
                 enhanced claim preferred before the National Commission?


           3(a)  Whether  the  claimant  seeking  to  amend  the  claim  of
           compensation under certain heads in the original claim  petition
           has forfeited his right of claim under Order II Rule 2 of CPC as
           pleaded by the AMRI Hospital?
           3(b)  Whether the claimant is justified in  claiming  additional
           amount for compensation under different heads without  following
           the procedure contemplated under the provisions of the  Consumer
           Protection         Act          and          the          Rules?


           4.   Whether the National Commission is  justified  in  adopting
              the multiplier method to determine the  compensation  and  to
              award the compensation in favour of the claimant?
           5.   Whether the claimant is entitled to pecuniary damages under
              the heads of loss of employment, loss of his property and his
              traveling expenses  from  U.S.A.  to  India  to  conduct  the
              proceedings in his claim petition?
           6. Whether the claimant is  entitled  to  the  interest  on  the
              compensation that would be awarded?
           7.  Whether the compensation awarded in  the  impugned  judgment
           and the apportionment of the compensation amount  fastened  upon
           the doctors and the hospital requires interference  and  whether
           the claimant is liable for contributory negligence and deduction
           of compensation under this head?
           8.  To what Order and Award the claimant is entitled to in these
           appeals?

     80. It would be convenient for us to take up first  the  Civil  Appeal
         No. 2866 of 2012 filed by Dr. Kunal Saha, the claimant, as he  had
         sought for enhancement of compensation.  If we  answer  his  claim
         then the other issues that would arise in  the  connected  appeals
         filed by the doctors and the AMRI  Hospital  can  be  disposed  of
         later  on.    Therefore,  the  points   that   would   arise   for
         consideration in these appeals by these Court have been framed  in
         the composite. The same are taken up in relation to the claimants’
         case in-seriatum and  are  answered  by  recording  the  following
         reasons:


      Answer to Point nos. 1, 2 and 3


     81. Point Nos. 1, 2 and 3 are taken up  together  and  answered  since
         they are inter related.
           The claim for enhancement of compensation by the claimant in his
      appeal is justified for the following reasons:
           The National Commission has rejected the claim of  the  claimant
      for “inflation” made by him without assigning any  reason  whatsoever.
      It is an undisputed fact that the claim of the  complainant  has  been
      pending before the National Commission and this Court for the last  15
      years.  The value of money that was claimed in 1998 has been  devalued
      to  a  great  extent.  This  Court  in  various  following  cases  has
      repeatedly affirmed that inflation of money should be considered while
      deciding the quantum of compensation:-

           In Reshma Kumari and Ors. Vs. Madan Mohan and Anr. (supra), this
      Court at para 47 has dealt with this aspect as under:
             “47.One of the incidental issues which has  also  to  be  taken
             into consideration is inflation.  Is  the  practice  of  taking
             inflation into consideration wholly  incorrect?  Unfortunately,
             unlike other developed countries in India  there  has  been  no
             scientific study. It is expected that with the rising inflation
             the rate of interest would go up. In India it does not  happen.
             It, therefore, may be a relevant factor which may be taken into
             consideration for determining the  actual  ground  reality.  No
             hard-and-fast rule, however, can be laid down therefor.”


            In Govind Yadav Vs. New  India  Insurance  Company  Ltd.(supra),
      this court at para 15 observed  as  under  which  got  re-iterated  at
      paragraph 13 of Ibrahim Vs. Raju & Ors. (supra):-
           “15. In Reshma Kumari v. Madan Mohan this Court reiterated  that
           the compensation awarded under the Act should be just  and  also
           identified the factors  which  should  be  kept  in  mind  while
           determining the amount of compensation. The relevant portions of
           the judgment are extracted below:  (SCC  pp.  431-32  &  440-41,
           paras 26-27 & 46-47)
           ‘26. The compensation which is required to be determined must be
           just. While the claimants are required to be compensated for the
           loss of their dependency, the same should not be  considered  to
           be a windfall. Unjust enrichment  should  be  discouraged.  This
           Court cannot also lose sight of the fact that in given cases, as
           for example death of the only son to a mother, she can never  be
           compensated in monetary terms.
           27. The question as to the methodology required  to  be  applied
           for determination of compensation as regards prospective loss of
           future earnings, however, as far as possible should be based  on
           certain principles. A person may have a bright future  prospect;
           he might have become eligible to  promotion  immediately;  there
           might have been chances of an immediate pay revision, whereas in
           another (sic situation) the nature of employment was  such  that
           he might not have continued in service; his chance of promotion,
           having regard to the nature of  employment  may  be  distant  or
           remote. It is, therefore, difficult for any court  to  lay  down
           rigid tests which should be applied in all situations. There are
           divergent views. In some cases it has been suggested  that  some
           sort of hypotheses or guesswork may be inevitable. That  may  be
           so.’
                 *     *     *
           46. In the Indian context several other factors should be  taken
           into consideration including education of the dependants and the
           nature of job. In the wake of changed  societal  conditions  and
           global scenario, future prospects may  have  to  be  taken  into
           consideration not only  having  regard  to  the  status  of  the
           employee, his educational qualification;  his  past  performance
           but also other relevant factors, namely, the higher salaries and
           perks which are being offered by  the  private  companies  these
           days. In fact while determining the multiplicand this  Court  in
           Oriental Insurance Co. Ltd. v. Jashuben held that even  dearness
           allowance and perks with regard thereto from  which  the  family
           would  have  derived  monthly  benefit,  must  be   taken   into
           consideration.
           47. One of the incidental issues which has also to be taken into
           consideration is inflation. Is the practice of taking  inflation
           into consideration wholly incorrect? Unfortunately, unlike other
           developed countries in India there has been no scientific study.
           It is expected that  with  the  rising  inflation  the  rate  of
           interest  would  go  up.  In  India  it  does  not  happen.  It,
           therefore, may be a relevant factor  which  may  be  taken  into
           consideration for determining the actual ground reality. No hard-
           and-fast rule, however, can be laid down therefor.”




     82. The C.I.I. is determined by the Finance Ministry of Union of India
         every year in order to appreciate  the  level  of  devaluation  of
         money each year. Using the C.I.I. as published by  the  Government
         of India, the original claim of Rs.77.7 crores  preferred  by  the
         claimant in 1998 would be equivalent to Rs.188.6 crores as of 2013
         and, therefore the enhanced claim preferred by the claimant before
         the  National  Commission  and  before  this  Court   is   legally
         justifiable as this Court is required to determine the just,  fair
         and reasonable compensation. Therefore, the  contention  urged  by
         the appellant-doctors and the AMRI Hospital that in the absence of
         pleadings in the claim petition before the National Commission and
         also in the light of the incident that the subsequent  application
         filed by the claimant seeking for amendment to the  claim  in  the
         prayer of the complainant being  rejected,  the  additional  claim
         made by the claimant cannot be examined for grant of  compensation
         under different heads is wholly unsustainable in law  in  view  of
         the decisions rendered by  this  Court  in  the  aforesaid  cases.
         Therefore, this Court is required to consider the relevant  aspect
         of the matter namely, that there has been steady  inflation  which
         should have been considered over period of 15 years and that money
         has been devalued greatly. Therefore, the decision of the National
         Commission in confining the grant of compensation to the  original
         claim of Rs.77.7 crores preferred by the claimant under  different
         heads and awarding meager compensation under the  different  heads
         in the impugned judgment, is wholly unsustainable in  law  as  the
         same is contrary to the legal principles laid down by  this  Court
         in catena of cases referred to supra.  We,  therefore,  allow  the
         claim of the claimant on enhancement of compensation to the extent
         to be directed by this Court in the following paragraphs.

     83. Besides enhancement of compensation, the claimant has  sought  for
         additional compensation of about Rs.20 crores in addition  to  his
         initial claim made in 2011 to include the economic  loss  that  he
         had suffered due to loss of his employment, home  foreclosure  and
         bankruptcy in U.S.A which would have never happened  but  for  the
         wrongful death of his wife.  The claimant has placed  reliance  on
         the  fundamental  principle  to  be  followed  by  the  Tribunals,
         District Consumer Forum, State Consumer Forum,  and  the  National
         Commission and the courts for awarding ‘just compensation’.     In
         support of this contention, he has also strongly  placed  reliance
         upon the  observations  made  at  para  170  in  the  Malay  Kumar
         Ganguly’s case referred to  supra  wherein  this  Court  has  made
         observations as thus:
           “170. Indisputably, grant of compensation involving an  accident
           is within the realm  of  law  of  torts.  It  is  based  on  the
           principle of restitutio in integrum. The said principle provides
           that a person entitled to damages should, as nearly as possible,
           get that sum of money which would put him in the  same  position
           as he would have been if he had not sustained  the  wrong.  (See
           Livingstone v. Rawyards Coal Co.)”


         The claimant made a claim under specific heads in great  detail  in
      justification for each one of the claim made  by  him.   The  National
      Commission, despite taking judicial notice of the claim  made  by  the
      claimant in its judgment, has rejected the entire claim solely on  the
      ground that the additional claim was not pleaded  earlier,  therefore,
      none of the claims made by him can be considered.   The  rejection  of
      the additional claims by the National Commission without consideration
      on the assumption that the claims made  by  the  claimant  before  the
      National Commission cannot be changed or  modified  without  pleadings
      under any condition  is  contrary  to  the  decisions  of  this  Court
      rendered in catena of cases. In support of his additional  claim,  the
      claimant places reliance upon such decisions as mentioned hereunder:
           (a)  In Ningamma’s case (supra), this Court has observed at para
      34 which reads thus:
             “34. Undoubtedly, Section 166  of  the  MVA  deals  with  “just
             compensation” and even if in the pleadings  no  specific  claim
             was made under Section  166  of  the  MVA,  in  our  considered
             opinion a party should  not  be  deprived  from  getting  “just
             compensation” in case the claimant is able to make out  a  case
             under any provision  of  law.  Needless  to  say,  the  MVA  is
             beneficial and welfare legislation. In fact, the court is duty-
             bound and entitled to award “just compensation” irrespective of
             the fact whether any plea in that  behalf  was  raised  by  the
             claimant or not.


           (b) In Malay Kumar Ganguly’s case, this Court by placing reliance
      on the decision of this Court in  R.D.  Hattangadi  Vs.  Pest  Control
      (India) (P) Ltd.,(supra) made observation  while  remanding  back  the
      matter to National Commission solely for the determination of  quantum
      of compensation, that compensation should include “loss of earning  of
      profit up to the date of trial” and that it may also include any  loss
      “already suffered or is likely to be suffered  in  future”.   Rightly,
      the claimant has contended that when original complaint was filed soon
      after the death of his wife in 1998, it would be impossible for him to
      file a claim for  “just compensation” for the pain that  the  claimant
      suffered in the course of the 15 years long trial.
             c) In Nizam Institute’s case supra, the complainant had  sought
      a compensation of Rs.4.61 crores before the National Commission but he
      enhanced his claim to Rs 7.50 crores when the matter  came  up  before
      this Court. In response to the claim, this Court held as under:

           “82. The complainant, who has argued his own case, has submitted
           written  submissions  now  claiming  about  Rs  7.50  crores  as
           compensation under various heads. He has, in addition  sought  a
           direction that a further sum of Rs 2 crores be set aside  to  be
           used by him should some developments beneficial to  him  in  the
           medical field take place. Some of the claims are  untenable  and
           we have no hesitation in rejecting them. We, however, find  that
           the claim with respect to some of the other  items  need  to  be
           allowed or enhanced in view of the peculiar facts of the case.”




           d)     In Oriental Insurance Company Ltd. Vs.  Jashuben  &  Ors.
      (supra), the initial claim was for Rs.12 lakhs which was  subsequently
      raised to Rs.25 lakhs. The claim was partly allowed by this Court.


           e)    In R.D. Hattangadi Vs. Pest Control  (India)  (supra)  the
      appellant made an initial compensation claim of Rs.4 lakhs  but  later
      on enhanced the claim to Rs.35 lakhs by this Court.


           f)    In Raj Rani & Ors. Vs. Oriental Insurance Company  Ltd.  &
      Ors.,(supra) this Court has observed that there is no restriction that
      compensation could be awarded only up to the  amount  claimed  by  the
      claimant. The relevant paragraph reads as under:


             “14. In Nagappa v. Gurudayal  Singh  this  Court  has  held  as
             under: (SCC p. 279, para 7)
             “7. Firstly, under the provisions of the  Motor  Vehicles  Act,
             1988, (hereinafter referred to as ‘the MV  Act’)  there  is  no
             restriction that compensation could be awarded only up  to  the
             amount claimed by the claimant. In an appropriate  case,  where
             from the evidence  brought  on  record  if  the  Tribunal/court
             considers  that  the  claimant  is   entitled   to   get   more
             compensation than claimed, the Tribunal may  pass  such  award.
             The only embargo is—it should be ‘just’ compensation,  that  is
             to  say,  it  should  be  neither   arbitrary,   fanciful   nor
             unjustifiable  from  the  evidence.  This  would  be  clear  by
             reference to the relevant provisions of the MV Act.”


           g)     In  Laxman  @  Laxaman  Mourya  Vs.  Divisional  Manager,
      Oriental Insurance Co. Ltd. & Anr.,(supra)  this  Court  awarded  more
      compensation than what was claimed by the claimant  after  making  the
      following categorical observations:-
           “In the absence of any bar in the Act, the Tribunal and for that
           reason,  any  competent  court,  is  entitled  to  award  higher
           compensation to the victim of an accident”


           h)    In Ibrahim Vs. Raju  &  Ors.,(supra)  this  Court  awarded
      double the compensation sought for by the complainant after discussion
      of host of previous judgments.


      84. In view of the aforesaid  decisions  of  this  Court  referred  to
      supra, wherein this Court has awarded ‘just  compensation’  more  than
      what was  claimed  by  the  claimants  initially  and  therefore,  the
      contention urged by learned senior counsel and other counsel on behalf
      of the appellant-doctors and the AMRI  Hospital  that  the  additional
      claim made by the claimant was rightly not considered by the  National
      Commission for the reason that the same is not supported by  pleadings
      by filing an application to amend the same regarding  the  quantum  of
      compensation and the same could not have been amended as it is  barred
      by the limitation provided under Section 23 of the Consumer Protection
      Act, 1986 and the claimant is  also  not  entitled  to  seek  enhanced
      compensation in view of Order  II   Rule  2  of  the  CPC  as  he  had
      restricted his claim at Rs.77,07,45,000/-, is not sustainable in  law.
      The claimant has appropriately placed reliance upon the  decisions  of
      this Court in justification of his additional claim and the finding of
      fact on the basis of which the National Commission rejected the  claim
      is based on untenable reasons. We have to reject the contention  urged
      by the learned senior counsel and  other  counsel  on  behalf  of  the
      appellant-doctors and the AMRI Hospital as it is wholly  untenable  in
      law and is contrary to the aforesaid decisions of this Court  referred
      to supra. We have to accept  the  claim  of  the  claimant  as  it  is
      supported by the decisions of this Court and the same is well  founded
      in law. It is the duty of the Tribunals, Commissions and the Courts to
      consider  relevant  facts  and  evidence  in  respect  of  facts   and
      circumstances of each and every case for awarding just and  reasonable
      compensation.   Therefore, we are of the view  that  the  claimant  is
      entitled for enhanced compensation under certain  items  made  by  the
      claimant in additional claim preferred  by  him  before  the  National
      Commission.  We have to keep in view the fact that  this  Court  while
      remanding the case back  to  the  National  Commission  only  for  the
      purpose  of  determination  of  quantum  of  compensation  also   made
      categorical observation that:



           “172. Loss of wife to a husband may always be truly  compensated
           by way of mandatory compensation. How one would do it  has  been
           baffling the court for a long time. For compensating  a  husband
           for loss of his wife, therefore, the courts consider the loss of
           income to the family. It may not be difficult to do when she had
           been earning. Even otherwise a wife’s contribution to the family
           in terms of money can always  be  worked  out.  Every  housewife
           makes a contribution to his  family.  It  is  capable  of  being
           measured on monetary  terms  although  emotional  aspect  of  it
           cannot be. It depends upon her  educational  qualification,  her
           own upbringing, status, husband’s income, etc.”
                                  [Emphasis laid by this Court]


            In this regard, this Court has also expressed similar view  that
      status, future prospects and educational qualification of the deceased
      must be judged for deciding adequate, just and fair compensation as in
      the case of R.K. Malik & Anr. (supra).

      85. Further, it is an undisputed fact that the victim was  a  graduate
      in psychology from a highly prestigious Ivy League school in New York.
       She had a brilliant  future  ahead  of  her.  However,  the  National
      Commission has calculated the entire compensation and prospective loss
      of income solely based on a pay receipt showing  a  paltry  income  of
      only $30,000 per year which she was earning  as  a  graduate  student.
      Therefore, the National Commission has committed grave error in taking
      that figure to determine  compensation  under  the  head  of  loss  of
      dependency and the same is contrary to the observations made  by  this
      Court in the case of Arvind Kumar Mishra Vs. New India Assurance which
      reads as under:
           “14. On completion of Bachelor of Engineering (Mechanical)  from
           the prestigious institute like BIT, it can be reasonably assumed
           that he would have got a good job. The appellant has  stated  in
           his evidence that in the campus interview  he  was  selected  by
           Tata as well as Reliance Industries and was offered pay  package
           of Rs. 3,50,000 per annum. Even if that is not accepted for want
           of any evidence in support thereof, there would  not  have  been
           any difficulty for him in getting some decent job in the private
           sector. Had he  decided  to  join  government  service  and  got
           selected, he would have been put in the pay scale for  Assistant
           Engineer and would have at least earned Rs.  60,000  per  annum.
           Wherever he joined, he had a fair chance of some  promotion  and
           remote chance of some high position. But uncertainties  of  life
           cannot be ignored taking relevant factors into consideration. In
           our opinion, it is fair and  reasonable  to  assess  his  future
           earnings  at  Rs.  60,000  per  annum  taking  the  salary   and
           allowances payable to an Assistant Engineer in public employment
           as the basis.”




      86.  The claimant further placed reliance upon the decisions  of  this
      Court in Govind Yadav Vs. New India  Insurance  Co.  Ltd.(supra),  Sri
      Ramachandrappa Vs. Manager, Royal Sundaram Alliance Insurance (supra),
      Ibrahim Vs. Raju  &  Ors.,  Laxman  @  Laxman  Mourya  Vs.  Divisional
      Manager, Oriental Insurance Co. Ltd. (supra) and  Kavita Vs.  Dipak  &
      Ors (supra) in support of his  additional  claim  on  loss  of  future
      prospect of income. However, these decisions do not have any relevance
      to the facts and circumstances of the present  case.  Moreover,  these
      cases mention about ‘future loss of income’ and not ‘future  prospects
      of income’ in terms of the potential of the victim and we are inclined
      to distinguish between the two.

      87. We place reliance upon the decisions of this Court in Arvind Kumar
      Mishra’s case (supra) and also in  Susamma  Thomas  (supra),   wherein
      this Court held thus:

           “24. In Susamma Thomas,  this  Court  increased  the  income  by
           nearly 100%, in Sarla Dixit the income was increased only by 50%
           and in Abati Bezbaruah the income was increased by a mere 7%. In
           view of the imponderables and uncertainties, we are in favour of
           adopting as a rule of thumb, an addition of 50% of actual salary
           to the actual salary  income  of  the  deceased  towards  future
           prospects, where the deceased had a permanent job and was  below
           40 years. (Where the annual income is in the taxable range,  the
           words “actual salary” should be  read  as  “actual  salary  less
           tax”). The addition should  be  only  30%  if  the  age  of  the
           deceased was 40 to 50 years. There should be no addition,  where
           the age of the deceased  is  more  than  50  years.  Though  the
           evidence may indicate a different percentage of increase, it  is
           necessary  to  standardise  the  addition  to  avoid   different
           yardsticks being applied or  different  methods  of  calculation
           being adopted. Where the deceased was self-employed or was on  a
           fixed salary (without provision for  annual  increments,  etc.),
           the courts will usually take only the actual income at the  time
           of death. A departure therefrom should be made only in rare  and
           exceptional cases involving special circumstances.”




      88.  Further, to hold  that  the  claimant  is  entitled  to  enhanced
      compensation under the heading of loss of future prospects  of  income
      of the victim, this Court  in  Santosh  Devi  Vs.  National  Insurance
      Company and Ors.  (supra), held as under:


           “18.  Therefore,  we  do  not  think  that  while   making   the
           observations in the last three lines of para 24 of  Sarla  Verma
           judgment, the Court had intended to lay down  an  absolute  rule
           that there will be no addition in the income of a person who  is
           self-employed or who is paid fixed wages. Rather,  it  would  be
           reasonable to say that a  person  who  is  self-employed  or  is
           engaged on fixed wages will also get 30% increase in  his  total
           income over a period of time and if he/she becomes the victim of
           an accident then the same formula deserves  to  be  applied  for
           calculating the amount of compensation.”


      89.  In view of the aforesaid observations and law laid down  by  this
      Court with regard to the approach by the Commission in  awarding  just
      and reasonable  compensation  taking  into  consideration  the  future
      prospects of the deceased even in the absence of any expert’s  opinion
      must have been reasonably judged based on the income of  the  deceased
      and her future potential in U.S.A.  However, in the present  case  the
      calculation of the future prospect of income of the deceased has  also
      been scientifically done by economic expert Prof. John F.  Burke.   In
      this regard, the learned counsel for the other  appellant-doctors  and
      the Hospital have contended that without amending the  claim  petition
      the  enhanced  claim  filed  before  the  National  Commission  or  an
      application filed in the appeal by the claimant cannot be accepted  by
      this Court.  In support of this contention, they have placed  reliance
      upon the various provisions of the Consumer Protection  Act  and  also
      decisions  of  this  Court  which  have  been  adverted  to  in  their
      submissions  recorded  in  this  judgment.   The   claimant   strongly
      contended by placing reliance upon the  additional  claim  by  way  of
      affidavit filed before the National Commission which was sought to  be
      justified with reference to the liberty given by  this  Court  in  the
      earlier proceedings which arose when  the  application  filed  by  the
      claimant was rejected and this Court has  permitted  him  to  file  an
      affidavit before the National Commission and the same has  been  done.
      The ground urged by the claimant is that the National  Commission  has
      not considered the entire claim including the  additional  claim  made
      before it. He has placed strong  reliance  upon  V.P.  Shantha’s  case
      (supra) in support of his contention wherein it was held as under:

           “53. Dealing with the present state of medical negligence  cases
           in the United Kingdom it has been observed:
           “The legal system, then, is faced with the  classic  problem  of
           doing  justice  to  both  parties.  The  fears  of  the  medical
           profession must be  taken  into  account  while  the  legitimate
           claims of the patient cannot be ignored.
           Medical  negligence  apart,  in   practice,   the   courts   are
           increasingly reluctant to interfere in  clinical  matters.  What
           was once perceived as a legal threat to medicine has disappeared
           a decade later. While the court will accept the  absolute  right
           of a patient to refuse treatment, they will, at the  same  time,
           refuse to dictate to doctors what treatment  they  should  give.
           Indeed, the fear could be that, if anything,  the  pendulum  has
           swung too far in favour of therapeutic immunity. (p. 16)
           It would be a mistake to think of doctors and hospitals as  easy
           targets for the dissatisfied patient. It is still very difficult
           to raise an action of medical negligence in Britain; some,  such
           as the Association of the Victims of  Medical  Accidents,  would
           say that it  is  unacceptably  difficult.  Not  only  are  there
           practical difficulties in  linking  the  plaintiff’s  injury  to
           medical  treatment,  but  the  standard  of  care   in   medical
           negligence cases is still effectively defined by the  profession
           itself. All these factors, together with the  sheer  expense  of
           bringing legal action and the denial of legal aid to all but the
           poorest, operate to inhibit medical litigation in a way in which
           the  American  system,  with  its  contingency  fees   and   its
           sympathetic juries, does not.
           It is difficult to single out any one cause  for  what  increase
           there has been in the volume of medical  negligence  actions  in
           the United Kingdom. A common  explanation  is  that  there  are,
           quite simply, more medical accidents occurring — whether this be
           due to increased pressure on  hospital  facilities,  to  falling
           standards of professional competence or, more probably,  to  the
           ever-increasing  complexity  of   therapeutic   and   diagnostic
           methods.” (p. 191)
           A patient who has been injured by an act of  medical  negligence
           has suffered in a way which is recognised by the law  —  and  by
           the public at large — as deserving compensation. This  loss  may
           be continuing and what may seem like an unduly large  award  may
           be little more than that sum which is required to compensate him
           for such matters as loss of future earnings and the future  cost
           of medical or nursing care. To deny a  legitimate  claim  or  to
           restrict arbitrarily the  size  of  an  award  would  amount  to
           substantial injustice. After all,  there  is  no  difference  in
           legal theory  between  the  plaintiff  injured  through  medical
           negligence and the plaintiff injured in an industrial  or  motor
           accident.” (pp. 192-93)
           (Mason’s Law and Medical Ethics, 4th Edn.)”
                                                   [Emphasis laid by this
                                   Court]

      90. He has also placed reliance upon the Nizam  Institute  of  Medical
      Sciences’s case referred to supra in support of his submission that if
      a case is made out, then the Court  must  not  be  chary  of  awarding
      adequate compensation. The relevant paragraph reads as under:

           “88. We must emphasise that the court has to  strike  a  balance
           between the inflated and unreasonable demands of  a  victim  and
           the equally untenable claim of the opposite  party  saying  that
           nothing is payable. Sympathy for the victim does not, and should
           not, come in the way of making a correct assessment,  but  if  a
           case is made out, the  court  must  not  be  chary  of  awarding
           adequate compensation. The “adequate compensation” that we speak
           of, must to some extent, be a rule of thumb measure,  and  as  a
           balance has to be struck, it would be difficult to  satisfy  all
           the parties concerned.”




      91. He  has  further  rightly  contended  that  with  respect  to  the
      fundamental principle for awarding just and  reasonable  compensation,
      this Court in Malay Kumar Ganguly’s  case  (supra)  has  categorically
      stated while remanding this case back to the National Commission  that
      the principle  for  just  and  reasonable  compensation  is  based  on
      ‘restitutio in integrum’ that is, the claimant  must  receive  sum  of
      money which would put him in the same position as he would  have  been
      if he had not sustained the wrong.


      92. Further, he has placed reliance upon the judgment of this Court in
      the case of Ningamma’s case (supra)   in support of the proposition of
      law  that  the  Court  is  duty-bound  and  entitled  to  award  “just
      compensation” irrespective of the fact whether any plea in that behalf
      was raised by the claimant or not.  The relevant  paragraph  reads  as
      under:

           “34. Undoubtedly, Section  166  of  the  MVA  deals  with  “just
           compensation” and even if in the pleadings no specific claim was
           made under Section 166 of the MVA, in our considered  opinion  a
           party should not be deprived from getting “just compensation” in
           case the claimant is able to make out a case under any provision
           of law. Needless to say,  the  MVA  is  beneficial  and  welfare
           legislation. In fact, the court is duty-bound  and  entitled  to
           award “just compensation” irrespective of the fact  whether  any
           plea in that behalf was raised by the claimant or not.”




      93. He has also rightly placed  reliance  upon  observations  made  in
          Malay Kumar Ganguly’s case referred to supra  wherein  this  Court
          has  held  the  appellant  doctors  guilty  of  causing  death  of
          claimant’s wife while remanding the matter back  to  the  National
          Commission only for determination of quantum of  compensation  for
          medical  negligence.   This  Court  has  further   observed   that
          compensation should include “loss of earning of profit up  to  the
          date of trial” and that it may  also  include  any  loss  “already
          suffered or likely to be suffered in  future”.  The  claimant  has
          also rightly submitted that when the original complaint was  filed
          soon after the death of his wife in 1998, it would  be  impossible
          to file a claim for “just compensation”. The claimant has suffered
          in the course of the 15 years  long  trial.   In  support  of  his
          contention he placed reliance on some other cases also where  more
          compensation was awarded than what was claimed, such  as  Oriental
          Insurance Company Ltd. Vs. Jashuben  &  Ors.,  R.D.  Hattangadi  ,
          Raj Rani & Ors, Laxman @ Laxaman  Mourya  all  cases  referred  to
          supra. Therefore, the relevant paragraphs from the said  judgments
          in-seriatum extracted above show that this Court has got the power
          under Article 136 of the Constitution and the duty to  award  just
          and reasonable compensation to do complete justice to the affected
          claimant.
            In view of the aforesaid reasons stated  by  us,  it  is  wholly
      untenable in law with regard to the legal contentions urged on  behalf
      of the AMRI Hospital and the  doctors  that  without  there  being  an
      amendment to the claim petition, the claimant is not entitled to  seek
      the additional claims by way of affidavit,  the  claim  is  barred  by
      limitation and the same has not been rightly accepted by the  National
      Commission.

      94. Also, in view of the  above  reasoning  the  contention  that  the
          claimant has waived his right to claim more compensation  in  view
          of the Order II Rule 2 of CPC as pleaded by the AMRI Hospital  and
          the appellant-doctors is also held to be wholly  unsustainable  in
          law.  The claimant is justified in claiming additional  claim  for
          determining  just  and  reasonable  compensation  under  different
          heads.  Accordingly, the point Nos. 1, 2, and 3  are  answered  in
          favour of the claimant and against the appellant-doctors  and  the
          Hospital.


      Answer to point no. 4


    95. With regard to point no. 4, the National Commission  has  used  the
    “multiplier” method under Section 163A read with the second schedule of
    the Motor Vehicles Act to determine  the  quantum  of  compensation  in
    favour of the claimant applying the multiplier method as has been  laid
    down by this Court in Sarla Verma’s case(supra). Consequently,  it  has
    taken up  multiplier  of  15  in  the  present  case  to  quantify  the
    compensation under the loss of dependency of the claimant. It is  urged
    by  the  claimant  that  use  of  multiplier  system  for   determining
    compensation for medical negligence cases involving death of  his  wife
    is grossly erroneous in law. The claimant has rightly  placed  reliance
    upon the cases of this Court such as, Indian  Medical  Assn.  Vs.  V.P.
    Shanta &  Ors.(supra),  Spring  Meadows  Hospital  &  Anr.  Vs.  Harjol
    Ahluwalia[33],  Charan  Singh    Vs.   Healing   Touch   Hospital   and
    Ors.(supra), J.J. Merchants &  Ors.  Vs.  Srinath  Chaturbedi  (supra),
    Savita Garg Vs. Director National Heart  Institute  (supra),  State  of
    Punjab Vs. Shiv  Ram  &  Ors.(supra),   Samira  Kholi  Vs.  Dr.  Prabha
    Manchanda & Anr.(supra), P.G. Institute of Medical Sciences Vs.  Jaspal
    Singh & Ors., (supra) Nizam  Institute  Vs.  Prasant  Dhananka  (supra)
    Malay Kumar Ganguly Vs. Sukumar Mukherjee & Ors. (supra) and V.  Kishan
    Rao Vs. Nikhil Superspeciality Hospital & Anr. (supra) to contend  that
    not a single case was decided by using the multiplier method.


            In support of this contention, he has further argued that in the
      three judge Bench decision in  the  case  of  Nizam  Institute’s  case
      (supra), this Court has rejected  the  use  of  multiplier  system  to
      calculate the quantum  of  compensation.  The  relevant  paragraph  is
      quoted hereunder:
           “92. Mr Tandale, the learned counsel  for  the  respondent  has,
           further  submitted  that  the  proper  method  for   determining
           compensation would be the multiplier method. We find  absolutely
           no merit in this plea. The kind of damage that  the  complainant
           has suffered, the expenditure that he has incurred and is likely
           to incur in the future and the possibility that his rise in  his
           chosen field would now be restricted, are matters  which  cannot
           be taken care of under the multiplier method.”
                                  [Emphasis laid by this Court]




             He has further urged that the ‘multiplier’ method  as  provided
      in the second Schedule to Section 163-A of the M.V.Act which provision
      along with the Second Schedule was inserted  to  the  Act  by  way  of
      Amendment in 1994, was meant for speedy disposal of ‘no  fault’  motor
      accident claim  cases.  Hence,  the  present  case  of  gross  medical
      negligence  by  the  appellant-doctors  and  the  Hospital  cannot  be
      compared with ‘no fault’ motor accident claim cases.

      96.   The appellant Dr. Balram Prasad on the other  hand  relied  upon
      the decision in United India Insurance  Co.  Ltd.  Vs.  Patricia  Jean
      Mahajan (supra) and contended that multiplier  method  is  a  standard
      method of determining  the  quantum  of  compensation  in  India.  The
      relevant paragraphs read as under:

           “20. The court cannot be totally oblivious to the realities. The
           Second Schedule while prescribing the  multiplier,  had  maximum
           income of Rs 40,000 p.a. in mind, but it is considered to  be  a
           safe guide for applying the prescribed multiplier  in  cases  of
           higher income also but in cases where the gap in  income  is  so
           wide as in the present case income is 2,26,297 dollars, in  such
           a situation, it cannot  be  said  that  some  deviation  in  the
           multiplier would be impermissible. Therefore, a  deviation  from
           applying the multiplier as provided in the Second  Schedule  may
           have to be made in  this  case.  Apart  from  factors  indicated
           earlier the amount of multiplicand also becomes a factor  to  be
           taken into account which in this case comes to 2,26,297 dollars,
           that is to say an amount of around Rs  68  lakhs  per  annum  by
           converting it at the rate of Rs 30. By Indian  standards  it  is
           certainly a high amount. Therefore, for  the  purposes  of  fair
           compensation, a lesser multiplier can  be  applied  to  a  heavy
           amount  of  multiplicand.  A  deviation  would   be   reasonably
           permissible in the figure of multiplier even  according  to  the
           observations made in the case of Susamma Thomas where a specific
           example was given about a person dying at the age of 45  leaving
           no heirs being a bachelor except his parents.


             XXX                  XXX                   XXX


           22.  We  therefore,  hold   that   ordinarily   while   awarding
           compensation, the provisions contained in  the  Second  Schedule
           may be taken as a guide including the multiplier, but there  may
           arise some cases, as the one in hand,  which  may  fall  in  the
           category having special features or facts calling for  deviation
           from the multiplier usually applicable.”




      97. It is further urged  by  the  learned  senior  counsel  Mr.  Vijay
      Hansaria for the appellant-AMRI Hospital relying on Sarla Verma’s case
      (supra) that the multiplier method has enabled  the  courts  to  bring
      about  consistency  in  determining  the  ‘loss  of  dependency’  more
      particularly in the death of  victims  of  negligence.   The  relevant
      paragraph reads as under:

           “14.  The  lack  of  uniformity  and  consistency  in   awarding
           compensation has been a matter of grave concern. Every  district
           has one or more Motor Accidents Claims Tribunal(s). If different
           Tribunals calculate compensation differently on the same  facts,
           the claimant, the litigant, the common  man  will  be  confused,
           perplexed and bewildered. If  there  is  significant  divergence
           among the Tribunals in determining the quantum  of  compensation
           on similar facts, it will lead to dissatisfaction  and  distrust
           in the system.”



          The learned counsel for the appellant-AMRI Hospital further argued
      that reliance placed upon  the  judgment  in  Nizam  Institute’s  case
      referred to supra by the claimant is misplaced  since  the  victim  in
      that case suffered from permanent disability which  required  constant
      medical assistance. Therefore, it was urged that Nizam Institute  case
      cannot be relied upon by  this  Court  to  determine  the  quantum  of
      compensation by not  adopting  multiplier  method  in  favour  of  the
      claimant.

          A careful reading of the above cases  shows  that  this  Court  is
      skeptical  about  using  a  strait  jacket   multiplier   method   for
      determining the quantum of compensation in medical negligence  claims.
      On the contrary, this Court mentions various instances where the Court
      chose to deviate from the standard multiplier method  to  avoid  over-
      compensation and also relied  upon  the  quantum  of  multiplicand  to
      choose the appropriate multiplier. Therefore, submission made in  this
      regard by the claimant is well founded and based on sound logic and is
      reasonable as the  National  Commission  or  this  Court  requires  to
      determine just, fair  and reasonable compensation on the basis of  the
      income that was being earned by the deceased at the time of her  death
      and other related claims on account  of  death  of  the  wife  of  the
      claimant which is discussed in the reasoning portion in answer to  the
      point Nos. 1 to 3 which have  been  framed  by  this  Court  in  these
      appeals. Accordingly, we answer the point  No.  4  in  favour  of  the
      claimant holding that the submissions made by the learned counsel  for
      the appellant-doctors  and  the  AMRI  Hospital  in  determination  of
      compensation by following the multiplier method which was sought to be
      justified by placing reliance upon  Sarla  Verma  and  Reshma’s  cases
      (supra) cannot be accepted by this Court and the same does not inspire
      confidence in us in accepting the said submission made by the  learned
      senior counsel and other counsel  to  justify  the  multiplier  method
      adopted by the National Commission to determine the compensation under
      the head of loss of dependency. Accordingly, we answer the point no. 4
      in favour of the claimant and against the appellants-doctors and  AMRI
      Hospital.
      Answer to Point no. 5


      98. It is the claim of the claimant that he  has  also  suffered  huge
      losses during this period, both direct loss of income from his job  in
      U.S.A. as well as indirect loss for pain and intense mental agony  for
      tenure  denial  and  termination  of  his  employment  at  Ohio  State
      University which was a direct result of the wrongful death of deceased
      in India as would be evident from the judgment passed by the Court  of
      Claims in Ohio which was filed by the Hospital on 18th July, 2011.  In
      lieu of such  pain  and  suffering  the  claimant  made  a  demand  of
      Rs.34,56,07,000/- under different heads of ‘loss of income for  missed
      work’, ‘travelling  expenses  over  the  past  12  years’  and  ‘legal
      expenses including advocate fees’ etc.


      99. We have perused through the claims of the claimant under the above
      heads and we are inclined to observe the following :-
           The claim of Rs.1,12,50,000/- made by the claimant under the head
      of loss of income for missed work, cannot be  allowed  by  this  Court
      since, the same has  no  direct  nexus  with  the  negligence  of  the
      appellant- doctors and the Hospital. The claimant further assessed his
      claim under the head of ‘Travel expenses over the past  12  years’  at
      Rs.70,00,000/-. It is pertinent to observe that the claimant  did  not
      produce any record of plane fare to prove his travel expenditure  from
      U.S.A.  to  India  to  attend  the  proceedings.  However,  it  is  an
      undisputed fact that the claimant is a citizen of U.S.A. and had  been
      living there. It cannot be denied that he had to incur travel expenses
      to come to India to attend the proceedings. Therefore, on an  average,
      we award a compensation of Rs.10  lakhs  under  the  head  of  ‘Travel
      expenses over the past twelve years’.


            Further, the claimant argues that he has spent  Rs.1,65,00,000/-
      towards litigation over the past 12 years while  seeking  compensation
      under this head. Again, we find the claim to be on  the  higher  side.
      Considering that the claimant who is a doctor by profession,  appeared
      in person before this Court to argue his case. We acknowledge the fact
      that he might have required rigorous assistance of lawyers to  prepare
      his case  and  produce  evidence  in  order.  Therefore,  we  grant  a
      compensation of Rs.1,50,000/- under  the  head  of  ‘legal  expenses’.
      Therefore, a total  amount  of  Rs.  11,50,000/-  is  granted  to  the
      claimant under the head of ‘cost of litigation’.


      Answer to Point no. 6


      100. A perusal of the operative portion of the  impugned  judgment  of
      the National Commission shows that it has awarded interest at the rate
      of 12% per annum but only in case of default by the  doctors  of  AMRI
      Hospital to pay the compensation within 8 weeks after the judgment was
      delivered on October 21, 2011. Therefore, in other words, the National
      Commission did not grant any interest for the long period of 15  years
      as the case was pending before the National Commission and this Court.
      Therefore, the National Commission has committed error in not awarding
      interest on the compensation awarded by it and the same is opposed  to
      various decisions of this Court, such as  in  the  case  of  Thazhathe
      Purayil Sarabi & Ors. Vs. Union of India & Anr. regarding  payment  of
      interest on a decree of payment this Court held as under:

           “25. It is, therefore, clear that  the  court,  while  making  a
           decree for payment of money is entitled to grant interest at the
           current rate  of  interest  or  contractual  rate  as  it  deems
           reasonable to be paid  on  the  principal  sum  adjudged  to  be
           payable and/or awarded, from the date of claim or from the  date
           of the order or decree for recovery  of  the  outstanding  dues.
           There is also hardly any room for doubt  that  interest  may  be
           claimed on any amount decreed or awarded for the  period  during
           which  the  money  was  due  and  yet  remained  unpaid  to  the
           claimants.
           26. The courts are consistent in their view that normally when a
           money decree is passed, it is most essential  that  interest  be
           granted for the period during which the money was due, but could
           not be utilised by the  person  in  whose  favour  an  order  of
           recovery of money was passed.


           27. As has been frequently explained by this Court  and  various
           High Courts, interest is essentially a compensation  payable  on
           account of denial of the right to utilise the money  due,  which
           has been, in fact, utilised by the person withholding the  same.
           Accordingly, payment of interest follows as a matter  of  course
           when a money decree is passed.


           28. The only question to  be  decided  is  since  when  is  such
           interest payable  on  such  a  decree.  Though,  there  are  two
           divergent views, one indicating that interest  is  payable  from
           the date when claim for the principal sum is made,  namely,  the
           date of institution of the proceedings in the  recovery  of  the
           amount, the other view is that such  interest  is  payable  only
           when a determination is made and order is passed for recovery of
           the dues. However, the more consistent view has been the  former
           and in rare cases interest has been  awarded  for  periods  even
           prior to the institution of  proceedings  for  recovery  of  the
           dues, where the same  is  provided  for  by  the  terms  of  the
           agreement entered into between the parties or where the same  is
           permissible by statute.”


      101. Further, in Kemp and Kemp  on Quantum of Damages,  the  objective
      behind granting interest is recorded as under:
           “The object of a court in  awarding  interest  to  a  successful
           litigant is to compensate him for being kept out of money  which
           the court has found is properly due to him. That  objective   is
           easy to achieve  where it is clear that on a  certain  date  the
           defendant ought to have paid to  the  plaintiff  an  ascertained
           sum, for example by way of repayment of  a  loan.  The  problems
           which arise in personal  injury  and  fatal  accident  cases  in
           relation to awards of interest result from the facts that while,
           on the one hand, the cause of action accrues at the time of  the
           accident, so that compensation is payable as from that time,  on
           the other hand


              a) the appropriate  amount of compensation cannot be  assessed
                 in a personal injury case with  any  pretence  of  accuracy
                 until the condition of the plaintiff has stabilised, and


              b) subject to the provisions of the Supreme  Court  Act  1981,
                 S.32A when that section is brought into force, when damages
                 are assessed they are assessed once for all in relation  to
                 both actual past and anticipated future loss and damage.


                 XXX       XXX      XXX XXX       XXX



           The necessity for guidelines, and the status of guidelines, were
           considered by the House of Lords in Cookson v.  Knowles.[34]  In
           that case Lord Diplock with whom the other members of the  House
           agreed, said:


                 The section as amended gives to the judge several  options
           as to the way in which he may assess the interest element to  be
           included in the sum awarded by the   judgment.  He  may  include
           interest on the whole of the damages or on a part of  them  only
           as he thinks appropriate. He may award it for the whole  or  any
           part of the period between the date when  the  cause  of  action
           arose and the date of judgment and he may award it at  different
           rates for different part of the period chosen.


           The section gives no guidance as to the way in which  the  judge
           should exercise his choice between the various options  open  to
           him.  This  is  all  left  to  his  discretion;  but  like   all
           discretions vested in judges by statute or  at  common  law,  it
           must be exercised judicially or, in the  Scots  phrase  used  by
           Lord Emslie in Smith V. Middleton, 1972 S.C. 30, in a  selective
           and discriminating manner, not arbitrarily or idiosyncractically-
            for otherwise the rights of parties to litigation would  become
           dependent upon judicial whim.


           It is therefore appropriate for an appellate court to  lay  down
           guidelines as to what matters it is proper for the judge to take
           into account in deciding how to exercise the discretion confided
           in him by the statute.  In exercising  this appellate  function,
           the court is not expounding a rule of law from which a judge  is
           precluded from departing where special circumstances  exist in a
           particular case; nor indeed, even in cases where  there  are  no
           special circumstances, is an appellate court justified in giving
           effect to the preference  of  its  members  for  exercising  the
           discretion in a different way from that adopted by the judge  if
           the choice between the alternative ways of exercising it is  one
           upon which judicial opinion might reasonably differ.”




      102. Therefore, the National Commission in not  awarding  interest  on
      the compensation amount from  the  date  of  filing  of  the  original
      complaint up to the date of payment  of  entire  compensation  by  the
      appellant-doctors and the  AMRI  Hospital  to  the  claimant  is  most
      unreasonable and the same is opposed to the provision of the  Interest
      Act, 1978. Therefore, we are awarding the interest on the compensation
      that is determined by this Court in the appeal filed by  the  claimant
      at the rate of 6% per annum  on  the  compensation  awarded  in  these
      appeals from the date  of  complaint  till  the  date  of  payment  of
      compensation awarded by this Court.  The  justification  made  by  the
      learned senior counsel on behalf of the appellant-doctors and the AMRI
      Hospital in not awarding interest on the compensation awarded  by  the
      National Commission is contrary to law laid down  by  this  Court  and
      also  the  provisions  of  the  Interest  Act,  1978.   Hence,   their
      submissions cannot be accepted as the same are wholly untenable in law
      and misplaced. Accordingly, the aforesaid point is answered in  favour
      of the claimant.

      Answer to point no. 7

      103. Before we answer this point, it is pertinent to mention  that  we
      are not inclined to determine the liability of the doctors in  causing
      the death of the claimant’s wife since the same has already been  done
      by the Court in Malay Kumar Ganguly’s case (supra).  We  will  confine
      ourselves to determine the extent to which the  appellant-doctors  and
      the Hospital are liable to pay compensation awarded  to  the  claimant
      for their acts of negligence in giving treatment to the deceased  wife
      of the claimant.


      Liability of the AMRI Hospital:


      104. It is the claim of appellant-AMRI  Hospital  that  the  arguments
      advanced on behalf  of  the  appellant-doctors  that  is,  Dr.  Balram
      Prasad, Dr. Sukumar  Mukherjee  and  Dr.  Baidyanath  Haldar  and  the
      claimant Dr. Kunal Saha, that the appellant AMRI is liable to pay  the
      highest share of compensation in terms of percentage on the  basis  of
      the cost imposed by this Court in the earlier round of  litigation  in
      Malay Kumar Ganguly’s case, supra are not sustainable in law.


      105. The learned senior counsel for the  appellant-AMRI  Hospital  Mr.
      Vijay Hansaria argued that the submission made  by  the  claimant  Dr.
      Kunal Saha is not sustainable both  on  facts  and  in  law  since  he
      himself had claimed special damages against the appellant-doctors, Dr.
      Sukumar Mukherjee, Dr. Baidyanath Haldar and Dr. Abani  Roy  Choudhury
      in his appeal and therefore, he cannot now in these proceedings  claim
      to the contrary.  On the other  hand,  the  claimant  Dr.  Kunal  Saha
      argues that though the National Commission claims that this Court  did
      not make any observation on apportionment of liability while remanding
      the matter back to it for determining  the  quantum  of  compensation,
      this Court had implicitly directed the bulk of compensation to be paid
      by the Hospital. Through Paragraph No.  196,  the  judgment  reads  as
      under:


                 “196. We, keeping in view the stand taken  and  conduct  of
           AMRI and Dr. Mukherjee, direct that costs of Rs 5,00,000 and  Rs
           1,00,000  would  be  payable   by   AMRI   and   Dr.   Mukherjee
           respectively. We further direct that if any foreign experts  are
           to be examined it shall be done only  through  videoconferencing
           and at the cost of the respondents.”


          This  Court  has  stated  that  the  bulk  of  the  proportion  of
      compensation is to be paid by the Hospital and the rest by Dr. Sukumar
      Mukherjee. None of the other doctors involved were imposed  with  cost
      though they were found guilty  of  medical  negligence.  The  claimant
      relied upon the decision in Nizam Institute‘s case  (supra)  in  which
      this  Court  directed  the  Hospital  to  pay  the  entire  amount  of
      compensation to the claimant in that case  even  though  the  treating
      doctors were found to be responsible for the negligence. The  claimant
      also relied upon the observations made by this Court  while  remitting
      the case back to National Commission for determining  the  quantum  of
      compensation, to emphasize upon the negligence  on  the  part  of  the
      Hospital. The findings of this Court in  Malay  Kumar  Ganguly’s  case
      read as under:

           “76. AMRI records demonstrate how abysmal the nursing care  was.
           We understand that there was no burn unit in AMRI and there  was
           no burn unit at Breach Candy Hospital either. A patient  of  TEN
           is kept in ICU. All emphasis has been laid on the fact that  one
           room was virtually made an ICU. Entry restrictions were strictly
           adhered to.  Hygiene  was  ensured.  But  constant  nursing  and
           supervision was required. In the name of  preventing  infection,
           it cannot be accepted that the nurses would not keep a watch  on
           the patient. They would also not come to  see  the  patients  or
           administer drugs.


           77. No nasogastric tube was given although    the  condition  of
           the mouth was such that Anuradha could not have been  given  any
           solid food. She required 7 to 8 litres of water  daily.  It  was
           impossible to give so much water by mouth. The  doctors  on  the
           very first day found that the condition of the mouth was bad.


           78. The ENT specialist  in  his  prescription  noticed  blisters
           around the lips of the patient which led her  to  difficulty  in
           swallowing or eating.  No  blood  sample  was  taken.  No  other
           routine pathological examination was  carried  out.  It  is  now
           beyond any dispute that 25-30% body surface  area  was  affected
           (re. Prescription of Dr. Nandy, Plastic Surgeon). The next  day,
           he examined the patient and he found that  more  and  more  body
           surface area was affected. Even Dr. Prasad found the same.
           79. Supportive therapy or symptomatic therapy,  admittedly,  was
           not administered as needle prick was prohibited. AMRI  even  did
           not maintain its records properly. The  nurses  reports  clearly
           show that from 13th May onwards even the routine check-ups  were
           not done.”




      106. The liability of compensation to be apportioned by this Court  on
      the appellant-AMRI Hospital is mentioned in paragraph 165 of the Malay
      Kumar Ganguly’s case which reads as under:
           “165. As regards, individual liability of Respondents 4, 5 and 6
           is concerned, we may notice the same hereunder. As regards AMRI,
           it may be noticed:
           (i)Vital parameters of Anuradha were not examined between  11-5-
           1998 to 16-5-1998 (body temperature, respiration rate, pulse, BP
           and urine input and output).
           (ii) IV fluid not  administered.  (IV  fluid  administration  is
           absolutely necessary in the first 48 hours of treating TEN.)”


      107. However, this Court in  the  aforesaid  case,  also  recorded  as
      under:
           “184. In R. V. Yogasakaran the New Zealand Court opined that the
           hospital is in a better position to disclose what care was taken
           or what medicine was administered to the patient. It is the duty
           of the hospital to satisfy that there was no  lack  of  care  or
           diligence. The hospitals are institutions, people expect  better
           and efficient service, if the hospital fails to discharge  their
           duties through their doctors, being employed  on  job  basis  or
           employed on contract basis, it is  the  hospital  which  has  to
           justify and not impleading a particular doctor will not  absolve
           the hospital of its responsibilities. (See also Errors, Medicine
           and the Law, Alan Merry and Alexander McCall Smith,  2001  Edn.,
           Cambridge University Press, p. 12.)”




      108. Even in the case of Savita  Garg  Vs.  National  Heart  Institute
      (supra) this Court, while determining the liability of  the  Hospital,
      observed as under:

           “15. Therefore,  as  per  the  English      decisions  also  the
           distinction of “contract  of       service”  and  “contract  for
           service”, in both the contingencies, the courts have  taken  the
           view that the hospital is responsible  for  the  acts  of  their
           permanent staff as well as staff whose services are  temporarily
           requisitioned for the treatment of the patients. Therefore,  the
           distinction which is sought to be pressed into service  so  ably
           by learned counsel cannot absolve the hospital or the  Institute
           as it is responsible for the acts of its  treating  doctors  who
           are on the panel and whose services are requisitioned from  time
           to time by the hospital looking to the nature of  the  diseases.
           The hospital or the Institute is responsible and no  distinction
           could be made between  the  two  classes  of  persons  i.e.  the
           treating doctor who was on the staff of  the  hospital  and  the
           nursing staff and the doctors whose  services  were  temporarily
           taken for treatment of the patients............


           16. Therefore, the distinction between the “contract of service”
           and “contract for service” has been very  elaborately  discussed
           in the above case and this Court has extended the provisions  of
           the Consumer Protection Act, 1986,  to  the  medical  profession
           also and included in its ambit the services rendered by  private
           doctors as well as  the  government  institutions  or  the  non-
           governmental institutions, be it free medical services  provided
           by the government hospitals. In the case  of  Achutrao  Haribhau
           Khodwa v. State of Maharashtra their Lordships observed that  in
           cases where the doctors act carelessly and in a manner which  is
           not expected of a medical practitioner, then in such a  case  an
           action in tort would be maintainable.  Their  Lordships  further
           observed that if the doctor has  taken  proper  precautions  and
           despite that if the patient does  not  survive  then  the  court
           should be very slow in attributing negligence on the part of the
           doctor. It was held as follows: (SCC p. 635)


               ‘A medical  practitioner  has  various  duties  towards  his
               patient and he must act with a reasonable  degree  of  skill
               and knowledge and must exercise a reasonable degree of care.
               This is the least which a patient expects from a doctor. The
               skill  of  medical  practitioners  differs  from  doctor  to
               doctor. The very nature of the profession is such that there
               may be more than  one  course  of  treatment  which  may  be
               advisable for treating a patient.  Courts  would  indeed  be
               slow in attributing negligence on the part of a doctor if he
               has performed his duties to the best of his ability and with
               due care and caution. Medical opinion may differ with regard
               to the course of action to be taken by a doctor  treating  a
               patient, but as long as a doctor acts in a manner  which  is
               acceptable to the medical profession  and  the  court  finds
               that he has attended on the patient with due care, skill and
               diligence and if the  patient  still  does  not  survive  or
               suffers a permanent ailment, it would be difficult  to  hold
               the doctor to be guilty of negligence. But  in  cases  where
               the doctors act carelessly and in  a  manner  which  is  not
               expected of a medical practitioner, then in such a  case  an
               action in torts would be maintainable.’


      Similarly, our attention was invited to a  decision  in  the  case  of
      Spring Meadows Hospital v. Harjol Ahluwalia. Their Lordships  observed
      as follows: (SCC pp. 46-47, para 9)


                 ‘9.…Very often in a claim for compensation arising  out  of
                 medical negligence a plea is taken that it  is  a  case  of
                 bona fide mistake which under certain circumstances may  be
                 excusable,  but  a  mistake  which  would   tantamount   to
                 negligence cannot be pardoned. In the former case  a  court
                 can accept that ordinary human  fallibility  precludes  the
                 liability while in the latter the conduct of the  defendant
                 is considered to have gone beyond the  bounds  of  what  is
                 expected of the skill of a reasonably competent doctor…’


           Therefore, as a result of our above discussion  we  are  of  the
           opinion that summary dismissal of the original petition  by  the
           Commission on the question of non-joinder of  necessary  parties
           was not proper. In case the complainant  fails  to  substantiate
           the allegations, then the complaint will fail. But  not  on  the
           ground of non-joinder of necessary party. But at the  same  time
           the hospital can discharge the burden by producing the  treating
           doctor in defence that all due care and caution  was  taken  and
           despite that the patient died.  The  hospital/Institute  is  not
           going to suffer on account of non-joinder of  necessary  parties
           and the Commission should have proceeded against  the  hospital.
           Even otherwise also the Institute had to  produce  the  treating
           physician concerned and has to produce evidence  that  all  care
           and caution was taken by them or their  staff  to  justify  that
           there was no  negligence  involved  in  the  matter.  Therefore,
           nothing turns on not impleading the treating doctor as a  party.
           Once an allegation is made that the patient was  admitted  in  a
           particular hospital and evidence is produced to satisfy that  he
           died because of lack of proper care  and  negligence,  then  the
           burden lies on  the  hospital  to  justify  that  there  was  no
           negligence on the part  of  the  treating  doctor  or  hospital.
           Therefore, in any case, the hospital is in a better position  to
           disclose what care was taken or what medicine  was  administered
           to the patient. It is the duty of the hospital to  satisfy  that
           there was no lack  of  care  or  diligence.  The  hospitals  are
           institutions, people expect better and efficient service, if the
           hospital fails to discharge their duties through their  doctors,
           being employed on job basis or employed on contract basis, it is
           the  hospital  which  has  to  justify  and  not  impleading   a
           particular  doctor  will  not  absolve  the  hospital   of   its
           responsibilities.”
                                               (Emphasis laid by this Court)




      109. Therefore, in the light of the rival legal contentions raised  by
      the parties and the legal  principles  laid  down  by  this  Court  in
      plethora of cases referred to supra, particularly, Savita Garg’s case,
      we have to infer  that  the  appellant-AMRI  Hospital  is  vicariously
      liable for its doctors. It is clearly mentioned in Savita Garg’s  case
      that a Hospital is responsible for the conduct of its doctors both  on
      the  panel  and  the  visiting  doctors.  We,  therefore,  direct  the
      appellant-AMRI Hospital to pay the total amount of  compensation  with
      interest awarded in the appeal of the claimant which remains due after
      deducting the total amount of Rs.25 lakhs payable by  the  appellants-
      doctors as per the Order passed by  this  Court  while  answering  the
      point no. 7.

      Liability of Dr. Sukumar Mukherjee:


      110. As regards the liability of Dr. Sukumar Mukherjee, it is his case
      that nowhere has this Court in Malay Kumar Ganguly’s decision hold the
      appellant  Dr.  Mukherjee  and  appellant-AMRI   Hospital   “primarily
      responsible” for the death of the claimant’s wife.  On  the  contrary,
      referring to paras 186 and 187 of the said judgment, under the heading
      of ‘cumulative effect’, the appellant’s counsel has  argued  that  his
      liability is not established by the Court.  The  said  paragraphs  are
      extracted hereunder:

           “186. A patient would feel  the  deficiency  in  service  having
           regard to the cumulative effect of negligence of all  concerned.
           Negligence on the part of each of the treating doctors  as  also
           the hospital may have  been  the  contributing  factors  to  the
           ultimate death of the patient. But,  then  in  a  case  of  this
           nature, the court must deal with the  consequences  the  patient
           faced, keeping in view the cumulative  effect.  In  the  instant
           case, negligent action has been noticed  with  respect  to  more
           than one respondent. A cumulative incidence, therefore, has  led
           to the death of the patient.
           187. It is to be noted that the doctrine of cumulative effect is
           not available in criminal law. The complexities involved in  the
           instant  case  as  also  the  differing  nature  of   negligence
           exercised by various actors, make it very  difficult  to  distil
           individual extent of negligence with  respect  to  each  of  the
           respondent. In such a scenario  finding  of  medical  negligence
           under Section 304-A cannot be objectively determined.”
      111. In the light of the legal contention raised by the  appellant-Dr.
      Mukherjee, we are inclined to make the following observation regarding
      his liability in the present case. The paragraphs relied upon  by  Dr.
      Mukherjee as  have  been  mentioned  above  are  in  relation  to  the
      culpability of the doctors for causing the death of the patient  under
      Section 304-A of IPC. It  is  imperative  to  mention  here  that  the
      quantum of compensation to be paid by the  appellant-doctors  and  the
      AMRI Hospital is not premised on their culpability under Section 304-A
      of IPC but on the basis of their  act  of  negligence  as  doctors  in
      treating the deceased wife of the claimant. We are therefore  inclined
      to reiterate the findings of this Court regarding the liability of Dr.
      Mukherjee in Malay Kumar Ganguly’s case which read as under:
           “159. When Dr. Mukherjee examined Anuradha, she had  rashes  all
           over her body and this being the case of dermatology, he  should
           have referred her to a  dermatologist.  Instead,  he  prescribed
           “depomedrol” for the next 3 days on his assumption that it was a
           case of “vasculitis”. The dosage of 120 mg depomedrol per day is
           certainly a higher dose in case of a TEN  patient  or  for  that
           matter any patient suffering  from  any  other  bypass  or  skin
           disease  and  the  maximum  recommended  usage   by   the   drug
           manufacturer has also been exceeded by Dr. Mukherjee.  On  11-5-
           1998, the further prescription of depomedrol without  diagnosing
           the nature of the disease is a wrongful act on his part.


           160. According to general practice, long-acting steroids are not
           advisable in any clinical condition,  as  noticed  hereinbefore.
           However, instead of  prescribing  a  quick-acting  steroid,  the
           prescription of a long-acting  steroid  without  foreseeing  its
           implications  is  certainly  an  act  of   negligence   on   Dr.
           Mukherjee’s part without exercising any care or caution.  As  it
           has been already stated by the experts who  were  cross-examined
           and the authorities that have been submitted that the  usage  of
           80-120  mg  is  not  permissible  in  TEN.  Furthermore,   after
           prescribing a steroid, the effect  of  immunosuppression  caused
           due  to  it,  ought  to  have  been  foreseen.  The  effect   of
           immunosuppression caused due to the use of steroids has affected
           the immunity of the patient and Dr. Mukherjee has failed to take
           note of the said consequences.”




      112. It is also important to  highlight  in  this  judgment  that  the
      manner in which Dr. Mukherjee attempted to shirk from  his  individual
      responsibility both in the criminal and civil cases made  against  him
      on the death of the claimant’s wife  is  very  much  unbecoming  of  a
      doctor as renowned and revered as he is. The finding of this Court  on
      this aspect recorded in Malay Kumar Ganguly’s case reads as under:
           “182. It is also of some great significance  that  both  in  the
           criminal as also the civil cases,  the  doctors  concerned  took
           recourse to the blame game. Some of them tried  to  shirk  their
           individual responsibilities. We may in this  behalf  notice  the
           following:
           (i) In response to the notice of Dr. Kunal, Dr.  Mukherjee  says
           that  depomedrol  had  not  been  administered  at   all.   When
           confronted with his prescription, he suggested  that  the  reply
           was not prepared on his instructions, but on the instruction  of
           AMRI.
           (ii) Dr. Mukherjee, thus, sought to disown his  prescription  at
           the first instance. So far as his prescription  dated  11-5-1998
           is concerned, according to him, because  he  left  Calcutta  for
           attending an international conference, the  prescription  issued
           by him became non-operative and, thus, he sought  to  shift  the
           blame on Dr. Halder.
           (iii) Dr. Mukherjee and Dr. Halder have shifted the blame to Dr.
           Prasad and other doctors. Whereas Dr. Prasad countercharged  the
           senior doctors including Respondent 2 stating:
           “Prof. B.N. Halder (Respondent 2) was so much attached with  the
           day-today treatment of patient Anuradha that he never found  any
           deficiency in the overall management at AMRI so much so that  he
           had himself given a certificate that her condition was very much
           fit enough to travel to Mumbai.…”




      113. Therefore, the negligence of Dr. Sukumar  Mukherjee  in  treating
      the claimant’s wife had been already  established  by  this  Court  in
      Malay Kumar Ganguly’s case. Since he is a senior  doctor  who  was  in
      charge of the treatment of the deceased, we are  inclined  to  mention
      here that Dr. Mukherjee has shown utmost disrespect to his  profession
      by being so casual in his approach in treating his patient.  Moreover,
      on being charged with the liability, he attempted to shift  the  blame
      on other doctors. We,  therefore,  in  the  light  of  the  facts  and
      circumstances, direct him to pay a compensation of Rs.10 lakhs to  the
      claimant in lieu of his negligence  and  we  sincerely  hope  that  he
      upholds his integrity as a doctor in the  future  and  not  be  casual
      about his patient’s lives.

      Liability of Dr.Baidyanath Haldar:

      114. The case of the appellant Dr. Baidyanath Haldar is that he  is  a
      senior consultant who was called by the attending physician to examine
      the patient on 12.5.1998. On examining the patient, he  diagnosed  the
      disease as TEN  and  prescribed  medicines  and  necessary  supportive
      therapies. It is his further case that he was not called either to see
      or examine the patient post 12.5.1998. The case against Dr. B.  Haldar
      is his prescription of Steroid Predinosolone at  the  rate  of  40  mg
      thrice a day which was excessive in view of the fact that the deceased
      was already under high dose of steroid. It is urged by the  appellant-
      Dr. Haldar that the deceased was under a high dose of steroid  at  the
      rate of 160 mg per day and it was the appellant who tapered it down by
      prescribing a quick acting steroid Predinosolone at 120  mg  per  day.
      The appellant-Dr. Haldar further urged that he was called only once to
      examine the deceased and he was  not  called  thereafter.  Hence,  the
      National Commission wrongly equated him with Dr. Balram Prasad who was
      the attending physician. Though the claimant did not make any  counter
      statement on apportioning liability to the appellant-Dr. Haldar, it is
      pertinent for us to resort to the findings recorded by this  Court  in
      the case while remanding  it  back  to  the  National  Commission  for
      determining the individual liability of the appellant doctors involved
      in the treatment of the deceased. The findings of this Court in  Malay
      Kumar Ganguly’s case supra, are recorded as under:
           “161. After  taking  over  the  treatment  of  the  patient  and
           detecting TEN, Dr. Halder ought to have necessarily verified the
           previous prescription that has been given to the patient. On 12-
           5-1998 although “depomedrol” was stopped,  Dr.  Halder  did  not
           take any remedial  measures  against  the  excessive  amount  of
           “depomedrol” that was already stuck in the  patient’s  body  and
           added more fuel  to  the  fire  by  prescribing  a  quick-acting
           steroid “prednisolone” at 40 mg three times daily, which  is  an
           excessive dose, considering the  fact  that  a  huge  amount  of
           “depomedrol” has been already accumulated in the body.


           162.   Life   saving   “supportive   therapy”    including    IV
           fluids/electrolyte replacement,  dressing  of  skin  wounds  and
           close monitoring of the infection is mandatory for  proper  care
           of TEN patients. Skin (wound) swap and blood tests also ought to
           be performed regularly to detect the degree of infection.  Apart
           from using the steroids, aggressive supportive therapy  that  is
           considered to be rudimentary for TEN patients was  not  provided
           by Dr. Halder.


           163. Further “vital signs” of a  patient  such  as  temperature,
           pulse, intake-output and blood pressure were not monitored.  All
           these factors are considered to  be  the  very  basic  necessary
           amenities to be provided to any patient, who is critically  ill.
           The failure of Dr. Halder to  ensure  that  these  factors  were
           monitored regularly is certainly an act of negligence. Occlusive
           dressings were carried out as a result of  which  the  infection
           had been increased. Dr. Halder’s prescription  was  against  the
           Canadian Treatment Protocol reference to which we  have  already
           made hereinbefore. It is the duty  of  the  doctors  to  prevent
           further spreading of infections. How that is to be done  is  the
           doctors concern. Hospitals or nursing homes where a  patient  is
           taken for better treatment should not be  a  place  for  getting
           infection.”




      115. Similar to the appellant Dr. Sukumar Mukherjee, the appellant Dr.
      Baidyanath Haldar is also a senior doctor  of  high  repute.  However,
      according to the findings of this Court in Malay Kumar Ganguly’s case,
      he had conducted with utmost callousness in giving  treatment  to  the
      claimant’s wife which led to her unfortunate demise. The appellant Dr.
      Baidyanath Haldar too, like Dr. Sukumar Mukherjee, made every  attempt
      to shift the blame to the other doctors thereby tainting  the  medical
      profession who undertook to serve. This Court thereby directs  him  to
      pay Rs.10 lakhs as  compensation  to  the  claimant  in  lieu  of  his
      negligence in treating the wife of the claimant.


      Liability of Dr Baidyanath Prasad:


      116. It is the case of the appellant-Dr. Balram Prasad that he was the
      junior-most attending physician at AMRI Hospital who saw the  deceased
      for the first time on 11.5.1998. He was not called upon  to  prescribe
      medicines but was only required to continue and monitor the  medicines
      to be administered to the deceased as prescribed by  the  specialists.
      The learned senior counsel on behalf  of  the  appellant-Dr.  B.Prasad
      argues that the complaint  made  by  the  claimant  had  no  averments
      against him but the one whereby it  was  stated  by  the  claimant  at
      paragraph 44 of the complaint which reads thus:
           “44. That Dr. Balram Prasad as attending physician at  AMRI  did
           do nothing better. He did not take any part in the treatment  of
           the patient although he stood like a second fiddle to  the  main
           team headed by the opposite party no. 2 & 3. He never  suggested
           even faintly that AMRI is not an ideal place  for  treatment  of
           TEN patient; on the converse, he was full of praise for AMRI  as
           an ideal place for the treatment of TEN patients knowing nothing
           how a TEN patient should be treated.”



      117. To prove his competence as a  doctor,  the  appellant-Dr.  Balram
      Prasad further produced a portion of the complaint which reads thus:
           “33………. that no skin biopsy for histopathology report  was  ever
           recommended by any (except Dr. B.Prasad),  which  is  the  basic
           starting point in such treatment,  the  same  mistake  was  also
           committed by the opposite party no. 1”




      118. The appellant Dr. Balram Prasad further emphasizes upon the cross-
      examination of the claimant to prove that he was not  negligent  while
      treating the patient. Question No. 26 of the cross  examination  reads
      as under:
           “Q. No. 26: Dr. Prasad says that Depomedrol  dose  according  to
           the treatment sheet of the AMRI hospital,  he  made  a  specific
           suggestion that the dose should be limited  to  that  particular
           day only. Is it correct?
           Ans: It is all matter of record. Yeah, he said that one  day  in
           AMRI record.”






      119. Though the claimant did  not  make  specific  claim  against  the
      appellant-Dr. Balram Prasad, appellant Dr. B. Haldar  claimed  in  his
      submission that he has been wrongly equated with Dr. Balram Prasad who
      was the attending physician and Dr. Anbani Roy Choudhury who  was  the
      physician in charge of the patient.


      120. It is pertinent  for  us  to  note  the  shifting  of  blames  on
      individual responsibility by the doctors specially the  senior  doctor
      as recorded by this Court which is a shameful act on  the  dignity  of
      medical profession. The observations made by this Court in this regard
      in Malay Kumar Ganguly’s case read as under:
           “182......(iii) Dr. Mukherjee and Dr. Halder  have  shifted  the
           blame to Dr.  Prasad  and  other  doctors.  Whereas  Dr.  Prasad
           countercharged  the  senior  doctors  including   Respondent   2
           stating:
           “Prof. B.N. Halder (Respondent 2) was so much attached with  the
           day-today treatment of patient Anuradha that he never found  any
           deficiency in the overall management at AMRI so much so that  he
           had himself given a certificate that her condition was very much
           fit enough to travel to Mumbai.…”
           In answer to a question as  to  whether  Dr.  Halder  had  given
           specific direction to him for control of day-today  medicine  to
           Anuradha, Dr. Prasad stated:
           “… this was done under the guidance  of  Dr.  Sukumar  Mukherjee
           (Respondent 1), Dr. B.N. Halder (Respondent 2) and Dr. Abani Roy
           Chowdhury (Respondent 3).”
           He furthermore stated that those three senior doctors  primarily
           decided the treatment regimen for Anuradha at AMRI.
           (iv) Dr. Kaushik Nandy had also stated that three senior doctors
           were in charge of Anuradha’s treatment.
           (v) AMRI states that the drugs had been administered and nursing
           care had been given as per the directions of the doctors.
           (vi) Respondents 5 and 6, therefore, did not own any  individual
           responsibility on  themselves  although  they  were  independent
           physicians with postgraduate medical qualifications.


           183. In Errors,  Medicine  and  the  Law,  Cambridge  University
           Press, p. 14, the  authors,  Alan  Merry  and  Alexander  McCall
           Smith, 2001 Edn., stated:
           “Many incidents  involve  a  contribution  from  more  than  one
           person, and this case is an example. It illustrates the tendency
           to  blame  the  last  identifiable  element  in  the  claim   of
           causation—the  person  holding  the  ‘smoking   gun’.   A   more
           comprehensive approach would identify the relative contributions
           of the other failures in the system, including failures  in  the
           conduct of other individuals.…”




      121. Paragraph 183 of the judgment indicates that the  Court  abhorred
      the shifting of blames by the senior doctor on the attending physician
      the appellant Dr. Balram Prasad even though the Court held him  guilty
      of negligence. This Court found the appellant-Dr. Balram Prasad guilty
      as under:

           “166. As regards, Dr. Balaram Prasad, Respondent 5,  it  may  be
           noticed:
           (i) Most doctors refrain from using steroids at the later  stage
           of the disease due to the fear of  sepsis,  yet  he  added  more
           steroids in the form of quick-acting  “prednisolone”  at  40  mg
           three times a day.
           (ii) He stood as a second fiddle to the treatment and failed  to
           apply his own mind.
           (iii) No doctor has the right to use the drug beyond the maximum
           recommended dose.”




      122.  We acknowledge the fact that Dr.  Balram  Prasad  was  a  junior
      doctor who might have acted on the direction of the senior doctors who
      undertook the treatment  of  the  claimant’s  wife  in  AMRI-Hospital.
      However, we cannot lose sight of  the  fact  that  the  appellant  Dr.
      Balram Prasad was an independent  medical  practitioner  with  a  post
      graduate degree. He still stood as a second fiddle and perpetuated the
      negligence in giving treatment to the claimant’s wife. This  Court  in
      Malay Kumar Ganguly’s case found him to be negligent in  treating  the
      claimant’s wife in spite of  being  the  attending  physician  of  the
      Hospital. But since he is a junior doctor whose  contribution  to  the
      negligence is far less than the  senior  doctors  involved,  therefore
      this Court directs him to pay a compensation of Rs.  5  lakhs  to  the
      claimant. We hope that  this  compensation  acts  as  a  reminder  and
      deterrent to him against being casual  and  passive  in  treating  his
      patients in his formative years of medical profession.


      Liability of the claimant - Dr. Kunal Saha:

      123. Finally,  we  arrive  at  determining  the  contribution  of  the
      claimant to the negligence of the  appellant-  doctors  and  the  AMRI
      Hospital in causing the death of his wife due to  medical  negligence.
      The National Commission has determined the compensation to be paid for
      medical  negligence  at  Rs.1,72,87,500/-.   However,   the   National
      Commission was of the opinion that the interference  of  the  claimant
      was also contributed to the death of his wife. The National Commission
      relied upon paragraph 123 of the judgment of this Court in Malay Kumar
      Ganguly’s case to arrive at the aforesaid conclusion. Paragraph 123 of
      the judgment reads thus:
           “123. To conclude, it will be pertinent to note that even if  we
           agree that there was  interference  by  Kunal  Saha  during  the
           treatment, it in no way diminishes  the  primary  responsibility
           and default in duty on part of the defendants.  In  spite  of  a
           possibility of  him  playing  an  overanxious  role  during  the
           medical proceedings, the breach of duty to take  basic  standard
           of medical care on the part of defendants  is  not  diluted.  To
           that extent, contributory negligence is not pertinent.  It  may,
           however, have some role to play for the purpose of damages.”


      Therefore,  holding  the   claimant   responsible   for   contributory
      negligence, the  National  Commission  deducted  10%  from  the  total
      compensation and  an  award  of  Rs.1,55,58,750/-  was  given  to  the
      claimant.


      124. The appellants-doctors and the  AMRI  Hospital  have  raised  the
      issue of contributory negligence all over again in  the  present  case
      for determining the quantum of compensation to  be  deducted  for  the
      interference of the claimant in treatment of the deceased.


      125. On the other hand, the claimant  in  his  written  statement  has
      mentioned that this Court has rejected the assertion that the claimant
      interfered with the  treatment  of  his  wife.  The  appellant-doctors
      raised the same issue in the revision petition which was appropriately
      dismissed. He relied upon the observations made by  this  Court  which
      read as under:
           “117.  Interference  cannot  be  taken  to  be  an  excuse   for
           abdicating one’s responsibility especially when an  interference
           could also have been in the nature of suggestion. Same  comments
           were said to have been made  by  Dr.  Halder  while  making  his
           statement under Section 313 of the Code of  Criminal  Procedure.
           They are admissible in evidence for the said purpose. Similarly,
           the statements made by Dr. Mukherjee and  Dr.  Halder  in  their
           written statements before the National Commission are not backed
           by any evidence on record. Even otherwise, keeping in  view  the
           specific defence raised by them  individually,  interference  by
           Kunal, so far as they are concerned,  would  amount  to  hearsay
           evidence and not direct evidence.


           122. The respondents also sought to highlight on the  number  of
           antibiotics which are said to have been administered by Kunal to
           Anuradha  while  she  was  in  AMRI  contending  that  the  said
           antibiotics were necessary. Kunal, however, submitted  that  the
           said antibiotics were prescribed by the doctors at AMRI  and  he
           did not write any prescription. We would, however,  assume  that
           the said antibiotics had been administered by Kunal on his  own,
           but  it  now  stands  admitted  that  administration   of   such
           antibiotics was necessary.


           123. To conclude, it will be pertinent to   note that even if we
           agree that there was  interference  by  Kunal  Saha  during  the
           treatment, it in no way diminishes  the  primary  responsibility
           and default in duty on part of the defendants.  In  spite  of  a
           possibility of  him  playing  an  overanxious  role  during  the
           medical proceedings, the breach of duty to take  basic  standard
           of medical care on the part of defendants  is  not  diluted.  To
           that extent, contributory negligence is not pertinent.  It  may,
           however, have some role to play for the purpose of damages.”
                               (Emphasis laid by this Court)


      A careful reading of the above paragraphs together from  the  decision
      of Malay Kumar Ganguly’s case would  go  to  show  that  the  claimant
      though over-anxious, did to the patient what was necessary as  a  part
      of  the  treatment.  The  National  Commission  erred  in  reading  in
      isolation the statement of this Court that the claimant’s  action  may
      have played some role for the purpose of damage.


      126. We further intend to emphasize upon the observation of this Court
      in Malay Kumar Ganguly’s case which reads as under:

           “194. Further, the statement made by the  High  Court  that  the
           transfer  certificate  was  forged  by  the  patient  party   is
           absolutely erroneous, as Dr. Anil Kumar Gupta deposed before the
           trial court that he  saw  the  transfer  certificate  at  AMRI’s
           office and the words “for better treatment” were written by  Dr.
           Balaram Prasad in his presence and these words were  written  by
           Dr. Prasad, who told it would be easier for  them  to  transport
           the patient. In a case of this nature, Kunal would have expected
           sympathy and not a spate of irresponsible accusations  from  the
           High Court.”



      In the abovementioned paragraph, this Court clearly deterred the  High
      Court from making irresponsible accusations against the  claimant  who
      has suffered not only due to the loss of his wife but also because his
      long drawn battle for justice. Unfortunately, the National  Commission
      made the same mistake.


      127. We, therefore, conclude that the  National  Commission  erred  in
      holding that the claimant had contributed to  the  negligence  of  the
      appellant-doctors and the Hospital which resulted in the death of  his
      wife when this Court clearly absolved the claimant of  such  liability
      and remanded the matter back to the National Commission only  for  the
      purpose of determining the quantum  of  compensation.  Hence,  we  set
      aside the finding of the  National  Commission  and  re-emphasize  the
      finding of this Court that the claimant  did  not  contribute  to  the
      negligence of the appellants-doctors and AMRI Hospital which  resulted
      in the death of his wife.




      Answer to point no. 8


      128. This Court, while remanding  the  matter  back  to  the  National
      Commission, has categorically  stated  that  the  pecuniary  and  non-
      pecuniary losses sustained by the claimant and future losses of him up
      to  the  date  of  trial  must  be  considered  for  the  quantum   of
      compensation.  That has not been done  in  the  instant  case  by  the
      National  Commission.   Therefore,  the  claimant  is   entitled   for
      enhancement of compensation on the aforesaid heads as he has  incurred
      huge amount of expenses in the court of more than 15 years long  trial
      in the instant case.  The total claim, original as  well  as  enhanced
      claim by  way  of  filing  affidavit  with  supporting  documents,  is
      Rs.97,56,07,000/- that includes pecuniary damages of Rs.34,56,07,000/-
      and non pecuniary damages of Rs.31,50,00,000/-, special damages of  US
      $4,000,000 for loss of job/house in Ohio and punitive  damages  of  US
      $1,000,000.  The updated break-up of the total claim has been  perused
      and the same has  not  been  considered  by  the  National  Commission
      keeping in view the claim and legal evidence and observations made and
      directions issued by this Court in  Malay  Kumar  Ganguly’s   case  to
      determine just and reasonable compensation. Therefore, we are  of  the
      view that the claimant is entitled for enhanced compensation that will
      be mentioned  under  different  heads  which  will  be  noted  in  the
      appropriate paragraphs of this judgment.


      129. The National Commission has also not taken into consideration the
      observations  made  by  this  Court  while  remanding  the  case   for
      determining the quantum of compensation with regard to the  status  of
      treating doctors and the Hospital.  Further, the  National  Commission
      has failed to take into consideration the  observations  made  in  the
      aforesaid judgment wherein in paragraphs 152 and 155 it is  held  that
      AMRI Hospital is one of the best Hospitals in Calcutta and the doctors
      were best doctors available.  This  aspect  of  the  matter  has  been
      completely ignored by the National Commission  in  awarding  just  and
      reasonable compensation in favour of the claimant.
      130.  Since, it has already been determined  by  the  Court  that  the
      compensation paid by the National Commission was inadequate  and  that
      it is required to  be  enhanced  substantially  given  the  facts  and
      evidence on record, it will be prudent to take up the different  heads
      of compensation separately to provide  clarity  to  the  reasoning  as
      well.


      Loss of income of the deceased:



      131. The grievance of the claimant is that the National Commission has
      failed to take into consideration the legal and  substantial  evidence
      produced on record regarding the income of the deceased  wife  as  she
      was  a  citizen  of  U.S.A.  and  permanently  settled  as   a   child
      psychologist and the  claimant  was  AIDS  researcher  in  the  U.S.A.
      Therefore, the National Commission  ought  to  have  taken  the  above
      relevant factual aspect of the case into consideration  regarding  the
      status and standard of living of the deceased in U.S.A.  to  determine
      just compensation under the head of loss of dependency.  The  claimant
      has rightly relied upon the case involving death of a 47-48 years  old
      U.S.A. citizen in a road accident in India, in United India  Insurance
      Co. Ltd. & Others Vs. Patricia Jean Mahajan & Ors. referred  to  supra
      where this Court has awarded compensation  of  Rs.10.38  crores  after
      holding that while awarding compensation in such cases the Court  must
      consider the high status and standard of living of both the victim and
      dependents. However, the National  Commission  did  not  consider  the
      substantial and legal evidence  adduced  on  record  by  the  claimant
      regarding the income that was being earned by the claimant’s wife even
      though he has examined the U.S.A. based Prof. John  F.  Burke  through
      video conferencing in May-June, 2011. He was also  cross  examined  by
      the counsel of  the  appellant-  doctors  and  the  Hospital  and  had
      scientifically calculated and testified under direct as well as  cross
      examination as to how he came to calculate  the  prospective  loss  of
      income for a similarly situated person in U.S.A.  as of the  deceased.
      Prof. John F. Burke has  categorically  stated  that  direct  loss  of
      income of the deceased on account of her premature death, would amount
      to 5 million and 125 thousand dollars. The loss of income  on  account
      of premature death of the claimant’s wife was calculated by  the  said
      witness who is an Economist in America and he has also  deducted  one-
      third for her personal expenses out of her annual income which  is  at
      par with the law laid down by this Court in number of cases  including
      Sarla Verma’s case (supra). In  the  cross  examination  of  the  said
      expert witness by the learned counsel for  the  appellant-doctors  and
      the Hospital, he has also explained how  he  calculated  the  loss  of
      income on the premise of the premature death of the  claimant’s  wife.
      According to Prof. John F. Burke, the above calculation of  5  million
      and 125 thousand dollars for loss of income of the deceased was a very
      conservative  forecast  and  other  estimates  the  damages  for   her
      premature death could be 9 to 10 million dollars.  It is the claim  of
      the claimant that loss of income of multi-million  dollars  as  direct
      loss for the wrongful death of the deceased may appear as  a  fabulous
      amount in  the  context  of  India  but  undoubtedly  an  average  and
      legitimate claim in the context of the instant case has to be taken to
      award just compensation. He has placed reliance upon the  judgment  of
      this Court in Indian Medical Association’s case  (supra)  wherein  the
      Constitution Bench has stated that to deny the legitimate claim or  to
      restrict arbitrarily the size of an award would amount to  substantial
      injustice. We have considered the above important aspect of  the  case
      in the decision of this Court for enhancing the compensation in favour
      of the claimant.


      132.  As per the evidence on record, the deceased was earning $ 30,000
      per annum at the time of her  death.  The  appellant-doctors  and  the
      Hospital could not produce any evidence to rebut  the  claims  of  the
      claimant regarding the qualification of her wife. Further, Prof.  John
      F. Burke, an economic expert testified that the  deceased  could  have
      earned much more in future given her  present  prospect.  But  relying
      upon the principle laid  down  by  this  Court,  we  cannot  take  the
      estimate of Prof. John F. Burke to be the income of the  deceased.  We
      also feel that $30,000 per annum earned by  the  deceased  during  the
      time of her death was not from a regular  source  of  income  and  she
      would have earned lot more had it been a  regular  source  of  income,
      having regard to her qualification and  the  job  for  which  she  was
      entitled to. Therefore, while determining the income of the  deceased,
      we rely on the evidence on record for the purpose of  determining  the
      just, fair and reasonable compensation in favour of the  claimant.  It
      would be just and proper for us to take her  earning  at  $40,000  per
      annum on a regular job. We further rely upon  the  paragraphs  in  the
      cases of  Sarla  Verma  and  Santosh  Devi  referred  to  supra  while
      answering the point no. 1, to hold that 30% should  be  added  towards
      the future loss of income of the deceased. Also, based on the law laid
      down by this Court in catena of cases referred to supra, 1/3rd of  the
      total income is required to be deducted under  the  head  of  personal
      expenditure of the deceased to arrive at the multiplicand.


      133.  The multiplier method to be applied has been convincingly argued
      by the learned counsel for  the  appellant-doctors  and  the  Hospital
      against by the claimant which we concede with based on  the  reasoning
      mentioned while answering the point no. 4. Therefore,  estimating  the
      life expectancy of a healthy person in the present age as 70 years, we
      are inclined to award  compensation  accordingly  by  multiplying  the
      total loss of income by 30.

      134. Further, the claimant has  rightly  pointed  that  the  value  of
      Indian currency  has  gone  down  since  the  time  when  these  legal
      proceedings have begun in this country. This argument of the  claimant
      has been accepted by us while  answering  the  point  nos.  2  and  3.
      Therefore, it will be prudent for us to  hold  the  current  value  of
      Indian Rupee at a stable rate of Rs.55/- per 1$.
           Therefore, under the head of ‘loss of income  of  the  deceased’
      the claimant is entitled to an amount  of  Rs.5,72,00,550/-  which  is
      calculated as [$40,000+(30/100x40,000$)-(1/3 x 52,000$) x 30 x Rs.55/-
      ] = Rs.5,72,00,550/-.


      Other Pecuniary Damages:


      135.  The pecuniary damages incurred by the claimant due to  the  loss
      of the deceased have already been granted while  answering  the  point
      no. 5. Therefore, we are not inclined  to  repeat  it  again  in  this
      portion. However, the expenditure made  by  the  claimant  during  the
      treatment of  the  deceased  both  in  Kolkata  and  Mumbai  Hospitals
      deserves to be duly compensated for awarding reasonable  amount  under
      this head as under:-




      (a) For the medical treatment in Kolkata and Mumbai:


      136.   An amount of Rs.23 lakhs has been claimed by the claimant under
      this head. However, he has been able to produce the medical bill  only
      to the extent of Rs.2.5 lakhs which he had paid to  the  Breach  Candy
      Hospital, Mumbai. Assuming that  he  might  have  incurred  some  more
      expenditure, the National Commission had quantified the expenses under
      this head to the tune of Rs.5 lakhs. We still consider this amount  as
      insufficient in the light of the fact that the deceased was treated at
      AMRI Hospital as an in-patient for about a week; we deem it  just  and
      proper to enhance the compensation  under  this  head  by  Rs.2  lakhs
      thereby awarding a total amount Of Rs.7 lakhs under this head.




      (b) Travel and Hotel expenses at Bombay:


      137. The claimant has sought for compensation  to  the  tune  of  Rs.7
      lakhs for travel and expenses for 11 days he had to stay in Mumbai for
      the treatment of his wife. However, again he has failed to produce any
      bills to prove his expenditure. Since, his travel to  Mumbai  for  the
      treatment of his wife  is  on  record,  the  National  Commission  has
      awarded compensation of Re.1 lakh under this head. We find it fit  and
      proper to enhance the compensation  by  Rs.50,000/-  more  considering
      that he had also incurred  some  unavoidable  expenditure  during  his
      travel and stay in Mumbai at the time of treatment  of  the  deceased.
      Therefore, under this head, we award a compensation of Rs.1,50,000/-.


      138. However, with respect  to  the  claim  made  under  the  cost  of
      chartered flight, a sum of Rs.5,00,000/- is  already  awarded  by  the
      National Commission and we are not inclined to interfere with the same
      in absence of any evidence which alters the computation  of  the  cost
      incurred in chartered flight. Hence, we uphold the amount  awarded  by
      the National Commission under the head of ‘cost of chartered flight’.


      Non pecuniary damages:


      139. It is the case of the claimant that the National  Commission  has
      awarded paltry amount equivalent  to  $20,000  for  the  enormous  and
      lifelong pain, suffering, loss of companionship and amenities that  he
      had been put through due  to  the  negligent  act  of  the  appellant-
      doctors and the Hospital. The claimant had claimed Rs.50 crores  under
      this head before the National Commission without giving any  break  up
      figures for the amount. Before this Court however,  the  claimant  has
      reduced the claim to Rs.31,50,00,000/- under three different heads. He
      has claimed Rs.13,50,00,000/-  for  loss  of  companionship  and  life
      amenities, Rs.50,00,000/- for emotional distress, pain  and  suffering
      of the  husband-  the  claimant  and  Rs.4,50,00,000/-  for  pain  and
      suffering endured by the deceased during her treatment.


      140. In this regard, we are inclined to make  an  observation  on  the
      housewife services here.  In  the  case  of  Arun  Kumar  Agarwal  Vs.
      National Insurance Company[35], this Court observed as follows:
           22. We may now deal with the question formulated in the  opening
           paragraph of this judgment. In  Kemp  and  Kemp  on  Quantum  of
           Damages, (Special  Edn.,  1986),  the  authors  have  identified
           various heads under which the husband can claim compensation  on
           the death  of  his  wife.  These  include  loss  of  the  wife’s
           contribution to the household from her earnings, the  additional
           expenses incurred  or  likely  to  be  incurred  by  having  the
           household run by a housekeeper or servant, instead of the  wife,
           the expenses incurred in buying clothes for the children instead
           of having them made by the wife, and similarly  having  his  own
           clothes mended or stitched elsewhere than by his wife,  and  the
           loss of that element of security provided to the  husband  where
           his employment was insecure or his health was bad and where  the
           wife could go out and work for a living.


           23. In England the courts used to award damages  solely  on  the
           basis of pecuniary loss to family due to the demise of the wife.
           A departure from this rule came to be made in Berry  v.  Humm  &
           Co. where the plaintiff claimed damages for  the  death  of  his
           wife caused due to the negligence of the  defendant’s  servants.
           After taking cognizance of some precedents,  the  learned  Judge
           observed: (KB p. 631)


           “… I can see no reason in  principle  why  such  pecuniary  loss
           should be limited to the value of money lost, or the money value
           of things lost, as contributions of food or clothing, and why  I
           should be  bound  to  exclude  the  monetary  loss  incurred  by
           replacing services rendered gratuitously by a relative, if there
           was a reasonable prospect of their being rendered freely in  the
           future but for the death.”


           24. In Regan  v.  Williamson  the  Court  considered  the  issue
           relating to quantum of compensation payable to the dependants of
           the woman who was killed in a road accident. The facts  of  that
           case were that on the date of accident, the plaintiff  was  aged
           43 years and his children were aged 14 years, 11 years, 8  years
           and 3 years respectively. The deceased wife/mother was  aged  37
           years.  The  cost  of  a  housekeeper  to  carry  out   services
           previously rendered by his wife was 22.5 pounds  per  week,  the
           saving to him in not having to clothe and feed his wife  was  10
           pound per week, leaving a net loss of 12.50 pounds per  week  or
           600 pounds a year. However, the  Court  took  into  account  the
           value of other services previously  rendered  by  the  wife  for
           which no substitute was available and accordingly increased  the
           dependency to 20  pounds  a  week.  The  Court  then  applied  a
           multiplier of 11 in reaching a total fatal  accidents  award  of
           12,298 pounds. In his judgment, Watkins, J. noted as under: (WLR
           pp. 307 H-308 A)


           “The weekend care of  the  plaintiff  and  the  boys  remains  a
           problem  which  has  not   been   satisfactorily   solved.   The
           plaintiff’s relatives help him to a certain  extent,  especially
           on Saturday afternoons. But I formed the clear  impression  that
           the plaintiff is often, at weekends, sorely tired in  trying  to
           be an effective substitute for the deceased. The problem  could,
           to some extent, be cured by engaging another woman, possibly  to
           do duty at the weekend, but finding such a person is  no  simple
           matter. I think the plaintiff has not made  extensive  enquiries
           in this regard. Possibly the expense involved  in  getting  more
           help is a factor which has deterred him. Whatever be the reason,
           the plain fact is that the deceased’s services  at  the  weekend
           have not been replaced. They are lost to the  plaintiff  and  to
           the boys.”


           He then proceeded to observe: (WLR p. 309
           A-D)
           “I have been referred to a number of cases in which judges  have
           felt compelled to look upon the task  of  assessing  damages  in
           cases involving the death of  a  wife  and  mother  with  strict
           disregard to those features of the life of a woman beyond her so-
           called services, that is to say, to  keep  house,  to  cook  the
           food, to buy the clothes, to wash them and  so  forth.  In  more
           than one case, an attempt has been made to calculate the  actual
           number of hours it would take a woman to perform  such  services
           and to compensate dependants upon that basis at so much an  hour
           and so relegate the wife or mother, so it seems to  me,  to  the
           position of a housekeeper.
                                               (Emphasis laid by this Court)


      While I think that the law inhibits me from, much as I should like to,
      going all the way along the path to which Lord Edmund-Davies  pointed,
      I am, with due respect to  the  other  judges  to  whom  I  have  been
      referred, of the view that the word ‘services’ has been  too  narrowly
      construed. It should, at least, include an acknowledgment that a  wife
      and mother does not work to set hours and, still less, to rule. She is
      in constant attendance, save for those hours when she is, if  that  is
      the fact, at work. During some of those hours she may  well  give  the
      children instruction on essential matters to do with their  upbringing
      and, possibly, with such  things  as  their  homework.  This  sort  of
      attention seems to be as much of a service, and probably more valuable
      to them, than the other kinds of service conventionally so regarded.”

      25. In Mehmet v. Perry the pecuniary value of a wife’s  services  were
      assessed and granted under the following heads:
      (a) Loss to the family of the wife’s housekeeping services.
      (b) Loss suffered by the children of the personal attention  of  their
      mother, apart from housekeeping services rendered by her.
      (c) Loss of the wife’s personal care and attention, which the  husband
      had suffered, in addition to the loss of her housekeeping services.


      26. In India the courts have 210recognized that the contribution  made
      by the wife to the house is invaluable and cannot be computed in terms
      of money. The gratuitous services rendered by the wife with true  love
      and affection to  the  children  and  her  husband  and  managing  the
      household affairs cannot be equated  with  the  services  rendered  by
      others. A wife/mother does not work  by  the  clock.  She  is  in  the
      constant attendance of the family throughout the day and night  unless
      she is employed and is required to  attend  the  employer’s  work  for
      particular hours. She takes  care  of  all  the  requirements  of  the
      husband and children including cooking of food,  washing  of  clothes,
      etc. She teaches small children and provides  invaluable  guidance  to
      them for their future life. A housekeeper or maidservant  can  do  the
      household work, such as cooking food, washing  clothes  and  utensils,
      keeping the house clean, etc., but she can never be a substitute for a
      wife/mother who renders selfless service to her husband and children.


      27. It is not possible to quantify any amount in lieu of the  services
      rendered by the  wife/mother  to  the  family  i.e.  the  husband  and
      children. However, for the purpose of award  of  compensation  to  the
      dependants, some pecuniary estimate has to be made of the services  of
      the housewife/mother. In that context, the term “services” is required
      to be given a broad meaning and  must  be  construed  by  taking  into
      account the loss of personal care and attention given by the  deceased
      to her children as a mother and to her husband as  a  wife.  They  are
      entitled to adequate compensation in lieu of the  loss  of  gratuitous
      services  rendered  by  the  deceased.  The  amount  payable  to   the
      dependants cannot be diminished on the ground that some close relation
      like a grandmother may volunteer to render some of the services to the
      family which the deceased was giving earlier.




      30. In A. Rajam v. M. Manikya Reddy, M. Jagannadha Rao, J. (as he then
      was) advocated giving of a wider meaning to  the  word  “services”  in
      cases relating to  award  of  compensation  to  the  dependants  of  a
      deceased wife/mother. Some of the observations made in  that  judgment
      are extracted below:
      ‘The loss to the husband and children consequent upon the death of the
      housewife or mother has to be  computed  by  estimating  the  loss  of
      ‘services’ to the family, if there was  reasonable  prospect  of  such
      services being rendered freely in the future, but for  the  death.  It
      must be remembered that any substitute to be so employed is not likely
      to be as  economical  as  the  housewife.  Apart  from  the  value  of
      obtaining substituted services, the expense of giving accommodation or
      food to the substitute must also be computed. From this total must  be
      deducted the expense the family would have otherwise been spending for
      the deceased housewife.
      While estimating the ‘services’ of the  housewife,  a  narrow  meaning
      should not be given to the meaning  of  the  word  ‘services’  but  it
      should be construed broadly and one has to take into account the  loss
      of ‘personal care and attention’ by the deceased to her children, as a
      mother and to her husband, as a wife.  The  award  is  not  diminished
      merely because some close relation like a grandmother is  prepared  to
      render voluntary services.’


           XXX                     XXX             XXX


      32. In National Insurance Co. Ltd. v.  Mahadevan  the  learned  Single
      Judge referred to the Second Schedule of the  Act  and  observed  that
      quantifying the pecuniary loss at the same rate or amount  even  after
      13 years after the amendment, ignoring the escalation in the  cost  of
      living and the inflation, may not be justified.


      33. In Chandra Singh v. Gurmeet Singh, Krishna  Gupta  v.  Madan  Lal,
      Captan Singh v. Oriental Insurance Co. Ltd. and Amar Singh Thukral  v.
      Sandeep Chhatwal, the Single and Division Benches of  the  Delhi  High
      Court declined to apply the judgment of this Court in Lata Wadhwa case
      for the purpose of award of compensation under  the  Act.  In  Krishna
      Gupta v. Madan Lal the Division Bench of the High  Court  observed  as
      under: (DLT p. 834, para 24)


      “24. … The decision of the Apex Court in Lata Wadhwa in our considered
      opinion, cannot be said to have any application in the  instant  case.
      The Motor Vehicles Act, 1939 was the complete code by itself.  It  not
      only provides for the right of a victim  and/or  his  legal  heirs  to
      obtain compensation in case of bodily injury or death arising  out  of
      use of motor vehicle, but the Forum therefor  has  been  provided,  as
      also the mode and manner in  which  the  compensation  to  be  awarded
      therefor. In such a situation, it would be inappropriate to rely  upon
      a decision of the Apex Court, which had been rendered in an absolutely
      different fact situation and in relation whereto there did  not  exist
      any statutory compensation. Lata Wadhwa was decided in a matter  where
      a fire occurred during a celebration. The liability  of  Tata  Iron  &
      Steel Co. Ltd. was  not  disputed.  Compensation  was  awarded  having
      regard to the peculiar feature obtaining in that case  which  has  got
      nothing to do  with  the  statutory  compensation  payable  under  the
      provisions of the Motor Vehicles Act.”
                                               (Emphasis laid by this Court)


      141.  Also, in a three judge Bench decision of this Court in the  case
      of Rajesh & Ors. Vs. Rajvir Singh and Ors.[36],  this  Court  held  as
      under:
           “20. The ratio of a decision of this Court, on a legal issue  is
           a precedent. But an observation made by this  Court,  mainly  to
           achieve uniformity and consistency on a socio-economic issue, as
           contrasted from a legal principle, though a precedent,  can  be,
           and in fact ought to  be  periodically  revisited,  as  observed
           in Santhosh Devi (supra). We may therefore, revisit the practice
           of awarding  compensation  under  conventional  heads:  loss  of
           consortium to the spouse, loss of love,  care  and  guidance  to
           children and funeral expenses. It may be noted that the  sum  of
           Rs. 2,500/- to Rs. 10,000/- in those  heads  was  fixed  several
           decades ago and having regard  to  inflation  factor,  the  same
           needs to be increased. In Sarla  Verma's  case (supra),  it  was
           held that compensation for loss of consortium should be  in  the
           range of  Rs.  5,000/-  to  Rs.  10,000/-,  In  legal  parlance,
           'consortium' is the right of the spouse to  the  company,  care,
           help, comfort, guidance, society, solace, affection  and  sexual
           relations with his or  her  mate.  That  non-pecuniary  head  of
           damages has not been properly understood by our Courts. The loss
           of companionship, care  and  protection,  etc.,  the  spouse  is
           entitled to  get,  has  to  be  compensated  appropriately.  The
           concept of non-pecuniary damage for loss of consortium is one of
           the major heads of award of compensation in other parts  of  the
           world  more  particularly  in  the  United  States  of  America,
           Australia, etc. English Courts have also recognized the right of
           a spouse to get compensation even during the period of temporary
           disablement. By loss of consortium,  the  courts  have  made  an
           attempt to compensate the loss of spouse's  affection,  comfort,
           solace, companionship, society, assistance, protection, care and
           sexual  relations  during   the   future   years.   Unlike   the
           compensation awarded in other countries and other jurisdictions,
           since the legal heirs are otherwise adequately  compensated  for
           the pecuniary loss, it would not be  proper  to  award  a  major
           amount under this head. Hence, we are of the view that it  would
           only be just and reasonable  that  the  courts  award  at  least
           rupees one lakh for loss of consortium.”
                                               (Emphasis laid by this Court)



      142. Under the heading of loss due to pain and suffering and  loss  of
      amenities of the wife of the claimant, Kemp and Kemp write as under:
           “The award to a plaintiff of damages under the  head  “pain  and
           suffering” depends as Lord Scarman  said  in  Lim  Poh  Choo  v.
           Camden  and  Islington  Area   health   Authority,   “upon   the
           claiamant’s  personal  awareness  of  pain,  her   capacity   of
           suffering. Accordingly, no award is appropriate if and in so far
           as the claimant has not suffered and is  not  likely  to  suffer
           pain, and has not endured and is not likely to endure suffering,
           for example, because he was rendered immediately and permanently
           unconscious in the accident. By contrast, an award of damages in
           respect of loss of amenities is appropriate whenever there is in
           fact such a loss regardless of the claimant’s awareness  of  the
           loss.”
                 ……….
      Further, it is written that,



           “Even though the claimant may  die  from  his  injuries  shortly
           after the accident, the evidence may justify an award under this
           head. Shock should also be taken account of as an ingredient  of
           pain and suffering and the claimant’s  particular  circumstances
           may well be highly relevant to the extent of her suffering.

                 ……….

           By considering the nature of amenities lost and the  injury  and
           pain in the particular case, the court must  assess  the  effect
           upon the particular claimant. In deciding the appropriate  award
           of damages, an important consideration  show  long  will  he  be
           deprived of those amenities and how long the pain and  suffering
           has been and will be endured. If it is for the rest of his  life
           the court will need to take into account  in  assessing  damages
           the claimant’s age and his expectation in life. That applies  as
           much in the case of an unconscious plaintiff as in the  case  of
           one sentient, at least as regards the loss of amenity.”



           The extract from Malay Kumar Ganguly’s case read as under:


           “3. Despite administration of the said  injection  twice  daily,
           Anuradha’s condition deteriorated rapidly from bad to worse over
           the next few days. Accordingly, she  was  admitted  at  Advanced
           Medicare Research Institute (AMRI) in the morning  of  11-5-1998
           under Dr. Mukherjee’s supervision. Anuradha was also examined by
           Dr. Baidyanath Halder, Respondent 2  herein.  Dr.  Halder  found
           that she had been suffering from  erythema  plus  blisters.  Her
           condition, however, continued to deteriorate further. Dr.  Abani
           Roy Chowdhury, Consultant, Respondent 3 was also consulted on 12-
           5-1998.


           4. On or about 17-5-1998 Anuradha was shifted  to  Breach  Candy
           Hospital, Mumbai as her condition further deteriorated severely.
           She breathed her last on 28-5-1998……”


      143. The above extracted portion from the above  judgment  would  show
      that the deceased had undergone the ordeal of pain for  18  long  days
      before she breathed her last.  In  this  course  of  period,  she  has
      suffered with immense pain and suffering and  undergone  mental  agony
      because of the negligence of the appellant-doctors  and  the  Hospital
      which has been proved by the claimant and needs no reiteration.


      144. Further, in the case of Nizam Institute (supra), the claimant who
      was also the surviving victim of a motor vehicle accident was  awarded
      Rs.10 lakhs for pain and suffering.  Further,  it  was  held  in  R.D.
      Hattangadi’s case (supra) as follows:
          “14. In Halsbury’s Laws of England, 4th Edn.,  Vol.  12  regarding
          non-pecuniary loss at page 446 it has been said:


             Non-pecuniary loss: the pattern.— Damages awarded for pain  and
             suffering and loss of amenity  constitute  a  conventional  sum
             which is taken to be the sum which society deems fair, fairness
             being interpreted by  the  courts  in  the  light  of  previous
             decisions. Thus there has been evolved a  set  of  conventional
             principles providing a provisional  guide  to  the  comparative
             severity of different injuries, and  indicating  a  bracket  of
             damages into which a particular injury will currently fall. The
             particular circumstances of the plaintiff,  including  his  age
             and any unusual deprivation he may suffer, is reflected in  the
             actual amount of the award.”|



      145. Therefore, the claim  of  Rs.4,50,00,000/-  by  the  claimant  is
      excessive since it goes against the amount awarded by this Court under
      this head in the earlier cases referred to supra. We  acknowledge  and
      empathise with the fact that the deceased  had  gone  through  immense
      pain, mental agony and suffering in  course  of  her  treatment  which
      ultimately could not save her life, we are not inclined to award  more
      than the conventional amount set by this Court on  the  basis  of  the
      economic status of the deceased. Therefore, a lumpsum amount of  Rs.10
      lakhs is awarded to the claimant following the Nizam Institute’s  case
      (supra) and also applying the principles laid in Kemp and Kemp on  the
      “Quantum of Damages”, under the head of ‘pain  and  suffering  of  the
      claimant’s wife during the course of treatment’.


      146. However, regarding claim of Rs.50,00,000/- by the claimant  under
      the head of ‘Emotional distress, pain and suffering for the  claimant’
      himself, we are not inclined to  award  any  compensation  since  this
      claim bears no direct link with the negligence caused by the appellant-
      doctors and the Hospital in treating the claimant’s wife.


           In summary, the details of compensation  under  different  heads
      are presented hereunder:


           |Loss of income of the deceased   |Rs.5,72,00,550/-              |
|For Medical treatment in Kolkata |Rs.7,00,000/-                 |
|and Mumbai                       |                              |
|Travel and Hotel expenses at     |Rs.6,50,000/-                 |
|Mumbai                           |                              |
|Loss of consortium               |Rs.1,00,000/-                 |
|Pain and suffering               |Rs.10,00,000/-                |
|Cost of litigation               |Rs.11,50,000/-                |


      147.   Therefore,  a  total  amount  of   Rs.6,08,00,550/-    is   the
      compensation awarded in this appeal to the claimant Dr. Kunal Saha  by
      partly modifying the award granted by the  National  Commission  under
      different  heads  with  6%  interest  per  annum  from  the  date   of
      application till the date of payment.


      148. Before parting with the judgment we are inclined to mention  that
      the number of medical negligence cases against doctors, Hospitals  and
      Nursing Homes in the consumer forum are increasing day by day. In  the
      case  of  Paschim  Banga  Khet  Mazdoor  Samity  Vs.  State  of   West
      Bengal[37], this Court has already pronounced that right to health  of
      a citizen is a fundamental right guaranteed under Article  21  of  the
      Constitution of  India.  It  was  held  in  that  case  that  all  the
      government Hospitals, Nursing Homes and  Poly-clinics  are  liable  to
      provide treatment to the best of their capacity to all the patients.


      149. The doctors, Hospitals, the Nursing  Homes  and  other  connected
      establishments are to be dealt with strictly if they are found  to  be
      negligent with the patients who come to them pawning all  their  money
      with the hope to  live  a  better  life  with  dignity.  The  patients
      irrespective of their social, cultural  and  economic  background  are
      entitled to be  treated  with  dignity  which  not  only  forms  their
      fundamental right but also their human right. We, therefore, hope  and
      trust that this decision acts as a deterrent and a reminder  to  those
      doctors,  Hospitals,   the   Nursing   Homes   and   other   connected
      establishments who do not take their responsibility seriously.

      150. The central and the state governments may consider enacting  laws
      wherever there is absence of one  for  effective  functioning  of  the
      private Hospitals and Nursing Homes. Since the conduct of  doctors  is
      already regulated by the Medical Council of India, we hope  and  trust
      for impartial and strict scrutiny from the body. Finally, we hope  and
      believe  that  the  institutions  and  individuals  providing  medical
      services to the public at large educate and  update  themselves  about
      any new medical discipline and rare diseases so as to avoid  tragedies
      such as the instant case where a valuable life could have  been  saved
      with a little more awareness and wisdom from the part of  the  doctors
      and the Hospital.

      151. Accordingly, the Civil Appeal No. 2867/2012 filed by  Dr.  Balram
      Prasad, Civil Appeal No. 858/2012 filed by Dr. Sukumar  Mukherjee  and
      Civil Appeal No. 731/2012 filed by Dr. Baidyanath  Haldar  are  partly
      allowed by modifying the judgment and order of the National Commission
      in so far as the amount fastened upon them to be paid to the  claimant
      as mentioned below. Dr. Sukumar Mukherjee and  Dr.  Baidyanath  Haldar
      are liable to pay compensation to the tune of Rs.10 lakhs each and Dr.
      Balram Prasad is held liable to pay compensation of Rs.5 lakhs to  the
      claimant. Since,  the  appellant-doctors  have  paid  compensation  in
      excess of what they have been made liable to by  this  judgment,  they
      are entitled for reimbursement from the appellant-AMRI Hospital and it
      is directed to reimburse the same to the above  doctors  within  eight
      weeks.


      152. The  Civil  Appeal  No.  692/2012  filed  by  the  appellant-AMRI
      Hospital is dismissed and it is liable to pay compensation as  awarded
      in this judgment in favour of the claimant after deducting the  amount
      fastened upon the doctors in this judgment  with  interest  @  6%  per
      annum.



      153. The Civil Appeal No. 2866/2012  filed  by  the  claimant-Dr.Kunal
      Saha is also partly allowed and the finding on contributory negligence
      by the National Commission on the part of the claimant is  set  aside.
      The direction of the National Commission to deduct 10% of the  awarded
      amount of compensation on account of contributory negligence  is  also
      set aside by  enhancing  the  compensation  from  Rs.1,34,66,000/-  to
      Rs.6,08,00,550/- with 6% interest per  annum  from  the  date  of  the
      complaint to the date of the payment to the claimant.



      154. The AMRI Hospital is directed to comply  with  this  judgment  by
      sending demand draft of the compensation awarded in this appeal to the
      extent of liability imposed on it after deducting the amount, if  any,
      already paid to the  claimant,  within  eight  weeks  and  submit  the
      compliance report.





                                                    …………………………………………………………J.
                                       [CHANDRAMAULI KR. PRASAD]




                                                    …………………………………………………………J.
                                          [V. GOPALA GOWDA]


      New Delhi,
      October 24, 2013.













                           -----------------------
      [1]    (2009) 9 SCC 221
      [2]    (2008) 4 SCC 162
      [3]    (2002) 6 SCC 281
[4]                [5] (2009) 6 SCC 1
[6]    (2009) 14 SCC 1
[7]    (2001) 8 SCC 197
[8]    (2001)  8 SCC 151
[9]    (2011) 14 SCC 481
      [10]    (2011)12 SCC 695
      [11]    (2012) 5 SCC 370
      [12]    (2012)     6 SCC 430
      [13]    (2003) 2 SCC 274
      [14]    (2011) 10 SCC 634
      [15]    (2011) 10 SCC 655
      [16]   (1995) 6 SCC 651
      [17]    (2009) 13 SCC 710
      [18]    (1995) 1 SCC 551
      [19]    (2009) 13 SCC 654
      [20]   (2011) 10 SCC 756

      [21]    (2010) 10 SCC 254
      [22]     (2011) 1 SCC 343
      [23]      (2011)   10 SCC 683
      [24]      (2011)  13 SCC 236
      [25]      (2012)   8 SCC 604
      [26]   (2004) 8 SCC 56
[27]   (2002) 7 SCC 668
[28]   (1998) 4 SCC 39
[29]    (2009)  7 SCC 372
      [30]   511 U.S. 244, 1994
      [31]    (2009)  5 SCC 212
      [32]   536 S.E. 2d 408 2000
      [33]   781 N.E. 2d, 2002
[34]   (1998) 4 SCC 39
[35]   [1979] A.C. 556
      [36]   (2010) 9 SCC 218
[37]   2013 (6) SCALE 563
      [38]    (1996) 4 SCC 37

                           -----------------------
210


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