The Chief Judicial Magistrate- Shri. Anil Kumar Ji Pandemic Public Grievance Committee
Smart City Nagar Nigam
Subject: Compensation (Total Refund) for loss of life due to Medical Incompetence/ Negligence and Administrative Failure of Private Hospital (Total Bill: about 9.50 Lakhs)
My husband, Shri. Dinesh Pratap Singh (Administrative Officer, LIC, Agra) aged 49 showed initial symptoms of COVID-19 on 22nd and 23rd April 2021. He was exhibiting mild symptoms of COVID including fever and weakness. HRCT Thorax Scan done on 28th April indicated moderate infection (10/25). Later, on the morning of 2nd May, his SPO2 dropped to 90 and the treating doctor advised on phone to admit him to a COVID hospital for better care and recovery. My son, Himanshu (Senior Tech Asst at DRDO, Ministry of Defense) confirmed about availability of beds at Yashwant Hospital, New Agra. Upon bed confirmation, he was admitted there at 10.30 pm same day without much delay. During and after the course of his treatment, following issues were encountered:
1.0 Part One (Financial Issues)
1.1 Exorbitantly High Charges: We were charged a hefty amount of Rs. 5,60,940 by the hospital
for 16.5 days. Additionally, hospital pharmacy charged us a total of Rs. 3,88,777. The sum total is:
(Rupees Nine Lakhs Forty-Nine Thousand Seven Hundred and Seventeen !!)
This is a big violation of the rates determined by the state government for treatment of COVID-19. Considering the per day expenditure, this amount is even higher than that charged in the famous case of Ravi Hospital from Late Shri. Arun Kansal Ji. He was admitted for 19 days including ventilator support and was charged 9.60 lakhs. But my husband was in the hospital for 16.5 days including just last 2 days of ventilator support (intubated). A similar violation was committed by Wims Hospital (earlier Ram Raghu Hospital) against Late Smt. Susheela Devi admitted for 20-21 days by charging 8 Lakh Rupees. Private hospitals in Agra are not taking a lesson and repeatedly committing the same crime.
1.2 Code Words used in Bill: The original hospital bill received on 22nd May had code words like “LEVEL-2” and “LEVEL-3”. When asked for justification and clear breakdown of the charges in medical terms, the revision was done by hospital and new bill given on 23rd May with same total (Rs. 5,60,940)
24th May 2021
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Original Charges (22nd May 2021)
After Breakdown (23rd May 2021)
ICU Bed Charge
BIPAP Ventilator/ Day
Nursing Charge ICU
Infusion Pump Charge
1.3 Unjustified Charges: The services which have to be included in the ICU charges have been charged separately for 17 days. These include Oxygen (Rs. 4,000 x 17 = Rs. 68,000), BiPap/ Ventilaor (Rs. 10,000 x 17 = Rs. 1,70,000), Nursing (Rs. 17,000), Suction (Rs. 11,900), Infusion Pump (Rs. 25,500), RMO (Rs. 17,000), Doctor Visit (Rs. 2,000 x 26 = Rs. 52,000), Investigations and Tests (About Rs. 50,000), Blood Sugar (Rs. 2,100), Consumables (Several Thousands), Drugs (Several Lakhs), etc. This is a huge, grave and serious violation of The Epidemic Diseases Act (Section 3).
The cost which is charged for Infusion Pump (Rs. 25,500) is same as the cost of a new Infusion Pump Machine. Similarly, new suction machine can also be bought at the cost suction is charged (Rs. 11,900). Two branded Glucometers can be bought at the cost charged for blood sugar testing (Rs. 2,100).
1.4 Fake Charges: Nebulizer was not given on all days of hospitalization, but charges have been taken for 17 days. Similarly, Suction Machine, Infusion Pump was not used on all 16.5 days. The BiPAP Machine was started from 4th May not on 3rd May. The intubation for ventilator was done on 17th May afternoon.
1.5 Fake Rate List Displayed: As evident by the bill, the rate list displayed at the entry of hospital is only for formality and not being actually followed. This is a violation of the orders of The District Magistrate, Agra.
1.6 Imaging Charges: As per the instructions from UP government to all DMs and CMOs, the imaging charges are included in the ICU Bed Charges. But we have been separately charged for X-Ray Chest seven times (Rs. 2800 @ Rs. 400/X-Ray) and once for HRCT Thorax (Rs. 5000) in our bill. The rate set by government for CT Scan is Rs. 2500.
The Clinical Guidance for management of COVID by Government of India (22nd April) says that X-Ray/CT Scan has to be done only after worsening of situation, but X-Ray has been repeatedly done 7 times in 16.5 days.
1.7 Monitoring Charges: During initial days of hospitalization, we observed that the patient who were alone without their attendants were not taken much care of. Monitoring was done only of patients whose attendants were present on the spot. Therefore, ignoring the risk of infection to self, we decided to be present all the time inside or near the ICU. During the entire hospitalization duration of 16.5 days, I went home only once. Issues like dip in oxygen saturation level, difficulty in taking breath by patient, leakage of oxygen from mask, gaining consciousness while on ventilator, etc. were not taken care of staff by themselves by their own, we had to tell them to do the needful. In spite of this, monitoring cost of Rs. 17,000 (Rs. 1000/ day) has been charged separately. The government has clearly said that ICU Bed charges are inclusive of monitoring charges and violation of same is violation of Epidemic Disease Act.
1.8 Overpriced Medicines in Hospital Pharmacy: Zydus Exemptia 40mg/0.8 ml was sold to us by hospital pharmacy at MRP for Rs. 25,000. The same drug is available in the market at Rs. 7,500 and also from another brand as Cadlia Cadalimab 40mg/0.8 ml of MRP Rs. 15,000 and selling price Rs. 10,000. Sixteen injections Reliance ImmunoRel 5g/100 ml were sold to us for Rs. 1,60,000 (Rs. 10,000 each). In market they are sold for Rs. 6,500 to Rs. 7,500 each. Other brands are even as cheap as Rs. 5,000. In hospital pharmacy, the medicines are sold very close to MRP and the medicines available there are those of expensive brands.
1.9 Selling Higher than MRP: On 03rd May, one vial of Inj Remdesivir was brought by us at higher price INR Rs. 6,000 from hospital pharmacy due to shortage in market. The MRP of the drug is Rs.
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3,490. The bill is issued near MRP (Rs. 3,400) and not on selling price (Rs. 6,000). In spite of agreeing to buy at cost higher than MRP, we requested them again on next day to provide the injection but they cited shortage and asked us to arrange by ourselves.
1.10 Hospital and Pharmacy not different: It is for your information that ‘Chamunda Pharmacy’ and ‘Yashwant Hospital’ are units of ‘Bhudevi Medicare Pvt Ltd’ and ‘Bhagaur Advanced Health Care Pvt Ltd’ respectively. Both companies are headed jointly by Shri. Surendra Singh Bhagaur and his spouse Smt. Hema Singh. Thereby the pharmacy is not to be treated as an external unit, but as an integral part of the hospital itself both physically and financially. The option of buying medicines from outside was not available with us because the prescription was automatically sent by staff early morning to the hospital pharmacy.
1.11 Extra Expenses: The expenses which were incurred additionally are not inclusive of total bill. These include charges of Ambulance (Rs 3000 + 800), multiple vials of Inj. Remdesivir, one vial of Inj. Tocilizumab (Rs. 36,000), getting drug 2-DG from DRDO Delhi Office for 5 days, 2 Empty Oxygen Cylinders and their Regulators, Keys, Filling of cylinders, Hi-Flow Mask, Plasma Kit (Rs. 7000 X 2), Anti Body test for Plasma Donor and so on… It is to be noted that we could not preserve all medicine bills due to panicked state of mind. The pharmacy bill is total of only the bills that were preserved by us. Had all bills been preserved, the figure could have been even higher.
Taking everything into account, the total figure is expected to be around Rs. 10,00,000 to Rs. 11,00,000.
2.0 Part Two (Medical Incompetence/ Negligence)
2.1 Delayed Drug Administration: The Clinical Guidance for management of COVID by Government of India clearly states that Inj. Tocilizumab (Trade Name: Actmera) has to be administered preferably within 24 to 48 hours of ICU admission. But the drug was prescribed on 14th May 2021, i.e, 12 days after ICU admission. The inflammatory markers values for your information and better understanding of condition are CRP- 90, IL6- 15 (3rd May) and CRP- 70, IL6- 68 (14th May). The condition deteriorated day by day after administration of this costly drug on 14th May and there was not a little benefit post administration.
2.2 Unnecessary Experimental Drug Administration: A News Article published in the journal BMJ on 01 Oct 2020 states that a trial drug Adalimumab will be given to COVID patients in care homes/ community care settings (meaning non-hospitalized patients). It further states that this treatment was associated with decreased chance of hospitalization. The question to ponder upon here is why an injection which costs Rs. 25,000 and is meant for preventing hospitalization given after being hospitalized. It is to be noted that the journal BMJ is a very reputed journal and is ranked fourth worldwide in the field of general medicine.
2.3 Unproven, Ineffective, Expensive, Experimental Drug used repeatedly: One drug, Intravenous Immunoglobin (IVIG) had been administered 16 times to my husband during the course of entire treatment. But an article in the reputed publication, Clinical Microbiology and Infections 2021 reports that there were no significant differences between IVIG group and Non-IVIG group in COVID- 19 patients. Total cost of this course comes out to be Rs. 1,60,000 (Rs. 10,000/injection each). Administration of this drug by hospital has been stopped after 10-12 injections for other patients in ICU, then why my husband’s dose was extended to 16 Injections? Had he been alive for more days, they would have minted even more money. The motive behind using a highly expensive drug despite showing no benefit for prolonged duration is highly dubious.
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2.4 Unscientific Drug Administration: The Clinical Guidance for management of COVID by Government of India (on 22nd April) clearly states in red color that Convalescent Plasma can be considered preferably within 7 days of symptoms onset and is of “NO USE AFTER 7 DAYS”. In spite of such clear instructions, we were asked to arrange COVID recovered plasma of matching blood group on 4th May (12th day of symptom onset) and Plasma therapy was performed on 04th and 05th May (one unit each day). The immediate problem he complained after plasma therapy completion was increased restlessness and nervousness.
2.5 Irrational Drug Administration: The Clinical Guidance for management of COVID by Government of India (22nd April) states that Remdesivir may be considered “ONLY” in patients who are within 10 days of onset of symptoms. It is understood that it plays no role after 10 days. The first dose of Inj. Remdesivir was given to our patient on 03rd May, i.e, 11-12 days after onset of symptoms. ICMR Guidelines state that unnecessary/ irrational use of Remdesivir could be harmful.
2.6 Dangerous Drug Administration: The ICMR guidelines state that Remdesivir is to be given for a total period of “FIVE DAYS ONLY”. We had one extra vial of inj. Remdesivir, we asked the doctor what should we do with this extra vial- should we keep it or return it. He advised us to get it administered the next day (08th May). We were not aware of dose and were following whatever the doctor was advising without raising any doubts or questions. But the ICMR Guidelines have already stated that “Unnecessary/ irrational use of Remdesivir could be harmful.”
2.7 Medical Ethics: Despite multiple requests by my son, ICU nursing staff did not try prone position (lying on stomach) even once during last ten days of hospitalization. Page 20 of ‘Clinical Management Protocol: COVID-19’ by Indian Government clearly states that prone position is strongly recommended and should be done as much as possible for more than 12 hours in a day.
2.8 No Co-morbidity, Young Age, No Other Severe Disease, Mentally Strong: The age of my husband was less than 50 years, was not suffering from cardiovascular disease, obesity, diabetes or any other immunocompromised state. He was neither having any chronic lung/ kidney/ liver disease in the past. All his vital organs were perfectly fine. He was also exhibiting extraordinary mental strength during hospitalization. It is the irrational and unscientific use of experimental drugs which has resulted in increased complications to which he ultimately succumbed to on 19th May (12 noon).
A sick human body might be a sample for experimentation to hospital, but for us he meant everything. His family might be an opportunity to earn profits, but for them it means the savings of their lives. When a single page guideline by government is not followed by doctor then how can we expect him to go into the depths of such a complex disease and treat it.
3.0 Part Three (Administrative Failure)
3.1 Arrangement of Backup Oxygen Cylinders: The District Magistrate, Agra had issued orders in the starting of month that FIR will be registered against hospital management for asking patients to arrange their own oxygen cylinders. Despite of the order, the nursing staff and RMO in ICU were citing possibility of oxygen shortage and asking patients to arrange their own emergency backup cylinders. Acting on the same, we got this written from the main doctor on 5th May as a proof. Gate Pass of two oxygen cylinders arranged on 4th and 6th May are also attached as proof.
3.2 Oxygen Shortage in Ambulance: On 3rd May, my husband was being taken to Agra Diagnostic Centre by ambulance for HRCT Thorax while being on oxygen support. The oxygen cylinder being used for him got empty even before the CT scan could start. He immediately started feeling shortness of breath and restlessness. The total time he had to bear without oxygen was about 15 minutes (2
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minutes for CT Scan, 3 minutes for transferring to ambulance and 10 minutes to reach back to hospital). My relatives and son who were present with him in ambulance are witness of the incident.
3.3 Bed Availability not updated: The bed availability status has not been updated even once during our stay at hospital for 16.5 days. It was displayed same every day as- Available Beds: 40; Occupied Beds: 35; Vacant Beds: 05. This is a repeated violation of orders of The District Magistrate.
3.4 Faulty ICU Equipment: The display screen of ventilator on which my husband was kept was not working.
3.5 Frequent Oxygen Pressure Drop in Night: The staff deployed for changing oxygen cylinder for hospital oxygen line wasn’t much dedicated and often slept at night. There used to be drop in oxygen pressure multiple times in the night and my husband was on heavy demand high flow oxygen during his last days. ICU staff had to call the oxygen cylinder changing person every time to wake him up and he did not used to do it on his own. One night when he was not picking call and was in deep sleep, I had to rush from second floor ICU to ground flood by stairs to wake him up for changing cylinder. Who would have been responsible if I had fallen or slipped on the stairs in hurry?
3.6 No Shortcoming from our side: During the treatment, we were not aware about the game being played with us. We were treating doctor like God and praying only for one thing from him all the time- the recovery of my husband. It is only now after discussing with our family and friends that we got to know how we got overcharged and cheated. Earlier we were following every word of doctor, doing as he said… arranging all medicines on time, making timely payments by arranging money without any bargaining, motivating the patient, etc. We arranged the DRDO drug 2-DG on 11th May, even before it reached the market (two days after it was shown on news). We might have been the first one in Agra or UP to do so. Still doctor failed to get an idea about how precious he was to us.
3.6 Un-sympathetic Attitude: After the unfortunate incident of his death on 19 May (12 noon), the first thing communicated by hospital reception staff to our family was to clear the dues of the hospital. My son informed them that it is not possible to arrange the amount at such difficult time and Rs. 50,000 have already been paid in the morning, the remaining dues will be arranged by the evening after cremation. The staff did not agree and allowed to take dead body only after complete payment. This unconcerned, insensitive and cold-hearted attitude reveals the true nature of the business: “Squeeze until the last drop”
3.7 Other Miscellaneous Carelessness: (1) The oxygen humidifier bottle was not filled timely. (2) The CPAP/ BiPAP humidifier was also not refilled timely. My husband often complained of extreme dryness in nose, mouth and throat due to all this. (3) The ventilator compressor air filter needs to be cleaned daily. But it was cleaned only once in 2.5 days. (4) On one morning, 2-3 tablets were found on his bed near his legs. Later we got to know that the tablets had to be given to him the previous night but person giving medicines took them out of packing strip and forgot to give to him. (4) Another day we saw in file that one injection was ticked in the list but not administered to him, it was present on his table. Had it been given; it would not have been there. (5) The ICU nursing staff wasn’t too good at their job. It was evident by the fact that his right hand had swollen to about 150-175% of its original size due to improper use of intracath, IV, etc. (6) Suction machine was not working when required, we had to wait until it got repaired before it could be used.
3.8 The issue of hospital’s sweeper staff’s indecent expressions on hospital stairs towards me during a night will be reported separately in suitable manner viz. police complaint.
“In short, this tragic death was nothing less than a murder.”
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In the view of all above issues, I request the Pandemic Public Grievance Committee to instruct the private hospital to refund the entire cost of treatment born by us. I also request the higher authorities to penalize the hospital to provide additional compensation for our loss due to their incompetence.
The mode of complaint is not a personal attack on hospital management but complaint about the professional services rendered by them. The intention of the complaint is not to gain financial benefits or avenge my spouse’s death, but it is to improve the private hospitals’ overall conditions in the district so that other lives are not lost in the similar fashion and more families don’t get destroyed by being overcharged by private hospitals.
All the claims are backed by evidences attached with this application. Any typographic or calculation errors may kindly be ignored
We look forward to justice.
The Chief Minister- Shri. Yogi Adityanath Ji, Lucknow (UP)
The Additional Chief Secretary (Medical & Health)- Shri. Amit Mohan Prasad Ji, Lucknow (UP)
The District Collector- Shri. Prabhu Narain Singh, Agra (UP)
The Members, Pandemic Public Grievance Comtt. (Dr. Prabha Kant Awasthi, Prof Dr. Manish Bansal) The Chief Medical Officer, Agra (UP)
Popular Daily Newspapers (The Times of India, Hindustan, Amar Ujala, Danik Jagran, etc)
In the memory of…
Shri. Dinesh Pratap Singh 05/12/1971 to 19/05/2021
Meera Singh (W/O Late Shri. Dinesh Pratap Singh Ji)
Attachment HRCT Thorax Report on 28th April (Three days before Hospitalization): A score of 10/25
indicating mild to moderate infection.
Point No 1.1: Hospital Bill of Rs. 5,60,940 (Page 1/3)
Point No 1.1: Hospital Bill of Rs. 5,60,940 (Page 2/3)
Point No 1.1: Hospital Bill of Rs. 5,60,940 (Page 3/3)
Point No 1.1: Hospital Pharmacy bill of total of Rs. 3,88,777
Pharmacy Bill (Rs)
9,543 30,464 12,329 12,898
6,374 15,332 34,691 26,699 23,785 38,727
14,145 19,473 21,398 20,315 25,820 35,375
Day-Wise Breakdown of Hospital Pharmacy Bill
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Bill 1/18; Date: 02nd May 2021
(Only last page of each bill scanned showing amount to pay)
Attachment Point No 1.1: Hospital Pharmacy bill of total of Rs. 3,88,777 (Bill 2/18 & 3/18)
Date: 03rd May 2021
Date: 04th May 2021
Attachment Point No 1.1: Hospital Pharmacy bill of total of Rs. 3,88,777 (Bill 4/18 & 5/18)
Date: 05th May 2021
Date: 06th May 2021
Attachment Point No 1.1: Hospital Pharmacy bill of total of Rs. 3,88,777 (Bill 6/18 & 7/18)
Date: 07th May 2021
Date: 08th May 2021
Attachment Point No 1.1: Hospital Pharmacy bill of total of Rs. 3,88,777 (Bill 8/18 & 9/18)
Date: 09th May 2021
Date: 10th May 2021
Attachment Point No 1.1: Hospital Pharmacy bill of total of Rs. 3,88,777 (Bill 10/18 & 11/18)
Date: 11th May 2021
Date: 12th May 2021
Attachment Point No 1.1: Hospital Pharmacy bill of total of Rs. 3,88,777 (Bill 12/18 & 13/18)
Date: 13th May 2021
Date: 14th May 2021
Attachment Point No 1.1: Hospital Pharmacy bill of total of Rs. 3,88,777 (Bill 14/18 & 15/18)
Date: 15th May 2021
Date: 16th May 2021
Attachment Point No 1.1: Hospital Pharmacy bill of total of Rs. 3,88,777 (Bill 16/18 & 17/18)
Date: 17th May 2021
Date: 18th May 2021
Attachment Point No 1.1: Hospital Pharmacy bill of total of Rs. 3,88,777 (Bill 18/18)
Date: 19th May 2021
(Only last page of each bill scanned showing amount to pay)
Attachment Point No 1.2: Use of Code Words in Bill issued on 22nd May (Page 3/3)
When doubt was raised on use of these terms and justification cum breakdown of this charge was demanded by us, the current bill was issued on 23rd May.
Attachment Point No 1.3: Unjustified Charges (in the current bill given on 23rd May)
The services which have to be included in the ICU charges have been charged separately.
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Link: https://indianexpress.com/article/cities/lucknow/up-govt-capes-hospital-charges- for-covid-patients/
Point No 1.5: Fake Rate List Displayed outside Hospital
Charges are not taken as per the displayed rate list. Violation of orders of The State Government and The District Magistrate
Point No 3.3: Bed Availability not updated
The bed availability status has not been updated even once during our stay at hospital for 16.5 days. It was displayed same every day as- Available Beds: 40; Occupied Beds: 35; Vacant Beds: 05. This is a repeated violation of orders of The District Magistrate.
Point No 1.6
Point No 2.5
Point No 2.6
Point No 2.1 Point No 2.4
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Point No 1.8: Overpriced Medicines in Hospital Pharmacy
Rs. 25,000 (MRP) charged from us for Exemptia Injection 40 mg/0.8 ml on 03rd May
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Selling Price of Injection in market is about Rs. 7,500 to Rs. 9,000.
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Similarly, Rs. 1,60,000 charged for 16 Injections ImmunoRel 5g/100ml at Rs. 10,000 each which is available in market at Rs. 6,500 each.
Attachment Point No 2.2: Unnecessary Administration of Trial Drug ‘Adalimumab’
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An article published in the journal BMJ on 01 Oct 2020 states that a trial drug Adalimumab will be given to COVID patients in care homes/ community care settings (meaning “non- hospitalized patients”). It further states that this treatment was associated with “decreased chance of hospitalization”. The question to ponder upon here is why an experimental drug which costed us Rs. 25,000 and is meant for preventing hospitalization given after being hospitalized. It is to be noted that the journal BMJ is a very reputed journal and is ranked fourth worldwide in the field of general medicine.
It seems that the drug is still in experimentation stage and the outcomes will become more clear after further trials.
Attachment Point No 2.3: Unproven, Ineffective, Expensive, Experimental Drug used repeatedly
The drug, Intravenous Immunoglobin, which has been rendered ineffective for COVID-19 patients due to not being associated with significant changes was repeatedly given 16 times to our patient.
This experimental and unproven drug was highly expensive, total cost being Rs. 1,60,000.
One of the most common side effects of IVIG include tachycardia, symptoms of which our patient was exhibiting during the last days of his illness.
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Point No 2.8: Not trying Prone Position in Last Days
Front Page and Page No 20 of Clinical Management Protocol: COVID-19 by Government of India (July 2020)
It distinctly states that prone position is strongly recommended and should be done as much as possible for more than 12 hours in a day. But despite multiple requests by us, ICU nursing staff did not try prone position even once during last ten days of hospitalization.
Prone position was done only a few times in the first three days of hospitalization and not again after that.
The expensive drugs which have not been proven yet are used multiple times but a technique which costs nothing and has shown significant benefits was just ignored.
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Attachment Point No 3.1: Hospital asking patients to arrange oxygen cylinders (Part 1/2)
“Kindly arrange two cylinder oxygen for Dinesh Pratap Singh. Urgent need patient on BiPAP”… Dr. Surendra Singh Bhagaur 05/05/21
Attachment Point No 3.1: Hospital asking patients to arrange oxygen cylinders (Part 2/2)
News Article published on May 3, 2021.
Proof of arrangement of two personal oxygen cylinders by us.
The line for oxygen cylinder refiling was about 8-10 hours at that time.
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Point No 3.4 Faulty ICU Equipment: The display screen of ventilator on which my husband was kept was not working.
Point No 3.7 (5)
The ICU nursing staff wasn’t too good at their job. It was evident by the fact that his right hand had swollen to about 150-175% of its original size due to improper use of intracath, IV, etc.
Photo is a bit old, but during last days it was so much swollen that it was impossible to move/ lift it and it had to be covered in dressing.
Remembering once again…
Shri. Dinesh Pratap Singh 05/12/1971 to 19/05/2021
“The dead cannot cry out for justice. It is a duty of the living to do so for them.”