pgi chandigarh scam case judgement ii

IN THE COURT OF JAGDEEP JAIN,SPECIAL Jude, CBI COURT, CHANDIGARH.

CORRUPTION CASE NO:26COMPUTER I.D. NO:36014R0034262006DATE OF INSTITUTION:02.03.2006DATE OF DECISION:02.03.2009

Central Bureau of Investigation

Versus

1. Dr. R.S.Dhaliwal, son of Joginder Singh Dhaliwal, resident of House No.58, Sector 24-A, Chandigarh.

2. Sat Pal Singla, son of Hari Ram, resident of House No.15, Sector 11-A, Chandigarh.

.....Accused

FIR No.RC No. 18 (A) 03 dated 29.5.2003, (Chargesheet No.II) Under Sections 120-B, 420, 467, 468 and 471 of the Indian Penal Code and under Section 13 (1) (d) of the Prevention of Corruption Act,1988. P.S. CBI,SPE, Chandigarh.

Present:Shri R.L. Negi,Senior Public Prosecutor for C.B.I.Accused R.S.Dhaliwal on bail being assisted by Shri Matwinder Singh, Advocate.

Accused Sat Pal Singla on bail being assisted by Shri Vinod Arya, Advocate

1

J U D G M E N T:

Post Graduate Institute of Medical

Educational Research, Chandigarh (for short the

P.G.I.) is a premier institute. It has a

department of Cardio Vascular & Thoracic Surgery

(for short CVTS) which deals with open heart,

closed heart, lung and related surgeries. Open

Heart Surgery can be performed only by a doctor

of the rank Associated Professor or above. He is

assisted by Senior Resident doctor along with

Anesthesia and Nursing Staff.

2. Dr. R.S.Dhaliwal the accused named above

joined the CVTS department in 1976. He became

head of the department in 1998.

3. In the year 2001, the CBI registered a

preliminary inquiry on receiving information that

Dr.R.S.Dhaliwal in criminal conspiracy with a

private person Surinder Singh Uppal had been

dishonestly referring a number of patients

requiring open heart surgery to the latter for

the purchase of artificial heart valves and the

latter had been supplying valves at exorbitant

rates and sharing profits with Dr.R.S.Dhaliwal in

2

the ratio of around 70:30. It was also suspected

that M/s. Paul Medical Hall, Chandigarh and M/s.

Northern Remedies, Chandigarh had also been

supplying artificial heart valves and other

material in the like manner. Preliminary inquiry

was converted into regular case.

4. During investigations it was found that

Dr. R.S.Dhaliwal had conducted 324 open heart

operation as open heart surgeon during the period

January 1994 to July 2001. Out of them 38 cases

were shortlisted and investigated in detail. It

was found that in 24 cases Surinder Singh Uppal

was involved with Dr. R.S.Dhaliwal while in 14

cases it was M/s. Paul Medical Hall and Dr.

R.S.Dhaliwal. It was found that all the 14

patients were private grant/sponsored patients in

the sense that for their treatment money had been

deposited in the PGI by the respective funding

Agencies in advance. Dr. R.S.Dhaliwal would send

requisition to M/s Paul Medical Hall through the

Medical Superintendent, PGI specifying the items

to be supplied for the treated patients. He would

requisition the artificial heart valves by brand

name St. Jude which was costing Rs.45,000/- per

3

piece. M/s. Paul Medical Hall would issue cash

memos/invoices showing the sale of St. Jude heart

valves whereas actually the valves supplied were

Omni Science or Starr Edwards which were cheaper.

It was also established that in some cases two

valves were requisitioned for a patient. Payment

was received for two valves but only one was

implanted. In some cases two St. Jude heart

valves were requisitioned but only one St. Jude

valve was implanted while the other valves would

be cheaper viz. Omni Science or Starr Edwards or

Machhi or Edward Mira. In some cases, Dr.

R.S.Dhaliwal made interpolations in the record to

justify the bills raised by M/s. Paul Medical

Hall.

5. Following are the 14 instances in which

Dr. R.S.Dhaliwal and M/s. Paul Medical Hall were

involved:-

1. Pt. Dwarka Prasad CR No.398793 operated on 30.5.2000.

The patient was member of ESI. A

sum of Rs.1,40,000/- was deposited in PGI

for his treatment vide receipt No.99289.

4

Vide letter dated 24.4.2000 issued

through Medical Superintendent, PGI. Dr.

R.S.Dhaliwal requested M/s. Paul Medical

Hall to supply the items including one

Mitral (St. Jude heart valve-Bileaflet).

M/s. Paul Medical Hall issued cash memo

dated 24.5.2000 for Rs.45,000/- as cost

of valve. The amount was released by the

office of Medical Superintendent by way

of cheque. However, instead of St. Jude

heart valve, Dr. R.S.Dhaliwal implanted

Omni Science valve Serial Number 676371.

This valve had been purchased by M/s.

Paul Medical Hall from M/s. B.L.

Marketing Services Limited. The result

was that M/s. Paul Medical Hall received

payment for St. Jude Valve against the

supply of Omni Science valve.

2. Pt. Baldev CR No.395456 operated on 18.6.1999.

The Govt. of Punjab had deposited

Rs.1,50,000/- with PGI for the treatment

of Baldev. Vide letter dated 11.5.1999

5

issued through Medical Superintendent,

PGI. Dr. R.S.Dhaliwal requested M/s. Paul

Medical Hall to supply the items

including two heart valves Mitral/Aortic

(St. Jude heart valve Bileaflet) for

Rs.45,000/- each as cost of valve. The

amount of Rs. 1,12,543-75 was released by

the office of Medical Superintendent, PGI

in favour of M/s. Paul Medical Hall. This

included costs of two valves. However,

only Mitral valve replacement was done in

the patient on 18.06.1999. However,

neither the unused valve was returned nor

the amount of Rs.45,000/- towards costs

for unused valve was refunded.

3. Pt. Jigri Singh CR No.194769 operated on 02.09.99.

The Employer of the patient had

deposited Rs.95,000/- with PGI for the

treatment of Baldev vide letter dated

03.08.1999 issued through Medical

Superintendent, PGI. Dr. R.S.Dhaliwal

requested M/s. Paul Medical Hall to

6

supply the items including two heart

valves Mitral/Aortic Starr Edwards for

Rs.24,500/- each as cost of valve. The

amount was released by the office of

Medical Superintendent, PGI in favour of

M/s. Paul Medical Hall. This included

costs of two valves. The patient was

operated on 2.2.1999. One Omni Science

and one Starr Edwards valves were

implanted. However, the patient died on

3.9.1999 in the PGI itself. Vide letter

dated 6.9.1999 Dr. R.S.Dhaliwal requested

the office of Medical Superintendent, PGI

to make additional payment of Rs.20,500/-

to M/s. Paul Medical Hall for the price

of difference between St. Jude Valve

which was implanted and Starr Edwards

Valve which was requisitioned. The office

of Medical Superintendent called for

clarification in response to which Dr.

R.S.Dhaliwal gave a note dated 16.10.1999

justifying the implantation of St. Jude

valve instead of Starr Edwards. Whereas

no Starr Edwards valve had been

7

implanted. Since the balance left in the

account of the patient was Rs.15,033/-

this much was released through cheque in

favour of M/s. Paul Medical Hall. The

latter issued bill dated 2.9.1999 showing

the supply of St. Jude heart valve

whereas no such valve had been supplied.

4. Pt. Suresh Kumar CR No.399748 operated on 08.10.99.

Dr. R.S.Dhaliwal issued letter

dated 15.9.1999 through Medical

Superintendent, PGI requesting M/s. Paul

Medical Hall to supply items including

one Mitric (St. Jude bileaf let) heart

valve for Rs.45,000/-. M/s. Paul Medical

Hall raised bill. The amount was released

by the office of Medical Superintendent,

PGI. However, when the patient was

operated on 8.10.1999 Omni Science heart

valve bearing No.670399 was implanted in

his heart. Therefore against supply of

Omni Science the payment received for

Mitric (St. Jude bileaflet) heart valve.

8

5. Pt. Sheela Devi CR No.447298 operated on 04.05.2000.











valve was implanted in her heart.

Therefore against supply of Omni Science

the payment received for Mitric (St. Jude

bileaf let) heart valve.

6. Pt. Narinder Kumar CR No.401753- operated on 14.10.99.






9







his heart. Therefore, against supply of


Mitric (St. Jude bileaf let) heart valve.

7. Pt. Rajesh Kumar CR No.437812 operated on 23.5.2000.












his heart. Therefore, against supply of

10


Mitric (St. Jude bileaf let) heart valve.

8. Pt. Raj Kumar CR No.444411 operated on 11.04.2000.










operated on 11.4.2000 Starr Edwards heart

valve was implanted in his heart.

Therefore, against supply of Starr

Edwards the payment received for Mitric

(St. Jude bileaf let) heart valve.

9. Pt. Shiv Shankar CR No.356543- operated on 06.04.2000.




11







operated on 6.4.2000 Starr Edwards heart

valve was implanted in his heart.

Therefore, against supply of Starr

Edwards the payment received for Mitric

(St. Jude bileaf let) heart valve.

10. Pt. Dayal Singh CR No.426450- operated on 15.10.1999.

The Govt. of Himachal Pardesh had

deposited Rs.1,50,000/- with PGI for the

treatment of Dayal Singh. Vide letter

dated 9.9.1999 issued through Medical

Superintendent, PGI, Dr. R.S.Dhaliwal



valves Mitral/Aortic (St. Jude heart

valve Bileaf let) for Rs.45,000/- each as

cost of valve. The amount of Rs.

12

1,12,543-75 was released by the office of



costs of two valves. However, only Mitral

valve replacement was done in the patient

on 15.10.1999. The valve implanted was

Mira Bextor Edward. However, neither the

unused valve was returned nor the amount

of Rs.45,000/- towards costs for unused

valve was refunded. Even the price

difference between St. Jude heart valve

and Mira Bextor Edward was not refunded.

11. Pt. Sneh Lata CR No.239492- operated on 25.10.1999.

The Govt. of Himachal Pradesh had


treatment of Sneh Lata. Vide letter dated





valves Mitral/Aortic (St. Jude heart


13

cost of valve. The amount of Rs.

1,113,798/- was released by the office of



costs of two valves. However,only Mitral

valve replacement was done in the patient

on 25.10.1999. The valve implanted was

MVR 29 mm St. Jude. However, neither the

unused valve was returned nor the amount

of Rs.45,000/- towards costs for unused

valve was refunded. Later on Dr.

R.S.Dhaliwal falsified the official

record by making addition in operation

note to show that apart from MVR it was

also a case of AVR. Dr. Sukant who issued

discharge summary confirmed that only MVR

was done. But, Dr. R.S.Dhaliwal had made

the addition in the operation note in his

presence and since he was a junior doctor

he subsequently issued discharge summary

mentioning AVT 21 at the instance of Dr.

R.S.Dhaliwal.

12. Pt. Mani Mari CR No.018187- operated on 18.04.2000.

14

The Poor Help Council had


treatment of Mani Mari. Vide letter dated





valves Mitral and Aortic (St. Jude heart


cost of valve. The payment was released.

The patient was operated on 18.4.2000.

One Omni Science valve Serial Number

676215 and one SJM Serial Number 60317357

were implanted. Therefore, the payment

received was for two St. Jude heart

valves against supply of one Omni Science

and one SJM.

13. Pt. Ram Sabad CR No.101239- operated on 18.11.1999.

A sum of Rs. 1,76,000/- was

deposited by the Employer of the patient

for his treatment. Vide letter dated



15



valves Mitral and Aortic (St. Jude heart


cost of valve. The Paul Medical Hall

issued cash memo showing the sale of two

St. Jude Mitral valves for Rs.45,153/-

each. The payment was released by the

Office of Medical Superintendent

accordingly. The patient was operated on

18.11.1999. But instead of two St. Jude

heart valves one Mira Mitral Serial No.

99020066 and one SJ Aortic Serial

No.80537792 were implanted. Therefore,

the payment received was for two St. Jude

heart valves against supply of one Mira

Mitral and one SJ Aortic.

14. Pt. Ishwar Chand CR No.287442- operated on 17.10.1994.

The patient was a member of ESI.

An amount of Rs.1,00,000/- was deposited

in PGI for his treatment. Vide letter

dated 23.09.1994, Dr. R.S.Dhaliwal

16

requested the Medical Superintendent, PGI

to issue a cheque in the sum of

Rs.32,000/- in the name of the patient so

that artificial valve could be purchased

by him. Accordingly Cheque No.021343 for

Rs.32,000/- was released in favour of the

patient on 7.10.1994. He encashed the

cheque on 10.10.1994 and as per direction

of Dr. R.S.Dhaliwal the whole amount was

given to him for purchasing the valve.

Dr. R.S.Dhaliwal paid Rs.26,000/- out of

that amount to Surinder Singh Uppal for

purchase of valve. Surinder Singh Uppal

procured a valve for Rs.15,000/-. Out of

the profit he gave Rs.5,000/- to Dr.

R.S.Dhaliwal. The patient was operated on

17.10.1994 and his Mitral valve was

replaced with Machhi 3MAV. Subsequently

vide letter dated 26.10.1994 Dr.

R.S.Dhaliwal submitted five bills

amounting to Rs.63,000/- issued by M/s.

Paul Medical Hall and requested the

Medical Superintendent to release the

payment in favour of M/s. Paul Medical

17

Hall. Subsequently the said amount was

released vide cheque No.021415, dated

28.10.1994. As per one of the bills which

had been attached with Dr. R.S.Dhaliwal

with his letter one Starr Edwards Valve

worth Rs.30,000/- had been supplied by M/

s. Paul Medical Hall for patient Ishwar

Chand. To justify this Dr. R.S.Dhaliwal

subsequently added the words “& Aortic

valve replacement” in the discharge

summary.

6. The documents in which interpolations/

additions/ alterations were made were sent to the

Govt. Expert of Questioned Documents (for short

GEQD). He gave positive opinion as to the

authorship of Dr. R.S.Dhaliwal.

7. It was found that Dr. R.S.Dhaliwal was

cooperating with Surinder Singh Uppal and M/s.

Paul Medical Hall separately. Therefore, the

cases in which there was involvement of Dr.

R.S.Dhaliwal and Surinder Singh Uppal were

segregated and separate charge sheet was filed in

respect thereof.

18

8. The investigation established that M/s.

Paul Medical Hall is the partnership firm having

three partners namely Sat Pal Singla, Smt. Usha

Rani Singla and Anita Rani Singla. It was

established that Satpal Singla was the active

partner while the remaining two were the sleeping

partners. Hence, Satpal Singla was arrayed as an

accused while the remaining partners were left

out.

9. Sanction for prosecution of Dr.

R.S.Dhaliwal was obtained and on completion of

investigations charge sheet was filed.

10. Copies of charge sheet and documents

were supplied to the accused named above free of

costs in compliance of the provisions contained

in Section 207 of the Code of Criminal Procedure.

11. Finding prima facie case, charges under

Section 120-B, 420, 467,468 and 471 of the

Indian Penal Code were framed against both the

accused while charges under Section 13 (1) (d)

of Prevention of Corruption Act, 1988 were also

framed against accused Dr. R.S.Dhaliwal. The

accused pleaded not guilty and claimed trial.

19

12. To prove its case, the prosecution

examined 49 witnesses. They can be divided into

following categories.

The officials/Doctors from PGI.I. PW1 Dr. V.K. Batra, Professor,

Department of Anesthesia.

II. PW2 Dr. V.K. Grover, Professor, Department of Anesthesia.

III. PW5 Dr. R.K. Sharma, Deputy Medical Officer.

IV. PW6 Smt. Kanchan Ba Jandeja, Chief Perfusionist, department of CVTS.

V. PW7 D.P. Mehta, Joint Medical Superintendent.

VI. PW8 Dr. Anil Kumar Gupta, Medical Superintendent.

VII. PW10 Gauri Shankar Sinha, Senior Medical Record Officer.

VIII. PW13 Sh. Bihari Lal, Principal Private Secretary to the Head of the Department.

IX. PW15 Dr. Deepak Puri, who joined PGI as Junior Resident and worked as Senior Resident and as Assistant Professor in CVTS.

X. PW16 Dr. Rana Sandip Singh, Additional Professor, Department of CVTS.

XI. PW17 Dr. Devinder Mohan, the then Senior Resident, who worked as Senior Resident in the department of

20

CVTS from January 2000 to December 2002.

XII. PW18 Dr. Gangadhar. He did senior residency from department of CVTS from January 2001 to December 2003.

XIII. PW19 Smt. Satnam Kaur. She worked as Stenographer in the department of CVTS from 1991-1992 to 2001.

XIV. PW22 Sh.Jagmohan Singh, Superintendent Purchase.

XV. PW23 Dr. A. Rai Baruah. He pursued his Post Graduate Study MCH in the department of CVTS from July 1994 to June 1996.

XVI. PW-25 K.K. Sharma. He remained posted as Senior Lab. Technician, Technical Assistant and Profusionist from 1971 to 2002.

XVII. PW29 Daya Dhar, Assistant Cashier.

XVIII. PW36 Suman Arora, Senior Assistant, Accounts Branch.

The patients or their wards.I. PW14 Pt. Dawarka Prashad.

II. PW24 Ashok Kumar- Ward of patient Dayal Singh.

III. PW27 Amar Nath- Ward of patient Jigri Singh.

IV. PW31 Pt. Ishwar Chand.

V. PW32 Pt. Rajesh Kumar.

VI. PW33 Pt. Baldev.

VII. PW37 Om Parkash-Ward of Patient Sheela Devi.

21

VIII. PW38 Pushminder Singh- Ward of patient Sneh Lata.

IX. PW40 Pt. Raj Kumar.

The Suppliers/representatives.I. PW20 Kewal Kumar Seth, C&F Agent of

TTK Health care.

II. PW21 Sh. Sunil Aggarwal, Director of M/s. BL Marketing Services Limited.

III. PW28 Sh. Sandeep Ghaisas Distribution Manager, Edwards Life Sciences India Pvt. Ltd.

IV. PW35 Arvind Kumar Aggarwal, Accountant, Paul Distributor, Chandigarh.

V. PW39 Rajiv Kumar Gupta, Assistant Finance Manager, Baxter India Private Limited.

VI. PW47 Surinder Singh Uppal.

Bank Officers.I. PW12 Mandeep Singh, the then Senior

Manager, Bank of Punjab (now in Centurian Bank of Punjab), Chandigarh.

II. PW34 Sh. P. Anant, Manager, Canara Bank,Jalandhar.

III. PW43 Vinod Kapoor, the Chief Officer, SBI, PGI Branch.

IV. PW44 V.K. Narula, the then Officer, Bank of India, Sector 17, Chandigarh.

V. PW45 V.P. Mehta, the Manager Accounts, State Bank of Patiala,

22

Sector 7-C, Chandigarh.

VI. PW46 M.L. Gupta, Special Assistant, State Bank of India, PGI Branch.

Sanctioning Authority.I. PW9 Dr. K.K. Talwar, Director, PGI.

Witnesses as to handwriting.I. PW42 S.K. Sharma, AG-I (M), FCI- in

whose presence specimen signatures and writings of Sat Pal Singla and Ashok Kumar were taken.

II. PW48 Dr. Ravindra Sharma, Assistant Govt. Examiner of Questioned Documents.

Witnesses as to Miscellaneous matters.I. PW3 Dr. Raman Nijawan, SMO,

Radiology, General Hospital, Sector 16, Chandigarh.

II. PW4 Dr. Prem Chand, SMO, Radiology, General Hospital, Sector 16, Chandigarh.

III. PW11 S.S. Parmar, the then Assistant Excise and Taxation Commissioner, Chandigarh.

IV. PW41 Kashi Ram, Senior TOA, Office of GMT, Ferozepur, Punjab.

Investigating Officer.I. PW49 Jai Singh Inspector CBI.

13. In their statements recorded under

Section 313 of Code of Criminal Procedure, when

23

confronted with incriminating circumstances, the

accused pleaded innocence.

14. The following explanation was given by

Dr. R.S.Dhaliwal:-

“I became the HOD of CVTS Department in 1998. There was no proper purchase procedure for procuring disposable items or Artificial Heart Valves (AHVs) for open heart surgery before I became HOD. There was no purchase system as prevalent in AIIMS, Delhi and other prestigious Private Hospitals (like Appolo Hospital, Fortis Hospital etc.). During my tenure also despite my best efforts I could not succeed in introducing efficient system due to various impediments.

At that time there were very few

suppliers of AHVs and disposable items

for open heart surgery e.g.

1. Paul Medical Hall2. Bharat Medicos.

Before I became HOD of CVTS, in cases of

private patients the patients or their

wards were verbally told to go to one of

the supplier and procure disposable items

and AHVs. Set (s) of AHVs however were

24

supplied by supplier to operation theatre

directly. Usually particular suppliers

kept particular brands of valves. The

information regarding the suppliers was

sought by patients/wards from other

patients, wards of other patients, staff

and doctors of CVTS department.

In case of sponsored patients the

requisition was sent to MS office and it

was the prerogative of the MS office to

procure the AHVs and disposables. At the

M.S. Office the system in practice was

either to form Spot Committees or float

short term tenders for procuring these

items. Even in the cases of sponsored

patients the suppliers brought the set of

AHVs (consisting of 5-6 AHVs of different

sizes) to the operation theatre as the

price of only one AHV was paid to the

supplier.

When I joined as HOD in 1998, I

tried to streamline process of purchase

by introducing lists of disposable items

25

and valves for different open heart

operations. Thereafter the lists Started

being given to patients or their

attendants. Similar lists were supplied

to MS office regarding sponsored

patients.

When the patient comes to OPD of

CVTS department, directly or after having

been referred by Cardiology or Pulmonary

Medicine Department, then he is firstly

checked by Junior residents or senior

residents of CVTS department and

thereafter shown to a consultant Surgeon

and after a set of investigations the

decision regarding the replacement of

Heart valve (HV) is taken. Patient and

his attendants are told to arrange blood

and told about approximate expenditure

involved in the operation. The procedure

for fixing the dates and supply of lists

of consumables/ disposables and AHVs to

the patients or their wards is handled

mainly by senior residents.

26

Files of the patients and

operation notes and pre and post

operation progress notes are written by

senior residents as it is their main

duty.

Regarding the allegation that

patients were charged for 2 AHVs but

only one implanted or patients charged

were for expensive AHV but cheaper one

implanted it is explained that ever since

I joined CVTS department, the procedure

followed relating to surgery for

implanting the AHV remained almost the

same. The supplier/ his representative

would bring a set of AHV (consisting of

different sizes) to the operation theatre

just before the AHV was to be implanted.

The set was handed over by the supplier

to one of the Profusionist or a

technician of CVTS operation theatre. The

Profusionist and attending nurse opened

the sealed boxes containing the AHVs and

handed over the same to the Operating

Surgeon in the presence of surgeon

27

/anesthesia team. In case two AHVs were

planned to be implanted then two sets

would be brought.

Each set used to contain the AHVs

of following sizes:

The AHVs of St. Jude, Omni and TTK brands

consisted of following sizes:

Mitral Aortic

21mm 17mm

23mm 19mm

25mm 21mm

27mm 23mm

29mm 25mm

31mm 27mm

The AHVs of Starr Edwards and Machhi

brands consisted of following sizes :

Mitral Aortic

1m 8A

2m 9A

3m 10A

4m 11A

5m 12A

28

Many a times the set/ sets brought

by supplier consisted of AHVs of

different brands. It was because at times

the supplier did not have complete set/

sets of one brand which had been

requisitioned or for which the patient

had been charged by the supplier. In such

circumstances there was no time to

arrange the set of the specific brand of

AHV which was requisitioned as by the

time the set was brought to operation

theatre the patient was connected to

heart lung machine and his heart was

exposed and opened for implantation.

However AHV of whatever brand was

implanted was duly mentioned in the

operation notes in the patient file. The

AHVs were always of reliable and

established brand conforming to

international standards. The remaining

AHVs i.e the ones left after use from the

set/sets, were taken by the supplier/

representative back after the surgery. At

times after the surgery the doctors

29

including myself used to mention the size

of the AHV which had been used for the

information and record of the supplier/

his representative. I mentioned the sizes

of the AHV implanted on few occasions on

my letter head on being requested by

supplier or his representatives.

The patients/wards used to pay

only for one or two AHV(s) to the

supplier directly or through MS/PGI,

whereas the supplier used to bring to the

operation theatre full set/ sets of AHVs

because the size of AHV(s) to be

implanted could be known only after

opening the chamber of the heart of the

patient, where valve had to be implanted.

Due to that reason the AHV was never

handed over to the patient/ward by the

supplier because while the patient paid

for only one or two AH valves the exact

AHV(s) had to be chosen from the full

set/ sets, each set consisting of 5/6

AHVs of different sizes, which was many

more time costly than the single valve.

30

The AHV was also not handed over

to the patients/wards because it is

packed in a highly sterile sealed box and

there was risk of contamination of AHV if

the same was opened before operation by

the patients/ wards out of curiosity.

Some such instances had been noted in the

past.

There were times when the doctors

planned to implant two AHVs during pre

operative work up of patient but at the

operation table, on examination of heart,

it was concluded/ decided that it was

possible to repair one heart valve or not

to treat it in any way as the defect was

too minor, therefore, even if two AHV

sets were requisitioned, only one AHV was

implanted. Similarly if one heart valve

was planned for replacement, but at the

operation table it was found repairable

or was found all right then the whole set

of the AHVs requisitioned or brought by

supplier was returned to supplier without

implantation of AHV.

31

Whether two or one or no AHV was

implanted was duly mentioned in the

operation notes.

The operation notes were always written

by senior resident doctors assisting the

main operating surgeon. In case senior

resident doctors sought any guidance then

operating surgeon used to give/ provide

the same. It was always expected of the

senior resident doctors to write the

operation notes correctly and honestly.

After the surgery it was always expected

of the suppliers that they would refund

the amounts to the patients or the PGI in

case the AHV(s) supplied by them were not

implanted and therefore returned to them

or if they had supplied the AHV of brand

of lesser price after having charged for

AHV of brand of higher price. This

procedural aspect was not within the

control of main operating surgeon.

The disposables and AHVs were

supplied by suppliers after the receipt

of money from patients directly or

32

through MS office of PGI. The disposable

items were handed to the patients/

attendants but AHVs i.e. the set of AHVs

was supplied directly in the operation

theatre at the time of open heart

surgery.

The bills submitted by the

patient/wards for verification for the

purpose of reimbursement at CVTS

department, were verified by senior

residents in OPD. Because of the heavy

work load some discrepancies could have

remained undetected as the bills were

verified by the senior residents in

routine without meticulous comparison

between the bills and operation files of

the patient.

Regarding SS Uppal it is explained that:

The wife of SS Uppal and my wife

were close friends before marriage.

During their school times both were

Punjab State Level and National Level

33

Basketball players. They played together

many tournaments as team mates and

traveled and stayed together during those

times and became good friends. After SS

Uppal’s marriage the social interaction

between the families also continued as

both of them i.e my and SS Uppal’s wife

settled in Chandigarh. His wife was

teacher to both of my sons in their

nursery school i.e. Ankur Nursery School

(Panjab University Campus)

As SS Uppal was not well settled

in any profession, therefore, he

continued to change his professions e.g.

1. Private Tuitions

2. Sold books (Agent)

3. Sold electric meters.

SS Uppal and his wife borrowed

money from us after their marriage

somewhere in middle 80s at various stages

totaling about over Rs.2.00 lacs which SS

Uppal always promised to return whenever

his financial condition became stable.

34

SS Uppal at his own initiative

made inquiries from me and various other

doctors and employees of CVTS department

regarding procedure for the supply of

AHVs and other materials for use in CVTS

department, PGI.

Taking advantage of close social

relations with me he was able to campaign

and persuade the various doctors and

employees of CVTS department to introduce

the names of his concerns to the patients

and their wards regarding supply of AHVs.

There were very few suppliers of

AHV in Chandigarh at the time when he

established himself in this field e.g.

1. Paul medical Hall

2. Bharat Medicos.

I never directly helped him by

specially mentioning the names of his

concerns to the patients or their wards

regarding AHVs.

The patients and their wards

35

decided about the suppliers of AHVs by

asking from other patients/ wards,

employees and doctors of the CVTS

department.

Whenever the patients/ wards

directly asked me then I used to mention

the names of all the established

suppliers including the name of SS

Uppal’s concerns after I found him also

to be a reliable supplier.

I never gave any referral slips to

patients/ wards in favour of SS Uppal’s

concerns or any other supplier. However I

did mention the exact implanted AHVs

brand name and size on my letter head

after the implantation on being asked by

supplier or his representative for their

information or record. Such information

was also given in writing by other

doctors whenever the supplier asked for

the same. Such information on my letter

heads is being projected wrongly as

reference slips in favour of SS Uppal/his

firms.

36

Regarding Diary of SS Uppal it is explained that:

After he Started supplying the

AHVs to CVTS department, it appears that

he Started having stable income and then

he Started repaying the loans he had

taken from us. On few occasions, he made

the repayments by cheques from his

concerns. I told him that since he was

supplying the AHV to CVTS departments

through his concerns/firms therefore the

repayments of loans by cheques from those

concerns could be misconstrued. Therefore

the repayments of loans were

predominantly by cash. This is the reason

why the cheque payments could not be

connected to allegations of profit

sharing between SS Uppal and myself even

in the fabricated diary.

He repaid the loans by 1998. I

never received payments for AHVs or for

any other purpose on behalf of SS Uppal/

37

his concerns or on behalf of any other

supplier. I never shared any profits from

the sale of AHVs with owners of Paul

Medical Hall. From the time I joined in

preliminary inquiry and regular case

investigation by EO/IO the CBI officials

did not even show or mention to me the

diary/ledger allegedly prepared

contemporaneously by SS Uppal.

The diary is a fabrication, a

forged document prepared in connivance

between the CBI officials and SS Uppal

after SS Uppal decided to become an

approver probably when he was confronted

by CBI with evidence of overcharging from

patients for AHVs. The purpose was to

entangle me in a false case as otherwise

the CBI were not in a position to

implicate me.

For making SS Uppal the approver,

the CBI officials apparently subjected

him to persistent physical and mental

torture.

38

The open heart register at CVTS

department was filled by the

Perfusionists. It was taken for reference

by various senior residents, junior

residents, doctors in connection with

their medical research papers and

publications not only of CVTS department

but other departments as well. It never

remained in custody of any one in

particular and never remained in lock and

key of anyone.

All the allegations of

interpolation, erasures, forgeries

against me whether in open heart/

operation register, in patient files, or

bills or any where else are false. All

the allegations that I campaigned for or

referred the patients/wards to SS Uppal’s

concerns are false.

The PWs were tutored by IO Jai

Singh to make allegations against me

while recording their statements and then

in the court with various pressure

39

tactics. He pressurized them by threats

that in case the PW did not make

statements as recorded by him under

section 161 Cr.P.C. then they would be

prosecuted for perjury. He lured them by

mentioning compensation if the PWs

deposed in a particular way regarding

deaths of the relatives.

A few patients died after the open

heart surgery because of various reasons.

Surgery for replacing HV is a major

surgery and there is always a heavy risk

involved.

The patient can die because of

following reasons :-

i. Heart failure due to weak muscle

of the heart or prolonged heart

disease.

ii. Due to bleeding during post

operative period, which could be

because of prolonged Cardio

pulmonary bypass, use of heparin,

damage to components of blood by

40

H/L machine, multiple blood

transfusion and deranged

coagulation profile of the patient

which is common in long standing

heart disease.

iii. Acute renal shut down which can

happen in any patient after open

heart surgery.

iv. Respiratory failure because lungs

are badly damaged in most of heart

patients.

v. Infection

vi. Myocardial infarction

vii. Cerebro vascular accident like

brain hemorrhage or thrombosis.

viii.Due to poverty, negligence or

ignorance, number of patients do

not take anti coagulant tablets/

drugs after implantation of AHV.

This can lead to thrombosis on the

valve leading to its mal-

functioning which can lead to

death.

ix. Due to excessive intake of anti

41

coagulant drugs by patients it can

result in hemorrhage in brain or

in any other vital organ.

But in order to prejudice the PWs

against me the PWs were fed with

misinformation that inferior quality AHVs

were implanted leading to deaths of their

relations.

Jai Singh IO was always present

outside the court and tutored/

pressurized the PWs before they deposed

in the court.

There were times when the MS

office of PGI told the staff of CVTS

department to transmit the cheques of the

suppliers to them i.e. the suppliers. On

receiving the information through

telephone call the cheques were brought

by CVTS staff and passed on to the

suppliers. This task was assigned to CVTS

department especially because of shortage

of staff with MS office and their heavy

load of work.

42

This case is the result of the

influence exerted on the CBI by vested

interests who wanted to harm me

professionally for their own selfish

ends.”

15. Accused Sat Pal Singla gave the following

explanation:-

“I am innocent. I have been falsely

implicated in this case. M/s. Paul

Medical Hall was supplying consumables

/surgical equipments to the PGI as Paul

Medical Hall was on the approved list of

PGI for supplying consumables/surgical

including artificial heart valves. The

goods as requested by the doctors were

deposited in the Central Store of the

Medical Superintendent after due

verification. Since at the time of

surgery the members of the valves and

brand of valves, due to the need of the

patient could not be foreseen, therefore,

numerous valves and brands were sent at

43

the time of planned surgery. In case

requisition came for two valves then two

valves were deposited in the store.

However, the bills were prepared before

the deposit of goods in the store,

subsequently excess or less amount

received were subject to reconciliation

and finalization of accounts and at that

time actual goods were also compared.

Since there was acute shortage of the

staff in Medical Superintendent Office,

reconciliation of the accounts could not

take place despite sending numerous

officials of the Chemists number of times

to the Medical Superintendent's Office.

In many cases excess amount received has

been returned to the PGI and in many

other cases amount received was less.

Thus, there were ongoing transactions

between the PGI and Paul Medical Hall.

The Investigating Officer in this case

has taken into account the wholesale

price at which valve was received by the

Chemist. However, valves were supplied at

44

the rate taking into account expenses for

promotion of brand, literature, holding

of conferences, seminars, sale tax and

interest cost for maintaining huge

inventory and the capital employed as it

could not be foreseen which number, size

and brand of the valve will be consumed.

The artificial heart valves being very

delicate and fragile also could be

rendered useless. Since the technology

was rapidly changing, valves light in

weight and durable were replacing

conventionally used brands of valves.

Omni Science being a better product

technologically and clinically same was

insisted for users by the Medical

fraternity”.

16. In defence the following witnesses were

examined:-

DW-1 Jarnail Singh, whose son Jagtar

Singh was operated by accused

R.S.Dhaliwal.

45

DW-2 Mandhir Mohan, whose wife was

treated by Dr. R.S.Dhaliwal.

DW-3 Dr. Rama Krishana who did

senior residency in the department of

CVTS from 2000 to 2003.

DW-4 Subhash Gupta, whose wife Indu

Gupta was treated by Dr. R.S.Dhaliwal.

DW-5 Dr. Lakhbir Dhaliwal. She is the wife of Dr. R.S.Dhaliwal and Head of

Department of OB Gynecology.

DW-6 Dr. Kuldeep Singh Sidhu who did

senior residency CVTS from 1985 to

1987.

DW-7 Dr. Rajan Mehra, who did senior residency CVTS from 1991 to 1993.

DW-8 Ms. Jassy Anand, Documents

Expert.

17. Dr. R.S.Dhaliwal himself appeared in the

witness box as DW9 after getting due permission

within the meaning of Section 315 of the Code of

46

Criminal Procedure.

18. I have heard the learned Public

Prosecutor and learned counsel for the accused.

19. Following points arise for

determination:-

(i) Whether cognizance has been taken

on the basis of valid sanction for

prosecution of accused Dr. R.S.Dhaliwal?

(ii) Whether there was criminal

conspiracy between R.S.Dhaliwal and Sat

Pal Singla to cheat the patients, the

funding agencies and the PGI?

(iii) Whether in pursuance of conspiracy

accused Sat Pal Singla of M/s. Paul

Medical Hall used to charge the price for

a particular valve but Dr. R.S.Dhaliwal

used to implant a different heart valve

of lesser price in the patients?

(iv) Whether in pursuance of the

conspiracy the accused Sat Pal Singla

used to charge for two artificial heart

47

valves but only one used to be supplied

and implanted?

(v) Whether in pursuance of conspiracy

accused Sat Pal Singla prepared and

issued false bills/invoices?

(vi) Whether in pursuance of conspiracy

accused Dr. R.S.Dhaliwal tampered with

record?

20. In so far as the sanction of prosecution

is concerned PW-9 Dr. K.K. Talwar has made clear

that Governing Body of the PGI was competent

authority and as such the relevant papers

supplied by CBI were placed before the Governing

Body and vide agenda item No.17, dated 9.1.2006

(ExD2) it accorded sanction and simultaneously

authorized him, being Member Secretary, to sign

and convey the sanction on behalf of Governing

Body.

21. Learned counsel for accused would argue

that the sanction is bad for the following

reasons:-

48

I. As admitted by PW9, vide Agenda

Item No.17 he was only authorized to sign

and convey the sanction whereas the

discussion regarding the matter had taken

place on earlier dates i.e. 31.8.2005 and

20.12.2005.

II. Neither the Agenda Item No.17 nor

the minutes of 31.8.2005 and 20.12.2005

were supplied to the Investigating

Officer.

III. There is no reference to the

meetings dated 31.8.2005 and 20.12.2005 in

the Agenda Item No.17.

IV. Admittedly the sanction order was

prepared only after the meeting dated

9.1.2006 in which Agenda Item No.17 was

taken up but the same was never placed

before the Governing Body for its approval

before being signed by PW9.

V. The Sanction order was prepared by

the Vigilance Section attached with the

office of PW9. This means that there was

49

no application of mind by the

competent authority i.e. Governing Body.

VI. PW9 does not remember which

documents were gone through or perused by

him before he signed the order prepared by

the Vigilance Section. He even could not

remember what documents were circulated to

the Governing Body and how the documents

were circulated.

22. To my mind the reasons cited by the

defence are not convincing. There is no doubt

that Governing Body of the PGI is the competent

authority to remove Dr. R.S.Dhaliwal from

service. It cannot be disputed that the

Governing Body can authorize any person to sign

the orders on its behalf. Whether the decision

to accord sanction for prosecution of Dr.

R.S.Dhaliwal was taken on 20.12.2005 the fact

remains that agenda came to be signed by the

Chairman of the Governing Body on 9.1.2006.

Therefore, what is relevant is the Agenda Item

vide which the decision to accord sanction was

taken. A bare perusal of Agenda Item No.17 ExD2

50

would make it clear that Governing Body had

taken the decision to accord sanction. Since

the minutes were signed on 9.1.2006 technically

it can be said that the decision was taken on

9.1.2006 irrespective of the fact that

practically the decision was taken on

20.12.2005.

23. When PW9 says that the decision to accord

sanction had been taken on 20.12.2005 but he was

authorized to convey and sign the sanction on

9th January 2006, he does not mean to say that

these were two different meetings. He never said

that Agenda Item No.17 was meant to only

authorize him to sign the sanction order. As

discussed above, the Agenda Item No.17 is self

explanatory that decision to accord sanction and

to authorize PW9 to sign and convey the sanction

on behalf of the Governing Body was taken in one

meeting. Since the minutes of meeting were

signed by the Chairman of the Governing Body on

9.1.2006 PW9 said that the decision to accord

sanction was taken on 20.12.2005 but, he was

authorized to convey and sign the sanction

order on 9.1.2006. There was the technical

51

reasons for him to say so. Because authorization

could be possible only after signing of the

minutes by the Chairman of the Body.

24. Agenda Item No.17 itself makes it clear

that the decision to accord sanction was being

taken after due deliberations and after

considering all aspects of the case. The

documents which were gone through by the

Governing Body are mentioned in the Agenda Item.

The report of S.P. includes the statements of

witnesses. It is therefore, evident that

Governing Body had gone through the entire

record and only thereafter it was satisfied

about the necessity to accord sanction. Merely

because at this stage PW9 could not recall as to

which particular documents were circulated among

the members of the Governing Body it does not

mean that the decision was taken without

application of mind. Agenda Item No.17 is self

explanatory. Moreover, the sanction order itself

mentions that the material examined included the

statements of the witnesses and other relevant

documents.

52

25. In so far as placing of the sanction

order before the Governing Body again for its

approval is concerned the same was not required

because, there was no such direction by the

Governing Body that PW9 would sign the order

only after getting the draft approved. Once the

decision to accord sanction had been taken and

PW9 had been authorized to sign and convey the

same, there was no need of placing the draft of

sanction order before the Governing Body before

signing and conveying it. There is presumption

that all officials acts were duly performed.

26. There is nothing wrong if help from the

Vigilance Section was taken because PW9 makes it

clear that he signed the order only after

finding it to be in order. Therefore, it cannot

be said that it was the Vigilance Section and

not the Governing Body of the PGI which accorded

sanction. Even otherwise, the defence has not

been able to show any defect which could be a

pointer to non application of mind by the

members of the Governing Body. Merely because

PW9 does not know what does Section 467 of

Indian Penal Code mean, it does not mean non

53

application of mind, the provisions of law

alleged to have been violated by the accused

were mentioned in the FIR as well as the report

of SP. If the Vigilance Section found them to be

attracted and assisted PW9, there is nothing

wrong.

27. All said and done, the defence has not

been able to prove that the sanction for

prosecution of Dr. R.S.Dhaliwal is invalid.

Hence, point No.1 is answered in favour of the

prosecution.

28. Coming to the allegations, since all the

14 cases discussed above were those of sponsored/

private grant patients, before proceeding

further, it would be fruitful to have a bird's

eye view of the procedure for procurement of

disposables /valves and for payment. As stated by

PW-8 Dr. Anil Kumar Gupta, there were three

phases during which different procedures were

prevailing. Those are as under:

i. Till 1996 The treating doctor would send a

54

requisition enlisting the items required

along with the names of the

manufacturers and the cost. The amount

would be sent to him in the shape of

cheque to be forwarded to the supplier

as per his request. If there was no such

request, the cheque would be sent

directly to the supplier.

ii.From 1996 to 2000 With the assistance of the Heads of

Departments, specifications of the items

required were collected and through

tenders rate contracts were arrived at

which were supplied to the respective

departments to be adhered to. The

treating doctor used to send the order

directly to the supplier whose rate

contract had been approved by the

competent authority. The copy of the

order used to be endorsed to the Office

of Medical Superintendent.

iii. From 2000The system of constituting spot

55

committees comprising representatives of

treating surgeon, representative of

financial Advisor and an Officer from

the Office of Medical superintendent was

introduced. Spot committees would

collect the quotations for the items

required and after evaluating the

quotations they would recommend

purchases from the supplier quoting

lowest rates. Supplier would supply the

items to the Central store of the

hospital. The treating doctor/his

representative would come to the store;

verify the items and indent them for

surgery.

29. From the perusal of record and statements

of the witnesses, the following facts stand

established beyond doubt:

(1)On the basis of preliminary

investigations/diagnosis, the treating

surgeon would determine how many valves

need to be replaced.

56

(2)The treating surgeon would furnish an

estimate of expenses.

(3)On the basis of the estimate, the

funding agency will deposit the amount

in PGI.

(4)After admitting the patient in the ward,

the treating surgeon would issue a

requisition/supply order to the supplier

/chemist through the Medical

Superintendent mentioning the items with

specifications and the price (In the

instant case all but one instance

pertain to the period when rate contract

was in prevalence. The rate contracts of

Paul Medical Hall had been approved vide

Ex.PW-22/1 to Ex.PW-22/3. The price, in

the supply order was being mentioned as

per the rate contract.

(5)The Office of Medical superintendent

would issue cheque in the sum mentioned

in the supply order to the supplier

/chemist. Normally, the cheque would be

issued before the date fixed for

57

surgery.

(6)Depending on the diagnosis, the treating

doctor would have an idea as to which

brand of valve was required.

Accordingly, he will requisition that

particular brand. However, since the

size of valve required to be implanted

would be known only after opening the

chest, the valve will not be supplied in

advance. The supplier/chemist or his

representative will bring a set

consisting 5-6 valves of different sizes

directly to the operation theater in the

morning when the operation was to be

performed. Sometimes a set/sets brought

by the supplier/chemist would consist of

valves of different brands because at

that particular time he will not have

the complete set/sets of one brand which

had been requisitioned or for which the

price has been received.

(7)In cases where the double valve

replacement had been planned, there

58

could be a possibility that only one

would be replaced and the other

repaired. Similarly, in cases where

single valve replacement had been

planned there could be a chance of the

valve being repaired and, hence, no

replacement.

(8)The number of valve/valves actually

implanted and the brand/brands used to

be mentioned in the operation notes as

well as in the open heart register.

(9)Operation notes used to be written by

the Senior Residents assisting the

operating surgeon. The entries in open

heart register used to be made by the

Profusionist.

30. The gist of offence of conspiracy lies

in the forming of agreement of conspiracy. Such

an agreement need not be formal or express. It

may be inherited in and inferred from the

circumstances, especially declaration, act and

conduct of the conspirator. In State of

59

Tamilnadu Versus S. Nalini and others, 1999 Crl.Law Journal, page 3124 the Hon'ble Supreme Court has observed that Conspiracy is hatched in

private or in secrecy. It is nearly impossible

to establish a conspiracy by direct evidence.

Usually, both the existence of the conspiracy

and its objects have to be inferred from the

circumstances and the act and conduct of the

accused.

31. To prove conspiracy Section 10 of the

Evidence Act also comes handy. Once a prima

facie evidence is found affording a reasonable

ground for the Court to believe that two or more

persons anything said, done or written by any

one of them in reference to their common

intention will be evidence not only for the

purpose of proving the existence of the

conspiracy but, also for the purpose of showing

that the said persons were party to it.

Needless to say that once a conspiracy to commit

an illegal act is prima facie proved, any act

done by one conspirator in pursuant to the

agreement becomes the act of other. As observed

in State of Tamilnadu Versus S. Nalini and

60

others (Supra), this joint responsibility

extends not only to what is done by any of the

conspirators pursuant to the original agreement

but also to collateral acts incidental to and

growing out of the original purpose.

32. Having discussed the law on the point let

us take up the instances separately to find out

whether there was criminal conspiracy between

Dr. R.S.Dhaliwal and Sat Pal Singla.

PATIENT: ISHWAR CHAND

As per patient file Ex.PW-10/1, Ishwar

Chand was operated on 17.10.1994. On the

admission form Ex.PW-16/1. Originally, the

following surgical procedure was mentioned:

On 17/X/94

CPB Mitral Valve replacement done using

SE No.3 valve by Dr. R.S.Dhaliwal.

By cutting the words 'SE' the words

'Machi No.3' were written so as to give the

61

impression that the valve implanted was Machi

No.3. In open heart register Ex.PW-6/1 Page No.9,

Serial No.81 (Ex.PW-25/1) also, there is a

erasure in the encircled portion Q-7. After

erasure the words written are “3 Machhi”.

This was a case of private

grant/sponsored patient. Rupees One lac were

deposited in advance for the treatment vide

receipt Ex.PW-7/2.

On 23.09.1994, Dr. R.S.Dhaliwal wrote

letter Mark PB/1, whereby he requested the

Medical Superintendent for issuance of a cheque

of Rs.32,000/- in the name of the patient so that

he could get the valves from the company. The

words 'in the name of patient' were written after

striking off the words 'Alfa Surgicals'.

Learned counsel for the accused would

argue that this document cannot be read in

evidence, as the original is not on record and no

permission to lead secondary evidence has been

sought or granted.

To my mind, there is no merit in the

62

contention. PW-7, the then Deputy Medical

Superintendent has categorically stated that

letter Mark PB/1 was received in the Office of

Medical Superintendent and after processing the

same, cheque for Rs.32,000/- duly signed by the

then Medical Superintendent was handed over to

Ishwar Chand on 07.10.1994. In the requisition

Ex.PW-7/7 vide which the cheque was sought to be

issued by Medical Superintendent, there is a

column as to for what purpose the amount is

required. Against this column, it is clearly

mentioned that it is for the purchase of double

valve for open heart surgery. Since the amount

could not have been released without

recommendation by the treating surgeon, there can

be no doubt about the authenticity of the letter

Mark PB/1. Even if, for a pause, it is admitted

that this letter cannot be read in evidence for

substantive purpose, it can still be read for

collateral purpose of corroborating the statement

of PW-7. To that extent, this letter is

admissible. On the basis of this letter, the

cheque Ex.PW-29/24 dated 05.10.1994 was released

by the Office of Medical Superintendent in favour

63

of the patient Ishwar Chand. The said Ishwar

Chand appeared in the witness box as PW-31 and

deposed that after encashing the cheque he had

given Rs.32,000/- to Dr. R.S.Dhaliwal who had

represented that the second valve was with him.

As per diary Ex.PW-47/1, Page No.27,

Surinder Singh Uppal received Rs.26,000/- from

Dr. R.S.Dhaliwal on 10.10.1994 for patient Ishwar

Chand. He supplied valve worth Rs.15,000/- and

out of profits gave Rs.5,000/- to Dr.

R.S.Dhaliwal.

As to why the words 'Alfa Surgicals' were

struck off from the letter Mark PB/1 and in their

place the words 'in the name of patient' were

written would be clear from the fact that by the

time the letter was issued Alfa Surgical had not

yet opened its account in the bank. Ex.PW-33/18

proves that the account in the name of Alfa

Surgicals was opened only on 21.11.1994.

Accused R.S.Dhaliwal did not stop at

this. The patient was discharged on 26.10.1994 as

is evident from the discharge summary Ex.PW-19/1.

In this summary, the final diagnosis was

64

mentioned as chronic RHD with MR, MS + Gr. II AR.

In the column of operation, the following was

mentioned:

“Mitral valve replacement under CPB on

17.10.1994”

However, the words 'and Aortic valve replacement'

were added in hand to show that it was a case of

double valve replacement.

While going through the record to

ascertain as to whether these words are in the

hand of Dr. R.S.Dhaliwal, I have come across

many documents on which there is no doubt about

the writing of Dr. R.S.Dhaliwal. Out of those

documents, the following are being referred to

specifically:

(1)The noting Ex.PW-8/35 in the patient

file of Jigri Singh.

(2)The certificate Ex.PW-13/10 filled in by

Dr. R.S.Dhaliwal.

(3)The application dated 07.05.1987 written

by Dr. R.S.Dhaliwal to the Head of

65

Department of CTV Surgery.

(4)The application dated 26.06.1985

Ex.PW-13/14 written by Dr. R.S.Dhaliwal

to Director, PGI, Chandigarh.

In the noting Ex.PW-8/3, the accused has

used the word 'Aortic'. This writing matches the

writing of the word 'Aortic in the portion Q-40

on the discharge summary Ex.PW-19/1in all its

details and particulars except for the fact that

on Ex.PW-8/35, the word has been started with

small 'a' while on Ex.PW-19/1 this word starts

with capital 'A'. The manner of joining the

letters 'o', 'r', 't' and 'i'; the manner of

writing the letter 'i'; with dot not on the top

but on the right side and the manner of writing

the letter 'c' in the end at some distance from

the letter 'i' is identical. There is striking

similarity in the execution of the word 'valve'

in Ex.PW-8/35 and on Ex.PW-19/1. The manner in

which the letter 't' has been executed whenever

it comes in the end is identical in the words

'patient', 'cost' and 'root' etc., as appearing

in Ex.PW-8/35 and the word 'replacement'

appearing in Ex.PW-19/1. The manner and style of

66

joining the letters 'r' and 'e' whenever the

word starts with small 'r' is identical in the

words 'recommendation' and 'rest', as appearing

in Ex.PW-13/14 and Ex.PW-13/12 respectively and

the word 'replacement' in portion Q-40 on

Ex.PW-19/1. Similarly, the manner of writing the

letters 'm', 'e' and 'n' and joining them is

identical in the word 'recommendation' as

appearing in Ex.PW-13/14 and the word

'replacement' as appearing in portion Q-40

Having looked at the record with as much

care as it could, this court has also gone

through the opinion evidence. While the

prosecution has examined the Government Expert as

PW-48, the defence has examined a private expert

Ms. Jassy Anand as DW-8. Naturally, the opinion

of Government Expert is in favour of the

prosecution while that of private expert is in

favour of the defence. However the Court has

considered the opinion of both the experts with

one eye without any bias or prejudice keeping in

mind the settled principle that the evidentiary

value of defence witnesses is the same as that of

prosecution witnesses.

67

It is worth mention that while standard

writings/signatures of Dr. R.S.Dhaliwal were

forwarded to the Government Expert along with

the disputed writings/signatures, the private

expert opted to obtain the specimen writings in

her laboratory and compared them with the

disputed writings. Dr. R.S.Dhaliwal had moved an

application seeking permission from the court to

the expert Jassy Anand to take photographs of

his disputed handwritings and admitted

signatures/handwritings from the court file and

to take his specimen signatures and handwriting

in the court. Vide order dated 23.04.2008,

permission was granted to the expert to take

photographs from the court file. At the same

time, it was made clear that no indulgence of the

Court was required insofar as the taking of the

specimen signatures/handwritings of Dr.

R.S.Dhaliwal by the expert was concerned, as this

could be done by the expert at her own level.

This, however, did not mean that accused could

select the mode of proof. Had the accused Dr.

R.S.Dhaliwal been serious, he would have asked

for the summoning of the record having his

68

handwriting from the PGI so as to be compared

with the questioned writing. Instead he opted to

lend his specimen writing in the laboratory of

the expert engaged by him. The possibility of his

having changed his writing under the expert

supervision cannot, thus, be ruled out. The

disputed writings were available when the

specimen writings were taken by expert Jassy

Anand. Changing the speed, wrist movement,the

size and spacing between the letters, the

alignment and, the slant while having the

disputed writings in front would not have been a

difficult task particularly, when there was an

expert to guide.

While drawing this inference, the Court

has exercised utmost caution in not getting

swayed by surmises and conjectures. The Court is

alive and conscious that an inference is to be

drawn not from another inference but from facts.

The manner in which the facts are presented is

also a relevant consideration. Therefore, the

Court has to be at its intuitive best to separate

grain from the chaff.

69

It is quite interesting to note that

while taking specimen handwriting of Dr.

R.S.Dhaliwal, the expert DW-8 has, inter alia,

taken the following specimen:

“Please make payment from the balance

left. Rest will be paid by patient's

attendant”.

While comparing the above portion which

has been marked SH by DW-8 with the disputed

writing Q-68 (Ex.PW-13/8), she has come to the

conclusion that this writing (Q-68) along with

the other disputed writings is a result of copied

forgery. By opining this, DW-8 has made the job

of the court easy. In fact, Dr. R.S.Dhaliwal

never denied the noting Q-68 despite having got

an opportunity when he stepped in the witness

box. Therefore, denial by DW-8 is virtually

meaningless. It is worth mention that in the

specimen SH, Dr. R.S.Dhaliwal had lent his

writing as well as signatures. DW-8, while making

comparison, ignored the signatures and just

concentrated on the writing as would be evident

from the photograph Ex.DW-8/25. It is evident

that the segregation of writing from the

70

signatures was done deliberately as no opinion as

to the forgery of the signatures would have been

possible. The portion Q-68 (Ex.PW-13/8) is the

noting given by Dr. R.S.Dhaliwal on the back of

his letter Ex.PW-8/33 in response to the

information given by the Office of Medical

Superintendent. Although, this noting was in

context of patient Jigri Singh yet, the same is

being considered here for the sole purpose of

testing the genuineness of the opinion rendered

by DW-8. Dr. R.S.Dhaliwal does not say that his

signatures in the portion Q-68 (Ex.PW-13/8) are

genuine but the writing is not that of him. Even

otherwise, it is not understandable as to why Dr.

R.S.Dhaliwal would affix his signatures with date

on the back of the letter in blank portion and

why would somebody else copy his writing by

giving a note above the signatures. It is evident

to naked eye that the entire note with signatures

has been executed in one go with same pen. The

note is not out of the context as would be

evident from the letter Ex.PW-8/33 and the

notings Ex.PW-8/34, Ex.PW-8/35 and the subsequent

notings given on the face of the letter

71

Ex.PW-8/33. In fact, nobody stood to gain by

forging this noting Ex.PW-13/8. So long as there

is no dispute about the noting Ex.PW-8/35, no

question mark can be raised against the noting

Ex.PW-13/8. But, in their wisdom the accused

R.S.Dhaliwal and DW-8 have ventured to prove that

the noting Ex.PW-13/8 is a result of copied

forgery. This sole instance shows the worth of

the opinion rendered by DW-8. To say that she has

gone out of the way in supporting Dr.

R.S.Dhaliwal, who had engaged her, would not be

exaggregation. Even regarding the remaining

questioned writings, DW-8 has termed natural

variations as inherent dis-similarities. If there

could be dissimilarities between the specimen SH

and the portion Q-68 (Ex.PW-13/8), the fact that

there are dis-similarities between the remaining

questioned writings and the specimen writings is

meaningless. Even if, it is assumed that while

lending specimen, Dr. R.S.Dhaliwal was not

tutored by DW-8 or that he did not try to change

his writing deliberately, the mere fact that

according to DW-8 herself there are

dissimilarities between specimen SH and disputed

72

writing Q-68, the dissimilarities as highlighted

by her between the other specimen and questioned

writings, have to be ignored being natural

variations. While expressing so, the Court has

taken the noting portion Q-68 (Ex.PW-13/8) as

duly proved to be in the hand of Dr. R.S.Dhaliwal

and none else.

No gain saying that proof of authorship

of a document/signature is proof of a fact like

any other fact and as held in Mubarak Ali Ahmad Versus State of Bombay AIR 1957 SC 657, the evidence relating thereto may be direct or

circumstantial. It may consist of direct evidence

of a person who saw the document being

written/signed it may be the proof of the

handwriting of the contents or the signatures by

one of the modes provided in Sections 45 and 47

of Indian Evidence Act. It may also be proved by

internal evidence afforded by the contents of

the documents and other external evidence.

In coming to the conclusion that the

noting portion Q-68 (Ex.PW-13/8) is duly proved

to be in the hand of Dr. R.S.Dhaliwal the Court

has taken into account the statement of PW-13 who

73

had been working under Dr. R.S.Dhaliwal as his

Private Secretary. The Court has also looked at the internal evidence afforded by the contents of

the document and other external evidence. Hence,

the overzealous but partisan opinion rendered by

DW-8 has to be ignored. Instead of assisting, she

has tried to mislead the court in order to serve

the interests of Dr. R.S.Dhaliwal, who engaged

her. As against this, the Court finds the opinion

rendered by PW-48 to be truthful, unbiased and

convincing.

In Murari Lal Vs. State of M.P. AIR 1980 (SC) 531,

the Hon'ble Supreme Court after considering a

catena of precedents held that where the reasons

for the opinion of handwriting expert are

convincing and there is no reliable evidence

showing a doubt, the uncorroborated testimony of

the expert may be accepted. The Hon'ble Apex

Court observed:-

“An expert deposes and not decides. His duty is to furnish the Jude with the necessary scientific criteria for testing the accuracy of his conclusion so as to enable the Jude to form his own independent judgment by the application of these criteria to the facts proved in evidence ------------. By comparing the writing itself the Court would not assume to itself, the

74

role of an expert. Section 73 of the Evidence Act expressly enables the Court to compare disputed writings with admitted or proved writings to ascertain whether a writing is that of a person by whom it purports to have been written. Where there are expert opinions, they will aid the Court. Where there is none, the Court will have to seek guidance from some authoritative text book and the Court's own experience and knowledge. But discharge it must, its plain duty with or without expert with or without other evidence.”

Murari Lal's case (supra) acts as a beacon

light to guide the Courts as to how the opinion

evidence of handwriting expert is to be

appreciated. No doubt, the science of

identification of handwriting is not as perfect

as the science of identification of finger prints

is. However, in cases where the Court comes to

the conclusion about the identity of the

handwriting in dispute with or without expert

opinion, no further corroboration is required and

the accused can be convicted accordingly.

Learned counsel for the accused has

argued that as per prosecution version, the

accused had added the words 'and Aortic valve

replacement' in the discharge summary Ex.PW-19/1.

However, in response to a specific question,

75

PW-59 Dr. Ravinder Sharma, the handwriting expert

has stated that he had only expressed his opinion

on the writing 'MVR Mitral'. Therefore, according

to the counsel, there is no opinion on the

writing 'and Aortic valve replacement' on

Ex.PW-19/1.

To my mind, the contention is misplaced.

The question, to which reference is being made,

was regarding the portion Q-41, whereas the

portion in question on the discharge summary

Ex.PW-19/1 is marked Q-40. The portion Q-41 is in

the progress sheet in the file Ex.PW-10/1 in

which the words 'MVR Mitral' appear. Therefore,

the expert was right when he stated that with

regard to Q-41, he has expressed his opinion only

with regard to the writing MVR Mitral. Otherwise

as discussed above, there is least doubt that the

writing of the portion 'and Aortic valve

replacement' in the portion Q-40 on Ex.PW-19/1 is

in the hand of Dr. R.S.Dhaliwal. From the X-rays

Ex.PW-3/5 and Ex.PW-3/6 and report Ex.PW-3/7, it

is evident that only one valve was implanted in

the heart of Baldev Singh.

Dr. A.Rai Baruah, who prepared the

76

discharge summary Ex.PW-19/1, appeared in the

witness box and categorically stated that the

words 'and Aortic valve replacement' were not

there when the discharge summary was issued. It

is, thus, proved beyond doubt that accused

R.S.Dhaliwal added these words in the discharge

summary.

Having done this, Dr. R.S.Dhaliwal wrote

letter Ex.PW-7/8 to the Medical Superintendent on

the same day enclosing duly verified bills

amounting to Rs.63,000/- towards the cost of

Oxygenator disposables and other medicines etc.

purchased from Paul Medical Hall. He requested

that a cheque for Rs.63,000/- may be prepared and

sent to him so that the same could be forwarded

to the chemist. On the strength of this letter,

Cheque No.68678 for Rs.63,000/- was issued. This

was credited to the account of Paul Medical Hall

on 04.11.1994, as is evident from the statement

of account Ex.PW-35/26. This fact stands

acknowledged by accused Sat Pal Singla of Paul

Medical Hall vide his letter Ex.PW-35/25.

Along with the letter Ex.PW-7/8, the

bills with following details were attached:

77

Sr.No. Bill No. Date Amount1. 4718 16.10.94 Rs.4302.002. 4719 16.10.94 Rs.22525.003. 4720 16.10.94 Rs. 2027.00 4. 4721 16.10.94 Rs.33394.405. 4745 16.10.94 Rs. 751.60

It is quite strange that out of the five bills,

one bill Mark PB/2 is Photostat. The remaining

four bills are original. It is the Photostat bill

in which mischief was committed. It is evident to

naked eye that Item No. I Starr Edwards valve for

Rs.30,000/- was added subsequently in the bill

Mark PB/2. Therefore, the bill, which was for

Rs.3,394.40 Ps., was inflated to Rs.33,394.40 Ps.

It appears that original bill was removed from

the file Ex.PW-7/1 with the purpose of concealing

the commission of forgery therein. It is evident

that the writing of the words 'Starr Edwards

Valve' as appearing in the bill Mark PB/2 is

different from remaining writing in the bill.

This is even different from the writing in the

bills Ex.PW-13/47 to Ex.PW-13/50. There is strong

possibility that the original bill was removed

subsequently and photo copy was placed in the

file.

78

Learned counsel for accused Dr.

R.S.Dhaliwal argued that he had nothing to do

with the verification of the bills and payment to

the suppliers, as verification used to be done by

the Senior Residents and payment used to be made

by the Office of Medical Superintendent. Drawing

attention of the Court to the statement of PW-17

made in cross-examination, learned counsel argued

that due to heavy work load the Senior Residents

had no time to cross-check the bills with the

operation files before verification and,

therefore, there could be some discrepancies

which, by no means, can be attributed to the

accused Dr. R.S.Dhaliwal. He further argued that

if the supplier committed some mischief by adding

a particular item in a particular bill either

before or after submission thereof and that

mischief went un-noticed, it is the supplier and

not Dr. R.S.Dhaliwal who is liable.

To my mind, there is no substance in the

above contentions. If Dr. R.S.Dhaliwal had

nothing to do with the verification and if this

was the job to be performed by the Senior

Residents, question arises as to why did he

79

verify the particular bills submitted by Paul

Medical Hall. Heavy work load cannot be an excuse

for mischief. If Dr. R.S.Dhaliwal was not to come

in picture for the payment of the bills and the

supplier had to send the bills directly to the

Medical Superintendent Office, question arises as

to why did Dr. R.S.Dhaliwal receive the bills;

verified and then send them to the Medical

Superintendent Office vide recommendation

Ex.PW-7/8. Another particular question would be

as to why he requested Medical Superintendent to

send the cheque to him so as to be forwarded to

the supplier? It is evident that Dr. R.S.Dhaliwal

and Paul Medical Hall were in league.

Quite interestingly, Dr. R.S.Dhaliwal has

deposed that he had planned replacement of two

valves and accordingly two artificial heart

valves were procured from two different

suppliers. He has stopped short of telling the

names of the suppliers but from the statement of

Surinder Singh Uppal and the entry in the diary

Ex.PW-47/1, it is proved that the second supplier

was Alfa Surgicals owned by Surinder Singh Uppal.

Dr. R.S.Dhaliwal has not made clear as to which

80

particular valve was procured from which

supplier. At the same time, he has cleverly

concealed as to out of two suppliers, to whom the

valve was returned. Therefore, the statement of

Dr. R.S.Dhaliwal conceals vital information and

reveals little.

It is pertinent to mention that this was

a case of private grant/sponsored patient.

Requisition to the supplier for disposables,

medicines, valves etc. had to be made by the

treating surgeon through the Office of Medical

Superintendent as was being done in case of other

such patients. However, in this case, no such

requisition was made. Rather, an amount of

Rs.32,000/- was cleverly got released in favour

of the patient and then taken from the patient to

be paid to Surinder Singh Uppal. When there was

no other requisition, how can the accused claim

that two valves were procured from different

suppliers? In fact, only one valve was procured

and that was through Surinder Singh Uppal.

Another interesting fact to be noticed is

that while writing the letter Ex.PW-7/8, accused

81

R.S.Dhaliwal concealed that the bills included

the bill for artificial heart valve. He simply

mentioned that the bills were towards the cost

of Oxygenator disposables for open heart surgery

and other medicines etc. There was no reference

to artificial heart valve. This was a clever ploy

to keep the Medical Superintendent Office in dark

because for procuring artificial heart valve, a

sum of Rs.32,000/- had already been got released

and subsequently there was no intimation to the

Medical Superintendent Office that one more valve

was to be procured. Although, the Office of the

Medical Superintendent, on its part, was lax in

releasing the payment on the strength of the

bills annexed by Dr. R.S.Dhaliwal with the letter

Ex.PW-7/8 without properly checking the record

yet, the fact remains that it was a clever

manoeuvre by Dr. R.S.Dhaliwal in association with

Paul Medical Hall to hoodwink the Medical

Superintendent Office into complacency.

Taking the court through the statement of

Dr. R.S.Dhaliwal made by him while deposing as a

defence witness, learned counsel pointed out that

out of the two valves that had been procured, one

82

was implanted and the other was returned to the

supplier. However, the bill had already been

raised by the supplier before surgery but, it

came to him after surgery and as he had returned

the valve, he presumed that the supplier must

have refunded the requisite money to the Medical

Superintendent Office and, therefore, he cleared

the bill in routine. This, according to the

counsel, cannot be termed as fraudulent act.

The statement of Dr. R.S.Dhaliwal itself

exposes him. As observed above, there is no

requisition to Paul Medical Hall to supply the

valve, disposables etc. Therefore, no payment had

been made to Paul Medical Hall by the Medical

Superintendent Office in advance as was being

done in case of other patients. No doubt that the

bills were raised by the Paul Medical Hall on

16.10.1994 and the same were verified by Dr.

R.S.Dhaliwal after the surgery on 26.10.1994.

The cheque was released in favour of Paul Medical

Hall on 28.10.1994 on the basis of those very

bills. When no payment to Paul Medical Hall had

been made before 28.10.1994, question arises as

to how Dr. R.S.Dhaliwal could presume on

83

26.10.1994 that Paul Medical Hall must have

refunded the price of the returned valve? It is

evident that Dr. R.S.Dhaliwal has come up with

the explanation as an afterthought. If the valve

had been procured from Paul Medical Hall a day in

advance but the same had been returned on the

date of operation; if the bill had been raised on

the date of supply of the valve but, the same

came up for verification after the surgery, there

was no point in verifying the same without first

asking Paul Medical Hall to delete the item at

Serial No.1 in the bill Mark PB/2. Dr.

R.S.Dhaliwal was himself requesting the Office of

Medical Superintendent vide letter Ex.PW-7/8 to

release the amount of the bills in favour of Paul

Medical Hall but, now he says that he thought

that Paul Medical Hall must have refunded the

amount of the returned valve. This is, indeed, a

strange explanation.

By taking the plea that one valve was

returned, Dr. R.S.Dhaliwal admits that it was a

case of single valve replacement. This amounts to

implied admission that even on 26.10.1994 he knew

that only one valve had been replaced while the

84

other had been returned. Therefore, the

interpolation made by him in the discharge

summary in the portion Q-40 is not

understandable. This interpolation amounts to

forgery. Needless to say that despite the denial

by Dr. R.S.Dhaliwal, it has been proved on record

that the interpolation was made by him.

Therefore, this was not a case, where the

chemist/supplier committed mischief on its own.

This was a case of meeting of minds between Paul

Medical Hall and Dr. R.S.Dhaliwal for agreeing to

do or causing to be done an illegal act and in

pursuance of that conspiracy Paul Medical Hall

submitted false bill. Dr. R.S.Dhaliwal verified

the bill and asked the Medical Superintendent

Office to release payment. To justify this, even

forgery was made in the discharge summary

Ex.PW-19/1. The plea of innocence raised by Dr.

R.S.Dhaliwal, therefore, fails to convince the

Court.

PATIENT: JIGRI SINGH

As per file Ex.PW-15/1 and Operation Note

Ex.PW-15/2, Jigri Singh was operated on

85

02.09.1999. The surgical procedure was 'Repair of

RSOV (RSOV stands for Raptured Sinus of Valsalva)

+ AVR (19 MM Omni Science) and TVR (32 MM SE)

(AVR stands for Aortic Valve Replacement and TVR

stands for Tricuspid Valve Replacement). As per

open heart register Ex.PW-6/1 Page No.115 Entry

No.109/1 Ex.PW-25/3, the serial numbers of the

valves were Omni Science 673893 and Starr Edwards

Jude FJ0184.

This was a case of private grant

/sponsored patient. Rupees One lac were deposited

by the employer of the patient vide receipt

Ex.PW-8/28.

Vide Ex.PW-8/30 addressed to Paul Medical

Hall through Medical Superintendent, the

disposables and valves were requisitioned by Dr.

R.S.Dhaliwal. This included two Starr Edwards

ball cage valves for Rs.24,500/- each. On the

basis of this requisition, Cheque No.196329

(Ex.PW-29/17) was issued on 11.08.1999. As per

the statement of account Ex.PW-44/1, the amount

was credited to the account of Paul Medical Hall

on 04.09.1999.

86

Jigri Singh died on 03.09.1999.

On 06.09.1999, Dr. R.S.Dhaliwal wrote

letter Ex.PW-8/33 to the Medical Superintendent.

The text follows as under:

“The above said patient was taken up

for double valve replacement on

2.9.1999 and two Starr Edward Valves

were procured from M/s Paul Medical

Hall for replacement in Mitral and

Aortic position. However, on table it

was found that the aortic root was very

narrow and hence a St. Jude Heart Valve

was procured from M/s Paul Medical Hall

and inserted in aortic position instead

of Starr Edward Valve. The cost of St.

Jude Heart Valve is Rs.45,000/- while

the cost of Starr Edward is Rs.24,500/-

so that the balance amount of

Rs.20,500/- may please be forwarded to

M/s Paul Medical Hall”.

The letter Ex.PW-8/33 was taken up in the

Office of Medical Superintendent. Vide noting

Ex.PW-8/34 in the file Ex.PW-8/27, Medical

87

Superintendent asked for the reasonableness of

the cost of the material (This amounts to asking

for the reasons why St. Jude heart valve worth

Rs.45,000/- was implanted, whereas the cost of

Starr Edwards was Rs.24,500/-.

On 16.10.1999, Dr. R.S.Dhaliwal gave the

following reason vide his noting Ex.PW-8/35:

“I have written in my letter, why St.

Jude valve was required.

Technically in a small Aortic

root Starr Edwards valve is contra-

indicated and St. Jude's valve has to

be implanted which was done in this

patient.

His balance money is lying in

PGI, it should be paid, rest patient

(Or his family) will pay.

The price (cost) is

reasonable).”

As a sum of Rs.15,033/- only was lying in

balance with PGI in the account of Jigri Singh,

88

Cheque No.197005 dated 27.10.1999 (Ex.PW-29/9)

for this much was sent to Paul Medical Hall. As

per the statement of account Ex.PW-44/1, this

amount was credited to the account of Paul

Medical Hall on 28.10.1999.

On the face of it, the letter Ex.PW-8/33

reflects dishonest intention because as per

record the valves implanted were Omni Science and

Starr Edwards. These brands were not only

mentioned in the operation note Ex.PW-15/2 and

open heart register Ex.PW-6/1 but, also mentioned

on the admission form Ex.PW-10/2. In fact, on the

back of the admission form, the sticker of Starr

Edwards stands pasted while the slip of Omni

Science stands stappled. Although, the slip does

not specifically mention the name of the brand

i.e. Omni Science yet, the simple fact that the

details mentioned in the columns are identical

with the details mentioned in the open heart

register, it is proved that the slip is that of

Omni Science valve. Even otherwise from invoice

Ex.PW-21/2 issued by B.L. Marketing Services

Limited, it is evident that Omni Science heart

valve Serial No.673893 was supplied to Paul

89

Medical Hall a for which payment was made by Paul

Medical Hall vide cheque No.1318205 dated

25.10.1999 (Ex.PW-44/17).

It is worth mention that Dr. R.S.Dhaliwal

appeared in the witness box as DW-9. In cross-

examination, he admitted that no St. Jude valve

was implanted in the heart of Jigri Singh and

that as per operation note Ex.PW-15/2, one Starr

Edwards and one Omni Science valve were

implanted.

Dr. R.S.Dhaliwal tried to explain his

position in the following manner:

“In case of Jigri Singh, the bill raised

for St. Jude heart valves was passed by

me. On clarification from MS office I

had informed that in place of Starr

Edwards, St. Jude valves had been used

due to some technical reasons. When the

bill came to me, it was not accompanied

by any file of the patient. Even

discharge slip was not there because the

patient died after surgery. Therefore in

routine, I passed the bill. Even when

90

clarification was given, I recalled from

my memory and thought that there were

technical reasons to implant Saint Jude

valve and informed the office of MS

accordingly. Even at that time I had no

file or discharge slip of the patient”.

The above explanation clarifies little.

It is more of a confusing statement. Not that

there was confusion in the mind of Dr.

R.S.Dhaliwal. He rather tried to confuse the

Court. Instead of offering explanation as to the

letter Ex.PW-8/33, he tried to project as if

everything happened because he had passed the

bill raised for St. Jude heart valve without

going through the patient file and when

clarification was sought by the Medical

Superintendent Office he thought that there must

have been some technical reasons to implant St.

Jude valve. As a matter of fact, there was no

stage for Dr. Dhaliwal to pass the bills. In case

of sponsored patients, the bills used to be sent

by the supplier/chemist to the Office of Medical

Superintendent directly. No witness has stated

that the bills had to be routed through the

91

surgeon or that the amount could be released only

after the bills had been passed by the surgeon.

Therefore, it is clear that Dr. R.S.Dhaliwal has

concocted the story that since he had already

passed the bill raised for St. Jude heart valve,

while giving clarification to the Medical

Superintendent Office, he was under the

impression that due to technical reason St. Jude

valve must have been implanted. He cleverly

tried to evade the issue of the letter

Ex.PW-8/33. In other words, he had no explanation

to offer as to under what circumstances, this

letter was written by him. In fact, the Medical

Superintendent Office sought clarification only

after receipt of the letter Ex.PW-8/33 and not

just because there was some doubt about the bill.

A perusal of the letter Ex.PW-8/33 would make it

clear that it was categorical assertion by Dr.

R.S.Dhaliwal that although, two Starr Edwards

valves were procured yet, on table it was found

that the Aortic root was very narrow and, hence,m

St. Jude heart valve was procured and inserted

instead of Starr Edwards valve. such a

categorical assertion cannot be due to oversight

92

or inadvertence as has been tried to be projected

by accused R.S.Dhaliwal.

In fact, by coming up with the

explanation as above, accused R.S.Dhaliwal has

tried to put the entire blame on Paul Medical

Hall. He has tried to depict that because the

bill Ex.DW-9/2 was raised, it created a false

impression in his mind which, he thought was

genuine impression and due to that he wrote the

letter Ex.PW-8/33. As observed above, Dr.

R.S.Dhaliwal has admitted that no St. Jude valve

was implanted in the heart of Jigri Singh. This

indirectly means that the bill Ex.DW-9/2 raised

by Paul Medical Hall was false. On the other

hand, Paul Medical Hall too has also not made a

clean breast of it. In his statement under

Section 313 of the Code of Criminal Procedure,

Satpal Singla was put the following question:

“Q.14 That on 6.9.99 after the death

of the patient your co-accused RS

Dhaliwal vide letter Ex.PW-8/33 asked

the Medical Superintendent to release

Rs.20,500/- on the ground that St. Jude

93

Heart Valve had been implanted in the

heart of patient in aortic postilion

instead of Starr Edwards valve?

In reply he simply stated “I do not

know”.

He even denied having received Cheque

No.197005 dated 27.10.1999 which is otherwise

proved to have been credited to his account on

29.10.1999. The fact remains that the bill

Ex.DW-9/2 was raised for one Starr Edwards Mitral

valve and one St. Jude valve Aortic. When the

valves requisitioned were Starr Edwards, the bill

should have been for Starr Edwards valves. If St.

Jude valve had not been implanted in the heart of

Jigri Singh, there was no question of supply

thereof by Paul Medical Hall for that patient. It

is, thus, evident that the bill Ex.DW-9/2 was

raised by accused Sat Pal Singla in criminal

conspiracy with accused R.S.Dhaliwal and to

facilitate the smooth passage of the bill,

R.S.Dhaliwal wrote letter Ex.PW-8/33 and gave

clarification vide noting Ex.PW-8/35. All this

was done to draw excess of Rs.20,500/- from the

94

account of Jigri Singh who, by that time, was no

more. Ultimately, the accused succeeded in

getting Rs.15,033/-. This was the fruit of

illegal means adopted by the accused persons in

furtherance of the object of the conspiracy.

Assuming that Accused Satpal Singla was

not aware of the letter Ex.PW-8/33 and the noting

Ex.PW-8/35, it will not affect his culpability.

The simple fact that he raised the bill for St.

Jude valve, whereas the valve supplied was Starr

Edwards proves that he was associated with the

object of the conspiracy. It is not necessary

that all the conspirators must know each and

ev3ery detail of the conspiracy as long as they

are the co-participators in the main object.

Different techniques are adopted by the

conspirators to achieve the common goal of

conspiracy and for that purpose there may be

division of performances in the chain of actions

with one object. In other words, there must be

unity of object or performance but there could be

cruelty of means. The only relevant fact is that

all means adopted and illegal acts done must be

and purported to be in the furtherance of the

95

object of the conspiracy.

PATIENT: BALDEV

As per file Ex.PW-10/4, Operation Note

Ex.PW-15/6 Baldev was operated on 18.06.1999 and

his Mitral valve was replaced with 31 MM st. Jude

artificial valve. As per the open heart register

Ex.PW-6/1 Page No.109 Entry No.73/9 (Ex.PW-25/2)

the serial number of St. Jude valve implanted was

80615242.

Baldev was a private grant/sponsored

patient. Vide requisition Ex.PW-13/89,

disposables and two St. Jude heart valves (M & A)

worth Rs.45,000/- each were requisitioned by Dr.

R.S.Dhaliwal from Paul Medical Hall through

Medical Superintendent, PGI. Bill No.326 of Bill

Book Ex.PW-35/32 was raised for two St. Jude

heart valves costing Rs.90,000/- in total.

Cheque dated 05.06.1999 Ex.PW-29/23 was issued by

the Office of Medical Superintendent in favour of

Paul Medical Hall. This was for Rs.1,12,549/-.

The amount included the cost of disposables and

medicines. As per the statement of account

Ex.PW-44/1, the cheque was credited to the

96

account of Paul Medical Hall on 09.06.1999.

Baldev appeared in the witness box as

PW-33 and stated that at the time of discharge

Dr. R.S.Dhaliwal had told him that his two valves

had been changed.

PW-15 Dr. Deepak Puri, who assisted Dr.

R.S.Dhaliwal in the surgery, has stated that

Mitral valve of Baldev was replaced with

artificial valve while Tricuspid was repaired.

It is, therefore, evident that against

supply of one valve, Paul Medical Hall received

payment for two valves.

PATIENT: SNEH LATA


Ex.PW-15/10 Sneh Lata was operated on 25.10.1999

and her Mitral valve was replaced with 29 MM St.

Jude artificial valve. In the open heart register

Ex.PW-6/1 Page No.119 Entry No.12/135

(Ex.PW-25/7), it is mentioned that St. Jude MVR

serial No.80655807 was implanted. Sticker of only

one St. Jude valve bearing this serial number

stands affixed. As per the discharge summary

97

Ex.PW-19/2 also, the operative procedure was 'MVR

29 MM St. Jude valve'. However, on the operation

note Ex.PW-15/10, the words 'AVR 21 MM' were

added in the portion Q-49 by way of

interpolation. On the admission form Ex.PW-15/9

in the column of surgical procedures initially

the words 'MVR 29 MM St. Jude valve were written

but by cutting the letter 'M' it was changed into

'D' to give the impression that it was DVR

(meaning double valve replacement). In between

the words 'MVR' and numerals '29' the numerals 21

were subsequently added to give the impression

that the valves were 21 MM and 29 MM St. Jude. It

is, therefore, clear that the record was fudged

purposely by way of cuttings and interpolations,

it was projected through the operation note and

admission form that two St. Jude heart valves had

been implanted. No such interpolations/cuttings

were, however, made in the open heart register

and discharge summary.

Vide requisition Ex.PW-13/9, disposables

and two St. Jude heart valves (M & A) worth

Rs.45,000/- each were requisitioned by Dr.


98

Medical Superintendent, PGI. Bill No.396 dated

24.10.1999 of Bill Book Ex.PW-35/32 was raised

for two St. Jude heart valves costing Rs.90,000/-

in total. Cheque No.196717 dated 24.09.1999

Ex.PW-29/18 was issued by the Office of Medical

Superintendent in favour of Paul Medical Hall.

This was for Rs.1,13,799/-. The amount included

the cost of disposables and medicines. As per the

statement of account Ex.PW-44/1, the cheque was

credited to the account of Paul Medical Hall on

26.10.1999.

Question would be as to when there are

additions and cuttings in two documents but in

other two documents there are no such

cuttings/interpolations, which document is to be

taken to be containing authentic information? It

could be argued that in fact both Mitral and

Aortic valves of Sneh Lata were replaced with St.

Jude artificial valves but in the open heart

register and discharge summary this fact could

not be mentioned. However there would be no

substance in such a contention because it is

evident to that it was a case of Mitral valve

replacement. There was no question of Aortic

99

valve being replaced inasmuch as the diagnosis

was RHD, severe MR with mild AR.

PW-15 Dr. Deepak Puri, who assisted Dr.

R.S.Dhaliwal has categorically stated that Mitral

valve replacement was done with 29 MM St. Jude

valve. No suggestion was given to him that it

was a case of DVR i.e. double valve replacement.

Learned counsel for Dr. R.S.Dhaliwal

would argue that since Paul Medical Hall had

issued bill for two St. Jude heart valves and had

received payment for two valves but, only one

valve was replaced, interpolations/cuttings were

made in the operation note and admission form at

its behest to justify the receipt of money for

two valves. Learned counsel would question what

benefit Dr. R.S.Dhaliwal was going to get by

getting the record fudged? He would contend that

it was not the duty of R.S.Dhaliwal to prepare

and maintain the record, therefore, if there is

forgery, the same cannot be linked to him.

It is interesting to note that despite

having diagnosed that the patient was having

severe MR and mild AR, Dr. R.S.Dhaliwal had, vide

100

requisition Ex.PW-13/9, asked for two St. Jude

heart valves.

Although in ordinary course, the Court

should not question the wisdom of the doctor who

is an expert in his own right yet, in the

circumstances of this case, the court has tried

to find out as to whether there was justification

in requisitioning two valves. As per acc. org

practice Guidelines mentioned in the Journal of

American College of Cardiology (JACC) 2008, 52:

1-142 the patients with mild AR are not

candidates for AVR.

Despite this, if Dr. R.S.Dhaliwal asked

for two artificial heart valves, it can be safely

inferred that his intention was dishonest right

in the beginning. Otherwise, as per diagnosis,

there was no need to call for two valves. Hence,

there is no substance in the contention of Dr.

R.S.Dhaliwal that if there is forgery the same

cannot be linked to him. Notwithstanding the fact

that the expert has not been able to point out

whether the disputed writing in the disputed

portions is that of Dr. R.S.Dhaliwal,

101

circumstances indicate that the forgery was done

either by Dr. R.S.Dhaliwal himself or by another

person at his behest.

PATIENT: RAJ KUMAR


Ex.PW-15/17, Raj Kumar was operated on 11.04.2000

and his Mitral valve was replaced with 3 M SE

(Starr Edwards). On the admission form

Ex.PW-15/16, sticker of Starr Edwards Serial

No.FJ1784 stands pasted. In the open heart

register Ex.PW-6/1 Page No.131 Entry No.54/7

(Ex.PW-25/10) also sticker of Starr Edwards

serial No.FJ1784 stands pasted showing that it

was a case of Mitral valve replacement.


and one St. Jude heart valves worth Rs.45,000/-

was requisitioned by Dr. R.S.Dhaliwal from Paul

Medical Hall through Medical Superintendent, PGI.

Bill No.207 of Bill Book Ex.PW-35/30 was raised

for one St. Jude heart valve costing Rs.45,000/-.

Cheque No.19456 dated 05.04.2000 Ex.PW-29/21 was

issued by the Office of Medical Superintendent in

favour of Paul Medical Hall. The amount included

102




11.04.2000.

From Bill Ex.PW-35/16, it is proved that

the valve serial No. FJ-1784, Starr Edwards, was

supplied to Paul Medical Hall. It is, thus, clear

that accused Satpal Singla supplied Starr Edwards

valve but he received and retained the price of

St. Jude valve. From letter Ex.PW-8/33 written by

Dr. R.S.Dhaliwal itself, it is clear that the

price of St. Jude was Rs.45,000/- while that of

Starr Edwards was Rs.24,500/-. Therefore, the

accused took pecuniary advantage to the extent of

Rs.20,500/-.

PATIENT: DWARKA PRASAD

As per file Ex.PW-10/12, Dwarka Prasad

was operated on 30.05.2000 and his Mitral valve

was replaced with 27 MM Omni Science artificial

heart valve. As per open heart register Ex.PW-6/1

Page No.135 Entry No.77/17, the valve replaced

was Omni Science Serial No.676371

103


and one St. Jude heart valve worth Rs.45,000/-



Bill dated 24.05.2000 of Bill Book Ex.PW-18/7

was raised for one St. Jude heart valve costing

Rs.45,000/-. Cheque dated 16.05.2000 Ex.PW-29/11

was issued by the Office of Medical






As per Ex.PW-21/5, the invoice of B.L.

Marketing an Omni Science valve with the same

serial number was supplied to Paul Medical Hall

for Rs.33,000/-. However against supply of Omni

Science valve for patient Dwarka Prasad, Paul

Medical Hall received payment of St. Jude valve.

When the matter came up before the Office of

Medical Superintendent for refund of the balance

to the funding agency, vide noting Ex.PW-18/9 the

file was sent to Dr. R.S.Dhaliwal for

verification of the bills. Dr. Dhaliwal gave

104

noting “needful has been done”. After this

verification, the balance amount was refunded.

At no point of time did Dr. R.S.Dhaliwal point

out the discrepancy that the valve requisitioned

was St. Jude, the one implanted was Omni Science

but, the bill had been raised for St. Jude. This

shows that Dr. R.S.Dhaliwal and Paul Medical Hall

were in league. Dr. R.S.Dhaliwal cannot escape

the liability by simply claiming that due to rush

of work, he had verified without referring to the

file/record.

PATIENT:MANI MARI


Ex.PW-15/19, Mani Mari was operated on 18.04.2000

and her Mitral and Aortic valves were replaced

with 27 MM Omni Science and 17 MM St. Jude

valves. In open heart register Ex.PW-6/1 Page

No.132 Entry No.56/9 (Ex.PW-25/11), the serial

numbers of the valves are mentioned as under:

“Omni Science- Sr. No.676215

St.Jude- Sr. No.60317357

105

Vide requisition Ex.PW-13/69, two St.

Jude heart valves (M & A) worth Rs.45,000/- each

were requisitioned by Dr. R.S.Dhaliwal from Paul


Bill No.214 dated 18.04.2000 of Bill Book

Ex.PW-35/30 was raised for two St. Jude heart

valves costing Rs.90,000/-. Cheque No.194217

dated 17.02.2000 Ex.PW-29/13 was issued by the

Office of Medical Superintendent in favour of

Paul Medical Hall. The amount included the cost

of disposables and medicines. As per the



20.04.2000.

As per Ex.PW-21/4, the invoice of BL

Marketing an Omni Science valve with the same

serial number i.e. No.676215 was supplied to Paul

Medical Hall for Rs.33,000/-. It is, therefore,

clear that Paul Medical Hall supplied Omni

Science valve for patient Mani Mari, whereas the

valve requisitioned was St. Jude. Needless to say

that against the supply of Omni Science valve

Paul Medical Hall received payment for St. Jude

valve.

106

PATIENT: RAM SHABAD

As per file Ex.PW-10/3 Operation Note

Ex.PW-15/4, Ram Shabad was operated on 18.11.1999

and his Mitral and Aortic valves were replaced

with St. Jude valve and Edward Mira. As per the

stickers pasted in open heart register Ex.PW-6/1

Page No.120 Entry No.7/144 (Ex.PW-15/8), the

serial numbers of the valves are as under:

Edward Mira Serial No.99020066

St. Jude- Serial No.80537792

Vide requisition Ex.PW-13/54, two St.

Jude heart valves (M & A) worth Rs.45,000/- each

were requisitioned by Dr. R.S.Dhaliwal from Paul


Bill No.399 dated 31.10.1999 of Bill Book

Ex.PW-35/32 was raised for two St. Jude heart

valves costing Rs.90,000/-. Cheque No.196873

dated 09.10.1999 Ex.PW-29/14 was issued by the

Office of Medical Superintendent in favour of

Paul Medical Hall. The amount included the cost

of disposables and medicines. As per the

107



02.11.1999.

As per Mark D-1, the invoice of Baxter

India Limited Edward Mira valve with the same

serial number i.e. No.99020066 was supplied to

Paul Medical Hall for Rs.38,000/-. It is,

therefore, clear that Paul Medical Hall supplied

Edward Mira valve for patient Ram Shabad, whereas

the valve requisitioned was St. Jude. Needless to

say that against the supply of Edward Mira valve,

Paul Medical Hall received payment for St. Jude

valve.

PATIENT: DAYAL SINGH

As per file Ex.PW-10/6, Dayal Singh was

operated on 15.10.1999 and as per Operation Note

at Page No.14 of the said file, his Mitral valve

was replaced with 29 MM Edward Mira valve. As

per the open heart register Ex.PW-6/1 Page No.118

Entry No.8/131 (Ex.PW-25/6) serial number of

Edwards Mira valve implanted was 98040674.


108

and two St. Jude heart valves (M&A) worth

Rs.45,000/- each were requisitioned by Dr.


Medical Superintendent, PGI. Bill No.392 dated

14.10.1999 of Bill Book Ex.PW-35/32 was raised

for two St. Jude heart valves costing Rs.90,000/-

in total. Cheque No.196643 dated 15.09.1999



This was for Rs.1,12,080/-. The amount included




16.10.1999.

Shri Ashok Kumar, PW-24, the father-in-

law of Dayal Singh stated that before surgery Dr.

R.S.Dhaliwal had told them that each valve will

cost Rs.45,000/-. As per invoice Ex.PW-39/2, the

Edward Mira valve implanted in the heart of

patient was purchased by Paul Medical Hall from

Baxter India Limited. It is, thus, evident that

against supply of Edward Mira Mitral valve, Paul

Medical Hall received payment for two St. Jude

valves.

109

This was a case, where the patient had

been diagnosed with severe MR and mild AR.

Despite this, Dr. R.S.Dhaliwal, vide requisition

Ex.PW-13/52 called for two St. Jude artificial

heart valves.

Although in ordinary course, the Court

should not question the wisdom of the doctor who

is an expert in his own right yet, in the

circumstances of this case, the court has tried

to find out as to whether there was justification

in requisitioning two valves. As per acc. org

practice Guidelines mentioned in the Journal of

American College of Cardiology (JACC) 2008, 52:

1-142 the patients with mild AR are not

candidates for AVR.

Despite this, if Dr. R.S.Dhaliwal asked

for two artificial heart valves, it can be safely

inferred that his intention was dishonest right

in the beginning. Otherwise, as per diagnosis,

there was no need to call for two valves. Hence,

there would be no merit in the contention of Dr.

R.S.Dhaliwal that if Paul Medical Hall received

payment for two valves did not refund the price

110

of one valve to the PGI, he is not at fault. As

discussed above, conspiracy is a clandestine

activity. People generally do not form illegal

covenants openly, therefore, the factum of

conspiracy is to be inferred from the

circumstances, the act and conduct of the

accused. Here the act of Dr. R.S.Dhaliwal in

requisitioning two artificial valves despite the

diagnosis as stated above indicates that he set

the ball rolling. Thereafter, in view of the

procedure flaws, it was a cake-walk for Paul

Medical Hall. Needless to say that the technique

was adopted to achieve the common goal although

there was division of performances in the chain

of actions.

PATIENT: SHIV SHANKAR


Ex.PW-15/15 Shiv Shankar was operated on

06.04.2000 and his Mitral valve was replaced with

3 M SE (Starr Edwards). On the admission form

Ex.PW-15/14, sticker of Starr Edwards Serial

No.FJ1778 stands pasted. In the open heart


111

(Ex.PW-25/9) also sticker of Starr Edwards serial

No.FJ1778 stands pasted showing that it was a

case of Mitral valve replacement.







Cheque No.194709 dated 23.03.2000 Ex.PW-29/20 was

issued by the Office of Medical Superintendent in

favour of Paul Medical Hall. The amount included




06.04.2000.

From Bill dated 29.03.2000 (Ex.PW-35/16),

it is proved that valve serial No. FJ-1778 Starr

Edwards was supplied to Paul Medical Hall by

Baxter India Limited. It is, thus, clear that

accused Satpal Singla supplied Starr Edwards

valve but he received and retained the price of

St. Jude valve.

112

PATIENT: SHEELA DEVI


Ex.PW-2/2, Sheela Devi was operated on 04.05.2000

and her Mitral valve was replaced with 29 MM Omni

Science artificial heart valve. On the admission

form Ex.PW-15/13, Sticker of Omni Science

No.676257 stands pasted. As per open heart


(Ex.PW-25/12), the valve replaced was Omni

Science Serial No.676257.





Bill No.239 Ex.PW-18/2 of Bill Book Ex.PW-35/30

was raised for one St. Jude heart valve costing

Rs.45,000/-. Cheque No.195045 dated 24.04.2000







113

As per Ex.PW-21/7, the invoice of B.L.

Marketing, an Omni Science valve with the same

serial number was supplied to Paul Medical Hall

for Rs.33,000/-. However against supply of Omni

Science valve for patient Sheela Devi, Paul

Medical Hall received payment of Rs.45,000/- for

St. Jude valve.

When the matter came up before the

Office of Medical Superintendent for issuing

utilization certificate to the funding agency,

vide noting Ex.PW-18/5 the file was sent to Dr.

R.S.Dhaliwal for verification of the bills. Dr.

Dhaliwal gave noting “needful has been done”.

After this verification, the balance amount was

returned to the funding agency. At no point of

time did Dr. R.S.Dhaliwal point out the

discrepancy that though the valve requisitioned

was St. Jude, the one implanted was Omni Science

but, the bill had been raised for St. Jude. This

shows that Dr. R.S.Dhaliwal and Paul Medical Hall

were in league. Dr. R.S.Dhaliwal cannot escape

the liability by simply claiming that due to rush

of work, he had verified without referring to the

file/record.

114

PATIENT: NARINDER KUMAR


Ex.PW-2/3, Narinder Kumar was operated on


29 MM Omni Science artificial heart valve. As per


No.7/130 (Ex.PW-25/5), the valve replaced was

Omni Science Serial No.663106.





Q-78 is written in the hand of R.S.Dhaliwal. Bill

No.391 dated 14.10.1999 Ex.PW-13/37 was raised


Cheque No.196605 dated 09.09.1999 Ex.PW-29/19 for

Rs.67,019/- was issued by the Office of Medical






The Omni Science valve No.663106 was

115

supplied by Paul Medical Hall after purchasing

the same from BL Marketing. As per invoice

Ex.PW-21/1, BL Marketing supplied the said valve

to Paul Medical Hall on 04.11.1999 for

Rs.33,000/-.

It is, therefore, established that

against supply of Omni Science valve, Paul

Medical Hall received payment for St. Jude valve.

PATIENT: RAJESH KUMAR


Ex.PW-13/13, Rajesh Kumar was operated on

23.05.2000 and his Aortic valve was replaced with

21 MM Omni Science artificial heart valve. As per


No.73/13 (Ex.PW-25/13), the valve replaced was 21

MM Omni Science Serial No.676103.







116








The Omni Science valve implanted in the

heart of patient Rajesh Kumar was supplied by

Paul Medical Hall, as the same valve had been

purchased by Paul Medical Hall from BL Marketing

vide invoice Ex.PW-21/4.


against the supply of Omni Science valve, Paul


PATIENT: SURESH KUMAR


Ex.PW-15/8, Suresh Kumar was operated on


31 MM Omni Science artificial heart valve. On the

admission form Ex.PW-15/7, Sticker of Omni

117

Science No.670399 stands pasted. As per open

heart register Ex.PW-6/1 Page No.118 Entry

No.5/128 (Ex.PW-25/4), the valve replaced was

Omni Science Serial No.670399.














The Omni Science valve implanted in the

heart of patient Suresh Kumar was supplied by

Paul Medical Hall, as the same valve had been

purchased by Paul Medical Hall from BL Marketing

vide invoice Ex.PW-21/3.


118

against supply of Omni Science valve, Paul


33. A perusal of the above would reveal a

pattern. Leaving aside the case of Ishwar Chand,

in all but one case the valves requisitioned were

St. Jude. However, only in the cases of Baldev,

Sneh Lata, Ram Shabad and Mani Mari, the valves

actually implanted were St. Jude albeit, in the

cases of Baldev and Sneh Lata one valve each was

implanted against the requisition of two while in

case of Mani Mari and Ram Shabad against

requisition of two St. Jude, the valves actually

implanted were one St. Jude and one Omni science

(Mani Mari) and one Edward Mira and a St. Jude

(Ram Shabad). In the cases of Raj Kumar and Shiv

Shankar, the valves actually implanted were Starr

Edwards. In the case of Dayal, the valve actually

implanted was Edward Mira while in the case of

Dwarka Parshad, Sheela Devi, Narinder Kumar,

Rajesh Kumar and Suresh Kumar, the brand of the

valve actually implanted was Omni Science. In

case of Jigri, the valves requisitioned were two

Starr Edwards. The valves actually implanted were

one Omni Science and one Starr Edwards. However

119

by manipulation, it was shown that the valves

implanted were a Starr Edwards and a St. Jude.

34. While prosecution has asserted that the

price of Edward Mira was Rs.38,000/- and that of

Omni Science was Rs.33,000/- against which the

amount charged was Rs.45,000/- which was the

price of St. Jude, the defence has pointed out

that the prosecution has only established the

price at which the Omni Science and Edward Mira

were being supplied to Paul Medical Hall by the

concerned distributor. According to the defence

counsel, the valves purchased for Rs.33,000/- and

Rs.38,000/- respectively were to be sold by Paul

Medical Hall at profit and since there is nothing

on record to suggest as to what was the MRP, it

cannot be said that Paul Medical Hall cheated or

that against supply of cheaper valves the price

of expensive valves was charged.

35. There appears some force in the

contention of the defence counsel inasmuch as

the prosecution has simply proved the cost of

acquisition and not the retail price of Edward

Mira and Omni Science valves. Therefore, it

120

cannot be said that against supply of cheaper

valve (Edward Mira and Omni Science), Paul

Medical Hall received payment for expensive valve

(St. Jude). However, this will not exonerate the

accused. As pointed out above in cases of Raj

Kumar and Shiv Shankar, the valves actually

implanted were Starr Edwards against the

requisition of St. Jude and it has been

conclusively established on record that the

retail price of St. Jude was Rs.45,000/- and that

of Starr Edwards was Rs.24,500-Rs.25,000/-.

36. A question would arise as to why in all

cases except that of Jigri Singh, St. Jude valve

was being requisitioned but actually some other

valve was being implanted. Related question would

be as to why in case of Jigri Singh, Starr

Edwards valve had been requisitioned but, valves

of other brands were implanted. The defence would

argue that this was because of the availability

of a particular brand of valve of the required

size at the relevant time.

37. On first blush, this contention would

appear attractive but it lacks substance. There

121

was a reason behind requisitioning St. Jude

valves in almost all the cases and Starr Edwards

in case of Jigri Singh. It has already been

noticed above that From 1996 to 2000 the system

of rate contract was in vogue. The rate contracts

of Paul Medical Hall and Bharat Medical Store for

supply of different items were approved. The

valve approved in case of Paul Medical Hall was

St. Jude for which the price fixed was

Rs.45,153/- (vide Ex.PW-22/1). This rate contract

was extended till 30.11.2000 vide Ex.PW-22/2 and

Ex.PW-22/3. The valves approved in case of Bharat

Medical Store were Starr Edwards for which the

price fixed was Rs.25,000/- (Ex.PW-22/4) and St.

Jude for which the price fixed was Rs.45,153/-

(Ex.PW-22/5). It is, therefore, evident that the

brands of artificial heart valves on the approved

list were St. Jude and Starr Edwards only. Omni

Science and Edward Mira were not on the approved

list. This explains why the valves being

requisitioned were St. Jude and Starr Edwards.

This was to satisfy the conditions. The

explanation that sometimes a set of different

sizes of different brands had to be brought to

122

the operation theatre depending upon the

availability of a particular size of a particular

brand does not justify the use of Omni Science

and Edward Mira. If the chemist had quoted the

price of a particular brand and that had been

approved it was expected of him to keep in stock

all sizes. If the treating surgeon had noticed

that all sizes of the approved brand were not

available, he should have brought it to the

notice of the Director/Office of Medical

Superintendent. However, the fact remains that

Dr. R.S.Dhaliwal, at no point of time, pointed

this out. It is not that he simply acquiesced

keeping in mind the interest of the patients. At

the same time, the question is not as to whether

Omni Science and Edward Mira were inferior to St.

Jude. The question is that the brands on the

approved list were St. Jude and Starr Edwards. To

bye-pass the rate contract, Dr. R.S.Dhaliwal used

to requisition St. Jude and Starr Edwards. Paul

Medical Hall used to supply Omni Science in most

of the cases and Edward Mira in some cases. If

the transactions were genuine, Paul Medical Hall

should have issued bill/invoice for the valve

123

actually supplied and not just for the valve

requisitioned. It is evident that there was a

deliberate move by Paul Medical Hall in

connivance with Dr. R.S.Dhaliwal to push other

brands which were not on the approved list. The

price difference, therefore, between St. Jude,

Omni Science and Edward Mira becomes immaterial

although it may be material in case of St. Jude

vis-a-vis Starr Edwards. It is evident that

nothing was by chance. It is not that the valve

of a particular brand was not in stock of Paul

Medical Hall and, therefore, some other valve was

supplied or brought to the operation theatre.

Everything was deliberate. The Office of the

Medical superintendent was being informed

selectively whenever it suited the accused. In

case of Jigri Singh one of the valves was Omni

Science against the requisition of Starr Edwards.

Since Starr Edwards was less expensive, the

Medical superintendent was informed by Dr.

Dhaliwal. It is another aspect that even then he

misled and asked for price difference between st.

Jude and Starr Edwards by making categorical

assertion that the valve implanted was St. Jude.

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Had he acted bonafide, he would have informed

that the valve implanted was Omni Science. Two

inferences can be drawn from this. Firstly, that

Omni Science being not on the approved list, Dr.

Dhaliwal deliberately misinformed the Medical

Superintendent; secondly that St. Jude was not

fetching the kind of profits to Paul Medical Hall

as Omni Science and Edward Mira were.

38. No doubt, that implanting a valve of a

brand different from the one requisitioned would

not have, by itself, meant much even if it was

not on the approved list. However, the manner in

which the circumstances were created and

manipulated, as discussed above, reveals the true

picture.

39. The defence of the accused Sat Pal Singla

is that the goods requisitioned by the doctors

used to be deposited in the central store of the

Medical Superintendent after due verification and

in case requisition was for two valves, then two

valves used to be deposited in the store but

since at the time of surgery the number of valves

and the brand of valves, due to the need of the

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patient could not be foreseen, therefore,

numerous valves and brands used to be sent at the

time of planned surgery but since the bills used

to be prepared before the deposit of the goods in

the store, subsequently excess or less amount

received were subject to reconciliation and

finalization of accounts when the actual goods

used to be compared. According to the accused,

there was acute shortage of staff in Medical

Superintendent Office, therefore reconciliation

of accounts could not take place despite his

representative contacting the Office of Medical

Superintendent a number of times.

40. Much emphasis has been laid by counsel

for Sat Pal Singla on the statement of PW-8 Dr.

Anil Kumar Gupta that Utilization Certificate is

issued after verification of consumables and

reconciliation of accounts and; that due to

paucity of staff, reconciliation of accounts used

to take considerable time and, for that reason,

Utilization Certificates, in most of the cases,

were issued after 2-3 years. Taking the Court

through the statement of PW-8, learned counsel

argued that while doing reconciliation, the

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supplier could refund the amount or receive more

amount later on once it was verified by the

treating surgeon that more or lesser consumables/

costly/cheaper consumables had been used. It has

been further argued that if, as admitted by PW-8,

there were on going transactions between the PGI

and the supplier and discrepancies, if any, used

to be reconciled, no fault can be found with

accused Sat Pal Singla particularly, when PW-8

admits to the possibility of his (the supplier)

having approached the Office of Medical

Superintendent for reconciliation of accounts.

Learned counsel summed up that if there was a

change of brand of valve in some cases while in

other cases only one valve against the supply of

two had been used, the PGI could always ask for

refund from the accused and if no reconciliation

of accounts took place and due to that the PGI

authorities did not ask for refund/adjustment, it

cannot be inferred that the accused was

dishonest.

41. To my mind, the statement made by PW-8 in

cross-examination by accused Sat Pal Singla has

to be read carefully to draw proper conclusions.

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The same is reproduced hereunder for facility of

reference:

“-------Utilization certificate is issued after verification of consumables and reconciliation of accounts. It is correct that in case of Dwarka Parshad requisition Ex.PW-8/16 is dated 24.4.2000 and after receipt of consumables cheques were issued to the party Pal Medicals after receipt of consumables in the stores. similarly in case of Sneh Lata requisition Ex.PW-8/21 is dated 15.09.1999 and cheque was issued to Pal Medicals after receipt of consumables in the stores on 24.09.1999. Voltd. as per the record I approved the payment on 20.9.99 and cheque dated 24.9.99 was issued to Sunita Kumari. It is not clear from the record as to when was the cheque issued/handed over to Sunita Kumari. It is correct that consumables are received in the store. It is true that in some cases all the consumables that have been requisitioned are not consumed while in some of them

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some more consumables are required.Therefore, subsequently reconciliation on the recommendation of the treating doctor does take place. It is correct that during surgery brand of the valve required, size of the valve can be decided by the operating surgeon then and there taking condition of the patient into consideration, and accordingly the brand and the size of the valve can be substituted. In all cases of rate contract the utilization certificate is of 2003. The case of Sneh Lata, Jigri Singh, Dwarka Parshad, Narinder Kumar, Narinder Kumar mentioned in my statement are cases of rate contract. So is the case of Sheela Devi. It is correct that reconciliation of the accounts regarding return of goods or substitution or requisition of more goods used to take place after few days of the operation. It is correct that in case of approved source while doing reconciliation approved firm could refund the amount or receive more amount later on

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once it was verified by the treating surgeon that more consumables /costly consumables had been used. Hence there were on going transactions between the PGI and the approved supplier. Discrepancies if any used to be reconciled at appropriate stages so far as accounts were concerned. In case of change of brand of valve reconciliation used to take place on the recommendation of the treating doctor. Due to error some mistakes in the accounts could occur but none of those nature came to my notice. There used to be 2/3 major surgeries in a week in the department of CTVS. However, I am not sure. I cannot tell how many minor surgeries used to take place per day or per week. Without going through documents I cannot szay yes or no to the question as to whether 6/7 major surgeries used to be scheduled for a week. But it is quite possible. It is correct that the staff available in my office is not adequate to deal with all the matters, particularly

130

procurement of consumables on rate contract basis; regarding the reconciliation of accounts and dispersal of amount. This is one of the reasons as to why utilization certificates were issued after 2/3 years. The possibility of approved sources approaching my office for reconciliation of accounts during that period cannot be ruled out. Since the staff was inadequate the possibility of delay in reconciliation in spite of the visits of approved firm for reconciliation of accounts cannot be ruled out. During the period when rate contract was on vogue, hundred of operations may have taken place”.

42. The above statement has to be understood

with reference to the context. It is not denied

that all the 14 cases pertained to sponsored

/private grant patients. The amount for treatment

of the patient concerned used to be deposited in

the PGI by the relevant funding agency. In the

file of Sneh Lata (Ex.PW-8/17), I have come

across letter written by the Joint Secretary,

Government of Himachal Pradesh (the funding

131

agency) to the Director, PGI. While sending the

bank draft for the treatment of Sneh Lata, the

funding agency requested the PGI to remit the

unspent balance after treatment to the agency

along with medical bills/necessary documents in

token of the treatment having been obtained and

the funds utilized. Therefore, when PW-8 is

referring to reconciliation of accounts in the

opening lines of his cross-examination, the

context is 'Utilization Certificate'. He means to

say that for issuance of Utilization Certificate

to the funding agency, reconciliation of accounts

has to be done. How this is done, would be

evident from the proceedings conducted in the

Office of Medical Superintendent. For example in

the file Ex.PW-8/13 pertaining to patient Dwarka

Parshad, there are notings under the subject

“Issue of Utilization Certificate”. The Office of

Medical Superintendent pointed out that out of

the grant of Rs.1,40,000/-, an amount of

Rs.86,007/- had been utilized and the balance had

to be refunded along with Utilization

Certificate. On a side of the noting, the

following details are mentioned:

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Requisition No. & Date

Amount utilized Reference to Page No. of file

1/26.04.2000 Rs.77,972/- P-7Less Rs. 6,663/- P-2Balance Rs.71,309/- Cheque cancelled2/27.04.2000 Rs. 6,663/- P-233/14.06.2000 Rs. 8,035/- P-49Total Rs.86,007/-

43. When the matter was put up before the

Joint Medical Superintendent, he asked the branch

to get all the cash memos verified by the A.M.A.

Since the patient had received treatment in the

department of CTVS and the medicines had been

purchased on the basis of the supply orders

/requisitions of that department, the bills were

sent to that department for verification with

reference to their supply orders/requisitions.

Consequently, Dr. R.S.Dhaliwal made the

verification and thereafter the Utilization

Certificate was issued. Therefore, when PW-8 says

reconciliation of accounts before issuance of

Utilization Certificate he means verification of

the bills with reference to the supply

orders/requisitions.

44. Insofar as reconciliation of accounts

133

between PGI and the supplier is concerned, PW-8

has made clear that the same used to take place

after few days of the operation on the

recommendation of the treating doctor. While

saying that there were on going transactions

between the PGI and the supplier, PW-8 does not

mean to say that there was running account in

strict sense. He means to say that while doing

reconciliation of accounts, the supplier could

receive more amount or refund some amount

depending upon the circumstances. When PW-8 says

that the staff in his office was inadequate to

deal with the matters regarding reconciliation of

accounts, the context is 'Utilization

Certificate' and not the reconciliation of

accounts between the PGI and supplier which,

according to him, used to take place after a few

days of the operation. There was no suggestion to

the witness that even that reconciliation of

accounts also used to take place after 2-3 years.

No doubt, towards the end of the statement, PW-8

admits to the possibility of delay in

reconciliation of accounts in spite of the visits

of the approved firm/supplier but, this was in

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response to suggestion. With no precise and

particular instance having been cited, naturally

PW-8, who had himself committed that the strength

of staff at his command was inadequate, had no

option but to say that possibility could not be

ruled out. Such a wide suggestion would, however,

not mean that reconciliation of accounts between

the supplier and the PGI used to take so much of

time.

45. Even if, for a pause, it is assumed that

the strength of staff being inadequate,

reconciliation of accounts could have taken 2-3

years, the question arises as to on what basis

reconciliation of accounts between PGI and the

supplier was to be done? Whether it was to be

done on the basis of the requisition and the

bills/invoices? If 'yes', the supplier had no

role to play, as the requisition and the bills

used to be available on file. Whether it was to

be done at the instance of the supplier? If

'yes', there should have been a request by him

along with new/amended bill. Whether it was to be

done on the request/report of the treating

doctor? If 'yes', there had to be a communication

135

by the treating doctor citing the reasons. Apart

from the three eventualities, there was no scope

for reconciliation of accounts, as it was

understood that the bills had been issued against

the supply of the items which had been

requisitioned. Therefore, a bald suggestion that

possibility of delay in reconciliation of

accounts in spite of the visits of the approved

firm would not lead to a definite conclusion that

the supplier/his representative used to ask for

reconciliation but due to paucity of staff in the

Office of Medical Superintendent, his request

would be kept pending.

46. It would be axiomatic to say that a man

may lie but the circumstances do not. It is

equally correct that when a document as to a

particular transaction/circumstance is proved to

have been executed in due course, oral evidence

to the contrary is not admissible. The Court has

tried to look into the record to find out as to

what was being done in case more items than the

requisitioned had been used or in cases where

lesser/cheaper items than the requisitioned had

been used. During the exercise, the Court has

136

come across two files i.e. the file of Daya

Krishan and the file of Jigri Singh.

47. In the file of Daya Krishan, there is a

letter Ex.DW-3/1 which is written by Dr.

R.S.Dhaliwal to Paul Medical Hall with a copy to

Medical Superintendent. The text of the letter is

as under:

“Kindly refer to our supply order No. CTU/2000/166 dated 2.2.2000 vide which two St. Jude Heart Valves were procured for implantation in Mitral and aortic position. However, during surgery an Aortic Valve was not implanted. Therefore, it is being returned to you. A cheque/draft for the cost of this valve i.e. Rs.45,000/- may please be issued in the name of the Director, PGI, Chandigarh and forwarded to the undersigned so that it can be sent to the Medical Superintendent's office.”

48. In the file of Jigri Singh, there is a

letter Ex.PW-8/33 written by Dr. R.S.Dhaliwal to

the Medical Superintendent, the contents of the

letter are as under:

“The above said patient was taken up

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for double valve replacement on

2.9.1999 and two Starr Edward Valves

were procured from M/s Paul Medical

Hall for replacement in Mitral and

Aortic position. However, on table it

was found that the aortic root was very

narrow and hence a St. Jude Heart Valve

was procured from M/s Paul Medical Hall

and inserted in aortic position instead

of Starr Edward Valve. The cost of St.

Jude Heart Valve is Rs.45,000/- while

the cost of Starr Edward is Rs.24,500/-

so that the balance amount of

Rs.20,500/- may please be forwarded to

M/s Paul Medical Hall”.

49. If the letters Ex.DW-3/1 and Ex.PW-8/33

are placed in juxtaposition, it would be clear

that whether some amount is to be refunded by the

supplier or whether some more amount is to be

paid to the supplier, it is on the recommendation

of the treating surgeon. He is the Pivot. He

knows what has been used and what has been

returned. The Office of Medical Superintendent is

138

to go by his recommendation and if there is no

such recommendation, there is no question of any

reconciliation of accounts between the PGI and

the supplier. Whatever reconciliation of accounts

takes place is the internal procedure whereby the

bills issued by the supplier are verified by the

concerned department with reference to the supply

order/requisition so as to enable the Office of

Medical Superintendent to issue the 'Utilization

Certificate'. Needless to say that PW-8 is not

wrong when he says that Utilization Certificate

is issued after reconciliation of accounts and

that it takes about 2-3 years for Utilization

Certificate to be issued. As pointed out above,

this is in context of Utilization Certificate. At

the same time, PW-8 is not wrong when he says

that in some cases, all the consumables that have

been requisitioned are not consumed while in some

of them some more consumables are required,

therefore, subsequently reconciliation on the

recommendation of the treating doctor does take

place. This is with reference to the settlement

of accounts between PGI and the supplier. PW-8

has made explicit that in case of change of brand

139

of valve, reconciliation used to take place on

the recommendation of the treating doctor. Again

he is correct and is supported by record. But the

sequence and positioning of the questions put to

him in cross-examination is such as would give

the impression that there used to be on going

transactions between PGI and the suppliers and it

used to take 2-3 years for reconciliation of

accounts between them. However, if the entire

statement is read in its entirety without picking

up one sentence from here and there, it would be

evident that reconciliation of accounts between

the supplier and the PGI used to take place on

the recommendation of the treating doctor

/surgeon. It is reiterated albeit, at the cost of

repetition, that in the absence of any such

recommendation by the treating doctor or, in the

alternative, a request by the supplier, duly

verified by the treating doctor there could be no

question of reconciliation of accounts.

50. It is quite interesting though, not

strange, that both the accused adopted different

lines on the point of the manner of supply of the

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valves. As discussed above, the defence of

accused Sat Pal Singla is that the valves used to

be deposited in the central store after due

verification, the defence taken by Dr.

R.S.Dhaliwal is that there was no such procedure.

According to him, the representative of the

chemist concerned used to bring the whole set to

the operation theatre on the day of surgery and

he used to remain present till the end of the

surgery in order to take back the remaining

valves of the set. From this line, accused Dr.

R.S.Dhaliwal has developed defence that it was

always expected of the chemist/supplier that he

would refund the amount to the patient or PGI in

case the valve supplied by him had not been

implanted or if he had supplied the valve of a

brand of lesser price after having charged for

the brand of higher price.

51. It is basically the statement of PW-8

which has caused much confusion. In cross-

examination, he stated that in case of rate

contract the consumables have to be in the store

before surgery and that the cheque used to be

issued only after the verification of the

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consumables by the representative of the surgeon.

This statement of his is not in sync with his

statement in examination-in-chief, wherein he

stated that the deposit of items in the central

store was a condition under the system of spot

committees. In examination-in-chief, he no where

stated that even under the system of rate

contracts, such was a condition. Even the record

does not support this point of view that the

consumables had to be in the store before the

operation or that the cheque used to be issued

only after the representative of the treating

surgeon had verified the items after their

receipt in the store.

52. I have gone through all the files. There

is noting to suggest that even under the rate

contract, there was a system of deposit of the

consumables in the central store or their

verification by the representative of treating

surgeon. There is no record to support the

contention that the cheque used to be issued only

after receipt of consumables in the store and

their verification by the representative of the

treating surgeon. Otherwise, it is clear that on

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receipt of the requisition from the treating

surgeon, cheque in favour of the supplier/chemist

used to be issued. For example, in the case of

Dwarka Parshad, the following proceedings were

conducted:

53. First of all, it was pointed out that a

sum of Rs.1,40,000/- stood deposited with the

cashier for the treatment of Dwarka Parshad.

Then, it was pointed out that the professor and

head of CTVS had intimated that the patient had

been admitted in the ward and a sum of

Rs.77,972/- was required for the purchase of

medicines/surgical items/hospital charges etc.

Then, it was requested that the accounts branch

be directed to issue a cheque in favour of the

chemists/suppliers. Pursuant thereto, requisition

was prepared and the cheques were issued in

favour of the suppliers/chemists including Paul

distributors. There was no noting that the

consumables/items had already been received in

the store before the cheques were issued. There

was no order for the verification of the items by

the representative of Head of Department of CTVS.

There is no document to suggest that the

143

representative of the department had actually

verified the items before the cheques were

issued.

54. It is interesting to note here that one

of the cheques in case of Dwarka Parshad was for

Rs.6,663/- in favour of Kumar Brothers. The

cheque was issued on 16.05.2005. However, Kumar

Brothers returned the cheque. The matter was put

up by the Superintendent before the Medical

Superintendent in the following manner:

“As per Rate Contract with M/s. Kumar

Brothers, Sec-11, Chandigarh Cheque was

issued in favour of M/s. Kumar Brothers

Sector-11 amounting to Rs.6663/- for

the purchase of surgical items

/Medicines for the patient Sh. Dwarka

Parsad which has been received back

with the following remarks:-

“It is observed that lowest rates

of various items have been picked

up from our two different offers.

This does not seem to be a proper

course of action. PGI Authorities

144

are requested that they may kindly

operate any one of our offer for

all items. Only in that case we

shall be able to honour their

orders for supplying various items

on rates quoted above”.

As per order of the Medical

Superintendent patient Shri Dwarka

Parsad was directed to obtain the

materials from M/s. Bharat Medical

stores at the rate contract rate. A

copy of the list was given to the

patient. The material was received by

the patient amounting to Rs.6,663/- and

bill has been received from M/s.

Bharat Medical Stores.

In view of the above, if agreed,

we may sent a requisition to Accounts

Branch for issue of cheque amounting to

Rs.6,663/- in favour of M/s. Bharat

Medical Stores and also cancel the

Cheque No.195362 dated 16.05.2000

amounting to /Rs.6,663/- in favour of

M/s. Kumar Brothers.

145

Requisition is placed below for

signatures please”.

55. After going through the noting, the

Medical Superintendent allowed the cheque in

favour of Kumar Brothers to be cancelled. A fresh

cheque in favour of Bharat Medical Stores was

prepared. This would show that the cheque had

been issued before the supply of consumables

/items. In fact, Kumar Brothers had refused to

supply the medicines/items for the reasons cited

in their letter referred to in the noting and had

returned the cheque which had been issued in its

favour.

56. Even in the case of Jigri Singh, the

cheque in favour of Paul Medical Hall was issued

on 11.08.1999. The amount was credited to his

account on 04.09.1999. As per the bills, the

consumables/items were supplied on 02.09.1999.

Therefore, it is established from the record that

there was no system of deposit of the

consumables/items in the central store of the

Medical Superintendent and issue of cheque only

thereafter. Resultantly, the statement made by

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PW-8 in his cross-examination has to be taken

with a pinch of salt. Such a statement could have

been made by him in an unguarded moment.

57. No doubt, where a witness makes two

inconsistent statements in his evidence either at

one stage or at two stages in view of the law

laid down in Suraj Mal Versus State AIR 1979 SC 1408, the testimony of such witness becomes

unreliable and unworthy of credence but, if the

entire statement of PW-8 is read, it would be

clear that the inconsistency creeped in due to

lack of concentration or for any like reason.

This is definitely not a case, where the witness

deliberately made inconsistent statements. A

witness though wholly truthful is liable to be

over-awed by the court atmosphere and the

piercing cross-examination made by the counsel

and out of nervousness he may mix up facts, get

confused or fill up details from imagination on

the spur of moment. The sub-conscious mind of

the witness sometimes so operates on account of

the fear of looking foolish or being disbelieved

though the witness is giving a truthful and

honest account.

147

58. It is worth mention that even PW-13 in

his cross-examination stated that the articles

requisitioned for private grant patients used to

be received in the stores and that the cheque

used to be issued to the supplier after the

consumables were received. However, this

statement does not matter much because he was not

referring to any particular phase. His intention

was never invited by the defence as to whether

this practice was being followed under the system

of rate contract. It was a general suggestion and

he replied in affirmative. Since, the system of

deposit of consumables in the central stores

during the currency of spot committee system was

there, it can be inferred that the witness may

have been referring to that.

59. Even if, for a pause, the statement of

PW-8 were to be taken out of reckoning due to

inconsistency, it is established on record, as

observed above, that the cheques to the

suppliers/chemists used to be issued before

supply of medicines/items and that there was no

system of deposit of the consumables/items in the

central store. It is rather proved that the

148

supplier/chemist used to bring a set of different

sizes, sometimes of different brands to the

operation theatre just before the surgery; the

surgeon used to implant the valve of the suitable

size; the remaining valves used to be taken back

by the supplier/chemist. However, this will not

shift the focus from Dr. R.S.Dhaliwal to Paul

Medical Hall as has been tried by Dr.

R.S.Dhaliwal. If the latter had nothing to do

with the matter once the surgery was over and if

the onus was upon Paul Medical Hall to refund the

amount to the patient/PGI, question arises as to

what was the need for Dr. R.S.Dhaliwal to make

interpolations in the record and to write letters

to the Medical Superintendent Office in the

manner discussed in detail above? If there was

to be reconciliation of accounts as canvassed by

Paul Medical Hall, question arises, did he submit

fresh/amended bills at any stage? The case of

Ishwar Chand is a glaring example of how the

things were manipulated by both the accused in

conspiracy. If no valve had been supplied by

Paul Medical Hall, why the bill Mark PB/2 was

issued? If Paul Medical Hall had not made

149

interpolations in the bill thereby, including one

Starr Edwards valve for Rs.30,000/- in that bill

and if the interpolation had been made by Dr.

R.S.Dhaliwal or by anybody else, the question

arises as to why Paul Medical Hall accepted the

money. If the interpolation had been made by Dr.

R.S.Dhaliwal or by any other person at his behest

and if Dr. R.S.Dhaliwal wrote the letter

Ex.PW-7/8 without the knowledge of Paul Medical

Hall, the question arises as to what benefit was

Dr. R.S.Dhaliwal going to get. The cheque would

have been issued in favour of Paul Medical Hall.

The fact that Paul Medical Hall got the cheque

and encashed it proves that there was perfect

meeting of minds between the accused.

60. The fact remains that the case is not as

simple as has been tried to be projected by the

defence. The issue is not reconciliation of

accounts. The point is not as to what was

expected of Paul Medical Hall once the valve

other than what had been requisitioned had been

implanted. The issue is manipulation of record.

61. Faced with this situation, learned

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defence counsel fell back upon the statement of

PW-6 and argued that if the operation notes were

to be written by senior residents and entries in

the open heart register were to be made by the

Perfusionist and if the surgeon did not have any

occasion to check the patients' files and, the

open heart register did not use to remain under

the lock and key, the chances of errors cannot be

ruled out and, the interpolations, if any, cannot

be attributed to the accused. Learned counsel

would point out that according to PW-6 the

entries in the open heart register used to be

made in advance and later on corrections used to

be made but, in some cases, there could be

errors.

62. There is no substance in the above

contention. When PW-6 says that the entries in

the open heart register used to be made in

advance, it is evident that the endeavour is to

help the accused in diverting attention of the

court. In examination-in-chief, she stated that

entry in the open heart register is made after

the completion of operation albeit, the name of

patient, diagnosis planning for type of operation

151

etc. are entered before the operation. However,

in cross-examination she stated that all the

entries in the register are made at the time of

entry of the patient in the operation theatre

when incision is made. Even in response to court

question, she stated that the entry as to the

size/brand of the valve is made before the

operation commences. Even in re-examination by

learned Public Prosecutor, she stuck to this

false version and categorically denied the

suggestion that the make/brand of the valve is

also entered in the register after the completion

of surgery and not before that. It is another

matter that having said so, she contradicted

herself by saying that the make of the valve is

known in advance as it has been prescribed, but

the serial number and size are entered after

completion of surgery. She went on to state that

if brand/make is also changed, cutting has to be

made in the register. It is, thus, evident that

PW-6 Kanchan Ba Jadeja kept on changing her

statement just to prove one thing that the size

and the brand of valve actually implanted in the

heart of the patient is mentioned in the register

152

before hand and only requisite changes are made

after the surgery is over. This version is absurd

on the face of it because the witness has herself

admitted in cross-examination by accused Sat Pal

Singla that it is not possible to know before the

surgery as to which particular valve would be

implanted. If actually, it is not possible to

know before hand as to which particular size and

brand would be implanted, the question arises as

to what is the justification in making the entry

of the valve and size in the open heart register

even before the operation commences. The purpose

as to why PW-6 Kanchan Ba Jadeja lied appears to

be to explain a large number of cuttings made in

the open heart register where the make of the

valve is mentioned. Needless to say that it is

her statement in examination-in-chief which

appears to be correct in that all the entries

except the name of the patient, diagnosis and

planning are made after the completion of the

operation.

63. The fact that PW-6 Kanchan Ba Jadeja has

deliberately lied would also be clear from the

answers given by her in re-examination by the

153

public prosecutor. She said that every valve has

a sticker and whatever valve has been implanted,

its sticker is pasted in the open heart register

against the relevant entry after the completion

of surgery and, if there is any difference

between the entry earlier made and the sticker,

then cutting in the entry is made. She further

stated that TTK brand did not use to have a

sticker and that a card containing serial number

used to be there in the sealed box and, after

opening the box when the valve used to be

implanted the serial number used to be written in

the open heart register. When her attention was

drawn to entry at serial No.62/2 C.R.No.226754 at

Page No.113 (actually the page No. is 133 but

inadvertently it has been typed while recording

the evidence as No.113. For all intents and

purposes the page number would be read as 133) of

open heart register. She admitted that sticker of

TTK was pasted there. Again she tried to hoodwink

the court by claiming that since the sticker is

in a language different from English, it is

generally not pasted. Again her attention was

invited to the sticker pasted against the

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relevant entry. She admitted that the language on

the sticker was English. The purpose why the

witness resorted to this tactic is not clear but

the same is even not material at this stage

except for the purpose of proving that PW-6 has

gone out of the way in trying to help the accused

Dr. R.S.Dhaliwal.

64. It is interesting to note here that when

the attention of the witness was drawn to the

entries Ex.PW-6/2 and Ex.PW-6/3 at Page 132 and

135 of the open heart register respectively, she

stated that in the entry Ex.PW-6/2, the words

'TTK F66314' were entered after completion of

surgery meaning thereby that only the words 'MVR'

were mentioned in the relevant column before the

surgery started and that in the entry Ex.PW-6/3,

the words 'MVR small Steronotomi TTK' were

written before the operation started and the

'words 27 S. No.F663713' were written after

completion of surgery. Therefore, she ended up

making clear that only the 'procedure' used to be

mentioned before the surgery would start, for

example: MVR or CABH or DVR or ASD. The brand and

the size and the serial number used to be

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mentioned after the completion of surgery. If

that was so, so many cuttings in the name of the

brand of the valve in the relevant column are not

explainable. On the top of it, almost all the

cuttings are in those entries where the surgery

was performed by Dr. R.S.Dhaliwal. These along

with other manipulations cannot be glorified as

errors.

65. If Dr. Dhaliwal had nothing to do with

the operation notes and had no occasion to check

the patients' files, how can he explain the

interpolations, the cuttings and additions made

in some? The fact that it was he who made these

cuttings, additions and interpolations has been

established to the hilt. He not only tampered

with record but also facilitated the payment of

money to Paul Medical Hall by making firm but

wrong assertions as in the cases of Jigri Singh

and Ishwar Chand. Sat Pal Singla too cannot

escape the liability. His having issued wrong

bills claiming that he had supplied St. Jude

valves, whereas he had actually supplied Omni

Science and Edward Mira valves; his having issued

bills where no valves had been supplied and, his

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having received payment on strength of those

bills cannot be termed as innocent. Needless to

say that without there being a meeting of minds

between Dr. R.S.Dhaliwal and Sat Pal Singla, it

would not have been possible to deceive the PGI.

66. Once it is proved that there was

conspiracy between Dr. R.S.Dhaliwal and Paul

Medical Hall (Sat Pal Singla), all the overt acts

committed by one of them in reference to their

common intention would, by fiction of law created

by Section 10 of the Evidence Act, be construed

as the acts of both.

67. As discussed above while dealing with

each instance separately, both the accused were

complementing each other. The manner in which the

things were manipulated leaves no room for doubt

that the accused were party to the conspiracy in

pursuance of which record was tampered with and

fabricated dishonestly and fraudulently with

intent to cheat the patients/wards and the PGI

and to support claim for money where it was not

due or to support claim for more than what was

due in some cases as highlighted above. The

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forged and fabricated documents were deliberately

used as genuine with the same dishonest

intention. At the same time, it is proved that

accused R.S.Dhaliwal not only abused his official

position but also adopted corrupt and illegal

means for obtaining for himself and Paul Medical

Hall (Sat Pal Singla) pecuniary advantage. The

prosecution has, therefore, been able to bring

home the guilt to the accused beyond doubt. As

such, the accused R.S.Dhaliwal and Sat Pal Singla

are hereby convicted under Sections 120-B, 420,

467, 468 and 471 of Indian Penal Code. In

addition thereto, accused R.S.Dhaliwal is also

convicted under Section 13 (1) (d) read with

Section 13 (2) of the Prevention of Corruption

Act.

Pronounced: Special Judge,02.03.2009 Chandigarh.

This judgment contains 158 pages and all the pages have been signed by me.

` Special Judge,Chandigarh.

158

Question of SentencePresent:Shri R.L. Negi,Senior Public Prosecutor

for C.B.I.

Convict R.S.Dhaliwal on bail being assisted by Shri Matwinder Singh, Advocate.

Convict Sat Pal Singla on bail being assisted by Shri Vinod Arya, Advocate

Heard the convicts on question of

sentence.

2. Convict Sat Pal Singla has placed his

medical record before the Court to show that his

health is in critical stage inasmuch as he has

already undergone tripple vessel bye-pass

surgery in 1997 and second heart surgery in

2008. He is a diabetic with all related

problems and has enlarged prostrate. He suffers

from gastro and eye ailments as well. He is 74

years of age.

3. Citing the position of the health of the

convict, his counsel pleads for lenient view,

arguing that he is first offender with no

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criminal background.

4. Convict Dr. R.S.Dhaliwal claims that his

incarceration may not serve the ends of justice

as he has to serve the society being a surgeon.

His counsel pleads that the time wasted, if the

convict is sent behind bars, would be at the

cost of society. Pleading that the convict

should be given a chance to reform. Learned

counsel has pleaded for leniency.

5. Fridemant in his 'Law in changing

Society' has observed that “the State of

Criminal Law continues to be - as it should be -

a decisive reflection of social consciousness of

Society”. Therefore,in operating the sentencing

system the law should adopt the corrective

machinery or the deterrence based on factual

matrix. The facts and given circumstances in

each case, the nature of the crime, the manner

in which it was planned and committed, the

motive for commission of crime, the conduct of

the accused and all other attending

circumstances are relevant facts which as

observed by the Hon'ble Apex Court in State of M.P. Vs. Santosh Kumar 2006 (3) R.C.R.

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(Criminal) 554,would enter into the area of consideration.

6. In Sevaka Perumal Vs. State of Tamul Nadu 1991(2) RCR (Criminal) 427, it was observed by Hon'ble Supreme Court that undue sympathy to

impose inadequate sentence would do more harm to

the justice system to undermine the public

confidence in the efficacy of law and Society

could not endure under such serious threats. It

is, therefore, the duty of every court to award

condign punishment.

7. For deciding just and appropriate

sentence to be awarded, the aggravating and

mitigating factors and the circumstances in

which the crime has been committed are to be

delicately balanced in a dispassionate manner.

8. Here, this Court is dealing with an

unscrupulous doctor/public servant who has not

only failed to preserve the purity of his life

which he had promised while taking Hippocratic

oath but has also adopted devious means to earn

money. Such like persons debase and defile the

very system they are expected to protect and

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uphold. The kind of crime committed by him in

common parlance is known as 'corruption in civil

life' which is spreading its tentacles far and

wide. It is getting contagious and threatening

to devour the very vitals out of the bone marrow

of the society. A crime committed in the heat of

passion may call for sympathetic consideration.

But a calculated and organized crime like the

one committed by the convict Dr. R.S.Dhaliwal in

the instant case must be visited with severe and

deterrent punishment.

9. The plea that sending the convict behind

bars will not serve any useful purpose in that

it will deprive the society of the services of

an able surgeon does not find favour with the

Court. A surgeon has to be a human being. If the

element of honesty and sincerity is taken out of

a surgeon, there will be no difference between

him and a robot. A gentleman surgeon with

average capability will do great service to the

society. But a corrupt surgeon with exceedingly

fine and efficient hand will only end up causing

harm to the system.

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10. Needless to say that there are virtually

no mitigating circumstances in favour of convict

Dr. R.S.Dhaliwal. The fact that he is under

suspension and is likely to lose his job is

hardly a reason to sympathize with him. He was

being paid for his services by the Government.

He was being treated like God by the patients

and the wards. Therefore, except for greed there

was no motive with him to commit the crime.

11. The age of the convict; the stage of life

he is at and, the fact that he has shown

inclination to reform himself are though, the

factors to be given due weightage.

12. The Court, after giving thoughtful

consideration to the facts, circumstances, and

nature of the crime; the manner in which it was

planned and committed; and the motive and

conduct of convict Dr. R.S.Dhaliwal sentences

him as under:

i) Section 120-B of Indian Penal Code:

To undergo rigorous imprisonment for 3

(three) years and to pay fine of

Rs.10,000/-. In default of payment of

fine, to undergo further rigorous

163

imprisonment for 1 (one) month.

ii) Section 420 of Indian Penal Code:






iii. Section 467 of Indian Penal Code:


(five) years and to pay fine of



imprisonment for 3 (three) months.

iv. Section 468 of Indian Penal Code:






v. Section 471 of Indian Penal Code:


164

years and to pay fine of Rs.10,000/-. In

default of payment of fine, to undergo

further rigorous imprisonment for 1 (one)

month.

vi. Section 13(1)(d) read with Section 13 (2)

of Prevention of Corruption Act.


(five) years and to pay fine of




13. It is evident that Dr. R.S.Dhaliwal was

the Kingpin. He was the axis around which the

things revolved. Sat Pal Singla was, no doubt,

his ally but it will not be fair to treat him

with the same severity which Dr. R.S.Dhaliwal

deserves. No doubt, Sat Pal Singla was also

driven by greed but he was simply the

beneficiary. The master mind was Dr.

R.S.Dhaliwal. It was he who manipulated

everything. It was Dr. R.S.Dhaliwal who

subverted the system. Sat Pal Singla simply

165

assisted him in achieving the object. Keeping

all this in mind as well as the critical state

of health of the convict Sat Pal Singla, the

Court sentences him as under:

i) Section 120-B of Indian Penal Code:


(two) years and to pay fine of




ii) Section 420 of Indian Penal Code:






iii. Section 467 of Indian Penal Code:






166

iv. Section 468 of Indian Penal Code:






v. Section 471 of Indian Penal Code:






14. All the sentences shall run concurrently.

The period already undergone by the convicts in

custody shall be set-off against the term

awarded. It is made clear that out of the same

FIR, two separate chargesheets were filed.

Since Dr. R.S.Dhaliwal has been convicted in

Chargesheet No.1 as well, it is directed that

the sentence awarded in this Chargesheet shall

run concurrently with the sentence awarded in

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Chargehseet No.1. Fine paid by both the

convicts. All the un-exhibited documents be

returned to the concerned quarters against

proper receipt. File be consigned to the record

room.

Pronounced: (Jagdeep Jain)03.03.2009 Special Judge,

Chandigarh.

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