Sanjay Kishan Kaul, C.J. - (1.) GROSS negligence on part of various persons resulted in a patient of the same name being wheeled in for surgery which was to be carried on qua another patient of the same name. Fortunately, a small incision detected the possibility of a mistake averting a greater tragedy. The origin of the tragedy of errors begins with two patients with the same name Saroj Devi wife of Jagdish and Saroj Devi wife of Udhal Singh being admitted in the Government Medical College and Hospital, Chandigarh, on 19.7.2001. The first Saroj Devi was admitted for superficial Parotidectomy and, thus, was in the ENT Ward while the second one was to undergo Endoscopy D.C.R. and was an OPD patient. Smt. Saroj Devi, who was to undergo an Endoscopy procedure, was wheeled into the Operation Theater for Parotidectomy procedure. After the ground work for surgery was done, an incision was made by the Surgeon who found that the tissues were healthy and, thus, the surgery was immediately stopped and the mistake detected. This incident is stated to have received vide adverse publicity in newspaper - Times of India.
(2.) A preliminary inquiry was instituted where the role of Nurses and Doctors was gone into. Respondent No. 2 before us -Ms. Sukhwinder Kaur was deployed as a Scrub Staff Nurse/Circulating Nurse and a preliminary finding was reached that she failed to follow the procedure of the Operation Theatre and did not write the name of the patient on the board with the names of the Surgeon and Anaesthetist against it. There were findings adverse against other persons also and, thus, this preliminary inquiry resulted into a regular inquiry under Rule 8 of the Punjab Civil Services (Punishment and Appeal) Rules, 1970 (for short 'the Rules'). The Article of Charges was served, inter alia, on the respondent No. 2 with a Statement of Amputation of misconduct alleging that she had misconducted herself on 19.7.2001 by receiving the patient Mrs. Saroj Devi wife of Udhal Singh in the pre -operative area of the ENT Operation Theatre without checking the identification of the patient, following the procedure for surgery and pre -operative instructions, etc., resulting in the patient being operated for Parotidectomy while the patient had been admitted as a case of Endoscopy D.C.R. In pursuance to the regular inquiry, the parties were given opportunity to defend themselves, statements were recorded and on completion of the inquiry, the Inquiry Officer submitted report dated 17.5.2002, returning a finding of guilt against respondent No. 2. The relevant portion of the inquiry report is reproduced as under: - - As regards Sukhwinder, she has admitted that on 19.7.2001 she was posted inside the Operation Theatre of OT level -II from 8.00 AM to 2.00 PM, along with Mr. Jacob. She has also admitted that she was assisting as a Circulator Staff Nurse whereas Sh. Jacob was assisting as Scrubbed Staff Nurse in the first Operation on that day. In the second case, she was to act as Scrubbed Staff Nurse but when she was getting ready, she had been informed by Mr. Jacob that as per the desired/advice of the surgeon she may act as Circulator and not as Scrubbed. She had agreed during her cross examination by PO that as Circulating Nurse she could not write on the board since the file of the patient was not made available to her and even the OPD card of the patient have been sent and she was told by the Jr. Technician Anesthesia that the OPD card of the patient had also been sent for getting the file of the patient. She also admitted that when the patient entered in the Operation Theatre she was being scrubbed and she could not check the patient as it was not possible for her at that time. The argument of the PO that the Circulator Staff Nurse Ms. Sukhwinder failed to perform her assigning duty to write the name of the patient, name of surgeon, diagnosis and C.R. No. on the board existing in the OP specifically for this purpose as very valid and further I agree with the PO that CO (Ms. Sukhwinder) fail to perform her duty. She told the operating surgeon/Anaesthetists that she is not in a position to write the particulars specially the diagnosis etc. because the non availability of the file. Nothing has been brought before me to show that this nurse brought to the notice of the Capt. of the team/or any other doctor and thus failed to discharge her duty. The defence of the CO is not convincing. The allegation levelled against her that she committed the serious professional misconduct by not performing her duty while posted in the ENT OT on 19.7.2001 when the patient Ms. Saroj Devi was received there for operation is established. Thus the charge levelled against the CO is established. In pursuance to the inquiry report, show cause notice was issued to respondent No. 2 by the disciplinary authority, tentatively agreeing with the inquiry report and proposing to impose a major penalty of "withholding of one increment of pay with cumulative effect" under rule 5(v) of the Rules. Respondent No. 2 submitted a reply to the same. A detailed order was passed on 2.1.2003. In terms of order dated 2.1.2003, the disciplinary authority finally agreed with the findings of the Inquiry Officer and imposed the punishment as proposed. The appeal filed before the appellate authority was also dismissed on 10.12.2003.
(3.) RESPONDENT No. 2, thereafter, filed OA No. 889/CH/2004 before the Central Administrative Tribunal, Chandigarh Bench, which allowed the application filed by respondent No. 2 and quashed the charges against respondent No. 2. It is this order which is sought to be assailed before us by the department in the present petition under Article 226/227 of the Constitution of India.;