A panel that probed the circumstances leading to former Chief Minister J Jayalalithaa's death in 2016 indicted V K Sasikala, the confidante of the late leader, and the Tamil Nadu government on Tuesday said it would initiate action after getting legal opinion.

The panel's report, that was tabled by the state government in the Assembly on Tuesday also indicted former Health Minister C Vijayabaskar, medical doctor K S Sivakumar (Sasikala's relative) and the then Health Secretary J Radhakrishnan and recommended a probe against all the four persons.

The Justice A Arumughaswamy Commission of Inquiry (CoI) said, they "have to be found fault with and investigation is to be ordered." Sasikala is indicted considering several aspects, it said.

The government said that considering the CoI's disagreement on certain aspects vis-a-vis the AIIMS doctors committee's report, "it was decided to initiate appropriate action" against "certain individuals," after obtaining the opinion of legal experts. This is in view of the CoI's recommendations in its report.

The panel recommended an investigation against the then State Chief Secretary Rama Mohana Rao and two medical doctors, though it did not specify if it found "fault" with them or not.

It said the government may, "decide and investigate" the matter against the chairman of a corporate hospital, where she was treated.

The CoI's Terms of Reference (ToR) was to inquire into the circumstances leading to Jayalalithaa's hospitalisation on 22 September 2016 and subsequent treatment provided in the hospital till her demise on 5 December 2016. She was treated at the Apollo Hospitals here.

In its finding, as regards the first part of the ToR on circumstances leading to the late AIADMK supremo's hospitalisation, the Commission said it, "has not found anything abnormal or unnatural" in the conduct of people including Sasikala. Adequate care was taken to shift Jayalalithaa to the Apollo Hospitals promptly without delay, it said.

On the other aspect of the ToR, which is on treatment, the CoI indicted four persons including Sasikala and former Minister Vijayabaskar. It favoured a probe on three others including the former Chief Secretary Rao and left it to the government to decide if the investigation is warranted in respect of the chairman of the hospital.

The CoI, in its 475-page report, goes into allegations of conspiracy against Jayalalithaa by Sasikala and her relatives. The panel said that it was very clear that, "only on strong suspicion," Jayalalithaa sent Sasikala out of her Poes Garden residence (from November 2011 to March 2012).

Subsequently, after getting a letter from Sasikala that she would not interfere in politics, Jayalalithaa allowed her back into her Poes Garden residence and the leader kept her "at a distance."

Citing depositions of witnesses, the panel said that it is "inferable" that due to some strained relationship, Jayalalithaa would have asked Sasikala and her relatives to leave Poes Garden.

During Jayalalithaa's hospitalisation here, a cardiothoracic surgeon from the USA, Dr Samin Sharma, recommended a life-saving cardiac surgery in view of vegetation in her heart.

Sharma examined her in the hospital on November 25, 2016, and discussed it with Jayalalithaa she was conscious and gave her consent to the surgery.

It was however not performed after a UK doctor, who was an intensivist, gave an opinion that cardiac surgery was not needed. When Dr Sharma was confident to perform the angiography procedure, what was the necessity to bring an intensivist into the picture, the panel wondered.

Therefore, the commission said it concluded that the hospital doctor "played a trick" to bypass the performance of angiography to convince "some power centre," and the intensivist gave an opinion that surgery can be postponed.

Sasikala was the one and the only person consulted by doctors, more particularly the doctors of Apollo Hospitals on the course of the treatment and only upon her consent they proceeded, the CoI said.

On a plea to cross-examine former Chief Minister Edappadi K Palaniswamy, the panel said the applicant has not adduced sufficient reasons.

The panel submitted its report to the government on 27 August this year and it was taken up for discussion in the Cabinet meeting held on 29 August 2022.