State Consumer Disputes Redressal Commission
Mukat Hospital And Heart Institute, vs Mr.Dibyendu Ghara on 1 July, 2013
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, U.T., CHANDIGARH First Appeal No. : 270 of 2013 Date of Institution : 25.06.2013 Date of Decision : 01.07.2013 Mukat Hospital and Heart Institute, SCO No.47-49, Sector 34-A, Chandigarh, through its Director/Authorized Representative. Appellant/Opposite Party V e r s u s Mr.Dibyendu Ghara,, resident of House No.414A, Sector 29-A, Chandigarh. ....Respondent/complainant Appeal under Section 15 of the Consumer Protection Act, 1986. BEFORE: JUSTICE SHAM SUNDER (RETD.), PRESIDENT. MR. DEV RAJ, MEMBER.
Argued by: Sh. Maninder Arora, Advocate for the appellant.
PER JUSTICE SHAM SUNDER (RETD.), PRESIDENT This appeal is directed against the order dated 20.05.2013, rendered by the District Consumer Disputes Redressal Forum-I, U.T., Chandigarh (hereinafter to be called as the District Forum only), vide which, it partly accepted the complaint, filed by the complainant (now respondent), and directed the Opposite Party (now appellant), as under:-
For the reasons recorded above, we find merit in the complaint and the same is partly allowed. The OP is directed :-
i) To refund a sum of Rs.28,107/- to the complainant with interest @9% p.a. w.e.f. the date of deposit till realization.
ii) To make payment of a compensation of Rs.10,000/- to the complainant towards mental agony and harassment.
iii) To make payment of litigation expenses to the tune of Rs.7500/- to the complainant.
12. This order shall be complied with by the OP within one month from the date of receipt of its certified copy, failing which, OP shall be liable to refund the above said awarded amount to the complainant along with interest @12% p.a. from the date of filing of the present complaint, till its realization, besides costs of litigation.
2. The facts, in brief, are that the complainant is a Central Govt. Employee, and was authorized to take treatment, from private hospital under the CGHS & CS (MA) Rules 1944. The Opposite Party hospital (now appellant) was empanelled under the said Rules, valid for the period from 01.05.2012 to 30.04.2013. On 25.12.2011 Mrs.Anamika Ghara, wife of the complainant, felt abdomen pain and the complainant took her to the Opposite Party, for medical check up. On 26.12.2011, in the forenoon, the wife of the complainant was admitted in the Opposite Party Hospital. Dr.Jasmeet Singh, checked her and informed that she was having stone, in her GB (Gall Bladder) lumen. She was sent to Dr.Shamsher Singh Memorial Radio-Diagnostic Centre, for ultrasound, which, vide Annexure C-3 confirmed the presence of two stones, in her GB Lumen. The complainant got permission, from the General Manager, Ordnance Cable Factory, Govt. of India, Ministry of Defence, for getting treatment of her wife from the Opposite Party Hospital. It was directed that the payment be charged, as per the CGHS/CSMA rates. On 27.12.2011, the operation of the wife of the complainant was conducted and she was discharged on the evening of 29.12.2011. As per the discharge summary Annexure C-5 Laparoscopic Cholecystectomy was done, on the wife of the complainant, on 27.12.2011. It was stated that according to the separate reports of Dr.Sanjeev Bhatia and Medical Superintendent, single operation was carried out, on the wife of the complainant, on 27.12.2011. The Doctors of the Opposite Party told the complainant, to pay an amount of Rs.69,000/-, towards the approximate expenses for the operation of her wife, without providing copy of the bill. Copy of the certificate-B is Annexure C-6. The Ordnance Cable Factory, Chandigarh sent a draft of Rs.69,000/-, in favour of the Opposite Party, which was handed over to it, by the complainant. The Opposite Party did not issue any final bill, despite repeated requests, and visits of the complainant.
3. It was further stated that, in the month of January, 2012, the Opposite Party, issued final bill, which showed more than one operation, done on the wife of the complainant, to cover up the amount of Rs.69,000/-, in violation of the Package Rules. It was further stated that the package included registration charges, admission charges, accommodation charges including patients diet, operation charges, injection charges, dressing charges, doctor/consultant visit charges, ICU/ICCU charges, monitoring charges, transfusion charges, anesthesia charges, operation theatre charges, procedural charges/ surgeons fee, cost of surgical disposables and all sundries, used during hospitalization, cost of medicines, related routine and essential investigations, physiotherapy charges, nursing care and charges for its service. It was further stated that the Opposite Party, issued the bill, contrary to the Package Rules. It was further stated that, as per the Rules, if one or more minor procedures, form part of a major treatment procedure, then the package charge would be permissible for major procedure, and only 50% of charges for minor procedure. It was further stated that the final bill, issued by the Opposite Party, was sent to the Principal Controller of Accounts (PCA), Kolkata, for regularization, and he directed that an amount of Rs.33,630/-, be recovered from the salary of the complainant, as it was found that the bill was, in excess, of the package amount. The complainant was informed to recover the excess amount, from the Opposite Party, but the latter refused to refund the same, despite having been sent letters Annexures C-12, C-14 and C-15. Legal notice dated 16.12.2012 Annexure C-17, was also served upon the Opposite Party, to redress the grievance of the complainant, but to no avail. It was further stated that the aforesaid acts of the Opposite Party, amounted to deficiency, in rendering service, as also indulgence into unfair trade practice. When the grievance of the complainant, was not redressed, left with no alternative, a complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter to be called as the Act only), was filed, directing the Opposite Party, to refund the amount of Rs.33,630/- alongwith interest @18% p.a., or in the alternative, an amount of Rs.29,607/- alongwith interest @24%, from the date of deposit, till realization; pay compensation to the tune of Rs.1,00,000/-, for mental agony and physical harassment; and cost of litigation, to the tune of Rs.21,000/-.
4. The Opposite Party, in its written version, admitted that Mrs.Anamika Ghara, the wife of the complainant, was admitted in its hospital, on 26.12.2011, with the complaint of acute abdomen pain, and gastro enteritis. She was immediately given treatment and was medically stabilized, on the same day, with I.V.Fluids, Analgesics and IV antibiotic. It was stated that after ultrasound examination, it was found that she had a problem of gall bladder stone. On 27.12.2011, after proper stabilization, the wife of the complainant was operated upon for removal of gallstone. It was further stated that the wife of the complainant, was admitted in a private single room, for which she was not entitled, as a result whereof, the actual charges were reduced by 15%, as per the entitlement of the ward of the patient. It was further stated that, in this case lap-Cholecystectomy with CBD exploration and repair/ exploratory laparotomy/ adhesiolysis, had been done and the patient was charged according to the CGHS guidelines. It was further stated that copy of the bill bearing No.32617 dated 29.12.2011, showing details of the expenses, charged under different heads, is Annexure R-3. It was further stated that the said bill raised by the Opposite Party was, in accordance with the approved package rates. It was further stated that the Opposite Party was not liable to refund any amount, allegedly paid in excess by it. It was further stated that neither there was any deficiency, in rendering service, on the part of the Opposite Party, nor it indulged into unfair trade practice. The remaining averments, were denied, being wrong.
5. The Parties led evidence, in support of their case.
6. In the rejoinder, filed by the complainant, he reasserted all the averments, contained in the complaint, and repudiated those, contained in the written version of the Opposite Party.
7. After hearing the Counsel for the parties, and, on going through the evidence, and record of the case, the District Forum, partly accepted the complaint, in the manner, referred to, in the opening para of the instant order.
8. Feeling aggrieved, the instant appeal, has been filed by the appellant/Opposite Party.
9. We have heard the Counsel for the appellant, at the preliminary stage, and, have gone through the evidence, and record of the case, carefully.
10. The Counsel for the appellant, submitted that the complainant did not fall within the definition of a consumer. He further submitted that, in the absence of impleadment of the organization of the complainant, the complaint was not maintainable. It was further submitted that the charges claimed by the Opposite Party, were arbitrarily reduced without affording an opportunity to the Opposite Party, by the concerned Controller of Accounts. He further submitted that the amount charged from the complainant, for the operation of Gall Bladder of his wife, was in accordance with the package rates. He further submitted that the District Forum was, thus, wrong, in holding to the contrary. He further submitted that the order of the District Forum being illegal, is liable to be set aside.
11. The first question, that falls for consideration, is, as to whether, the complainant fell within the definition of a consumer or not. The complainant/respondent, at the relevant time, was an employee of the Central Government, and was covered under the CGHS & CS (MA) Rules 1944. He was, thus, covered under the CGHS Scheme. Since, the Opposite Party was empanelled as one of the hospitals, for giving treatment, to the Central Government Employees and their dependants, the complainant was, thus, beneficiary of this scheme. It was the organization of the complainant, which was to reimburse the amount, to the empanelled hospital, where he, his wife or his children took treatment. Since the excess amount of bill, raised by the Opposite Party, for treatment of the wife of the complainant, was recovered from the complainant, and he was authorized to recover the same, from the Opposite Party, he certainly fell within the definition of a consumer. It was the complainant, who hired the services of the Opposite Party, being Central Government employee and covered under the CGHS & CS (MA) Rules 1944, and, as such, beneficiary. It could not be said that the complainant was not a consumer, under Section 2(1)(d) of the Act. The submission of the Counsel for the appellant, in this regard, being devoid of merit, must fail, and the same stands rejected.
12. There is, no dispute, about the factum, that the wife of the complainant was admitted, in the Opposite Party hospital. The complainant was covered under the CGHS & CS (MA) Rules 1944. The Opposite Party, was an empanelled hospital, for the treatment of such employees or their dependants. Annexure C-9 contains that the package rates, which were required to be charged by the Opposite Party, for the operation of the wife of the complainant. From Annexure C-9, it is revealed that the Package Rate shall mean and include lumpsum cost of in-patient treatment/day care/diagnostic procedure for which a CGHS beneficiary has been permitted by the competent authority for treatment under emergency from the time of admission to the time of discharge, including (but not limited to) (i) Registration Charges, (ii) Admission Charges, (iii) Accommodation charges including patients diet, (iv) Operation Charges, (v) Injection Charges, (vi) Dressing Charges, (vii) Doctor/consultant visit charges, (viii) ICU/ICCU charges, (ix) Monitoring charges, (x) Transfusion charges, (xi) Anesthesia charges, (xii) Operation theatre charges, (xiii) Procedural charges/surgeons fee, (xiv) Cost of surgical disposables and all sundries used during hospitalization (xv) Cost of medicines, (xvi) Related routine and essential investigations, (xvii) Physiotherapy charges etc. (xviii) Nursing care and charges for its services. According to these Rules, if one or more minor procedures form part of a major treatment procedure, then package charges would be permissible for major procedure and only 50% of charges for minor procedure. In the instant case, the Opposite Party, charged the following amount from the complainant under different heads:-
S.No. Particulars Amount Room Charges etc.
1.
(a) Lap. Cholecystectomy & 23100/-
(b) CBD Exploration (SNo. 1101)
(c) -
2.
(d) Repair of CBD (S No.652) 13300/-
Operation Charges
3.
(a) Exploration Laparatomy (SNo.632) 8900/-
(b) Anesthesia Fee
4.
(c) Adhesiolysis (SNo.1116A) 10200/-
5.
(d) Room Charges Rs.1500/- x 1 day 1500/-
(e) Cost of Medicines 8800/-
Medical/Surgical Procedure
4. Consultants Visits :
Date Name of Doctor Dr.Sanjiv Bhatia No. of visits .2
Visiting fee 60/-
120/-
5. Investigations
(a) X-Ray @100/- x 1 100/-
(b) Echo/TMT/Hollar
(c) Laboratory 2582/-
(d) E.C.G. @Rs.75/- x 1 75/-
(e) Ultrasound @350/- x 1 350/-
6. Ambulance
7. Misc. Charges Total Amount 69027/-
Less Advance 27/-
Balance 69000/-
13. The Opposite Party issued the bill, in the sum of Rs.69,000/-, to the employer of the complainant. The employer of the complainant, disallowed an amount of Rs.33,537/-, and directed that the same be recovered, from the salary of the complainant, as per the letter dated 25.9.2012 Annexure C-13, received from the Office of the Principal Controller of Accounts (Factories), Kolkatta. The details of Admittance and Disallowances are as under:-
S.No. Particulars Amt. Claimed Amt. Admitt-ed Disallowa-nces Remarks
1.
Lapcholecystectomy CBD Exploration 23100 20790 2310 10% deducted as per his entitlement, hence admitted in full
2. Repair of CBD 13300 5985 7315 First 50% deducted from package rate then 10% deducted as per his entitlement as per MH & FW OMAS 11011/23/2009 CGHS DSI/Hospital Cell (Part 1) Dt.24.2.2011
3. Exploration Labratomy 8900 4005 4895
4. Lap.Adhesiolysis 10200 4590 5610
5. Bed Charges 1500
-
1500Included in package rate as per MH & FW O.M.N.S. 11011/23/2009. CGHS D1 Hospital Cell (Part 1) dt.24.2.2011
6. Medicines 8800
-
8800-do-
7. X-Ray 100
-
100-do-
8. E.C.G. 75
-
75-do-
9. Laboratory Charges 2582
-
2582-do-
10. Ultrasound 350
-
350-do-
Total :
68907 35370 Amount admitted Rs.35370/-
Advance Drawn Rs.69,000/-
Debit Balance Rs.33,630/-
It is evident, from the package rate that it included lumpsum cost of in-patient treatment, day care etc.. Under these circumstances, the amount of medicines, X-ray, ECG, laboratory charges and ultrasound were to be included, in the package rate. The Opposite Party was not justified to charge the said charges, from the complainant. The wife of the complainant was only entitled to the general ward, but she was kept in a private room. Therefore, the complainant was not entitled to get back the amount of Rs.1500/-, charged by the Opposite Party. The District Forum, was, thus, right in holding that the complainant was entitled to the refund of Rs.28,107/-, which was charged, in excess from him, by the Opposite Party, the details whereof, are given hereunder:-
S.No. Particulars Amount.
1.
Lapcholecystectomy CBD Exploration Nil
2. Repair of CBD 6650/-
3. Exploration Laboratory 4450/-
4. Lap.Adhesiolysis 5100/-
5. Bed Charges Nil
6. Medicines 8800/-
7. X-Ray 100/-
8. E.C.G. 75/-
9. Laboratory Charges 2582/-
10. Ultrasound 350/-
Total 28107/-
By charging this amount, in excess, from the complainant, for the treatment of his wife and not refunding the same, the Opposite Party was not only deficient, in rendering service, but also indulged into unfair trade practice.
14. No doubt, the Principal Controller of Accounts, Kolkatta, directed that the amount of Rs.33,630/-, had been charged, in excess, by the Opposite Party, from the organization, and the same be recovered from the complainant. It is also a fact that, no opportunity was granted to the Opposite Party, before coming to such a conclusion, yet, in our considered opinion, it was not necessary. The Opposite Party could charge for the operation and treatment of the wife of the complainant, only as per the Package Rate, and the same was already in place. Since, the Opposite Party charged the amount, over and above the package rate, the Principal Controller of Accounts, was right, in coming to the conclusion, that the amount charged, in excess, be first recovered from the complainant, and he could, thereafter, recover the same, from the Opposite Party. Fully knowing well, as to what were the package rates, the Opposite Party, charged, in excess, and, thus, it could not be heard to say, that no opportunity of being heard, was afforded to it. The submission of the Counsel for the appellant, in this regard, being devoid of merit, must fail, and the same stands rejected.
15. No other point, was urged, by the Counsel for the appellant.
16. In view of the above discussion, it is held that the order passed by the District Forum, being based on the correct appreciation of evidence, and law, on the point, does not suffer from any illegality or perversity, warranting the interference of this Commission.
17. For the reasons recorded above, the appeal, being devoid of merit, must fail, and the same is dismissed, at the preliminary stage, with no order as to costs. The order of the District Forum is upheld.
18. Certified copies of this order, be sent to the parties, free of charge.
19. The file be consigned to Record Room, after completion Pronounced.
July 01, 2013 Sd/-
[JUSTICE SHAM SUNDER (RETD.)] PRESIDENT Sd/-
(DEV RAJ) MEMBER Rg