State Consumer Disputes Redressal Commission
Central Government Health Service vs L.K. Narang on 20 February, 2008
IN THE STATE COMMISSION : DELHI IN THE STATE COMMISSION : DELHI (Constituted under Section 9 clause (b)of the Consumer Protection Act, 1986 ) Date of Decision: 20-02-2008 Appeal No.FA-2008/43 (Arising from order dated 14-08-2007 passed by District Forum-II, Udyog Sadan, Institutional Area, Behind Qutab Hotel, New Delhi Complaint Case No.879/2006) Joint Director, Appellant Central Government Health Through Service, Ms. Manisha Lavania, Ministry of Health & Family Welfare, Advocate. Nirman Bhawan, New Delhi. Versus Sh. L.K. Narang, Respondent C-13, Jangpura B, In person. New Delhi. CORAM : Justice J.D. Kapoor- President Ms. Rumnita Mittal - Member
1. Whether reporters of local newspapers be allowed to see the judgment?
2. To be referred to the Reporter or not?
JUSTICE J.D. KAPOOR, PRESIDENT (ORAL) Vide impugned order dated 14-08-2007 passed by the District Forum the appellant has been directed to pay Rs. 29,617/- towards reimbursement of the expenses incurred by the appellant on the treatment of his wife and also to pay Rs. 10,000/- as compensation for inconvenience and mental agony suffered and Rs. 5,000/- as cost of litigation.
2. Feeling aggrieved, the appellant has preferred this appeal.
3. The impugned order has been assailed mainly on the ground that Sir Ganga Ram Hospital is recognized under the CGHS only for Cardiology, Cardiac surgery and diagnostic Procedures, Renal Procedure, Renal Transplantation, Gastroenterology Procedures, Liver Transplantation and Genetic Lab Procedures and it is not recognized for gynaecology and there was no emergency for the operation and expostfacto permission could also not be granted.
4. Allegations of the respondent before the District Forum were that being a Government servant and beneficiary of Central Government Health Scheme (CGHS), took his wife, who developed a serious gynecological problem on 04-12-2003, to the CGHS dispensary No. 40 at Jangpura, New Delhi where the C.M.O. referred her to a specialist at Safdarjung Hospital. The Safdarjung Hospital referred the patient to some approved CGHS Centre as the private ward was not available there and the respondent then took his wife to the AIIMS on 24-12-2003 where the treatment was started. On 28-02-2004 Dr. K.K. Roy of AIIMS prescribed booking for a private ward for the operation. The AIIMS asked the respondent to try for a room on 13-03-2004/17-03-2004 and ultimately on 26-03-2004 he was asked to deposit Rs. 12,200/- towards admission and other charges and his wife was admitted on 26-03-2004 and was allotted room No. 7 in the private ward.
On 27-03-2004 at about 8.30 a.m. when Dr. K.K. Roy came on round, he ordered the patient to vacate the room as the same was required for some VIP. The respondent protested but in vain. AIIMS charged Rs. 1,300/- for the room for one night and refunded the balance amount.
Thereafter the respondent continued visiting AIIMS from time to time but Dr. Rachna asked him to keep on trying for the room. In the meantime condition of the respondents wife started deteriorating and he again contacted the CMO of the CGHS dispensary and explained to her the treatment received at AIIMS. The CMO advised the respondent to take his wife for treatment to Sir Ganga Ram Hospital, New Delhi as this hospital wa s also one of the recognized hospitals by the CGHS. Under the circumstances the respondent took his wife to Sir Ganga Ram Hospital on 16-04-2004 where Dr. M. Kochar, Sr. Consultant (OBST & Gyne) diagnosed her as post menopausal bleeding and advised for immediate operation in emergency to exclude cancer of uterus and ultimately she was operated on 26-04-2004 and was discharged on 29-04-2004. Respondent preferred a claim of Rs. 29,617/- with the appellant on 08-05-2004/14-05-2004 along with all relevant papers. However, vide letter dated 27-07-2005 appellant rejected the claim of the respondent on the ground that prior permission was not taken for treatment at a hospital not recognized by the CGHS.
5. In identical cases we have taken a view that under Central Services (Medical Attendance) Rules, Government servant is entitled for treatment free of charge at Government Hospital or empanelled hospital for special treatment and is entitled to full reimbursement of the amount spent on his treatment.
6. We have also taken a view that no Government authority has power to give administrative instructions or notify a circular limiting medical expenses to its members which is not at all in consonance with the statutory rule known as Central Services (Medical Attendance) Rules providing that every Government servant is entitled to get treatment free of charge at Government hospitals or empanelled hospital for special treatment.
7. We fail to understand that the simple words free of charge were not understood by the authorities in the right perspective. Once the Government or any public authority or statutory authority decides to bring private hospitals on their panel may be for any reason then it has no power to limit the expenses in these hospitals under the garb of package rates. To us it appears that private hospitals are empanelled to get the treatment either in case of emergency or in case where effective treatment is not available in the Government hospital or hospital run by an Organisation of which the employee is member of the scheme like Central Govt. Health Scheme or medical benefit of retired scheme.
8. We even go to the extent that such an employee who under Central Services (Medical Attendance) Rules is entitled for free treatment is entitled for reimbursement to the entire expenses incurred by him in the non-empanelled hospital if he lands there in emergency and life threatening situation. In such an eventuality the general statutory rule entitling the employee for reimbursement of entire expenses is applicable and no other instructions or O.M.s etc. are applicable as the latter have no statutory force.
9. In our view, the purpose and objective of bringing the private hospitals on the panel is to lighten the burden of Govt. hospitals and for better protection of health of the employee and to subject a patient/employee to recommendation of the Govt. hospitals or the reference by Govt. dispensary is also against the very object for which the private hospitals are empanelled.
10. Once an organization or an employer extends the medical benefits to its employees free of charge it has to reimburse the entire expenses incurred by him irrespective of the fact whether he receives a treatment at Government or at the empanelled hospital and in case of emergency at any other hospital. If such a facility is available to employee of private organization and public sector undertaking why the poor government servants should be discriminated.
11. This view of ours has been subscribed by Delhi High Court in some of the judgments which are as under:-
(i) J.C. Sindhwani Vs U.O.I. 2005 VIII AD Delhi 565;
(ii) Milap Singh Vs UOI 2004 V AD ( Delhi) 529;
(iii) Prithivi Raj Chopra Vs UOI 2004 III AD Delhi 569;
and
(iv) Sh. J.K. Saxena Vs. Govt. of NCT of Delhi.
reported in Delhi Law Times 117(2005)DLT451.
12. Case of the respondent is a very hard case. He took his wife from pillar to post. It is unfortunate that the poor Government servant for whom Govt. hospitals or AIIMS have been established was asked to vacate the room for accommodating a V.I.P. It appears we still have not shed off subjugated mentality. Such persons who indulge in such an arbitrary conduct to curry favour, needs to be dealt with sternly.
13. In this regard observations of Supreme Court in Ghaziabad Development Authority Vs. Balbir Singh and Lucknow Development Authority Vs. M.K. Gupta are quote-worthy and are as under:-
(i) Ghaziabad Development Authority Vs. Balbir Singh (2004) 5 Supreme Court Cases 65 The word compensation is of a very wide connotation. It may constitute actual loss or expected loss and may extend to compensation for physical, mental or even emotional suffering, insult or injury or loss. The provisions of the Consumer Protection Act enable a consumer to claim and empower the Commission to redress any injustice done. The Commission or the Forum is entitled to award not only value of goods or services but also to compensate a consumer for injustice suffered by him. The Commission/ Forum must determine that such sufferance is due to malafide or capricious or oppressive act. It can then determine amount for which the authority is liable to compensate the consumer for his sufferance due to misfeasance in public office by the officers. Such compensation is for vindicating the strength of law.
It acts as a check on the arbitrary and capricious exercise of power. It helps in curing social evil. It will hopefully result in improving the work culture and in changing the outlook of the officer/public servant. No authority can arrogate to itself the power to act in a manner which is arbitrary. Matters which require immediate attention should not be allowed to linger on. The consumer must not be made to run from pillar to post. Where there has been capricious or arbitrary or negligent exercise or non-exercise of power by an officer of the authority, the Commission/Forum has a statutory obligation to award compensation. If the Commission/Forum is satisfied that a complainant is entitled to compensation for loss or injury or for harassment or mental agony or oppression, then after recording a finding it must direct, the authority to pay compensation and also direct recovery from those found responsible for such unpardonable behaviour.
(II) Lucknow Development authority Vs. M.K. Gupta (1994) 1 Supreme Court Case 243 It is, therefore, necessary that the Commission when it is satisfied that a complainant is entitled to compensation for harassment or mental agony or oppression, which finding of course should be recorded carefully on material and convincing circumstances and not lightly, then it should further direct the department concerned to pay the amount to the complainant form the public fund immediately but to recover the same from those who are found responsible for such unpardonable behaviour by dividing it proportionately where there are more than one functionaries.
14. Miseries of respondent did not stop at AIIMS. He took his wife to different Government hospitals and ultimately her condition deteriorated to such an extent that she had to be taken to a private hospital viz. Ganga Ram Hospital. It was a case of emergency and appellant had no business to add insult to the injury.
15. Foregoing reasons persuade us to dismiss the appeal being devoid of merit. We hope the appellant shall keep the observations of Supreme Court in mind while dealing with such cases.
16. Impugned order shall be complied with within one month from the date of receipt of this order.
17. FDR/Bank Guarantee, if any, furnished by the appellant shall be returned forthwith after completion of due formalities.
18. A copy of the order as per the statutory requirements be forwarded to the parties free of charge and also to the concerned District Forum and thereafter the file be consigned to Record Room.
19. Announced on the 20th February, 2008.
(Justice J.D. Kapoor) President (Rumnita Mittal) Member jj