Document Fragment View

Matching Fragments

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.

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.

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:-