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C.G.H. Scheme:

13. For achieving the goal of Welfare State and for discharging its obligation to its employees and as per the assurance in the Directive Principle of State Policy, especially of security in old age, the Central Government has framed CGH Scheme as a welfare measure and is part and parcel of service benefits available to the employees in service and retired employees. This is clear from the Introductory Chapter of the C.G.H.Scheme which provides for eligibility for getting the benefit under the Scheme. It has been provided that employees and pensioners residing in the areas covered by the scheme and their family members can also avail the benefits of the scheme if they are totally dependent on the employee or/pensioner. It also provides that facilities can be availed at CGHS Hospitals/Dispensaries, Government Hospitals/Referral Hospitals, and in order to provide comprehensive and for certain specialized treatments not available in Government Hospital certain private hospitals have also been recognized under the scheme. It also provides that pensioners residing in non-CGHS areas are also entitled to fixed medical allowance of Rs. 100/- p.m. Such pensioners/employees availing CGH Scheme are required to make a nominal contribution every month as provided in the scheme. Not only this, he is also entitled to have traveling allowances in case any medical treatment involves travel. It is not necessary to discuss the other provisions.

Facts:

17. Keeping this scheme in mind, now would refer to the facts of the present case.

18. It is the case of the Complainant that he is the beneficiary of CGHS facilities for which purpose he had deposited a sum of Rs. 630/- with the CGHS, as prescribed in the orders of the Ministry of Health, Govt. of India. In order to provide better medical facilities, some nursing homes and private hospitals are prescribed by the Government. The Medical Officer of the CGHS dispensary, keeping in view the seriousness of the illness of the patient, can refer the patient to a better equipped nursing home or private hospital, which is recognised by the CGHS. The medicines prescribed by the specialist of the nursing home/private hospital, after the discharge of the patient, have to be supplied by the CGHS to the patient, and the Medical Officer cannot change the prescription on his own without the concurrence of the specialist of the private hospital/nursing home.

19. On 27.7.1997, the Complainant's wife had a sudden heart attack. The Medical Officer of the CGHS Dispensary referred her to Madhu Raj Nursing Home, a CGHS recognised hospital, as her condition was very grave. In that hospital, she was treated by Dr.D.P.Agrawal, a heart specialist. She was discharged on 2.8.1997 and certain medicines were prescribed by the Heart Specialist. The Complainant had paid the hospital bills amounting to Rs. 6,400/- and submitted them on 12.8.1997 to the Additional Director of the CGHS for reimbursement. It is the say of the Complainant that the prescribed medicines for one week were issued to him by the CGHS dispensary, and, the medicines for the next week were refused.

20. The Medical Officer then referred the patient to Helot Hospital on 13.8.1997 and the patient was under the supervision of Dr.Saxena for three months. Despite the treatment, the Complainant's wife could not recover and her condition deteriorated. He, therefore, requested the CGHS authorities to refer her to Dr.Agrawal, Heart Specialist of Madhu Raj Nursing Home. That request was turned down by the medical officers. She, thereafter, suddenly died on 5.9.1997.

21. It is the case of the Complainant that this was negligence and deficiency in service by the medical officer of the CGHS, R.K.Nagar Dispensary. He, therefore, prayed that he may be reimbursed the expenses of Rs. 6,400/- incurred at Madhu Raj Nursing Home and be paid damages to the tune of Rs. 4 lakhs.