KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

VAZHUTHACAUD, THIRUVANANTHAPURAM

APPEAL No. 221/2020

JUDGMMENT DATED: 03.08.2023

(Against the Order in C.C. 295/2014 of CDRF, Thrissur)

PRESENT:

HON’BLE JUSTICE SRI. K. SURENDRA MOHAN              : PRESIDENT

SMT. BEENA KUMARY. A                                                          : MEMBER

APPELLANT:

Medical Superintendent-Managing Director, Thrissur Co-operative Hospital Ltd. No. R 306, Shornur Road, Thrissur.

(By Advs. N. Krishna Prasad & N. Anand)

                                                Vs.

RESPONDENTS:

1. C.M. Shaiju, Pullokkaran House, Ammadam P.O, Thrissur-680 563.

2. Jincy, Pullokkaran House, Ammadam P.O, Thrissur-680 563

JUDGMENT

SMT. BEENA KUMARY A. : MEMBER

The appellant is the opposite party in C.C. No. 295/2014 on the file of the Consumer Disputes Redressal Forum, Thrissur (District Forum for short).  The respondents are the complainants, whereby the appellant was found guilty of deficiency in service to the respondents, in so much benefits of Rashtriya Swasthya Bima Yojana were not extended to them.  The District Forum directed the appellant to pay a sum of Rs. 12,000/- to the complainants along with interest @ 12% per annum and Rs. 2,000/- towards costs.

2.  As per the terms of the scheme Rashtriya Swasthya Bima Yojana every BPL family holding a yellow ration card is entitled to get a smart card containing their finger prints and photographs by paying a registration fee of Rs. 30/- which enables them to receive inpatient medical care up to Rs. 30,000/- per family per year in any of the empanelled hospitals.  The terms of the scheme covered only patients who used general ward and not extended to cases where patients chose private room.  The appellant hospital was among the private hospitals where treatment was being given under the scheme. 

3.  Brief facts of the case are as follows:  The 2^nd respondent was admitted to the hospital for delivery on 28.08.2013.  On 30.03.2013 a girl child was born to her.  Till delivery the complainant was admitted in the general ward.  After the delivery the complainant was shifted to a room.  The complainants stated that the hospital authorities compelled them to take a room for their further safety. 

4.  The child having developed symptoms of jaundice was shifted to NICU on 01.04.2013 for further observation.  When its condition improved, 2^ndrespondent was discharged on 02.04.2013 and the child on 03.04.2013.  The respondents were charged general ward rates for 28.03.2013 and 29.03.2013 and room charges for 30.03.2013 and 31.03.2013.  At the time of discharge the opposite party issued a bill of Rs. 12,000/- for the hospital treatment and room rent.  The complainant alleged that as per the scheme the complainant was entitled to get free treatment, but the opposite party illegally collected charges from them.  Hence the complainant issued a lawyer’s notice to the opposite party.  The opposite party sent a reply to that notice.  But no steps have been taken by them to redress the grievances of the complainants.  Hence the complaint was filed. 

5.  Opposite party filed version contending as follows:  The benefits of the scheme were not available to persons undergoing treatment in wards other than general wards.  The respondents at their own willingness had opted to forgo the benefits of the scheme by admitting themselves in a room.  The complainants have given their written consent that they did not want the benefits under the scheme and they want only a room.  The opposite party further stated that there was no deficiency in service from their side.  They provide all kinds of treatment for the mother and child.  The complainants have no case that there was any kind of deficiency in the treatment given to them.  Hence, they prayed for dismissal of the case with compensatory costs.

6.  Both sides filed chief affidavits.  No oral evidence was adduced by them.  From the side of the complainant 9 documents were marked as Exts. P1 to P9.  From the opposite party’s side hospital records are marked as Exts. R1 and R2.  On the basis of the affidavit filed by both parties and evidence produced by them, the District Forum found that there was deficiency in service from the side of the opposite party and therefore the opposite party has been directed to pay Rs. 12,000/- charged by them as hospital expenses to the complainant and Rs. 2,000/- as costs. 

7.  The finding of the District Forum was that the opposite party denied the medical benefits under the scheme to the complainants.  The opposite party compelled the complainant to take room for better treatment and not provided the general ward.  The complainants were fully aware that as per the scheme any person who takes room for treatment did not get the free medical benefit.  But at that crucial time the complainants were forced to take the room.  The act of the opposite party in rejecting the benefits under the scheme amounted to deficiency in service under the purview of the Consumer Protection Act and therefore the opposite party was liable to pay the amount.  Aggrieved by the impugned order the opposite party has filed this appeal. 

8.  The appellant contended that there was no compulsion from their side to the complainants for taking the room.  It was the complainant who requested for room after the delivery for better treatment of the baby and mother.  They expressed their consent in writing in Ext. R1 hospital record.  Therefore no deficiency in service occurred from their side. They further argued that the District Forum had not allowed time for cross examining the complainant.  It is seen in the order that the complainant was absent till the date of hearing of the complaint.   The order passed by the District Forum is not on the basis of merit, but only on the basis of the sympathy that the complainants were poor and belonging to Below Poverty Line.  So they prayed for setting aside the order of the District Forum and allow the appeal. 

9.  We have gone through the entire records on file.  From the arguments and evidence of the complainant we understand that the complainants were fully aware that as per the terms of the medical insurance policy only patients who treated in a general ward were covered and not extended to cases where patients chose a private room.  But the complainants had taken room and thereby they lost their claim under the policy.  They have given their consent in writing to the hospital authorities that “ഞങ്ങൾക്ക് RSBY ആനുകൂല്യംവേണ്ട Room മതി” (Ext.R1).  For that reason the opposite party charged hospital expenses from the complainants.  The complainants argued that the opposite party compelled them to take the room, but they were fully aware that if they chose the room, they would lose their benefit.  In those circumstances, they ought to have resisted that compulsion.  The complainants had availed the room facility after delivery and therefore they are not entitled to get the benefit under the scheme.  Hence the complainants violated the policy condition.  So they cannot make any claim under the scheme. 

10.  Here in this case the delivery of the 2^nd complainant happened without any complication.  The hospital authorities have given proper treatment to the mother and baby.  The complainants have no complaint regarding the treatment.  They have no case that there was any deficiency in the treatment given to them.  In these circumstances, we find that the order passed by the District Forum is without any merits.  There was no deficiency in service from the side of the opposite party. 

In the result, the appeal is allowed.  The order passed by the District Forum dated 01.07.2020 in C.C. No. 295/2014 is set aside.  No order of costs.

JUSTICE K. SURENDRA MOHAN  : PRESIDENT

                                                                        BEENA KUMARY. A         : MEMBER  

jb