Delhi

StateCommission

A/604/2015

SH. POORAN CHAND AGARWAL - Complainant(s)

Versus

CHIEF MEDICAL SUPDT. N. RLY. HOSPITAL & ANR. - Opp.Party(s)

21 Apr 2016

ORDER

 

 

IN THE STATE COMMISSION : DELHI

(Constituted under Section 9 of the Consumer Protection Act, 1986)

 

Date of Decision:18.05.2016

 

First Appeal- 604/2015

 

(Arising out of the order dated 20.11.2015 passed in Execution Petition No. M-8616/14 by the District Consumer Disputes Redressal Forum (West), Janak Puri, New Delhi)

Pooran Chand Agarwal,

A3/98, Janakpuri,

New Delhi-58.

•  

Versus

1. Chief Medical Superintendent,

14. Rly. Hospital, S.P.M. Marg,

Delhi-06.

     

2. Shri V.K. Gupta,

G.M., N. Rly., B. House,

New Delhi-01.

 

3. Chairman, Rly. Board,

Rail Bhawan,

New Delhi-01.

 

 ….Respondents

CORAM

Justice Veena Birbal, President

Salma Noor, Member

 

1.     Whether reporters of local newspaper be allowed to see the judgment?

2.      To be referred to the reporter or not?

Justice Veena Birbal, President

 

1. This is an appeal wherein challenge is made to order dated 20.11.15 passed by the Consumer Disputes Redressal Forum (West), Janakpuri, New Delhi (in short, “the District Forum”) in M-8616/2014.  By the aforesaid order, the Ld. District Forum has dismissed the petition for execution of the order dated 7.5.14 passed by CDRF(North) in CC No.211/13.
2. The relevant facts are as under:

 The appellant/complainant had filed a complaint against respondents/OPs under Section 12 of the Consumer Protection Act, 1986 (in short, the “Act”) alleging therein that he was the retired employee of the Railways.  He had contributed to the Health Scheme run by the respondent for its retired employees and was also issued necessary Medical Identity Card-000692 under Retired Employee Liberalized Health Scheme on payment of Rs.2,200/- (one month’s salary).  On 28.9.11, he had felt giddiness and there was profuse outflow of blood in urine.  He was admitted under emergency to Sir Ganga Ram Hospital which was near his residence.  It was alleged that under the aforesaid scheme, there was no scope available for any railway beneficiary to go to any private hospital on his/her own volition.  It was alleged that he was admitted in Sir Ganga Ram Hospital on 28.9.11 as an emergency case.  After he was discharged, he was not given the reimbursement of amount spent by him on his treatment in the said hospital. 

       The claim was opposed by the respondents/OPs on the ground that it was not a case of ‘emergency’ and as such the appellant/complainant was not entitled for any reimbursement.

       After hearing the parties and considering the material on record, the Ld. District Forum disposed of the Complaint Case No.211/2013 vide order dated 7.3.14 requesting the Medical Superintendent, Maulana Azad Medical College, New Delhi, to constitute a Board of medical experts and give opinion if the case of the appellant/complainant was that of real medical emergency necessitating his immediate admission in Sir Ganga Ram Hospital.  The appellant/complainant was directed to submit medical papers available with him in this regard to the Medical Superintendent of Maulana Azad Medical College. It was ordered that in case the Medical Board of Maulana Azad Medical College comes to conclusion that case of appellant/complainant was not of medical emergency, in that case complainant was not to be given reimbursement.

3. The aforesaid order was not challenged by the respondents/OPs and had become final.

4. As per directions given in the aforesaid order, the matter was referred to Medical Superintendent, MAMC, New Delhi for constituting a Medical Board.  A Board of 3 senior doctors was constituted which gave its report.

5. On the basis of aforesaid report, the appellant/complainant had filed an execution petition before the Ld. District Forum seeking reimbursement of expenses incurred in Sir Ganga Ram Hospital.

6. The said petition was opposed by the respondents/OPs by alleging that as per the opinion of the Medical Board, it was not a case of medical emergency, as such the appellant/complainant was not entitled for reimbursement.
7. After considering the submissions of the parties, Ld. District Forum had dismissed the execution petition by holding that as per medical opinion, it was not a case of medical emergency and the appellant/complainant was not entitled for reimbursement of amount and interest thereon.  The execution petition was accordingly dismissed vide impugned order dated 7.5.14.      
8. Aggrieved with the aforesaid order, present appeal is filed.
9. Appellant/complainant is a senior citizen of 80 years of age.  He has argued the appeal himself.  Appellant has contended that he was suffering from haematuria problem and was under the treatment of Railways Hospital for the past two years.  It is contended that facilities of surgical treatment for the haematuria was not available in the railway hospital as CMO had given in writing that no Urologist was available in the hospital.  It is submitted, in these circumstances, as an emergency case, he was admitted in Sir Ganga Ram Hospital on 28.9.11.  It is contended that Ld. District Forum has wrongly observed that as per opinion, the case of appellant/complainant was not that of real medical emergency.  It is contended that reading the entire medical opinion, it cannot be said that the case of the appellant/complainant was not that of medical emergency.  It is contended that impugned order be set aside and respondents be directed to make payment.
10. On the other hand, Ld. Counsel for the respondents has argued that the case of the appellant/complainant was not of medical emergency as per the opinion of the Board, as such appellant/complainant is not entitled for reimbursement and the Ld. District Forum has rightly dismissed the execution petition.
11. We have heard the parties and perused the material on record including the opinion given by the Medical Board. 
12. The opinion is reproduced as under:

 

“1.       As per item No.10 of the Order of Consumer Court dated 1^2th May 2014, the board has been asked to give opinion on the limited matter of whether the condition for which the patient was admitted to Sir Ganga Ram Hospital was an emergency or not in medical terms.

 

2. That, after having gone through the records so submitted; the patient was admitted on 28.09.2011 by Dr. Wadhwa on emergency basis and the reason given for admission was haematuria.

 

3. That, any medical or surgical emergency entails that either the suffering of the patient is relieved, or surgery/procedure is done to save the life or part of the body, or to prevent further worsening of the condition.

 

4. That, in this case, though haematuria is a medical emergency, there is no record to show that any procedure was done for relieving haematuria for the next two days, and he was directely taken up for surgery on 01.10.11 during which a definitive procedure for prostate enlargement was done.”

 

13. It is stated in the opinion that the haematuria is a medical emergency.  It is further stated in the opinion that on going through the records of the Sir Ganga Ram Hospital, the patient was admitted on an emergency basis as it was a case of haematuria.  It is further observed by the Board that any medical or surgical emergency entails that either the suffering of the patient is relieved, or surgery/procedure is done to save the life or part of the body or to prevent further worsening of the condition.  It has been further observed that after two days of admission, surgery for prostate enlargement was done.
14. It may be mentioned that enlarged prostrate is one of the causes of the haematuria. Reference is made                to www.uroassocgb.com, the website of Urology Associates of Green Bay, U.S.A.  The Medical Board has not categorically stated in the opinion that it was not a case of medical emergency.  The opinion has to be read in its entirety.  Reading the entire opinion, it cannot be said that the case of the appellant/complainant was not that of medical emergency specially when appellant/complainant was operated upon for prostate enlargement on 1.10.11.
15. Accordingly we accept the appeal and set aside the impugned order and allow the execution petition No.M-8616/2014 and direct the respondent/OP to reimburse the amount of Rs.1,22,659/- i.e. the amount which appellant/complainant had paid in Sir Ganga Ram Hospital along with the interest @ 6% from 1.1.12 till the payment is made.
16. Respondent/OP shall make the aforesaid payment within 8 weeks of receipt of this order.
17. A copy of this order as per statutory requirement be forwarded to the parties free of charge and also to the concerned District Forum.  The record of the District Forum be also sent back forthwith.  Thereafter the file be consigned to record room.

 

(Justice Veena Birbal)

President

 

 

(Salma Noor)

Member