Date of Filing : 03/03/2016

Order No.  15  dt.  08/02/2018

       The case of the complainant in brief is that the mother of the complainants was admitted to o.p. no.1 nursing home and she expired on 23.12.14 and she had been in the said nursing home from 7.2.14 to 23.2.14 as an indoor patient. The o.p. no.1 was empanelled as health care organization under the West Bengal Health Scheme, 2008. The complainants’ mother was beneficiary of WBHS, 2008 and was admitted on 17.2.14 for her treatment and the complainants had to bear the expenses of Rs.1,09,005/-. The o.p. no.1 demanded the charges like that all the non empanelled HCO instead of Rs.62,115/- as admissible to the beneficiary in question of the said WBHS, 2008 unfairly and illegally. As per the contractual obligation arisen out of the memo of agreement consigned between Govt. of West Bengal and o.p. no.1 which specifically emphasizes that ensuring of uninterrupted benefits of West Bengal Health Scheme to the beneficiary. The validity of the empanelment of o.p. no.1 remained continuing without any break for a single day. The complainant repeatedly requested the o.p. no.1 for refund of the charges taken from the complainant in excess of the charges, but o.p. no.1 refused to pay the same. On the basis of the said fact the complainant filed this case praying for direction upon the o.ps. to refund the amount of Rs.46,890/- towards the excess charges as well as compensation of Rs.25,000/- and litigation cost of Rs.10,000/-.

            The o.p. no.1 contested this case by filing w/v and denied all the material allegations of the complaint. The o.p. no.1 denied that the complainants were compelled to pay Rs.1,09,005/- to o.p. no.1 for their deceased mother. The o.p. no.1 also denied that the validity of empanelment of o.p. no.1 remained continuing without any break for validity even for a single day during the treatment of the mother of the complainants. It was further stated that Adity Roy, 82 years old was admitted to o.p. no.1 nursing home in a very critical condition on 17.2.14 under Dr. Somayug Bhowmik and unfortunately even after rendering the best possible care and treatment the patient expired on 23.2.14. While the patient was admitted in the said nursing home the empanelment of o.p. no.1 was not existing with WBHS 2008 because of the fact that the 1^st lap extension period ended on 31.1.14. The patient party had the knowledge of the fact which was informed by the staff of the Nursing Home and inspite of knowing the said fact they wanted to avail of the benefit of WBHS 2008. Having learned this, the patient party opted to go for and to get treatment of the patient as a general patient under the general standard rates and charges of o.p. no.1. Accordingly, an estimated cost for treatment of the patient was given to the patient party; they voluntarily paid the bills, raised objection although without any dispute or claim. The o.p. no.1 handed over all the necessary papers and the documents to the complainants including issued Form D3 and complied with all other facilities for reimbursement from WBHS 2008. It is now learned that the complainants have received Rs.62,115/- from Govt. of West Bengal under the said scheme at the rate applicable in the particular case. On the basis of the said fact o.p. no.1 prayed for dismissal of the case.

            In spite of receipt of notice the o.p. no.2 did not contest this case by filing w/v and as such, the case has proceeded ex parte against the o.p. no.2.

            On the basis of the pleadings of parties the following points are to be decided:

1. Whether the complainants’ mother was admitted to the nursing home of o.p. no.1?
2. Whether the said nursing home was empanelled with WBHS 2008 at the relevant point of time?
3. Whether there was any deficiency in service on the part of o.ps.?
4. Whether the complainant will be entitled to get the relief as prayed for?

Decision with reasons:

            All the points are taken up together for the sake of brevity and avoidance of repetition of facts.

            Ld. lawyer for the complainant argued that the mother of the complainants was admitted to o.p. no.1 nursing home and she expired on 23.12.14 and she had been in the said nursing home from 7.2.14 to 23.2.14 as an indoor patient. The o.p. no.1 was empanelled as health care organization under the West Bengal Health Scheme, 2008. The complainants’ mother was beneficiary of WBHS, 2008 and was admitted on 17.2.14 for her treatment and the complainants had to bear the expenses of Rs.1,09,005/-. The o.p. no.1 demanded the charges like that all the non empanelled HCO instead of Rs.62,115/- as admissible to the beneficiary in question of the said WBHS, 2008 unfairly and illegally. As per the contractual obligation arisen out of the memo of agreement consigned between Govt. of West Bengal and o.p. no.1 which specifically emphasizes that ensuring of uninterrupted benefits of West Bengal Health Scheme to the beneficiary. The validity of the empanelment of o.p. no.1 remained continuing without any break for a single day. The complainant repeatedly requested the o.p. no.1 for refund of the charges taken from the complainant in excess of the charges, but o.p. no.1 refused to pay the same. On the basis of the said fact the complainant filed this case praying for direction upon the o.ps. to refund the amount of Rs.46,890/- towards the excess charges as well as other reliefs.

            Ld. lawyer for the o.p. no.1 in his argument denied that the complainants were compelled to pay Rs.1,09,005/- to o.p. no.1 for their deceased mother. The o.p. no.1 also denied that the validity of empanelment of o.p. no.1 remained continuing without any break for validity even for a single day during the treatment of the mother of the complainants. It was further stated that Adity Roy, 82 years old was admitted to o.p. no.1 nursing home in a very critical condition on 17.2.14 under Dr. Somayug Bhowmik and unfortunately even after rendering the best possible care and treatment the patient expired on 23.2.14. While the patient was admitted in the said nursing home the empanelment of o.p. no.1 was not existing with WBHS 2008 because of the fact that the 1^st lap extension period ended on 31.1.14. The patient party was informed about the fact by the staff of o.p. no.1 when they wanted to avail of the benefit of WBHS 2008. Having learned this, the patient party opted to go for and to get treatment of the patient as a general patient under the general standard rates and charges of o.p. no.1. Accordingly, an estimated cost for treatment of the patient was given to the patient party; they voluntarily paid the bills, raised objection although without any dispute or claim. The o.p. no.1 handed over all the necessary papers and the documents to the complainants including issued Form D3 and complied with all other facilities for reimbursement from WBHS 2008. It is now learned that the complainants have received Rs.62,115/- from Govt. of West Bengal under the said scheme at the rate applicable in the particular case. On the basis of the said fact o.p. no.1 prayed for dismissal of the case.

            Considering the submissions of the respective parties that the complainants’ mother became seriously ill and she was admitted to o.p. no.1 nursing home. After undergoing treatment for several days, unfortunately the mother of the complainants expired. It appears from the materials on record that the mother of the complainants was 82 years old  and in spite of best effort made by o.p. no.1 she could not survive. At the time of admission of the patient in the said nursing home, the staff of o.p. no.1 informed the complainants that the nursing home was not empanelled with WBHS 2008. In spite of knowing the said fact the complainants admitted their mother and she was treated and normal charges were claimed by o.p. no.1. The o.p. no.1 also issued Form D3 and complied all other formalities, on the basis of which the complainants reimbursed the medical bill from Govt. of West Bengal under WBHS 2008 to the tune of Rs.62,115/-. The complainants have filed this case praying for balance amount paid by them. But since the charges varied as per the charges outside under WBHS 2008 and the charges made by the nursing home to an ordinary patient, thereby we hold that o.p. no.1 rightly claimed the amount which was paid by the complainants without raising any objection and simply because higher amount had to be paid by the complainants than that of the amount the complainants will be entitled as per WBHS 2008, for that reason it cannot be said that there was any deficiency in service on the part of o.p. no.1 and the complainants will be entitled to get the reimbursement of the amount from them. In view of such fact we hold that the case filed by the complainant has got no merit and the complainants will not be entitled to get any relief as prayed for. Thus all the points are disposed of accordingly.

            Hence, ordered,

            That the CC No.97/2016 is dismissed on contest against the o.p. no.1 and dismissed ex parte against the o.p. no.2 without cost.