ORDER

(Per: Mr. D.K. Tyagi, Member):

          This is an appeal under Section 15 of the Consumer Protection Act, 1986 against the order dated 30.07.2014 passed by the District Forum, Dehradun in consumer complaint No. 41 of 2013. By the order impugned the District Forum has allowed the consumer complaint against the opposite party No. 2 & 3 (jointly or separately) and has directed them to pay to the complainant a sum of Rs. 13,200/- alongwith interest @ 7% per annum from the date of filing the consumer complaint, Rs. 5,000/- as compensation and Rs. 3,000/- towards litigation expenses, within two months. 

2.       Briefly stated the facts of the case as mentioned in the consumer complaint are that the complainant Dr. Ramsharan Singh Chauhan is serving as ENT Surgeon in District Hospital, Dehradun under Uttarakhand Health Service for the last so many years.  In the year, 2011 the Uttarakhand State has started a Health Smart Card (U-Health Card) scheme under an agreement with M/S M.D. India Health Care Service Pvt. Ltd., Pune for cash less treatment of employees of the State Government, for which employees of Uttarakhand State shall voluntarily contribute a definite amount of money from their salary and thereafter M/S M.D. India Health Care Service Pvt. Ltd., Pune shall issue U-Health Card to the employees as well as to the dependents of the employees. In Case of any treatment U-Health Card holder and dependent members of employee shall avail cash less treatment in all Government Hospital as well as private hospitals empaneled by the State Government. Combined Medical Institute Hospital (CMI Hospital) is also included in the listed hospitals.  The complainant is the member of M/S M.D. India Health Care Service Pvt. Ltd., Pune in the year 2011 and contributed Rs. 5,000/- from his salary, which was deducted by the department.  On 24.08.2011, the complainant became ill due to disease Deep Vein Thrombosis and for the treatment of the said disease, he contacted CMI, Hospital, a listed hospital situated at 54, Haridwar Road, Dehradun.  The complainant was hopeful that his treatment will be cash less under the terms and conditions of the U-Health Card, but CMI, Hospital charged Rs. 13,200/- from him towards some investigation against the terms of U-Health Card.  It was told by the CMI, Hospital that this amount shall be refunded to the complainant, when received from Uttarakhand State/ M/S M.D. India Health Care Service Pvt. Ltd., Pune.   The complainant was discharged from the hospital on 26.08.2011, but no amount has been refunded to him by CMI, Hospital so far ever after 15 months of the treatment. The complainant contacted State Nodal Officer Dr. (Smt.) Saroj Naithani on 22.06.2012.  Even then after 7 months of treatment no money has been refunded to the complainant.  CMI, Hospital has charged Rs. 13,200/- against the terms and conditions of U-Health Card scheme.  The complainant visited CMI, Hospital ten times and also contacted the State Nodal Officer several times, even then no money has been refunded to the complainant. The complainant sought refund of Rs. 5,000+13,200 with Rs. 1.00 lac for mental agony and                Rs. 10,000/- for litigation expenses.

3.       The opposite party No. 1 has filed written statement and pleaded that it is admitted that CMI is empaneled with M/S M.D. India Health Care Service Pvt. Ltd., Pune.  It is also admitted that the complainant was admitted in CMI, Hospital on 24.08.2011 for his treatment.  The answering opposite party has admitted that the complainant was discharged from CMI, Hospital on 26.08.2011 after proper treatment.  In additional pleas, the answering opposite party has pleaded that CMI, Hospital is a reputed multi-specialty hospital of Dehradun providing medical facility to the people of Dehradun and neigbhouring cities for last more than 13 years and is affiliated with many Government and private agencies including U-Health Scheme of Uttarakhand Government. The complainant was admitted in CMI, Hospital on 24.08.2011 for his treatment of acute Deep Vein Thrombosis lower and upper limb and was treated by Dr. Praveen Jindal.  Dr. Praveen Jindal advised complainant various pathological test such as Protein-C, Protein S, Antithronbin-III, LFT and Factor V Leiden, out of which tests for Protein-C, Protein S, Antithronbin-III, LFT and Factor-V Leiden were not available at CMI, Hospital.  Accordingly, the complainant was informed and was told that if he desires he can get the same done by him on his own from any other pathology.  The complainant requested the CMI, Hospital to get the same done through some agency, because if the same were done by the complainant himself, he may not get the benefit under U-Health card scheme.  The CMI Hospital had informed the complainant that the complainant will have to bear the charges of the pathological tests which will be conducted outside and when the payment of bill regarding treatment of complainant would be received by the CMI, Hospital, the amount charged from the complainant would be refunded to the complainant.  The complainant consented to the above arrangement and the said tests were sent to Dr. Lal Path labs for investigation.  These tests costs Rs. 13,200/- which was received by CMI, Hospital from the complainant and paid to Dr. Lal Path labs. The complainant was treated to his satisfaction and was discharged on 26.08.2011.  The total bill regarding treatment of the complainant was Rs. 22,059/-, which was sent to opposite party No. 3 on 16.09.2011 for payment, but till date no amount has been received by CMI, Hospital in respect of same. The CMI, Hospital has not charged a single penny for the services provided by it from the complainant which includes doctor’s fee, room rent, medicines and investigation, which were conducted in the hospital itself.  Only the charges for the investigations conducted outside were taken as per arrangement mentioned above with the consent of complainant. That entire bill regarding treatment of complainant is still pending and stands unpaid.  Answering opposite party is not the Managing Director of Combined Medical Institute as alleged in the complaint.  He is only one of the Directors of the Combined Medical Institute, which is a private limited company.  There is no relationship of service provider and consumer between answering opposite party and the complainant as the answering opposite party in his personal capacity never rendered any services to the complainant.  There is no privity of contract between answering opposite party and the complainant.  The answering opposite party cannot be made liable in his personal capacity for any misconduct or deficiency in service of the said company.  The complainant has no cause of action against the answering opposite party for present complaint. The complainant has malafidly impleaded answering opposite party in the present case just to harass and humiliate. 

4.       The opposite party No. 2 has filed written statement and pleaded that the complainant has not produced certificate of his contribution in U-Health Card scheme so far despite reminders to him.  The file of the complainant was returned from the account section only on the condition that the complainant has not produced contribution certificate in the scheme. The answering opposite party wrote letters dated 22.02.2012 and 12.02.2012 to the complainant to produce contribution certificate, even then the complainant did not produce the same and, therefore, bills of the complainant were not reimbursed.  The complainant has produced bills of other pathology labs and bills of Lal Path labs, Dehradun.  These labs are not empaneled in the U-Health Card scheme of M/S M.D. India Health Care Service Pvt. Ltd., Pune. In these conditions, the complainant is not entitled for the payment of bills of Lal Path lab.  The complainant is only entitled for bills of empaneled hospitals.  A bill of Rs. 16,000/- was produced before M/S M.D. India Health Care Service Pvt. Ltd., Pune, who passed the bill, but the U-Health Section returned the bill on 17.04.2012 for reconsideration, because this bill was to be verified according to the CGHS package rates. Again a bill of Rs. 4,621/- was sent by M/S M.D. India Health Care Service Pvt. Ltd., Pune to U-Health Section.  The District Forum has no jurisdiction to try and decide the matter.  It is made clear that the bills of treatment are sent by the empaneled hospitals to the M/S M.D. India Health Care Service Pvt. Ltd., Pune, which are forwarded to the U-Health Section.  After proper valuation and verification of the bills, the payment to the empaneled hospitals is to be made by Uttarakhand State through M/S M.D. India Health Care Service Pvt. Ltd., Pune.  The complainant has paid money to the registered hospital, but did not inform the U-Health Section in writing and no documents have been produced by the complainant to the U-Health Section.  In these conditions U-Health Section cannot take any action against the M/S M.D. India Health Care Service Pvt. Ltd., Pune as well as against empaneled hospital. The complainant is an educated man and he knew the things very well, therefore, prior to his treatment he must keep these things in his mind.  If any amount has been paid by the complainant to the CMI, Hospital, then he is free to get back his money from CMI, Hospital.  The complainant has made opposite party No. 2 party by name, who is an officer in Government Department.  Therefore, the complaint of the complainant is not maintainable against the opposite party No. 2.

5.       The opposite party No. 3 M/S M.D. India Health Care Service Pvt. Ltd., Pune has not filed any written statement before the District Forum, Dehradun.

6.       The District Forum, on an appreciation of the facts and circumstances of the case, has allowed the consumer complaint No. 41 of 2013 vide order dated 30.07.2014 in the above terms.  Aggrieved by the said order, the opposite party No. 2-Director General, Medical Health & Family Welfare, Uttarakhand, Dehradun and Dr. (Smt.) Saroj Naithani (State Nodal Officer) have filed the present appeal.

7.       Sh. Ashok Dimri, learned counsel for the appellants and Sh. Pradeep Bartwal, learned counsel for the respondent appeared before this Commission.  We have heard learned counsel for the parties and perused the material placed on record.

8.       Learned counsel for the appellants has submitted before this Commission that the order dated 30.07.2014 passed by the District Forum, Dehradun is against the law and facts.  The District Forum has ignored the fact that the respondent-Dr. Ramsharan Singh Chauhan was to be reimbursed according to C.G.H.S. package rates under U-Health Smart Card, for which the bill was passed.  Even then the District Forum has not appreciated this fact.  Learned counsel has argued that the respondent was admitted in the CMI, Hospital on 24.08.2011 and after treatment he was discharged on 26.08.2011.  The respondent has added an amount of pathology tests after his discharge and these pathological tests were conducted outside in pathology lab, which are not empaneled by M/s M.D. India Health Care Service. 

9.       Learned counsel for respondent has argued that the respondent              Dr. Ramsharan Singh Chauhan is the member of U-Health Smart Card scheme, who has availed the cash less treatment in CMI, Hospital from 24.08.2011 to 26.08.2011.  The respondent has already filed certificate of his contribution in the said scheme as well as discharge summary and a receipt of Rs. 13,200/- for pathology tests issued by CMI, Hospital, Dehradun. 

10.     There is no dispute that the respondent Dr. Ramsharan Singh Chauhan contributed in the Health Smart Card (U-Health Card) scheme and deposited Rs. 5,000/- as contribution from his salary, as is evident from the certificate of Superintendent, Doon Hospital, Dehradun (paper No. 9 on the District Forum’s record).  This amount of contribution was deducted from the salary for the month of August, 2011 in the office of CMS, Doon Hospital, Dehradun.  There is also no dispute that the respondent was admitted in CMI, Hospital, Dehradun on 24.08.2011 for the treatment of Deep Vein Thrombosis lower and upper limb.  He was treated at this Hospital and was discharged on 26.08.2011. Meanwhile during treatment the respondent was advised by CMI, Hospital to deposit Rs. 13,200/- for some pathological tests. Discharge summary of treatment (paper No. 11 on the District Forum’s record) and receipt of pathological tests (paper No. 12 on the District Forum’s record)  against an amount of Rs. 13,200/- given by CMI, Hospital to the respondent. The respondent has also filed a copy of letter dated 22.06.2012 sent to Director, Medical Health and Family Welfare, Uttarakhand, Dehradun for reimbursement of money spent during treatment (paper No. 13 on the District Forum’s record).  The respondent has also written a letter to the Managing Director/incharge, Dr. R.K. Jain, CMI, Hospital, Dehradun to refund               Rs. 13,200/-, which were received by CMI, Hospital during treatment (paper No. 14 on the District Forum’s record).  The respondent has also filed an affidavit in evidence (paper No.  30 to 32 on the District Forum’s record) in support of his contention pleaded in the complaint. There is no affidavit filed by the appellant-opposite party No. 2 on record of District Forum to controvert the affidavit of respondent in the District Forum.  The only dispute is that whether the respondent is entitled to get back Rs. 13,200/- received by CMI, Hospital during his treatment on account of pathology tests.

11.     The respondent is a member and U-Health Smart Cardholder and is entitled to get cash less treatment from any of the hospital empaneled by M/S M.D. India Health Care Service Pvt. Ltd., Pune.  The CMI, Hospital is listed with M/s M.D. India Health Care Service Pvt. Ltd., Pune, therefore, the respondent availed cash less treatment in this hospital.  During the treatment, the CMI, Hospital advised the respondent to deposit Rs. 13,200/- against some pathology lab reports for which he deposited the same.  Before District Forum, the opposite party No. 1 Dr. R.K. Jain, one of the directors in CMI, Hospital has admitted that CMI, Hospital has charged Rs. 13,200/- against the pathology lab tests from respondent and CMI, Hospital has forwarded the bills for reimbursement, which are pending before opposite party Nos. 2 & 3.  The appellants have never controverted the evidence adduced by the respondent before the District Forum by an affidavit.  The amount charged during treatment from respondent by CMI, Hospital for pathology lab reports is a part of treatment, if any amount is taken during treatment for any cause or path lab reports should be reimbursed to the respondent.

12.     The District Forum has properly considered the facts and circumstances of the case and has committed no illegality or irregularity in passing impugned order and has rightly held that the appellants and opposite party No. 3 are (jointly and separately) liable to pay the amount of Rs. 13,200/- alongwith interest @ 7% per annum from the date of filing the consumer complaint.  However, the order for payment of Rs. 5,000/- against mental agony is liable to be quashed and an amount of Rs. 3,000/- as litigation expenses is liable to be reduced to Rs. 1,000/-.  In this way, the impugned order is modified accordingly. 

13.     For the reasons aforesaid, the appeal is partly allowed.  The impugned order passed by the District Forum, Dehradun for payment of Rs. 13,200/- alongwith interest @ 7% per annum from the date of filing the consumer complaint till the date of payment is hereby confirmed.  The order for payment of Rs. 5,000/- against mental agony is hereby quashed and the order for payment of Rs. 3,000/- towards litigation expenses is reduced to Rs. 1,000/-.  Cost of the appeal made easy.