DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SAHIBZADA AJIT SINGH NAGAR (MOHALI)

                                      Consumer Complaint No.220 of 2015

                                                Date of institution:  11.05.2015                                         Date of decision   :  21.12.2016

Ashok Kumar Bansal son of Amar Nath, resident of 1703, Nirwana Society, Sector 49-B, Chandigarh.

 ……..Complainant

                                        Versus

1.     Fortis Hospital, Sector 62, Phase-8, Mohali through its authorised Signatory/Principal Officer Incharge.

2.     Director Health Services, Haryana Government, Sector 6, Panchkula.

                                            ………. Opposite Parties

Complaint under Sections 12 of

the Consumer Protection Act.

Quorum

Shri Ajit Pal Singh Rajput, President                          Shri Amrinder Singh Sidhu, Member.

Mrs. R.K. Aulakh, Member.

Present:    Shri Deep Singh, counsel alongwith the complainant.

                Shri Munish Kapila, counsel for OP No.1.

                OP No.2 ex-parte.

ORDER

By Ajit Pal Singh Rajput, President

                Complainant Ashok Kumar Bansal son of Amar Nath, resident of 1703, Nirwana Society, Sector 49-B, Chandigarh has filed this complaint against the Opposite Party (hereinafter referred to as the OP) under Sections 12 of the Consumer Protection Act. The brief facts of the complaint are as under:

                The complainant is a retired employee of Haryana Govt. and is entitled to reimbursement of medical treatment from the empanelled hospitals and the name of OP No.1 is included in the empanelled hospitals. OP No.1 consented to provide treatment to employees/pensioners at packages/rates vide letter dated 23.04.2013. The complainant was admitted with OP No.1 on 10.11.2014 where he underwent angioplasty stents and was discharged on 12.11.2014. Three stents were planted in the arteries of the complainant for which OP No.1 charged a sum of Rs.5,50,159/-. The complainant submitted the claim to his department for reimbursement but an amount Rs.3,38,240/- only was reimbursed to him out of Rs.5,50,159/-. The reimbursement was made to the complainant on the basis of rates approved by OP No.2.  The Govt. of Haryana issued guidelines for implementing packages/rates on 06.08.2013 which shall be fully reimbursable to the employees/pensioners. The case of the complainant falls under serial No. 9  i.e. balloon Coronory   Angioplasty/PTCA/Intra Coronary stenting, direct stenting. The cost of implant of setent was to be charged as per guidelines 3 (g) as per actual rates fixed by the Govt.  As per the cost of DGCI and FDA approved during eluting stents was Rs.65,000/-  The doctors of OP No.1 also certified that the stents implanted by OP No.1 were DGCI and FDS approved. OP No.1 has charged Rs.1,39,000/- as cost of each stent whereas it was to charge only Rs.65,000/- for each stent. Thus, the OP No.1 has charged Rs.74,000/- more for each stent from the complainant. The complainant time and again approached OP No.1 but the extra amount of Rs.2,11,919/- has not been refunded to him till date. Hence the complainant has sought direction to the OP No.1 to refund him the amount of Rs.2,11,919/- alongwith interest @ 18% per annum from 12.11.2014 till actual payment; to pay him Rs.1,00,000/- as compensation for mental agony, harassment and Rs.33,000/- as costs of litigation. 

2.             OP No.1 in the preliminary objections of the written statement has admitted that the complainant was admitted to Emergency on 10.11.2014 with complaints of chest pain radiating to left arm. Aman Bansal/Amandeep Bansal son of the complainant was fully explained about the availability of better quality stents and about availability of stents approved by the Govt. of Haryana. Son of the complainant chose deployment of better quality of higher value stent that the maximum ceiling prescribed by the Haryana Govt. for reimbursement as per admissible rates. It was only after undertaking given by son of the complainant that three stents of Rs.1,39,000/-  each were deployed. This undertaking was given by the son of the complainant without any pressure, undue influence, coercion or force.  The complainant is not consumer of OP No.2 and the dispute, if any, is between State and its employee.  On merits, the OP No.1 has denied all the averments of the complaint and  sought dismissal of the complaint.

3.             Notice sent to OP No.2 through registered post was delivered on 08.06.2015 as per report of India post. None having appeared for it, OP No.2 was proceeded against exparte vide order dated 24.06.2015.

4.             In order to prove the case, the complainant tendered in evidence his affidavits Ex. CW-1/1 and Ex.CW-2/1; copies of bills dated 12.11.2014 Ex.C-1 and C-2; sanction letter Ex.C-3; empanelment letter of the OP Ex.C-4; guidelines Ex.C-5; amended rate list Ex.C-6; certificate dated 14.03.2015 and memo dated 27.07.2015 Ex.C-8. In rebuttal, OP No.1 has tendered in evidence affidavit of Abhijit Singh, Facility Director Ex.OP-1/1 and affidavit of Ms. Divya, Counsellor of OP No. Ex.OP-1/2 and copies of documents Ex.OP-1/A.

5.             After hearing the Ld. Counsel for the parties and going through pleadings, evidence and written arguments of the parties and heard the oral submissions, addressed by the learned counsel for the parties, we find there is force in the contention of the Ld. Counsel for the complainant that OP No. 1 Fortis Hospital is guilty of deficiency of service and unfair trade practice in the matter of giving the treatment to the complainant.

6.             The complainant has alleged that as emergency case he was admitted in the OP hospital on 10.11.2014 and he underwent angioplasty stents and was discharged on 12.11.2014. Three stents were planted in the arteries of the complainant and OP No. 1 gave a bill for a sum of Rs.5,50,159/- and the said amount was paid by the complainant. He produced the copy of bills i.e. Ex.C-1 and Ex.C-2. The Government of Haryana entered into a contract with the OP No. 1 and the package rates were issued on 06.08.2013 regarding charging of fixed package rates from the employees of the Haryana Government and the said amount of the package was reimbursable to the employees/ pensioners.  Learned counsel for the complainant has relied upon Clause-3A of the guidelines which is reproduced below:-

“3(a) The empanelled hospitals shall charge of package rates from employees / pensioners and their dependent to provide treatment on these 21 procedures listed in the table below. It is not applicable to the procedures, which are not covered under package rates.”

7.             The above clause 3(a) shows that OP No. 1 could only charge the rates mentioned in the package and could provide the treatment as per package. The package and implant rates are mentioned in the letter dated 21.05.2015. According to the said package, the coronary stents which could be implanted in the case of the complainant was costing Rs.65,000/- whereas the OP No.1 instead of implanting the authorised coronary stents implanted the stents costing at Rs.1,39,000/- per stent and the price of these three stents came to be Rs.4,17,000/-, but the price as mentioned in the bill dated 12.11.2014 (C-1) is shown as Rs.4,24,392/-.  In this connection, the OP No.1 has relied upon the certificate of undertaking dated 10.11.2014 (Ex. OP 1/A) and has pleaded that the said costly stents were implanted at the request of the complainant. The evidence produced in this connection is affidavit dated 15.03.2016 of Abhijit Singh, Facility Director and Affidavit dated 16.03.2016 of Divya, an employee of the OP No.1. The evidence produced by OP No.1 is totally insufficient, unreliable and untrustworthy. Ms. Divya who filed her affidavit Ex. OP/2 has stated that she was a counselor at Fortis Hospital, Mohali. In her affidavit she stated that on 10.11.2014 after angiography when the patient was detected to have blockage in his arteries, Mr. Aman Bansal prior to angiography was explained that the patient would be requiring insertion of stents. He was also explained about the qualities of stents available in the Hospital and the prices including the availability of Haryana Government approved stents priced at Rs.65,000/- each which was reimbursable by the Haryana Government. Aman Bansal agreed only on getting the higher value stents implanted which was priced at Rs. ,39,000/- each whose rate was more than the approved rates by the Haryana Government.

8.             The affidavit submitted by Ms. Divya is self contradictory. It is mentioned that after angiography when the patient was detected to have blockage in his arteries, Aman Bansal prior to angioplasty was explained the insertion of the stents. It is not understood as to whether Aman Bansal was explained the consequences before the angioplasty or after the angioplasty. This clearly leads us to believe that the affidavit has been furnished falsely. In the certificate of undertaking Ms. Divya signed the certificate as a billing staff but she filed the affidavit as a Counsellor which are two different assignments. The certificate Ex. OP -1/A shows that it was a stereotyped document with leaving the blanks unfilled and is used by the OP No.1 for its benefit. The certificate was required to be signed by Ashok Kumar Bansal complainant who was the patient and not by somebody on his behalf. It is nowhere mentioned that Ashok Kumar Bansal was not in a position to give his consent. This language of the certificate shows that it is used invariably by the Hospital authorities for their benefit to cover up their wrong doings. How Aman Bansal could give the undertaking as mentioned in the certificate dated 10.11.2014 when the stents the price of which was Rs. 65000/- per stent were available then and how the OP No. 1 could insert costly stent of the value of Rs.1,39,000/- each. No document has been placed on record by the OP No.1 as to what is the difference of quality and content between the stents of the value of Rs.65,000/- and Rs. 1,39,000/-

9.             Once there was agreement between the Hospital Authorities (OP1) and the Haryana Government regarding the quality of the treatment to be given, then how OP No. 1 could commit breach of the terms of the package for its own benefits which made the complainant to suffer to the extent of Rs.2,11,219/-. The affidavit dated 15.03.2016 of Abhijit Singh shows that prior to angioplasty undertaking of complainant’s son Aman Bansal was obtained. How they could know prior to angioplasty that stents were required to be inserted. If the undertaking was to be obtained prior to the angioplasty then why the consent of Ashok Kumar Bansal was not obtained. It clearly shows that the hospital authorities are indulging unscrupulous trade practices. There was no reason for the hospital authorities not to fix the stents of the value of Rs. 65000/- each. How the stent of Rs. 1,39,000/- was better than that of Rs. 65000/- has not been explained by Abhijit Singh in his affidavit. The hospital authorised were duty bound to provide the treatment only in accordance with the terms and conditions of the agreement between Haryana Government and the OP 1.

10.          Ashok Kumar Bansal in his affidavit dated 11.05.2015 (Ex. CW-1/1) and Aman Bansal in his affidavit dated 12.10.2015 (Ex. CW-2/1) have supported the allegations made in the complaint and has thoroughly rebutted the evidence produced by the OP No. 1.

11.           The plea of Ld. Counsel for  OP No. 1 that the dispute if any is between the State and its employee and it is not a consumer dispute and this Forum has no jurisdiction to entertain and decide the compliant, is without any basis. It is clear case of deficiency of service and unfair and unscrupulous trade practice adopted by OP No. 1. In order to earn more and more profits the poor patients are subjected to and compelled to sign the documents like certificate of undertaking when the patient is on death bed and attendants with all the keenness to save the life of their dear ones, have to sign such like documents under stress and under undue influence which amounts to adopting unscrupulous trade practice.

12.          The judgment Jagmittar Sain Bhagat and others vs. Director, Health Services, Haryana and others (2013) Supreme Court cases (136) is not applicable to facts of the case. The complainant in this case has not raised any service condition for adjudication by this Forum. The Hon’ble Supreme Court in para 20 of the judgment held that Government Servant cannot raise any dispute regarding his service conditions or his payment of gratuity or GPF or any of his retiral benefits. Obviously, the present complaint by the complainant does not relate to any of such dispute. It is a simply claim due to deficiency of service and unfair trade practice on the part of the OP No. 1. The complainant has not made any claim against OP No. 2 because OP No.1 has not committed any violation, cognizable by this Forum.

 13.          Accordingly in view of our aforesaid discussions, we direct the OP no.1 to refund the excess amount i.e. Rs.2,11,919/-(Rs. Two lakhs eleven thousand nine hundred nineteen only).We also find that the complainant is entitled to a sum of Rs.50,000/- (Rs. Fifty thousand only) on account of mental agony caused due to the act and conduct of the OP no.1 alongwith litigation cost of Rs.10,000/- (Rs. Ten thousand only). The present complaint stands allowed against OP No.1. Complaint against OP No.2 is dismissed.

                The OP no.1 is further directed to comply with the order of this Forum within 45 days from the date of receipt of this order, otherwise the OP no.1 shall be liable to pay 8% interest per annum on the total cost awarded.

                The arguments on the complaint were heard on 13.12.2016 and the order was reserved. Now the order be communicated to the parties. Copy of the order be sent to the parties free of cost and thereafter the file be consigned to the record room.

Pronounced

Dated: 21.12.2016    

                                         (A.P.S.Rajput)           

President

        (Amrinder Singh Sidhu)

Member

(Mrs. R.K. Aulakh)

Member