Andhra Pradesh

East Godwari-II at Rajahmundry

CC/1/2012

Gollakoti Manikyala Rao - Complainant(s)

Versus

G.S.L. Medical College & G.S.L General Hospital, - Opp.Party(s)

G. Anjaneyulu

06 Oct 2016

ORDER

                                                                                                Date of filing:   31.12.2011

                                                                                                Date of Order: 06.10.2016

 

BEFORE THE DISTRICT CONSUMER FORUM-II, EAST GODAVARI

DISTRICT AT RAJAHMUNDRY

 

                                      PRESENT:   Smt H.V. Ramana, B.Com., L.L.M.,   PRESIDENT(FAC)

                      Sri A. Madhusudana Rao, M.Com., B.L., MEMBER          

    

                   Thursday, the 6^th day of October, 2016

 

 

C.C.No.1 /2012

Between:-

 

1)  Gollakoti Manikyala Rao, S/o.Rama Krishna Brahmam,

      aged about 70 years, Un-employee, Resident of Door No.1-13,

      Bank Street, Narsipudi Village, Alamuru Mandal, E.G. District.

 

2)  Gollakoti Ramakrishna Brahmam, S/o. late Manikyala Rao,

      Hindu, aged 49 years, D.No.2-139/2, Madiki village,

      Alamuru Mandal, E.G. Dist.

 

3)  Dangudubiyyam Satya Nagalakshmi, W/o. Subba Rao, Hindu,

      aged 44 years, D.No.7-86, Raja Street, Kadiyam village and mandal,

      E.G. Dist.

 

4)  Alladi Subrahmanyeswari, W/o. Satya Surya Prakasa Rao, Hindu,

      aged 42 years, D.No.17-1-37, Gold Smith Colony, Bhadrachalam,

      Khammam Dist., Telangana, 2-139/2, Madiki village, Alamuru Mandal,

      E.G. Dist.

 

5)  Gollakoti Veera Venkata Satya Durga Visweswara Rao, S/o. late Manikyala

      Rao, Hindu, aged 40 years, D.No.7-96, Raja Street, Kadiyam village and

      Mandal, E.G. Dist.

 

6)  Gollakoti Surya Chandra Durga Prasada Rao, S/o. late Manikyala Rao,

      Hindu, aged 38 years, D.No.1-12, Bank Street, Narsipudi village,

      Alamuru mandal, E.G. Dist.                                                                                 .. Complainants

(Complainant Nos.2 to 6 added as per the orders passed

  in IA.No.167/2015 dated 27.11.2015).

 

                                                And

 

1)  G.S.L. Medical College & G.S.L. General Hospital,

      (Promoted by G.S.L. Educational Society, Regd. No.546/1999),

      Represented by its Chairman, Dr. Ganni Bhaskara Rao, N.H.5,

      Lakshmipuram, Rajanagaram Village, Rajahmundry-533 294.

 

2)  Aarogyasri Health Care Trust, Represented by its C.E.O.,

      Dr. Y.S.R. Bhavan, Opp: Dr. B.R. Ambedkar Open University,

      Road No.46, Jubilee Hills, Hyderabad-500081, Andhra Pradesh.                     .. Opposite parties    

 

 

            This case coming on 07.09.2016 for final hearing before this Forum in the presence of Sri Gopalam Anjaneyulu, Advocate for the complainants and Sri S.R.K. Hanumantha Rao and Sri S. Kumar, Advocates for the opposite party No.1, and the opposite party No.2, who appeared in person and having stood over till this date for consideration, this Forum has pronounced the following:  

 

 

 

O R D E R

[Per Smt.H.V. Ramana, President(FAC)] 

This is a complaint filed by the complainants U/Sec.12 of Consumer Protection Act 1986 to direct the opposite parties to pay an amount of Rs.5,00,000/- towards mental agony, deficiency of service; to payRs.50,613/- collected from them illegally with interest from 31.12.2009 till the date of realization and award other reliefs.

2.         The case of the complainants is as follows:-  It is submitted the 1^st complainant is the husband of late Gollakoti Paravathi, who was underwent treatment as inpatient in the            1^st opposite party under Aarogyasri Medical Benefit Scheme. The 1^st opposite party failed to take minimum care of health and due to their negligence, she died on 1.1.2010 after conducted operation on 31.12.2009 for problem of pain to her bone at the hip. The said Paravathi approached the 1^st opposite party and joined as inpatient. The 1^st opposite party made arrangements and issued an inpatient card through Rajiv Aarogyasri Community Health Insurance Scheme of the 2^nd opposite party on 11.12.2009. the 2^nd opposite party issued a referral card to her on 13.12.2009.  First, three or four days, she was given medicines at free of cost and afterwards, the doctors of the 1^st opposite party asked her to pay the amount for medicines and other charges. Then she informed that she admitted in the hospital and she need not pay money as asked by the doctors. The doctors represented she has to obtain the letter from the revenue authorities, as there is another women with the same name. The complainant family members enquired and came to know that there is no such woman in the village of Gummileru and informed the same to the doctors. The opposite party stated that until the submission of letter from the revenue authorities, she has to pay the medical charges and stated that after receipt of the claim amount under Aarogyasri, they have to refund the amount to the complainant. Believing the same, the complainant deposited an amount of Rs.50,613/-. The said Parvathi was got operated on 31.12.2009 and on the day of the operation they informed the complainant that the said Parvathi would walk on her own on the very next day and most unfortunately she died on 1.1.2010 due to the negligent treatment of the doctors of the 1^st opposite party. Both the opposite parties failed to get the claim amount under Aarogyasri scheme. Hence, the opposite parties are liable for the unfair trade practice committed and liable to pay the damages.  Hence, the complaint.   

 

3.         The 1^st opposite party filed its written version and denied the allegations made by the complainant. This opposite party submits that Gollakoti Parvathi, 60 years, female was admitted on 9.12.2009 with I.P.No.24683 in female Orthopedic ward, GSL General Hospital, Rajahmundry with Intravascular fracture Neck of Rt. Femur upon admission patient is known diabetic and cardiac patient on treatment. The patient was evaluated with investigations and planned for surgery. Patient got the preoperative profile investigations necessary for the anesthesia on 10.12.2009. Patient was applied below knee skin traction for fractured limb. Patient had Hb 8.9 gm% of “A” negative blood group and was advised to arrange one packet of compatible blood for transfusion and buildup HB level as suggested by the Anesthetist. Patient also had the lung problem and was referred to T.B. & Chest Diseases department professor. Patient was advised nebulization and deriphyllin injections by the concerned professor. Patient was also kept on Injection Fragmin as the prophylaxis for deep vein thrombosis preoperatively keeping her co-morbid conditions, old age, and obesity of her in the mind of the doctor. They arranged blood on 27^th and the blood was transfused on 28.12.2009. The fitness for the Anesthesia was obtained on 28.12.2009 with a prerequisite to reserve two packets of comparitable blood reserved for the surgery. After obtaining the consent from the patient and her attendants explaining the complications both intra-operatively and postoperatively in view of her co-morbid conditions, her age, patient was operated on 31.12.2009 for Hemiarthroplasty of Rt. Hip. The procedure was uneventful. On the day of the surgery the patient was conscious and coherent and her vital signs were stable. On the first post operative day i.e. 1.1.2010 at 10.15 a.m., she complained of breathlessness and chest pain and was immediately attended by Anesthetist and the team of doctors and tried to resuscitate her. Inspite of the maximum efforts by this opposite party’s team of the doctors, the patient died on 1.1.2010 at 12.05 noon due to massive pulmonary embolism. Regarding Aarogyasri, the patient initially claimed that they have Aarogyasri card with the patient name and photo included in it. The complainant produced the ration card, but not the Aarogyasri card. The ration card was produced by the complainant with the WAP number 044202100509. On verification in the website, there is a ration card with same number issued on the name of Sesharatnam from the same place of the wife of the complainant. The patient’s ration card could not be seen from database in Aarogyasri website. Hence, the patient was not provided the services under Aarogyasri after confirmation from preauthorization department. The patient was advised to arrange amount of Rs.18,000/- to Rs.20,000/- approximately towards her surgery, medication and investigation charges or if failed so they can go to the Government General Hospital where they can undergo the surgery at free of cost. The complainant and his wife pleaded that they are ready to bear the charges on their own and undergo the treatment in the hospital of this opposite party only. The complainant has no paid Rs.50,613/- to this opposite party at any time. The very fact is that the complainant after  two years issued notice and filed this complaint. This opposite party issued reply notice dt.29.12.2011 to the notice dt.19.12.2011 with true and correct facts.  Hence, there is no fault on the part of this opposite party and the complaint is liable to be dismissed with costs.  

4.         The 2^nd opposite party filed written version and the complaint against this opposite party is not maintainable. This opposite party submits that any deficiency in service by the empanelled hospitals (Provider) or noncompliance of the provisions of MOU will be scrutinized by the Empanelment & Disciplinary Committee (EDC) constituted as per the Aarogyasri Health Care Trust Resolution No.134/2009 comprising of representatives from the Trust and Insurer and make deliberations to suspend/de-list/stop payments or any other appropriate action based on the nature of the complaint against the Provider. The Provider shall abide by the decisions made by the EDC and Trust. As the present scheme floated by the government for the beneficial interests of certain class of persons (BPL), hence it cannot come under the purview of ‘service’ under the Consumer Protection Act. Even, if it is so, the said service is out of the scope of the Consumer Act, as it is the service provided free of charge and it is not under a contract of personal service. Hence, the complaint lacks the jurisdiction of the Hon’ble Forum. The 2^nd opposite party has called for explanation from the NWH (OP.No.1) with regard to the present notice. As such the 1^st opposite party has given the following explanation dt.2.1.2012 with respect to the matter in notice: It is the stated by the Network hospital in its explanation that Sri Manikyala Rao has admitted his wife Smt. Gollakoti Parvathi, female aged about 60 years on 9.12.2009 at 15:33 hours with H/o. fall at Narsipudi village on 2.12.2009 at her house. She had been pin right hip at the time of admission and was diagnosed as a case of a intracapsular fracture neck of Femur. It is stated by the NWH that Sri Manikyala Rao produced a ration card bearing No.WAP044202100509 for registering under Aarogyasri Scheme. The card was handed over to Mitra for registration under Aarogyasri. The Mitra did card search and did not find the card details of Smt. Gollakoti Parvathi in database and instead the details of different beneficiary with name Medisetti Sesha Ratnam, female, aged 35 years and wife of Satyanarayana, R/o. Gummileru (V), East Godavari (D) were displayed. It is stated by the NWH that they informed pre-authorization department and the team leader about the non-availability of card details and the procedure they have to follow since the ration card is available and the details of this patient not available on database. The NWH further stated that they were told that the patient details are not available the case cannot be registered under Aarogyasri and they have to go for CMCO beneficiary certificate. The NWH has stated that they informed the same to Sri Manikyala Rao, husband of the patient. Further it is mentioned in the explanation and as alleged by the NWH that Sri Manikyala Rao also talked to Aarogyasri staff for several times for obtaining permission under Aarogyasri. It is stated that he expressed that since his wife is acutely ill and cannot be moved to Hyderabad for obtaining CMCO certificate, he will pay charges and get her operated and he will claim bills under CMRF. It is stated in the explanation that the patient as per the request of Sri Manikyala Rao was treated on payment. She was operated for HernioThroPlasty of right hip with Autsin Moores Prosthesis under spinal anesthesia on 31.12.2009. It is stated by the NWH that patient was treated from 9.12.2009 to 1.1.2010 and unfortunately she expired on 1.1.2010 at 12:05 PM due to of massive pulmonary embolism. It is stated that the NWH was subsequently instructed for similar instances by Aarogyasri Trust to register the case under Aarogyasri by Aarogya Mitra and to generate Mitra registration form even if the card details are not found in database. It is stated by the NWH in its explanation that this facility was not available at the time of registration of Smt. Gollakoti Parvathi on 9.12.2009. In MOU between the Trust and NWH, it is stated that the provider will be responsible for all omission and commissions in treating the patients referred under the scheme and will also be responsible for all legal consequences that may arise. Insurer/Trust will not be held responsible for the choice of treatment and outcome of the treatment or quality of the care provided by the provider and should any legal complications arise and it called upon to answer, the provider will pay all legal expenses and consequent compensation, if any. Further, it is stated in MOU that “the provider admits and agrees that if any claim arises out of alleged deficiency in service on their part or on the part of their men or agents, then it will be the duty of the provider to answer such claim. In the unlikely event of insurer being proceeded against for such cause of action and any liability was imposed on them, only by virtue of its relationship with the provider and then the provider will step in and meet such liability on their own.”  Hence, there is no deficiency of service on the part of this opposite party and the complaint is liable to be dismissed with costs.         

5.         The chief affidavit filed by the 1^st complainant, Exs.A1 to A13 have been marked for the complainants and 1^st complainant was examined as P.W.1. The chief affidavit filed by the 1^st opposite party, Exs.B1 to B14 have been marked for the 1^st opposite party and R.W.1 & R.W.2 have been examined.

6.         Heard both sides. The 1^st opposite party filed written arguments.

7.         Points raised for consideration are:

 

1. Whether there is any deficiency in service on the part of the 1^st opposite party in

     giving treatment to the deceased patient?

2. Whether the deceased Paravathi is entitled medical treatment under Aarogyasri or

     not?

            3. Whether the complainants are entitled for the reliefs asked for?

            4. To what relief?

 

8.   Point No.1 & 2:  The admitted facts of the complaint are that the 1^st complainant died due to old age during the pendency of this case. Later, the complainants 2 to 6 were impleaded as legal heirs of the 1^st complainant as per order in IA.No.167/2015 dated 27.11.2015.  The complainants submitted that their mother was admitted as inpatient on 9.12.2009 in the 1^st opposite party hospital under Aarogyasri Medical Benefit vide Ex.A2, in which they mentioned the referral card number vide 05 as they were having white ration card vide Ex.A1. Initially, after admission of the deceased mother of the complainant, they gave medicines to her. Later they stopped giving medicines to her, because on verification, the ration card issued in their name was not reflecting the number mentioned on the ration card. The said card shows another family members, but not the family belongs to the complainants. On verification of the record, the complainant’s mother was issued a referral card dated 13.12.2009 for her surgery and the same was signed by the concerned doctor on the rear side of Ex.A4.  At the time of approaching the 1^st opposite party, the complainants informed that she is not having the Aarogyasri Card, but she is having the white ration card. Basing on that card, the 1^st opposite party admitted her into the hospital. Later on verification, then the 1^st opposite party realized that the ration card was not matching the family of the complainants. Immediately, they informed the complainants. Then, the 1^st complainant approached the Thasildar of Alamuru, he gave a certificate dated 10.12.2009 that the deceased G. Paravathi, Manikyala Rao and Varahala Rao are the members of the white ration card vide No.WAP044202100509 and also mentioned that Smt. Paravathi is entitled for medication under Aarogyasri and the same is confirmed by them vide Ex.A3. Basing on the said card, the opposite party issued referral card dt.13.12.2009 and also mentioned “shaft of femur upper end.” He also submitted that a certificate issued by the Revenue Divisional Officer of Rajahmundry that the family of the complainants are holding white ration card and their mother is eligible to undergo treatment under Aarogyasri Community Health Scheme vide Ex.A5. The 1^st opposite party wrote a letter to the Medical officer of Aarogyasri Health Care Trust, Hyderabad and explained all the details and also requested them to issue CMCO referral card after due verification for her eligibility under Aarogyasri to provide cashless health facility under the scheme vide Ex.A6. The Thasildar of Alamuru also wrote a letter vide Ex.A7 to the Collector of East Godavari about the eligibility of the deceased Paravathi under Aarogyasri or CMRF. The deceased Paravathi took treatment from the 1^st opposite party from 9.12.2009 and later they got operated her on 13.12.2009 and the doctors informed that she walk under home on very next day, but unfortunately she died on 1.1.2010 due to the negligent treatment of the 1^st opposite party, to that extent they filed discharge summary of deceased Paravathi vide Ex.A8 and the death certificate vide Ex.A9. The complainants submitted that on verification with regard to the complainants ration card, except their family members in that village, no such woman was there in their village. They also submitted that unless the opposite parties received a letter from revenue authorities, the patient has to pay the charges for the medication and also represented that after receiving the claim amount under Aarogyasri, the amount paid would be refunded to the complainant. Believing the said words, the complainants paid Rs.50,613/- vide Ex.A10. The complainants have no other way, except to pay the money to the 1^st opposite party, even after submission of Exs.A3, A5, A6 & A7.  The 1^st opposite party collected the amount from the 2^nd opposite party and also from the complainants. After the death of complainants’ mother, they got issued a legal notice vide Ex.A11 to both of the opposite parties with regard to the negligence in giving the medical treatment to the patient and also informed the 2^nd opposite party with regard to collection of medical expenses from the complainant. In this regard, the 2^nd opposite party wrote a letter to the 1^st opposite party “why the patient was not treated under Aarogyasri Scheme and asked their explanation.”  The said letter is herewith filed vide Ex.A12.  The 1^st opposite party also gave a reply notice vide Ex.A13 by denying the allegations. The complainant mainly submitted that the 1^st opposite party was negligent in giving the treatment to Smt. Paravathi, therefore, she died on the next day of the surgery and they also contended that even though they had an Aarogyasri Benefit under white ration card, they collected the amount of Rs.50,613/- for medical expenses.

            The 1^st opposite party filed written version by denying the allegations made by the complainants and also denied that they issued inpatient card dated 11.12.2009 to the deceased Parvathi. This opposite party submitted that they denied when the Aarogyasri was not issued to anyone in the entire Alamuru Mandal, therefore, Aarogyasri is not required and the wife of the 1^st complainant will be treated on the basis of white ration card and she also allotted a bed in the ward.  They admitted that Smt. Gollakota Paravathi, age 60 years, female was admitted on 9.12.2009 with I.P.No.24683 in Female Orthopedic Ward, GSL General Hospital, Rajahmundry with intra vascular fracture neck of Rt. femur upon admission, patient is known diabetic and cardiac patient on treatment. After making investigations, they planned for surgery and also made necessary investigations giving anesthesia. The patient was applied below knee skin traction for fractured limb. The patient had HB count 8.9 gm and was advised to arrange for blood for transfusion and to build up HB level as suggested by the anesthetist. This opposite party also submitted that the patient had the lung problem and was referred to TB and Chest diseases Department and they advised nebulization and deriphyllin injection. The patient was kept on injection fragmin as the prophylaxis for deep vein thrombosis preoperatively keeping her co-morbid conditions, old age, and obesity of her in the mind of the doctor. On 27^th of December, 2009, the complainants arranged the blood and the same was transfused on 28.12.2009. After examination of the anesthetist, he approved the fitness of the patient and also reserved two packets of compatible blood for the purpose of surgery. After taking the consent of the patient and her family members, they operated the patient on 31.12.2009 for Hemiarthroplastic of right hip. The procedure was uneventful and on the date of surgery, the patient was conscious and coherent and her vital signs were stable.   

They arranged blood on 27^th and the blood was transfused on 28.12.2009. The fitness for the Anesthesia was obtained on 28.12.2009 with a prerequisite to reserve two packets of comparitable blood reserved for the surgery. After obtaining the consent from the patient and her attendants explaining the complications both intra-operatively and postoperatively in view of her co-morbid conditions, her age, patient was operated on 31.12.2009 for Hemiarthroplasty of Rt. Hip. The procedure was uneventful. On the day of the surgery the patient was conscious and coherent and her vital signs were stable. On the first post operative day i.e. 1.1.2010 at 10.15 a.m., she complained of breathlessness and chest pain and was immediately attended by Anesthetist and the team of doctors and tried to resuscitate her. Inspite of the maximum efforts by this opposite party’s team of the doctors, the patient died on 1.1.2010 at 12.05 noon due to massive pulmonary embolism. Regarding Aarogyasri, the patient initially claimed that they have Aarogyasri card with the patient name and photo included in it. The complainant produced the ration card, but not the Aarogyasri card. The ration card was produced by the complainant with the WAP number 044202100509. On verification in the website, there is a ration card with the same number issued to one Sesharatnam from the same place of the wife of the 1^st complainant and the patient’s ration card could not be seen from the date base in the Aarogyasri Website. Hence, the patient is not provided the services under Aarogyasri and this opposite party also advised the patient to arrange an amount of Rs.18-20 thousand towards her surgery and medical expenses or they can go to a government general hospital where they can undergo surgery at free of cost. The 1^st complainant and his wife pleaded that they are ready to bear the charges on their own and to undergo the treatment in the hospital of this opposite party. This opposite party also submitted that the 1^st complainant has not paid Rs.50,613/- as mentioned in their notice. This opposite party also issued reply notice dt.29.12.2011.

            The 2^nd opposite party also filed their written version and denied the allegations made by the complainants. This opposite party submitted that the 1^st complainant was not brought to their notice prior to filing of this complaint as the trust has its own machinery to receive the complaints and grievances and to redress them through Empanelment Disciplinary Committee and they also submitted that any deficiency in service by the empanelled hospitals (Provider) or noncompliance of the provisions of MOU will be scrutinized by the Empanelment & Disciplinary Committee (EDC) constituted as per the Aarogyasri Health Care Trust Resolution No.134/2009 comprising of representatives from the Trust and Insurer and make deliberations to suspend/de-list/stop payments or any other appropriate action based on the nature of the complaint against the Provider. The Provider shall abide by the decisions made by the EDC and Trust. This scheme is floated by the government for the benefit of certain class of people, therefore, cannot come under the purview of Consumer Protection Act. This opposite party also submitted that they issued a referral card to the patient on 31.12.2009. This opposite party further submitted that in MOU between the Trust and NWH, it is stated that the provider will be responsible for all omission and commissions in treating the patients referred under the scheme and will also be responsible for all legal consequences that may arise. Insurer/Trust will not be held responsible for the choice of treatment and outcome of the treatment or quality of the care provided by the provider and should any legal complications arise and it called upon to answer, the provider will pay all legal expenses and consequent compensation, if any. This opposite party submitted that they are not liable or responsible to pay any amount or damages for causing deficiency in service and the claim against this opposite party may be dismissed with costs.

            On the examination of P.W.1, the 1^st complainant admitted that his wife was suffering from diabetes by the date of joining her in the hospital of the 1^st opposite party. They also submitted that the said diabetes was mild. He denied that his wife was having cardiac and lung problem at the time of joining the hospital and also referred her T.B. and Chest Disease Department of Nebulization and referred deriphyllin injections by the concerned professors. He also denied that they have not taken any consent from him prior to the operation. He admitted that the signature on the concerned form is belongs to him. They also submitted that he has given his ration card and he took the entire record from the 1^st opposite party and at the time of operation, he paid Rs.50,613/- to the 1^st opposite party.

            The R.W.1 by name Dr. V. Nageswara Rao was examined and he submitted that he prepared the death summary of the patient and signed on that. They also stated that the team of the doctors confirmed the death of the patient and also stated that he was not aware the names of team of doctors. He also stated that the patient was died due to pulmonary embolism, it may be caused due to old age, obesity and prolonged immobilization, DVT (Deep Vein Thrombosis), underlying lung problems. In this case, the patient was suffering from lung problem and old age and also submitted that he was not there at the time of surgery of the patient, but he treated the patient as per the protocol treatment of long bone fracture of old aged person and they have taken all the necessary precautions while giving the treatment. He submitted that he referred the patient to the Department of Pulmonology as she was having breathlessness and others and the patient was acyanotic as per the examination by the Pulmonology Assistant Professor on 18.12.2009. Cyanosis is a major warning sign of pulmonary embolism might be one of the signs. As per record, the CTPA (Computed Tomography Pulmonary Angiogram) was not conducted to the patient in this case. The death of the patient was declared by the Anesthetist and we are not concerned to the declaration of the death. As per the case sheet in page No.35, the notes was written by the Anesthetist and Orthopedic Surgeon at 11-30 AM on 1.1.2010 and stated that he was not there in the scene.  In this case, the patient consult form vide page No.67 and witness also signature and also stated that  there is no negligence on their part while giving the treatment to the patient and also admitted that he has no knowledge about Exs.B12 to B14.

            The R.W.2 by name Dr. Machiraju Venkata Ramananda Sarma, Medical Coordinate of Aarogyasri of GSL Medical College was examined and he submitted that Ex.A2 was issued by the Aarogya Mitra of Arogyasri Scheme at the time of any patient, first approach to the hospital. Ex.A3 certificate issued by the Thasildar of Alamuru Mandal was never produced by the patient or her husband in this hospital. Ex.A4 is the referral card issued by the PHC, Alamuru under Aarogyasri.  Ex.A5 is the certificate issued by the R.D.O., Rajahmundry on 14.12.2009. Ex.A6 letter dt.14.12.2009 addressed to the Medical Officer, C.M. Camp Office, Aarogyasri Health Care Trust, Hyderabad by their hospital to get Aarogyasri benefit. He also submitted that the above said documents are required to register under Aarogyasri Benefit by the Aarogya Mitra appointed for this purpose. He also submitted that the letter of R.D.O., was not considered by them due to technicalities in the year 2009 and the same was rectified during the year 2010 particularly in Alamuru Mandal, East Godavari District.  Ex.A7 is the letter addressed by the Collector, East Godavari by Thasildar, Alamuru for providing Aarogyasri Benefit as the patient is eligible for the same and he also submitted that he is not aware of Ex.A10 medical bill as it is the duty of Accounts Department. The witness further submitted that in this case, the patient was not admitted under Aarogyasri Scheme, but she was admitted on the basis of general case. This witness denied all the other allegations made by the complainant and also stated that they have no claimed money from Aarogyasri, but they collected money from the patient.

            As per I.A.No.86/2013, this Forum sent medical record for the opinion of the Medical Board, Government Hospital, Kakinada of East Godavari. The said opinion is received by this Forum and the opinion was given by Dr. M.V.V. Thirumala Rao, MD, Professor and HOD, Department of Medicine, Government General Hospital/Rangaraya Medical College, Kakinada. After perusing the medical record of Smt.G. Paravathi, W/o.Manikyala Rao and thorough and careful study of the case sheet and medical reports, he made certain observations that at the time of admitting the patient, her HB count was 8.4 gms % and one unit of blood was transfused on 12.12.2009 and the Anesthetist evaluated for fitness of the surgery on 18.12.2009 and he observed that the patient was known case of diabetes for the last five years and using medicines for control of her diabetes.  The Assistant Professor of Respiratory Medicine examined the patient on 18.12.2009 and noticed that the patient was suffering from shortness of breath and wheezing. On the examination, the patient was acyanotic and was having bilateral polyphonic rhonchi and occasional crepitations and the patient was treated with necessary bronchodilator therapy to relieve her breathlessness and also observed that the 1^st opposite party made all the necessary investigations and all of them are within the limits except HB which was below normal range and also stated chest x-ray showed changes of chronic bronchitis. As per the records, they also given anticoagulant therapy and started preoperatively to prevent deep vein thrombosis and pulmonary embolism as per the recommendations in fractures of lower limbs.  As per the records, the patient was operated on 31.12.2009 (HEMIARTHOPLASTY) and surgery was uneventful, but on the first postoperative day i.e. 1.1.2010, the patient developed the sudden onset of breathlessness with tachypnoea and follow up blood pressure. All the necessary measures for resuscitation of the patient were done and inspite of that the patient was expired on 1.1.2010 at 12.05 PM. He also submitted that the death in this case seems to be due to massive pulmonary embolism which is the major cause of mortality, postoperatively in fractures of lower limbs. In his opinion, he submitted that Smt.G. Paravathi, W/o. Manikyala Rao was treated properly and no act of negligence was identified in the medical management of the patient.

            The 1^st opposite party relied on the following citations:

1. 2011(1) ALD (Cons.) 7 (NC),
2. 2011(1) ALD (Cons.) 11 (NC) and
3. 2012(2) ALD (Cons.) (NC)

 

            After perusing the material on record, it is observed that the 1^st opposite party denied all the allegations made by the complainants and also denied the amounts received from the 1^st complainant during the treatment given to his deceased wife. As per Ex.B14, the complainants filed civil supplies card, in which it is mentioned that they are having Health card bearing No.WAP044202100509 and they also filed the case sheet of deceased Paravathi and filed some of the documents which are related to her treatment vide Exs.B2 to B10. They also filed the death summary of Smt. Paravathi vide Ex.B11. The 1^st opposite party wrote a letter to the 2^nd opposite party by explaining why they could not conduct the surgery and  treatment under Aarogyasri scheme vide Ex.B12 and the courier receipt filed by them vide Ex.B13.

            After going through the case sheet, and the evidence of R.Ws and also the opinion given by the Medical board, Government Hospital, Kakinada, it is observed that the              1^st opposite party thoroughly examined the deceased Paravathi from the date of admission till the operation. As seen from the records, it is evident that the 1^st opposite party has taken all the precautions from time to time and did all sorts of tests as per the requirement for doing surgery to the patient and the Anesthetist is also mentioned in the case sheet time and again about the condition of the patient and mentioning the same in the case sheet. Therefore, as per the expert opinion, it is observed that the complainant is already having lung problem and she is under medication for that ailment. It is observed by the Medical board that Smt. Paravathi was treated properly, but the cause of death in this case seems to be due to massive pulmonary embolism, which is the major cause of mortality postoperatively in fractures of lower limbs. The 1^st opposite party relied on the above said citations, which are applicable to the present case on hand, in this case the complainants failed to establish that the 1^st opposite party treated the patient negligently, due to that Smt. G. Paravathi died. After verification of the medical records of Smt.Parvati, it is noticed that there is no deficiency in service on the part of the 1^st opposite party in giving the treatment to the patient from the date of admission till her death.

            If it comes to perform surgery in free of cost under the Aarogyasri Scheme and collected the amount from the complainants and RW2 also admitted in his examination Ex. Contains the signature of the hospital superintendent, the signature of billing head and the signature of  of the husband of the patient but, the 1^st opposite party totally denied that they have not received any amount from the complainants, but they received the amount and issued a receipt vide Ex.A10 to the complainant. The main observation with regard to the applicability of Aarogyasri Scheme to the deceased Paravathi is in question. As per our observation, the 1^st complainant approached the 1^st opposite party and submitted his civil supplies card, in which it is clearly mentioned the Health card number of the 1^st complainant’s family members. When the opposite parties informed that there is difference in the name of the health card, the 1^st complainant approached the Thasildar and obtained the confirmation letter vide Ex.A3, in which it is clearly mentioned that Smt. Paravathi and her husband Manikyala Rao and their son are the beneficiaries of white card. He also filed a referral card vide Ex.A4 and also filed a certificate from the Revenue Divisional Officer that the above said three members are eligible to undergo treatment under Aarogyasri Community Health Scheme. The 1^st opposite party wrote a detailed letter to the Aarogyasri Health Care Trust dated 14.12.2009 vide Ex.A6 and requesting them to issue CMCO Referral Card to Smt. G. Paravathi for the eligibility under Aarogyasri to provide cashless health facility under the scheme. Even though the 1^st opposite party wrote a letter to the concerned authorities on 14.12.2009, they have not received any information from the 2^nd opposite party. The Thasildar of Alamuru also wrote a letter to the District Collector, East Godavari with regard to the Aarogyasri scheme for the patient and requested the Collector to consider under Aarogyasri vide Ex.A7.  In this case ration card issued in the name of the complainants by the concerned authorities and mistakenly issued the same card to another family is not the fault of the complainants, even then they made  lot of correspondence through various people such as the 1^st opposite party, the Thasildar and the Revenue Divisional Officer of Rajahmundry, the Aarogyasri Health Care Trust failed to give their consent to the                  1^st opposite party with regard to conduct surgery under cashless scheme i.e. Aarogyasri Health Care Scheme.

            As per the record, it is observed that the 1^st complainant approached all the officers for the benefit of Aarogyasri scheme, but he could not succeed even though he is entitled for the above said scheme. A letter written by the 1^st opposite party to the 2^nd opposite party, in which they clearly mentioned that they have faced similar instances by Aarogyasri Trust to register the case under Aarogyasri by Aarogya Mitra and to generate Mitra registration from even if the card details are not found in the database. Mere, non-availability of information in database with regard to Aarogyasri Benefit to a white card holder will not defeat their right to take medical treatment from the notified hospitals. In  our opinion the 1^st opposite party also made their efforts  in getting the consent from 2^nd opposite party, but they could not succeed. Hence, the claim against the 1^st opposite party is dismissed and we answered the Points 1 & 2 accordingly.

9.   Point No.3:  In view of the above discussion, we opined that  the deceased G. Paravathi is entitled for the benefit of cashless treatment from the Aarogyasri Health Care Trust and the amount paid by her husband i.e. 1^st complainant vide Ex.A10 to the 1^st opposite party to be reimbursed to the complainants by the 2^nd opposite party.                             

 

10.   POINT No.4:  In the result, the complaint is allowed in part, directing the 2^nd opposite party to pay the medical expenses i.e. Rs.50,613/- under the Aarogyasri Scheme and also to pay Rs.2,000/- towards costs of the complaint to the complainants. The claim against the       1^st opposite party is dismissed. Time for compliance is two months from the date of this order.

 

Typed to dictation, corrected and pronounced by us in open Forum, on this the           

6^th day of October, 2016.

    

                     Sd/-                                                                                          Sd/-

              MEMBER                                                                              PRESIDENT(FAC)

         

 

 

 

 

APPENDIX OF EVIDENCE

WITNESSES EXAMINED

 

FOR COMPLAINANTS:                                   FOR OPPOSITE PARTIES:

 

P.W.1  : Gollakoti Manikyala Rao (1^st complainant)   R.W.1 : Dr.Vutharkar Nageswara Rao.

 

                                                                                R.W.2 : Dr. Machiraju Venkata Ramananda

        Sarma.

 

DOCUMENTS MARKED

 

FOR COMPLAINANTS:

 

 

Ex.A1    dt/6.6.2006       The self-attested copy of Household Card.

Ex.A2    dt/9.12.2009     Inpatient card issued by the 2^nd opposite party.

Ex.A3    dt/10.12.2009   Confirmation letter (Druvapatram) issued by the Thasildar, Alamuru.

Ex.A4    dt/13.12.2009  Self attested copy of Referral card No.1294 issued by the                

               2^nd opposite party.

Ex.A5    dt/14.12.2009  Certificate issued by the Revenue Divisional Officer, Rajahmundry.

Ex.A6    dt/14.12.2009  Self attested copy of the letter addressed to the Medical Officer,

   Chief Minister’s office by the 1^st opposite party.

Ex.A7    dt/29.12.2009  Self attested copy of the letter addressed to the Collector, East

   Godavari District by the Thasildar, Alamuru.

Ex.A8    dt/31.12.2009  Discharge summary attested by the Gazetted officer.

Ex.A9    dt/5.3.2010       Death certificate attested by the Gazetted officer.

Ex.A10 dt/12.3.2010     Consolidated bill for Rs.50,613/- attested by the Gazetted officer

   issued by the 1^st opposite party.

Ex.A11 dt/19.12.2011  Notice issued by the complainant.

Ex.A12 dt/                    Letter addressed to the 1^st opposite party by the 2^nd opposite party.

Ex.A13 dt/29.12.2011  Reply notice issued by the 1^st opposite party.

 

 

FOR 1^st OPPOSITE PARTY:-  

 

Ex.B1  dt/9.12.2009     Case sheet including OP Ticket and cover pages (68 pages).

Ex.B2   dt/9.12.2009    X-Ray report (X ray film issued to husband G. Manikyalarao).

Ex.B3   dt/10.12.2009  Clinical Pathology Report.

Ex.B4  dt/10.12.2009  Biochemistry report.

Ex.B5  dt/10.12.2009  Serology Report.

Ex.B6  dt/25.12.2009  ECG Record.

Ex.B7   dt/16.12.2009  X Ray Chest Report )X ray film issued to G. Manikyala Rao).

Ex.B8   dt/23.12.2009  Biochemistry Report.

Ex.B9   dt/24.12.2009  Clinical Pathology.

Ex.B10 dt/28.12.2009  Blood cross matching report.

Ex.B11 dt/1.1.2010      Death summary.

Ex.B12 dt/30.12.2011 Letter addressed to CEO, Arogyasri Health Care Trust, Hyderabad.

Ex.B13 dt/30.12.2011 Courier Receipt.

Ex.B14 dt/                   Copy of Ration Card.

 

 

                    Sd/-                                                                                         Sd/-

             MEMBER                                                                               PRESIDENT(FAC)