Kerala

Idukki

CC/14/6

Adv. K.S Cyriac - Complainant(s)

Versus

Medical Officer - Opp.Party(s)

30 Oct 2014

ORDER

DATE OF FILING : 9.1.2014

BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM, IDUKKI

Dated this the 30^th day of October, 2014

Present :

SRI. LAIJU RAMAKRISHNAN PRESIDENT

SMT. LIZAMMA ABRAHAM. K. MEMBER

SRI. BENNY. K. MEMBER

CC NO.6/2014

Between

Complainants : 1. K.S. Syriac S/o Sakharias,

Kallidukkil House,

Alakkodu, Thodupuzha,

Idukki District.

2. Kochuthresia James,

Retired High School Assistant,

St. Thomas High School,

Thudanganadu, Thodupuzha,

Idukki District.

And

Opposite Party : The District Medical Officer

(Allopathy),

Idukki,

Painavu P.O.,

Idukki District.

O R D E R

 

SRI. LAIJU RAMAKRISHNAN (PRESIDENT)

 

1^st complainant undergone an operation for his heart at Amrita Hospital, Kochi since there was no other government hospital having such a facility at Idukki district. 2^nd complainant, who is the wife of the 1^st complainant applied for getting expenses incurred for the same as reimbursement and applied with the bill through the Deputy Director of Education, to the opposite party. But it was rejected by the opposite party without certifying the same. Eventhough it is informed by the Deputy Director of Education that the contention raised by the opposite party is not at all sustainable, the opposite party deliberately rejected the same. Hence this petition is filed for getting a direction against the opposite party for certifying the bill submitted through the Deputy Director of Education and also for compensation.

 

2. As per the written version filed by the opposite party, the petition is not at all maintainable before this Forum because there is no consumer relationship

(cont....2)

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between the complainant and opposite party. It is admitted that an application has been given for getting reimbursement through the Deputy Director of Education to the opposite party which was for the treatment done at Amritha Hospital. As per the Medical Attendance Rules 1960, the complainant never produced the OP Ticket for the treatment in Idukki District Hospital under the Health Services and also the reference letter (Appendix II) stating that emergency treatment is not at all available in this hospital. But a letter from the Superintendent of Government Homeo Hospital, Muttam was produced by the complainant, so that it was returned stating the same. But again the Deputy Director of Eduction issued a letter stating that the Amritha Institute of Medical Science Hospital is a hospital approved by the Government and so that Appendix II is not needed for the same. But as per the Kerala Government servants medical attendance rules 1960, clause 8(3), reimbursement is possible if the treatment was done in the private hospital in the emergency situation. So the reference letter with Appendix II is necessary and if it is not able to prove the same, a specific sanction is needed from the Government and that was intimated to the complainant with a letter as No.D4-5861/13 dated 16.1.2013. So there is no deficiency from the part of the opposite party.

 

3. The point for consideration is whether there was any deficiency in service from the part of the opposite party, and if so, for what relief the complainant is entitled to ?

 

4. The evidence consists of oral testimony of PW1 and Ext.P1(series) marked on the side of the complainant and oral testimony of DW1 and Exts.R1 to R6 marked on the side of the opposite party.

 

5. The POINT :- Complainant produced evidence as PW1. Ext.P1(series) are the copy of the letters issued by the District Medical Officer to the Deputy Director of Education stating that as per the Kerala Government servants medical attendance rules 1960, clause 8(3), OP Ticket and reference letter with Appendix II is necessary for medical reimbursement. Copy of application given by the complainant also produced. PW1 has undergone a heart surgery at Amritha Hospital and applied for reimbursement for the amount paid at the hospital by the wife of the complainant, who is a retired H.S.A. through the Deputy Director of Education to the opposite party. But the opposite party rejected the same as per the above said letter.

 

DW1 who is the District Medical Officer, produced the letter issued from the Deputy Director of Education, Idukki, to the opposite party stating that

(cont....3)

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form Appendix II is not at all necessary for the medical reimbursement because Amritha Hospital is an approved hospital of the Government. Ext.R3 is the letter issued by the District Medical Officer to the Deputy Director of Education, stating that if it is not at all in emergency situation, Appendix II is necessary. Copy of the prescribed form of Appendix II is also produced by DW1 and marked as Ext.R4. Copy of the rule stating that Amritha hospital is an approved hospital of the Government is marked as Ext.R5. Copy of the rule stating the treatment departments in the hospital for medical reimbursement is marked as Ext.R6.

 

As per the Kerala Government servants medical attendance rules 1960, clause 8, Special concessions in regard to medical treatment :-

“Government servants who have no Government Medical Institutions within a radius of 5 miles of their station, may resort to such Private Institutions and the charges incurred by them would be reimbursed by Government to the extent they would have received such treatment free in a Government Institution or at the hands of an Authorised Medical Attendant”.

Note:- Private Institutions recognised for treatment in Rule 8(3) should be resorted to only in cases of emergency and not as a routine course. Bills for reimbursement submitted as per the above rules should be certified by the nearest District Medical Officer of Health as to the emergency of each case.

 

So as per the opposite party, the reference letter from the Government hospital is very necessary for getting reimbursement, as per clause 8(3) of the

(cont....4)

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rules. But it is specifically stated in the rule 8(3) that the,

“charges incurred by them would be reimbursed by Government to the extent they would have received such treatment free in a Government Institution or at the hands of an Authorised Medical Attendant”

and Amritha hospital is an authorised Government hospital, but as a note, it is stated that,

“should be resorted to only in cases of emergency and not as a routine course”.

But as per DW1, the DMO, after perusing the certificates and records, it is never stated that it is not at all an emergency situation for the complainant for the treatment at Amritha hospital. Eventhough the first treatment was done in the Homeo hospital, the surgery was done after 6 months. But the reason for such a delay is not at all challenged by the opposite party. It may be due to any other technical difficulties that the surgery was postponed to such a date in Amrith hospital and there is no case for the opposite party that it was delayed due to non-emergency. There is no contention for the opposite party that it was not an emergency situation to the complainant. It is stated in Ext.P1(series) letter given by the Superintendent of District Homeo hospital, Muttam, the complainant was under observation for one day in that hospital and it is requested for further diagnosis and treatment. It is a reference letter from the Homeo hospital and that was also submitted before the opposite party. So the opposite party never proved that the condition of the complainant is not at all an emergency situation, so that the treatment was not at all needed at Amritha hospital. Moreover, the only contention of the opposite party is that the reference letter with Appendix II is very necessary for availing reimbursement to the complainant and copy of the Appendix II is also attached which is marked as Ext.R4.

 

But we think that it is specifically stated in Rule 76, order (ii) of the Kerala Government servants medical attendance rules 1960,

“When a patient is referred to another institution outside Collegiate Hospital/Government Hospital it should be with the permission of the Unit Chief or Head of the Department of the Institution. For taking treatment outside the State the Government servant has to obtain prior permission from the Director of Health Services. A prescribed proforma at Appendix -II to this order will be filled in for cases which require reference to centres outside the State.”

So the proforma Appendix II has been stated in the Rule 76 as specifically about the treatment done in outside state and not for the person who treated in

(cont....5)

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Kerala in Government hospital or authorised hospital. So the contention of the opposite party is not at all sustainable. It is very important to notice that Appendix II is not at all stated in Kerala Government servants medical attendance rules 1960, clause 8(3) and the denial of the opposite party due to the same is a deficiency from the part of the opposite party and the complainant is entitled to get the reimbursement as per Rule 8(3). Opposite party never tried to prove that the treatment for the complainant was not at all an emergency situation. Eventhough the complainant is praying for a compensation of Rs.1 lakh, but there is no evidence produced by the complainant to show that the complainant incurred such a loss due to the act of the opposite party.

 

Hence the petition allowed. The opposite party is directed to certify the bills and other documents produced by the complainant through the Deputy Director of Education, within 15 days of receipt of the same and the opposite party is also directed to pay Rs.1000/- as cost of this petition to the complainant within 30 days of receipt of a copy of this order, failing which the amount shall carry 12% interest per annum from the date of default.

 

Pronounced in the Open Forum on this the 30^th day of October, 2014

 

 

Sd/-

SRI. LAIJU RAMAKRISHNAN (PRESIDENT)

 

 

Sd/-

SMT. LIZAMMA ABRAHAM. K. (MEMBER)

 

 

Sd/-

SRI. BENNY. K. (MEMBER)

 

 

 

 

 

 

 

 

(cont....6)

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APPENDIX

Depositions :

On the side of the Complainant :

PW1 - K.S. Syriac.

On the side of the Opposite Party :

DW1 - Dr. Anil V.

Exhibits :

On the side of the Complainant :

Ext.P1(series) - Copy of the letters issued by the District Medical Officer

to the Deputy Director of Education.

On the side of the Opposite Party :

Ext.R1 - Copy of the letter issued by the District Medical Officer

to the Deputy Director of Education.

Ext.R2 - Copy of the letter issued by the Deputy Director of Education

to the District Medical Officer.

Ext.R3 - Copy of the letter issued by the District Medical Officer

to the Deputy Director of Education.

Ext.R4 - Copy of the prescribed form of Appendix II.

Ext.R5 - Copy of the rule stating that Amritha hospital is an approved

hospital of the Government.

Ext.R6 - Copy of the rule stating the departments in the hospital

eligible for reimbursement.

 

 

 

 

Forwarded by Order,

 

 

 

 

SENIOR SUPERINTENDENT