Punjab

Ludhiana

CC/17/888

Gurjit Kaur - Complainant(s)

Versus

Medical Supdt.CMC&H - Opp.Party(s)

Hardip S. Bir adv

30 Mar 2021

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                                                Complaint No: 888 dated 11.12.2017                     

                                     Date of decision: 30.03.2021. 

Gurjit Kaur aged 72 years w/o S.Pritam Singh r/o House No.1173, MIG Flats, Sec-32, Chandigarh Road, Ludhiana.                                                                                                                                                             ..…Complainant

                                                Versus

1.The Medical Superintendent, Christian Medical College & Hospital, Ludhiana.

2.The Principal Secretary, Department of Health and Family Welfare, Room No.313, 3^rd Floor, Mini Secretariat, Chandigarh.

3.The Director, Health and Family Welfare, Parivar Kalyan Bhawan, Sector 34-A, Chandigarh.

4.The Chief Medical Officer, Civil Surgeon Office, Dandi Swami Road, Civil Lines, Near Old Court, Ludhiana.

                                                                                      …..Opposite parties

              Complaint under Section 12 of Consumer Protection Act, 1986

QUORUM:

SH. K.K. KAREER, PRESIDENT

SH.INDERJIT, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant             :         Sh.Gagandeep Singh, Advocate

For OP1                         :         Complaint not admitted vide order dated

15.05.2018.

For OP2 to OP4             :         Dr.Puneet Sidhu, Medical Officer and Dr.Manu

Viz, Medical Officer

 

ORDER

PER K.K. KAREER, PRESIDENT

1.                Shorn of unnecessary details, the case of the complainant is that she was diagnosed to have been suffering from the breast cancer by the doctors of OP1. The complainant remained admitted with the OP1 from 09.12.2016 to 02.01.2017. The doctors of the OP1 performed surgery upon the complainant. The complainant came to know that there was one Punjab Government scheme known as Mukh Mantri Punjab Cancer Rahat Kosh for the benefit of the cancer patients. As per the said scheme, certain hospitals in the State of Punjab are empanelled to implement the scheme. The OP1 was one of the empanelled hospitals as per notification dated 05.09.2013. As per the scheme/notification dated 05.09.2013, the entire expenditure of treatment of the cancer patient was to be paid by the Government of Punjab through the OP2 to OP4. When the complainant was admitted in the hospital, she asked the officials of the OP1 to provide her the necessary form for availing the benefits of the scheme but the officials of the OP1 did not hand over the form to the complainant saying that they had not been supplied such forms by the OP2 to OP4. The complainant approached the office of the Civil Surgeon (OP4) and obtained the form but the officials of the OP1 refused to receive the same. In this regard, the complainant lodged complaints with the OP2 against the officials of the OP1 but no action was taken. The complainant underwent treatment at the hospital of the OP1 and paid a sum of Rs.84,048.75P. The said amount was required to be reimbursed to the complainant under Mukh Mantri Punjab Cancer Raahat Kosh Scheme. Since the amount in question was not reimbursed to the complainant, it amounts to deficiency in service on the part of the OPs who were liable to implement the scheme in letter and spirit. The complainant got issued a legal notice dated 30.10.2017 upon the OP1 to settle the claim but despite that the amount of the claim was not reimbursed. In the end, it has been requested that the OPs be directed to pay the amount of Rs.84,048.75P along with compensation and damages of Rs.2 lacs for having caused mental and physical harassment.

2.                The complaint was not admitted against the OP1.

3.                Upon notice, the OP2 to OP4 appeared and filed short reply in the shape of an affidavit stating that the complainant never applied to the competent authority as per rules 4 (iii) dated 18.06.2015 and therefore, the complaint is not maintainable. Moreover, the complainant is not covered under the definition of consumer as per the provisions of the Consumer Protection Act. On merits, it has been pleaded that the OP2 and OP3 received one email dated 04.01.2017 sent by grandson of the complainant and the same was duly replied to on 06.01.2017. Thereafter, another email was received by the OP3 which was also replied to on 24.01.2017. Thereafter, email dated 16.02.2017 was received by the OP3 which was also replied to the sender with a request to send cancer confirmation report of the patient along with residential proof. After that, on 26.06.2017, the husband of the patient sent another email to the OP2 and OP3. During the correspondence with the grandson of the complainant, on 16.08.2017 an instruction was issued to the grandson of the complainant to make the necessary compliance so that the matter could be disposed of. The grandson of the complainant was also advised to contact District Cancer Control Cell or with CMC Ludhiana but neither any compliance was made nor the official of the District Cancer Control Cell of Ludhiana was contacted on behalf of the complainant. Thereafter, vide letter dated 23.10.2017, the grandson of the complainant was again asked to make the compliance. It has, however, been admitted that CMC Ludhiana (OP1) was empanelled under the scheme and the patient has to submit the required documents under Rule 4(iii) dated 18.06.2015 which includes application form, estimate form, self declaration, histopathology report and residence proof to the Civil Surgeon Office. As per the scheme, the complainant can avail treatment upto Rs.1.5 lac free of costs through the empanelled hospitals. Performas of the documents such as application form etc are available on the net and also in the office of the OPs. The complainant never moved any application for obtaining the requisite forms nor the complainant contacted any officials of the OP2 nor it had moved any complaint against the officials of CMC Ludhiana. Moreover, the documents/bills/estimate of alleged expenses incurred by the complainant were never supplied to the OPs after getting the same verified from the CMC Ludhiana. According to the OP2 to OP4, the scheme in question is a cashless scheme for the welfare of cancer patients under which expenses upto Rs.1.5 lac can be reimbursed. The benefits of the scheme can be availed only when the concerned patient submits the required documents such as confirmation of cancer report, valid residence proof etc. The patient or his relative had to move his case as per rules before the concerned authorities along with complete requisite forms and proof. However, the complainant did not submit the necessary and valid documents at the hospital of treatment for obtaining the cashless treatment. Therefore, the complainant cannot be held entitled for the alleged expenses of Rs.84,048.75P or for any compensation, as prayed for in the complaint. In the end, it has been requested that complaint may kindly be dismissed.

4.                In evidence, the complainant submitted her affidavit as Ex.CW1/A along with documents Ex.CW1/1 to Ex.CW1/56 and closed the evidence.                    

5.                On the other hand, the OP2 to Op4 submitted affidavit Ex.RA of Dr.Rajesh Kumar, Civil Surgeon, Ludhiana (OP4) along with documents Ex. R1 to Ex. R8 and closed the evidence.

6.                           We have heard the counsel for the parties and have also gone through the record on file very carefully.

7.                During the course of arguments, learned counsel for the complainant has contended that the complainant is a senior citizen and was suffering from breast cancer. Counsel for the complainant has further contended that as per the scheme of Punjab Government, the complainant was entitled to get reimbursement to the extent of Rs.1.5 lac spent by her on treatment by any of the hospital empanelled under the scheme. Counsel for the complainant has further contended that the complainant received treatment of cancer at CMC Hospital of the OP1 which is admittedly an empanelled hospital under the scheme but despite that the OPs have not reimbursed any amount to the complainant despite the fact that the complainant and her relative have been contacting the OP2 to OP4 for availing the benefit of the scheme. Counsel for the complainant has further contended that the complainant being a cancer patient was entitled for the benefit of the scheme, she is definitely covered under the definition of the consumer.

8.                On the other hand, Dr.Puneet Sidhu, Medical Officer appearing on behalf of the OP2 to OP4 has pointed out that there was a discrepancy in the documents submitted by the complainant. He has further contended that the patient was entitled to get cashless treatment and there is no provision under the scheme for reimbursement of the amount. The complainant was required to submit the cancer confirmation report, residence proof of the patient such as voter card, driving license, ration card etc., but the complainant did not submit the said requisite documents due to which the benefits of the scheme could not be granted to her. Dr.Puneet Sidhu has further pointed out that since the complainant has herself at fault in not submitting the complete documents, she cannot be held entitled to the benefits of the scheme and further that complaint deserves to be dismissed.

9.                We have weighed the rival contentions raised by counsel for the parties.

10.              It is the admitted case of the parties that as per the scheme titled as Mukh Mantri Punjab Cancer Rahat Kosh, a cancer patient could avail treatment upto an amount of Rs.1.5 lac free of costs through empanelled hospitals. The complainant received treatment of cancer at CMC Ludhiana which is admittedly one of the empanelled hospitals under the scheme. Therefore, the complainant was eligible for the cashless treatment under the scheme to the extent of Rs.1.5 lac. In the affidavit Ex.RA of Dr.Rajesh Kumar, Civil Surgeon, Ludhiana, it is stated that the scheme is a cashless one for the welfare of cancer patients. It is further stated in the affidavit that the concerned patient has to submit the required documents such as confirmation of cancer report, valid residence proof etc. Dr.Rajesh Kumar has further submitted in the affidavit Ex.RA that the complainant did not submit the required valid documents at the hospital. The complainant has further not placed the application form with the required documents and therefore, she is not entitled for reimbursement of the expenses of Rs.84,048.75P incurred by her on the treatment. In this regard, a further reference can be made to the letter Ex.R7 placed on record by the OPs. In the said letter, primarily two objections have been raised. Firstly, the required documents were not submitted in time and secondly, there has been a difference in the name of cancer patient in the residence proof and the diagnosis report submitted by the concerned hospital. It is further mentioned that to get the treatment under the scheme, it is requested that the correct documents be deposited in the concerned hospital. From the letter Ex.R7, it is emerges that the claim of the complainant has not been entertained due to the fact that the requisite documents were not submitted in time and there was some discrepancy in the name of the patient mentioned in the residence proof and in the record of CMC Hospital where the complainant was treated. However, these objections do not seem to be glaring enough to warrant rejection of the claim of the complainant if she was otherwise eligible to get the benefit under the scheme. It is the case of the complainant that when she was admitted in CMC Hospital, she asked the officials of the OPs to hand over the necessary forms to be filled up for availing the benefit of the scheme but the officials of the hospital refused to hand over the same on the pretext that they had not been provided with such forms. As a result, the complainant approached the office of Civil Surgeon, Ludhiana and obtained the forms but the officials of the hospital again refused to receive the same even though, the complainant filed a complaint against the officials of the hospital with the concerned department. It is mentioned in the email Ex.CW1/2 that CMC Hospital was not providing the forms of the scheme to the complainant and in this regard, a complaint was also lodged with the Civil Surgeon, Ludhiana and further that after getting the forms from the Civil Surgeon, the main office of CMC Hospital was contacted and they were asked to fill up the forms but again the officials of the CMC refused to fill the same saying that it was not their duty. Thereafter, emails Ex.CW1/3 and Ex.CW1/4 were sent to the Department of Health and Family Welfare, Punjab. It is evident from the record that the complainant has been trying to avail the benefit of the scheme ever since the complainant was admitted in CMC Hospital, Ludhiana for treatment of cancer. It is further evident from the letter Ex.CW1/8 addressed to the relative of the complainant by the Assistant Director, Directorate Health & Family Welfare, Punjab that the claim of the complainant has been rejected as the application was not deposited in time and there was some discrepancy in the residential proof of the complainant furnished with the said documents. In the considered opinion of this Commission, a genuine claim should not have been rejected on technical ground if the complainant was otherwise eligible to avail the benefit of the scheme. Moreover if the forms were not available at the CMC Hospital, which is admittedly an empanelled hospital under the scheme, and the officials of the hospital also did not cooperate with the complainant in availing the benefit of the scheme, the complainant should not be made to suffer on this account. It would have been appropriate if the complainant was asked to submit a correct residential proof or the record of the hospital could have been verified to remove the doubt about identity of the complainant, if any. No doubt the benefit under the scheme is a cashless one which means that under the scheme, the expenses incurred by the complainant are not supposed to be paid to her but the same are payable to the empanelled hospital where the treatment of cancer has taken place, but again, in the considered opinion of this Commission, this cannot be made a ground to deny the complainant the benefit of the scheme of which she was otherwise eligible. In this regard it is worthwhile to mention that the complainant did approach the empanelled hospital itself for applying for the benefit of the scheme but the forms were not available with the CMC Hospital and the officials of the hospital also did not help the complainant in any manner in availing the benefit of the scheme with the result the complainant had to apply directly to the Department of Health & Family Welfare, Punjab and by the time the complainant had already paid up the expenses of the treatment amounting to Rs.84,048.75P. Therefore, on this technical ground also, the claim of the complainant should not have been rejected. Moreover, even it is a cashless scheme, in the considered opinion of this Commission, the Government has to pay the expenses and it does not matter whether the expenses are paid directly to the hospital or to the patient especially when the complainant has not been at fault. On the contrary, it is duty of the concerned department of the State to facilitate and simplify the procedure so that the benefit of the scheme can be availed by the eligible patients. Therefore, the payment of the expenses incurred by the complainant on her treatment of cancer should not have been denied on the pretext that the scheme in question is a cashless scheme only

11.              As regards the objection that the complainant is not covered under the definition of consumer, it is the considered opinion of this Commission that once the Government floats a scheme for the benefit of its citizens, the citizens, who are eligible for the scheme, can definitely approach this Commission if they are not provided with the benefit of the scheme to which they are otherwise eligible and entitled. Therefore, the complaint cannot be dismissed on technical ground that the complainant is not covered under the definition of consumer. Secondly, it is a settled principle of law that a Welfare State should not hide behind the technicalities to defeat the valuable rights of the citizen. Therefore, the objection that the complainant is not covered under the definition of consumer is also not sustainable in the eyes of law.

12.           As a result of the above discussion, the complaint is allowed with an order that the OP2 to OP4 shall consider the claim of the complainant regarding reimbursement of the expenses incurred by her on the treatment of cancer from the CMC Hospital, Ludhiana between 09.12.2016 to 02.01.2017 and shall pay the same after affording an opportunity to remove the discrepancies, if any, in the documents or in the application form submitted by the complainant. There shall, however, be no order as to compensation and litigation costs. The compliance of the order be made within 45 days from the date of receipt of copy of order. Copies of order be supplied to parties free of costs as per rules.

13.              File be indexed and consigned to record room.    

14.              Due to rush of work and spread of COVID-19, the case could not be decided within the statutory period.

                             (Inderjit)                                          (K.K.Kareer)

                    Member                                           President

Announced in Open Commission.

Dated:30.03.2021.

Gurpreet Sharma