DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II

Udyog Sadan, C-22 & 23, Qutub Institutional Area

(Behind Qutub Hotel), New Delhi-110016

Case No.60/2016

1. Mr. Ashok Kumar

R/o New Extension Colony,

Gali No.8, Palwal Haryana

2. Mrs. Sunita Devi

W/o Ashok Kumar

R/o New Extension Colony,

Gali No. 8, Palwal, Haryana.                                        ….Complainants

Versus

1. Managing Director,

Metro Hospitals & Hear Institute,

14 Ringh Road, Lajpat Nagar,

New Delhi-110024

2. Dr. S. Mukherjee

Metro Hospitals & Heart Institute,

14, Ringh Road, Lajpat Nagar,

New Delhi-110024.                                        ….Opposite Parties

                                                Date of Institution        : 02.03.2016      Date of Order                : 12.03.2020

Coram:

Ms. Rekha Rani, President

Ms. Kiran Kaushal, Member

Ms. Kiran Kaushal, Member

ORDER

1. Brief facts of the case as pleaded by the complainants are that the complainant’s wife was admitted in Metro Hospital & Heart Institute (OP) and was advised to undergo surgery and get a pacemaker implanted.  The surgery was accordingly done at OP’s Hospital.
   1. It is averred that on 01.12.15 complainant No.1 was forced to deposit Rs.40,000/- under ‘Non Admissible Items’ as mentioned in invoice dated 03.12.15. Photocopy of the invoice dated 03.12.15 is annexed as Annexure C-2. The doctors of the OP’s hospital refused to treat the complainant’s wife unless and until he deposited the aforesaid amount of Rs.40,000/-. The complainant was thereafter given an ‘Inpatient Bill’ dated 04.12.15 by OP wherein Package Charges of the complainant are mentioned. The package was made which included Coronary Angiography for Rs.11,902/-, Permanent Pacemaker Implantation for Rs.19,996/- and Cost of Pacemaker i.e. Rs.83,200/- and the total that was billed to the complainant  was Rs.1,15,098/- which is evident from the copy of invoice dated 04.12.15. The complainant was shocked when Rs.40,000/- the amount initially taken was not adjusted by the hospital in the final bill dated 04.12.15. The complainant requested OP hospital to refund Rs.40,000/- which was refused by the OP hospital. Aggrieved at the illegal charges of Rs.40,000/- made by OP, the complainant  approached this Forum with the prayer seeking direction to OP to                                                           refund the amount of Rs.40,000/- which was wrongfully charged @ 18% interest per annum and Rs.2 lacs towards damages for harassment and litigation cost.                 
2. OP resisted the complaint and  submitted inter-alia that wife of the complainant was admitted and treated satisfactorily by OP. OP raised a preliminary objection stating that complainant has no locus standi in the instant complaint as it was complainant’s wife who was treated at OP hospital and the bills raised by the hospital are also in her name.
   1. It is pleaded that OP as per the requirement, rules and regulations of medical treatment had received the sum of Rs.40,000/- in advance. The package as mentioned in the invoice dated 04.12.15 includes cost on coronary angiography and permanent pacemaker implantation and cost of pacemaker only. Rest of the services taken by the wife of the complainant are not included in the said invoice. It is stated that amount mentioned in the invoice dated 04.12.15 was not the full and final amount for the services provided by the OP.                                                                                                                                                                                                                                                                                                   
   2. OP further submits that the initial amount of Rs.40,000/- deposited by the complainant  was to meet the expenses of the treatment of the complainant’s wife and the said amount was adjusted in the cost of the pacemaker for which OP had paid Rs.1,23,200/-.
   3. Denying any deficiency in service or unfair trade practice on its part OP has prayed for dismissal of the complaint.                                                                                                                                                             
3. Amended complaint alongwith amended memo of parties is filed by complainant wherein wife of the complainant is impleaded as co-complainant.  
4. Rejoinder and evidence by way of affidavit are filed by the complainant wherein averments made in the complaint are reiterated.  Evidence by way of affidavit is filed by Mr. Divender Yadav AR for OP. Written arguments are filed on behalf of the parties. Submissions made on behalf of the parties are heard.  Material placed on record is perused carefully.   
5. Complainant has only one grievance against OP that OP has illegally charged Rs.40,000/- from the complainant which is reflected in the bill dated 01.12.2015 appended at page-25 of the complaint. Preliminary objection raised by OP lost its significance when this Forum vide order dated 29.09.2016 allowed the complainant to amend the complaint whereby the name of his wife Mrs. Sunita Devi as complainant No.2 was added.
6. Before we decide the contention of the parties, it is important to reproduce the documents placed on record. Annexure C-3 appended at page 26 of the complaint is a bill dated 04.12.2015 generated by OP is reproduced as under:-

7. OP with its additional evidence has annexed as Annexure OP/1, a Tax Invoice dated 02.12.2015 which is reproduced below:-

8. Copy of the office memorandum bearing No.S11045/36/2012-CGHS(HEC), Ministry of Health & Family Welfare dated 01.10.2014 is annexed as Annexure OP/2 wherein revised package rates applicable under CGHS Delhi and NCR are provided. The detailed guidelines/ terms and arrangements between the hospitals and Government to provide the cashless treatment to the Government beneficiaries has been prescribed. Copy of the same is appended at Page-8 of the additional evidence. As per para-1.1.15 of the above,

“….cost of implants / stents / grafts is reimbursable in addition to package as per CGHS ceiling rates or as per actual, whichever is lower

In case a beneficiary demands a specific Brand of stent/ implant and give his consent in writing the difference in cost over and above the ceiling rate may be charged from the beneficiary which is non-reimbursable.”

9. Another office memorandum dated 22.07.2014 is appended at page-24 of the additional evidence by OP wherein ceiling rate for reimbursement of the cost of cardiac pacemaker and others is given. The revised ceiling cost of the ‘dual chamber cardiac pacemaker’ which was implanted in the complainant’s wife, is Rs.83,200/-.
10. It is pertinent to mention here that the complainant before getting the implant gave an undertaking with OP hospital which is annexed as R-5 1/1 wherein the complainant has specifically undertaken the following in point 2 and point 3 of the undertaking:-

2.   I hereby give my express and unconditional consent and I am willingly agreeing for the implantation of higher value.

3.   I undertake to make the payment of the difference in the amount between the high value (*Implantation) and the ceiling rate of the same which is approved by CGHS M/o Health & Family Welfare, Govt. of India.

11. Having given the undertaking the complainant is now bound by the terms of the undertaking. From reading of the documents mentioned above, it is evident that Rs.40,000/- was the difference in the amount between the actual cost of implantation and the ceiling rate approved by CGHS. Though OP has averred in written statement that bill dated 04.12.2015 was not the full and final amount, OP has not placed anything on record to show that any other bill was also raised. Hence, we are of the opinion that OP on account of being ambiguous about receiving the payment of Rs.40,000/-  is held deficient in service to the extent that it did not disclose in the final ‘Inpatient Bill’ that Rs.40,000/- is adjusted towards the cost of the implant. Therefore, OP is directed to pay Rs.7,500/- to the complainant towards compensation for harassment and litigation cost within one month of receipt of copy this order. Failing which OP shall become liable to pay interest @ 12% p.a. on the amount of Rs.7,500/- from the date of filing of the complaint till realization.
12. Let a copy of this order be sent to the parties as per regulation 21 of the Consumer Protection Regulations. Thereafter file be consigned to record room.

Announced on 12.03.2020