BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT HYDERABAD.
OF 2008 AGAINST C.C.NO.966 OF 2006 DISTRICT CONSUMER FORUM-II HYDERABAD
Between
S.Lakshmi Narayana S/o Venkata Subbaiah
Aged about 62 years, R/o H.No.1-4-90/A
New Maruthi Nagar (East) Kothapet
Ranga Reddy District-35
Appellant/complainant
A N D
1. The Director
Central Government Health Scheme
Directorate General of Health Services
Nirman Bhavan, New Delhi-110001
2. The Additional Director
Central Government Health Scheme
Prakash Nagar, Begumpet, Hyderabad
3. The Director
Nizam’s Institute of Medical Sciences
Panjagutta, Hyderabad
Respondent/opposite parties
Counsel for the Appellant Dr.A.Raghu Kumar
Counsel for the Respondents No.1&2 Sri G.Jaya Prakash Babu
Counsel for the Respondent no.3 Sri S.S.Bhatt
QUORUM: SRI SYED ABDULLAH, HON’BLE MEMBER
&
SRI R.LAKSHMINARSIMHA RAO, HON’BLE MEMBER
TUESDAY THE SEVENTEENTH DAY OF AUGUST
TWO THOUSAND TEN
Oral Order ( As per R.Lakshminarsimha Rao, Member)
***
The unsuccessful complainant is the appellant
The facts of the case as narrated by the complainant is that he is a retired employee of the DOT drawing pension from the department. The complainant had also obtained a card from the Central Government Health Scheme by paying admission fee. The complainant applied for `5,20,000/- towards his wife’s treatment from opposite parties no.1 and 2 in opposite party no.2 hospital. Accordingly, the opposite party no.3 issued a letter showing the exact amount to be paid for Bilateral DBS implant to the wife of the complainant. However, the opposite parties no.1 and 2 sanctioned only an amount of `3,75,000/- and the complainant sought for full amount of `5,20,000/-. The case of the complainant is that as the opposite parties no.1 and 2 did not release the amount as prayed for them, his wife died. The opposite party no.3 is also negligent in not administering timely treatment to the wife of the complainant. Hence, the complainant is seeking direction to the oppose parties to pay compensation of `10 lakhs.
The opposite parties no.1 and 2 resisted the claim by filing parawise remarks. It was contended that the appellant is not a consumer for availing facilities under CGHS. The complainant under the CGH Scheme has to avail medical facilities through CGH Scheme dispensaries at Begumpet, Himayatnagar in Hyderabad. Bilateral Deep Brain Stimulator Implantation is not an approved procedure under the CGH Scheme. Therefore, the case of the complainant was referred to Director, CGHS, New Delhi on 21.7.2004. As DBS Implant is a new procedure and no permission in such cases was issued earlier, the case of the complainant along with two other similar cases recommended by the opposite party no.3 hospital were forwarded to the Director, CGHS, New Delhi who examined the various aspects and approved the procedure at the ceiling rate of `3,75,000/- The government has to examine all aspects before taking a new decision to approve any new procedure. Hence, the approval for the new procedure had taken some time to take such important decision. There was no deficiency of service on the part of the opposite parties no.1 and 2. Hence, prayed for dismissal of the complaint.
Respondent no.3 hospital remained exparte.
The appellant has filed affidavit in support of his case as also the documents marked as Exs.A1 to A27.
On behalf of the respondents, the respondent no.2, Dr.G.V.Raghuram has filed his affidavit. Exs.B1 to B5 had been marked.
The points for consideration are:
1) Whether there was deficiency of service on the part of the respondents no.1 to 3?
2) To what relief?
POINT NO.1 The appellant, a retired employee of the D.O.T. obtained CGHS (life time) card. His wife, for 12 years prior to the filing of the complaint, suffered from Parkinson’s disease which according to the complainant him compelled him to opt for his voluntary retirement from the service. The appellant states that he lost his two mentally retarded sons within a gap of five years. The version of the appellant is that the opposite parties no.1 and 2 had not sanctioned the amount of `5,20,000/- the amount assessed by the Respondent no.3 hospital for implantation of Bilateral Deep Brain Stimulator. The appellant’s wife was admitted to the Respondent no.3 hospital on 22nd April, 2004 and she was discharged on 1st May,2004 with an advice to undergo surgery for implantation of Deep Brain Stimulator. A perusal of the averments of the complaint would show that at the time of discharge, the complainant had not obtained any estimate for the operation charges from the Respondent no.3 hospital. In the 3rd paragraph of the complaint it is stated as under:
“Later, NIMS has issued a Certificate of Estimation for the treatment indicating the approximate cost of the treatment, `5,20,000/”.
The appellant has not specified the date of certificate of estimation issued by the Respondent no.3 hospital. The appellant applied for seeking permission and sanction of the amount, `5,20,000/- on 17th July,2004 and the respondent no.1 forwarded his application to the respondent no.2 on 21stJuly,2004. The appellant submitted representation to the Member of Parliament and the Ministers as also he had sent a reminder dated 20th April,2005 to the respondents which eventually evoked response from the respondent no.1 who through the respondent no.2 and by the letter dated 12th May,2005 informed the appellant that the maximum amount admissible towards the expenditure for implantation of Bilateral Deep Brain Stimulator is `3,75,000/- subject to the recommendation of a Neuro Physician from a Government Health Center to the effect that the patient is informed of the cost and efficacy of the treatment and that the patient should be a case of Idiopathic Parkinson resisting to conservative treatment. The appellant submitted another representation that the respondent no.3 is a government medical institute and it has quoted the surgery expenditure as `5,20,000/- whereon the respondent no.2 brought the request of the appellant for the entire amount of `5,20,000/- to the notice of the respondent no.1 .
The appellant, on 8th August,2005 requested the respondent no. to accord permission for admitting the appellant’s wife in the respondent no.3 hospital. After the respondent no.2 granted the permission, the appellant admitted his wife on 18th August,2005 in the respondent no.3 hospital. The respondent no.3 hospital again requested on 19th August,2005 for grant of the amount of Rs.5.10 lakh for the implantation of bilateral DBS Implantation and the respondent no.1 forwarded the representation to the respondent no.2.The respondent no.3 issued another estimation certificate dated 13th December,2005 indicating the expenses of the treatment as `5.2 lakh whereof the Hon’ble Chief Minister sanctioned an amount of `10,000/-
Admittedly, Deep Brain Stimulators implantation is a new procedure. According to the respondents no.1 and 2 no such cases, had come across earlier. Therefore, the case of the appellant’s wife was referred to the Director, CGHS, New Delhi and in the process some delay was caused which however, had no bearing on the treatment offered at the respondent no.3 hospital as the amount required for the DBS Implantation was `5,20,000/- and although the appellant was pursuing for the sanction of the amount quoted by the respondent no.3 hospital against the permissible ceiling limit of `3,75,000/- as prescribed by the Director of CGH Scheme.
The appellant’s wife was suffering from Parkinson disease for about 12 years prior to the date of her final admission at the respondent no3 hospital. On the previous occasions there was no complaint of any delay in granting permission or sanctioning the amount within the ceiling limit prescribed therefor. Taking into consideration of these facts, we do not find any lapse on the part of the respondents’ no.1 and 2 is sanctioning of the amount for the treatment of the appellant’s wife. It is also to be considered that the respondent no.1 and 2 contended that the appellant has no locus standi to file the complaint in terms of the Sec.2(1)(d)(g) of C.P.Act. There is no negligence alleged against the respondent no.3 hospital except the contention that the respondent no.3 hospital denied timely treatment to the wife of the appellant which however, has not been pressed into service at the time of enquiry before the District Forum as also before this Commission. In the circumstances, the appeal cannot be said to have any substance.
In the result the appeal is dismissed confirming the order of the District Forum. No costs.
Sd/-
MEMBER
Sd/-
MEMBER
Dt.17.08.2010
KMK*
