FA  939  of 2009  against  C.C. 28/2008, Dist. Forum, Kakinada      

Between:

Mohd. Ismail Khadari

S/o. M. A. Hussain

Age: 65 years,

Retd. Railway Employee

D.No. 70-7-66/C4

TSR Nagar, Kakinada                                  ***                           Appellant/

          .                                                                                       Complainant

                                                                   And

1)  The Chief Medical Superintendent

Railway Hospital

South Central Railway

Vijaywada.

2)  The Divisional Railway Manager

South Central Railway

Vijayawada

3)  The Chief Medical Director

South Central Railway

Rail Nilayam

Secunderabad

4)  The General Manager

South Central Railway

Rail Nilayam

Secunderabad                                             ***                         Respondents/

                                                                                                Opposite Parties

Counsel for the Appellant:                          M/s.  Gopi Rajesh & Associates

Counsel for the Respondent:                      M/s.  Dilip Kumar.                 

CORAM:

HON’BLE SRI JUSTICE D.APPA RAO, PRESIDENT.

      SMT. M. SHREESHA, MEMBER

   &

                                    SRI R. L. NARASIMHA RAO, MEMBER

MONDAY, THIS THE EIGHTEENTH DAY OF JULY  TWO THOUSAND ELVEN

ORAL ORDER:  (Per Hon’ble Sri Justice D. Appa Rao, President)

***

1)                 Appellant is unsuccessful complainant.

2)                 The case of the complainant in brief is that   he is a retired railway employee having attained superannuation on 30.6.2002.    A scheme was evolved  for retired employees to have benefit of medical treatment on par with working employees.    In fact it was re-opened  from  28.1.2005 to 31.12.2005.    In view of the fact that he was entitled to the  benefits under the scheme  he paid his contribution.    He and his wife are hypertension  patients undergoing treatment/regular check up  with their family doctor Dr.  S. Venkata Prasad, Former Head & Professor of Medicine,    registered civil surgeon, Government General Hospital, Kakinada.  Despite his repeated requests to the Medical Superintendent, health Unit, Samalkot  and Chief  Medical Superintendent, Railway Hospital, Vijayawada  to supply medicines they refused.  In fact they were empowered to purchase medicines  in the local market.   When they could not supply  as he has no other alternative  he purchased the same in open market, and submitted  bills.    The  Chief Medical  Superintendent by his letter dt. 29.6.2006  directed them to attend  Railway Hospital at Vijaywada for examination.    It was impossible  for them to travel such a long distance.    He informed the said fact  and that said medicines are available at  Kakinada itself.    On that chief medical  superintendent   directed him to appear before the Medical Officer, Health Unit, Kakinada.  Accordingly he attended along with his wife and undergone various tests.   They in turn prescribed medicines on different dates.  Despite his requests the medicines  were not supplied nor  ordered reimbursement of medical bills.    The medical bills pertaining to the period from 11/2005 to 1/2007 incurred by him were also not paid.    Therefore he sought reimbursement  of Rs. 35,113/-  under medical bills from 11/2005 to 10/2007  incurred by him due to non-supply of medicines, or supply medicines as per the prescription and allow treatment either at corporate hospitals or government general hospital and for costs. 

3)                 The opposite parties resisted the matter.  While  admitting floating  of the scheme  for retired railway employees,   they alleged that the retired employees would be provided medical treatment  as available in railway hospitals.   During the lock in period,    the employees  were not entitled for referral to private hospitals or for reimbursement  of medical claims  for  the treatment  taken in private hospitals.    The complainants have thus violated the conditions.   The purchase of medicines  by the complainant was  on his own volition.   It is contrary to the scheme.  The complainant and his wife are  entitled to travel in A/c coach from Kakinada to Vijayawada.    The allegation that it is impossible for them to travel  such a long distance  is not correct.   They are medically fit to travel from Kakinada to Vijayawada.   When the complainant and his wife attended the dispensary  at Kakinada  the doctor who examined them informed that  they were not entitled to any reimbursement or cost of medicines  or treatment  made and prescribed  by the private doctors at Kakinada.   The question of their satisfying  with the  treatment of the Railway doctor and therefore he went to a private doctor cannot be countenanced.   He was informed that ‘lock up dispensary and  ‘lock up period’   are different and distinct.   Lock up dispensary is conducted at a station where there is no Railway Health unit for the benefit of railway employees, and whereas the lock-in-period  is a condition governing  reimbursement of  medical expenses.   The Railway Medical Officer  at Kakinada  informed that the complainant has been refusing to take the medicines with different brand names available in the railway health unit, Samalkot, and demanding for brand name drugs  as prescribed by the private medical  practitioners of his choice in spite of clear advise that generic drug is one and same  though brand names were different.   Due to his adamant attitude he  could not be supplied with  drugs that were prescribed.  When requisite medicines   which were sought to be supplied  were  given  there cannot be said to be any deficiency in service.   He is not entitled to any reimbursement of  amount  under medical bills from 11/2005 to 10/2007 nor continue to reimburse the bills.  There was no deficiency in service  on their part, and therefore prayed for dismissal of the complaint with costs. 

4)                 The complainant in proof of his case filed his affidavit evidence and got Exs. A1 to A82 marked while the  opposite parties filed Exs. B1 to B8.

5)                 The Dist. Forum after considering the evidence placed on record opined that when the complainant was not accepting the generic medicines available in the railway hospital  he cannot claim reimbursement of bills purchased  in open market prescribed by the private doctors.   The complainant cannot ask the  railway hospital to supply branded drugs  in place of generic drugs.    There was no deficiency in  service  on the part of opposite parties,  and therefore dismissed the complaint.

6)                 Aggrieved by the said decision, the complainant preferred the appeal contending that the Dist. Forum did not appreciate either facts or law in correct perspective. It ought to have seen that  he had spent Rs.  45,223.80 ps from  January, 2006 to August, 2008  evidenced under Exs. A19 to A24 and A26 to A32, and that he was entitled to the benefits like serving employees.   The drugs that were sought to be supplied were distinct and different from generic drugs, and therefore he was not  willing to take those medicines.   He cannot be directed to travel along with  his wife to a distance of 250 Kms when they are  senior citizens.  Therefore he prayed that the complaint be allowed, and direct the amount be paid. 

7)                The point that arises for consideration is whether the order of the Dist. Forum is vitiated by mis-appreciation of fact or law?

8)                It is an undisputed fact hat the complainant and his wife are entitled to medical facilities on  par with serving railway employees,   he having worked in railways   by virtue of health scheme RELHS-97.  He was  enrolled as a member entitled to the treatment from railway hospitals or reimbursement of claims as the case may be.   He got clinical tests conducted at Apollo Hospital, Kakinada wherein certain branded drugs were prescribed.  Later in view of the scheme he approached the Medical Superintendent, Health Unit, Samalkota  and sought for supply of branded medicines.  He alleges that  when the medical superintendent tried to issue other than the prescribed medicines, despite his letters  dt. 19.12.2005 and 23.12.2005  medicines were not supplied, and therefore  he was forced to purchase  the same from open market and sought for reimbursement of amount which they did not reimburse, and therefore filed the complaint seeking reimbursement of the same. 

9)                 The respondent railway hospitals have categorically stated that when he attended the dispensary  at Kakinada Railway Station  he sought branded medicines to be supplied to him when they tried to supply generic medicines  with similar composition  with different name  he refused to receive  on the ground that he should be supplied branded drugs that were prescribed by the doctors.

10)               He alleges that  when he  approached the railway dispensary on  5.12.2006 along with his wife, the railway doctor examined them and prescribed certain medicines under Ex. A12.  The railways contends that the drugs given were the same except change in brand name.    The complainant in the grounds of appeal at ground No. 9 maintains that “the Medical Superintendent insisted to take medicines which are available  at Health Unit by that time contrary to the actual prescribed medicines  required to maintain health of the complainant and his wife  who are chronic patients.  The appellant  further submits that railways are procuring a few drugs and supplying the same to all irrespective of their ailments as “Sarvaroga Nivarani’.   

11)              Therefore it is not his claim  that  medical superintendent refused to supply medicines.  What all he wanted was that branded drugs that were prescribed  must be supplied to him.   In fact medical prescription Ex. A12  issued by  Medical Officer, Railway Lock Up Dispensary, Kakinada  noted generic medicines and not branded drugs.  They are  to be supplied through railway hospitals or government hospitals.    It is not the case of the complainant even that the branded drugs prescribed by railway doctor under  Ex. A12 or for that matter the  other drugs  that were prescribed  were not the same which the railway dispensary  was to supply to him.   He insisted branded drugs  instead of generic drugs that were sought to be supplied.   Since the complainant failed to establish that the medicines prescribed  to him are different from drugs that were sought to be supplied it cannot be said that the railways were  at fault or that amounts to deficiency in service.    The complainant was clearly at fault  in  not taking medicines given to him, and insisting on branded drugs.    He cannot unilaterally purchase drugs  from  open market  and sought for reimbursement.   The railway hospitals never rejected his claim stating that  they were not having requisite medicines that were prescribed by the doctors.   The complainant cannot claim reimbursement, nor rules  authorised to supply such medicines.   The railways have rightly repudiated the claim.   We do not see any mis-appreciation of fact or  law by the Dist. Forum in this regard.  We do not see any merits in the appeal. 

12)               In the result the appal is dismissed.  However, in the circumstances of the case no costs. 

1)       _______________________________

PRESIDENT                 

2)      ________________________________

 MEMBER          

3)      ________________________________

 MEMBER          

       18/07/2011

*pnr

“UP LOAD – O.K.”