Complainant by filing this complaint has submitted that he is working in a private limited company namely M/s. SARAL Industries, 2 Turner Road, Kolkata – 700002 and it was not possible for him to bear the huge financial expense for which he opted Insurance Policy bearing No. 4111206144 of ESI Scheme and he felt chest back pain in the month of May-2012 and went to Sealdah ESI Hospital OPD regularly for treatment and his blood test and TMT were also held.  But after a few days he again felt worst and physical condition was deteriorated day to day and ultimately to save his life he was compelled to take assistance from private doctors and accordingly Angiography and CABG were done at Peerless Hospital and at BelleVue Clinic on 14.06.2012 and 29.06.2012 respectively.

          But practically complainant has no such fund for which he took personal loan and got such treatment from outside and against the said Hospital op, complainant lodged a complaint to Nodal Officer Health System Development for taking step but the West Bengal Medical Council reported that they are not empowered to proceed against any medical institution.  So, in the above circumstances complainant has prayed for proper relief and compensation against the ops.

          On the other hand op no.1 by filing written statement submitted that when there is a conflict between the Special law and General Law, the Special Law will prevail and in the above principal of law employees’ State Insurance Act 1948 shall prevail and adjudication of the issue can be filed before the Special Tribunal and not before this Forum.

          Further it is submitted that the present complaint is not maintainable as per Section 75 of ESI Act.  But it shall be decided by the Employees’ Insurance Court.  Further it is submitted that complainant Abhijit Ghosh Insurance No. 4111206144 was advised to attend ESI Hospital at Sealdah on 14.05.2012 by his IMO on 12.05.2012 with complaints of Numbness of Left Hand and Weakness.  Thereafter complainant visited on 14.05.2012 and the OPD doctor after examining diagnosed it clinically effort angina and prescribed medicines and certain blood test was done and as per treatment sheet the patient was provided better, medicines prescribed and TMT was done for positive TMT report.  But after last time on 30.05.2012 he visited.  But thereafter he did not turn up and fact remains there was no negligence and deficiency on the part of the op.  If op after 30.05.2012 failed ill, it was his duty to report to ESI Hospital forthwith.  But complainant did not attend the same for which there was no scope on the part of the ops to treat him and probably he himself arranged for his treatment outside ESI Hospital and in the above circumstances, the present complaint should be dismissed.

Decision with reasons

          On proper consideration of the complaint and written version including the treatment sheet and the argument as advanced by the complainant and the Ld. Lawyer for the op, it is clear that complainant attended the ESI Hospital on 12.05.2012.  Thereafter complainantvisited on 14.05.2012and he was further examined and proper medicines were given and thereafter complainant again was examined on 12.05.2012 and thereafter on 06.06.2012.  Up to that stage complainant as and when went to ESI Hospital and got such medicines, treatment etc.  But against such treatment there was no allegation of the complainant that ops did not properly treat him and he was not referred to Cardiology Department for treatment etc. and has also not brought any allegation of negligence and deficiency of service on the part of the ops.  But it is clear that on 13.06.2012 complainant was admitted to Peerless Hospital and was discharged on 14.06.2012 with a complaint of heaviness in back chest pain and chest discomfort on exertion for 2 – 3 months, resting ECG – ST sagging in inferior leads and TMT – positive at low workload of exercise and admitted for CAG. 

          On final diagnosis it was found that multiple-vessel coronary artery disease and normal LV – systolic function and effort angina.  Thereafter treatment was given and he was released on 14.06.2012.  Thereafter complainant was admitted to Belle Vue Clinic on 28.08.2012 and was discharged on 08.07.2012 operation was held on 29.06.2012 and it was diagnosed that Multi vessels Coronary Artery disease (Unstable Angina).  Operation CABG X4: OPCAB [LIMA-INTM, RIMA – LAD, SVG – DIAGI + RCA] was done by Dr. H.K. Dasmahapatra.

          Now question is when complainant was admitted to Peerless Hospital on 13.06.2012 and was discharged on 14.06.2012 then why after 14.06.2012 complainant did not report to the ESI Hospital Superintendent about that fact and if it would be reported in that case invariably op may get such chance to refer to other hospital for proper treatment.  But truth is that the complainant did not report to the ops after 06.06.2012, probably he did not think for a moment to go to ESI Hospital for better treatment and also did not report that such an incident took place on 13.06.2012 for which he was admitted to Peerless Hospital and was discharged on 14.06.2012 after getting such treatment.  If that matter would be brought to the notice of the ESI Hospital Superintendent, in that case invariably op ought to have get chance by referring to specialist hospital of ESI at Manicktala where there is very good Cardiology Department. 

          But fact remains complainant did not turn up and at the same time during the period of treatment from 12.05.2012 to 06.06.2012 complainant casually attended and he was treated and medicines were supplied at free of cost and all tests were done and invariably during that period complainant was OK and complainant did not make any allegation about any further deterioration of his health.  At the same time no document is produced by the complainant to show that in between 12.05.2012 to 06.06.2012 he was on leave and he was completely bed ridden.  Further he has failed to produce of any further document from 06.06.2012 to 13.06.2012 that he was bed ridden or he was on leave.

          So, considering all the above fact and circumstances, it is clear that complainant’s has not brought any allegation of negligence and deficient manner of treatment by the ops during the period of his treatment by the ops from 12.05.2012 to 06.06.2012.  At the same time it is true that after 06.06.2012 complainant did not turn up to ESI Hospital.  But at his own wish he was admitted to Peerless Hospital on 13.06.2012 and was discharged on 14.06.2012 got treatment at Belle Vue Clinic and within that period no doubt he spent money but for that reason ESI Hospital cannot be responsible because it is the duty of ESI to give treatment if insured comes in their hospital.

          Moreover in the complaint there is no whisper of negligent and deficient manner of service made by the ops at the time of treatment of the complainant from 12.05.2012 to 06.06.2012.  In view of the above findings we are convinced to hold that there is no merit in this case because there is no allegation of deficiency of service or negligent manner of treatment by the ops.

          In the result, the complaint fails.

          Hence, it is

ORDERED

          That the complaint be and the same is dismissed on contest against the ops but without any cost.