BEFORE THE TELANGANA STATE CONSUMER DISPUTES REDRESSAL COMMISSION : HYDERABAD

FA NO.671 2013 AGAINST CC NO.124 2010

ON THE FILE OF DISTRICT FORUM-II, HYDERABAD

Between:

The Chief Medical Director,

South Central Railways,

Rail Nilayam, Secunderabad.

…Appellant/Opposite party

And

T.Subba Reddy S/o T.Ram Reddy,

Aged about 73 years, Occ: Retired Office

Superintendent, CPOs office, SCR, Secunderabad,

R/o Plot No.156, Vasavi Nagar,

Karkhana, Secunderabad – 500 015.

…Respondent/Complainant

Counsel for the Appellant           :         Sri R.Dilip Kumar

Counsel for the Respondent       :         Sri M.Mohan Bujji

Coram                  :

Hon’ble Sri Justice B.N.Rao Nalla   …      President

and

Sri Patil Vithal Rao … Member

Wednesday, the Twenty Eighth day of September

Two thousand Sixteen

Oral Order : (per Hon’ble Sri Justice B.N.Rao Nalla, Hon’ble President)

***

1)       This is an appeal filed by the Opposite party aggrieved by the orders dated 05.03.2013 of the District Forum-II, Hyderabad made in C.C.No.124 of 2010 in allowing the complaint partly and directing the Opposite party to reimburse a sum of Rs.40,000/- (page 3 of Ex.A3) to the Complainant, within a period of one month and on failure to comply within the stipulated time, the Complainant is entitled for interest @ 9% p.a. from the date of default. 

2)       For the sake of convenience, the parties are referred to as arrayed in the complaint.

3)       The case of the Complainant, in brief, is that he retired from service of OP as OS (P), CPO/O/SC, in the month of August 1996 and he is eligible for free medical treatment in the Railway Hospital a well as its sponsored private hospitals in and around the Hyderabad City, however, the OP is collecting one month’s basic salary last drawn from the retired employees and issued the identity cum medical care with Railway Employees Liberalised Health Scheme.  This scheme is not only covered to the retired employees but also to the spouse and dependants.  In case the beneficiaries are availing treatment from outside the railway hospital, they are eligible to get reimbursement of the same. 

4)       Complainant has been suffering from explorated neck = excisition of left paratorchial mass and has been undergoing treatment from the railway hospital.  However, on account of severity, required further investigation by specialist doctors, the OP referred the Complainant to Indo-American Cancer Institute, Hyderabad for further evaluation and management by Surgical Oncologist for IP and OP services vide letter No.4311117070701, dated 17.07.2007.  As Indo-American Cancer Institute is far off from his residence, the Complainant took treatment at Soumya Hospital, Karkhana, Secunderabad which is adjacent to his residence, incurring Rs.40,000/- and made claim for reimbursement by application dated 08.04.2008, to which, by letter dt.10.06.2009 the OP’s department replied that the case is not one of the emergency and does not require any operation.  As against which, Complainant preferred appeal before the Chief Medical Director, wherein, vide letter dated 14.07.2009 it was replied that as the treatment is taken in private hospital instead of referred one, the claim is repudiated.

5)       Though the Opposite party referred the Complainant to Indo-American Cancer Institute, Hyderabad, on account of urgency, he got admitted at nearby private hospital and got treated.  Hence, the complaint praying to direct the OP to take action on the claim submitted by complainant without any further delay; to pay damages of Rs.15,000/- as compensation for the agony suffered by Complainant; to award costs of the complaint at Rs.5,000/- and any other reliefs.

6)       Opposite party resisted the claim by way of written version contending that the complaint is not maintainable either on facts or on merits.  The reimbursement will be made as per IRMM rules but not on any individual/personal capacity and same is applicable to all the retired persons.  All the retired employees are eligible for free treatment in the Railway hospitals as well as in the sponsored private hospitals recognized by the Railway Board as per the list released from time to time but not as per the wish of the beneficiaries.  Treatment can also be obtained from the recognized hospitals after due reference from the railway doctors.  The beneficiaries can avail treatment outside the railway hospital provided there is an emergency at the time of admission in the private hospital as per Railway Board guidelines.

7)       In case of emergency, the beneficiary has to intimate the Railway Medical authority within 24 hours, which is not complied with in the present case.  Moreover, the Complainant was discharged on 03.08.2007 and he made the claim on 08.04.2008 approximately after 8 months, at his wish but not per the Rules laid down therein.  The OP Railways referred the Complainant to Indo American Cancer Institute on 17.07.2007, whereas, on his own volition, he got admitted in Sowmya Multi-Speciality Hospital on 28.07.2007.  It denied not having surgical facilities at its hospital.  It has recognized surgical Oncologists, Medical Oncologists on case-to-case basis.  The purpose of referring the Complainant to Indo-American Cancer Institute is to take a decision regarding the line of treatment and for evaluation of the case and not for immediate surgery.  The claim of Complainant was not allowed as it was not an emergency and need not be operated immediately.  Mere referring to other Institute cannot be treated as urgent.  It is worth-while to mention that Complainant is interested to be treated by Dr.C.S.Rao, but not as a condition of emergency, hence, the reimbursement claim is not allowed.  As per Railway Board letter No.2005/H/6-4/ Policy-II, dated 31.01.2007, paragraph-I (sub-para-2), in exceptional cases, CMDs of Zonal Railways can obtain special permission from Railway Board for treatment in any private hospital on case-to-case basis. 

8)       In the said letter, paragraph-1 (2), the meaning of emergency is also given which shall mean any condition or symptom resulting from any cause, arising suddenly and if not treated at the very convenience, be detrimental to the health of the patient or will jeopardize the life of the patient.  Some of them are road accidents, other types of accidents, acute heart-attack, etc.,  Under such conditions, when the beneficiary feels that there is no scope of reporting to his authorized Railway Medical Officer, may avail treatment in the nearest and suitable private hospital and claim reimbursement.  Even they have to give clinical findings at the time of admission for evaluating the emergency.  The reimbursement cannot be processed unless emergency is established and the hospital which has treated the patient is referred by the Railway doctor, accordingly, the claim is repudiated. 

9)       There is a memorandum of understanding between Railway hospital and recognized hospitals for payment of treatment charges, such arrangement does not exist between railways and non-recognized private hospitals.  Medical reimbursement is permissible only after establishing the presence of emergency condition at the time of admission in the private hospitals which is not applicable in the present case.  Hence, prayed to dismiss the complaint with costs.

10)     During the course of enquiry before the District Forum, in order to prove his case, the Complainant got filed his evidence affidavit and Exs.A1 to A9.  On behalf of the Opposite party, got filed the affidavit of one C.Ravindra Sharma, its Additional CMD, and marked no documents. 

11)     The District Forum after considering the material available on record, allowed the complaint in part, as stated, in paragraph No.1 supra.

12)     Aggrieved by the said orders, the Appellant/Opposite party preferred this appeal contending that the forum below (a) committed material irregularity under law, facts and submissions in not properly appreciating the complaint, the written version filed by the Appellant, the evidences and documents; (b) failed to take note of the willful dishonest acts of the Respondent who misused the Forum for gaining dishonestly; (c) has not taken into account the Rules & regulation contained in the manual issued by Railway Board.  Hence, prayed to allow the appeal by setting aside the orders dated 05.03.2013 made in CC No.124/2010.

13)     The point that arises for consideration is whether the impugned order as passed by the District Forum suffers from any error or irregularity or whether it is liable to be set aside, modified or interfered with, in any manner?  To what relief ?

14)     Both the Appellant and Respondent filed their written arguments reiterating the averments made before the forum below as also in the grounds of appeal. 

15)     It is not in dispute that the Respondent had underwent surgery at Sowmya Hospital, Hyderabad, a private unrecognized hospital and thereby incurred Rs.40,000/-, which the Appellant repudiated.  The short issue for consideration is whether the case of Respondent falls under ‘emergency’ clause or not and whether the Respondent is entitled for reimbursement of the amount.

15)     There is no dispute from the side of Appellant as regards the line of treatment underwent by the Respondent at Sowmya Hospital, Hyderabad or else the expenditure incurred thereon.  It is vehemently contended that the Respondent took treatment in an unrecognized private hospital on his own volition, which is not in dispute.  To prove that the line of treatment underwent by the Respondent at Sowmya Hospital is not one of the exigency, it is for the Appellant.  Except filing the copy of letter No.2005/H/6-4/ Policy-II, dated 16.09.2007, no piece of paper is filed to show that the line of treatment underwent by the Respondent does not fall within the meaning of ‘emergency’.  It is also not the case of the Appellant that they have expert Oncologist in their hospital. 

16)     Except stating that due procedure is not followed, nothing is brought on record by the Appellant to show that the treatment underwent by the Respondent at Sowmya Hospital does not fall under ‘emergency’ clause.  Even it is not the case that such line of treatment was available with the Appellant hospital.  In the letter No.2005/H/6-4/ Policy-II, dated 31.01.2007 “emergency” is defined as follows:

“Emergency” shall mean any condition or symptom resulting from any cause, arising suddenly if not treated at the early convenience, be detrimental to the health of the patient or will jeopardize the life of the patient.  Some examples are – Road accidents, other types of accidents, acute heart attack etc., other conditions, when the Railway beneficiary feels that there is no scope of reporting to his/her authorized Railway Medical Officer and avails treatment in the nearest and suitable private hospital, the reimbursement claims are to be processed for sanction, after the condition of the emergency is confirmed by the authorized Railway Medical Officer expostfacto.”

Admittedly, the Respondent took treatment at Sowmya Hospital on 28.07.2007 and was discharged on 03.08.2007 and submitted the claim on 08.04.2008.  From the above definition, it can be conveniently stated that if beneficiary feels that there is no scope of reporting to the Railway Medical Officer and avails treatment in the nearest and suitable private hospital, the reimbursement claims are to be processed for sanction.  It is not brought on record by the Appellant whether the condition of emergency is not confirmed by the authorized Railway Medical Officer expostfacto. 

17)     We need it necessary to state that the potency of life is an economic value assigned to life in general, or to specific living organisms.  In social and political sciences, it is the marginal cost of death prevention in a certain class of circumstances.  In the instant case too, as there was ray of hope in the mind of the Respondent that particular doctor would treat him in a better manner, he chosen to join at Sowmya Hospital, a private unrecognized hospital and place himself in a safe place. 

18)     Now, it is to be seen whether the Respondent is a “consumer” as defined under the provisions of the Act, since he being a government servant retired from service.  In this regard, the counsel for Appellant placed his reliance on the orders passed by Hon’ble Supreme Court of India in Civil Appeal No.5476 of 2013 (arising out of SLP © No.11381 of 2012) in the matter of Dr.Jagmittar Sain Bhagat Vs. Director, Health Services, Haryana & Others, decided on 11.07.2013, wherein the Hon’ble Court after discussing at length has observed as below:

“In view of the above, it is evident that by no stretch of imagination a government servant can raise any dispute regarding his service conditions or for payment of gratuity or GPF or any of his retrial benefits before any of the Forum under the Act.  The government servant does not fall under the definition of a “consumer” as defined under Section 2(1)(d)(ii) of the Act.  Such government servant is entitled to claim his retrial benefits strictly in accordance with his service conditions and regulations or statutory rules framed for that purpose.  The appropriate forum, for redressal of any his grievance, may be the State Administrative Tribunal, if any, or Civil Court but certainly not a Forum under the Act.”

In the instant case, the Respondent failed to bring on record as to how he is termed as “consumer” under the provisions of the Consumer Protection Act, 1986, which is the basic ingredient for adjudication of the matter, which the forum below failed to give any finding. 

19)     We totally concur with the above decision of Hon’ble Supreme Court.  Nowhere in the complaint, it is stated that the Respondent paid any consideration to the Appellant Hospital.  Instead, the Appellant hospital is providing its services at free of cost, which do not give rise a consumer dispute under any stretch of imagination.  In the present case, the Respondent not only failed to establish that he is a ‘consumer’ as defined under the Act, but also failed to establish any deficiency in service on the part of the Appellant.  In the circumstances explained supra, the point framed for consideration in paragraph No.13, supra, is answered accordingly.

20)     In the result, the appeal is allowed setting aside the order of the District Forum, but in the circumstances, parties to bear their own costs. 

PRESIDENT                   MEMBER

Dt. 28.09.2016