DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II U.T. CHANDIGARH [Complaint Case No:582 of 2010] Date of Institution : 10.09.2010 Date of Decision :02.08.2011 --------------------------------------- Sh. Narinder Singh Kohli son of Sh. Gulab Singh Kohli resident of House No.2154, Sector 38C, Chandigarh. ---Complainant. V E R S U S The Additional Director, Central Government Health Scheme, Homeopathy Dispensary Campus, Sector 34, Chandigarh. ---Opposite Party. BEFORE: SHRI LAKSHMAN SHARMA PRESIDENT SMT. MADHU MUTNEJA MEMBER Argued By: Sh. Narinder Singh Kohli, complainant in person. Sh. Sanjay Goyal, Advocate for the OP. PER LAKSHMAN SHARMA, PRESIDENT Sh. Narinder Singh Kohli has filed this complaint under section 12 of the Consumer Protection Act, 1986 praying therein for the following reliefs:- i) To quash/set aside instructions dated 18.3.1992; ii) To reimburse Rs.13,224.60Ps incurred on purchase of medicines along with interest @18% p.a; iii) To pay a sum of Rs.20,000/- as compensation for mental agony, harassment and inconvenience. iv) To pay Rs.5,000/- as litigation expenses. 2. The admitted facts are that the complainant, retired as a Central Government employee. He is getting pension from the Central Government. He is beneficiary of Central Government Health Scheme (hereinafter for short to be referred as CGHS) vide Token No.P-2041. The complainant was referred by the Chief Medical Officer, CGHS dispensary, Sector 45 to Silver Oaks Hospital, Phase IX, Mohali for total hip replacement vide letter dated 25.4.2009. He was permitted to take treatment from the said hospital. So, the complainant got admitted in the said hospital on 25.5.2009. He was operated upon on 26.5.2009. After operation, he was discharged on 1.6.2009. At the time of discharge, some medicines were prescribed by the doctors of Silver Oaks Hospital for post operational treatment. The complainant purchased the said medicines worth Rs.13,224.60Ps as per requirement from time to time from the open market without approaching the CGHS dispensary for this purpose. Thereafter, he submitted a claim to the Additional Director, Central Government Health Scheme, Homeopathy Dispensary Campus, Sector 34, Chandigarh. However, the said claim was declined on the following ground:- “….the OPD Medicines are not reimbursable under the CGHS as per Para 3(X) of GOI M/o H&FW OM No.S-11012/1/91-CGHS (P) (Vol.I) dated 18.3.92.” Thereafter, the complainant wrote a letter dated 13.11.2009 explaining the circumstances under which he had to purchase the medicines from the open market instead of CGHS dispensary and also asserting that in the circumstances explained in the letter, he is entitled for the reimbursement of the amount spent on the medicines purchased by him. However, vide letter dated 9.4.2010, the claim was again rejected asserting that the claim is not permissible in view of the provisions mentioned in letter dated 18.3.1992. The case of the complainant is that the complainant had to purchase the medicines himself immediately in order to continue the treatment without gap. Immediate procurement of the medicines from CGHS dispensary was not possible. It would have taken 4-5 days. So, the gap in the treatment could have adversely affected his health. Therefore, the complainant had to purchase the medicines under compelling circumstances. Otherwise also, according to the complainant, under CGHS, OP is duty bound to provide medicines to the complainant. So, even if the complainant has purchased the medicine from open market, no loss has been caused to it. It has further been pleaded that letter dated 18.3.1992 contains only administrative instructions, which have been issued to avoid fraudulent claims. However, these instructions cannot be made applicable in genuine cases. So, according to the complainant, he is entitled for reimbursement of Rs.13,224.60Ps spent by him on the purchase of medicines. Refusal to accept the claim and to reimburse the amount mentioned above amounts to deficiency in service on the part of OP. In these circumstances, the present complaint has been filed seeking the reliefs mentioned above. 3. On the other hand, the case of OP is that as per CGHS rules, medicines taken after hospitalization are treated as OPD medicines and the same are supplied by CGHS Wellness Centre. Purchase of such medicines from source other than CGHS Wellness Centre is not permitted and the claim for the same cannot be sanctioned. In the present case, according to OP, as the medicine has been purchased by the complainant from open market without approaching CGHS Wellness Centre, so the claim has been rightly rejected. According to OP, there is no deficiency in service and the complaint deserves dismissal. 4. We have heard the complainant in person and Sh. Sanjay Goyal, Advocate for the OP and have gone through the documents on record. 5. Clause 3(xi) of letter No.S-11012/1/91-CGHS (P) (Vol.1) dated 18.3.1992 of MH & FW reads as under: - “(xi) Medicines prescribed for outdoor treatment is not reimbursable under CGHS. However, expenditure on investigations and tests done in Government/referral/ recognized hospitals may be reimbursed, if such tests/ investigations have been done on the advice of the specialist of Government hospitals.” 6. From the bare reading of this clause, it is apparent that the medicine prescribed for outdoor treatment is not reimbursable under CGHS. 7. In view of the above said instructions, to our mind, the claim has been rightly rejected. 8. Faced with this situation, it was argued by the complainant that the said instructions are only administrative instructions and the complainant cannot be made to suffer for his genuine claim because of procedural technicalities. This Forum has no jurisdiction to go into the question as to whether the instructions are proper or not. This Forum is bound by the instructions. So, the argument advanced by the complainant has no force. 9. Consequently, the present complaint is dismissed being devoid of any merit. However, the parties are left to bear their own costs of litigation. 10. Certified copy of this order be communicated to the parties, free of charge. After compliance file be consigned to record room. Announced. 2nd August 2011. (LAKSHMAN SHARMA) PRESIDENT (MADHU MUTNEJA) MEMBER Ad/-
C.C.No.582 of 2010 Present: None. --- The case was reserved on 28.07.2011. As per the detailed order of even date recorded separately, this complaint has been dismissed. After compliance file be consigned. Announced. 02.08.2011 President Member
| | MRS. MADHU MUTNEJA, MEMBER | HONABLE MR. LAKSHMAN SHARMA, PRESIDENT | , | | 
