DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BARNALA, PUNJAB.

 

Complaint Case No : CC/90/2020

Date of Institution : 03.06.2020

Date of Decision : 25.01.2021

Jit Singh son of Munshi Singh resident of Jandawala Road, Near Old Sadar Police Station, Barnala, Tehsil and District Barnala. …Complainant

Versus

1. The Director, Regional Centre, ECHS, Chandi Mandir, C/O 56 APO.

2. Incharge ECHS, Station Headquarter, Air Force Station, Barnala, Punjab, India.

3. SP Singh, GP Captain (Retd.) OIC, ECHS, Polyclinic C/O Air Force Station, Barnala, Punjab, India. 

…Opposite Parties

Complaint Under Section 12 of the The Consumer Protection Act,1986.

Present: Sh. Sat Parkash counsel for complainant.

Sh. AK Jindal counsel for opposite parties.

Quorum.-

1. Sh. Kuljit Singh : President

2. Sh. Tejinder Singh Bhangu : Member

(ORDER BY SHRI KULJIT SINGH PRESIDENT):

    The complainant Jit Singh filed the present complaint under Section 12 of the Consumer Protection Act 1986 (as amended up to date) against The Director, Regional Centre, ECHS, Chandi Mandir C/O 56 APO and others. (in short the opposite parties). 

2. The facts leading to the present complaint as stated by the complainant are that the complainant is Ex-Military man and admitted in the hospital at Bathinda for treatment and director of Max Hospital advised the complainant to use BMC BIPAD machine continuously and it was purchased by the complainant from Front Line System, Bathinda for a sum of Rs. 48,500/- and claim was forwarded to the opposite party No. 3 vide No. BNL/ECHS/01/01Polyclinic dated 10.7.2018. But the opposite parties failed to make the payment to the complainant then complainant got served a legal notice upon the opposite parties vide notice dated 6.6.2019 to reimburse the bill of the complainant within 60 days from the date of issuance of notice. The opposite party No. 3 replied the said notice vide reply dated 20.6.2019 that BIPAP Machine which is domiciliary medical equipment is procured by the Senior Executive Medical Officer (SEMO) of the dependent Service Hospital out of the budget allotted separately for ECHS. These domiciliary medical equipment are procured through the Authorized Vendor by the SEMO subject to approval from service/military hospital. On supply of the equipment to the ECHS beneficiary, the payment to the authorized vendor towards the costs of the machine is done through Cheque by the SEMO out of the ECHS fund allotted by Higher HQs  Procedure for procurement of domiciliary equipment is laid down in Cent Org ECHS letter No. b/49761/AG/ECHS/Policy dated 31st May 2018. In this case Ex-Sep Jit Singh did not follow the correct procedure and purchased the BIPAP machine on the advice of treatment doctor of Civil Hospital without taking consent of the ECHS Authorities. ECHS beneficiaries are provided cashless treatment at service/empanelled hospital along issuing of prescribed medicines and domiciliary medical equipment. The payment towards procurement of medicine/medical equipment is done to the authorized vendors and not to the individual ECHS beneficiary. The amount was paid by the complainant for the purchase of goods from his own pocket and as such reimbursement amount was required to be paid to the complainant. The opposite party No. 3 with the connivance of vendors cause double jeopardized to the complainant. The act of the opposite parties is deficiency in service and unfair trade practice. Hence, the present complaint is filed seeking the following reliefs.-

1) The opposite parties may be directed to make the payment of Rs. 48,500/- to the complainant for BMC BIPAD machine.   

2) To pay Rs. 20,000/- on account of compensation for mental agony and  harassment.             

3) To pay Rs. 10,000/- as litigation expenses.  

4) To pay interest at the rate of 12% per annum to the complainant till realization.

5) Any other fit relief may also be given. 

3. Upon notice of this complaint, the opposite parties filed written reply taking legal objections on the grounds that complainants have no locus standi or cause of action to file the present complaint. Further, the complainant Ex. SPP Jit Singh is a member of Ex Service Men Contributory Health Scheme (ECHS) so he is entitled for the cashless treatment at ECHS Polyclinics and all other empanelled facilities. He report of ECHS Polyclinics Barnala for treatment of hypertension and breathlessness and  he was referred to ECHS, Bathinda for further treatment on 24.5.2018. After diagnose it was advised by the Max Hospital, Bathinda to the complainant to use BMC BIPAP Machine continuously and he purchased the said machine without getting permission from Parent Polyclinics (ECHS), Barnala or concerned Regional Centre i.e. Chandi Mandir, so his complaint is not maintainable. Further, this is not a consumer dispute and outside the purview of the Act. Further, complainant is a negligent person and by-passed all the laid down guidelines for procurement of domiciliary equipment and purchased himself BMC BIPAP Machine without getting necessary permission from the concerned authorities. 

4. On merits, it is admitted that complainant is an Ex-Military Man and admitted in hospital at Bathinda for treatment. Further, the opposite parties repeat the contents as mentioned in legal objections and also raised objection that as per issue of domiciliary medical equipment for ECHS beneficiaries the Central Organization ECHS made some rules and guidelines. As per these guidelines mentioned at Sr. No. 4.-

“Issue Procedure: Once the concerned specialist approves issue of any domiciliary equipment, patient will collect the copy of issue voucher from the service hospital concerned and get endorsed from OIC ECHS Polyclinic of the issuing service hospital regarding entry of issue details of equipment in the patient's ECHS card and system. Hospital to issue the equipment after confirmation of entry of details in the ECHS Card.” 

5. Further, the complainant has submitted his claim for reimbursement of Rs. 48,500/- spent by him for purchase of BMC BIPAP machine. The claim of the complainant was forwarded to ECHS Regional Centre, Chandi Mandir who intimated the Barnala office that reimbursement of claim for purchase of said machine and treatment of Jit Singh complainant is not allowed in ECHS as per policy as he purchased the equipment against the laid down policy of ECHS. Further, in reply to the legal notice sent by the complainant through his Advocate it is mentioned that domiciliary equipment are to be procured by SEMO of service hospital and then issue to the beneficiary. The said machine is procured by Senior Executive Medical Officer of the dependent service hospital after taking approval from the competent Financial Authority, as per the guidelines set by Government of India. The procurement is done from the lowest bidder through Government E-market place or from the empanelled vendor at competitive prices. All the payments made for procurement of domiciliary medical equipments are subject to audit by Principal Controller of Defense Account. Reimbursement of a claim, which has procedural lapses and lacks in transparency is paid, will certainly invite serious audit objection. Lastly, the opposite parties prayed for the dismissal of the present complaint with costs. 

6. In support of his complaint, the complainant tendered into evidence his own affidavit Ex.C-1, copy of letter dated 10.7.2018 Ex.C-2, copy of legal notice Ex.C-3, postal receipts Ex.C-4 to Ex.C-7, copy of letter dated 20.6.2019 Ex.C-8, copy of bill dated 1.6.2018 Ex.C-9, copies of bills dated 7.6.2018 Ex.C-10 and Ex.C-11, copies of ID Cards Ex.C-12 and Ex.C-13, copy of certificate Ex.C-14, copy of referral form Ex.C-15, copy of medical case sheet Ex.C-16, copy of letter dated 2.4.2019 Ex.C-17, copy of letter dated 3.6.2019 Ex.C-18, copy of letter dated 20.12.2018 Ex.C-19, copy of letter dated 1.4.2019 Ex.C-20 and closed the evidence. 

7. To rebut the case of the complainant, the opposite parties  tendered in evidence affidavit of Munish Sabharwal, Group Captain Station Commander Air Force Barnala Ex.OP-1.2.3/1, copy of reply of legal notice Ex.OP-1.2.3/2, copy of policy Ex.OP-1.2.3/3, copy of letter dated 10.4.2019 Ex.OP-1.2.3/4 and closed the evidence.

8. We have heard the learned counsel for the parties and have gone through the record. Written arguments also filed by both the parties.

9. It is admitted fact between the parties that the complainant is a Ex-Military Man and admitted in hospital at Bathinda for treatment. It is also admitted by the opposite parties that complainant is a member of Ex Service Men Contributory Health Scheme (ECHS) and entitled for the cashless treatment at ECHS Polyclinics and all other empanelled facilities. It is also admitted by the opposite parties that complainant reported to ECHS Polyclinics, Baranala for treatment of hypertension and breathlessness and he was referred to ECHS, Bathinda for further treatment on 24.5.2018 vide referral form Ex.C-15. It is also admitted by the opposite parties that after diagnose it was advised by Max Hospital, Bathinda to the complainant to use BMC BIPAP machine continuously and complainant purchased the same vide bill dated 1.6.2018 Ex.C-9. But the opposite parties have taken a plea that the complainant purchased the said machine without getting permission from the parent polyclinics (ECHS), Barnala or concerned regional centre at Chandi Mandir. It is admitted by the opposite parties that the complainant submitted his claim for reimbursement of Rs. 48,500/- spent by him for purchase of said machine which was forwarded to the Regional Centre, Chandi Mandir vide letter dated 10.7.2018 Ex.C-2, which was not allowed by the regional centre in ECHS as per policy as he purchased the machine against the said policy of ECHS. 

10. The main grievance of the complainant is that he purchased BMC BIPAP machine on the advise of Director of Max Hospital who advised the complainant to use the same continuously but the opposite parties failed to reimburse the amount of said machine of Rs. 48,500/- to the complainant. The complainant proved on the file vide copy of referral form Ex.C-15 that he firstly approached the opposite party No. 2 at Barnala for treatment of hypertension and breathlessness on 24.5.2018 who referred the complainant to Max Super Speciality Hospital, Bathinda. Further, the complainant also proved on the file vide copy of certificate Ex.C-14 that doctor of Max Hospital, Bathinda recommended and sanctioned for the BIPAP machine so that patient can be discharged. Due to this reason the complainant purchased the said machine immediately on 1.6.2018 vide bill  Ex.C-9 without the permission of opposite parties but in this situation we are of the view that the said machine was urgently required to the complainant so he purchased the same in emergency. 

11. When we find meaning of BIPAP machine Internet it came to our knowledge that in some situations it may be advantageous to use an alternative to standard continuous positive airway pressure (CPAP) called bilevel positive airway pressure (BIPAP). What is BIPAP therapy and when is it most often used ? Learn how BIPAP is used to treat obstructive sleep apnea and central sleep apnea by delivering two alternative pressures via a face mast. What is BIPAP or Bilevel Therapy ? Many of the components of a BIPAP machine are the same as the standard CPAP machine. For example, it still requires a face mast and tubing connected to the device. The key distinguishing feature of BIPAP is that the pressurized air is delivered at two alternating levels. The inspiratory positive airway pressure (IPAP) is higher and supports a breath as it is taken in. Conversely, the expiratory positive airway pressure (EPAP) is a lower pressure are preset based on a prescription provided by your sleep doctor and alternate just like your breathing pattern. Beyond these standard settings, there are a few other variations that are available. Bilevel ST includes the time delivery of a breath if breathing pauses occur. These pauses are often present in central sleep apnea. In addition, auto or adaptive servo-ventilation (ASV) includes more sophisticated settings that vary the timing, length and volume of the breaths that are delivered. When BIPAP Therapy is used BIPAP is a method of breathing support that is often used to treat central sleep apnea, a condition that occurs in the setting of opioid use, congestive heart failure, and prior stroke. It may also be used in more severe obstructive sleep apnea, especially if mixed apnea events are present, suggesting a component of central sleep apnea. From all this detail of BIPAP machine as mentioned in this para of the order, we are of the view that the BIPAP machine was immediate necessityfor the complainant who is a 74 years old senior citizen, only due to that he purchased the same without prior permission of opposite parties. Further, in our view if the complainant who is a senior citizen having 74 years of age not purchased the same immediately on the recommendation of treating hospital then any mishap can be occurred with him at any time.

12. The opposite parties admitted in their written reply that the complainant purchased the said machine on the recommendation of the doctor of Max Hospital, Bathinda, so we are of the view that when the opposite parties admitted that the complainant purchased the said machine on the certification of Max Hospital, Bathinda where the opposite parties themselves referred the complainant then now they cannot denied for the reimbursement of the amount of this machine. The opposite parties failed to prove on the file that  the said machine is not urgently required by the complainant and he can wait for the purchase of the same for how many days from the date when the complainant purchased the said machine. In this way, denying of the genuine claim of the complainant is clear cut deficiency in service and unfair trade practice on the part of the opposite parties No. 1 and 2. 

13. Further, the opposite parties filed a document Ex.OP-1.2.3/3 in which it is clearly mentioned that the recommendation and procurement of CPAP/BIPAP machine is up to Rs. 50,000/- and in the present complaint the complainant purchased the said machine for Rs. 48,500/- which amount is within the financial limit as per the rules of the opposite parties so on this score also the complainant is entitled for the amount of Rs. 48,500/- from the opposite parties. 

14. As a result of our above discussion, there is merit in the present complaint and same is partly allowed against the opposite parties No. 1 and 2.  Accordingly, the opposite parties No. 1 and 2 are directed to pay Rs. 48,500/- to the complainant on account of purchase of BIPAP machine. However, no order as to costs or compensation. Compliance of the order be made within the period of 45 days from the date of the receipt of the copy of this order. The opposite parties No. 1 and 2 jointly and severally liable to comply the above mentioned order of this Commission. Copy of this order be supplied to the parties free of costs. The file be consigned to the records after its due compliance. 

ANNOUNCED IN THE OPEN COMMISSION:

        25th Day of January 2021

 

 

            (Kuljit Singh)

            President

              

 

(Tejinder Singh Bhangu)

Member