IN THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MURSHIDABAD AT BERHAMPORE.
CASE No. CC/43/2017.
Date of Filing: Date of Admission: Date of Disposal:
10.11.17 17.11.17 12.02.2020
Complainant:Md. Asraf Ali
S/o HaziInsan Ali
Narayanpur, PO-Amdahara,
PS-Ranitala, Dist-Murshidabad
Pin-742123
-Vs-
Opposite Party:1. The Director/Chairman
Gitaram Hospital Pvt. Ltd.
N.H-34, P.O- Radharghat, P.S.-Berhampore
Dist-Murshidabad, Pin-742187
2. Chief Medical Officer of Health
PO&PS-Berhampore, Dist-Murshidabad,
Pin-742101
Agent/Advocate for the Complainant :Smt. Bidishya Sarkar
Agent/Advocate for the Opposite Party Nos.1&2 : Sri. S.S.Dhar.
Present: Sri AsishKumar Senapati………………….............President.
Smt. Aloka Bandyopadhyay……………………..Member.
FINAL ORDER
Asish Kumar Senapati, Presiding Member.
One Md. Asraf Ali (here in after referred to as the Complainant) filed the case against Director/Chairman, Gitaram Hospital Pvt. Ltd. and another (here in after referred to as the OPs) praying for compensation alleging deficiency in service.
The sum and substance of the complaint case is as follows: -
The Complainant is an Indian citizen. The wife of the Complainant got admitted in the OP No.1 on 28.12.16 for amputation of her above right knee under Dr. Avijit Roy and she was discharged from the OP No.1 on 07.01.17. The Complainant paid a sum of Rs.60,563/- to the OP No.1 for the purpose of operation including all charges. The Complainant is a Government employee of Irrigation Dept. and under the rules and regulations of the Government Office he is eligible to claim the amount invested for the said operation of his wife. Accordingly, the Complainant gave form D2 issued by the OP No.2 under West Bengal Health Scheme, 2008 to the OP No.1 to fill it up with all nursing home details but the Complainant astonished to see that the total claim amount was mentioned as Rs.28,000/- in place of Rs.60,563/- in form D2. Moreover, the Complainant gave the form D2 issued by the OP No.2 but the OP No.1 mentioned the procedure code number as 01026057.Aas per annexure1 of revised rate list under the West Bengal Health Scheme treatment code, the Complainant is eligible to get Rs.10,450/- for the treatment of his wife but actually the Complainant paid a sum of Rs.60,563/- for treatment of his wife. The Complainant went to the OP No.1 more than once and requested for rectification of the form but the OP No.1 denied to rectify the said amount in the Form which is unfair trade practice. Ultimately, the wife of the Complainant sent an advocate’s letter dated 27.02.17 to the OP No.1 through registered post but the OP No.1 did not pay any heed to it which amounts to deficiency in service. Hence, the Complainant has filed the case praying for a direction upon the OP No.1 to rectify the form number D2 and compensation including 10% interest from the date of payment and to direct the OP No.1 to pay a sum of Rs.3,000/- for cost and Rs.20,000/- for compensation.
The OP No.1 contested the case by filing written version on 29.06.17 contending that the case is not maintainable, and the Complainant is not a consumer. It is the specific case of the OP No.1 that the wife of the Complainant Nasima Bibi admitted in OP No.1 on 26.10.16 with extensive wound on her lower limb. At the time of admission as per standard protocol the relatives of the patient were asked as to whether the patient had insurance coverage and/ or facility under any scheme or not but the relatives of Nasima Bibi informed that they would make payment directly by cash as the patient had no such coverage and facility. Accordingly, the patient was admitted under two senior consultants Dr. Avijit Roy and Dr. Prabhat Kr. Patra. Both the Doctors tried to save the life of the patient, but the condition was such that the patient would undergo amputation of injured limb. The surgical option was discussed and explained to the patient and her relatives. The emergency operation package was fixed at Rs.37,000/- (including medicine and diet) and the patient also require multiple advanced medicine which had cost at Rs.16,434/- and the patient was finally discharged on 07.01.17 and the total bill amount was Rs.53,424/- that after discharge of the patient and at the time of first follow up on 18.01.17, the husband of the patient informed for the first time that the patient is a beneficiary to West Bengal Health Scheme and asked the OP No.1 to help him to get some reimbursement on the Hospital Bill. He also admitted that he was not aware that his wife was also covered under the West Bengal Health Scheme. Only on humanitarian ground, the OP No.1 provided the documents according to West Bengal Health Scheme rate as laid down by the Government of West Bengal which is a sum of Rs.28,000/-. The OP No.1 has been classified as class 2 service provider as per provisions of West Bengal Health Scheme and the package rate for amputation above knee is sum of Rs.35,000/- as per notification No. 796 F (MED) dated 31.01.11 and 80% of which is a sum of Rs.28,000/-. The OP No.1 provided detailed bill of the treatment as per standard hospital rates which is illegal higher than what is provide under West Bengal Health Scheme. That as per provision of the West Bengal Health Scheme, the Complainant was entitled to get reimbursement of Rs.28,000/- only if he would provide the health card in due time. There is no deficiency in service and unfair trade practice on the part of the OP No.1. The OP No. 1 prays for rejection of the complaint.
The OP No.2 file written version on 18.12.18 contending that the case is not maintainable, and the complainant is not a consumer. It is also the case of the OP No.2 that the case is barred by law of limitation. The OP No.2 has asserted that the OP No.2 is an unnecessary party and he is not the competent authority of the West Bengal Health Scheme, 2008. The OP No.2 prays for dismissal of the complaint.
On the basis of the above version the following points are framed for proper adjudication of the case:
Points for consideration
1. Is the Complainant a consumer under the provision of the CP Act, 1986?
2. Has this Forum jurisdiction to entertain the complaint?
3. Have the OPs any deficiency in service, as alleged?
4. Is the Complainant entitled to get any relief, as prayed for?
Point no.1
The Ld. Advocate for the Complainant submits that the Complainant is a consumer as he hired services of the OP No.1 for consideration.
On going through the complaint, written version and other materials on record and on a careful consideration over the submission of both sides, we find that the Complainant is a consumer in terms of section 2 (I )(d) (ii) of the C.P.Act, 1986.
Point No.2
The Ld. Advocate for the Complainant submits that the cause of action of this case arose within the territorial jurisdiction of this Forum and this Forum has pecuniary jurisdiction to entertain the complaint.
On a careful consideration over the materials on record, we find that the cause of action arose within the territorial jurisdiction of this Forum and this Forum has pecuniary jurisdiction to entertain the complaint.
Point Nos.3&4
The Ld. Advocate for the Complainant submits that the wife of the Complainant, namely, Nasima Bibi admitted at OP No.1 for her treatment and amputation above knee of the patient was done by Doctors at OP No.1. It is urged that the Complainant paid a sum of Rs.60,563/- for treatment of his wife but the OP No.1 issued form D2 (essentiality certificate cum statement of expenditure certified by treating specialist for indoor or day care treatment or related OPD treatment). It is argued that the code number of amputation above knee as per revised rate list under the West Bengal Health Scheme, 2008 is 01026051 but the OP No.1 mentioned the code as 01026057 which is for anthrography and osteomedullography. It is argued that the OP No.1 has deficiency in service. He contends that the wife of the Complainant issued advocate’s letter dated 27.02.17 for rectification of the form but of no result. It is contended that the OP No.1 has deficiency in service. He prays for a direction upon the OP No.1 for rectification of form D2 issued by the OP No.1.
In reply, the Ld. Advocate for the OP No.1 submits that the Complainant never asked for rectification of procedure code number. It is contended that maximum approved rate for amputation above knee is Rs.35,000/- as per revised rate list under the West Bengal Health Scheme, 2008 and code number is 01026051 but code number has wrongly been mentioned as 01026057 due inadvertence though amount of Rs.28,000/- which is 80% of the maximum approved rate of Rs.35,000/- has been mentioned in form D2. It is contended that the OP No.1 is a class 2 service provider and as per provisions of West Bengal Health Scheme and the package rates admissible amount is 80% out of Rs.35,000/-. It is submitted that the OP No.1 is ready and willing to rectify form D2 if sought for by the Complainant. It is contended that the OP No.1 has no deficiency in service or illegal trade practice.
The Ld. Advocate for the OP No.2 submits that the OP No.2 is an unnecessary party and the OP No.2 has no role to play.
Admittedly, the wife of the Complainant admitted at the OP No.1 for her treatment and amputation of her knee was done and she was treated from 28.12.16 to 07.01.17 at OP No.1. Admittedly, the Complainant paid the cost of operation including cost of medicine for treatment of his wife to the OP No.1 and the OP No.1 has mentioned procedure code number 01026057 in lieu of 01026051. The Advocate’s letter dated 27.02.17 has no mention about rectification of procedure code number. The Complainant claimed that he paid Rs.60,563/- for treatment of his wife but according to the West Bengal Health Scheme, 2008 the maximum approved rate for amputation above knee is Rs.35,000/- and the Complainant may get reimbursement of 80% of the amount i.e. Rs.28,000/- as the Complainant opted for treatment of his wife at OP No.1 which is a class 2 service provider. Considering the submission of both sides and on a careful consideration over the materials on record, we find that the purpose of the Complainant will be served if the procedure code as mentioned in form D2 is rectified by the OP No.1. We think that the OP No.1 may be directed to rectify the procedure code in form D2 on receipt of the form D2 in respect of treatment of Nasira Bibi for the period from 28.12.16 to 07.01.17.
Reasons for delay
The Case was filed on 24.03.17 and admitted on 07.04.17. This Forum tried its level best to dispose of the case as expeditiously as possible in terms of the provision under section 13(3A) of the CP Act,1986. Delay in disposal of the case has also been explained in the day to day orders.
Fees paid are correct.
In the result, the complaint case succeeds in part.
Hence, it is
ORDERED
that the Consumer Complaint Case No. CC/43/2017 be and the same is hereby allowed in part on contest against the OP No.1 without cost and dismissed on contest against the OP No.2 without cost.
The Complainant is directed to submit form D2 issued by the OP No.1 for treatment of his wife Nasima Bibi for the period from 28.12.16 to 07.01.17 for rectification of procedure code as early as possible.
The OP No.1 is directed to rectify the procedure code by 10 days from the date of receipt of the original form D2 from the Complainant. Procedure code for amputation above knee is of 0126051 which is to be rectified in relevant columns of the form by the OP No.1
Let plain copy of this order be supplied free of cost, to each of the parties / Ld. Advocate/Agent on record, by hand/by post under proper acknowledgment as per rules, for information and necessary action.
The Final Order will also be available in the following Website:
confonet.nic.in
Dictated & corrected by me.
President
Member President.
