JUSTICE B.N.P. SINGH Considered submissions and written arguments of petitioner and also submissions of learned counsel for respondent – Government of India, on admission. Written arguments submitted by petitioner be taken on record. Factual matrix – petitioner, retired Chief Labour Welfare Inspector of Railways, joining Scheme of Retired Employees Liberalised Health Scheme was a beneficiary of Scheme to avail life-long free treatment. As ill-luck would have it, he suffered chest pain for which he was referred to Jagjivan Ram Hospital by CMS (Chief Medical Superintendent), Railways on 18.04.2006. He was admitted there from 21.04.2006 to 16.05.2006. Even though he had been referred to Jaslok Hospital by D/o Railways for his admission therein on 17.05.2006, which was to follow cardio-surgical operation on 19.05.2006, he took voluntary discharge from Jagjivan Ram Hospital to stay over-night with his grand-children. Allegedly, while he was to stay over-night with his grand-children for which he took voluntary discharge from Hospital, he experienced chest pain and fell unconscious. His son got him admitted in near by Asian Heart Institute which followed by-pass surgery on 17.05.2006. Medical emergency certificate too was issued by Dr. Ramakanta Panda of Asian Heart Institute. After petitioner lodged his claim with respondent – authority for medical expenses which he incurred over treatment in Asian Heart Institute, claim was rejected by Railways. Though matter was further pursued, that too did not bear desired result. A second medical certificate too was obtained from Asian Heart Institute to show that delay in surgery would have been fatal to respondent. Yet, claim was not considered. Parties are, however, at variance about state of emergency that necessitated admission of respondent in Asian Heart Institute. Following rejection of his medical claim, respondent moved District Forum, filing a complaint which was resisted by respondent – authority reiterating there being no state of emergency necessitating admission of petitioner in Asian Heart Institute and that too without reference by Railways. District Forum, however, accepting claim of petitioner, directed respondent – Government of India to reimburse medical expenses of Rs. 2,37,809/- to petitioner along-with compensation of Rs. 2,000/- for deficiency in service. Cost of proceeding of Rs. 1,000/- too was awarded by District Forum. In appeal that was preferred by Government of India – respondent, State Commission appreciating all sequence of events, which fail to make out a state of emergency with petitioner necessitating his admission in Asian Heart Institute without reference by Railways, reversed finding of District Forum and dismissed complaint. It is how petitioner is in revision. Petitioner who appears in person has pinned all hopes on certificate issued by Dr. Ramakanta Panda for state of emergency that necessitated his admission in Asian Heart Institute while he was on way for stay over-night with his grand-children. Emergency defined in CGHS Scheme has been taken notice of by State Commission. Certain parameters have also been laid down in Scheme to establish emergency condition. Discharge Summary of Asian Heart Institute mentions complaint experienced by petitioner about chest pain, breathlessness, palpitation, etc. History of patient mentioned in treatment papers of Asian Heart Institute which too was taken notice of by State Commission shows that petitioner had been to Hospital for further management of ailment which he suffered and rightly, State Commission held that this itself would belie respondent’s contention about state of emergency necessitating his admission in Asian Heart Institute. State Commission, in my view, rightly on these premises drew conclusion that there was no change in vital parameters showing state of emergency. Even observations made by Dr. A.V. Mehta, Director of Department of Cardiology of Jaslok Hospital did not obviously suggest state of emergency of petitioner. If one goes by treatment papers issued by Asian Heart Institute which fail to make out a case of emergency with petitioner, certificate issued by Dr. Ramakanta Panda would not bear much credence. It is not in dispute that had the case of petitioner been referred by Railways to Asian Heart Institute which was on the panel, reimbursement would have been permissible. Though petitioner alleges to have informed concerned Railway authorities about state of emergency on telephone, no evidence of clinching nature was ever adduced seeking permission from Railways for treatment of petitioner in Asian Heart Institute. Even sequence of events noticed earlier and attending circumstances of case would strongly militate against case of petitioner that in fact he got himself admitted in Asian Heart Institute in a state of emergency after securing voluntary discharge from Jagjivan Ram Hospital. I appreciate that State Commission has taken pains to appreciate issue in right perspective, which, in my considered opinion, would not justify interference for no good reasons. However, on consideration that petitioner had suffered heart stroke twice and he was in the evening of his life, running from pillar to post for redressal of his grievance and his claim having frustrated for lack of reference to Railway authorities, we had asked learned counsel for respondent to appraise us as to what was the extent of admissibility of claim of petitioner, had he been treated at Jaslok Hospital. Learned counsel has taken pains and put on record a communication issued from Jagjivan Ram (JR) Hospital, Mumbai which shows that expenses reimbursable for angiography with CABG was Rs. 1,00,000/-. As I feel that rightful claim of petitioner is not to be pitted against technicalities, direct respondent authorities to consider claim of petitioner restricted to its admissibility in Jaslok Hospital and with these observations, this revision petition is disposed of. However, there will be no order as to cost. The aforesaid communication received from Jagjivan Ram (JR) Hospital be taken on record.
......................JB.N.P. SINGHPRESIDING MEMBER | |