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RAJASTHAN STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Sunil Kumar Garg, President, T.P. Gupta and Vimla Sethia, Members
RAJASTHAN STATE PENSION AND PENSIONERS WELFARE DEPARTMENT AND ORS. - Appellants
Versus
M.M. TIWARI - Respondent
Appeal No. 646 of 2006
Decided on : 09-01-2008
Mr. M.L. Vyas, Advocate, for the Appellant; Mr. K.N. Parikh, Advocate, for the Respondent
The central legal point established in the judgment is the obligation of the State to provide medical aid to its employees, especially in emergent circumstances, and the need to protect the right to life and dignity of every human being.
Headnote:
Consumer Protection Act - Reimbursement of Medical Expenses - Section 15 - [Consumer Protection Act, 1986, Section 15] - The court discussed the provisions of the Rajasthan State Pensioners Medical Concession Scheme and the entitlement of pensioners to medical assistance for specialized treatment. It highlighted the obligation of the State to provide medical aid to its employees, especially in emergent circumstances, and emphasized the need to protect the right to life and dignity of every human being. The court also referred to previous judgments that emphasized the importance of not denying reimbursement on hyper-technical grounds and observed disparities in granting medical facilities to government servants.
Fact of the Case:
The complainant, a retired Deputy Director of Police Forensic Science Laboratory, Jaipur, underwent bypass surgery at a private hospital in Jaipur and sought reimbursement of medical expenses. The appellants rejected the claim on the grounds that the hospital was not approved for treatment of government servants. The District Forum allowed the complaint, ordering the appellants to reimburse the medical expenses and pay damages to the complainant.
Finding of the Court:
The court found that the appellants had committed deficiency in service by rejecting the claim for reimbursement of medical expenses. It emphasized the need to provide medical assistance to pensioners, especially in emergent circumstances, and upheld the District Forum's order.
Issues: The issues revolved around the entitlement of pensioners to reimbursement of medical expenses for specialized treatment, the practicality of fixed limits for treatment expenses, and the obligation of the State to provide adequate medical facilities to its employees.
Ratio Decidendi: The court held that the State is obligated to provide medical aid to its employees, especially in emergent circumstances, and should not deny reimbursement on hyper-technical grounds. It emphasized the right to life and dignity of every human being and observed disparities in granting medical facilities to government servants.
Final Decision: The appeal was dismissed, and the impugned order was upheld. The court directed the Registry to send a copy of the judgment to the Chief Secretary, Government of Rajasthan, Jaipur.
ORDER
T.P. Gupta, Member - This appeal has been filed by the appellants under Section 15 of the Consumer Protection Act, 1986 against the order in Complaint No. 179/03 dated 3.3.2006 passed by the learned District Forum, Jaipur II, Jaipur whereby the complaint of the complainant was allowed in the manner that the appellants would reimburse an amount of Rs. 1,08,117 spent by the complainant on his treatment at Jaipur and would also pay an amount of Rs. 7,000 as damages to the complainant.
2. The brief facts giving rise to this appeal are that the complaint-respondent is a retired Deputy Director of Police Forensic Science Laboratory, Jaipur and is a member of the Rajasthan State Pensioners Medical Concession Scheme floated by the Government of Rajasthan for grant of medical concession to State Government pensioners. The complainant had an Angina pain on 14th January, 1999 for which he took treatment in a private hospital, namely, Santokba Durlabhji Hospital (hereinafter referred to as SDMH), Jaipur as indoor patient from 14.1.1999 to 21.1.1999. Later, his angiography was done on 11.3.1999 and 100% and 80% obstructions were diagnosed. The complainant was accordingly advised for CABG (Bypass surgery). The complainant showed the papers of his treatment to Dr. R.K. Madhok who was Heart Specialist in S.M.S. Hospital at Jaipur. On seeing the papers, the Doctor is reportedly got annoyed and ill-treated the complainant. The Controller of the Hospitals, however, constituted a Medical Board of Dr. R.K. Madhok (Convener) and Dr. R.K. Saxena and Dr. C.P. Srivastava as Members on 15.3.1999. The complainant alleges that the Medical Board gave incomplete report on 17.3.1999. The complainant took the matter with the Chief Secretary of the State as a result of which the matter was again referred to the Medical Board on 24.4.1999 to give clear opinion. The Medical Board delayed its recommendation but later on recommended to refer the complainant to A.I.I.M.S., New Delhi for Moderate LV dysfunction. This recommendation was sent by the Principal and Controller of SMS Medical College, Jaipur to the District Collector, Jaipur on 15.5.1999. In the meantime, the complainant's condition deteriorated and he had to be operated immediately at SDMH, Jaipur on 27.4.1999 and for further complication on 8.5.1999. Thereafter, the complainant submitted a claim for reimbursement of Rs. 1,47,152 on 1.1.2000 to the Treasury Officer, Jaipur. The Secretary and Treasury Officer of Jaipur informed the complainant on 1.7.1999 that he had taken treatment in a private hospital at Jaipur which is not in accordance with rules. Aggrieved by this, the complainant filed a complaint in the Forum below claiming reimbursement of medical expenses and other compensation.
3. The O.P.-appellants filed a reply stating that the claim of the complainant was not accepted because instead of taking treatment at Delhi, the complainant had taken treatment at SDMH which is not an approved hospital for treatment of the State Government pensioners. The O.P.-4 (Dr. Madhok) did not file any reply.
4. After hearing both the parties, the learned District Forum came to the following conclusions:
1. The complainant had heart attack twice, first on 14.1.1999 and second on 24.1.1999 at Jaipur and thereafter the complainant was advised to undergo CABG (Bypass surgery).
2. It is well proved from the certificate of Dr. Nikhil D. Parikh of SDMH that only in emergent circumstances and for saving his life, the complainant had taken treatment at Jaipur in a hospital which was not approved hospital for the purposes of Medical Attendant Rules.
3. The Hon'ble Rajasthan High Court and this Commission had, in the past, ruled that the Appellants is obliged to make reimbursement of the expenses on saving life of a patient.
4. The appellants have committed deficiency in service in rejecting the claim of the complainant on the ground that SDMH was not an approved hospital for treatment of Government servants.
5. The Governmen
