DATE OF FILING : 20.10.2014

IN THE CONSUMER DISPUTES  REDRESSAL FORUM, IDUKKI

Dated this the  28th  day of  March, 2019

Present :

SRI. S. GOPAKUMAR PRESIDENT

SMT. ASAMOL. P    MEMBER

CC NO.339/2014

Between

Complainants       :       Haridas K. Raju,

     Kalluvelil House,

     Anakkara, 

     Idukki.

     (By Adv: Shiji Joseph)

And

Opposite Parties                                          :   1.  The Managing Director,

       Medical Trust Hospital,

       Nedumkandam. 

  2. Dr. LGT Gowda,

      Medical Trust Hospital,

      Nedumkandam.

3.  The State of Kerala.

      Represented by

      The District Collector, Idukki,

      Painavu P.O., Idukki.

O R D E R

 

SRI. S. GOPAKUMAR, PRESIDENT

Case of the complainant is that,

        The complainant and his family are insured in the RSBY scheme of Health Insurance and the Health Insurance Card was issued in the name of the mother of the complainant Smt. Thayyammal K. Raj.  

        On 4.7.2014 at 8 pm, the complainant brought his 4 ½ year old son to the 1st opposite party hospital for treatment of fever.   Around in Nedumkandam, 1st opposite party hospital is the only registered hospital for extending free medical treatment under RSBY scheme of the Government.  At the time of admitting the complainant’s son, the 1st opposite party told him that, his son is suffering from typhoid and since the staff handing the RSBY insurance section will arrive only at 8 am next day and till then the complainant has to stay in a room at his own expense.  Since no other way, the complainant had agreed for the same.  On the

(cont....2)

-  2  -

 next day, that is, 5.4.2014, the complainant’s wife was also found suffering from fever and was consulted by this 2nd opposite party of the 1st opposite party hospital.  At that time 2nd opposite party told that complainant’s wife is also suffering from typhoid fever and is in a critical stage and was admitted.  Eventhough the complainant requested the opposite parties 1 and 2 to admit her along with their son, in the same room, but the opposite party insisted the complainant to take a separate room for his wife.  When the complainant expressed his unwillingness for taking a separate room, because of his financial difficulties, the opposite parties stated that if he is not willing to take a separate room for his wife, the RSBY scheme would not be sanctioned.  Hence the complainant demanded for discharge his son.  Then the opposite parties asked to write the reason for discharge.  In  paper complainant written the entire matters happened there.  After some time, the PRO along with 15 other people came there and threatened the complainant to write in another paper that the discharge of his son is on his own risk.  When the complaint was reluctant for that, the above said people pressurized him for a long time at last the complainant contacted the child line authorities.  Due to the intervention of child welfare officials, the hospital authorities released the complainant and his son from the hospital.  From there  the complainant took the son and wife to Government hospital, Nedumkandam, since there was no doctors there, the  complainant went to St. Johns Hospital, Kattappana.  At there, it is revealed that, the complainant’s son and wife had no typhoid.  

        The complainant further averred that he had spent Rs.656/- and Rs.1571/- for his son and wife in 1st opposite party hospital.  Further he had spent Rs.6860/- for his son’s treatment and Rs.5540/- for his wife’s treatment.  Eventhough the 1st opposite party had adequate facility to diagnose  the disease, done a wrong diagnosis on the basis of a false lab report.  Opposite party had failed to exercise adequate care which resulted in severe mental tension.  Hence the complainant filed this petition alleging deficiency in service and unfair trade practice against opposite parties 1 and 2 and he prays for allowing reliefs such as to direct the opposite parties to pay Rs.2 lakhs as compensation for the lack of care and negligence in the treatment and also for mental and physical torture and the 3rd  party, being the State Government, may be directed to repay 

(cont....3)

-  3  -

the treatment expenses incurred to him at St. Johns Hospital, Kattappana, under RSBY scheme further direct the opposite parties to pay cost and compensation.  

        Upon notice, opposite parties entered appearance and filed detailed reply version.  In this version 1st opposite party contended that on 4.7.2014 at 9.30 a male child named Albin, 4 ½ years came to the hospital casualty and was seen by the duty doctor Naveen, child was having fever of one week duration, cough and cold.  They have brought investigation report done by outside.  After considering the report, medicine given and admitted in the paediatrics  and advised paediatric consultation.    On 5.7.2014, at 10 am, the child was seen by the paediatrician, Dr. Molly, who made provisional diagnosis of urinary infection and advised further investigation which the complainant refused.  So they were advised to continue same treatment.  On admission, by-standers wanted to get admitted in private room and were admitted in B block 327.  On 5.7.2014, Beena Haridas, the wife of the complainant came to the physician's OP with fever, cough and cold.  After investigation, she was given nebulization injection dexoua, etc.  She was not admitted, contrary averment is denied.  Argument that the child was denied RSBY facility is wrong because those who are admitted in general ward can avail RSBY facility.  As they are admitted in private room, RSBY facility cannot be provided as per RSBy guidelines.  RSBY facility is not available for opposite party investigation and treatment as per rules.  On 5.7.2014, they quarrelled in the hospital for they wanted to remain in the pay ward room and avail the RSBY facility which is not possible and got discharge on request.  The complainant did not lodge any complaint with this opposite party as alleged that the PRO along with other  people manhandled him.  The complainant got his son discharged against the medical advice on his  own and the complainant’s wife was not admitted at all and therefore there is no question of discharge as well.  This opposite party did not purposefully deny RSBY facility to the complainant.  Moreover,  this opposite party had given proper care, attention and treatment to the complainant’s son and wife.  Typhoid is a disease which could be diagnosed on proper surveillance and clinical examination to which neither the complainant not his son or wife was ready to co-operate with this opposite party.  this opposite party did not do any wrong diagnosis of the disease as alleged, nor is in any way liable to any of the claim of the complainant.  The question  of the claim is baseless and illogical.        (cont....4)

-  4  - 

        Complainant and one Chacko Chacko were examined as PWs1 and 2.  Exts.P1 to P11 and X1 marked.  Ext.P1 is the copy of ration card.  Ext.P2 is the copy of RSBY registration card.  Ext.P3 is the discharge summary of Albin Haridas, of St. Johns hospital, Kattappana.  Ext.P3(a) is the discharge card of Medical Trust hospital, Nedumkandam (1st opposite party).  Ext.P4(series) are the medical bills of 1st opposite party.  Ext.P5 is the lab test report of 1st opposite party.  Ext.P6 is the bills of 1st opposite party.  Ext.P7 is the copy of request submitted by the complainant to the 1st opposite party.  Ext.P8(series) are the medical bills.  Ext.P9 is copy of complaint lodged before the Police Inspector, Nedumkdandam.  Ext.P10 is the copy of bank cheque.  Ext.P11 is the acknowledgement receipt in petition issued by the police authorities.  Ext.X1 is the copy of the report, prepared by the child line authorities through PW2, the child line co-ordinator.

        From the opposite party’s side, Dr. Rosamma Joseph, Director, 1st opposite party hospital was examined as DW1.  Exts.R1 to R3 marked.  Ext.R1 is the copy of case sheet of Dr. Sujith Kumar, who attended the son of the complainant on 4.7.2014.Ext.R2 is the case sheet copy of the complainant’s son Albin.  Ext.R3 is the copy of case sheet of Beena Haridas.

        Heard both sides.

        The point that arose for consideration is whether there is any deficiency in service on the part of the opposite parties and if so, for what relief the complainant is entitled to ?

        The POINT :-  We had heard the counsels for both the parties and had gone through the evidence on record.  It is an admitted fact that, the complainant brought his son to the 1st opposite party hospital for the complaint of fever vomiting on 4.7.2014, at about 8 pm.  But on records, it is seen that, the doctor attended the child at 9.15 pm.  After thorough check up, the child was admitted due to suspected typhoid fever.

At the time of admission, complainant requested for the benefit of RSBY scheme where  his family is insured in this scheme and his family is categorized as BPL.  At that time, the hospital authorities informed him that, the concerned persons who are handling the RSBY cases will come at  8 am on next day,        (cont....5)

-  5  -

till then he was allotted an independent room in pay ward.  The next day, the hospital authorities denied the RSBY benefit on the reason that, the complainant himself demanded for a separate private room and it is against the rules of RSBY scheme.  But the learned counsel of the complainant argued that eventhough the complainant demanded for an admission in RSBY ward, the 1st opposite party denied to provide it and the opposite party insisted so many tests to his son, in order to make unlawful gain through the RSBY scheme.  When it was denied by the complainant and the doctor advised to continue same line of treatment.  The learned counsel for the complainant further argued that, next day of this incidence, that is, 5.7.2014, complainant brought his wife to this hospital due to severe fever and on examination, 2nd opposite party opined that, she is suffering from severe typhoid fever and is in a critical stage and was admitted.  Though the complainant asked the 1st opposite party to admit her along with his son in the same room, but the 1st opposite party insisted for a separate room.  The 1st opposite party further informed him that, if he is not willing to admit his wife in a separate room, the complainant’s wife’s RSBY benefit will not be allowed.  Under this circumstances, the complainant requested for discharge of the  patients.  At that time, the henchmen of 1st opposite party along with the PRO threatened him to write the request on a paper, that the discharge of the patients is on demand of the complainant and on his will.  When the complainant was reluctant to do this, the people of 1st opposite party confined him in a room and manhandled.  The complainant was escaped from there due to the intervention of child welfare officials.

The entire allegations levelled against the opposite party are denied by the opposite party in their version.  On going through the deposition of witness and records, Forum found that, complainant's son was admitted in an independent room, but the version of the opposite party that, it is opted by the complainant itself.  But no evidence is produced by both the parties to establish their version.  The main allegation levelled against the 1st opposite party is the denial of RSBY benefit legally entitled to the family of the complainant.  To prove the enrolment in the RSBY scheme, complainant produced copy of ration card and ID card of RSBY issued by the Government authority in the name of his mother.  The documents are marked as Exts.P1 and P2 and are unchallenged.  

(cont....6)

-  6  -

It is also to be consider that, the 1st opposite party hospital is also a service provider of RSBY scheme.  It is the option of the complainant to avail this service of any one of the hospital having RSBY scheme.  It is also to be considered that the hospital, where providing RSBY facility is having a separate wing with round the clock service.  Here, as per the version of the complainant, at the time when he brought his son to the 1st opposite party hospital, the hospital authorities stated that there is no staff in the RSBY wing.  They closed their counter and they will come only 8 am next day, that is, the RSBY counter is not functioning in the night time and there is no evening staff to  manage      RSBY cases.  Except this allegation, no other allegation against the opposite parties can considered, since no corroborating evidence produced by the complainant as alleged in the complaint.

The scheme of RSBY provides 24 hours service to its members through the selected hospitals.  1st opposite party is one of the hospital having RSBY service.  In this case, the reason for denial of RSBY benefit pointed out by opposite party is that, due to the reason of availing separate room for admitting the son of the complainant.  At the same time, opposite party miserably failed to prove that, at that time, there is sufficient bed was available in the RSBY ward, or opposite party suggested for admitting the patient to RSBY ward and the complainant denied their suggestion.  No evidence is produced by the opposite parties to convince the Forum that the room allotted to the complainant's son only on the request of the complainant.  

The next point to be considered is that what is the reason behind the decision of the complainant for discharging his wife and son from the 1st opposite party hospital.  From the evidence on record, it is seen that his wife was not admitted therein and there was no direction from the part of the doctor who attended her.  The reason for demanding discharge is pointed out by the complainant in his averement and deposition is that, 1st  opposite party suggested so many tests to his son and wife, the complainant was not amenable for that, on the reason that the hospital authorities are trying to take advantage of the RSBY scheme by conducting unnecessary test.  That is why the complainant was not co-operate with the opposite parties.  It is also noted that, eventhough opposite party suggested some laboratory tests upon the son and the wife, when the complainant denied for that, opposite party decided to continue (cont....7)

-  7  -

the same line of treatment which was given at the time of admission of his son.  This is the version of the opposite party.  At this juncture, it is very pertinent to note that, if the tests which are so recommended by the opposite party is inevitable for the further treatment of the patient, how the opposite party decided to continue the same line of treatment which was started at the time of admission.  This contention of the opposite party created a shadow of doubt in our mind and by comparing this contention of the opposite party and allegation of the complainant in this matter, we convinced that, the tests which was suggested by the opposite party was not needed and only to make unlawful enrichment on the basis of the RSBY scheme.

On evaluating the evidence of this case, the Forum is of a considered view that, the denial of RSBY benefit by the 1st opposite party hospital is a sheer deficiency in service from the part of the 1st opposite party and it is proved by the complainant through exhibits produced by him.  No sufficient or cogent evidence is produced by the complainant to prove the rest of the allegation levelled against the opposite parties 1 and 2.

On the basis of above discussion, complaint allowed in part.  1st opposite party is directed to repay the Ext.P4(series) bill amount to the complainant along with Rs.10000/- as compensation and Rs.3000/- as litigation cost, within 30 days of receipt of a copy of this order, failing which the amount shall carry 12% interest per annum from the date of default, till its realisation.

Pronounced in the Open Forum on this the 28th  day of  March, 2019    

 

     

SRI. S. GOPAKUMAR, PRESIDENT

 

 

      

     SMT. ASAMOL. P.,MEMBER

 

 

 

 

 

   (cont....8)

-  8  -

 

APPENDIX

Depositions :

On the side of the Complainant :

PW1              -   Haridas K. Raj.

PW2              -   Chacko Chacko.

On the side of the Opposite Party :

DW1              -  Dr. Rosamma Joseph.

Exhibits :

On the side of the Complainant :

Ext.P1    -   copy of ration card.  

Ext.P2   -  copy of RSBY registration card.  

Ext.P3   - discharge summary of Albin Haridas, of St. Johns hospital,

      Kattappana.  

Ext.P3(a) - discharge card of Medical Trust hospital, Nedumkandam 

        (1st opposite party).  

Ext.P4(series) - medical bills of 1st opposite party.  

Ext.P5   - lab test report of 1st opposite party.  

Ext.P6  - bills of 1st opposite party.  

Ext.P7  - copy of request submitted by the complainant 

     to the 1st opposite party.  

Ext.P8(series) - medical bills.  

Ext.P9     - copy of complaint lodged before the Police Inspector,

         Nedumkdandam.  

Ext.P10   - copy of bank cheque.  

Ext.P11   - the acknowledgement receipt in petition issued 

         by the police authorities.  

Ext.X1    - copy of the report, prepared by the child line authorities.

On the side of the Opposite Party :

Ext.R1     -  copy of case sheet of Dr. Sujith Kumar, who attended the son 

of the complainant on 4.7.2014.

Ext.R2   -  case sheet copy of the complainant’s son Albin.  

Ext.R3   -  copy of case sheet of Beena Haridas.

 

 

       Forwarded by Order,

 

 

 

             SENIOR SUPERINTENDENT