A. NAGESWARA RAO vs E.S.I. HOSPITAL & ANR.

This Revision Petition has been filed under Section 21(b) of the Consumer Protection Act, 1986 against the impugned order dated 30.10.2009, passed by the Andhra Pradesh State Consumer Disputes Redressal Commission, Hyderabad (hereinafter referred to as ''the State Commission'') in first appeal, FA-957/2008, The Employees State Insurance Corporation (ESIC) vs. A. Nageswara Rao & Anr., vide which, while allowing the appeal, the impugned order dated 01.07.2008, passed by the District Consumer Disputes Redressal Forum, Krishna at Vijayawada in consumer complaint no. 136/2007, was set aside and the said consumer complaint was ordered to be dismissed.

The facts of the case are that the complainant/petitioner, being a retired employee, was member of the Scheme run by the Employees State Insurance Corporation (ESIC) for the year 2006-2007 and he was entitled for the benefit of medical treatment for him and his family members under the said Scheme. It is alleged that the wife of the complainant was taken to the ESIC hospital on 17.01.2007, where she remained admitted and was discharged on 25.01.2007. During her period of admission, she was sent to Government Hospital, Vijayawada for an ECHO test on 24.01.2007, where she was seen by the Head of the Department of Cardiology. It was discovered upon her examination that she was suffering from heart enlargement and other multiple problems. However, despite that, the OP hospital discharged her from the hospital on 25.01.2007. The patient suffered from severe problems on 31.01.2007 again and was brought to the OP hospital. She was admitted in the general ward of the hospital and kept on treatment in that very hospi tal , rather than refer r ing her to a super-specialty hospital. She died in the OP hospital on 04.02.2007. The case of the complainant is that there were no proper facilities at the OP hospital, where her condition could be properly monitored, resulting in her death on 04.02.2007. Alleging that there was deficiency in service on the part of the OPs in not referring the patient for proper treatment to a super-specialty hospital, the complainant filed the consumer complaint in question, seeking directions to the OPs to pay an amount of Rs. 10 lakhs as damages, alongwtih interest @ 24% per annum and litigation cost.

In their reply filed before the District Forum, the OP stated as follows:- "5. The patient Smt. A. Lakshmikanthamma, was admitted in the Opposite Party''s hospital on 17.01.2007 with breathlessness. Investigations done at Opposite Party''s hospital showed the patient was having hypertension, atrial fibrillation, and congestive heart failure. She was put on appropriate treatment and was referred to the Department of Cardiology, Government General Hospital, Vijayawada on 24.01.2007. On the same day she was seen by Prof. Dr. A. Srinivasa Rao, Head of the Department of Cardiology and echocardiogram test was done by him. As per his report she had dilated left ventricle, global hypkinesia, poor left ventricular function, Ejection fraction 30% pulmonary hypertension, moderate mitral regurgitation, moderate tricuspid regurgitation and his final diagnosis was Ischemic , dilated cardiomyopathy, Atrial fibrillation and congestive heart failure thereby confirming the Opposite Party diagnosis. As the patient was symptomatically better, she was discharged on 25.01.2007 prescribing medicines on the same lines as advised by Prof. A. Srinivasa Rao and asked her to come for follow up in O.P. Subsequently, she was re-admitted on 31.01.2007 with worsening of symptoms. She was again started an appropriate treatment and was regularly followed up in the ward. Unfortunately the patient expired on 04.02.2007 at 3 am in spite of the necessary medical treatment given on the lines suggested by Prof. A. Srinivasa Rao, Professor of Cardiology, GGH, Vijayawada."

The OP stated in their reply that without an eligibility letter issued by the ESI Corporation, they could not refer even a single patient for super-specialty treatment at a tie-up hospital. It has also been stated that the patients, eligible for such treatment through tie-up hospitals, are decided by the ESI Corporation through their local office at Vijayawada. There was no deficiency in service, therefore, on their part in the treatment of the patient.

The District Forum, after taking into account the averments of the parties, partly allowed the claim and directed the ESI Corporation to pay a compensation of Rs. 2 lakhs and Rs. 5,000/- as cost of litigation to the complainant. Being aggrieved against the said order, the ESI Corporation challenged the same by way of appeal before the State Commission, which was allowed vide impugned order dated 30.10.2009, and the order passed by the District Forum was set aside and consequently, the complaint was dismissed. It is against this order that the present revision petition has been made before this Commission by the complainant.

During hearing, the learned counsel for the petitioner stated that the OP hospital should have ensured that proper treatment was administered to the patient, looking at her medical condition, and they should have referred her to a super-specialty hospital as she had been diagnosed for heart enlargement already. In case, any permission etc. was required, or administrative formalities were to be fulfilled in pursuance of internal circulars/policy of the ESI Corporation, it was the duty of the OPs to ensure that the needful was got done and arranged in time. The order passed by the District Forum, therefore, reflects a correct appreciation of the facts on record, rather interest should also have been allowed by the District Forum alongwith compensation.

The learned counsel for the respondent stated on the other hand that the OP hospital had done proper treatment upon the patient and they even referred her to Government hospital, Vijayawada, where she was examined by a qualified cardiologist, and she was given further treatment as per advice of the said cardiologist. The learned counsel argued that the patient died a natural death, as she was suffering from hypertension, heart problems etc. The order passed by the State Commission was in accordance with law and should be upheld.

We have examined the entire material on record and given a thoughtful consideration to the arguments advanced by the learned counsel for the parties.

The facts and circumstances of the case bring out clearly, rather it is admitted by the OPs in their written version before the District Forum, that the patient was suffering from hypertension and heart ailment, when she was brought to their hospital on 17.01.2007. Based on her condition, they referred her to the Government General hospital, Vijayawada on 24.01.2007, where she was examined by Professor, Dr. A. Srinivasa Rao, Head of the Cardiology Department, and the requisite tests were also conducted upon her. The OPs have also stated in their reply that the patient was found suffering from multiple problems, concerned with heart ailment. It is not understood, therefore, as to how the OP hospital took a decision to discharge the patient on the very next day of her examination at Government hospital, Vijayawada i.e. on 25.01.2007. The patient was again brought to their hospital and re-admitted, just after six days i.e. on 31.01.2007, where she died after four days on 04.02.2007. It has been stated in the reply that the symptoms of the patient had worsened, by the time she was again brought to their hospital on 31.01.2007. Looking at the version of the OPs themselves, it becomes clear that they should have referred her to a super-specialty hospital, where she could be given proper treatment under the care of some specialist in Cardiology. On the other hand, they kept the patient admitted in the general ward of their own hospital, and they have admitted that there was no Department of Cardiology at their hospital. The opposite parties have given the version that they required some eligibility letter from the office of the ESI Corporation, located at Vijayawada itself, if the patient was to be sent to a tie-up hospital. It is beyond imagination to comprehend that the petitioner, which is a national-level organization, entrusted with the responsibility of looking after the health of millions of employees and their families, do not have proper arrangements to ensure that the needy patients are subjected to proper and prompt treatment within their own hospitals, or in the hospitals where they have made tie-up arrangements. It is admitted in the reply of the OPs that they do have tie-up arrangements with super-specialty hospitals for taking care of suitable cases. It is thus their bound duty to ensure that the patients do not have to suffer on account of completion of administrative formalities only. There is, therefore, clear-cut deficiency on the part of the OPs in the present case, when they had proper diagnosis done from the Government hospital, Vijayawada and still, they decided to keep the patient admitted in their own hospital.

Based on the discussion above, it is evident that the order passed by the State Commission does not reflect a correct appreciation of the facts and circumstances on record and hence, the said order is perverse in the eyes of law. The impugned order of the State Commission is, therefore, set aside. The order passed by the District Forum, by which a sum of Rs. 2 lakhs as compensation and Rs. 5,000/- as litigation cost has been allowed to the patient is ordered to be restored. The present revision petition is, therefore, allowed accordingly. There shall be no order as to costs.