R.P.PAREEK vs CHIEF SECRETARY, GOVERNMENT OF RAJASTHAN

THESE cross-appeals from the order dated 8.11.2001, made by District Forum No. 1, Jaipur in Complaint Case No. 494/2000, arise under the following circumstances. Shri R.P. Pareek, the complainant, is a State Government pensioner, admittedly entitled to the benefits of the Rajasthan State Pensioners Medical Concession Scheme, 1981 (the scheme). He had retired from Government service on 31.5.1988. On 21.2.1991 he experienced heart attack for which he was treated at the S.M.S. Hospital, Jaipur and discharged therefrom on 26.3.1991. After his discharge from the said Government Hospital, he continued to get treatment from Dr. S.S. Haldia, an Associate Professor in Cardiology in S.M.S. Medical College, Jaipur. On observing his T.M. Test in the said Hospital in the month of August, 1992, Dr. Haldia proposed immediate engiography and further heart operation for him and referred him to the Escort Heart Institute and Research Centre, Okhla Road, New Delhi (Escort Hospital) for the purpose. He was admitted in the said hospital on 8.9.1992 and was engiographed on 9.9.1992. But considering his case as one of emergent heart-operation, he was operated upon for his heart ailment on 12.9.1992. The operation was successful and he was discharged from the hospital on 14.9.1992. He submitted his claim to the Collector, Jaipur on 15.9.1992 for reimbursement of the medical expenses. The collector, Jaipur forwarded his bill to the concerned authorities of S.M.S. Hospital for verification of the expenses claimed. The Principal, Medical College, Jaipur constituted a Board of three doctors on 13.11.1992 and on the basis of the report of such Board dated 15.12.1992, the Principal recommended to the Collector, Jaipur, that the complainant may be made a payment of Rs. 67,895/-. The Collector, Jaipur, accepting the recommendation of the Principal, requested the Member-Secretary of the Scheme vide his letter dated 1.1.1993 to accept the claim of the complainant for reimbursement of medical expenses at Rs. 67,895/-. But the Member-Secretary and the Director of the scheme, rejected complainant''s claim on the ground that the case of the complainant had not been recommended by the Principal of the Medical College or the Director, Medical and Health Services for taking treatment in a hospital or institute outside the State. On a complaint having been filed by the complainant before it, the District Forum did not approve of the approach of the concerned authorities in the case of the complainant and allowed his claim but limited to the extent of Rs. 50,000/- only (which was later on raised to Rs. 1,20,000/-) on the basis of the order of the State Government dated 30.9.2000.

THE order as passed by the District Forum caused grievance to both the parties. THE grievance of the complainant-appellant in his appeal is that his claim for reimbursement of the actual expenses at Rs. 67,895/- has not been accepted by the Forum and he has not duly been compensated for mental agony and physical discomfort and litigation expenses. THE grievance of the opposite party-appellants in their appeal is that since the case of the complainant was not referred to outside hospital/institute as per instructions in the scheme no part of his claim should have been accepted. We heard the learned Counsel for the parties at length and studied the relevant scheme orders of the State Government made from time to time and the approach adopted by the Courts and the Redressal Agencies under the C.P. Act, 1986 in such cases. The facts of the case are quite simple and the dispute between the parties is quite short. It is the undisputed position that the complainant is a State Government pensioner entitled to the benefit of the beneficial provisions of the Scheme, 1981. There is also no dispute on the point that the complainant was faced with a heart attack in February, 1991 and was treated, therefore, in the S.M.S. Hospital, Jaipur. Even after his discharge from the said hospital on 26.3.1991, the complainant had continued to get treatment from Dr. Haldia of the said hospital. It was on the basis of T.M.T. that Dr. Haldia had to recommend his case to Escort Hospital, Delhi for engiography and further heart operation and the complainant was operated upon at that Hospital at New Delhi on emergent basis. His was a case of emergency and the complainant had acted upon the advice of the qualified doctor, in the employment of the opposite party-appellants in a Medical College/Government Hospital at the relevant time. Saving a human life was more important than observance of such technical rules of procedure wherein the worried patient and/or his attendants have no say. Dr. Haldia could have referred his case to the Principal, Medical College or the Director of Medical & Health Services but that could have possibly been done at the cost of a human life. Looking to the peculiar facts and circumstances of the present case, the Collector, Jaipur and the Principal, S.M.S. Medical College, Jaipur had adopted a more humane and realistic approach to the case of this Senior Citizen than the Member-Secretary of the Scheme and Director of Medical & Health Services, Government of Rajasthan, Jaipur.

Now in so far as the ceiling of Rs. 50,000/- is concerned, we find that in some of the cases coming before the Courts and the Redressal Agencies under the C.P. Act, 1986 such an issue was seriously considered and it was held that not only the provisions of the relevant scheme and orders of the State Government issued from time to time are required to be liberally construed for the benefit of the old and sick pensioners but also the protective wings of the beneficial enactment i.e., the Consumer Protection Act, 1986 should be liberally extended for the protection of the rights of the deserving consumers. Referring to Rules 4A and 16 of the Scheme, 1981, the Rajasthan High Court observed in the case of Smt. Nirmal Kumari Raizada v. Director, Pension & Pensioners Welfare, S.B. Writ Petition No. 746 of 1999, dated 14.2.2000 that "in case of emergency it is not expected from a person to observe the formalities and getting his case recommended for treatment from outside the State. Refusing reimbursement of medical bills is violation of Articles 14 and 21 of the Constitution". The views so expressed were approved of in D.B. Civil Special Appeal No. 595/2000 dated 5.4.2002. Similar views were expressed by this Commission in the cases of Chief Secretary, State of Rajasthan v. Jogendra Pal Singh, Appeal No. 165 of 2000, dated 17.7.2000 and Member-Secretary, Board of Trustees, Rajasthan State Pensioers and Medical Concession Scheme & Director, Pension & Pensioners Welfare Department v. Shri Ram Chandra Chauhan, Appeal No. 216 of 2001, dated 26.4.2002 upheld by the National Commission in Revision Petition No. 1076 of 2002 decided on 23.1.2003.

IN view of the discussion made hereinabove, Appeal No. 1637/2001 preferred by the Chief Secretary of Government of Rajasthan is dismissed but that of the complainant''s Appeal No. 1633/2001 is allowed. The respondents in Appeal No. 1633/2001 are directed to pay to the complainant Shri R.P. Pareek a sum of Rs. 67,895/- with interest at the rate of 9 per cent per annum from 1.2.1993 through Demand Draft sent to him through registered post at the address given by them in their appeal within a period of three months from today failing which the aforesaid amount shall be payable at the rate of 12 per cent per annum from the above mentioned date. The respondents shall further pay a sum of Rs. 2,500/- to the complainant as litigation expenses upto our stage. The impugned order shall be deemed to have been modified to the extent stated above. Ordered accordingly.