S.LAKSHMI NARAYANA Vs. DIRECTOR CENTRAL GOVERNMENT HEALTH SCHEME

JUDGEMENT

(1.) The unsuccessful complainant is the appellant

(2.) The facts of the case as narrated by the complainant is that he is a retired employee of the DOT drawing pension from the department. The complainant had also obtained a card from the Central Government Health Scheme by paying admission fee. The complainant applied for Rs. 5,20,000/- towards his wifes treatment from opposite parties no.1 and 2 in opposite party no.2 hospital. Accordingly, the opposite party no.3 issued a letter showing the exact amount to be paid for Bilateral DBS implant to the wife of the complainant. However, the opposite parties no.1 and 2 sanctioned only an amount of Rs. 3,75,000/- and the complainant sought for full amount of Rs. 5,20,000/-. The case of the complainant is that as the opposite parties no.1 and 2 did not release the amount as prayed for them, his wife died. The opposite party no.3 is also negligent in not administering timely treatment to the wife of the complainant. Hence, the complainant is seeking direction to the oppose parties to pay compensation of Rs. 10 lakhs.

(3.) The opposite parties no.1 and 2 resisted the claim by filing parawise remarks. It was contended that the appellant is not a consumer for availing facilities under CGHS. The complainant under the CGH Scheme has to avail medical facilities through CGH Scheme dispensaries at Begumpet, Himayatnagar in Hyderabad. Bilateral Deep Brain Stimulator Implantation is not an approved procedure under the CGH Scheme. Therefore, the case of the complainant was referred to Director, CGHS, New Delhi on 21.7.2004. As DBS Implant is a new procedure and no permission in such cases was issued earlier, the case of the complainant along with two other similar cases recommended by the opposite party no.3 hospital were forwarded to the Director, CGHS, New Delhi who examined the various aspects and approved the procedure at the ceiling rate of Rs. 3,75,000/- The government has to examine all aspects before taking a new decision to approve any new procedure. Hence, the approval for the new procedure had taken some time to take such important decision. There was no deficiency of service on the part of the opposite parties no.1 and 2. Hence, prayed for dismissal of the complaint. Respondent no.3 hospital remained exparte.