Centre has freedom to amend its CGHS scheme : Delhi High Court

The Delhi High Court on Tuesday declined to interfere with the modified Central Government Health Services (CGHS) scheme, saying it is for the Centre to decide how to give health benefits and supply medicines to its serving and retired employees.

A bench of Chief Justice D N Patel and Justice C Hari Shankar said prima facie the modified policy creates no hurdles in supply of medicines to the central government employees and also curbs misuse of the scheme as was being allegedly done in the past.

The observation came while dismissing a PIL challenging an e-tender issued for empanelment of authorised local chemists under the modified CGHS scheme for the national capital area. The petition had opposed the modified scheme also.

Under the earlier scheme, if medicines prescribed by a doctor were not available at a wellness centre or dispensary, an authorisation slip was issued to the patient for procuring the medicine from a local chemist, the Health Ministry told the court.

Under the new scheme, it said, if medicine was not available at the dispensary, the local empanelled chemist supplies it to the wellness centre which in turn provides it to the patient.

The central government further said the scheme was modified as earlier patients used to use the authorisation slip for buying toothbrushes, toothpastes, Horlicks and cosmetics from the chemist shop.

Noting the submission of the ministry, the bench said under the new scheme requirement of issuance of authorisation slip has been given a go-bye and “therefore, chance to buy toothbrushes, toothpastes, Horlicks and cosmetics has been brought down to zero as now medicines will come to wellness centre and patients need not go to the chemists”.

The court noted the ministry’s claim that subsequent to the modification in the scheme, participation by chemists has increased and they were offering better discounts than in the past, and said,”we see no reason to interfere with the modified CGHS policy.

“The government has to be given free movement in the joints. The government should be given the freedom to amend the schemes. More the misuse of a scheme, more tight would be the procedural aspect in grant of benefits. Sometimes government may also close down the scheme if it is being misused,” the bench said.

It noted under the new scheme there was no contact between the beneficiary and the local chemist, due to which “loss may have been caused to chemists as they can no longer sell toothpaste, toothbrushes, Horlicks and cosmetics instead of medicines”.

“However, we are not concerned by loss to chemists. We are only concerned that the benefits reach the central government employees. We, therefore, see no reason to interfere with the modified scheme or the notice inviting tender floated by the central government,” the court added.

PIL in High Court against new tender to empanel chemists under CGHS

The Delhi High Court has sought the response of the Centre on a PIL challenging an e-tender issued for empanelment of authorised local chemists under the Central Government Health Scheme (CGHS) for the national capital area.

A bench of Acting Chief Justice Gita Mittal and Justice C Hari Shankar issued notice to the Ministry of Health and Family Welfare and sought its reply to the plea by July 9, the next date of hearing.

The bench also said that the outcome of the tender process, for the financial years 2018-21, shall be subject to further orders on the writ petition.

The court said it was the government’s responsibility to notify all bidders about the petition and orders passed.

The petitioner, Inder Lal Marwah, has contended that the new tender, issued in January this year, has done away with the distance requirement as an eligibility criteria for empanelment of authorised local chemists for CGHS centres in Delhi.

Marwah, in his plea filed through advocate J C Vashista, has said that earlier there was a requirement that a chemist shop be located within five km distance of a wellness centre.

Later, the criteria was modified to the extent that the shop be located in the same zone as the wellness centre, the plea has said.

It has claimed that complete removal of the distance requirement “would adversely affect availability of emergency medicines required by wellness centre(s) or beneficiaries who are in dire need of said drug”.

The plea has also said that removing the distance criteria is “bound to increase mal-practices and sub-letting of the indented medicines drugs from empanelled chemists”.

“It will also increase the time limit for making available the emergency medicines/drug(s) which are not available at a wellness centre,” it has also said.

Supreme Court to Centre: Form panel to disburse medical claim under CGHS

In a bid to protect retired public servants from “unnecessary harassment” in claiming reimbursements under the Central Government Health Scheme (CGHS), the Supreme Court has asked the Centre to “expeditiously” set up a high-powered committee to disburse claims in a month.

A bench of justices R K Agrawal and Ashok Bhushan also directed the Ministry of Health and Family Welfare to form the panel within seven days.

It would comprise special directorate general, directorate general, two additional directors and one specialist in the field and shall ensure timely and hassle- free disposal of the claims to the pensioners, it directed.

“With regard to the slow and tardy pace of disposal of Medical Reimbursement Claims (MRC) by the CGHS in case of pensioner beneficiaries and the unnecessary harassment meted out to pensioners who are senior citizens, affecting them mentally, physically and financially, we are of the opinion that all such claims shall be attended by a secretary-level high powered committee in the ministry concerned which shall meet every month for quick disposal of such cases,” the bench said.

The directions came on a plea of a retired government servant who was denied medical claim under the CGHS in 2014 for his treatment at Fortis Escorts Hospital in Delhi and Jaslok hospital in Mumbai due to the non-empanelment of the hospitals under the scheme.

The bench, which directed the ministry to give the petitioner Rs 4,99,555 spent by him on his treatment, also observed that the CGHS officials responsible for clearing medical claims took a “very inhuman approach” by denying him the full cost of his treatment.

“Can it be said that taking treatment in speciality hospital by itself would deprive a person to claim reimbursement solely on the ground that the said hospital is not included in the government order.

“The right to medical claim cannot be denied merely because the name of the hospital is not included in the government order. The real test must be the factum of treatment…,” it said.

It observed that authorities must be responsive and ensure medical care to senior citizens after retirement.

“The relevant authorities are required to be more responsive and cannot in a mechanical manner deprive an employee of his legitimate reimbursement. The CGHS was propounded with a purpose of providing health facility scheme to the central government employees so that they are not left without medical care after retirement,” it said.

The apex court, while directing the ministry to form the panel expeditiously, said there shall be a time-frame for finalisation and disbursement of the claim amounts of pensioners.

“In this view, we are of the opinion that after submitting the relevant papers for claim by a pensioner, the same shall be reimbursed within a period of one month,” it said.

The court was hearing the petition filed by Shiva Kant Jha, seeking reimbursement on account of his treatment done in November, 2013 for Rs 9,86,343 for his cardiac ailment involving the implant of CRT-D device and two sets of bill amounting to Rs 3,98,097 for his treatment at Mumbai for cerebral stroke and paralytic attack.

He had claimed that he was denied the amount of Rs 4.99 lakh out of the entire amount on the ground that he did not seek approval of authorities for the device implant.

The court, taking note of the facts, said “the law does not require that prior permission has to be taken in such situation where the survival of the person is the prime consideration.”

The bench said that the CGHS is responsible for taking care of healthcare needs and well-being of the central government employees and pensioners.

“In the facts and circumstances of the case, we are of opinion that the treatment of the petitioner in non-empanelled hospital was genuine because there was no option left with him at the relevant time. We, therefore, direct the state to pay the balance amount of Rs 4,99,555 to the petitioner. We also make it clear that the said decision is confined to this case only,” it said.

Govt to pay employee for wife’s death in CGHS hospital

The Union government has been ordered by the country’s apex consumer panel to pay Rs 5 lakh as compensation to one of his employees, whose wife had died of excess bleeding in a CGHS hospital soon after giving birth to a child through cesarean section over 13 years ago.

 The National Consumer Disputes Redressal Commission (NCDRC) ordered the government to pay the compensation, as the woman died of excess bleeding after surgery with no blood available in blood bank of the Central Government Health Scheme (CGHS) maternity hospital.

 The government ordered compensation for the victim’s husband Arvind Pandey holding the union Ministry of Health and Family Welfare, the CGHS director general, the hospital and its doctor who performed the surgery, jointly liable for damages.

 The NCDRC held the doctor concerned, Dr Saran and the CGHS maternity hospital at R K Puram liable to pay damages saying they “failed to exercise due care on their part” leading to the death of Pandey’s wife.

 “The concerned doctor and the hospital had failed to anticipate problems arising out of the complications and to take precautionary measures, such as arranging for the blood or keeping an ambulance ready for shifting the patient,” the NCDRC bench presided by Justice R C Jain said.

 The NCDRC’s verdict came on Pandey’s complaint alleging his wife had died right after the delivery through cesarean section due to negligence of the CGHS maternity hospital and the doctors who were present during the surgery.

 The CGHS hospital and the doctors had contended in their defence that the best possible treatment was given to Pandey’s wife, who was a high-risk patient, and that he was informed before hand to arrange blood or blood donors.