Medicare for Rly Pensioners
RELHS-97
{That is :-Retired Railway Employees liberalized health scheme}
Beneficiaries of Retired Railway Employees Liberalized Health Scheme—97 in Railways do not ordinarily have the facility of availing medical services in private recognized hospitals and Diagnostic centers nearest to their place of residence even though very good world class medical facilities may be available locally, even in urgent cases needing specialized consultation they are directed to Railway hospitals at zonal headquarters far away from the place of residence of RELHS beneficiary, the retired employees are living in the far flung areas of cities even at zonal Railway HQ , in cities far away from zonal Rly HQ or in remote villages. What to speak of the cities away from Zonal HQ and the remote villages, even in cities like Delhi, Kolkata, Mumbai, Hyderabad, Chanai, Nagpur, Jablpur, Allahabad etc where Zonal hospitals are located, due to traffic conditions it takes well over one hour even to travel a distance of 20 Kms. The hardship, particularly for the old and infirm pensioners living alone in far flung areas of cities/remote villages can very well be imagined.
It is a medical truth that in case of a heart attack/ brain stroke the treatment given within first hour is crucial to save life/ to minimize permanent damage.
Many a times such pensioner patients are unable to reach suitable Rly hospital with in this crucial period and several precious lives are lost on this account every year.
The present infrastructure in Rly’s medical department was created to cater for the Serving employees, as at that point of time retirees were not getting medical facilities at par with serving employees. Subsequently Retired employees were brought at par with the serving employees for the purpose of medical facilities with the result; medical department has now to cater to over 12 lac of retirees, in addition to the serving employees, without any addition to the infrastructure.
The result is that now Zonal & Divisional hospitals are over crowded. Patients have to wait for hours for their turn & the Doctors are always under pressure to clear the rush. Consequently geriatric patient do not get the attention they need
Mode of joining RELHS-97 scheme::-
Attention of VIth CPC is drawn to Apex court judgment in case of Consumer Education& Research canter &s others v/s UOI &others writ petition (C) No.206 of 1986 {AIR 95 Vol. 82 Page922} Para 27 where honorable S.C. ruled “we therefore hold that right to medical aid to protect the health & vigor of a worker while in service or post retirement is Fundamental Right under Article 21, read with Article 39(e), 41,43,48A and all the related articles and Fundamental human rights to make the life of the workman meaningful and purposeful with dignity of person.”
And the apex court judgment in the case of Laxman Thamappa Kotgiri v/s G.M. C.Rly & others. Civil Appeal No. 171of 2004(Arising out of SLP ( C )No. 4994 of 2004, date of Judgment 6-01-05 {2005(1) Scale Page 600} Para6
Where in it has been laid down: that there is no dispute that the Hospital (read Rly hospital) in question has been set up for the purpose of granting medical treatment to the Railway Employees and their dependents. Apart from the nominal charges, which are taken from such Railway Employees, this facility is part of the service conditions of Railway Employees.
Medical aid to serving & to the retired employees is a fundamental Right. In Rly. Medical aid is a part of Service condition & it is at par to both serving & retired employees. Then why a cut of date to join RELHS-97 scheme & where is the justification for contribution of last months salary.? (Which is in addition to nominal charges paid at the hospital for registration purpose.)
The way out is outsourcing!
1. More number of Private hospital &diagnostic centers need to be recognized on bill system so that in case of a medical emergency no beneficiary has to travel a distance of more than 10 Kilometers. However, if a pensioner or his /her attendants in case of a medical emergency wants the patient to be treated in a private hospital of his/her own choice Reimbursement of medical bills be allowed at the package rates of recognized private hospital for similar treatment or at AIIMS rate +75%in excess thereto as per honorable Supreme courts judgment in the case of Suman Rakheja v/s State of Haryana and others Civil Appeal No. 5060of 2004 decided on August 6,2004 . (2004)13 S.C. Cases 562
In such a case patient or attendants should inform authorized medical attendant as soon as possible giving details of ailment& that of the hospital where patient is being treated, so that medical department can verify the emergency &may monitor the treatment. This will relieve extra load on Rly hospitals and immensely benefit the retirees
2. RELHS -97 schemes may be kept open permanently.
3. Retiring /retired employees should not be asked to deposit any contribution except for the nominal charges to be paid as registration fee at the hospitals.
4. Pay ward facilities should be allowed to persons attending patients in Rly hospitals .
5. Diet charges may not be recovered from pensioners & family pensioners
Reimbursement of medical expenditure
{ for treatment in private hospitals in cases of medical emergency}:-
Ignoring rulings of the honorable Supreme court of India, various high courts, State consumer dispute redressal commissions, where in it has been laid down that emergency knows no rules , saving of life is of paramount importance, Government is duty bound to grant post facto sanction & that refusing reimbursement of medical bills is violation of Article 14 and 21 of the Constitution,
Medical reimbursement claim in quite a good number of are denied on technical grounds .
Following case judgments may kindly be referred- Rajas than State consumer Dispute redressal Commission, Jaipur
R.P. Pareek V/s Chief Secretary Government of Rajas than Appeal No. 1633 and 1637 0f 2001 decided on 19th may 2003(2004(1)CLT page 212),Apex Court judgment in the case of Surjeet sing v/s state of Punjab &others, Civil Appeal No.2489of 1996(arising out of SLP.(Civil) No.18291of 1995) /-31-1-96 AIR 1996 1388S.C,
In the case of State of Punjab & others v/s, Mohinder Singh Chawla etc Civil Appeal No.16979 with 16980-81 of 1996(arising out of S.L.P. (C ) No. 12472 with 12945 and 18828 of 1996 D/- 17-12-96 ,Delhi High Court CWP. No. 509/98 Decided on 28-04-1999 Narendra pal Sing v/s UOI & others{79(19999 DLT358, Supreme court of India C.A. No. 111-1115 of 1998 etc Decided on 26-02-1998 State of Punjab &others v/s Ram Lubhaya Bagga ETC. ETC J.T 1998.
Even when the medical emergency is verified &accepted to be genuine by the medical department, the reimbursement of the medical expenditure incurred is nightmarish and takes months & some times years, even then 100% expenditure is not reimbursed &what ever reimbursement is given is at AIIMS rates where as per honorable Supreme courts judgment in the case of Suman Rakheja v/s State of Haryana and others Civil Appeal No. 5060of 2004 decided on August 6,2004 (2004)13 S.C. Case 562 claimant is entitled to 100% medical expenses at AIIMS rate and 75% of the expenditure in excess thereto.
Plight of pensioners who borrow money or mortgage their jewelry /other belongings to get money for treatment in emergency can well be imagined.
Very often pensioners in order to get their just reimbursements are compelled to seek redressal from the courts. Where, in 95% of the cases, Railway loose.
Legal proceedings dig a deep whole not only in pensioner’s pocket, but the administration also loose money and a good number of useful
men days.
Therefore ,Rules for Reimbursement of medical expenditure may be liberalized keeping in view the Apex court & high court judgments, and the interpretation of such rules is done with a human face.
S.C. Maheshwari
General Secretary
Retired Railway Employees Welfare Association (Regd)
490A/16 Gurudwara Road civil lines Gurgaon-122001