THE HONOURABLE SRI JUSTICE A.GOPAL REDDY and THE HONOURABLE SRI JUSTICE RAJA ELANGO Taken up W.P.No.10691 of 2010 Date of Order: 06-09-2010 Between: Paper Clipping dt. 21-04-2010 Of the Hindu English Daily News Paper ..Petitioner and 1.The NIMS, Punjagutta, Hyderabad rep. by its Director and another. ..Respondents The Court made the following Order THE HONOURABLE SRI JUSTICE A.GOPAL REDDY and THE HONOURABLE SRI JUSTICE RAJA ELANGO Taken Up W.P.No.10691 of 2010 Oral Order : (Per Honourable Sri Justice A.Gopal Reddy ) This is a Taken Up Writ Petition on the basis of news item published in Hindu Daily News Paper dated 21-04-2010 under the caption ‘A NIGHTMARE FOR SENIOR CITIZENS”. The news item reveals the miseries of the senior citizens, freedom fighters and pensioners visiting Nizam Institute of Medical Sciences (for short “NIMS”) for treatment. According to news item, by the time they manage to come out after meeting the doctor, little energy is left in their weary legs to go back home. On the basis of the news item report, the respondents were called upon to respond and the steps taken for special provision for the senior citizens, freedom fighters to consult the Doctor at the earliest without waiting; streamline the outpatient services efficiently by curbing the practice of insisting to opt for evening clinics; to take up diagnostic tests in laboratories outside and treat them on par with the patients with white card and Aarogyasri and provide cash less treatment for patients covered by CGHS scheme as in the case of AIIMS. In response to notice, a detailed counter has been filed by the Executive Registrar of NIMS, on each point, as referred to above, stating that a separate registration-cum-billing counter is available from 8.00 A.M. to1 P.M. at counter No.33. Exclusively for all the elderly patients, “Geriatric Specialty”. Out patient (O.P.) services are also available every Friday from 9.30 A.M., and the senior most faculty Dr.Y.Satyanarayana Raju, Professor & Head, Unit-I Department of General Medicine renders his services for senior citizens. With regard to streamlining of O.P. services efficiently and curb the practice of insisting them to opt for evening clinics, the steps taken by NIMS were enumerated in para-4 (a) to (k), which reads thus: (a) The O.P. centralized counters start at 7.30 A.M. and functions continuously till 2.30 P.M. the O.P. Registration timings is upto 11.30A.M. (b) In main block O.P.D. there are total 7 centralized counters for new registration patients, revisit cases, and issue of cash receipt and bills for investigations. In Millennium Block O.P.D. there are 4 such centralized counters. (c) To meet the inflow of patients, in addition to the above counters, special counters have been started exclusively at individual departments to facilitate the patients at Neurology Block, Cardiology Block, General Medicine Cubicle and Haematology Cubicle for issue of investigations bill and cash receipts. (d) For senior citizens, there is a Help Desk and assistance available at Room No.32. (e) It is not true that the patient or his attendant is advised to visit the faculty in evening clinic. All the faculties are available in morning O.P. service as per the schedule. A patient visits the evening Special Clinic only by prior appointment and it is purely optional to attend the Evening Clinic. No patient is directed or insisted to attend the Evening Special Clinic. (f) In case of need for the morning O.Ps. the patients approach the doctors at the department, wards or at evening clinic with the morning O.P. registration only and the evening O.P. registration is not insisted upon. (g) The Evening Special Clinic facility was introduced after demand and requests from a section of patients who are interested to consult in the Evening Special Clinic timings, being easy and flexible as per the patients’ convenience. (h) Only registered patients attend the evening clinic by prior appointment. Hence, VIPs and the affluent prefer to visit the evening clinic as there is less crowd and they prefer evening clinic for security reasons. (i) The flow of patients have increased voluminously over a period of time. The situation in the O.P. as well as in patient area is being monitored at regular intervals and constant improvements are being made to regulate the patient flow. (j) It is ensured that wherever possible, the laboratory investigations are made on the same day, except for a few investigations, where the patient needs to be fasting and under preparation for the investigation. (k) The morning O.P. registration fee for paying cases is only 50/-, for White Card Holders/Aarogyasri beneficiaries the registration fee is free. The registration fee for CGHS patient is only Rs.50/-. With regard to curb the practice of requiring senior citizens and freedom fighters to take up diagnostic tests in laboratories outside and to attend them on par with patients with white card and Aarogyasri, the steps taken by NIMS were enumerated in para-5 (a) to (i), which reads thus: (a) The allegation is baseless and it is not true that the patients are referred for diagnostic tests to outside laboratories. No patient is referred outside the tests are available in the Institute. (b) It is ensured that whatever possible, the laboratory investigations are made on the same day, except for a few investigations, where the patient needs to be fasting and under preparation for the investigation. (c) A separate counter for early appointments for radiological investigations has been started to facilitate the patients in Neurology O.P. department. (d) It is displayed at many places in O.P. department that the investigations suggested by the treating doctors are to be done in the Institute laboratories only. (e) It may be kindly noted that only the sick and needy people visit the Hospital. While it is agreed that the senior citizens are a special category of people requiring attending, it is to submit that there are patients of all age groups who require immediate and early attending in the O.P. area. (f) The policy of the Institute and indeed of any hospital is “FIFO” i.e. First in First Out. The patients are allotted a serial number at the individual OPDs. In general, the other patients will not oblige to bypass the serial order. (g) The senior citizens can avail the services of the Help Desk available at Room No.32 and all possible assistance is provided to the patients. (h) It is seen from the O.P. statistics that a large number of patients coming to O.P.D. are post-operative cases coming for follow-ups. Preference is given first to patients who are on wheel chairs, trolleys as they are already suffering. Further, the wheel chairs and trolleys are needed fro the other patients. (i) It may be noted that the senior citizens also form a large chunk of the Aarogyasri as well as White Card Holders. With regard to providing cashless treatment for patients covered by CHGS scheme like AIIMS, the steps taken by NIMS explained in para-6 of the counter which reads as under: (a) The facilities provided as on date for CGHS beneficiaries are as per the policy and procedure framed by the CGHS authorities. (b) Providing cashless treatment for CGHS patients cannot be provided from the Institute without formulating the credit bills realization policy. (c) The concerned authorities need to chalk out a policy in this regard and the Institute will be happy to render the services if the same are paid for in whatever way. With regard to the pensioners (Government of India), freedom fighters and ex-members of Parliament for cashless treatment, the services provided NIMS are stated in para-7, which reads thus: (a) With prior permission letter from Dispensary/CGHS. (The letter is valid for morning out patient and in-patient treatment) (b) Without prior permission letter with valid CGHS card. The patient is admitted in emergency (under Rule 11) with valid CGHS card on cashless treatment and extending the credit facility. (c) Without referral letter from Dispensary/CGHS, the payment can be made by the beneficiary and apply for reimbursement. On filing the above counter, this Court by order dated 30-08- 2010 called upon the Standing Counsel for NIMS to appraise the Court whether any separate registers are maintained for senior citizens and CHGHS patients for the purpose of outpatient treatment and also for diagnosed purpose and within what time the cases will be cleared in the hospital and if so, how many patients would visit the hospital for treatment. Learned standing counsel for NIMS today submitted that no separate registers have been maintained with regard to senior citizens, freedom fighters and CGHS patients for the treatment and diagnosis undertaken by them and the time for such treatment and diagnosis, but he has furnished a list of CGHS patients (retired Central Government employees and freedom fighters) treated in NIMS for the last five years, which reads thus: YEAR OUTPATIENT CONSULTATIONS OUTPATIENT INVESTIATIONS INPATIENT 2005-06 9352 4930 1115 2006-07 10489 4028 957 2007-08 10200 5143 840 2008-09 12700 6164 1169 2009-10 13666 5757 1089 Having regard to the fact that the NIMS has already taken care by providing separate counters for senior citizens, freedom fighters and CGHS patients and they are being treated along with regular patients, we hope and trust in future a separate registers will be maintained for senior citizens, freedom fighters and CGHS patients. The NIMS shall also display at the entrance as well as at the enquiry counter regarding the counters where senior citizens, freedom fighters and CGHS patients will be treated as OP and inpatient. It shall also maintain a grievance register at the enquiry counter, so that if the senior citizens and freedom fighters have any grievance, they can place it on record in the said register and a responsible officer may be appointed to attend the same in the NIMS. With the directions as above, the writ petition is disposed of. No costs. ________________ A.GOPAL REDDY, J. _____________ RAJA ELANGO,J. 06-09-2010 Murthy