Hesitation of Chief Medical Officers of CGHS Dispensaries

A CGHS beneficiary suffering from a serious ailment is compelled to seek permission from various authorities, even when the rules under the Scheme provide clear guidelines. The reason for this can’t be wholly or even partially malafide, but one that of mindset and of taking suo motu action on the part of the authorities. The technocrats including the scientists, doctors, engineers though they may be experts in their respective fields, but when it comes to exercising their discretionary powers constructively and in favour of the beneficiaries are very much circumspect. This results in unnecessary delays and avoidable inconveniences to the ailing persons and their kith and kin.

I happened to approach the CMO of the concerned CGHS dispensary for the follow up with a hospital in the CGHS panel for radiotherapy in the case of my father. I had the requisite / valid permission vide which radiotherapy was administered to my father. I was asked to come for a check up after one month. When I confronted the CMO with this situation, he said that I could not have the follow up from the recognised hospital and for this I have to again approach the government hospital. When I said that there is a provision in the rules especially for cancer patients that they could have the follow up from the same hospital where they had undergone treatment, he was left dumbstruck. After a while regaining his composure, he said that he can’t refer the patient on his own but instead he would forward the case to the Additional Director who will give me the permission.

In this case I feel it pertinent to cite the office memorandum no. S.11011/1/2000-CGHS (P) dated 10.4.2001 issued under the signatures of B.B. Bhattacharjee, Under Secretary to the Govt. of India of the Ministry of Health and Family Welfare, Department of Health. The operative part reads as follows:

“….. It has now been decided that the CGHS beneficiaries will be eligile for follow up treatment relating to Neuro Surgery, Cardiac Surgery (including Coronary Angioplasty & Implants), Cancer Surgery/ Chemotherapy/ Radiotherapy, Kidney transplantation, Hip/ Knee replacement Surgery and Accident cases in the same Institutions/ Hospitals where the treatmet was earlier carried out with prior permission of competent authority.

5. Permission for follow up treatment may be granted by Head of the Department in case of Central Government Employees, working employees and pensioners of Autonomous bodies admitted under the Scheme and by Rajya Sabha Secretariat/ Lok Sabha Secretariat as the case may be in case of Members of Parliament and Ex MPs and by CMO Incharge of concerned CGHS Dispensary in case of pensioners, freedom fighters etc. for 3-6 months at a time, which may be extended if required on the basis of medical record….”

In another order in the case of chronic cases medicines can be issued for three months by CGHS dispensaries. Though the order can be accessed from the CGHS website “mohfw.nic.in” but for the sake of convenience of the readers the letter no. S-11011/8/99-CGHS(P) daed 13th October, 1999 was issued by Brahm Dev, Under Secretary to the Govt. of India, Ministry of Health and Family Welfare, Department of Health. Again the operative portion for the benefit of the beneficiaries is as under:

“2. In order to alleviate the hardships being faced by such CGHS beneficiaries, CMO In-charge of the CGHS dispensaries all over the country are requested to issue them medicines for a period of 3 months at a time against the individual valid prescription containing the advice of the Government specialist”

But the regular practice indulged in by the incharges of CGHS dispensaries is to indent medicines for a week, or so. When the rule explicitly provides for issue of medicine for a period of three months in chronic cases, the same is resorted to as a matter of exception, and that too after much pleading. Thus, much of the time and energy and money are spent going round the various authorities seeking their permission/ approval. It is said that time is precious and has to be invested carefully. But the present scenario unfortunately belies this saying.

Are the CMOs / authorities concerned hesitant to interpret the rules in a constructive and a favourable manner. And why should they be, when the rules provide clearly for the same?

Are the CMOs fully versed with the basic rules in the matter of according permission/ issue of medicines. If not they should refresh their knowledge about the government policies on a regular basis.

I feel the doctors and incharges of the CGHS dispensaries should be sensitized towards the difficulties and inconveniences of the patients. It is perfectly humane nature that they might get irritated owing to the large number of patients, but regular sensitization to the needs of the masses may make much of difference.

In this connection I would like to add that regular meetings with the Area Welfare Officer of the concerned areas with the CMO should be made mandatory and members of public should be invited in the discussion to allay their problems.

Let us hope that this makes for a better start at least.

--Sudesh Negi