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Sunday, December 13, 2015

An important decision by the Delhi High Court on rank-based priority in ECHS

The Delhi High Court has rendered an important decision on the subject of Ex-servicemen Contributory Health Scheme (ECHS) on a Public Interest Litigation seeking an egalitarian approach for all ranks based on the averment that “as per policy in vogue, persons who are in possession of White Card (War Disabled/disabled) and Senior Citizens (male 75 years and above, female 70 years and above) are entitled for treatment in ECHS Polyclinics on priority” and that priority is not based upon the rank held in the military on retirement. 

Without stating anything for or against, on merits or demerits of the issue, it would be interesting to hear from the readers on this very complex subject in a military backdrop.

The questions that come to my mind are:

(i) Though it is fully understandable that some differentiation would always prevail in a military milieu, how far should it continue after retirement and in which spheres?

(ii) Is it time to gradually move towards a rank-neutral system in some aspects after retirement?

(iii) Does the CGHS follow a system of priority based on rank/grade held prior to retirement?

The excerpts from the decision are as follows:

“6. We can however well imagine the scenario prevalent in the ECHS Polyclinics, Military Hospitals / Empanelled Hospitals. The same is not typical of ECHS Polyclinics / Military Hospitals / Empanelled Hospitals only but of all institutions. We, as a country, ruled first by the kings and chieftains and later by the British, have it ingrained in us, to respect and give priority in all walks of life to rank, office and wealth. Rank, office and wealth opens doors to holders thereof without even there being any provision therefore in law, Rules and Regulations. Though our Constitution set the course right by ingraining therein the equality clause (Article 14) and by abolishing titles (Article 18) but the same has not been achieved in practice in the last more than 65 years.
7. We are in this matter, faced with a practice which is as ancient as mountains in this country. The said situation in our view cannot be changed merely with directions of the Court. Such practices, highlighting which and seeking redressal where against this petition is filed, are found not only in ECHS Polyclinics but at nearly all places providing services/amenities of public utility. In our view, the cure thereof is not in Courts. We have for this reason only not deemed it appropriate to issue notice of this petition and to give an opportunity to the respondents to show, whether despite being not in the scheme, elsewhere in the rules and regulations governing Armed Forces, there is such a distinction as maintained amongst officers and personnel of other ranks, because even if that be so, in our view, the same cannot continue post retirement, when both fall in the same category i.e. of ex-servicemen and when the Scheme does not provide there for. Once the Scheme does not classify its members according to their rank and does not provide for priority, in the matter of benefits under the Scheme or in the working of the Scheme, to be given as per rank, there can be no basis for such sub-classification or micro-classification or further classification among the class of ex-servicemen in treatment under the Scheme. The guarantee contained in Article 14 of equal protection extends, besides to substantive law, to procedure as well. There does not appear to be any basis for such sub-classification amongst ex-servicemen in relation to the object of the Scheme. We may however mention that "Regulation for Medical Services of Armed Forces-1983" also not providing for any such classification on the basis of rank and to be rather under the heading "Medical Ethics" providing that while dealing with a patient, the medical officers primary duty is always the patients welfare.

8. We are also of the view that even if we were to issue a direction for all members of the ECHS to be treated equally and even if the offending display boards were to be removed, the same may not eliminate the problem inasmuch as, the Doctors/Physicians and other Paramedics are likely to continue to give priority to the officer ex-servicemen. It cannot be lost sight of that the Defence Forces, more than any other, are steeped in hierarchy and the Doctors, Physician or Paramedics of a lower rank are likely to, out of habit and deference, give priority to those superior in rank, even if ex- serviceman.

9. We have wondered the solution for the problem.

10. The only solution according to us can be by building consensus and awareness not only amongst those who are imparting / rendering services at such Polyclinics / Military Hospitals / Service Hospitals / Empanelled Hospitals but also amongst the members of the Scheme. Not only have the doctors, paramedics and other staff of such Polyclinics / Military Hospitals / Service Hospitals / Empanelled Hospitals have to be taught to see patients strictly as per appointment if permissible or on first come first served basis but the members of the Scheme also have to be taught to respect the Scheme and to not seek any priority / favour in the matter of being attended to at the said Polyclinics / Hospitals. It is only when the ex-servicemen, of whatsoever rank, if not entitled under the Scheme to preferential treatment, starts respecting the que and not expect to be attended to first that the requisite correction in the society can take shape. The same in our opinion can be achieved by sending circulars, putting up boards / placards at the Hospitals / Polyclinics and by organizing group discussions, talks etc. on the subject, to build consensus amongst the providers and beneficiaries of the Scheme.

11. Yet another thought which comes to our mind is of equitably dividing the time and / or by introducing a system of consulting by appointment for certain hours of the day so that at that particular time only those with appointment are attended to and at other times the beneficiaries of the Scheme are attended to strictly on first come first served basis.

12. The above, but are our meandering of a solution to the issue and is by no means exhaustive. We are sure that the providers under the Scheme, being specialist, are better equipped and would be able to come up with a suitable solution to the problem so as to avoid heartburn amongst a certain category of ex-servicemen, of being denied equality under the Scheme and which is the cause of action for this petition.

13. We have faith in the good sense and well meaning intention of the ECHS organization which as per Chapter-5 of the Scheme is headed by a Managing Director (Major General) of the Indian Army.

14. We therefore dispose of this petition by directing the Managing Director of the ECHS to look into the issue raised in this petition and to address the same in the best possible manner, after considering the suggestions made by us hereinabove.”


Chandra Prakash Pant said...

The existing policy as quoted, establishes PRIORITY based on the patient's condition (age/ injury/ disability) and NOT his in-service Rank.

There should be no reason to change this

sudarshan tiwari said...

A very good initiative.Thank you very much.

Anonymous said...

Respected Maj Navdeep, Sir,
I've been an ardent follower of your blog
I thank you from the deepest of my heart for your continuing efforts with regard to Armed Forces personnel.
Let the great god be with in all walks of life and let him give you more energy.
The article was enlightening for all of us.
Kudos, Sir.

Sgt Swamy

SS Malik said...

Same service should also mean same subscription. If the subscription to ECHS is different so would be the priority. The service rendered should be such that there should be no long queues. Instead of asking for better service for everyone we are pulling the others down too.

dandyboy said...


marshal said...

Good post with thought provoking ideals.Presently in the ECHS, they have devised a methods ie. 4 ORs..... 1 offr patients ratio. Senior citizens(both men & women) are given priority. On Saturdays exclusive for Officers ; but emergencies for all will be attended to. 2. In the Military .Naval / Air force Hospitals , there are separate wards for different ranks ie. Officers ward/ JCOs ward/Officers Family ward/ Family wards etc. Besides VIPS ( Colonel /Brig and above) are given separately done up rooms in the wards. No cribbing about it also. I am of the opinion that status quo should continue. All ranks (retirees) seen to be giving proper respects to seniors even based on service entry rather than ranks amongst officers. Also all are seen to be respecting the aged veterans . It would continue . as it is the bonded on military discipline.

rustyg1 said...

It is only Defence services where Ranks are permitted to be carried post retirement , hence in our culture rank does play an important role post retirement also. We learn to respect our seniors without any question right from the day we wear our uniform. However in CGHS also the IAS/IPS and others do carry their rank, unofficially. I have myself experienced that a retired Chief Engineer of State Electricity Board was given preference over others in on of the CGHS clinic. Therefore it is the mindset. By this I do not propagate that officers should bulldoze their way on doctors in ECHS over PBORs (and that is generally not done), and allow doctors to call as per token No (in case there is only one doctor for all). However the patients need to be seen as per the urgency also and there are many incidences when officers have given way to PBORs in case their case is urgent.

Dhoop said...

ECHS already follows practices for delivering, in its own fashion, healthcare which tend to dissolve the in-service rank differentiation. In most, if not all, polyclinics, there are no separate counters for or systems of registration for officers. Patients are called in for consultation as per their registration numbers. Some of the polyclinics do provide for a separate counter for dispensing medicine to Officers. If a proper electronic token number is followed and dispensing is made efficient and speedy, where would the need be for separate counters?

It is the lack of evolved reasoning and un-refined thought processes that go into designing and administering such facilities that contribute to needless resentment, representations and, now, litigation, not the separate counters.

I have often wondered if the intervening layer of ECHS in veteran health-care, with its old-time and antiquated approaches could not simply be done away with and a large portion of the veteran class brought under some form of health insurance financed and catered for by MOD.

Commander said...

The PIL was bad in state, As it did not bring out the differential in fees paid for by the unit and consisting of Officer and Family by and large and others with more members at younger age. This lob sided funding has actually meant cross subsidizing the others from officers.

Except where appointments are taken by individual online (where there is no discrimination) one goes by the queue. In that system it would be impracticable to to have a strict first come first served attitude as Others out number Officers and a via method of 2 to 1 is followed and is fair.

The other issues raised have no substance as there is no evidence to show any discrimination.

ravindra said...

I have wondered how they praised the constitution so much in parliament recently, if article 14 does not help us in getting over the " pulling rank " culture where command and control is not the issue like in eg ECHS que.

Satheesh Kumar said...

The said suggestions will definitely help to enhance the reputation of the ECHS in particular and the veterans in general.....Jai hind

Mani Gupta said...

It seems that the ground realities have not been adequately highlighted. Rank-consciousness is handled with extreme sensitivity and sensibility in the Armed Forces, particularly, in the areas of Public Services where Indian Commissioned officers, junior Commissioned Officers and 'other-ranks and their dependants come together to avail the service.Examples can be easily found in hospitals/ medical facilities and CSD canteens where parallel/ simultaneous service is provided by running separate counters, often, multiple to cater to larger numbers. It is ensured that no one,just no one, is left out. Another system used is allocation of services on different days of week for different categories. all these methods of segregation and time-line restrictions are well established principles of management and not discreminatory practise. All Ranks of Armed Forces are trained to hold their respective 'Rank' in the correct perspective and they do it with elan, responsibility and pride, both during service and after. Disgruntled few be educated or,else, let all be kings & no followers, all 'drivers' & no passengers, all hands & no feet....whither shall we...!
subodh gupta lt col,retd

Ram Prakash Mishra said...

1. Service officers can use their ranks till death.
2. Even now, doctors see the patients on first come first served basis except for war disabled,veterans above 75 and lady members above 70. Only queues for registering their presence at ECHS clinics and drawing medicines are separate for officers, JCOs and other ranks.

Shankar said...

At some superspeciality OPDs we have been able to implement this letter to a great extent and have been doing so for many years. For eg at Command Hospital (AF) Bangalore, various superspecilaity OPDs run from 9 am to well beyond 2 PM. Of the average 70-80 patients seen, we have an appointment system for 16 patients ( 4 per hour) that can be taken on telephone. Since these OPDs see both serving and ex servicemen (Officers, ORs and families), no other system except that of OPD numbers is followed.

Patients self select themselves. Those coming in service transport see no advantage of taking appointments (you might get an appointment for 1 PM but by standing in line, you might get seen by 10 AM) while those who come from far away (Hosur, Madurai etc) can plan for a later appointment based on arrival of their trains/bus. Officers (both serving and Retd) often prefer appointments later in the day as they travel mostly in own cars.

All patients have to stand in line to get their tokens and get a registration number. Patients over 70 years get the opportunity to jump the queue and we display this privilege prominently. So if the queue is 60 people long, a 75 year old Ex serviceman can walk to front of line and collect a token number 25. If he had stood in queue he would have got token number 52. A cool 3 hours saved.

Some of our OPDs have honed it down to a perfect art. As a practicing rheumatologist with an OPD of 80-85 where OPD runs till 3 PM routinely, we have managed to fine tune this system over years and keep tempers down.

What works for one need not work for everyone, but an attempt to make the system as efficient and fair is well in order.

Dasila said...

Sir, I think first come first serve principle seems to be the workable solution. If this system is introduced than rates of contribution at the time of retirement for all ranks should be same. Treatment/medicine cost is same for all ranks. so rationale
of different contribution rates for officers, JCOs and other ranks is not justified. The logic of officers' strength less in comparison to JCOs and Jawans also seemly not justifiable reason. This is just food for thought. There may any number of views and solutions. ECHS org and mil hosp would decide after due deliberation as suggested by the hon'ble HC.

Shimlacharlie said...

The Hon'ble Court has taken it for granted that officers are accorded priority whereas no such practice exits in ECHS polyclinics to the best of my knowledge and experience of using ECHS services for over ten years.As far as priority to war disabled/disabled or senior citizens or any patient needing urgent care is concerned, I am sure none would or should grudge it.

dattatreyahg@yahoo.com said...

Pl check whether this can be implemented in CGHS with IAS retirees.

Cdr AK said...

If there a difference in "contribution" by "contributors" based on rank (officer/PBOR) in the "contributory" health schemes, then there HAS to be a difference between the facilities/ priority. 'Equality' in treatment can only flow from 'equality' in contribution.

Col Sushil Dwivedi. said...

Yes. I agree with the views expressed here. The basic principle is that unequals should not be treated equally. This inequality could be in terms of rank, age,disability and condition of patient. The officer in charge on ground is the best person to deal with it in the best possible manner. We should shed the tendency of seeing a problem where there is none. The basic principle to be followed is that the remedy should not be worse than the disease.

PK REDDY said...

Standing in queue is a matter of discipline. difference in contribution may be for allotment of ward only.

raj said...

Recently I took my 80 year old mother to ECHS Dehradun but found no plastic chair for her to sit as she is too old and sick to stand.I could see a room marked Officers with lot of vacant sofas.I asked my parents to go there and sit but they refused and seemed to be scared.Probably lot of ex servicemen are willing to make higher contribution to the scheme to get equal treatment but unfortunately they are denied that options because may be army leadership needs an excuse to discriminate and segregate even ex servicemen till death.

Anonymous said...

In case equal status is accorded to one and all, what will be a situation when a ECHS member is referred to a service hospital. Giving priority to veteran members who are senior citizens, disabled or decorated over and above the others is a matter of humanity and respect and need not be emphasized or forced but asking for equality with officers which are not more than 2-3 % of other ranks is unnecessary. This is once again a propaganda of civil babus using age old tactics of divide & rule. If such things are picking up as is evident from few of the comments, officers of todays generation have failed to command respect for themselves. Otherwise one Mr Raju who looked for a vacant chair for his 80 year old mother in Officers' room but did not comment if any OR sitting in ORs room offered a chair for his mother or not? Why did he has to peep into officers room for a chair for his mother.

Only solution to this can be abolishing ECHS clinics and allowing everyone to go for treatment to the hospital of their choice where only entitlement as per their contribution will matter.

This is a dangerous trend which is creeping in; specially in ex servicemen ORs and should be tackled judiciously avoiding any kind of confrontation. Otherwise time is near when similar demands will arise among serving personnel also.

Waiting to see what changes are made by MD ECHS. Don't expect much. Officers prepare to buy a mediclaim policy for yourselves as may be like other policies this welfare policy is about to become only for ORs very soon.

Anonymous said...

In Comments number of retired officers are speaking about difference of contribution without knowing where this difference is compansated. This difference of is for providing private, semi private wards for Offrs and JCO respectively during hospitalisation. Some offrs are talks about maintaining Rank structure post retirement. Ex-servicemen do not go to polyclinic for fighting enemy where command and control hierarchy is required. He and his family goes to poly clinic for fighting diseases. Where the rank plays the role?. Some one talked about different wards for different ranks in all Military Hospitals. This is also one type of colonial hangover. What is the status quo required to be continued. For the rank all officers are well compensated during the service and also after retirement. The diseases cause same amount of pain to all. Worst thing in Millitary Hospitals is sperate wards, toilets and waiting hall arrangments for families of officers and other ranks. I don't think govt allotting seperate scale of funds for treating officers family and OR family. Think dear officers there is lot of discrimination and exploitation in the name of Rank structure in service. Let not to continue the same after retirement also.......

HFL Vijeyta Oberoi said...

I saw many member of the community pointing out the difference in contribution factor and suggesting it should form the basis of differentiation, which is just. I wonder if they have read the judgement delivered.

and the CGHS vis-a-vis Gentlemen/Lady retired IAS Services in this context is just "whataboutism"

Honbl' Court's had duly noted the contributory factor and weighed it before it gave its judgement.

Dear Sir, There is something called natural justice , let's appreciate the good judgement.

W.P.(C) No.5522/2015 Para 5

"It is thus obvious that the Scheme does not sanction preferential treatment to or priority to be given to officers, over other cadres or amongst officers as per their rank, though the contribution to the Scheme is based on un-commuted basic monthly pension plus dearness pension and from which

It can be deduced that the contribution of the officers, to the Scheme, would be more than the contribution of the members of the Scheme belonging to the other cadres and the contribution amongst officers would be higher of those retiring from a higher rank"

kummar praveen said...

Most of the gentlemen are emphasizing on equal contribution. My say is when a IAS retiree after paying a contribution of around Rs. 68000/- can stand in a que with a Chaprasi who pays merely Rs. 18000/ subscription. Why can't service officers stand in a common queue after retirement? If so why they are not asking separate queue at Bus Stand/Railway Stations/Airports and at Graveyards and Shamshan Ghats for last rites.

Anonymous said...

The point which need to be understood is today excess crowd and long waiting hrs are unnecessarily putting pressure on individuals at ECHS polyclinics. All are not free to waste 3-6 hrs for a minor treatment and at time do not resort to polyclinic. A very large number of ORs, apart from family have parents as dependents who are very regular and undergoing time consuming treatment leading to rush at ECHS. As a remedy either phone based appointment should be resorted to or less frequent personnel should be given due weightage apart from emergency cases.

suku nair said...

Case of higher contribution,
Amount is not decided by OR.
I am willing to pay more than officers contribution, will I get priority. Please change mind set.

Ashutosh Pathak said...

Can a retired defence officer ask for a separate Que or preference over other's at railway reservation counter.so if they can make a Que at reservation counter, then why not at defence hospitals.giving the rank and promotion is only in the favour of nation, and must not be mingled with personal prestige....That's the correct democracy.To join a soldier as PBOR become a life long trauma, even after retirement, when at every steps it become a cause of embarrassing and create a sense of a person with least importance along with family.At one side everyone of Us advocating for removal of cast system, but at same time through wealth, and rank , doing the same thing.