INDIAN RAILWAY ESTABLISHMENT CODE (Vol - I)

||  Index  ||  Chapter 1  ||  Chapter 2  ||  Chapter 3  ||  Chapter 4  ||  Chapter 5  ||  Chapter 6  || 
|| Chapter 7  ||  Chapter 8  ||  Chapter 9  ||  Chapter 10  ||  Chapter 11  ||  Chapter 12  ||
||  Appendix & Annexure   ||

Chapter 6
Medical Attendance and Treatment Rules

             610.  Sub-section 2-instructions regarding diet.—Diet to be provided in railway hospitals, railway administration should, as a result, provide cooked food to all the in-patients in railway hospitals. 

            Scale (1) : the scale of diet to be served in railway hospitals should be drawn up by the railway administration with a view to suit the local conditions and basic caloric requirement of the patient. 

            Scale  (2)  : Scale of diet provided in railway hospitals should be published in the weekly gazette once a year for general information . 

Charges           

             611. Diet supplied to patients in railway hospitals will be charged as per following schedule:

Categories

Charges per day to be recovered

 A. Railway Employees: 

1. Railway employees

(a)    Whose basic pay does not exceed Rs. 1150/- in case of Gr. ‘D’ categories; and

(b)    Who are in grade Rs.950-1350 in case of other than Gr. “D” categories.

   

 

    Free

 
   75% of the actual  direct cost fixed by           Railways

2. Railway employees whose basic pay is Rs.1351 & above.

   Actual direct cost to be recovered.

3.  Railway employees injured in the course of duty (not exceeding beyond one year after they are declared permanently unfit and discharged from service).

    Free

4.  Retired Railway Employees governed by the Retired Railway Employees Contributory Health Scheme/Retired Employees Liberalised Health Scheme/Private Servants and outsiders etc.

Charges to be fixed by the Railway Administration to recover the diet cost.

5. (i)  Railway employees whose pay is below Rs.2000/- when receiving treatment for TB/Leprosy or Mental diseases in a Railway or approved institution. 

     (ii)Railway employees whose pay is Rs.2000/- and above when receiving treatment for TB/Leprosy or Mental diseases in a Railway or approved institution

Free 

 

  
Actual cost to be recovered

B. Family members and Dependent relatives:

1.(a) Family members receiving treatment for TB/Leprosy or Mental diseases and dependent relatives of railway employees receiving treatment for TB/ or Leprosy in a Railway or approved institution when the pay of the Railway employee concerned is below Rs.2000/-        

(b) Family members and dependent relatives not covered by (A) above.

 

 

Free

 

 

Charges to be fixed by the Railway so as to recover the direct cost.

(Railway Board’s letter No.86/H/8-1/39, dated 22-3-90.) 

Note: 

(1) Special articles of food not ordinarily provided by railway hospitals to inpatients shall be dealt for separately. 

(2) General Managers have powers to sanction free diet to railway employees injured in the course of duty for such period as they remain indoor patients not extending beyond one year after they are declared permanently unfit and discharged from service.  This provision applies to all railway employees gazetted  or non-gazetted irrespective of pay limits. 

(3)  Free diet is admissible to casual labour while undergoing treatment in railway hospitals in connection with accident cases following under the Workman’s  Compensation Act and other cases referred to under sub-section 16 of Section B of this Chapter. 

(4)   Passengers and trespassers injured or taken ill and removed to a railway hospital may be dieted at the expense of the Railways.   The expenditure being treated as a part of ordinary expenses of working in the railway hospitals.  

(5)  The charges of diet when supplied by non-Government/recognised hospitals to railway employees, when not indicated separately in the tariff, should, for reimbursement purposes be reckoned to the 20% of the flat rate charge. 

(6)  Pay limits referred to basic pay and/are exclusive of dearness pay. 

(7)  Diet provided by hospital is for patients only.  In exceptional cases diet may have to be provided to patients attendants who of necessity had to stay in hospital having come from outside long distances or in serious cases.  Such cases should  be charged to recover full costs and all overheads and should be on the high side to be a disincentive. 

(8)  A patient taking diet from the hospital on discharge may be charged for the full day if he has been admitted before 12 hours and, only half diet charges, if he has been admitted after 12 hours.   

 612.  Review of diet charges.—The Railways should periodically revise the rates of recovery  against diet charges in consultation with their FA & CAO in respect of such of the in-patients who are no  supplied free diets.  The  rates to be fixed on “No profit no loss” basis.  The rates must be reviewed every three years.  Action for review should be initiated one year in advance on the basis of last two years so that the revised charges are made effective immediately after three years.  The revised rates will apply prospectively.  

 613. Option for hospital diet.—The patient not entitled to free diet must give in writing whether he prefers to have his own diet or wants to get hospital diet on payment as prescribed.  Patients who have exercised their option for hospital diet to start with will not ordinarily be allowed to change over to own diet during the stay in hospital and vice-versa.  

(Items (51) of Appendix VII-GIII, Section III of Chapter XIV of the IREM and Railway Board’s letters MH59NES/418 Med. dated 4-11-1960,  61M7H/1/32 dated 4-9-1961, PC68/D-1/4 dated 6-6-1970  72/H/6-3/12 dated 16th August 1972, 75/H/6-1/9 dated 16-7-1977, 79/H/6-3/14 dated 25-11-1979.) 

Sub-section 3: Instructions regarding Nursing    

             614. (1) Nursing in railway hospitals.All in-patients in railway hospitals should be provided ordinary and special nursing to the extent possible. 

            (2) Engagement of special nurse.—Engagement of special nurses should be considered on merits.  The attending medical officer should recommend the employment of special nurses only where their services are absolutely essential and that too for the minimum period necessary.                

                (Rule 903(V) and 933-RI and progressions 1438 1439 of the IREM and Railway Board’s letter No. MH60ME1/4 Med. dated 10-3-1960). 

            (3) Nursing in non-railway hospitals.—(a) For ordinary nursing provided in a Government recognised hospitals, the charges are normally included in the hospital bills and are not separately recovered from the patient.  If, however, these charges are recovered separately they are reimbursed.

                (b)  Where special nursing is required, a certificate from the Medical officer incharge of the hospital should be obtained before hand.  The necessary recommendations be made in the form of a certificate as given as an annexure to this chapter.  As for the reimbursement of charges in such cases, the railway employee should bear cost uptto 25% of his pay for which special nursing was arranged.  The rest being borne by the Railway administration.  This does not, however, apply in the case of the railway employee who is injured on duty.  

             615. Railway employees injured on duty.—A railway employee injured on duty in addition to treatment ordinarily admissible to others be entitled, free of cost, to such special nursing as the authorisd medical officer may certify in writing to be essential for the recovery or for the prevention of serious deterioration in the condition of a railway employee. 

            Note.—The above concessions will also be admissible to railway employees on duty who receive injuries in connection with severe disturbances.  For this purpose, railway employee in a disturbed area shall be considered on duty and any injury received by him as a result of those disturbances shall be held to have been received in the hours of duty, unless the facts of the case give a clear indication to the contrary.  This also applies to railway employees on leave in a disturbed area in whose case it should be presumed, unless the facts of the case give a clear indication to the contrary, that he was attacked/injured in case he is a railway employee.  

Sub-section (4) : Reimbursement 

             616. Reimbursement allowed if medical attendance is at the instance of the authorisd medical officer.—A railway employee obtaining treatment for himself or member of a family or dependent relative should consult his authorized medical officer first and proceed in accordance to his advice. In case of his failure to do so, his claim for  reimbursement will not be entertained as provided. All claims for reimbursement should be scrutinized with a view that the authorisd medical officer or any other  medical officer who is either of equivalent rank of immediately junior in rank to the authorisd medical officer and attached to the same hospital/health unit as the authorisd medical attendant was consulted in the first instance. 

            (Rules 905, 919 RI, Para 1443 to 1448, 1452, 1457 (i)  of the IREM and Railway Board’s letter No. 67/H/1/11 dated 4-3-1968 and 71/H/1-1/6 dated 9-11-1971). 

             617.  Treatment in an emergency.—In an emergency if a railway employee has to go for treatment including confinement to a government hospital/recognised hospital or a dispensary run  by a philantherapic organisation without prior consultation with the authorised medical  officer, reimbursement of the expenses incurred to the extent otherwise admissible , will be permitted if after a careful examination of the circumstances of the case, the competent medical authority accords ex-post facto approval.  In such case, before reimbursement is admitted, it will be necessary to obtain in addition to other documents prescribed, a certificate in the prescribed form from the medical superintendent of the hospital  to the effect that the facilities provided were the minimum and essential for the patients treatment.  

Note :

            (1) In such cases, GMs  are delegated powers to allow reimbursement of medical expenses upto a limit of Rs.3000/- in each case in private institution and upto Rs.10000/- in recognised/Government hospitals.

            (Railway  Board’s letter No. 91/H/6-4/26 dated 20-11-95.) 

            (2) CMDs are authorised to reimburse claims upto Rs.1000/- of railway employees in the event of special investigations (laboratory tests etc.) got done from non-recognised institutions on the advice of the authorised medical officer in the absence of such facilities in the railway hospital. These cases should be decided in consultation with FA & CAO  provided these were done at the instance of the authorized medical officer.  These powers will not be re-delegated. 

            It  has also been decided that claims above those permitted in Note (1)  and (2)  above, be referred to the Railway Board for consideration along with FA & CAO’s  comments and the circumstances which necessitated such investigations being done at non-recognised institutions. 

(Railway Board’s letter No 91/H/6-4/26  Pt.  Dated 5-1-94 & 4-5-94) 

(3) Sterility- pre-se.—Cases of treatment of sterility may also be treated at par with other cases for reimbursement under the exisiting rules.              

(Railway Board’s letter No.86/H/6-4/58 dated 21-12-1988) 

            (4) Recognition of  CATSCAN test for reimbursement.-   (1) General Managers are fully empowered to sanction charges levied at a Government hospital for catscan. 

(2) In case catscan in a government hospital is not possible in time, CMD will arrange for catscan at a reasonably priced private institution.  In such case, General Manager is empowered to sanction Catscan facility charges upto Rs. 2000/- in each case.  MRI, CMDs can within their power sanction Rs. 3000/-.  For fees beyond this amount, concurrence of associate finance be obtained and proposals submitted to Railway Board for consideration and sanction.  Chief Medical Director should ensure that prior permission is accorded to get this Catscan done only in very deserving and definitely needed cases. 

            (Railway Board’s letter No. 86/H/3/3  dated 22-1-1987) 

(5) General Managers have been delegated powers for granting post-facto sanction even in cases where prior permission of Chief Medical Director could not be obtained for reimbursement of expenses incurred on Catscan upto Rs. 2000/- only in each case done in Government hospitals. 

            (Railway Board’s letter No. 88/H/6-4/80  dated 12-5-89) 

            (6)  Chief Medical Directors are  empowered to  sanction Catscan fee charges  upto      Rs. 2000/- in each case.  Powers are also delegated for granting  post-facto sanction. 

            (Railway Board’s letters No. 88/H/6-4/57 dated 21-12-88 and 88/H/6-4/80  dated 9-9-89) 

            (7) Chief Medical Directors  can sanction reimbursement of the cost of hearing aid for employees and dependent family members upto Rs.  1500/-.  The cost shall be paid to the firm directly.  Cases where cost of hearing aid exceeds the limit of Rs. 1500/- they should be referred to the Railway Board duly concurred by the FA&CAO. 

            (Railway Board’s Letter No. 85/H/6-4/28    dated 26-9-1988.) 

            (8) Reimbursement of expenses on purchase/replacement repair/adjustment of artificial electronic larynx. –Reimbursement of the cost of the artificial electronic larynx should be made to the railway employees and their family members governed by the Railway medical attendance rules on the recommendations of the Director General Health Services. The payment would, however, be made by the administrative authority direct to the supplying agency and not to the railway employee concerned.   

                (Railway Board’s letter No. 82/H/6-1/21 dated 11-10-1984.)

            (9) Provision of specialized medical services to construction staff.—General Managers on merits in such areas can decide provided provision of such consultants is within the norms laid down by Railway Board for appointment of consultants.  Cases not falling within the framework of these norms shall be referred to the Board for approval.

                (Railway Board’s letter No. 89/H/2/3/5 dated 24-7-89.)

                (10) Utilising the service of an Anaesthetist from outside during emergencies.—When Railway Anaesthetist is not available because the post/posts is/are vacant or the anaesthetist had/have gone on leave/sick or is not on duty elsewhere/out of station, the services of an anaesthetist from outside may be utilized on payment of Rs. 150 per case towards professional charges.

                (Railway Board’s letter No. 88/H/6-1/29 dated 6-1-89.) 

                 618. Families accompanying railway officials proceeding on tour.—(1) Medical expenses incurred on treatment of a member of railway em0ployees family accompanying  him on tour can be reimbursed on the same scale and conditions on which they can be reimbursed to the railway employees himself, if illness occurs during that period and treatment is taken in a government or railway hospital. 

            (2)   The above concession is not admissible if a railway employee takes a member of his family alongwith him with the intention of obtaining treatment in a place other than his headquarters.

            (Rule 916 RI) 

             619.  Treatment at residence.—(1) Where owing to the absence or of a suitable hospital (railway or otherwise) or owing to the severity of the illness or other causes considered adequate by the authorise medical officer, a railway employee receives treatment at his residence, the expenses incurred by the railway employee for such items and services as to what have been admissible to the patient otherwise, would be reimbursable.

                (2)  The above claims must be accompanied by a certificate by the authorised medical officer stating the reasons for his opinion as referred to above, and indicating the cost of treatment admissible to the patient otherwise.  Such cost should take into account the charges for medicines and dressings, as also amount of money, if any, paid to the authorized medical officer.  

(Rule 908 RI and note 4 below Rule 916 RI)  

 620. Payment of charges.--Payment to Government recognized hospital on account of hospital charges should in the first instance be made by the railway employee concerned to the hospital authorities and the reimbursement thereof claim at the railway administration later.   

Note.—State Government where agreeable should debit the railway administration   concerned by preferring bills for those items for which reimbursement is permissible.  Those Government recognised hospitals which press for advance deposit of money for treatment of cases referred to them, the medical officer concerned may be allowed an imprest of Rs. 500/-. The holder of the imprest should submit their report for the amount spent.    

(Note : below Rules 909(2) and 917 RI, Para 1431 of the IREM and Railway Boards Letter No. E 56ME1/34/Med.  dated 6-9-61.) 

 621.  Claims to be preferred within six months.—All Claims for reimbursement should be preferred within six months of the date of completion of the treatment as shown in the Essentiality certificate of the authorised medical officer. A claim for reimbursement of medical charges not countersigned and preferred within six months of the date of completion of the treatment, should be subject to investigation by the Accounts Officer, where a special sanction is accorded on an application from the railway employee for reimbursement of any charges in relaxation of the rules, the sanction will be deemed to be operative from the date of its issue, and the period of six months for preferment of claim will count from that date. 

(Note 2 below Rule 909(2) RI and para 1412 of the IREM). 

 622.  Forms for preferring claims.—The railway employee claiming reimbursement for expenses occurred on account of medical attendance and treatment in a government recognised hospital should claim in a prescribed form accompanied by the necessary documents indicated in the forms.

(Para 1430, 1453 of IREM) 

 623.  All claims for reimbursement should first be carefully scruitnised by the competent authority, should in consultation with the authorised medical officer where contrary, will disallow any claims or items, which do not satisfy rules and orders on the subject. These should be disposed of without delay.

(Rule 1458 of IREM) 

 624.  Rate and schedule of charges.—(1) The rates and schedule of charges of government/recognised hospitals concerned may be obtained from the respective state government.

(2)  In the case of government/recognised hospitals, the tariff which does not indicate the accommodation and diet charges separately, 20% of the flat rate should be reckoned as diet charges and 20% as charges for accommodation.

(Para 1436(2) and 1456(B) of the IREM) 

 625. Expenses incurred as outdoor patient.—Reimbursement of medical expenses incurred as an out-door patient in a railway hospital/health unit or in a government/recognised hospital is permitted.

(Note 3 below Rule 906 RI) 

 626.  Items and services not covered by the definition of the term ‘Treatment’. Expenditure incurred by a railway employee or a member of his family or dependent relatives on items and services not covered by the definition treatment will not be reimbursable.  

 627. Reimbursement of costs of medicines which are neither ordinarily stocked nor available in railway  medical institutions but are purchased from the market.—(1) To minimise claims for reimbursement of cost of items inadmissible, the medical officers concerned with the treatment of the patients, should determine that essentiality certificates should not be issued in respect of items which are not medicines but which are primarily food tonics etc. A decisions should depend whether the drug element is small in comparison with the food contents of the proportion prescribed.  A propriety item should not be prescribed if a non-propriety prescription of a similar therapeutic value is available.  Necessary guidelines should be taken from the Indian Railway Pharmacopoea. 

(2)  The charges for the cost of medicines which are reimbursable will be allowed only if the claim for reimbursement thereof is accompanied by the cash memo and a essentiality certificate duly countersigned by the authorised medical officer in the prescribed Proforma as given in the annexure.  Every cash memo must be countersigned by the doctor prescribing the medicines and the essentiality certificate must contain the name of the medicines prescribed and the amount incurred on the purchase of each medicine, whether or not the original prescription have been submitted.  

Note.—The underlined idea is to ensure that the medicines actually considered essential by the authorised medical officer and they may be purchased and consumed by the patient as directed. 

(3)  Sales tax paid on these medicines will be reimbursable. 

(4)  The charges for packing and postage if incurred will not be reimbursable. 

(5)  Ordinarily expenses on account of the cost of medicines intended for injections prescribed at the consulting room of the authorised medical officer but administered at the residence of a patient who is a member of the family or dependent relative of a railway employee will not be reimbursable.  In serious cases however the reimbursement is regular vide sub–para (2) above.   

(6)  The State Government where agreeable should debit the railway administration concerned by preferring bills or by raising debits in respect of cost of medicines, vaccination etc.  not ordinarily available at hospitals which are certified in writing to be essential for the recovery or prevention of serious deterioration in the condition of a railway beneficiary who is admitted to a non-railway government hospital for treatment at the instance of the authorised medical officer.  If the State Government concerned are not agreeable to such an arrangement, reimbursement to the railway employee concerned would be permissible as per rules. 

( Ministry of Railway’s decision No. 1,2,3 below Rule 903 RI and paragraph  1434 and 1435 (a) of the IREM).  

 629. The cost of heart valves, pace-makers and pulse generators, as well as the replacement of pulse generators in the case of railway beneficiaries will be made only on the recommendations of the CMD by the administrative  authority would make the payment involved direct  to the supplying agencies and not to the railway employees concerned.  

(Railway Board’s letter No. 78/H/6-4/16,  dated 12-12-78 and 81-H/6-4/37,  dated 4-6-1982). 

 630.  Items and services rendered in connection with medical attendance and treatment.—Charges for items and services rendered in connection with (but not included in) medical attendance and treatment of a patient entitled to railway medical attendance and treatment facilities shall be determined by the authorised medical officer and paid by the patient.

(Rule 909 RI)

 631.  Reimbursement  of medical expenses incurred abroad.—The matter has been reconsidered by the Government and it has been decided that, in supersession of all previous orders on the subjects, the following guidelines should be adopted in dealing with the cases relating to requests for medical treatment abroad and matters relating thereto:

(i)  As a rule, reimbursement of cost of medical treatment incurred abroad should not be allowed. 

(ii)  In exceptional cases, necessitating treatment of a kind yet to be widely established in the country, where railway employees, on medical advice, choose to go on their own, reimbursement could be authorised by the Ministry of Railways, but should be limited to the expenditure that would have been incurred had such treatment been received in India in a Govt. Hospital or a recognised hospital.  However, the question of reimbursement of air passage in such cases shall not arise at all.  

(iii)  Foreign Exchange may be released to railway employee for purpose of treatment abroad to the same extent as is permissible to private citizen. 

(iv)  The facilities for specialist treatment, as available in Railway Hospitals or other Government/recognised hospitals should be availed by the railway employees.  

Sub-section (5) : Other general instructions regarding medical attendance and treatment:-- 

             632. (1) Duties of Rly. Medical Officers in urgent cases.—Whenever a railway beneficiary calls  a railway medical officer for medical assistance for himself or for his family members or dependent relatives the medical officer is so called upon shall if the cause is represented as urgent render such assistance as may be necessary without hesitation leaving the question of urgency or of his being authorized medical officer and fees etc. to be enquired into and settled afterwards. 

            (Rule 910 R.I.) 

            (2)  Issue of passes under medical advice.—When a railway employee or a member of his family or dependent relatives travel under medical advice passes or PTOs of any class may be made available by any convenient train including mail trains at the discretion of the General Manager. 

            ( Railway Board’s letter No. 1000/TG/3 dated 7-11-49). 

            (3)  Provision of an attendant to a railway employee referred to railway/recognised hospital.—Normally depending upon the severity of the condition of the case the authorised medical officer may issue pass for one attendant to accompanying the patient.  If however the authorised medical officer feels the necessity for two attendants he may issue a pass for two attendants with a certificate recorded in writing indicating the urgency and necessity.  

             633. Maintenance and repairs of ambulance cars.—Ambulance cars should invariably be maintained in good running condition.  Regular servicing and repairs where necessary may be carried out promptly by any commercial concern in the same manner as is done in the case of staff cars.  Timely replacement must be made and planned for.  Effort should also be made to have good selected drivers.   

            ( Railway Board’s letter No. 66/H/2/18,   dated 23-1-68, 70/H/13/29, dated 23-7-71, 77/H/7/19,  dated 17-1-78 and 78/H/4/12,  dated 2-5-1978). 

             634.  Use of ambulance cars by lady doctors in emergency.—(1) Lady doctors when called to visit a patient may be allowed the use of ambulance cars for going to see the patient and also to bring her back to her residence/hospital in the following circumstances.   

(a)      When she has to attend an emergency. 

(b)      When the call for the house received by her from a remote  area. 

(c)      When the call is received from an unknown quarter. 

(d)      When the call is received late at night. 

(2) Validity of the points made for eligibility of use of the ambulance cars would be decided by the head of the hospital concerned. 

(3)  It is not necessary on the visit the lady doctor should bring the patient for admission if it is considered no necessary to admit the patient. 

(1)  No mileage allowance would be admissible to the lady doctor for such class.  If she draws any consolidated allowance there would be automatically proportionate deduction in the same for such use in the ambulance cars. 

(Railway Board’s letter No. 76/H/22/60,  dt. 18-1-1977). 

SECTION D—INFECTIOUS DISEASES AND QUARANTINE 

 635.  The rules in this part shall not apply to railway servants employed in the office of the Railway Board, the Research, Designs and Standards Organisation and the Office of the Railway Liaison Officer, whose headquarters are at New Delhi and who are governed by the rules in Part I.  Such railway servants shall be governed  by the rules applicable to staff in the Government of India Secretariat.  

 636.  For the purpose of the rules in this Section-- 

(1)    “Household” includes any member of the family of a railway servant resident with him:  any lodger or other person who at the time occupies any part of the same unit of residence; any servant of the above living in the same residence.   

(2)    “Medical Officer” means the authorised medical attendant as defined in rule 603(1). 

(3)    “Quarantine” means any restriction imposed upon the movements of a railway servants or upon his intercourse with other railway servants or other persons, designed to prevent the conveyance of disease by him to such other railway servants or persons; such  restriction being imposed when any member of the railway servant’s household is known, or on acceptable information believed, to be suffering or to have suffered within a period prior to congnisance of the fact by the quarantining authority not greater than that of the maximum incubation period of such disease, from a quarantinable disease. 

(4)    “Quarantinable diseases” means small pox, cholera, plague, typhus  fever, cerebro spinal meningitis,  diphtheria or such other diseases, as may have been declared to be infectious by a State Government within the areas under its administration. 

(5)   “Infectious diseases” mean any of the following disease,--Chicken pox, cholera, diphtheria, leprosy, measles, mumps, plague, scarlet fever, small-pox, typhus fever,  typhoid fever, whooping cough, cerebro spinal meningitis or such diseases as may have been declared to be infectious by  State Government within the area under its administration.   

 637.  Report of infectious diseases.—(1) Any railway servant who knows or has reason to suspect that either he himself or any member of his household is suffering from an infectious disease shall at once advise his superior official to this effect or, if working at the medical sectional headquarters, shall himself directly notify the Medical Officer. 

(2)   The railway servant’s superior official notified under (1) above shall take necessary steps to notify immediately the Medical Officer in sectional charge.  The message shall specify the suspected illness and the name, designation and address of the railway servant and whether  his residence is within railway premises, or if otherwise approximately how far therefrom.  If the disease suspected to have occurred in the household is a quarantinable disease, the railway servant concerned should, as early as feasible, be provisionally relieved from duty and debarred from mingling with other railway servants or persons. 

Note.—Regarding quarantine leave, see Rule 555.   

 638. Verification of disease when a railway servant resides within the prescribed beat of a Medical Officer.—It will be the duty of railway servant residing within the prescribed  beat of Medical officer, in whose household a case of an infectious disease is suspected to have occurred to facilitate the access of the Medicial Officer to examine the members supposed to be affected or such other members of the household as in the opinion of the Medical Officer may have contracted the disease.   

 639. Verification of disease when a railway servant resides beyond the prescribed beat of a Medical Officer.—A railway servant, living beyond the prescribed beat of a Medical Officer who knows or suspects a member or members of his household to be suffering from an infectious disease, should endeavour to take immediate steps to procure the examinationof the member or members of the household by a medical practitioner, registered or having registrable qualifications, and to procure a certificate from him stating the nature of the illness.  The certificate in question should be directed under cover to the Medical Officer in sectional charge through the railway servant’s immediately responsible superior. 

 640.  Duty of person under quarantine.—A railway servant to whom a “Quarantine admission certificate” has been issued shall not, until the issue of certificate terminating his period of quarantine (“Quarantine discharge certificate”)-- 

(1)    either himself frequent or permits members of his household to frequent places of public resort such as institutes, reading rooms places of worship and the like, or  

(2)     if resident in railway premises, leave without the express permission of the Medical officer, the station or any part thereof which the Medical Officer may consider proper, in the interests of the health of the public, to define, or  

(3)     permit any railway servant or any member of the family of a railway servant or any other person not being a member of the Medical or Sanitary staff or other expressly authorised person, to enter his house or hold unnecessary communication with himself or a member of his household. 

 641.  Duty of staff not under quarantine in whose household an infectious disease is verified.—A railway servant in whose household a non-quarantinable infectious disease, viz., chicken-pox, measles, mumps, scarlet fever,typhoid fever, leprosy or whooping cough is verified to be present in a contagious phase within a prior period not greater than the usual incubation period of such disease, shall attend at railway dispensary or hospital or other convenient place determined by the Medical officer at intervals arranged by the latter for examination, and will continue to do so until such time as it appears that the likelihood of the railway servant contracting the malady in question no longer exists. The railway servant shall also facilitate for a similar period such examination of the members of his household by the Medical Officer as the latter may reasonably deem requisite or, should the railway servant reside beyond the prescribed beat of the Medical Officer, he shall, when called upon, furnish a medical report obtained from a qualified medical attendant certifying to the health of household. 

 642.  When for lack of a railway infectious disease hospital or of isolation wards in a railway hospital or of accommodation in a railway hospital, it is declared by a Medical Officer, not below the rank of Divisional Medical Officer, to be necessary in the interests of the railway that the cases of infectious diseases occurring among the members of the family a servant residing in a railway colony should be removed to a civil hospital for treatment the charges which may ordinarily be leviable by the civil hospital in  such cases may be met from railway revenues. 

Medical attendance and treatment facilities may be given to family members of the consumer co-operative societies and to the staff and to the members of their families of the co-operative credit societies and Banks on per capita basis.  The per capita charge should be calculated on the basis of total expenditure on the  medical services (excluding health services) incurred on Railway employees in  India during the preceding financial year. 

 SECTION E—TREATMENT FOR SPECIAL DISEASES, VIZ. TUBERCULOUSIS, CANCER, POLIOMYELITIS AND MENTAL DISEASES 

 643. (i)  Railway servants and their families will received, free of charge, treatment for tuberculosis, to the  extent facilities are available in railway hospitals.  Railway servants and their families may also receive, free of charge, treatment for tuberculosis, in non-railway institutions sanatoria where separate annexes  or bed have been reserved for the purpose subject to the condition that the number admitted at any one time does not exceed the number of  beds provided in the annexes or reserved beds in the sanatoria at the cost of railway revenues. 

Note.—Cost of special medicines or extra diet should be borne by the Railway administrations if the cost of reservation per bed per annum does not include such charges.   

(ii) Such railway servants and their families may also be allowed re-imbursement, as admissible under the rules, when on the advice of their Railway authorised medical attendant, they go to and are admitted in non-reserved accommodation in the Tuberculosis Institutions recognised for the purpose of medical treatment of Central Government servants and their families suffering from tuberculosis subject to the following certificates being given by the authorised attendant-- 

(a)    Immediate sanatorium or hospital treatment is necessary. 

(b)    No Railway reserved bed is available. 

Note.—For this purpose the Chief Medical Director of the Railway should contact the Medical Superintendents of the approved sanatoria and refer to them the cases of tuberculosis for admission and treatment subject to the conditions that— 

(1)  the standard of treatment provided by them is good and efficient; 

(2)  the patient should as far as possible be admitted to a free ward; 

(3) if (2) is not possible, the patient should be admitted to the lowest class of paying wards, where charges should be comparable to those paid for reserved beds, or upto Rs. 2,400/- per bed, per annum, in other sanatoria; 

(4)  in case the patient prefers to be in paying/costlier ward even when accommodation is available in a free/lowest class of paying ward, he may be allowed to do so but additional cost should not be borne by the Railway.  

(iii)  In cases of post-treatment check-up of railway servants who were suffering from tuberculosis, the charges levied by the sanatorium should be borne by the Railway administration where it is considered by the District/Divisional Medical Officer concerned that the patient should be sent in person for a follow-up observation to the sanatorium, subject to the provision that  none of the beds reserved for railway servants was vacant; in the sanatorium at the time, to accommodate such a person. 

 644. A railway servant or a member of his family or dependent relative (who is eligible to receive treatment in non-railway hospitals) may receive free treatment for cancer, poliomyelitis, cerebral palsy and spastics at the nearest recognised hospital providing such treatment subject to the condition that such if treatment recommended by the authorised medical attendant. If the Medical Superintendent of the recognised hospital to whom the patient is sent for treatment by the authorised medical attendant, recommends that special treatment is necessary at the Tata Memorial Hospital, Bombay, in the case of cancer, and the Children’s  Orthopaedic Hospital, Bombay in the case of poliomyelitis, cerebral palsy and spastics, such patient may also receive free treatment at these hospitals. 

Note .—For the purpose of this rule, cancer may be defined to include any malignant new growth. 

Railway Board’s decision.—Advances may be granted to those railway servants whose pay does not exceed Rs.900/- per month in cases of specialised treatment for cancer, and Rs. 500/-per month in the case of Polio cerebral palsy or spastics Paralysis on the terms and conditions mentioned below:-- 

 (1)    The advance would be admissible only in cases where a railway servant or a member of his family is being treated as an in-Patient in one of the recognised hospitals for cancer. 

(2)     The application for an advance should be supported by a certificate from the medical officer-in-charge that the patient is being treated as an in-patient in the hospital such a certificate should also indicate the probable duration of stay of the patient in the hospital and the anticipated cost of treatment which would otherwise be reimbursable under the rules and be also countersigned by the authorised medical attendant. 

(3)    The advances should not in any circumstances, be allowed in a case where treatment is being obtained at the residence of the railway servant or at the consulting room of the authorised medical attendant or as an out-patient at a hospital. 

(4)     The amount of the advance will in each case be limited to four months pay of the railway servant concerned or Rs. 500/- in the case of cancer and two months pay of  the railway servant concerned or Rs. 200/- in the case of polio cerebral palsy or spastics paralysis or such other amount as the medical officer-in-charge of the hospital may recommend, whichever is the lowest.  

 (5)    Not more than one advance should be granted in respect of the same illness. 

(6)     The amount of the advance should be adjusted against the subsequent claim for reimbursement of the expenditure as admissible under the medical attendance and treatment rules and the balance., if any, recovered from the pay of the railway servant concerned in two equals monthly installments after the discharge of the patient from the hospital. 

(7)     An advance under these orders will be admissible only to those railway servants whose pay does not exceed Rs. 500 p.m.  The term ‘Pay’ for this purpose shall be as defined in rule 103(35). 

(8)     In the case of temporary railway servants the grant of an advance under these orders would be subject to the production of surety from a permanent railway servant not governed by the Payment of Wages Act.  

              ( Railway Board’s letter No.E52ME1/19/Medical,dated the 21st April 1956). 

             645.  Consultation and/or treatment for mental diseases.—A Railway servant or a member of his family or dependent relative suffering from mental diseases may receive consultation and/or treatment in the nearest Government recognised Mental Hospital, on the advice of the authorised medical attendant and with the prior approval of the Chief Medical Officer, subject to the condition that the duration of the treatment for which reimbursement of medical expenses will be admissible to the Railway servant concerned should not exceed six months unless the Medical Superintendent of the Mental  Hospital concerned, certifies that treatment for a reasonable period upto one year in two or more separate spells (i.e., 6 months or less at a time) beyond the six months limit is likely to lead to complete recovery of the patient. 

Note 1.—A list of mental hospitals for treatment of Railway servants and the members of their families suffering from mental diseases is given in Appendix V of the Indian Railway (Establishment) Manual. 

Note 2.—The amended rule will take effect from 7th March 1962.

* * *