Medical Attendence Rules

PAKISTAN WATER AND POWER DEVELOPMENT AUTHORITY

The Pakistan Wapda Employees Medical Attendence Rules, 1979

(AS AMENDED UPTO 01-06-2001)

PAKISTAN WATER AND POWER DEVELOPMENT AUTHORITY

Telephone: 69911/204 722-Wapda House,

Telegrams: WAPDA, LAHORE Lahore

No. S/SO (R) 14/21348-21947 Dated 10th November, 1979

In exercise of the powers conferred by Section 13 of the Pakistan Water and Power Development Authority Act, 1958 (West Pakistan Act No, XXXI of 1958), the Pakistan Water and Power Development Authority is pleased to majke the following rules namely—

THE PAKISTAN WAPDA EMF MEDICAL ATTENDANCE RULES, 1979

1, (a) These Rules may be called the Pakistan Wapda Employees Medical Attendance Rules, 1979.

*(b) "These Rules shall apply to all Wapda Employees both serving and retired including Government servants of Old Electricity Department (enbloc transferees), serving deputationists from Civil Government as well as Armed Forces whether they are on duty or leave or under suspension. Cash medical allowance shall be admissible only to serving Wapda Employees in grade 1-15."

1. Medical facilities, will be provided to the employees of the Authority at Lahore and other stations in Pakistan, where Wapda's Hospitals/Dispensaries exist in accordance with the provisions contained in the following Rules. Government servants, i.e. from the Civil Government or the Armed Forces who are on deputa tion with the Authority will also be governed by the provisions of these Rules. They will be entitled to consult Government Doctors only when advised by the authorised medical attendant/Director General Medical Services.
   
   
2. (1) Employees on extraordinary leave (without pay) when it extends over six (6) months,-will not be entitled to a*/ail of these benefits unless the Authority agrees to extend the facilities in cases where illness is directly attributable to the employee's official duties.

1. Wapda Employees in Grade 1—15 will be allowed to draw Cash Medical Allowance during leave, if otherwise admissible, except during E.O.L. when pay and allowances are not admissible.
   
   
   
   ♦Substituted vide O.M. No. DG/DD(R)/07456/34/X/71701-50 dated 2-12-1993.
   1. The Director ^General Medical Services will be assisted in the discharge of his duties by such Specialists and Medical Officers/Lady Medical Officers as may be appointed by the Authority from time to time.
      ***(f) "All retired Wapda Employees will get themselves registered with the nearest Wapda Hospital/Dispensary under the same procedure as applicable to Wapda- Employees. The reimbursement of medical charges to retired Wapda Employees, duly verified by the Wapda authorised Medical Attendant will be made by the office from where the retired Wapda Employees receives pension. Employees who get pension from Banks/Treasury will be attached to a Wapda Division/Office nearest to the place of residence of the retired employee. Funds will be provided to respective offices for reimbursement of costs."
      1. DEFINITIONS
         
         
         In these Rules, unless there is anything repugnant in the subject or context:—
         
         
         1. "Authorised Medical Attendant" means Specialist/Medical Officer/Lady Medical Officer; Part Time Medical Officer/Lady Medical Officer appointed by the Authority.
            *(b) "Family11 means employee's wife/husband, unemployed legitimate and step children upto the age of 25 years and unmarried and unemployed daughters and parents residing with and dependent upon the employee. Parents of WAPDA employees shall be allowed treatment available only in WAPDA Hospital/Dispensary and not otherwise. Only one wife is entitled to avail of these facilities. **(c) "Hospital" means all Wapda In-door/Out-door Hospitals and Dispensaries.
            
            
            1. "Medical Attendance" means an attendance in Out-patients or Indoor Hospital including such pathological, bacteriological, radiological or other examinations that are considered essential by the authorised medical atten dant and such consultations with a specialist on the advice of authorised medical attendant/D.G.M.S.
            2. "Patient" means a Wapda Employee/Government Servant from the Civil Government or the Armed Forces who is on deputation to the Authority, including any member of his/her family as defined in these Rules, and to whom these Rules apply and has fallen ill.
               
               
            3. 'Treatment" means the use of all medical and surgical facilities available at Wapda Hospital and Dispensaries and includes:
            ( 1 ) 'Such pathological, bacteriological, radiological or other method* as ate considered necessary by the authorised medical attendant,
            
            
            
            ♦Amended Vide O.M. No. (IM(A)/AI)(I>IA)()7() 12/26/20038-20688, dated 01-06-1998.
            ♦♦Modified vide O.M. No. DG(S&GA) DD(Rules)/07456/34/23666-2f)211, dated 4-8-1991.
            ♦♦♦Added vide O.M. No. DG/DD(R)/07456/34/X/71701-50 dated 2-12-1993.
            1. the supply of such medicines, vaccines, sera or other therapeutic substances as are ordinarily available in the Hospital/Dispensary,
            2. the supply of such medicines, vaccines, sera or other therapeutic substances not ordinarily available as the authorised medical attendant may consider essential for the recovery or for the prevention of serious deterioration in the condition of the employee,
            3. such accommodation as is ordinarily provided in the Hospital.
            4. such nursing as is ordinarily provided to indoor patients by the Hospital and,
            5. the specialist consultation if considered essential by Authorised Medical Attendant/D.GJytS.

*(7) dental treatment which includes treatment of alveolar (gum and jaw bone) disease, extraction of teeth, treatment for dental caries, gingivi­ ties, pyorrhoea and filling (temporary or permanent) of dental cavities including root canal treatment and scaling but does not include crowning of teeth and provision of dentures."

1. (a) Employees of the Authority including those in NPS 1—4 (posted at Lahore and other stations where Wapda's own Hospital/Dispensaries exist), except casual . workers and those engaged on daily rate basis, will be entitled to make use of these facilities. Wapda employees in NPS 1—15 who are drawing Cash Medical Allowance as sanctioned by the Authority from time to time will also be allowed the facility of consultation and hospitalization in case of acute illness/accident (Emergencies).
   1. Government servants/deputationists in Grade 1—15 may opt for Cash Medical Allowance as sanctioned by the Authority from time to time plus certain rest ricted medical facilities or for medical facilities (without Cash Medical Allowance; as admissible under the Rules of the Authority.
   2. Notwithstanding the drawal of Cash Medical Allowance by Wapda employees in Grade 1—15, they and their families, as defined in Rule 2 b. will be entitled to:—
      1. (a) Indoor treatment in Wapda Hospitals/Government Civil Hospitals free of charge in case of acute illness/accident (Emergencies). A Wapda employee in grade 1—15, who is in receipt of cash medical allowance, will also be entitled to medical treatment as an outdoor patient if, in the performance of his duties, he sustains such bodily injuries as do not necessitate indoor treatment in Wapda Hospital.
         (b) In case a Wapda Medical Officer refers an Employee in Grade 1—15 to a Specialist the amount paid by the Employee to the Specialist on account of his fee/charges shall be re-imbuiseable, on production of a Cash Receipt duly verified/countersigned by the Referring Medical
         
         
         
         ♦Added Vide O.MNo. GA (A)/DD (R) 07450/35/V/149259-150378, Dated, 5-111988
         Officer. Any amount incurred by the Employee on the purchase of medicines as advised by the Specialist, shall, however, be borne by the Employee drawing Cash Medical Allowance.
         
         
      2. The recipients of Cash Medical Allowance and their families as defined under the rules,.would be entitled to consult any Medical Officer appointed by the Authority, free of charge. X-Ray, pathological tests and dental treatment, wherever available in Wapda Hospitals/Dispensaries or other medical arrange­ ments made by Wapda would also be free. However, the cost of medicines to be purchased by the Wapda employees on prescription of Wapda Medical Officers for outdoor treatment would be borne by the employees drawing Cash Medical Allowance.
   
   
   (3)' Exemption for revision of option from Gash Medical Allowance to medical facilities will be allowed for those cases, who, at a latter stage, develop any disease which requires prolonged treatment. Such patients will be subjected to scrutiny by the Medical Board to justify grant of exemption.
   
   
   1. (a) In far-flung areas/Power Houses, where Dispensaries are stocked with medicines, treatment and medicines will be provided and Employee will be permitted to opt for not to draw Cash Medical Allowance.
      *(b) If any employee is transferred from one station where the medical facility is not available to another station where medical facility is available then he will be allowed to change his option from Cash Medical Allowance to medical facility within one month from the date of joining. Similarly, if any employee is transferred from one station where the medical facility is available to another station where the medical facility is not available then he will be allowed to change his option from medical facility to Cash Medical Allowance within one month from the date of joining.
      
      
   2. Maternity cases will continue to be paid for by Wapda irrespective of the number of children.
   
   
   Note 1.—Those Wapda employees who wish to obtain exemption or to revise option previously exercised, shall have to produce a certificate from the Medical Board as defined above. On the authority of Medical Board's certificate, the GMs/CEs/Heads of Divisions will be competent to grant such exemptions. When exemption is given, then the employee and his dependents (all) will become eligible for medical treatment irrespective of the fact whether the certificate obtained is in respect of one dependent member of the family or the employee himself, and the employee will cease to draw Cash Medical Allowance.
   
   
   
   * Substituted vide O.M. No. S/DD(R)/07456/34/10167-946, dated 22-01-1984.
2. All Wapda employees will initially be examined by their nominated Authorised Medical Attendants. Specialists cover will also be available to the employee subject to referred by Authorised Medical Attendant/DGMS Specialist cover will be available for emergencies round the clock.
3. The Medical Officers will maintain such registers and other records in respect of the patients treated by them as the Authority or the DGMS may direct them from time to time.
4. Employees of the Authority will be required to carry Identity Cards with them bearing their photographs and appropriate Code Numbers. Failure to produce Identity Cards may result in medical facilities being refused. Family members of the employees will carry with them their "Shanakhti Cards" employees and their family members Shanakhti Card Numbers will be entered in the Treatment Book of each employee.
5. Ordinarily, employees and their dependents will get treatment as indoor patients in Wapda Hospitals/Dispensaries. If the patient cannot be treated in Wapda Indoor Hospital due to non-availability of bed or non-existence of treatment of a particular disease/ailment, the DGMS/MS/Medical Officer/Part Time Medical Officer as the case may be, may refer the case to Government Civil Hospital for admission and treatment. Employees drawing pay in NPS-16 and above will be entitled to receive treatment in private wards of Government Hospitals at the expense of the Authority. Employees drawing pay in NPS 1—15 will be entitled to treatment in •General Wards'. The DGMS/MS/Medical Officer/Part Time Medical Officer as the case may be, may refer cases other than Government Civil Hospital in excep tional circumstances, i.e. in cases of accidents where this is unavoidable or where admission in a non-Government Hospital is necessary as a life saving measure. In such cases all the obligatory charges incurred by the patients in that Hospital will be reimbursed by the Authority, except charges for diet, extra bed and other optional amenities. Patients desirous of going to CMH or any other non-Government Hospital will do so, if permitted by the DGMS (or authorised) medical attendant in case of outstations and in such cases, reimburse ment will be allowed at Government Civil Hospital rates according to entitlement. If any patient seeks admission in a Hospital other than Government Civil Hospital, at his own option, i.e. without the concurrence of the DGMS/MS/Medical Officer/Part Time Medical Officer as the case may be, he will not be allowed any reimbursement of the expenditure incurred by him on his treatment.
   ♦Note l.HFree food will be provided in Wapda Hospital only to Wapda employees and Government servants serving on deputation and their dependents as defined above, drawing pay in BSP-1 toBPS-11 ••♦.
   Note 2.— If blood transfusion is considered essential by the Pbysici8n/Surgeon Incbarge, the cost of blood purchased including the cost of bag/bottle, will be reimbursed
   at the prevalent market rate provided the receipt is countersigned by the DGMS/ Wapda Authorised Medical Attendant and he also certifies that the rate being
   
   
   
   ♦Substituted Vide O.M.No, DG/DD (Rules)/07456'34 'Vol. V77 RG.it7.8-.18C ^^d 3140-1985 **' Added vide O.M. No. DG/DD(R)/07456/34/IX/22239-23489 dated 31-3-93.
   5
   charged is in conformity with the prevalent market rate. The fee for blood grouping and matching will be reimbursed at the Government Hospital rates. The reimbursement of fee for blood groupingwill be admissible only once in a h capitalisation case.
   
   
   Note 3.— Air-conditioning charges in respect of Wapda patients admitted in private rooms of Government Hospitals including CMH will be reimbursed to the officer/ employees.
   
   
   Note 4.— If a hospital has two types of room with different rents, the employee in National Pay Scale No. 17 and above (and their dependents) will be eligible to occupy the room 'With the higher rent, and all other employees and their dependents will be eligible to occupy the room with lower rent.
   Note-5 "Patients desirous of going abroad under their own arrangements for medical treatment may do so if recommended by the Central Medical Board Wapda Lahore and in such cases, reimbursement in local currency will be limited to the extent as the treatment would have been availed in Government Hospitals of Pakistan."
6. In the case of patients entitled to treatment in private wards of hospitals, when a composite lumpsum is levied by an institution, as an inclusive charge to cdver medical surgical and nursing charges (including diet and accommodation charges etc.) which cannot be specified separately, 20 percent of such a sum will be taken as representing diet charges to be borne by the patient and the balance of 80 percent as representating the medical/ surgical charges etc. to be borne by the Authority.
7. The Authority has made arrangements for pathological Laboratory test and X-rays in Wapda Hospitals. The Employees referred by DGMS/Authorised Medical Attendant for a pathological Laboratory test and X-rays etc. performed in other Laboratories will get their receipts verified from DGMS/Authorised Medical Attendant and the expenditure incurred will be reimbursed by the competent authority aslaid down in Section-X V (G) of the Book of Financial Powers, 1977.

10 Cost of maternity cases will be allowed upto the following maxima, if the delivery is conducted at residence of employees:­

a.	Employees in BPS-1-4	Rs. 600
b.	Employees in BPS-5-15	Rs. 800
c.	Employees in BPS-16 and above	Rs. 1000

* Substituted vide O.M. Nc DG (S&GA)/DD (R)/07456/34/XIII/13009-14309 dated 14-3-1995.

♦•Addedvide OM NO. DG (S&GA) DD (Rl/07450/3 t/IX/20ft5-31ftft dated 7-1-1092

Note 1.— Twin/Multiple deliveries shall constitute and be considered as single delivery for the purpose of reimbursement irrespective of the fee received by the attending Lady Doctor/Midwife.

*Note 2.~Deleted.

Note 3.— Reimbursement of the cost of maternity cases will not be admissible in respect of spontaneous or legal abortions, miscarriages and still births, except when delivery is conducted in Wapda Indoor Hospital/Government Hospitals on proper reference from the authorised Wapda Medical Officer.

Note 4.—Reimbursement of charges of normal/Caeserean delivery cases conducted in a Government Hospital will be admissible according to entitlement. If a Wapda employee gets the normal/Caeserean delivery case conducted in a Hospital other than Government Civil Hospital, reimbursement will be admissible at Government Civil Hospital rates according to entitlement. Reimbursement will be limited to cost of medicines and will not include items of normal labour room/theatre items like needles, sutures etc.

** Note 5.— In cases where delivery is conducted at home and the employee is entitled to reimbursement of charges as defined in rule 10 above (subject to production of necessary documents including a birth certificate issued by a Municipal Corpora­ tion/Municipal Committee/Notified Area Committee/Town Committee/Union Council concerned) no medicines will be issued at Wapda's cost during seven days after delivery, as reimbursement of delivery charges cover the cost of medicines used during this period.

***Note 6 Reimbursement of normal deliveries in Hospital will be limited to a maximum amount of Rs. 40000 including fee and medicines etc. For Caeserean and other complicated cases, the maximum amount will be Rs. 7000.

Note 7.~ Reimbursement for ante-natal/post-natal visit fees will be allowed for omy one ante-natal and one post-natal visit.

11. (a) (i) When a patient is referred for a specialist's consultation to another station by DGMS/MS/MO as the case may be, he/she shall be entitled to Travelling Allowance on tour rates only and no Daily Allowance will be allowed for the period in transit or halt. If the patient is a member of his/ her family, he/she will be entitled to the same Travelling Allow­ ance on tour rates as admissible to the Wapda employee whose depen­

♦Deleted Vide OM. No. S/DD (Rules)/07456/34/10167-946 dated 221-84. ♦♦Substituted Vide OJM.No. S/DD (Rules/07456/34/10167-946 dated 22-1-84. ♦"♦Substituted vide O.M. No. DG (S&GA)/DD (R)/07456/34/XIII/13009-14309 dated 4-3-1995.

dent he/she is, and no Daily Allowance will be allowed for the period in

transit or halt.

(ii) Employee or any person may accompany a patient as Attendant in serious cases only if advised by the Director-General Medical Services/ Medical Superintendent/Medical Officer. In that event theAttendant will be entitled to Travelling Allowance at tour rates as admissible to the Wapda employees and no Daily Allowance will be admissible to the Attendant for the period in transit or halt.

1. In case a patient is to be removed to a Hospital in ambulance in lying condition and the ambulance is not provided by the Authority, cost of transportation by ambulance may be reimbursed as admissible under Wapda
   T.A. Rules for engagement of a full Jtaxi subject to a certificate to be recorded by the Authorised Medical Attendartt that no Wapda ambulance was available at that time.
   1. Medicines prescribed by the medical officers but not supplied from the Wapda
      Dispensary will be obtained from the approved Wapda Chemists.
      Note.— If a medicine which expression includes protective and curative vaccine/sera, is not available with UUJ Wapda Chemists, Wapda employee and Government deputa­ tionists will be permitted to purchase it from a chemist on proper cash receipt and the expenditure thus incurred will be reimbursed, subject to non-availability certificate from ai least one of the Wapda Chemist and countersignature of the Cash Receipt by (he Director-General Medical Services/Medical Superintendent/ Medical Officer/Authorised Medical Officer.
   2. (a) Medical facilities as indicated above will also be available to employees of the Authority posted in the mofussil if they fall ill while on a short visit to or while on leave at Lahore.
   *(b) No employee shall be allowed to avail medical facility at place other than place of his posting. On transfer from one station to an other station, medical facility will not be provided until and unless cancellation of such facility from the station of transfer is provided and placed on relevant record. For this purpose, the Green Book maintained by Hospital/Dispensary for each employee shall be transferred to his new hospital/dispensary accordingly.
2. In case of transfer of an employee, who does not take his family along, the budget for Green Book of such employee shall be given to the Hospital/Dispensary wherefrom his family gets treatment.
3. Cases for consultation by the Specialists and or hospitalization in Lahore will be referred to the DGMS by the appropriate Medical Officer (at Projects, or the Government Medical Officers at other places) only if Lahore happens to be the nearest station. In such cases, the patients will bring with him a reference chit from the appropriate Authorised Medical Officer together with a note riving the history of the case and the treatment previously given.

♦Amended vide O.M No. GM(A)/AD(E-IA)()7() 12/26/20038-20688, dated 01-06-1998.

14. In case of special hardship the Authority may relax any of the foregoing provisions.

••• 15. Deleted vide O.M No. DG/DD (R)/07456/34/4036-5306 dated 25-1-1994.

♦16. Widows and dependent children upto the age of 21 years and unmarried/unemployed daughters of all deceased employees will be provided medical facilities only in Wapda Hospital and dispensaries where they exist. Treatment at residence, reimbursement of expenditure on purchase of medicines/specialist consultation is not covered.

"•"■"Clarification. It is hereby clarified that the effective date of the application of rule 16 above shall be 7-5-1985.

***** yj perrnanently and totally incapacitated/crippled children of serving, retired and deceased Wapda Employees, who are not able to earn their living, will be allowed medical treatment irrespective of their age. The treatment will be limited to whatever is available in Wapda Hospitals/Dispensaries where the patient is registered. However, the patient may be referred to nearest Wapda Hospital for hospitalization, if needed. The disability will be certified by Wapda Central Medical Board."

1. If a question arries as to the correct interpretation of any of the provisions of these Rules, the orders of the Authority will be obtained through the Secretary and General Manager (S&GA) Wapda.
   
   
   Note.- The Director-General Medical Services will be consulted where certain changes/amendments are to be incorporated. Authority's ruling through Secretary and General Manager (S&GA) will be final.
   
   
2. Rules Regulating the Medical Attendance and Treatment of Wapda Employees in Lahore and Karachi, promulgated vide No. S/OSD (R&CM) SO (R) 6 (14)/104698-798, dated December 6, 1977 are hereby repealed Medical Attendance Rules for the employees of the Authority working on Projects, issued vide Office Order No. KGA-10 (6) Med/578, dated 26-1-1963, and amended from time to time, are also hereby repealed.

♦Clarified Vide O.M. No. DG/DD (R)/07456/34/Vol. VIII/99539-100359 dated 18-12-1985.

♦♦Added Vide O.M. No. S/DD (R)/07456/34/Vol. III//59707-60666 dated 7-7-1986.

♦♦♦Deleted wide O.M. No. DG/DD (R)/07456/34/X/71701-50 dated 2-12-1993.

♦♦•♦Amended Vide O.M. No. DG/DD (R)/07456/34/4036-5306 dated 25-1-1994.

20 PROCEDURES REGARDING MEDICAL BOARDS/CATEGORIZATION/INVALID ­

MENT

1. General
   
   
   Convening of Medical Boards
   
   
   1. The competent authority shall require an employee suspected to be suffer ing from a mental or bodily illness which is likely to render him permanently incapable of discharging his official duties, to have himself examined by the Medical Board at Lahore or the respective Medical Board. Failure to appear before the Board will make the employee liable to action under the E&D Rules applicable to him.
   2. The Medical Boards will normally be assemblediunder orders of the Director- General Medical Services, Medical Superintendents of Wapda Hospitals or Medical Superintendents of Government Hospitals as per written directions of Director-General Medical Services.
      
      
2. The Medical Superintendent of a Hospital will be the President of the Medical Board unless directed otherwise.
   
   
3. The President of the Board will ensure that all formalities are completed before the documents are submitted to the Director-General Medical Services.
   
   
4. As for as possible, the specialists concerned and the Medical Officer Incharge of the case will not be the Members of the Board and in no case will either of them act as President of the Board.
5. Approval of Medical Board Proceedings
   The proceedings of all Medical Boards will be approved by the Director-General Medical Services, should the approving authority not concur with the findings of a Medical Board, it may direct that:­
   1. A fresh Medical Board be held; or
   2. the case be retained in hospital for further treatment/observation; or
   3. thq xase be disposed bf otherwise as per directions of the approving/confirm ing authority.
6. A Medical Board will normally be assembled for the following purposes:—

1. For initial recruitment;
2. For medical categorization/re-categorization;
3. For Invalidment out of service; and
4. For re-assessing percentage of disability of those invalided out, if so directed

10

by the Authority.

* (e) Medical Board for Treatment Abroad

The Medical Board which will examine all cases for treatment abroad shall consist of the following members

(1)	Director General Medical Services	Convenor
(2)	Medical Specialist	Member
(3)	Surgical Specialist	Member

** 7. New entrants including workcharged will be recruited in medical category 'A' unless otherwise specified by the Authority. The existing workcharged employees who have rendered more than 10 years of service or have attained the age of 50 years can be retained in service even in lower medical categories in case their disability/disease, if any, is not advanced or of serious nature. Retention in lower medical category will be on recom­ mendation of Medical Board duly approved by Director General Medical Services.

1. A Medical Board/Medical Officer will examine the candidates in accordance with the standards laid down and communicate the result direct to the Director-General Medical Services. The deformities/disabilities responsible for the temporary/permanent unfitness will be communicated to the Officer/Official by the Director-General Medical Services or the Authorised Medical Attendant/or the Appointing Authority.
2. A candidate declared temporarily unfit will be directed to report for re-examina tion after the expiry of the period for which he/she is declared temporarily unfit.
   
   
3. Medical Board/Medical Officer after examining a fresh entrant may:—
   
   
   1. Declare him/her as physically fit; or
   2. Declare him/her as physically unfit; or
   3. Declare him/her as temporarily unfit for a specified period.
      Mote.— Such candidates as are declared temporarily unfit will be re-examined by the Medical Board after treatment/Operation, as the case may be, on a specified date. If he/she desires that Medical examination may be carried out earlier, then he/she will have to produce a certificate from a Specialist that he/she has been treated/ operated upon successfully.
4. Leave on Medical Certificate

1. Medical Board will recommend leave on Medical Certificate under the following conditions:—
   1. After recovery from major illness or injury.
   2. In excess of the period required for full recovery.
      
      
      
      ♦ Added Vide O.M. No. G.M. (A)/DD (R)/07456/34/92857-93930. Dated 30-9-1987 **
      Substituted Vide OM. No.S/DD (Rules)/07456/34/Vol. VIII/105057-105836 dated 25-11-84.
      
      
      11
      Directorate of Rules (S&GA) WAPDA
      Publication No.8 VI
      (Edition)
   3.