Dayal Chandra Mathur vs State of Rajasthan and Others

H.R. Panwar, J.—By the instant writ petition under Article 226 of the Constitution of India, the petitioner seeks to direct the respondents to reimburse his medical claim to the extent of actual expenses incurred by him for undergoing the treatment of Angioplasty at Sterling Hospital, Ahmedabad.

The facts and circumstances giving rise to the instant write petition are that the petitioner who is Govt. servant working on the post of Executive Engineer and Technical Assistant in Public Works Department of the State. While the petitioner was posted as Executive Engineer, PWD, Division, Sagwada, district Dungarpur, in the month of November, 2003, he suddenly developed a server chest plain and was taken to Govt. Hospital, Udaipur for treatment. While undergoing treatment at Govt. Hospital, Udaipur, it revealed that the petitioner is suffering from heart ailment. However, he remained under treatment at the said Govt. Hospital, Udaipur from 06.11.2003 to 10.11.2003 in Intensive Care Unit and thereafter he was discharged vide Annex.1. On 14.11.2003, while the petitioner was at Banswara, again the petitioner developed chest pain and was taken to Mahatma Gandhi Hospital, Banswara and remained admitted in Intensive Care Unit and was discharged vide Annex.2. On 17.11.2003, the petitioner again developed a serve chest pain and therefore, on 18.11.2003, he was taken to Sterling Hospital, Ahmedabad for undergoing the treatment of Angiography, where he underwent the Angiography vide Annex.3 and on advise of the treating doctors, an urgent angioplasty was done. The petitioner incurred the expenses for the said treatment to the extent of Rs. 2,44,964/- and submitted his medical bills for reimbursement which have not been reimbursed so far by the respondents. Hence this writ petition.

A reply to the writ petition has been filed by the respondent stating that Sterling Hospital, Ahmedabad is neither recognized nor approved as per the Appendix 11 to the Rule 7 of the Rajasthan Civil Services (Medical Attendance) Rules, 1970 (for short ''the Rules of 1970'' hereinafter) and the petitioner at his own got treated in the said hospital and therefore, the State Govt. is not liable to reimburse the expenses incurred by the petitioner.

I have heard learned Counsel for the parties. Carefully gone through the material available on record.

Rule 7(1) of the Rule of 1970 provides that a Government Servant and the members of his family suffering from a disease for which treatment is not available in any Government Hospital in the State shall be entitled to medical attendance and treatment to the extent indicated in Sub-rule (2) of this rule in a Hospital/Institution outside the State recognized by the Government, provided that it is certified by the Principal of a Medical College/Director of Medical Attendant to the effect that the treatment of a particular disease from which the patient is suffering is not a available in any Government Hospital in the State and it is considered absolutely essential for the recovery of the patient to have treatment at a hospital outside the State.

Sub-rule (2) of Rule 7 of the Rules of 1970 provides the items reimbursable.

Thus, from Rule 7 of the Rules of 1970, it is clear that a Government employee is entitled to medical attendance and treatment free of charge in accordance with the Rules of 1970 and reimbursement of the expenditure incurred by him on account of medical attendance and his treatment and his family members to the extent and in the manner provided in the Rules of 1970.

It is true that the Sterling Hospital, Ahmedabad does not find mention in the list of Hospital/Institutions outside the State whicha re recognized for the purpose of Rule 7(3) of the Rules of 1970. However, this controversy came to be considered by a Division Bench of this Court in Anil Kumar Surolia v. State of Rajasthan and Ors. 2005 (3) WLC 396 . In that case, the petitioner therein had to go to Ahmedabad to meet his brother Anupam Surolia in August 2000, where he suffered another heart attack and was taken to Rajasthan Hospital at Ahmedabad where due to non-availability of heart surgeon, he was taken to Krishna Heart Institute where his Angiography and Angioplasty was done. Krishna Heart Institute charged a sum of Rs. 78,000/- towards Angiography and Angioplasty and other medical expenses. The petitioner therein submitted his representation for reimbursement of his mediclaim, however, after process, the authorities refused to sanction the reimbursement of mediclaim of the petitioner. The petitioner again moved by way of representation to Principal, SMS Medical College. His case was referred to the Registrar General of this Court who once again referred the case of the petitioner to the Secretary to Govt. Law and Legal Affairs. The Principal, SMS Medical College once again refused to grant sanction for reimbursement of mediclaim on the ground that Krishna Heart Institute was not an approved institute of the Govt. of Rajasthan. The Deputy Secretary to Govt. Law Department also refused the mediclaim of the petitioner on the ground that he was not referred out of the State for treatment and Krishna Heart Institute was not approved hospital under the Rajasthan Civil Services (Medical Attendant) Rules. On a writ petition before this Court, the Division Bench of this Court held that the petitioner was entitled to the medical treatment in a hospital which was not a Government hospital necessitated on account of circumstances beyond the control. The Division Bench observed as under:

In the factual background as detailed above, we are of the firm view that even if the required treatment was available is SMS Hospital at Jaipur or other approved hospitals in the State of Rajasthan, the petitioner was indeed entitled to medical reimbursement if he had got the treatment elsewhere necessitated on account of circumstances beyond his control. Self perseverance is the first instinct in every human being. Person having suffered heart attach is not expected to await treatment at a far off distance as time is the essence in saving valuable life in such matters. There is every risk of a person breathing his last if he has to await treatment of heart attack. In the circumstances, even if such medical treatment as obtained by a government employee be available in the State itself, he shall be still entitled to medical reimbursement for the treatment obtained elsewhere if the same is necessitated on account of circumstances beyond his control. In emergent situation thus it is not incumbent for a patient to obtain medical treatment only in approved hospitals of the Government. We would have discussed the matter in further details as per provisions of the Rajasthan Civil Services (Medical Attendant) Rules, but it is conceded during the course of arguments that if the petitioner was to obtain medical treatment at SMS Hospital at Jaipur or other Government approved hospitals in the State of Rajasthan, he would have been paid the same amount for the treatment he ultimately got from Krishna Heart Institute. If that be a fact, and which as mentioned above, is concerned, we are of the view that the stand taken by the State Government is obdurate and wholly uncalled for. We could imagine if perhaps the petitioner had spent far more and was claiming the same while getting treatment in a non-approved hospital. Government in any case had to pay the same amount spent by the petitioner at Krishna Heart Institute even if the petitioner was to get treatment in SMS Hospital or other approved hospital in the State of Rajasthan. This Court cannot but deprecate the attitude of the Government in rejecting justified claims in teeth of the recommendations made by this Court. Registrar General of this Court indeed supported the cause of the petitioner but the favorable recommendation made by this Court have been turned down on wholly untenable grounds.

Relying on the decision of this Court in Anil Kumar Surolia''s case (supra), a Division Bench of this Court in State of Rajasthan and Ors. v. Surendra Kumar Kalra 2008(2) WLC 430 observed that in an emergent situation, the Government cannot insist upon a Government servant to get himself treated at Government recognized institution and, therefore, held that a Government servant having suffered a severe cardiac problem or heart attack cannot wait for being taken to a Government hospital as for him every second is precious and delay of few minutes in the treatment may be fatal and while agreeing with the view taken by the Division Bench in Anil Kumar''s case (supra) held that in a situation like this where a Government servant is required to be treated in a emergency, the Government cannot insist upon its employee to get himself treated at the Government hospital and the Govt. must reimburse the concerned employee at the rates that may be applicable in the recognized/approved government institutions/hospitals.

Thus, the rules regarding reimbursement of the medical claim of an employee of the State when he obtains treatment from a hospital of his choice can be made limited and limiting such reimbursement cannot be said to be against the provisions of law. Such rules framed under the provisions of Article 309 of the Constitution of India, constitute conditions of service in terms whereof on the one hand the employee would be granted the facility of medical aid free of cost from the recognized Government hospitals and on the other hand, he at his option, may get himself treated from other recognized hospital/institutions subject of course to the condition that the reimbursement by the State therefore would be limited. Rule 7 of the Rules of 1970 limits the reimbursement in a situation where Government servant takes the treatment outside the State though such treatment is available in the State. Even Rule 7 provides that a Government servant and the members of his family suffering from a disease for which treatment is not available in any Government hospital in the State, shall be entitled to medical attendance and treatment to the extent indicated in Sub-rule (2) of this rule in a Hospital/Institution outside the State recognized by the Government.

In the instant case, the petitioner earlier on two occasions suffered server chest pain and remained admitted at Govt. Hospital, Udaipur and thereafter at Mahatma Gandhi Hospital, Banswara in Intensive Care Unit and thereafter when he was at Banswara, again suffered heart attack and in the given set of circumstances, the petitioner had no option except to be taken to nearest hospital having better facility for the treatment of the heart ailment and Sterling Hospital being near to the Banswara, the person attending the petitioner took him to the said hospital and got him treated and therefore, the petitioner is entitled for the reimbursement at the rate applicable for such treatment in the recognized/approved Govt. Hospital/Institutions. Now the question remains in consideration is as to at what rate and to what extent the petitioner is entitled for the reimbursement of the mediclaim for the treatment underwent by him at Sterling Hospital, Ahmedabad. Since in the instant case, the petitioner has taken his treatment from a hospital outside the State though not an approved hospital/institution for the purpose of Rule 7 of the Rules of 1970 under compelling circumstances and the treatment is available within the State, and therefore, in my opinion, the petitioner is entitled for reimbursement of his medical claim to the extent payable had such treatment been taken from SMS. In this view of the matter, the petitioner is entitled for reimbursement of his medical claim at the rate applicable in SMS for the treatment which the petitioner has taken.

Accordingly, the respondent are directed to reimburse the medical bills of the petitioner at the rate applicable in SMS Hospital, Jaipur for the treatment which the petitioner has taken, within a period of two months from the date of production of certified copy of this order.

The writ petition is allowed to the extent above. No order as to costs.