Gurprem Dass vs Central Administative Tribunal and Others

Hemant Gupta, J.—The challenge in the present writ petition,, is to the order passed by the Central Administrative Tribunal, Chandigarh Bench, Chandigarh (hereinafter to be referred as "the Tribunal") on 28.02.2007 whereby the Original Application filed by the petitioner challenging the rejection of his medical reimbursement claim, was dismissed.

It is the case of the petitioner that on 23..09.2004, he was admitted in the General '' Hospital on account of hypertension. He was discharged on 26.09.2004 and was advised bed rest upto 18.10.2004. On 15.10.2004, his condition worsened and was rushed to Fortis Hospital at Mohali. On doing angiography, Coronary Artery Bye-pass Grafting (CABG) was recommended, he was removed to Escort Heart Institute, New Delhi, where CABG was performed on him on 19.10.2004. A sum of Rs. 2,14,599/- was spent for which he submitted medical bills but reimbursement to the extent of Rs. 76,239/- and Rs. 5,503/- alone was made. Therefore, the petitioner invoked the jurisdiction of the Tribunal for claiming the balance amount along with interest thereon.

The stand of the respondents in the reply before the Tribunal was that the petitioner has not taken permission to get treatment from a private hospital after he was discharged nor he reported for treatment at PGI, therefore, ex post facto sanction could be accorded. The case was reviewed by the Medical Board on 20.12.2005 and ex post facto sanction was again declined.

Learned Counsel for the petitioner, before the learned Tribunal, relied upon the order of the Tribunal in J.D. Verma v. Union of India O.A. No. 646-CH of 1995 decided on March 27, 1996. The said judgment was distinguished by the learned Tribunal on the ground that in the case of J.D. Verma (supra), the treatment was taken in a private hospital in emergent conditions but in the present case, it was not performed in an emergent situation. The Medical Board considered the claim of the petitioner for ex-post facto sanction but the petitioner could not satisfy the Medical Board in respect of emergent situation in which he has taken treatment. It was also found that the Government employees are entitled to claim medical reimbursement at PGI/AIIMS/Government rates and that prior permission is required to be obtained from the competent authority in case medical treatment is to be taken from the hospital other than the prescribed in the rules.

Before this Court, learned Counsel for the petitioner has relied upon judgments of Division Bench of this Court reported as Sadhu R. Pali v. State of Punjab through Secretary, Health and Family Welfare Punjab 1994 (1) RSJ 335; K.L. Kohli v. State of Punjab and Ors. 1995 111 P.L.R. 715; Mrs. Surya Pandit, I.A.S. (Retd.) Vs. State of Punjab and Others, ; Ravi Mohan Duggal v. State of Punjab 1995 (3) RSJ 399; and a judgment of Hon''ble Supreme Court in Surjit Singh v. State of Punjabi 1996 (1) RSJ 845, whereas on behalf of respondents reliance was placed upon a judgment of Supreme Court reported as State of Punjab v. Ram Lubhaya Bagga (1998) 4 SCC 177 and a Division Bench decision of this Court in Harnam Singh v. State of Punjab 2007 (2) RSJ 478. It is contended by the learned Counsel for the respondents that the policy of the Punjab Government regarding medical reimbursement dated 13.02.1995 and 25.1.1991 has been adopted by the Chandigarh Administration and, therefore, the interpretation of such policy by the Hon''ble Supreme Court in Ram Lubhaya Bagga''s case (supra) is entirely applicable to the facts of the present case. In view of the said judgment, the petitioner is entitled to reimbursement of medical expenses to the extent of the amount charged by the AIIMS/PGI for such treatment only.

The judgment referred to by the learned Counsel for the petitioner are prior to the judgment rendered by the Hon''ble Supreme Court in Ram Lubhaya Bagga''s case (supra) and, in fact, Surjit Singh''s case (supra) referred to by the petitioner has been considered in the aforesaid judgment. Hon''ble Supreme Court held to the following effect:

The right of the State to change its policy from time to time, under the changing circumstances is neither challenged nor could it be. Let us now examine this new policy. Learned Senior Counsel for the appellants submits that the new policy is more liberal in as much as it gives freedom of choice to every employee to undertake treatment in any private hospital of his own choice anywhere in the country. The only clog is that the reimbursement would be to the level of expenditure as per rates which are fixed by the Director, Health and Family Welfare, Punjab for a similar package treatment or actual expenditure, whichever is less. Such rate for a particular treatment will be included in the advice issued by the district/State Medical Board for fixing this. Under the said policy a Committee of Technical experts is constituted by the Director to finalize the rates of various treatment packages and such rate list shall be made available to the offices of the Civil Surgeons of the State. Under this new policy, it is clear that none has to wait in a queue. One can avail and go to any private hospital anywhere in India. Hence the objection that, even under the new policy in emergency one has to wait in a queue as argued in Surjit Singh case does not hold good.

In the aforesaid judgment, while considering the policy adopted by Chandigarh Administration in not reimbursing the full medical expenses incurred by the government employee in any hospital not being government hospital in Punjab, the Court found that the framing of a policy is based upon a number of circumstances on facts, including constraints based on its resources.

Such policy is based on expert opinion and, therefore, it will be dangerous if Court is asked to test the utility or beneficial effect of the policy. While considering the rates for a particular treatment in the policy the Court found that such provision is justified. It held to the following effect:

No State of any country can have unlimited resources to spend on any of its project. That is why it only approves its project to the extent it is feasible. The same holds good for providing medical facilities to its citizens including its employees. Provision of facilities cannot be unlimited. It has to be to the extent finances permit. If no scale or rate is fixed then in case private clinics or hospitals increase their rate to exorbitant scales, the State would be bound to reimburse the same. Hence we come to the conclusion that principle of fixation of rate and scale under this new policy is justified and cannot be held to be volative of Article 21 or Article 47 of the Constitution of India.

In view of the aforesaid discussion, policy dated 13.02.1995 was upheld. In Harnam Singh''s case (supra), the matter was examined by this Court and found that the said case does not fall within the parameter recorded in Para 39 of the judgment in Ram Lubhaya Bagga''s case (supra). In para 39 of the judgment, the claim of medical reimbursement to the extent of expenses incurred on the treatment taken from Escort Hospital was reimbursed as there was long strike in AIMS. Such direction was given in exercise of the powers conferred on the Supreme Court under Article 142 of the Constitution of India when it was stipulated therein that such order of grant of reimbursement is not to be treated as a precedent but has been given on the facts and circumstances of the said case.

As a general rule, medical expenses have to be reimbursed as per the rates fixed-by the Director, Health and Family Welfare, Punjab for a similar treatment package or actual expenditure whichever is less. As recorded in Ram Lubhaya Bagga''s case (supra), the rates fixed by the Director, Health and Family welfare, Punjab are the same which are charged by the AIIMS. Therefore, reimbursement of medical expenses to the extent of rates charged by AIIMS cannot be said to be arbitrary or unjustified which may warrant interference in writ jurisdiction of this Court.

Consequently, we do not find any merit in the present writ petition and the same is hereby dismissed with no order as to costs.

Sd/- Mohinder Pal, J.