Kailash Chandra Purohit vs State of Rajasthan and Others

Sandeep Mehta, J.—By way of the instant writ petition, the petitioner seeks a direction to be issued to the respondents to reimburse the medical expenses borne by him in the treatment of his cardiac ailment, which he had to undergo in an emergent condition at the Goyal Hospital and Research Centre, Jodhpur in October 2006.

The petitioner is a retired employee from the Forest Department of State of Rajasthan. He retired from service on 31.5.2000 and was issued with a PPO No. 428-316(R) and also a medical diary by the respondents. He is a permanent resident of Jalore.

It is averred in the writ petition that he suddenly faced a cardiac pain in September 2006 and was immediately taken to Government Hospital, Jalore wherefrom he was referred to Jodhpur. The petitioner was examined at the M.G. Hospital, Jodhpur and from there, was referred to the SMS Hospital, Jaipur for the procedure of Aortic Valve replacement which was not available at the MGH, Jodhpur. However, the petitioner''s condition was not such that he could travel to Jaipur. In the meanwhile, while undergoing treatment at Jodhpur, the petitioner again developed acute cardiac pain upon which he was immediately rushed to the Goyal Hospital and Research Centre, Jodhpur. He remained admitted at the said hospital, where he was subjected to the surgical procedure of Aortic Valve Replacement wherein a total expenditure of Rs. 1,70,450/- was incurred in addition to the expenses towards purchase of medicines etc. The petitioner submitted the bills of medical expenses to the respondent department and claimed reimbursement thereof but the same was rejected by the respondent No. 2 vide order dated 21.6.2007 (Annex. 8) on the ground that the treatment of the petitioner was not undertaken in a government hospital. Hence, the petitioner has approached this Court for issuance of a writ or order to the respondents to reimburse the medical bills of the petitioner.

Learned counsel for the petitioner submits that the petitioner had to undergo treatment in an emergent condition at the Goyal Hospital, Jodhpur and as such, it was absolutely impossible for him to have approached a government hospital for getting treatment of his sudden and acute cardiac problem. He relies on the decision of this Court in the case of Jawahar Lal Bohra v. State of Rajasthan (S.B. Civil Writ petition No. 6350/2005) decided on 26.3.2014 and prays that the writ petition deserves to be accepted and the respondents be directed to reimburse the medical expenses borne by the petitioner in accordance with Rajasthan State Pensioners Medical Concession Scheme.

Learned counsel for the respondents has vehemently opposed the submissions advanced by the learned counsel for the petitioner. However, he candidly conceded that in similar matters, this Court has directed reimbursement of the medical expenses borne by the retired employees at the rate which is applicable for similar treatment in recognised hospitals.

The controversy regarding the entitlement of the retired government employees to receive medical reimbursement has already been settled by this Court in a catena of decisions including the judgments rendered in the case of Gyanendra Kumar Pareek Vs. State of Rajasthan and Others, and in the case of Anil Kumar Surolia Vs. State of Rajasthan and Others, .

It is admitted that the petitioner, a retired government employee, faced a cardiac problem and was admitted in an emergent situation at MGH Jodhpur from where he was referred to SMS Hospital, Jaipur for further treatment. However, before he could travel to Jaipur, he suffered a sudden cardiac pain. He was admitted in an emergent situation in the Goyal Hospital and Research Centre, Jodhpur and was subjected to Aortic Valve Replacement. Definitely and without any doubt, it was on account of an emergent condition that the petitioner had to be subjected to Aortic Valve Replacement at the above hospital. In such situation, the petitioner is entitled to be reimbursed with medical expenses borne by him in his treatment at the Goyal Hospital and Research Centre, Jodhpur in accordance with the Rajasthan State Pensioners Medical Concession Scheme.

This Court considered the issue of emergent situation in the case of Gyanendra Kumar Pareek Vs. State of Rajasthan and Others, and held that when a family member suffers from cardiac ailment, the prime objective of the other family member would be to save his/her life. At that time, services of whichever hospital is suited could be utilized because emergency knows no law and no procedure and when human life is at stake, in such situation, ultimate responsibility of the State cannot be washed off. While deciding Gyanendra Kumar Pareek''s case (supra), the Court relied upon the decision of the Division Bench of this Court in Anil Kumar Surolia Vs. State of Rajasthan and Others, wherein the Division Bench observed as under:--

"Government cannot insist upon an employee to get himself treated at recognized government institution. All that the Government in these circumstances can do is to reimburse the concerned employee at the rates that may be applicable in the recognized government institution. Reference in this connection may be made to the judgment of the Hon''ble Supreme Court in Surjit Singh Vs. State of Punjab and Others, and State of Punjab and Ors. v. Mohan Lal Jindal reported in (2001) 9 SCC-217. Consequently, the reimbursement of the medical expenses borne by the State Government employees and pensioners has to be done even if the treatment is undertaken at unrecognized hospital outside the State even though reference may not have been taken prior to treatment." 9. Certain amendments were made in the Rajasthan State Pensioners Medical Concession Scheme vide order dated 19.12.2004 which are relevant for the purpose of disposal of this writ petition and are reproduced hereinbelow:--

"The Governor is pleased to make the following amendments in the Rajasthan State Pensioners Medical Concession Scheme, namely-

In the said Scheme.

The existing words "Implantation of Pacemaker and Angioplasty/Balloonplasty" appearing in the sub-para 4B(i) shall be deleted and the existing sub-para 4B (ii) may be re-numbered as sub-para 4B(iii) and new sub para 4B(ii) may be inserted as under:--

"(ii) A Pensioner and the members of his family as defined in sub-para (5) of para 3 of the scheme shall be entitled for grant of financial assistance in respect of specialized treatment of implantation of Pacemaker and Angioplasty/Balloonplasty taken in Government Hospital within the State of Rajasthan as under:

(a) Pacemaker

Actual cost of Pacemaker subject to the maximum of Rs. 60,000/-

(b) Angioplasty/Balloonplasty

Actual expenditure incurred subject to the maximum of Rs. 35,000/-

(c) For Stent/Stents

Actual expenditure incurred subject to the maximum of Rs. 75,000/-."

The existing para 4E shall be substituted by the following namely.

"4E. Treatment of heart ailment in recognized hospital outside the State (with or without the recommendation of the Medical Board) (w.e.f. 5.8.2004). (a) In case it is recommended by the Medical Board that by-pass surgery for heart is indicated, the pensioner can get himself operated in any of the hospitals recognized by the Government outside the State for this purpose. Such pensioner may be allowed 80% of hospital expenses limited to Rs. 48,000/- being 80% of General Ward charges of All India Institute of Medical Sciences, New Delhi.

(b) In case a pensioner undergoes by-pass surgery of heart (cardio Thoracic surgery) in any recognized hospital outside the State in emergent circumstances without any recommendation of the Medical Board, he may be allowed 80% of hospital expenses limited to Rs. 48,000/- i.e. 80% of General ward charges of AIIMS, New Delhi provided that he submits a Certificate from a cardiologist who took a degree of D.M. In Cardiology as MCH in Cardio Thoracic Surgery stating that pensioner''s condition was such that immediate treatment was essential.

In case a pensioner takes treatment of Angioplasty/Balloonplasty and stent(s) in recognised hospitals outside the state, he/she may be allowed financial assistance as under:--

(i) For Angioplasty/Balloonplasty

Actual amount of expenditure incurred subject to the maximum of Rs. 35,000/-

(ii) For Stent/Stents

Actual cost of Stent/Stents subject to the maximum of Rs. 60,000/- (80% of Rs. 75,000/-)"

Thus, as per the said amendment, the only hurdle against the petitioner for being granted the relief of reimbursement of his bills is that he took treatment at an unrecognised hospital. However, as has been noted above, the Division Bench of this Court has already laid the issue to rest by observing that even if the treatment is taken at an unrecognized hospital outside the State, and without any reference, the reimbursement thereof has to be done at the rates prescribed in the Concession Scheme. Another order came to be passed by the State Govt. on 21.12.2009 which completely puts the controversy to rest and reinforces petitioner''s claim for reimbursement. The order is quoted hereinbelow:--

"No. F.1(6) FD(Rules)/2012 Jaipur dated 21 DEC 2009

Subject:- Reimbursement of cost of implants and reimbursement of medical attendance and treatment in private hospitals to pensioners/family pensioners under Rajasthan Pensioners Medical Concession Scheme.

State Government has decided to extend the facility of Medical Attendance and treatment to State pensioners/family pensioners in private or charitable hospitals, as applicable to State Government servants under Finance Department order No. F.6(4)FD(Rules)/03 Pt.-I dated 27.11.2009 pertaining to the period prior to 19.06.2009.

Such claims of treatment shall be considered and decided by the Sub-Committee of the Trust."

Upon a perusal of the aforesaid clauses of the Concession Scheme, it is evident that none of the clauses deals with a case of Aortic Valve replacement surgery. Thus, while assessing the rate of reimbursement, the concerned authorities shall have to seek estimate of the cost of such surgery if the same is being conducted at the SMS Hospital, Jaipur and if not, then from the AIIMS.

As a consequence, the action of the respondents in refusing to reimburse the medical bills of the petitioner cannot be approved as being unjust and arbitrary.

In such situation, the petitioner is entitled to be reimbursed with medical expenses borne by him in his treatment at the Goyal Hospital and Research Centre, Jodhpur in accordance with the Rajasthan State Pensioners Medical Concession Scheme.

Furthermore for the period during which the reimbursement was not given to the petitioner, he is entitled to receive interest as well.

Accordingly, it is hereby directed that the respondents shall forthwith reimburse the amount of medical expenses borne by the petitioner in his treatment at the Goyal Hospital and Research Centre, Jodhpur in accordance with the Rajasthan State Pensioners Medical Concession Scheme. The reimbursement shall be made within a period of four weeks from the date of receipt of copy of this order. Furthermore, the amount to be paid to the petitioner shall also carry interest @ 9% w.e.f. the date on which the bill was presented to the date of payment. If the payment is delayed beyond the period of four weeks, the amount due shall carry interest @ 12%.

IA No. 5865/2014 filed by the petitioner for early hearing is also disposed of.

No order as to cost.