M. Manickam vs The Commissioner of Treasuries and Accounts, The Chief Educational Officer and The Head Master Government Boys Higher Secondary School

D. Hariparanthaman, J.—The Original Application in O.A. No. 838 of 2003 before the Tamil Nadu Administrative Tribunal (hereinafter

referred to as ""the Tribunal"") is now Writ Petition in W.P. No. 8614 of 2006 before this Court.

Heard Mr. G. Elanchezhian, learned Counsel for the petitioner and Mr. P. Muthu Kumar, learned Government Advocate for the respondents.

The petitioner is a Night Watchman at the Government Girls Higher Secondary School at Tittakudi and later, he was promoted as Office

Assistant. After working at various stations, he was transferred and posted to the Government Boys Higher Secondary School, Tittakudi. He

rendered more than 30 years of service and he is a member of the Tamil Nadu Medical Fund Scheme.

While so, he suffered from heart disease. There was no proper treatment available at Tittakudi. Hence, he was referred to the Apollo Hospital,

Chennai, for treatment. He was admitted on 20.05.2002 in the Apollo Hospital in a serious condition and a major surgery was performed on

21.05.2002. In medical terminology, the same is called as ''Angio Plasty/PTCA stent''. He was discharged on 24.05.2002. He spent Rs.

1,50,744/- towards the hospital expenditures. He made a claim on 30.05.2002 for reimbursement of 75% of the amount spent by him i.e., Rs.

1,13,058/-. He made an application for reimbursement of the medical expenses to the second respondent through the Head Master, the third

respondent herein. The third respondent forwarded the matter to the second respondent. The second respondent in his letter dated 03.07.2002

recommended for sanction of the amount as claimed by the petitioner, as per the rules. However, the first respondent returned the application of

the petitioner by way of the impugned letter No. Dis.40339/H4/2002 dated 12.09.2002. It is stated therein that the disease for which he was

treated in the Apollo Hospital is not included in the G.O.Ms. No. 400, Finance (Salary), dated 29.08.2000 and the same was intimated by the

second respondent in his letter dated 25.10.2002.

Hence, the petitioner filed Original Application in O.A. No. 838 of 2003 (W.P. No. 8614 of 2006) praying for a direction to the first

respondent to accept the recommendations of the second respondent made in R.C. No. 5471/A1/2002 dated 03.07.2002 and to issue a cheque

in favour of the petitioner to the tune of Rs. 1,00,000/- for medical reimbursement as per the Tamil Nadu Employees Health Fund Scheme 1991.

The first respondent does not dispute the factum of treatment, i.e., the petitioner underwent major heart surgery in the Apollo Hospital, Chennai,

is not in dispute. It is also not in dispute that the petitioner underwent the procedure of ''Angio Plasty/PTCA stent''. The only objection of first

respondent for not sanctioning the claim of the petitioner was that the said surgery is not included in G.O.Ms. No. 400, Finance (Salary), dated

29.08.2000.

The learned Counsel for the petitioner submits that the matter is squarely covered by a decision of this Court in W.P. No. 4980 of 2006, dated

26.06.2006, wherein also a Government employee was not sanctioned the medical expenses on the ground that he underwent ''Angio

Plasty/PTCA stent'' which was not a disease included in the G.O.Ms. No. 400, Finance (Salary), dated 29.08.2000. This Court found that later

the Government issued G.O. No. 556, Finance (Salaries) Department, dated 08.11.2004 including the disease of ''Angio Plasty/PTCA Stent'' as

also one of the treatments for the claim to be made. It is also held therein that the claim of the Government Servant cannot be rejected on technical

grounds, particularly, when a Government Employee factually took treatment. Relevant paragraphs 6 to 9 are extracted hereunder from the said

judgment dated 26.06.2006 in W.P. No. 4980 of 2006:

The other reason for rejecting the claim of the petitioner that the G.O.Ms. No. 400 does not include either Vijaya Heart Foundation or PTCA

Stent for entitlement to make reimbursement, I am of the considered view that the same is unreasonable and cannot be accepted. In fact, my

attention is drawn to the subsequent Government Order issued by the Government in G.O. No. 556 Finance (Salaries) Department on

08.11.2004 including not only the Vijaya Heart Foundation as one of the recognised hospitals but also the entitlement for Angioplasty/PTCA Stent

as one of the treatment for the claim to be made.

In matters like this, the Government Orders should not be strictly construed as on the date when the Government Order was issued, the

treatment viz., PTCA Stent could not have been invented or introduced. In recent days, the concept of treating ailments, has advanced so much,

thanks not only to the Speciality Hospitals, Doctors specialized in the modern/advance treatments, but also the advanced techniques in method of

treatment with use of sophisticated equipments. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests

only with the Doctor, who is well versed and expertised both on academic qualifications and experience gained. Very little scope is left to the

patient or his relative to decide as to manner in which the ailment should be treated.

In regard to the reasons as to the non inclusion of the Hospital in Government Order for denial, this Court cannot brush aside the advancement

in modern medical treatment. Speciality Hospitals are established for treatment for specified ailments and services of Doctors specialized in a

discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by

itself would deprive the beneficial order of the Government, solely on the ground that the said Hospital is not included in the Government Order. It

cannot be so, as the Government Order should be read keeping the purpose for which the same was issued. The right to medical claim cannot be

denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment. Before any

medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment

is supported by records duly certified by Doctors/Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds as

found in the impugned order. Having regard to the above lacunae in the earlier Government Order and issuance of subsequent Government Order

including not only the treatment but also the hospital, I am of the view that the petitioner is entitled to claim reimbursement.

For the above reasons, I am of the view that the order dated 03.08.2004 rejecting the request of the petitioner for medical reimbursement

cannot be sustained and the reasons cannot be the basis for denial of such claim. Accordingly, the Writ Petition is allowed and the first respondent

is directed to consider the claim of the petitioner as contained in his Claim dated 19.07.2004 for medical reimbursement on merits and in

accordance with law and without reference to the above three reasons mentioned in the Order dated 03.08.2004 and pass orders within a period

of six weeks from the date of receipt of this order or on production of the same by the petitioner. No costs. Consequently, W.P.M.P. No. 5349 of

2006 is closed.

In view of the categorical pronouncement of this Court in an identical matter, I am of the view, the writ petition deserves to be allowed.

Accordingly, the same is allowed and the second respondent is hereby directed to re-submit the application of the petitioner along with his

recommendation dated 03.07.2002 to the first respondent and the first respondent is directed to pass an order sanctioning the amount towards the

reimbursement as per the rules within a period of four weeks from the date of receipt of a copy of this order. No costs.