Om Parkash vs State of Haryana and Others

Rajesh Bindal, J.—The petitioner, who retired as Mandi Supervisor from Haryana State Agricultural Marketing Board on 30.11.2009, has filed the present petition impugning the action of the respondents, whereby the claim for reimbursement of medical bill has been rejected on the ground that the treatment was taken from unapproved private hospital. Learned counsel for the petitioner submitted that after retirement, the petitioner is residing at Panipat. On account of intolerable low backache on 11.9.2010, the petitioner rushed to Fortis Hospital, Noida, on account of their expertise in treatment of the disease. He was admitted, remained hospitalized from 12.9.2010 to 17.9.2010 and was operated upon. The petitioner claimed medical reimbursement of Rs. 3,04,158.25 for the aforesaid operation on 4.10.2010. The same was rejected on the ground that Fortis Hospital, Noida is neither a government hospital nor an approved hospital.

Learned counsel for the petitioner submitted that even if the treatment is taken from an unapproved hospital, reimbursement equivalent to the rates of PGIMER, Chandigarh is admissible as per policy in case of an emergency. As there was emergency, the petitioner got treatment from Fortis Hospital, Noida. He is entitled to reimbursement of expenses made on his treatment equivalent to the rates of PGIMER, Chandigarh. In support of his argument, reliance was placed upon a judgment of this Court in C.W.P. No. 10745 of 2007 Smt. Shail Bala Mittal v. The State of Haryana and others, decided on 19.2.2009.

On the other hand, learned counsel for the respondents submitted that in terms of the policy, a certificate is required from the Head of the Department, who is competent to certify the emergency in consultation with the concerned civil surgeon. In the present case, Head of the Department has not certified this to be a case of emergency, hence, the petitioner is not entitled to the relief, prayed for.

After hearing learned counsel for the parties, I find the action of the respondents to be totally arbitrary. The petitioner in the present case was operated upon for spinal stenosis. The procedure note, as recorded in the hospital at the time of operation, is extracted below:

After preliminary preparation a vertial midline incision was given from L3 to S2 spinous process and flaps raised in the subcutaneous plane on either side. Lumbodorsal fasica incised paralled to the midline on either side and muscle split to expose L4/L/S1 facets and transverse processes and pedicle screws inserted (45 x 6 - (2), 40 x 5 - (2), 40 x 45 (2) Depuy). A mid line incision was then given to expose L4-S1 laminae and laminectomy done. Canal was severely stenotic with hypertrophic ligamentum flavum and was adequately decompressed and exiting roots seen. Rods were placed between the pedicle screws followed by graft between the transverse process of L4/L5 and S1. After ensuring hemostasis the wounds were closed in layers over a drain.

The disease, if not treated, could lead to numbness, weakness in legs, paralysis and incontinence (source- Mayoclinic.com).

The complications in surgery of the kind could lead to a deep infection in the surgical wound; a skin infection; blood clots in the deep leg or pelvic veins (deep vein thrombosis), which in rare cases travel to the lungs (pulmonary embolism); an unstable spine (more common after multiple laminectomies are done without using spinal fusion); nerve injury, including weakness, numbness, or paralysis; tears in the fibrous tissue that covers the spinal cord and the nerve near the spinal cord, sometimes requiring a second surgery; difficulty passing urine or loss of bladder or bowel control and death (rare) related to major surgery. If you have diabetes or circulation problems or if you are a smoker, you may be at greater risk for complications (source- WebMD).

Hon''ble the Supreme Court in Surjit Singh Vs. State of Punjab and Others, , while dealing with the case of medical reimbursement, quoted certain passage from Garuda Purana on self preservation of one''s life. Paragraph 11 thereof is extracted below:

It is otherwise important to bear in mind that self preservation of one''s life is the necessary concomitant of the right to life enshrined in Article 21 of the Constitution of India, fundamental in nature, sacred, precious and inviolable. The importance and validity of the duty and right to self preservation has a species in the right of self-defence in criminal law. Centuries ago thinkers of this great land conceived of such right and recognised it. Attention can usefully be drawn to Verses 17, 18, 20 and 22 in Chapter 16 of the Garuda Purana (A dialogue suggested between the Divine and Garuda, the bird) in the words of the Divine:

Medical treatment, especially where the surgeries are to be conducted, is not a matter of luxury which anybody opts without there being a need. In case of an emergent need any person reaches the hospital, where he can get best treatment. At that stage, there is no time to find out or peruse the list of government/approved hospitals, which could enable an employee to get reimbursement of the expenses incurred. While getting himself operated upon, any patient runs the risk of his life. Had there been no emergency, any patient would certainly go to the hospital which is recognised by the Government as in that case, he gets full reimbursement. In case of treatment from government hospital, full reimbursement is allowed. If an employee is treated in an approved hospital, reimbursement on the expenditure incurred for treatment is made at the rates equal to PGIMER, Chandigarh. As against that, no reimbursement is allowed in case of treatment from an unapproved hospital.

The relationship of a doctor and a patient is a matter of confidence and trust. Any patient would like to go to the best doctor available. Even if the petitioner had not gone to any government or any of the approved hospitals and had chosen to get himself treated from an unapproved private hospital, the liberty cannot be left with the Head of the Department to refuse reimbursement, once it is found that the patient had been operated upon. It is not that only medicines are to be taken orally. The rejection of the claim on these hypertechnical grounds, especially in the case of a retired employee who is dependent on pension and certain other benefits granted to him after retirement on account of his satisfactory service career, is totally arbitrary. The beneficial policies cannot be interpreted or kept in water tight compartment. These are to be interpreted liberally considering the facts and circumstances of the case. The fact that the petitioner had been operated upon in Fort is Hospital, Noida for his low backache is not in dispute. Once that is so, the entitlement of the petitioner to reimbursement of the expenses made by him in terms of the rates prescribed by PGIMER, Chandigarh cannot be denied. Accordingly, the action of the respondents in denying medical reimbursement to the petitioner is declared illegal. They are directed to process the claim made by the petitioner as per rates prescribed by PGIMER, Chandigarh. Needful be done within a period of two months and due payment be made to the petitioner.

The petition stands disposed of