Rakesh Kumar Bansal vs State of Rajasthan and Another

H.R. Panwar, J.—By the instant writ petition under Article 226 of the Constitution of India, the petitioner seeks a direction to the respondents to reimburse the medical bills for the treatment of his mother incurring the expenses of Rs. 3,86,430/- as per the bills submitted by him with interest.

The facts and circumstances giving rise to the instant writ petition are that the petitioner, the Member of the Rajasthan Higher Judicial Services, while posted as Additional District Judge, Kota, his mother Smt. Premlata fell ill due to Multiple Brain Aneurysm, however, the petitioner''s mother at the relevant time when she fell ill was at Udaipur. The petitioner''s mother was taken to RNT Medical College and Controller, Associated Group of Hospital, Udaipur for check-up and treatment. The Principal, RNT Medical College and Controller, Associated Group of Hospital, Udaipur by office order Annexure-2 came to the opinion on the basis of the opinion of the Authorized Medical Attendant/Medical Board and Dr. Tarun Kumar Gupta, Asstt. Professor in Neuro Surgery that it is absolutely essential for the recovery of the patient to have specialized treatment/ investigation at Bombay Hospital, Mumbai, which has been recognized for the purpose of Rule 7(3) of the Rajasthan Civil Services (Medical Attendance) Rules, 1970 (for short "the Rules of 1970" hereinafter). It was further opined by the Authorized Attendant/Medical Board that it is unsafe for the patient to travel unattendant and that an attendant is necessary to accompany the patient to the place of the treatment and back. In pursuance of the Government notification dt. 22.03.1985 and the Government circular dt. 06.03.2002, Smt. Premlata was referred to Bombay Hospital, Mumbai for her specialized treatment with one attendant. The petitioner took her mother Smt. Premlata for getting her treated at Bombay Hospital, Mumbai and incurred expenses to the tune of Rs. 3,86,430/- including the travelling expenses for obtaining such treatment and submitted the bills to the respondents for reimbursement, which have not yet been reimbursed. A notice for demand of justice by Annexure-9 dt. 29.03.2006 was served on the respondents before seeking the writ of mandamus to the respondents directing them for making the payment aforesaid. Even after the notice for demand of justice, the respondents failed to reimburse the amount of medical expenses noticed above. Hence this writ petition.

A reply to the writ petition has been filed by the respondent-State stating therein that petitioner''s mother was referred to Bombay Hospital, Mumbai on the request of the petitioner and, therefore, the petitioner is entitled for the reimbursement of the medical claim to the extent of limit of expenses had the patient be treated by All India Institute of Medical Science, New Delhi (for short "the A.I.I.M.S" hereinafter). Be that as it may, even the petitioner''s claim has not been reimbursed even according to the stand taken by the respondent-State.

I have heard learned Counsel for the parties. Carefully gone through the record of the case.

It is contended by learned Counsel for the petitioner that the petitioner''s mother suddenly fell ill and she was taken to the RNT Medical College and Government Hospitals nearest, for the treatment but since such treatment was not available in the hospital of the State Government and was only available at the Bombay Hospital and therefore, the petitioner''s mother was referred to Bombay Hospital, Mumbai by the Medical Board vide Anneuxre-2 and accordingly, the petitioner took her mother to Bombay and got her treated and therefore, now it is not open for the respondents to deny reimbursement of the expenses incurred for the treatment of his mother. Learned Counsel submits that Rule 7 of the Rules of 1970 in clear terms 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 reimbursable treatment-expenses. The Rule 7 of the Rules of 1970 read as under:

Treatment of a disease for which treatment is not available in the State.-(1) 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 recognised by the Government, provided that it is certified by the Principal of Medical College/Director of Medical and Health Services on the basis of opinion of the Authorised Medical Attendant to the effect that the treatment of a particular disease from which the patient is suffering is not 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.

(2) The following charges/expenses shall be reimbursable:

(a) Cost (including Sales Tax) of Allopathic Drugs, Medicines, Vaccines, Sera or other therapeutic substances reimbursable under these rules.

(b) Sums actually paid to the Hospital/Institution on account of medical attendance and treatment including charges for surgical operations and ordinary nursing facility.

(c) Travelling allowance for journey by rail/road from duty point at the station at which the patient falls ill to the place of treatment outside the State and back to a single fare of the class to which his classification entitles him under Rajasthan Travelling Allowance Rules. Such travelling allowance shall also be admissible for an attendant, if the Authorized Medical Attendant certifies in writing that it is unsafe for the patient to travel unattended and that an attendant is necessary to accompany the patient to the place of treatment and back.

(3) The facility of medical attendance and treatment in the type of cases mentioned in Sub-rule (1) can be had at any of Hospitals/institutions mentioned in Appendix 11.

(4) For the purpose of reimbursement, the original receipts issued by such hospital/Institutions and vouchers of medicines etc. Shall be countersigned by the Authorized Medical Attendant of Government Hospital on whose advice the treatment outside the State was undertaken.

Leaned counsel for the petitioner submits that even referring office-order in para 2, it nowhere states that the petitioner''s mother was referred to Bombay Hospital, Mumbai at the request of the petitioner. It was the Authorized Medical Board of the RNT, Medical College and Controller Associated Group of Hospitals, Udaipur, who decided that the proper hospital for the treatment of the petitioner''s mother is Bombay Hospital, Mumbai. According to learned Counsel for the petitioner, the petitioner has never requested for referring his mother for treatment at Bombay Hospital, Mumbai and it was for the Authorized Medical Board to decide as to which place she was to be referred. Learned Counsel also submits that the respondents has not placed on record any such request of the petitioner for referring his mother for treatment to Bombay Hospital, Mumbai.

Learned Deputy Government Counsel for the respondents submits that though Rule 7 of the Rules of 1970 do not provide limit of the expenses to be incurred for the treatment, however, the State Government by its order No. F 16 (3)ME/Gr1/99 dt. 06.03.2002 has made it clear that where treatment of a particular disease from which the patient is suffering, is not available in any Government Hospital in the State, then the case shall be referred to the A.I.I.M.S., New Delhi and if a Government servant wants to refer his case to some other recognized Hospital, then it can be referred on the condition that reimbursement will be made to the limit of expenditure to be incurred in A.I.I.M.S., New Delhi. However, no such circular has been placed on record.

Learned Counsel for the petitioner submits that the Bombay Hospital, Mumbai is the hospital recognized by the State Government under the rules of 1970 vide Appendix 11, which provides the Hospitals/Institutions outside the State recognized for the purpose of reimbursement of medical expenses under Rule 7(3) of the Rules of 1970. In Appendix 11 at serial No. 11, name of the Bombay Hospital, Bombay finds place which has been recognized/approved hospital/institutions outside the State for the purpose of Rule 7(3) of the Rules of 1970.

Sub-rule (3) of Rule 7 provides that the facility of medical attendance and treatment in the type of cases mentioned in Sub-rule (1) can be had at any of Hospitals/ institutions mentioned in Appendix 11 and according to learned Counsel for the petitioner, the petitioner is entitled for treatment expenses of his mother and the travelling expenses for that purpose including the expenses of one attendant as has been referred by the respondents vide office order Annexure-2.

Keeping in view the office order Annexure-2, more particularly, para 2 of the office order that the Authorized Medical Board of the RNT, Medical College and Controller Associated Group of Hospitals, Udaipur categorically opined that it is absolutely essential for the recovery of the patient to have specialized treatment/investigation at Bombay Hospital, Mumbai, which has been recognized for the purpose of Rule 7(3) of the Rules of 1970, in my view, the expenses incurred by the petitioner for getting his mother treated as also to travelling expenses of his mother and one attendant, the petitioner is entitled for reimbursement of the expenses incurred by him. So far as the contention of learned Counsel for the respondent that expenses are to be limited to the expenses incurred, had the petitioner''s mother be treated at the A.I.I.M.S. and expenses thereon, in my view, no such material has been placed on record that the petitioner''s mother has been referred to A.I.I.M.S, even otherwise, looking to the peculiar facts and circumstances of the case, when the respondents failed to establish that the petitioner''s mother was referred to the Bombay Hospital at the request of petitioner. In my view, the petitioner is entitled for reimbursement of the expenses claimed for.

Consequently, the writ petition is allowed, the respondents are directed to reimburse the amount of medical bills submitted by the petitioner for the treatment expenses of his mother and the travelling expenses for that purpose including the expenses of one attendant as payable under Rule 7(2) of the Rules of 1970. There shall be no order as to costs. Stay petition stands disposed of.