M.S. Sullar, Member (J).
1. The challenge in the instant Original Application (O.A.), instituted by applicant, Ram Singh, Postal Assistant (since retired), is to the impugned order dated 16.12.2016 (Annexure A-1), whereby his claim for medical reimbursement, was rejected by the Competent Authority.
2. The matrix of the facts & material, which needs a necessary mention, for the limited purpose, of deciding the core controversy, involved in the instant O.A. and exposited from the record, is that the applicant retired from service on 10.11.2014, as Postal Assistant, from the Post Master Branch, Mansa, after attaining the age of superannuation.
3. According to the applicant, that during the course of his service, he fell seriously ill on 12.7.2014. Taking into consideration his serious condition, his wife removed him in emergency of Dayanand Medical & Hospital (for brevity 'DMC'), Ludhiana. The Doctors, diagnosed him as patient of 'Acute Abdomen with Bleedings Per Rectum for which exploratory Laparotomy for Ceacal Perforation with drainage of Liver abscess with right Hemicolectomy with Ileostomy and Mecus Fistula with reduction and closure of right Inguinal Hernia'. He was operated upon on 13.7.2014. After the initial treatment, he was discharged on 28th July, 2014, subject to follow-up action.
4. The case, set up by the applicant, in brief, in so far as relevant, is that after some time, the applicant again remained admitted in emergency of the DMC, Ludhiana from 5.11.2014 to 6.10.2014, and 26.10.2014 to 9.11.2014. In all, he has spent a total amount of Rs.3,47,629/-, on his treatment, vide Discharge Summary and medical bills, Annexure A-2 and A-3, respectively. He submitted the bills to the competent authority for reimbursement but an objection was raised, as to why he had taken treatment from DMC, Ludhiana, without reference by the Civil Hospital, Mansa, vide letter dated 12.3.2015 (Annexure A-4). He explained the matter, vide letter dated 16.3.2015 (Annexure A-5), that he was seriously ill and his condition deteriorated, therefore, his wife had taken him to DMC, Ludhiana, to save his life. Thereafter, vide letter dated 16.4.2015, the respondent no.4 asked the applicant to submit the emergency certificate, with regard to the medical bills. He submitted the bill and entire information, as desired, vide reply (Annexure A-6). Another objection was raised, and in pursuance thereof, he again submitted the medical certificate and medical bills for his treatment of the pointed disease, Annexure A-8 and A-9. The grievance, projected by the applicant, in his legal notice dated 15.3.2016 (Annexure A-10), was negated vide impugned order dated 16.12.2016 (Annexure A-1), by the competent authority.
5. Aggrieved thereby, the applicant has filed the instant O.A., challenging the impugned order / action of the respondents, on the following grounds:-
(a) That the impugned order dated 16.12.2016 (A-1) passed by respondent No.3 is totally illegal, unconstitutional, arbitrary and thus the impugned order dated 16.12.2016 (A-1) is liable to be set aside by issuing direction to the respondents to reimburse the entire medical claim of the applicant.
(b) That the claim of the applicant regarding medical reimbursement has been illegally rejected only on the ground that he is a resident of VPO Kotli Kalan via Maur, District Mansa and the distance of the nearest Government Hospital from the residence of the applicant is 20 KM, whereas, the distance of Dayanand Medical College & Hospital, Ludhiana is about 125 KM which is a private hospital. The reason given by respondent no. 3 while rejecting the claim of the applicant is totally unjustified, unconstitutional and thus, the applicant is entitled for the reimbursement of his medical claim.
(c) That the issue regarding reimbursement of medical claim has been settled by the Hon’ble Supreme Court of India and Hon’ble Principal Bench of C.A.T. New Delhi. It has been held that obligation is on the part of the Central Government to reimburse the full amount to the applicant. A citizen is more a spectator to what state authority does not decide. If the hospital has charged over and above of the package rate, the respondent is under an obligation to pay to such charges as the petitioner has incurred over package rates at the first instance and if in law state can recover from the hospital concerned, they may do so, but they cannot deny their liability to pay the government employee who is entitled for medical reimbursement.
(d) That the very purpose of the CGHS for its beneficiary members is defeated if the health cover becomes faulty to the extent that the beneficiary get permanent disability due to wrong implants or the risk of death increases many folds due to wrong implementation of the scheme and unrealistic approach. It is the obligation on the part of the respondents to take suitable steps to provide the implants at prescribed rates. The Hon’ble Supreme Courtof India in Surjit Singh Versus State of Punjab has categorically held 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.
(e) That in Daljit Singh Vs. Government of NCT of Delhi and others WP No. 16651 of 2006 while relying upon an earlier decision in case of State of Punjab Vs. Mohan Lal Jindal 2001 (9) SCC 217, wherein the stand of the Government in refusing to reimburse the inpatient charges for treatment in the said hospital was rejected and the Government was held to be under the constitutional obligation to reimburse the expenses since right to heal is an integral to the right of life.
(f) That the concerned Doctor Ashvinda Bains Assistant Professor, Department of Surgery, DMC&H, Ludhiana, vide his letter dated 23.06.2015 (A-8) has given in writing that the applicant was admitted on 12.07.2014 in emergency being a case of Acute Abdomen with bleedings Per Rectum. The second and third operation was part of the first operation. The applicant had given complete information vide Annexure A-6. The applicant thereafter had also removed the objection. The respondents in unjustified manner has rejected the claim of the applicant vide impugned order dated 16.12.2016 (A-1), without taking into consideration that the applicant was operated in emergency and further he was taken to DMC, Ludhiana, to save his life as there was no well equipped Govt. Hospital near her house equivalent to DMC, Ludhiana, which is multispecialty hospital.
(g) That as per various judgments rendered by this Tribunal, coordinate benches, Hon’ble High Court and Hon’ble Supreme Court, the claim for medical reimbursement cannot be denied to a retired employee on the ground that they are not covered under CS (MA ) Rules. It is further pertinent to mention here that Hon’ble Punjab and Haryana High Court in case of Mohinder Singh Vs. Union of India & Others, 2008(2) SCT 539, has categorical held that the claim for medical reimbursement shall not be declined by the department on the ground that a retiree officer is getting fixed medical allowance and was residing in an area where CGHS facilities were not available and as such applicant cannot be denied benefit of medical reimbursement.
6. Levelling a variety of allegations and narrating the sequence of events, in detail, in all, the applicant claims that he is entitled to the reimbursement of the entire amount of the bills in question. On the strength of the aforesaid grounds, the applicant seeks to quash the impugned order / action, and claimed the reimbursement of the amount of Medical Bills, in the manner, indicated hereinabove.
7. On the contrary, the respondents have refuted the claim of the applicant and filed the reply, wherein it was admitted that the applicant had submitted the medical reimbursement bill of DMC, Ludhiana. The claim of the applicant in the legal notice was rejected on the ground that although he is resident of Kotli Kalan, District Mansa, but he has got treatment from DMC, Ludhiana. He should have under gone treatment at Civil Hospital, which is nearer to place of his residence, but he was taken to DMC, Ludhiana. The claim of the applicant was stated to have righty been rejected by the competent authority. In all, according to the respondents, that since the applicant got treatment from DMC, Ludhiana and not from Civil Hospital, Mansa, so he is not entitled to reimbursement of the impugned amount. Instead of reproducing the entire contents of the reply, in toto, and in order to avoid repetition of facts, suffice it to say that virtually acknowledging the factual matrix and reiterating the validity of the impugned order, the respondents have stoutly denied all other allegations and grounds contained in the OA and prayed for its dismissal.
8. Controverting the pleadings of the written statement filed by the respondents and reiterating the grounds contained in the OA, the applicant filed the rejoinder and prayed for the acceptance of the OA. That is how, I am seized of the matter.
9. Having heard the learned counsel for the parties, having gone through the record with their valuable help, and after considering the entire matter, I am of the firm view that the instant OA deserves to be accepted, in the manner and for the reasons, mentioned herein below.
10. Ex facie, the main celebrated arguments of learned counsel for the respondents and the reasons projected by the competent authority to deny the claim of the applicant, in the impugned order that since the applicant got the treatment from DMC, Ludhiana and not from Civil Hospital, Mansa, so he is not entitled to reimbursement of the impugned amount of medical bills, are not only devoid of merit but misplaced as well.
11. At the very outset, it will not be out of place to mention here that the Hon’ble Apex Court has ruled in the case of Kirloskar Brothers Ltd. vs. Employees State Insurance corporation, 1996 (2) SCC 682, that the Constitution envisages the establishment of a welfare State at the federal level as well as at the State level. The primary duty of the Government is to secure the welfare of the people. Providing adequate medical facilities for the people is an essential part of the obligations undertaken by the Government in the welfare State. The Government discharges this obligation by running hospitals and health centers which provide medical care to the person seeking to avail of those facilities. Article 21 imposes an obligation on the State to safeguard the right to life of every person. Preservation of human life is thus of paramount importance. The government hospitals run by the State and the medical officers employed therein are duty bound to extend medical assistance for preserving human life. Failure on the part of a government hospital to provide timely medical treatment to a person in need of such treatment results in violation of his right to life guaranteed under Article 21.
12. Sequelly, in order to give effect to the concept of life with dignity, the instructions of the medical claim have to be harmoniously constructed, in inclusive, purposive, welfare oriented and benevolent manner, in favour of the beneficiary. The Court or the Tribunal have to give preference to such interpretation in a beneficial manner, in favour of the victim of disease, otherwise it may deprive him benefit of medical reimbursement and defeat the very purpose for which these have been issued.
13. Moreover, possibly no one can dispute that, to have a good treatment from a Good Medical Hospital is a step in aid, to live with dignity, which is a fundamental right of a person guaranteed by Constitution of India. Any such contrary instructions or the rules, having the effect of non-reimbursement of medical expenses, are illegal, in-operative, and deserve to be ignored, on the analogy as contemplated under Article 13 of the Constitution of India.
14. At the same time, no one can lose sight of the fact that no person would voluntarily intend to be a patient of such dangerous disease. Such diseases are result of mis-fortune and destiny of a person. It is not the case of the respondents that the applicant has incurred the amount on wasteful expenditure, but indeed, he was extremely compelled, by unfortunate compelling circumstances, to spend the amount on his treatment in the hospital. Only the bearer knows where the shoe pinches. In that eventuality, everyone should render helping hand to solve the misery of such a patient instead of creating hurdles to increase his misery in the garb of technicalities.
15. Not only that, Hon’ble Punjab and Haryana High Court in thecase of Ayoudhia Prasad Duggal Vs. CAT, Chandigarh & Others, CWP No. 22833 of 2015, decided on 20.2.2017, has ruled as under :-
'We are therefore, inclined to concur with the decision of the Delhi High Court in a substantially identical matter being 'Daljit Singh Versus Govt. of N.C.T. Of Delhi & Ors.' WP (C) No.16651/2006 in which, relying upon an earlier decision in the case of 'State of Punjab & Ors. vs. Mohan Lal Jindal' 2001(9) SCC 217 wherein the stand of the Government in refusing to reimburse the in-patient charges for the treatment in the said Hospital was rejected and the Government was held to be under a constitutional obligation to reimburse the expenses since the right to health is an integral to the right of life, it was observed –
'14. The undisputed position that emerges is that a patient is entitled to reimbursement of the full amount of medical expenses and not only at the rates specified in the circular of 1996 and in case respondent No. 2 has charged a higher rate, than could have been charged, it is for respondent No. 1 to settle the matter with respondent No. 2. The petitioner cannot be deprived of the reimbursement.........
4. In view of the above it is no longer res integra that merely because the Government does not revise the package deal amount under the Medical Attendance Rules from time to time a person cannot be denied actual medical costs, and there has to be reimbursement of the actual medical expenses incurred.'
16. What cannot possibly be disputed here is that the applicant suffered a serious disease of 'Acute Abdomen with Bleedings Per Rectum for which exploratory Laparotomy for Ceacal Perforation with drainage of Liver abscess with right Hemicolectomy with Ileostomy and Mecus Fistula with reduction and closure of right Inguinal Hernia'. Keeping in view his serious condition, he was removed to emergency ward of the DMC, Ludhiana, where he was treated by the Doctors. It is not disputed that the applicant has submitted the medical bills amounting to Rs.3,47,629/- for reimbursement, which were rejected, mainly on the ground that he has not got treatment from Civil Hospital, Mansa and directly went to DMC, Ludhiana.
17. Here to me, the Competent Authority has slipped into deep legal error, in this regard. It cannot possibly be disputed here is that the indicated disease of the applicant was very serious in nature. No treatment was possible of such serious disease in Civil Hospital, Mansa. Every person is expected to take such a patient of serious disease to a good Medical Hospital and College, in order to save the life, instead of first completing the formalities of going to a Government Hospital. Moreover, rule 1(1) of the Appendix 8 of Central Services (Medical Attendance) Rules, 1944, also postulates that in emergency cases, involving the serious nature of disease,
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etc. the person/persons on the spot may use their discretion for taking patient for treatment in a private hospital, in case no Government or a re-cognized hospital, for his treatment, is available nearer than the private Hospital. Thus, the stand taken by the respondents is not legally permissible, and they have arbitrarily rejected the claim of the applicant, vide impugned order (Annexure A-1), which cannot legally be sustained, in the obtaining circumstances of the case. As mentioned above, that keeping in view the seriousness of the condition and illness of the applicant, he was rightly removed to Emergency of DMC, Ludhiana, for treatment, and he is entitled to the reimbursement of the amount of the medical bills. 18. Thus, the contrary arguments of the learned counsel for the respondents and the grounds, projected in the impugned order, to deny the medical reimbursement of the applicant, by the Competent Authority, deserve to be repelled, in the present set of circumstances. As such, the ratio of law laid down by Hon’ble ApexCourt and Hon’ble High Court, in the indicated judgments, mutatismutandis, is applicable to the present controversy and is the complete answer to the problem in hand. 19. No other point worth consideration has either been urged or pressed by learned counsel for the applicant. 20. In the light of the aforesaid prismatic reasons, the instant O.A. is hereby accepted. The impugned order (Annexure A-1) is set aside. At the same time, the respondents are directed to reimburse the amount of indicated medical bills, to the applicant, within a period of two months from the date of receipt of certified copy of this order. However, the parties are left to bear their own costs.