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Sohan Lal Gupta v/s State of Rajasthan & Others

    Civil Writ Petition No. 3224 of 2008

    Decided On, 19 July 2011

    At, High Court of Rajasthan


    For the Petitioner: Anoop Dhand, Advocate. For the Respondents: Sunita Satyarathi, Addl. Govt. Counsel.

Judgment Text

Ajay Rastogi, J.

1. Instant petition has been filed claiming reimbursement of medical bills having been rejected by respondents vide order dt. 20.2.2007 (Ann. 10) on the premise of Santokba Durlabhji Memorial Hospital, Jaipur ("SDMH") being not approved by State Government.

2. While the petitioner was serving as Superintending Engineer, PHED on 20.7.2006, all of a sudden he had a heart attack; as such his family members took hint to SMS Hospital, Jaipur; and since his condition, as alleged, was deteriorating owing to severe attack having complaint of Hypertension, DM, IHD, unstable angina, he was shifted to SDM Hospital, where after admitting in Intensive Care Unit, he was advised by treating doctors to get immediate Coronary angiography conducted along with cardiac catheterization and angioplasty, and after angiography done on 22.7.2006, its report revealed 99% and 70% blockage in arteries, and taking note whereof, he was surgically operated for angioplasty and stent implantation on 22.7.2006 as is evident from PTCA report and cardiac catheterization report (Anns. I to 3) and was discharged from hospital on 29.7.2006, and incurred expenses for surgical operation (supra) and medicine for a sum of र2,50,598/- - claim for reimbursement when was raised being a member of Rajasthan Civil Services (Medical Attendance) Rules, 2008 ("Medical Rules, 2008") but was rejected vide letter dt. 10.2.2007 Ann. 10) on the premise that SDM Hospital where he got treatment for his heart ailment is not recognized and approved hospital; as such his medical bills are not reimbursable.

3. Counsel for petitioner submits that earlier there was a controversy raised for consideration before this Court as to whether bills furnished by serving/retired personnel after having undergone medical treatment for their ailment in a private hospital being not approved by State Government are reimbursable and to what extent; but after long litigation regarding reimbursement of medical bills and judgments of this Court, the State Government issued a circular on 6.2.2009 and 27.1 1.2009 whereby it has been made clear regarding reimbursement of medical bills pertaining treatment having been taken prior to 16.9.2008 also, if bills are not settled, they will be settled in terms of circulars and list of approved rates having been laid down by State Government vide Circular dt. 16.12.2009 issued pursuant to Rule 4 of Rajasthan Civil Service (Medical Attendant) Rules, 2008 ("Medical Rules, 2008") on the recommendations made by Health Benefit Advisory Committee giving details of treatment packages which the Government is going to reimburse and which has been made applicable to the serving and retired personnel; and as per which the reimbursement is to be made to the employee irrespective of the expenses incurred by him and the rider of the hospital being Government or recognized would not cone in the way for reimbursement.

4. However, according to counsel, only condition stipulated in the Circulars (supra) is that he must proceed for taking treatment only in an emergent situation from a hospital not being recognized and approved by State Govt.

5. Reply to the writ petition has been filed by respondents wherein a stereotype objection has been raised and the State Government maintained its stand that since hospital is not approved, in the absence whereof, medical bills could not be reimbursed.

6. This Court has considered rival contentions of the parties and with their assistance, examined material on record. Medical Attendant Scheme has been examined by this Court in Raghuveer Sharma v. State, 2007 WLC (Raj.) UC 615 followed by Co-ordinate Bench in Gyanendra Kr. Pareek v. State, 2009(4) WLC 95 wherein judgment of Division Bench of this Court in Anil Kr. Surolia v. State, 2005(3) WLC (Raj.) 396 was relied upon and observed ad infra :

"8. ... held that 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 recognized Government institutions. Paras 7 and 8 of the judgment are reproduced as under:

"7. Before we may part with this order, we would like to mention that the 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 institutions.

Reference in this connection may be made to the judgment of the Supreme Court in Sudit Singh v. State of Punjab and others, AIR 1996 SC 1388 and State of Punjab and others v. Mohan Lal Jindal, (2001) 9 SCC 217."

9. In view of above authoritative pronouncement of this Court, it is clear that rejection of medical reimbursement bill of the petitioner on the ground that Santokba Durlabh Ji Hospital was not recognized hospital, is not tenable in the eye of law and impugned order is, therefore, liable - to be quashed and set aside. All that the Government can do is to reimburse the petitioner at the rates that may be applicable in the recognized Government institutions and in this connection, the petitioner has referred clauses (b) and (c) of sub-section (ii) of Section 4B of the Rajasthan State Pensioners Medical Concessions Scheme."

7. This Court would like to record that after judgment of this Court, even if the employee has undertaken treatment from a hospital being not approved and recognized by State Government, still he is entitled for reimbursement of medical bills tinder Medical Attendance Rules, 2008 and there remains nothing to be examined after the Government Circular dt. 6.2.2009 read with Circular dt. 27.11.2009 whereby it has been made clear that for medical attendance and treatment of State Government servants, Rajasthan Civil Services (Medical Attendance) Rules, 2008 have been framed making it effective from 16.9.2008 and such cases pertaining to the period prior to 16.9.2008 are to be allowed to be entitled for reimbursement at the rates prescribed vide Circular dt. 27.1 1.2009.

8. Apart from it, list of approved rates have been prescribed by State Government and reimbursement of medical bills has to be meted out in terms of Circular dt. 16.12.2009 (supra) issued by State Government laying down rates of treatment packages for various diseases for purposes of reimbursement of medical bills of serving and retired personnel. As regards reimbursement of drugs and medicines, tests, investigations, and diagnosis charges, order has been passed by State Government on 6.2.2009.

9. No distinction has been made after issuance of order dt. 21.12.2009 (No. F.1(6)FD (Rules)/2002) which extends the facility of medical attendance and treatment to serving and State Pensioners/family pensioners in private or charitable hospitals, as applicable to State Government servants under Order No. F.6(4)FD (Rules)/03 Pt.I/dt. 27.11.2009 pertaining to the period prior to 16.9.2008.

10. As regards emergent nature owing to sudden heart attack, it appears from material on record that petitioner was suffering from acute. heart ailment having complaint of HT, DM, IHD, unstable angina, and upon his coronary angiography done, its report revealed 99% and 70% blockage of arteries requiring emergent surgical operation for angioplasty and stent implantation and taking note of critical and emergent situation, initially he was taken to SMS Hospital but treatment was not upto their satisfaction, ultimately he was shifted by his family members to nearby SDM Hospital, Jaipur and as per diagnosis report given by treating doctors, emergent nature of his hospitalization in private hospitals cannot be ruled out.

11. In the light

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of what has been taken note of (supra), this Court considers that if the petitioners has taken treatment by emergent hospitalization in a private hospital which was not recognized/approved by State Government, still lie is entitled for reimbursement of medical bills in terms of above Circular dt. 16.12.2009. 12. Consequently, writ petition succeeds and is hereby allowed. Order dt. 20.2.2007 (Ann. 10) is set aside. Respondents are directed to make payment and reimbursement of medical bills raised by petitioner in terns of Rajasthan Civil Service (Medical Attendance) Rules, 2008 read with Circulars dt. 6.2.2009 and 16.12.2009, alongwith interest @ 6% per annum from the date of presentation of medical bills till actual payment whereof. The respondents shall ensure compliance of this order within three months. No order as to costs. Petition allowed.