Important Point
New Medical Reimbursement Policy of Punjab Government dated 13.2.1995 restricted by the financial constraints of the State to the rates in AIIMS for reimbursement of treatment expenses in Private Hospitals like Escorts is not violative of Article 21 of the Constitution.

Headnote:(i) New Medical Reimbursement Policy of 13.2.1995 of Punjab State Government-Restriction on total reimbursement of expenses incurred in private hospitals-Challenged as violative of Articles 21 and 47 of Constitution-Allowed by High Court-State’s appeal to Supreme Court by special leave-Preliminary objection that State cannot take up the same instance which has become final in dismissal of earlier SLP filed by State-Whether has any force? (No).
       Held : Before proceeding further we would like to refer to a preliminary objection raised by learned counsel for the respondent that under this new policy when the State Government denied such claim of an employee in circumstances similar to the present case, the said employee filed a writ petition which was allowed by the High Court in the case of Varian Singh v. State of Punjab (1996(4) SLR 177) against the judgment the State filed SLP (C) No. 12954 of 1996 and it was dismissed by this Court on 17th December, 1996. Hence it is contended for the respondent that the State cannot take up the same stand which has become final. We were informed and it is not disputed that the said dismissal of the SLP was not by any reasoned order. Points raised here before us was neither raised nor decided in that SLP by this Court. As this question is likely to come in future, we feel it is necessary to decide and settle it. Hence this preliminary objection raised by the respondent has no force. (Para 12)
       (ii) Constitution of India-Arts. 21 and 47-Fundamental right to live with human dignity and obligation of State to give priority to the health of its citizens-Medical Reimbursement Policy of Punjab Government-Old Policy of 1991 replaced by New Policy of 1995-Claim for treatment of heart ailment in Escorts, a non-Government hospital-Total reimbursement allowable in Old Policy-Now partially withdrawn in New Policy-Whether reasonable? (Yes).
       Held : The right of the State to change its policy from time to time, under the changing circumstances is neither challenged nor could it be. Let us now examine this new policy. Learned senior counsel for the appellants submits that the new policy is more liberal in as much as it gives freedom of choice to every employee to undertake treatment in any private hospital of his own choice anywhere in the country. The only clog is that the reimbursement would be to the level of expenditure as per rates which are fixed by the Director, Health and Family Welfare, Punjab for a similar package treatment or actual expenditure whichever is less. Such rate for a particular treatment will be included in the advice issued by the District/State Medical Board for fixing this. Under the said policy a Committee of Technical Experts is constituted by the Director to finalize the rates of various treatment packages and such rate list shall be made available to the offices of the Civil Surgeons of the State. Under this new policy, it is clear that none has to wait in a queue. One can avail and go to any private hospital anywhere in India. Hence the objection that, even under the new policy in emergency one has to wait in a queue as argued in Surjit Singh case (supra) does not hold good. (Para 22)
       In this regard Mr. Sodhi appearing for the State of Punjab has specifically stated that as per the Director’s decision under the new policy, the present rate admissible to any employee is the same as prevalent in AIIMS. It is also submitted, under the new policy in case of emergency if prior approval for treatment in the private hospital is not obtained, the ex-post-facto sanction can be obtained later from the concerned Board or authority for such medical reimbursement. After due consideration we find these to be reasonable. (Para 23)
       (iii) New Medical Reimbursement Policy of 13.2.95 of Punjab Government-Restriction on full reimbursement on treatment, if incurred in any hospital in India not being a Government hospital in Punjab on account of financial constraints-Whether violates Article 21 of Constitution? (No).
       Held : Learned counsel for the appellant submits that in the Writ Petition filed, the respondent did not specifically challenge the new policy of 1995. If that was done the State would have placed all such material in detail to show that financial strain. We having considered the submission of both the parties, on the aforesaid facts and circumstances, hold that the appellant’s decision to exclude the designated hospital cannot be said to be such as to be violative of Article 21 of the Constitution. No right could be absolute in a welfare State. A man is a social animal. He cannot live without the cooperation of large number of persons. Every article one uses is the contribution of many. Hence every individual right has to give way to the right of public at large. Not every fundamental right under Part III of the Constitution is not absolute and it is to be within permissible reasonable restriction. This principle equally applies when there is any constraint on the health budget on account of financial stringencies. But we do hope that government will give due consideration and priority to the health budget in future and render what is best possible. (Para 33)
       Held consequently : For the aforesaid reasons and findings we uphold government’s new policy dated 13th February, 1995 and further hold it not to be violative of Article 21 of the Constitution of India. (Para 34)
       (iv) Medical reimbursement-Individual cases-In two cases surgery in Escorts was after the introduction of new Policy-High Court allowing full reimbursement-Amount payable reduced according to rates prescribed by AIIMS as per new policy-Appeals allowed. (Para 35)
       (v) Medical reimbursement-Individual cases-In two cases treatment at Escorts after the new Policy-Amount claimed at Escorts rates already paid-No refund on facts and circumstances-In one case treatment at Escorts due to strike at AIIMS-So entitled to reimbursement at Escorts rate as a special case without being treated as a precedent-These appeals are dismissed accordingly-Order accordingly. (Paras 36, 37 & 38)

Judgment

Misra, J.-Leave granted.

2. In these set of appeals arising out of Special leave petitions, the common question which has come up for consideration is the entitlement towards medical expenses of the Punjab Government employees and pensioners as per the relevant rules and the Government policy. In pith and substance, the scale at which their reimbursement is admissible towards their medical expenses incurred in a non-governmental hospital. It is not a new phenomena, such employees have been and are still raising such issue repeatedly with the change of government policy. With the changing scenario, political, social and financial the policy of reimbursement is not static. In the recent past in spate of petitions dealing with the 1991 policy of the State Government this Court settled this principle in the case of Surjit Singh v. State of Punjab & Ors.1 and State of Punjab v. Mahinder Singh Chawla2 . Consequent to the effect of the said and other decisions and their resultant impact on the State exchequer and other factors led the State Government to reconsider its old policy of 1991 by making necessary modifications, deletions through order dated 9.9.94 till it was substituted through a new policy dated 13th February, 1995. All the earlier rulings were based on the aforesaid old policy including the clarification dated 8th October, 1991. The same was partially withdrawn on 9th September, 1994 followed by placing the new policy on 13th February, 1995. In short respondents, grievance is, the claim which was allowed by this Court earlier when such employees were admitted for heart ailment in Escorts a non-governmental hospital, is now being declined which is in contradiction to the said rulings of this Court.

3. In short in SLP (C) No. 13167 respondent is said to have suffered a severe heart attack on 13th March, 1995 and was taken to the Escorts Heart Institute and Research Centre in an emergency. On 27th March he underwent coronary artery bypass graft surgery. Finally he was discharged on 10th April, 1995. The entire expenses incurred for the treatment, surgery, post-operative check up etc. came to Rs. 2,11,758.70. In May, 1996 he has submitted the bill to the government for reimbursement.

4. The appellant’s stand is that as per new policy dated 13th February, 1995 the reimbursement of the medical expenses incurred in any private hospital is only admissible, if for such ailment, treatment is not available in any government hospital, and for this no objection certificate is obtained from the Civil Surgeon or Director of Health Services as the case may be. Respondent’s case was not referred to the Escorts for any treatment by any of the competent authority. For any such claim an employee must obtain no objection certificate from the concerned authority. In cases of emergency if admitted in a private hospital ex-post facto approval could be obtained from the concerned authority of course within the permissible parameters. As the claim relates to surgery conducted after the new policy and the reimbursement amount is claimed on the basis of the bill of the Escorts, the same is, according to appellant not permissible in as much as the Committee of Technical Experts has decided as per the new policy that only rates as prevalent in All India Institute of Medical Sciences, New Delhi, will be paid.

5. The respondents with vehemence challenge this stand and the new policy of the appellant which has come into force on 13.2.95 as the same being violative of Article 21 of the Constitution o India. It is argued this is one of the most sacred fundamental rights given to its citizen. Since right to life is protected under this Article hence refusing to pay the amount spent to save one’s life amounts to the curtailment of such right, hence violative of Article 21. In earlier decisions this Court has said that the right to live does not mean mere survival or animal existence but includes the right to live with human digni

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1998 Supreme(SC) 275

Important PointNew Medical Reimbursement Policy of Punjab Government dated 13.2.1995 res­tricted by the financial constraints of the State to the rates in AIIMS for reimbursement of treatment expenses in Private Hospitals like Escorts is not violative of Article 21 of the Consti­tution.

Cases Referred (6)

Important Point
New Medical Reimbursement Policy of Punjab Government dated 13.2.1995 restricted by the financial constraints of the State to the rates in AIIMS for reimbursement of treatment expenses in Private Hospitals like Escorts is not violative of Article 21 of the Constitution.