The denial of medical reimbursement for a heart transplant due to CGHS guidelines was unconstitutional, emphasizing individual health rights in critical situations.

Judgment :

G.S. Kulkarni, J.

1. Rule, made returnable forthwith. Respondents waive service. By consent of the parties, heard finally.

Preface

2. The case is a peculiar case, namely, of a dispute arising from the reimbursement of expenditure incurred by the petitioner on a serious medical treatment of a “heart transplant”. This medical condition is certainly not a routine affair for the hospitals much less for the Central Government hospitals or those under the Central Government Health Scheme.

3. The petitioner is a senior citizen. He is a pensioner, who obtained a voluntary retirement from the post of Assistant Commissioner, Central Excise and Customs, Pune. This is the second occasion for the petitioner to approach this Court on the cause of action as pursued in this petition.

4. The issue which arises for consideration is whether in the inescapable and pressing situation the petitioner, having undergone a heart transplant at a private hospital, could the petitioner be denied and/or not given full reimbursement of the medical expenses incurred by him for such major treatment. The question is also as to whether the rigors of normal rule of medical reimbursement should make a way for the case to be considered as a special case, for grant of full reimbursement. This, more particularly, as a heart transplant surgery is not walk-in category of surgery. It requires availability of the organ and the specialized transplant facilities and a team of experts to perform the surgery. This is certainly not available or feasible in many hospitals. Also a retired Central Government servant whether can be discouraged and/or forego and/or not have a heart transplant merely because he is likely to face financial difficulties for non-reimbursement of the expenditure which would be incurred, is also a question which needs to be pondered. More particularly considering such situations on the touchstone of the Constitutional guarantee of right to life, which includes right to health and certainly right to avail of treatment, necessary to save one’s life.

5. On such preface, the substantive prayers as made in the petition need to be noted, which reads thus:

A. that this Hon'ble Court be pleased to issue a Writ of Mandamus or a Writ in the nature of Mandamus or any other Writ, order or direction under Article 226 of the Constitution of India directing the Respondents by themselves, their officers and subordinates their officers and subordinates to forthwith sanction and grant reimbursement of Rs. 22,08,440/ with interest thereon at the rate of 9% per cent per annum;

B. that this Hon'ble Court be pleased to issue a writ of Certiorari or a Writ in the nature of Certiorari or any other appropriate Writ or order or direction under Article 226 of the Constitution of India calling upon the records of the Petitioner's case and after going into the legality and validity thereof be pleased to quash and set aside:

i. purported rejection the claim of the Petitioner for full reimbursement of expenses incurred by the Petitioner towards heart transplant by the Respondent No. 5 vide her letter dated 13.04.2022 and ii. Office Memorandum No. S.110011/23/2009-CGHS D.II/Hospital Cell (Part I) dated 28.08.2011 read with CGHS Mumbai Rates for Hospitals - 2010 (Updated on 14th May, 2021);

FACTS

6. The relevant facts are required to be noted:

The petitioner voluntarily retired from Central Excise and Customs, Pune, as an Assistant Commissioner in March 2008 and is receiving pension. He is based