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2004 Supreme(Del) 279

High Court Of Delhi
PRITHVI NATH CHOPRA - Appellant
Versus
UNION OF INDIA - Respondent
W.P.(C.) 770 of 2003
Decided On : 04/15/2004

Advocates Appeared:
S.S.Bakshi, TAMALI VAD

Headnote:Medical Claim - Health Care Facility provided by the Central Government Health Services — Reimbursement of — Denial on the ground of dispute over quantification of amount charged — Held that such dispute has to be resolved by the Central Government and the private hospital which was given land on concessional basis among themselves — Directions given for reimbursement of bill raised by the petitioner to full extent.

SANJAY KISHAN KAUL

( 1 ) RULE. With the consent of learned counsel for the parties, the matter is taken up for final disposal.

( 2 ) A welfare State like India is bound to provide the basic requirements of its citizens. Health care facility is an integral part of the same and the Central Government Health Scheme (CGHS) has been propounded for the benefit of the Central Government employees who should not be left without medical care after retirement.

( 3 ) THE petitioner was working as an Under Secretary in the Central Government when he took voluntary retirement on 5. 2. 1979 and is more than 80 years old. The petitioner and his wife Smt. Mohinder Chopra are covered by the CGHS scheme.

( 4 ) IN July, 2001, on certain tests being conducted, Smt. Chopra was diagnosed as suffering from breast cancer and the Medical Officer Incharge of the CGHS Dispensary, Faridabad referred her to the ordinary Surgeon in Dr. RML Hospital. It is stated that the junior attending Surgeon in the said hospital suggested 24. 9. 2001 as the date of operation instead of referring the patient to a cancer specialist and thus the petitioner again approached the Medical Officer Incharge at Faridabad and requested for a reference to a cancer specialist.

( 5 ) SMT. Chopra was referred on 21. 7. 2001 to a Surgeon at the B. K. Hospital, Faridabad who was not available for two days. Due to the fast deteriorating condition of his wife, the petitioner in an emergency took her to the Indraprastha Apollo Hospital which is a registered hospital under the CGHS for treatment of cancer. The nature of urgency was such that the wife of the petitioner was operated the very next day on 23. 7. 2001 for removal of the left cancerous breast and she remained as an Indoor Patient up to 31. 7. 2001.

( 6 ) THE petitioner paid the bills and vide letter dated 30. 8. 2001 submitted the bills of Rs. 1,27,712/- for reimbursement in a prescribed form to the Director General, CGHS for grant of ex-post facto sanction. The petitioner also sought amounts for post operative treatment.

( 7 ) THE petitioner vide letter dated 10. 9. 2001 informed the respondents that the Senior Consultant, Cancer Surgery had suggested chemotherapy and radiotherapy and further bill was submitted on 24. 9. 2001 of Rs. 12,530/ -. Some clarifications were sought by the respondents which were duly clarified by the petitioner.

( 8 ) ON 23. 12. 2001, part payments without detail were made to the petitioner of Rs. 23,589/- and Rs. 7,924/ -. The petitioner sought reimbursement of the balance amount and the details why deductions had been made. The petitioner submitted another bill of Rs. 42,221/- with requisite documents along with letter dated 9. 5. 2002. In July and September, 2002, fresh bills of Rs. 4845/- and Rs. 30,348/- respectively were submitted. The bill dated 26. 7. 2002 was rejected on 28. 11. 2002 and the petitioner was not even paid the balance amount.

( 9 ) THE petitioner has filed the present writ petition seeking quashing of the letter dated 28. 11. 2002 and for reimbursement of the remaining bills.

( 10 ) IN the counter affidavit filed by the respondents as well as during the hearing in court, learned counsel for respondents relied upon a judgment of the Supreme Court in State of Punjab and Ors. v. Ram Lubhaya Bagga and Ors. , (1998) 4 SCC 117. It was held therein that there was right to a healthy life under Articles 21, 41 and 47 of the Constitution of India but the government is justified in limiting the facilities to the extent permitted by its financial resources. It was observed in this respect as under:

"27. Coming back to test the claim of the respondents, the State can neither urge nor say that it has no obligations to provide medical facility. If that were so, it would be ex facie violative of Article 21. Under the new policy, medical facility continues to be given and now an employee is given free choice to get treatment in any private hospital in India but the amount of payment towards reimbur
































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