The respondent is obligated to reimburse the full amount of medical expenses incurred by the petitioner for specialized treatment at a private hospital, despite the charges exceeding the package rate set by the respondent.

( 1 ) PETITIONER is working as Commander in the National Security Guard. He is entitled to the medical benefits as are available to the Central Government employees under the Central Government Health Scheme for himself and his family members. It is the case of the petitioner that his minor son was diagnosed with heart ailment known as Ventrical Septal Defect at the age of four months and he was admitted to the National Security Guard hospital for assessment of his heart ailment. Thereafter he was referred to Heart Specialist at Safdarjung Hospital who referred him to Escorts Heart Hospital for Ventrical Septal Defect (VSD) involving Open Heart Surgery. The petitioner applied through proper channel and was granted permission by the respondent for necessary surgery and an advance estimate of about Rs. 1,60,000/- by the hospital was prepared. Respondent sanctioned 90% of the said amount, i. e. Rs. 1,44,000/ -. Operation was carried out on 31. 1. 2002 and thereafter the child was discharged. The total amount spent by the petitioner on the said operation came to Rs. 2,09,501/- in the NSG Hospital, Safdarjung Hospital and Escorts Hospital. Petitioner submitted the medical bill along with all requisite certificates to the respondent for reimbursement. However, the respondent only paid a sum of Rs. 1,42,736/- and asked for the refund of the remaining amount of the sum of Rs. 1,44,000/ -. When final representation of the petitioner was rejected from the NSG on 7. 11. 2002, the petitioner filed the present petition.

( 2 ) LEARNED counsel for the petitioner has contended that this Court in V. K. Abbi Vs. Director General of Health Services (CWP No. 6658/2002) decided on 4. 4. 2003, has directed the respondent to reimburse the full amount in similar circumstances. It was contended that against the said order, the respondent filed LPA No. 480/2003 which was also dismissed and the judgment has been implemented.

( 3 ) ON the other hand, learned counsel for the respondent has contended that the claim has been correctly admitted as per the rules and the claim has been allowed at the rates admissible in the case of Central Government employees. It was also contended that State has performed its part of the duty by asking the recognised hospital/diagnostic centres not to charge more than the package rates. In the counter affidavit the stand taken by the respondent is that it is the duty of every citizen including the petitioner to make sure that for getting treatment in these recognised hospital/diagnostic centres no extra is charged in excess of the rates prescribed as the State/govt. does not have unlimited resources in discharging its obligation to ensure the creation and the sustaining of conditions congenial to the good health of all its citizens.

( 4 ) WE have given our careful considerations to the arguments advanced by learned counsel for both the parties. It is not denied that the treatment taken at Escorts Hospital was pursuant to the recommendation made by the Safdarjung Hospital which is a Government hospital. Naturally, when a small child is to be treated for Ventrical Septal Defect involving open heart surgery, a specialised hospital and its services are required. Therefore, once the respondent themselves have recommended the treatment to be taken by the Escorts Hospital, they cannot deny the full reimbursement on the basis that the charges incurred by the petitioner over and above the package rate which the respondent has agreed with the said hospital cannot be reimbursed. At page 12 of the paper-book there is a letter conveying permission by the respondent to the petitioner to undertake specialised treatment from recognised private diagnostic centre. There is another letter of the respondent at page 22-23 of the paper-book in which it has been admitted that Escorts Heart Institute and Research Centre was also one of the hospitals which the petitioner was entitled for treatment. Now we come to the plea which has