High Court Of Delhi
NARENDRA PAL SINGH - Appellant
Versus
UNION OF INDIA - Respondent
Civil Writ 509 of 1998
Decided On : 04/28/1999
Held:
The law is, thereforee, well settled that right to health is an integral part to life and the Government has constitutional obligation to provide the health facilities to its employees or retired employees and in case an employee requires a specialised treatment in an approved hospital it is the duty of the Government to bear or reimburse the expenses. The petitioner in this case had to be operated in an emergency as he suffered a heart problem and in case he had wailed for a prior sanction he might not have survived. thereforee, in this situation it is the duty of the Government to grant ex-post facto sanction and not deny the claim of the petitioner on technical and flimsy grounds. Firstly the Government does not give any proper reasoning to deny the claim of the petitioner in its communication dated 4th December, 1997 and secondly the affidavit of Dr. P.K. Baliar Singh merely states that since the petitioner had taken the treatment in non-C.G.HS. covered area and as per Central Government Health Scheme Orders and instructions as issued by the Government, a pensioner is not entitled to the facilities of reimbursement. These reasons cannot be appreciated in view of the settled position that the petitioner is entitled to take recourse to an emergency treatment in any area if the circumstances and the nature of disease so warrant.
Service Law - Reimbursement of the medical claim — Serious heart problem, emergency treatment required — Waiting for prior sanction would have proved to be fatal — Grant of ex-post facto sanction is warranted not denying the claim on technical and flimsy ground keeping in view of the circumstances and nature of disease — Claim allowed.
( 1 ) THIS petition is directed against the respondents for issuance of a writ. in the nature of certiorari for quashing the Order dated 4th December, 1997 made by the Government of India, Office of the Additional Director, Central Government Health Scheme (Annexure-E to the petition) rejecting the case of the petitioner for reimbursement of the medical claim. The petitioner has further prayed for a writ of mandamus commanding the respondents to reimburse him the amount of Rs. 93,870. 00 with interest at the rate of 24% from the date of discharge from hospital i. e. 22nd February, 1996 to the date of payment. The petitioner retired on 31st July, 1988 as Assistant Engineer (Mechanical) from Government of India, Security Paper Mill, Hoshangabad, M. P.-461005. He was admitted in Mayo Hospital Savli Road, Harni,vadodara-390022 due to severe Chest Pain and Coronary Angiography was conducted on 12th February, 1996. The relevant report is filed as Annexure-A to the writ petition. The petitioner was operated for Coronary Artery By-pass, Grafting (CABG) as per diagnosis-Tripple Vessel Disease (Ischemic Heart Disease) on 14th February, 1996 and he was discharged on 22nd February, 1996. It is stated that the petitioner had to undergo the aforesaid operation, in an emergent situation and the requisite certificate dated 29th February, 1996 issued from Mayo Hospital is filed as Annexufe-C to the writ petition which reads as follows:-
"mayo Hospital (Promoted by GIL Hospitals Ltd.) Regd. Office: Savli Road, Harni, Vadodara-390022, India Phone: 451818/559139. Telex: 0175-6400 MAYO IN Fax: 0265-452249 Gram:-MAYOHOSP Date: 29/02/96. TO WHOMSOEVER IT MAY CONCERN This is to certify that Mr. N. P. Singh was admitted with chest pain on 12/02/96 after which angio was done as he had continuous pain and in view of severe tripple vessel disease he had to be operated on 14/02/96 in emergency. He had an uneventful post operative course. Thanking you, sd/- Dr. Rajesh Desai Cardialthoracic Surgeon. "
( 2 ) THE petitioner incurred a total expenditure of Rs. 93,870. 00. The petitioner submitted his medical reimbursement claim to respondent no. 3 but the said respondent has declined to reimburse on the ground that the treatment was taken in a non-C. G. H. S. covered area. The affidavit filed by Dr. P. K. Baliar Singh, Joint Director (Randh), Central Government Health Scheme, New Delhi has been filed to deny the claim of the petitioner. Paragraph 5 of the said affidavit reads as follows:-
"5. That his claim has been considered by the concerned authorities and was regretted since he had taken the treatment in non-CGHS covered area and as per Central Government Health Scheme orders and instructions issued by Government of India, Ministry of Health and Family Planning (Department of Health) a pensioner is not entitled to the facilities of reimbursement. The respondent is filing said scheme alongwith this affidavit. The relevant provision in the present case is on page 40 of" the said scheme. As per para 17 (iii) of the said scheme (Reimbursement) shall in the case of pensioners be limited to areas covered by the scheme. No reimbursement shall be made when pensioners and members of their families take medical treatment at a place not covered by the scheme unless specifically authorised by the Ministry of Health. Copy of the said scheme is being filed as ANNEXURER-1. "
( 3 ) THE petitioner has admittedly suffered the ailment and required urgent and immediate treatment in an emergency. The plea of the. Government that he has not taken prior sanction for treatment in non-C. G. H. S. Hospital is clearly erroneous and cannot be entertained. Moreover, the law does not require that prior permission has to be taken in such situation where the survival of the person is the prime consideration. It is always open for the Government to grant ex-post facto sanction subject to verification of the claim which has not been denied in the present case. Reference may be
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