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2001 Supreme(Guj) 565

Gujarat High Court
Judgename :P.B.MAJMUDAR
LEGAL HEIRS OF PURUSHOTTAM GAJADHAR UPADHYAY - Appellant
Versus
POLICE COMMISSIONER - Respondent
S.C.A. 10087 of 2000
Decided On : 08/07/2001

Advocates Appeared: MAYANK DESAI, Nilesh M.Shah

Headnote:

Petitioners are the heirs of one deceased Government employee deceased was working in the Police department as constable. It is averred in the petition that on got severe chest pain and he was taken to a private Clinic of. Shah and since his condition further deteriorated, he was shifted to Mayo Hospital. Coronary Angiography followed by a Coronary Angioplasty were performed on him. Deceased spent Rs. 98,521. 00 for the said treatment and he, therefore, submitted bills with the relevant material for the purpose of reimbursement of the said amount. However, respondent No. 1, by his letter refused to make any payment on the ground that the deceased was not entitled for any amount. deceased therafter again applied application was also dismissed Subsequently, after making those applications, unfortunately, he died heirs of the deceased employee, therefore, approached this Court by way of this petition, challenging the action of the respondents in not reimbursing the medical expenditure incurred by the deceased for the treatment. It is prayed that the Department should reimburse Rs. 98,521. 00 which is the amount spent by the deceased –Held, facts of the case themselves make it clear that there was no time left for the patient, i. e. the deceased employee, to take prior approval from the employer for the purpose of taking such treatment in non-government hospital. When it is found that the amount was genuinely spent for the said medical treatment, it was absolutely unjust on the part of the respondents to decline the reimbursement of the amount spent by the deceased for such treatment. If this is not a special case for giving reimbursement of medical expenditure, there can be no better case wherein such type of reimbursement can be sanctioned by the State Government. One would not like to sacrifice life by entering into correspondence for getting prior approval for the purpose of securing reimbursement of the amount spent for medical treatment. In all such cases, normally, attempt is made by the patient first to secure good medical treatment and at that time, nobody will be in a proper frame of mind to find out the Rules and Regulations and try to locate the Government hospital. In such cases, therefore, rational, pragmatic and humane approach is required to be taken by the Department before becoming rigid and technical in the matter of deciding the claim of reimbursement of the Government servant, who had undergone such medical treatment –Ordered Accordingly.

P. B. MAJMUDAR, J.

( 1 ) RULE. With the consent of the parties, the matter is taken up for final hearing today.

( 2 ) THE petitioners are the heirs of one Mr. Purushottam Gajadhar Upadhyay, a deceased Government employee. The deceased was working in the Police department as constable. It is averred in the petition that on December 12, 1996, he got severe chest pain and he was taken to a private Clinic of Dr. Rumin B. Shah and since his condition further deteriorated, he was shifted to Mayo Hospital. Coronary Angiography followed by a Coronary Angioplasty were performed on him on January 13, 1997.

( 3 ) THE deceased spent Rs. 98,521. 00 for the said treatment and he, therefore, submitted bills with the relevant material for the purpose of reimbursement of the said amount. However, respondent No. 1, by his letter dated 31st March, 1998, refused to make any payment on the ground that the deceased was not entitled for any amount. The deceased therafter again applied on 8. 6. 1998. That application was also dismissed on 21st December, 1998. Subsequently, after making those applications, unfortunately, he died on 17. 11. 1999. The heirs of the deceased employee, therefore, approached this Court by way of this petition, challenging the action of the respondents in not reimbursing the medical expenditure incurred by the deceased for the treatment. It is prayed that the Department should reimburse Rs. 98,521. 00 which is the amount spent by the deceased.

( 4 ) IN response to the notice issued in this matter, affidavit-in-reply has been filed by the Department. It is the say of the Department that while taking the treatment in Mayo Hospital, the deceased did not take prior approval of the State Government and that the Mayo Hospital is not a recognised private Hospital by the State of Gujarat. It is stated that the Director, Medical Services, by letter dated 31. 3. 1998 opined that reimbursement could not be granted in view of the fact that the same treatment is available at Government Hospital at Vadodara and Ahmedabad and the deceased did not go for treatment either in Vadodara or Ahmedabad. The proposal sent by the office of the deceased employee to the Additional Director, Medical Services, was also rejected and the said decision was intimated to the deceased by letter dated 19. 1. 1999. It is further stated in the affidavit-in-reply that the deceased had taken treatment in a private hospital not recognised by the Government of Gujarat and the employee can take treatment in a private hospital only when the said treatment is not available in the Government hospital and, therefore, the deceased was not entitled for reimbursement of the amount in question.

( 5 ) IT is required to be noted that because of the emergency, the deceased was required to be taken to Mayo Hospital and averment is also made in the petition in this behalf. The petitioners have also produced on record G. R. dated 1st May, 1997, wherein reference is made about granting amount as a special case. It was argued on behalf of the petitioners that even as per the said G. R. at Annexure `a, the deceased who had undergone Coronary Angiography and Coronary Angioplasty would be entitled to Rs. 58,000. 00 as per the amount prescribed on the aforesaid two heads as per the said G. R.

( 6 ) IT is required to be noted that when there is an emergency, normally, the person would like to save his own life and instead of admitting himself or herself at the Government Hospital or instead of wasting time to find out whether such type of treatment is available in Government hospital or not, a person would naturally try to get medical facility at the earliest by approaching the nearest hospital. This is not a case in which the deceased, even though having sufficient time, on his own volition, got himself admitted in the Mayo Hospital. It is not in dispute that the said Mayo hospital is a hospital which is giving treatment for heart ailments. It is also not in dispute that the deceased was





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