IN THE HIGH COURT OF GAUHATI
Michael Zothankhuma, J.
Lily Mazumdar - Petitioner
Versus
State of Assam and Others - Respondents
WP(C)No 4492 of 2018
Decided On : 05-03-2021
Assam Medical Attendance Rules, 2008 – Rule 19(ii), 6(c) – Reimbursement – Petitioner's prayer is for a direction to be issued to the respondents to grant ex post facto approval for the treatment given to the petitioner's husband at hospital, which is not a Govt. approved referral/empanelled hospital and for reimbursement of the medical expenses incurred by petitioner for treatment of her husband who eventually died in the hospital – Held, Fact that the petitioner's-husband had been admitted to Dispur Hospital due to acute medical emergency, due to which he succumbed 12 days later, this court is of the view that as there was no time to apply for approval from the authority to have the petitioner's-husband admitted to a non-referral/empanelled hospital – Keeping in view the facts and circumstances of the case and the law laid down by this court and the Apex Court, this court is of the view that the medical expenses incurred for treating the petitioner's-husband cannot be denied by the respondents. Accordingly the respondents are directed to re-consider the case of the petitioner, by granting ex-post facto approval for the treatment given to the petitioner's-husband at Hospital and thereafter pay/give medical reimbursement to the petitioner on due verification – Entire exercise should be concluded within a period of 3 months from the date of receipt of a copy of this order – Writ petition is accordingly disposed of.
ORDER :
1. Heard Mr. M. Mahanta, learned counsel for the petitioner. Also heard Mr. A. Phukan, learned counsel for the respondent Nos. 1 and 2 and Mr- D. Upamanyu, learned counsel for the respondent Nos. 3 and 4.
2. The petitioner's prayer is for a direction to be issued to the respondents to grant ex post facto approval for the treatment given to the petitioner's husband at Dispur Hospital at Guwahati, which is not a Govt. approved referral/empanelled hospital and for reimbursement of the medical expenses incurred by the petitioner for treatment of her husband who eventually died in the hospital.
3. The petitioner's case in brief is that due to a medical emergency, which necessitated the immediate hospitalization and treatment of the petitioner's-husband, the petitioner's-husband was admitted to Dispur Hospital on 3.11.2016, as it happened to be the nearest hospital from the residence of the petitioner. The petitioner's-husband was put on ventilator and eventually expired in the hospital on 15.11.2016, while undergoing treatment. The petitioner approached the authorities for reimbursement of the medical expenses incurred in the treatment of her husband which amounted to Rs. 2,95,500. However, the respondent-authorities rejected the claim of the petitioner on the ground that no approval had been given for treatment of the petitioner's-husband in a non-empanelled hospital and that medical reimbursement could only be considered if the treatment was undertaken in an empanelled hospital, recognized by the Government of Assam.
4. The petitioner's counsel submits that the petitioner's-husband was working as Sr. Accounts Assistant in the Secretariat (Civil) Department, Government of Assam prior to his retirement. He submits that in terms of the Notification dated 15.11.2008 issued by the Family & Health Welfare Department, Government of Assam, pensioners are entitled to medical reimbursement. He also submits that there being an acute medical emergency, there was no time to find out which hospital was empanelled and recognized by the Government of Assam, to which the petitioner's-husband could have been admitted. Also, there was no time to seek approval for treating the petitioner's-husband in a non-empanelled hospital. As such, the petitioner's-husband was admitted to the nearest hospital to save his life. He submits that a direction should be issued to the authorities to reimburse the medical expenses incurred on the petitioner's-husband after due verification of the medical bills and by giving ex post facto approval for the treatment given to the petitioner's- husband in Dispur Hospital.
5. Mr. A. Phukan, learned counsel for the respondent Nos. 1 and 2 and Mr. D. Upamanyu, learned counsel for the respondent Nos. 3 and 4 submit that medical reimbursement can be availed of only if the patient is admitted to an empanelled hospital recognized by the Government of Assam. As the petitioner's-husband was not admitted to an empanelled hospital and no approval had been given by the Government to have the petitioner's-husband admitted to Dispur Hospital, the petitioner's medical bill cannot be reimbursed.
6. I have heard the counsels for the parties.
7. The admitted facts of the case is that the petitioner's-husband was admitted to Dispur Hospital on 3.11.2016 and he expired in the hospital on 15.11.2016, while undergoing treatment. The fact that the petitioner's - husband was having a medical emergency is apparent, as he died while undergoing medical treatment.
8. In the case of Uttam Das v. State of Assam, (2015) 2 Gau LT 197, this court was seized of a similar case, wherein the petitioner who was in a very critical condition was admitted to the nearest hospital which was not an empanelled hospital recognized by the Government of Assam. This court held that in a case of acute medical emergency, necessitating immediate hospitalisation of patient, the Medical Referral Board may not have the occasion to examine the claim of the patient for referral t
Point of Law : Rule 6 (c) of the Assam Medical Attendance Rules, 2008 visualises consideration of the claim made by a patient for medical reimbursement after he obtains treatment without referral.
In emergency medical situations, full reimbursement of medical expenses is mandated regardless of any imposed ceiling limits, emphasizing the right to timely medical treatment.
Point of Law : Wherein Government servant concerned had to be admitted to hospital in an emergency condition held that medical expenses incurred would have to be reimbursed as per entitlement in term....
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