Point of Law : Medical reimbursement - right to health is an integral part of right to life guaranteed under the Constitution of India and the Government have Constitutional obligation to provide health facilities and bear the expenses incurred by the government servant for the treatment as per the policy of the Government.

JUDGMENT :

The 1st petitioner is working as an Assistant Professor in Catholicate College, Pathanamthitta. On 14.05.2018, the 2nd petitioner, the father of 1st petitioner who is wholly dependent on 1st petitioner sought treatment in General Hospital, Pathanamthitta and was diagnosed with Carcinoma Rectum and was referred to higher center. Accordingly, he was taken to Medical and Surgical Oncology Department of the St. Gregorious Medical Mission Hospital, Pathanamthitta which is a private specialty hospital for Cancer treatment. The Consultant Medical Oncologist opined that the 2nd petitioner has to undergo surgery and accordingly he was operated in the Laparoscopic Department of St. Gregorious Medical Mission Hospital.

2. The Government have issued Ext. P2 G.O.(P) No.10/2016/H&FWD dated 21/01/2016 empanelling certain private hospitals for treatment to facilitate medical reimbursement benefits under the Kerala Government Servants Medical Attendance Rules, 1960 (the 'Rules', for short). The name of St. Gregorious Medical Mission Hospital, Pathanamthitta (hereinafter referred to as the 'Hospital') appears at serial No. 20 of the Annexure to Ext. P2 G.O which provides for the list of private hospitals recognised by the Government for treatment under Rule 8 (3) of the Rules and the Departments recommended include Medical and Surgical Oncology. The relevant portion of the Annexure to Ext. P2 G.O which provides for the list of private hospitals for empanelment is reproduced hereunder :

3. According to the petitioners, the 2nd petitioner was initially admitted in the Hospital between 30.05.2018 and 09.06.2018 and during this period, 1st petitioner had incurred an amount of Rs.1,98,311/- towards treatment of the 2nd petitioner. The 1st petitioner submitted Ext. P3 application seeking reimbursement of Rs. 1,98,311/- with the required proforma issued by the Authorized Medical Attendant and Essentiality Certificate certifying that the medicines prescribed were essential for the recovery of the patient. Out of Rs. 1,98,311/- claimed in Ext. P3, the office of the Director of Health Service found that reimbursement claim for an amount of Rs. 1,26,368/- is admissible.

4. The 2nd petitioner had undergone further treatment in the Hospital between 12/06/2018 and 23/06/2018. During this period, the 1st petitioner incurred an amount of Rs.65,756/- and submitted Ext.P4 application dated 23/11/2018 seeking reimbursement of Rs. 62,756/-. The District Medical Officer (DMO), by Ext.P4 (b), found that, out of the aforesaid amount claimed, an amount of Rs. 23,580/- is admissible and forwarded necessary documents to the Deputy Director of Collegiate Education for approval.

5. The 2nd petitioner was again admitted in the Hospital from 22/08/2018 to 01/09/2018. During this spell, the 1st petitioner incurred an amount Rs. 86,744/- and he submitted Ext. P5 application seeking reimbursement of an amount of Rs. 86,744/-. The 2nd petitioner was further admitted in the Hospital from 04/09/2018 to 19/09/2018 and the 1st petitioner submitted Ext. P6 application seeking reimbursement of an amount of Rs. 1,20,227/-.

6. While so, on 12/06/2020, the Government issued Ext. P7 circular stating that medical reimbursement will not be made unless the treatment was availed in Government recognized private hospital. Based on Ext. P7, the Government issued Ext. P8 communication informing that the claim made by the 1st petitioner cannot be allowed since the department of Laparoscopic surgery at St. Gregorious Medical Mission Hospital was not empanelled under the Rules. Accordingly, by Ext. P9 letter a