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High Court of Judicature at Madras
THE HONOURABLE MR. JUSTICE F.M. IBRAHIM KALIFULLA
V.Palaniammal
Versus
The Secretary to Government, Finance (Salaries) Department, Fort St.George, Chennai-6 & Another
For the Petitioner:C. Prakasam, Advocate.
For the Respondents: V.R. Thangavelu, G.A.
Advancements in medical treatments and the expertise of treating doctors should be considered in interpreting government orders for entitlement to reimbursement.
Headnote:
Mandamus - Tamilnadu Government Employees Health Fund - G.O.Ms.No.400 Finance (Salaries) Department dated 29.08.2000 - G.O.Ms.No.378 dated 110. 2005 - The judgment discusses the classification of treatments under the G.Os., specifically addressing the eligibility for reimbursement of angioplasty and PTCA Stent treatment under the category of Cardiology and Cardio Thoracic Surgery. The court emphasizes the need to interpret government orders in light of advancements in medical treatments and the expertise of treating doctors, ultimately ruling in favor of the petitioner's entitlement to claim reimbursement.
Fact of the Case:
The petitioner, a retired school teacher, sought reimbursement for heart treatment expenses under G.O.Ms.No.400 dated 29.08.2000. The claim was rejected, leading to a writ petition and subsequent amendment seeking disbursement from the Tamil Nadu Government Employees Health Fund.
Finding of the Court:
The court allowed the amendment and considered the subsequent G.O.Ms.No.378 dated 110. 2005, emphasizing the classification of treatments and the equivalence of angioplasty to open heart surgery. The court rejected the respondents' contention that the petitioner was not entitled to claim benefits under the new G.O., ruling in favor of the petitioner's entitlement to reimbursement.
Issues: The main issue was the eligibility of the petitioner for reimbursement of heart treatment expenses under the government orders, specifically addressing the classification of treatments and the effective date of entitlement.
Ratio Decidendi: The court held that advancements in medical treatments and the expertise of treating doctors should be considered in interpreting government orders, ultimately ruling in favor of the petitioner's entitlement to claim reimbursement for the angioplasty treatment.
Final Decision: The court set aside the impugned order and directed the respondents to disburse the fund to the petitioner for the angioplasty operation, allowing the writ petition and closing the connected miscellaneous petitions.
The petitioner seeks for the issuance of Writ of Mandamus to direct the respondents to disburse the fund from Tamilnadu Government Employees Health Fund to the petitioner for the treatment to her heart by applying G.O.Ms.No.400 Finance (Salaries) Department dated 29.08.2000.
2. The petitioner was working as School Teacher and she retired from the service in the year 2003 as Headmistress of Middle School. For her heart ailment, she took treatment in the Apollo Hospital at Chennai wherein she underwent angioplasty on 09.07.2002. The expenses for undergoing the said treatment was stated to be Rs.2,04,359/-. When the petitioner made a claim for reimbursement based on G.O.Ms.No.400 dated 29.08.2000, the same was not considered. The petitioner, therefore, came forward with the present writ petition. Subsequent to the filing of the writ petition, an order came to be passed by the third respondent dated 10.06.2003, rejecting the petitioners claim holding that the same does not found under the categorised treatment as per G.O.Ms.No.400 dated 29.08.2000. The petitioner therefore, filed M.P.No.2 of 2008 seeking for necessary amendment of her prayer challenging the subsequent order dated 10.06.2003 and consequetial, direction for disbursement of the fund from the Tamil Nadu Government Employees Health Fund by applying G.O.Ms.No.400 dated 29.08.2000.
3. Having regard to the facts as narrated above, the prayer of the petitioner for amendment as made in M.P.No.2 of 2008 merits consideration and the amendment is accordingly allowed. When the claim of the petitioner is considered, the subsequent G.O. in G.O.Ms.No.378 dated 110. 2005 deserves to be considered. After referring to all other connected G.Os. including G.O.Ms.No.400 dated 29.08.2000, the State Government have now replaced the earlier Annexures by present Annexure I and II to G.O.Ms.No.378. Annexure I to the said G.O. has classified the various specialised advanced surgery/treatment for which assistance to the pensioners with effect from 01.04.2005 are allowed. In fact, the Hospital namely, Apollo Hospital at Chennai where the petitioner took treatment was stated to have already been approved in the list of approved Hospitals in the earlier G.Os. The claim of the petitioner was rejected on the sole ground that the treatment namely, angioplasty done to her heart did not fall under the category of open heart surgery and therefore, the assistance of reimbursement was not payable.
4. But the learned Government Advocate would contend that though in the present G.O.Ms.No.378 dated 110. 2005 angioplasty and PTCA Stent have been specifically classified as treatments falling under the category of Cardiology and Cardio Thoracic Surgery, since the inclusion of such treatment came to be made as from 01.04.2005, the petitioner was not entitled to claim the said benefit.
5. Having heard Mr.C.Prakasm, learned counsel for the petitioner as well as Mr.V.R.Thangavelu, learned Government Advocate, I am of the view such a stand taken by the respondents cannot be accepted. Once the Hospital which gave treatment to the petitioner has certified that coronary angioplasty with stenting done on the petitioner on 09.07.2002 is equivalent to bypass surgery in order to provide fresh blood supply to the areas, which is supplied by the blocked artery due to advanced technologies it will have to be held that the same would fall well within the classified treatments under the erstwhile G.Os. themselves. The revised detailed classification of the treatments mentioned in G.O.Ms.No.378 dated 110. 2005 by way of clarification can only be construed as classification of the treatment of open heart surgery in different forms. In fact, Annexure I to G.O.Ms.No.378 dated 110. 2005 the Cardiology and Cardio Thoracic Surgery falling under I category as stated as under:
"I CARDIOLOGY AND CARDIO THORACIC SURGERY
1.Open heart surgery including
(a)Caronary By-pass surgery (CABG)
(b)Valve replacement.
(c)Correction
