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2014 Supreme(Mad) 2851
High Court of Judicature at Madras
D. HARIPARANTHAMAN, J.
M.D. Venugopall
Versus
Director General of Police
W.P. No. 22222 of 2012
Decided On : 28-08-2014
For the Petitioner:S. Ilamvaludhi, Advocate.
For the Respondent: R. Ravichandran, Additional Government Pleader
The right of the patient to choose the treatment, especially when approved and recommended, should be respected, and denial of reimbursement for non-invasive treatment would violate Article 21 of the Constitution of India.
Headnote:
Health Insurance Scheme - Non-Invasive Treatment - G.O. No. 174 - I. CARDIOLOGY AND CARDIO THORACIC SURGERY - (i) Enhanced External Counter Pulsation Therapy (EECP)
Fact of the Case:
The petitioner, a retired government employee and severe cardiac patient, opted for non-invasive treatment (EECP) due to past family history with invasive treatment. The Commissioner of Police recommended reimbursement, but the Director General of Police rejected the request based on a Medical Board report.
Finding of the Court:
The court found that the petitioner's choice of non-invasive treatment was valid, approved under G.O. No. 174, and should be respected under Article 21 of the Constitution of India.
Issues: The main issue was the denial of reimbursement for non-invasive treatment under the Health Insurance Scheme and the Tamil Nadu Police Benevolent Fund.
Ratio Decidendi: The court held that the patient's right to choose treatment, especially when approved and recommended, should be respected, and denial of reimbursement for non-invasive treatment would violate Article 21 of the Constitution of India.
Final Decision: The impugned order was quashed, and the respondent was directed to pay the petitioner the amount of Rs. 90,400/- forthwith.
D. HARIPARANTHAMAN, J.
1. Heard both sides.
2. The petitioner was appointed as Junior Assistant in the respondent Department on 03.06.1981 and retired from service as Office Superintendent in the Office of the Joint Commissioner of Police, South Zone, Chennai on 30.04.2012.
3. The petitioner is a severe Cardiac patient since 2005. The same is not in dispute. It is also not in dispute that the Senior Cardiologists advised him to undergo Angiogram followed by a bypass surgery. But the petitioner was not willing to undergo an invasive treatment since both his father and brother died while performing Angiogram test. Hence, his family members did not opt for Angiogram followed by a by-pass surgery for the petitioner.
4. In these circumstances, the petitioner opted to undergo a non-invasive treatment called EECP (Enhanced External Counter Pulsation Therapy). He approached Oxymed Hospital, which is also an approved Hospital for the aforesaid non-invasive treatment. The Hospital stated that the estimated cost would come around Rs. 1,27,000/-.
5. The Joint Commissioner of Police, Chennai sent a letter dated 13.08.2010 to the General Manager, Star Health and Allied Insurance Co. Limited, Chennai, to which the petitioner was insured, to approve the estimated cost so as to undergo the treatment. But the Star Health and Allied Insurance Co. Limited sent a reply dated 23.08.2010 stating that the said Hospital has been collecting excess amount from the patients covered under the Scheme, who took treatment in the said Hospital and suggested four other Hospitals for the said treatment.
6. It is stated that those Hospitals suggested only invasive treatment for which the petitioner is not agreeable.
7. While so, the petitioner suffered severe neck pain and chest pain and immediately, he got admitted in SAAOL Heart Centre at T. Nagar, on 15.09.2010. He was discharged from the said hospital on 13.11.2010. In the said Hospital, he was treated with 35 sittings of ECP (External Counter Pulsation) and 18 infusions of BCA (Biochemical Angioplasty). After the said noninvasive treatment, the petitioner got relieved from the neck and chest pain. The hospital charged him Rs. 90,400/- for the aforesaid treatment.
8. The Commissioner of Police, sent a letter dated 03.12.2010 to the Director General of Police recommending to sanction Rs. 90,400/- towards cost for the aforesaid non-invasive treatment. The Commissioner of Police recommended to the Director General of Police that the said amount could be paid from the Tamil Nadu Police Benevolent Fund as a special case.
9. On receipt of the aforesaid letter from the Commissioner of Police, the Director General of Police, Chennai directed him to appear before the Medical Board to sanction the amount as recommended by the Commissioner of Police.
10. Accordingly, the petitioner appeared before the Medical Board. After examination of the Medical Board, the Director General of Police, passed an order dated 17.08.2011 rejecting the request of the petitioner for reimbursement of the medical expenses that was recommended by the Commissioner of Police, based on the report of the Medical Board. The report of the Medical Board was also enclosed along with the aforesaid order dated 17.08.2011 of the Director General of Police. The Medical Board, in its report has stated that the treatment taken by the petitioner was unorthodox and post treatment CT showed 60-70% block in RCA.
11. In these circumstances, the petitioner has filed this writ petition to quash the aforesaid order dated 17.08.2011 of the Director General of Police and for a consequential direction to the respondent to pay medical reimbursement of Rs. 90,400/- as per Government Order issued in G.O. No. 174, Finance (Salaries) Department, dated 28.04.2008.
12. A counter affidavit is filed by the respondent reiterating the contentions that are found in the impugned order.
13. Heard both sides.
14. The learned counsel for the petitioner has brought to
