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1995 Supreme(P&H) 865

PUNJAB & HARYANA HIGH COURT
G.S.Singhvi, J.
Surya Pandit, I.A.S.(Retd.)
Versus
State Of Punjab
Civil Writ Petition No. 17139 of 1994,
Decided On : AUGUST 4, 1995

The government cannot limit reimbursement of medical expenses for employees treated at recognized hospitals to the rates of a specific hospital, such as All India Institute of Medical Sciences.

Headnote:

MEDICAL REIMBURSEMENT - PUNJAB CIVIL SERVICES RULES, 1970 - RULE 11.1 - RECOGNIZED HOSPITALS - REIMBURSEMENT OF MEDICAL EXPENSES - GOVERNMENT EMPLOYEE - HEART AILMENT - BYPASS HEART SURGERY - ESCORTS HEART INSTITUTE AND RESEARCH CENTRE, NEW DELHI - ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI - RATES OF REIMBURSEMENT - LEGALITY OF CONDITION RESTRICTING REIMBURSEMENT - RATIO OF SADHU R. PALL V. STATE OF PUNJAB AND K. K. MALHOTRAS CASE (SUPRA) - APPLICABILITY.

Fact of the Case:

Petitioner's husband, a PCS member, underwent bypass heart surgery at Escorts Heart Institute and Research Centre, New Delhi, as recommended by the Medical Board and PGI Chandigarh. Despite sanction for treatment, reimbursement was limited to the rates of All India Institute of Medical Sciences, New Delhi, due to a condition in the sanction letter.

Finding of the Court:

The court held that the condition restricting reimbursement to the rates of All India Institute of Medical Sciences was illegal and arbitrary. The government's recognition of hospitals other than All India Institute of Medical Sciences for employee treatment meant that reimbursement could not be limited to the rates of the latter.

Issues: Whether the condition restricting reimbursement to the rates of All India Institute of Medical Sciences was legal and justified.

Ratio Decidendi: The court relied on the ratio of Sadhu R. Pall v. State of Punjab and K. K. Malhotras case (supra), which held that the government should take a liberal and humanitarian attitude in such matters and that refusing reimbursement for treatment in a recognized hospital was unreasonable, unjust, and arbitrary.

Final Decision: The court allowed the writ petition, quashed the condition restricting reimbursement, and directed the respondents to verify and pay the petitioner's claim for reimbursement of expenses incurred at Escorts Heart Institute and Research Centre, New Delhi, within 3 months.

Judgment

G.S.Singhvi, J.

1. Even after the death of her husband, who died in 1994 after being operated for bypass heart surgery and Miteral valve replacement, the petitioner has not been able to live in peace because she has to discharge the financial burden incurred by her and her late husband for incurring expenditure on his treatment at Escorts Heart Institute and Research Centre, New Delhi.

2. From the record, it is clearly revealed that late Shri Sant Ram Pandit, who was a member of the PCS, was recommended by the Medical Board and the Post Graduate Institute of Medical Education and research Centre at Chandigarh for by pass heart surgery. Late Shri Sant Ram Pandit applied for sanction for his treatment at Escorts Heart Institute and Research Centre New Delhi and the Director, Health and Family Welfare, Punjab, Chandigarh granted sanction vide letter dated 3.2.1994 (Annexure P-2) subject to the condition that reimbursement of expenditure will be made at the rates of All India Institute of Medical Sciences, New Delhi.

3. Late Shri Sant Ram and the petitioner were left with no other option, but to act according to the advice by the Medical Board and the Doctors of PGI and therefore he underwent bypass heart surgery at Escorts Heart Institute and Research Centre, New Delhi on 8.3.1994, but due to post operation infection, Shri Sant Ram Pandit died in the Institute itself on 30.4.1994.

4. After having recovered from the shock of the death of her husband, the petitioner moved the Government for medical reimbursement in respect of expenses incurred for his treatment by her and her husband. She vigorously pursued the case, but could not persuade the authorities to take humanistic view of the matter and this has compelled her to seek redress by moving this Court under Article 226 of the Constitution.

5. The only ground on which the writ petition has been opposed by the respondents is that while granting sanction to medical treatment of late Shri Sant Ram Pandit at Escorts Heart Institute and Research Centre, New Delhi, the Director, Health and Family Welfare, Punjab had made it clear that he would get reimbursement at the rates of All India Institute of Medical Sciences, New Delhi.

6. The argument of Shri Rajesh Gumber, the learned counsel for the petitioner is that Escorts Heart Institute and Research Centre is one of the recognised Hospitals/Institutes where the employees of Punjab and Haryana are entitled to get treatment relating to heart ailment and when the Medical Board and the Doctors at P.G.I. Chandigarh had recommended that Shri Sant Ram Pandit should undergo bypass heart surgery at the Escorts Heart Institute and Research Centre, New Delhi, there was left no option, but to go for bypass surgery and the action of the Director, Health and Family Welfare, Punjab, restricting his reimbursement at the rates of All India Institute of Medical Science is patently illegal and arbitrary. Mr. Gumber further argued that after having recognised certain institutes/hospitals by the State, the Escorts Heart Institute and Research Centre is one of them, for the treatment of heart ailment, the Government cannot limit the reimbursement of medical expenses at the rates of All India Institute of Medical Science. He relied on the decision of this Court in C.W.P. No. 13792 of 1993 (K.K. Malhotra v. State of Punjab), decided on 10.5.1994.

7. Mrs. Charu Tuli, the learned AAG Punjab supported the case of the respondents by arguing that the petitioner is bound by the condition incorporated in the letter of sanction dated 3.2.1994 (Annexure P-2). According to her, having accepted the condition incorporated in the letter of sanction, neither late Shri Sant Ram nor the petitioner could legitimately claim reimbursement of actual medical expenses incurred on his treatment at the escorts Heart Institute and Research Centre, New Delhi.

8. Having given my thoughtful consideration to the matter, I am of the considered opinion that the claim made by the pe



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