CGHS-recognised hospitals deemed recognised under BSNL MRS for cancer treatment; no separate indoor/outdoor bills required for chronic diseases.

ORDER

Per Rameshwar Vyas :

Being aggrieved by non reimbursement of the medical bills for expenditure incurred in treatment of his wife (now deceased), suffering from chronic disease Cancer since 2019, the applicant having retired as SDE/OFC, BSNL, in second round of this litigation has filed this OA after failing to get any relief from the respondents, with prayer to direct the respondents to reimburse the medical expenses to the tune of Rs.20,84,868/-.

2. Facts of the case in brief are as under :-

The applicant superannuated on 31^st March, 2006 from the post of SDE/OFC, BSNL, Jodhpur. After his retirement, he was issued a medical card for medical treatment in respect of himself and his wife Smt. Bhagwati Soni under the provisions of the BSNL MRS Rules. Unfortunately, the wife of applicant Smt. Bhagwati Soni developed life threatening disease i.e. Cancer (Stage-2), requiring immediate treatment. Keeping in view the severity of the disease, the consulting Doctor Sh. Vinay Vyas, attached to Goyal Hospital an empanelled private hospital under the CGHS, treated her as an emergent case. Dr. Vinay Vyas, Cancer Specialist prescribed injections/medicines for the disease to be procured and administered in hospital under constant medical care. It is the case of the applicant that for administration of the above injections/medicines, the wife of the applicant was admitted in the Goyal Hospital from 27.07.2019 to 28.07.2019 and 13.08.2019 to 14.08.2019 and during which the treatment of cancer was provided to her as an indoor patient.

Since the Goyal Hospital was not empanelled by the BSNL, he was advised by his office to take further treatment at the Kamla Nagar Hospital at Jodhpur which was empanelled by the BSNL but was not providing cancer treatment. Since the cancer treatment has to be further taken from the same Doctor, who was apprised of the difficulties for further treatment at Goyal Hospital .He was kind enough to treat his wife at Kamla Nagar Hospital as an indoor patient from 03.09.2019 to 04.09.2019 and 24.09.2019 to 25.09.2019 and 16.10.2019 to 17.10.2019. After treatment during the above period five medical bills for reimbursement of the medical expenses incurred in the treatment were submitted with documents after verification from the Doctor in accordance with rules. Unfortunately, the life of the wife of the applicant could not be saved; she died on 28.11.2019 on account of cancer. The bills submitted by the applicant were duly checked/approved by the Accounts Officer and sanctioned by the competent authority i.e. PGMM NTR, Jaipur (respondent No. 3) which were further submitted to the CGM, NTR, New Delhi (respondent No. 2) for financial approval vide letters dated 14.10.2020 (Annex.A/13) and 17.03.2020 (Annex.A/14).

3. Vide letter dated 11.11.2020 (Annex.A/15) and letter dated 12.03.2021 (Annex.A/16), the respondent No. 2 instead of according sanction for payment, has raised objections to the following effect :

The Finance Wing noted that primarily Patient has taken Injections/Medicines (Keytruda etc.) before hospitalization in both times of hospitalization at different dates. Claimant in this case should take waiver of Outer Limit for Cancer Treatment & then Injections / Medicines can be taken under outdoor Limit approved by CGM, NTR, New Delhi.

As per the Indoor treatment bills of Injections/Medicines outside the period of hospitalization after waiver-off Outdoor Treatment Limit should be submitted separately.

4. The above letters were r