Claim for medical reimbursement cannot be denied based on the technicality of hospital department recognition; actual treatment received takes precedence, affirming the right to health as fundamental under the Constitution.

JUDGMENT

The 1^st petitioner is working as an Assistant Professor in Catholicate College, Pathanamthitta. On 14.05.2018, the 2^nd petitioner, the father of 1^st petitioner who is wholly dependent on 1^st 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 2^nd 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 2^nd petitioner was initially admitted in the Hospital between 30.05.2018 and 09.06.2018 and during this period, 1^st petitioner had incurred an amount of Rs.1,98,311/- towards treatment of the 2^nd petitioner. The 1^st 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 ofÏce of the Director of Health Service found that reimbursement claim for an amount of Rs. 1,26,368/- is admissible.

4. The 2^nd petitioner had undergone further treatment in the Hospital between 12/06/2018 and 23/06/2018. During this period, the 1^st 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 OfÏcer (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 2^nd petitioner was again admitted in the Hospital from 22/08/2018 to 01/09/2018. During this spell, the 1^st petitioner incurred an amount Rs. 86,744/- and he submitted Ext. P5 application seeking reimbursement of an amount of Rs. 86,744/-. The 2^nd petitioner was further admitted in the Hospital from 04/09/2018 to 19/09/2018 and the 1^st 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 1^st petitioner cannot be allowed since the department of Laparoscopic surger