CWP 9503/06 //1// In the High Court of Judicature for Rajasthan Jaipur Bench ** Civil Writ Petition No.9503/2006 Dr. KL Pokarna Versus State & Anr. . Date of Order ::: 13/01/09 Hon'ble Mr. Justice Ajay Rastogi Mr. Sudesh Bansal, for petitioner Mr. JK Agrawal, Addl. Govt. Counsel, for respondent State Petitioner retired while serving as Dy. Director in Medical & Health Department on attaining age of superannuation and is a member Rajasthan Pensioner's Medical Concession Scheme and residing in Jaipur. As alleged in the petition, during his visit to New Delhi, on 21/05/06, he felt major heart attack besides chest pain, thereby his family members took him to Escorts Heart Institute & Research Centre, New Delhi and on account of he being in a critical state of his health, he was admitted in Intensive Care Unit at aforesaid Escorts Heart Institute and cardiac heart surgery was operated on 24/05/06 and after discharge therefrom on 29/05//06, submitted medical bills incurred of Rs.2,19,806/- as is evident from letter (Ann.4) but his claim to the extent of Rs.48,000/- was finally allowed as is evident from letter dt.14/11/06 (Ann.5). Hence this petition. Counsel submits that petitioner is a CWP 9503/06 //2// retired Government servant and a member of Rajasthan State Pensioners Medical Concession Scheme and in a critical condition, he was immediately taken to private Hospital where he was surgically operated; for which the bills were submitted in accordance with medical Scheme; as such very rejection of bills for reimbursement of total amount claimed on the premise that Escorts Heart Institute is not recognized/approved by Government, cannot be sustainable under law. In reply, respondents have inter-alia averred that the medical treatment of petitioner was available in SMS Hospital and even if he was in New Delhi, where he felt of heart ailment, according to para 4-E of the Scheme, there is a provision to reimburse expenses incurred of treatment in a General Ward of All India Institute of Medical Sciences only to the extent of 80% or Rs.48,000/- whichever is less, which has already been sanctioned and paid to him. Counsel for respondents submits that since petitioner has not been operated and medically treated in recognized hospital, is not entitled for medical reimbursement and placed reliance upon DB decision in State of Rajasthan Vs. Mithulal Gupta (Special Appeal (Writ) 858/07 decided on 24/03/08 (Per Hon. R.M.Lodha, J.). CWP 9503/06 //3// I have considered contentions of both the parties and with their assistance, pondered over material on record. This fact remain undisputed that because of his condition having been deteriorated, he was taken to Escorts Heart Institute New Delhi (supra) in an emergent situation, and was surgically operated for CABG on being diagnosed, for which he incurred expenses as is evident from letter (Ann.4). In State Vs. Mithulal Gupta (supra) this Court while dealing with such like controversy and taking note of Para 4E of Pensioners' Medical Scheme, observed ad infra: “11. The Counsel for the respondent then submitted that in any case the petitioner was entitled to the reimbursement to the extent of Rs.1,20,000/- as per the then existing rule 4B. Rule 4B provides the scale of assistance to the extent of 80% of hospital expenses or Rs. 1,20,000/- which is less in the case of bye-pass surgery if the treatment is taken in a Government hospital within the State of Rajasthan. The petitioner did not choose to avail of the specialised treatment in SMS Medical College and Hospital although angiography was done there but instead without any reference from that hospital went to Escort Hospital, New Delhi on his own. Having CWP 9503/06 //4// not chosen to have the specialisted treatment in a Government hospital within the State of Rajasthan, the scale of assistance provided in the para 4B of the Rules for treatment in such hospitals cannot be applied. The case of petitioner is covered by para 4E of the Scheme and according to that provision, scale of assistance is limited to Rs.44,000/- being 80% of general award charges of All India Institute of medical Sciences, New Delhi.” In instant case, petitioner took treatment from a hospital in Escorts Heart Institute, which is not recognised hospital at New Delhi duly approved by Government. Paras 4A of Pensioner medical concession scheme take note of treatment of disease not available in Government Hospital in the State of Rajasthan and so also para 4B is in respect of specialised treatment taken in Government hospital within State of Rajasthan. Para 4G deals with treatment of disease other than heart ailment in recognised hospital outside the State being entitled to AIIMS as per rates prescribed therein. At the same time, Para 4-E(a) & (b) of the Scheme deals with treatment of heart ailment in recognised hospital outside the State (with or without the recommendation of the of the medical Board and thus makes him CWP 9503/06 //5// entitlement for payment of medical expenses as per Schedule chart referred to therein. Escorts Heart Institute, New Delhi is not a hospital being recognised & approved by State Government, and it is not the case of petitioner as to what he is entitled in terms of para 4E has not been paid to him; as such petitioner is only entitled for reimbursement in proportion to the treatment at AIIMS New Delhi to the extent of 80% or Rs.48,000/- whichever is less, in terms of para 4E of the Scheme, which has already been paid to him as is evident from letter dt.14/11/06 (Ann.5) and what has been actually incurred by petitioner is not entitled to be reimbursed having not fallen within Scheme under which he claimed reimbursement. Consequently, writ petition fails and is hereby dismissed. No order as to costs. (Ajay Rastogi), J. K.Khatri/p.5/9503CW064E-13JnRajDs.doc