CW 14390/08 //1// In the High Court of Judicature for Rajasthan Jaipur Bench ** Civil Writ Petition No.14390/2008 Manak Chand Kothari Versus State & (2) Ors. Date of Order ::: 08/09/2010 Hon'ble Mr. Justice Ajay Rastogi Mr. Manak Chand Kothari, petitioner in person None, for respondent. Petitioner appeared in person and submits that the reply has already been filed on behalf of respondents and he is a retired personnel, his grievance may be redressed. Instant petition has been filed with the grievance that medical expenses incurred by petitioner for treatment undertaken in Santokba Durlabhji Hospital, Jaipur are not being reimbursed by respondents, despite being member of the Rajasthan State Pensioner Medical Concession Scheme; however, declined vide order dt.16/04/2008 (Ann.4) on the premise that Santokba Durlabhji Hospital is not an approved hospital from the Government. Petitioner while holding the post of Office Assistant in the Office of Deputy Director Education (Boys) Kekri (Ajmer) retired from service on 30/04/1994 and is a member of Raj. State Pensioner's Medical Concessional Scheme. Case set up by petitioner is that on 09/10/2006 he all of a sudden fell sick CW 14390/08 //2// deteriorating his physical health; as such he was taken by his family members to Medical Officer, Government Hospital, Kekri who advised him to go to Jaipur and his family members taking note of danger to his life due to delay being caused in treatment in Govt. Hospital, got him admitted in emergency ward of Santokba Durlabhji Memorial Hospital Jaipur on 10/10/2006 in a critical state of his condition as he had a severe chest pain and on having found in tremendous distress due to severe chest pain was admitted in intensive care unit and for which ultimately on expert medical opinion, he was advised to get bye-pass surgery of his artery which was undergone by Cardiologist on 17/10/2006 and discharged from Hospital on 29/10/2006 and incurred medical expenses of treatment (supra) to the tune Rs.1,61,758 as prayed for in writ petition and claimed for reimbursement, which was declined vide letter dt.16/04/2008 (Ann.6). Petitioner submits that because of emergent & critical situation of petitioner, his family members took him to Intensive Care Unit of Santokba Durlabhiji Hospital where immediately medical treatment for artery blockage for which bye-pass surgical operation was undergone in order to save his life, which resulted in incurring expenses as per medical CW 14390/08 //3// bills claimed for reimbursement submitted to respondents; as such in light of Pensioner's Medical Scheme, medical bills are required to be reimbursed in his favour and very rejection of bills for reimbursement on the premise that SDM Hospital is not Government recognized/ approved hospital, cannot be sustainable under law. However, in the reply the respondents averred that since petitioner has not been 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.). I have considered contentions of both the parties and pondered over material on record. Indisputably, petitioner is a member and entitled for reimbursement of medical expenses/treatment under Pensioner's Medical Concession Scheme. This fact remains undisputed that the petitioner was firstly taken to Govt. Hospital, Kekri in a critical condition, but there being delay in treatment and his health was deteriorating due to severe chest pain, ultimately he was shifted to S.D.M. Hospital Jaipur (supra) in an emergent situation, and was medically treated for artery blockage. CW 14390/08 //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 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.” CW 14390/08 //5// In instant case, the petitioner took treatment from a hospital in State of Rajasthan, which was not recognised & approved hospital by Government at the relevant time. Paras 4A of Pensioner medical scheme takes 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. No provision has been brought to the notice of this Court in regard to cases where treatment of dengue ailment has been undertaken by a member of pensioners medical scheme from a hospital within State of Rajasthan which is not a recognized hospital. At the same time, Para 4E of the Scheme, deals with treatment undertaken by member of the Scheme from a hospital not recognised by Govt. Thus, this Court considers it proper that in such cases, where the member has taken treatment from a hospital which is not recognised by Government within State of Rajasthan shall also be entitled to claim reimbursement under para 4-E of the Scheme. It has also been brought to the notice CW 14390/08 //6// of this Court that vide notification No.F.6(4) FD (Rules)/2003 dt.15/02/2010, State Government included three hospitals as “approved Hospitals” as defined in Rule 3(7) of Rajasthan Civil Services (Medical Attendance) Rules, 2008 in the Appendix I thereof, - 1. Santokba Durlabhji Memorial Hospital, Jaipur; 2. SK Soni Hospital, Jaipur 3. Geesibai Memorial Mittal Hospital & Research Centre, Ajmer In view of what has been observed above, instant petitioner is entitled for reimbursement of medical bills furnished by him, in terms of Rule 4-E of the Scheme. Consequently the writ petition succeeds and is hereby allowed. Order dt.16/04/2008 (Ann.6) is quashed & set aside. Respondents are directed to make payment of medical bills raised in terms of Rule 4E of the Scheme with interest @9% per annum from the date of presentation of bills till actual payment. The respondents may ensure compliance of this order within three months. No order as to costs. (Ajay Rastogi), J. K.Khatri/p.6/ 14390CW2008Sep8MedRmbRetrd.doc