CWP NO. 13173 of 2007 1 IN THE HIGH COURT OF PUNJAB AND HARYANA AT CHANDIGARH. CWP NO. 13173 of 2007 Date of Decision:27.8.2008. Paramvir Singh ..........Petitioner. Versus State of Punjab and others. ..........Respondents. CORAM:HON'BLE MR.JUSTICE JASBIR SINGH HON'BLE MR.JUSTICE JASWANT SINGH. Present:Mr.M.S.Balianwali,Advocate for the petitioner. Ms.Charu Tuli,Sr.D.A.G.Punjab for the official respondents. JASWANT SINGH,J. This petition has been filed by the petitioner seeking the quashing of impugned order dated 30.7.2007 (Annexure P-10) issued by the Director, Family and Health Welfare, Punjab, whereby reimbursement of medical expenses has been accorded at lower rates than the actual expenditure. Further challenge has also been laid to the policy dated 13.2.1995 (Annexure P-1) issued by the Government of Punjab, regulating the grant of medical reimbursement. Facts in brief are that the petitioner is working as an Assistant Divisional Manager (Stores) with the Department of Transport, Government of Punjab. His daughter namely Simarroop, soon after birth in the year 1998 was diagnosed as suffering from “Billiary Cirrhosis” and Post CWP NO. 13173 of 2007 2 Graduate Institute of Medical Education & Research, Chandigarh (for short PGI) advised that she needed Liver transplant, which facility was not available in India at that time. The petitioner on account of his financial condition did not go abroad for her treatment, but continued her routine treatment at PGI, since the treatment in abroad was estimated at about one crore rupees. In the year 2006 when she was eight years old, it was again advised by the PGI that in view of her advanced liver disease, she needed liver transplant. The facility was still not available at PGI at that time. In view of the advice, the petitioner contacted a Hospital in Singapore, which was conducting liver transplant and the estimated cost intimated was about Rs.60.80 lacs. The petitioner further found out that liver transplant operations were being conducted at three institutes in India,namely at All India Institute of Medical Sciences, New Delhi (for short AIIMS), Apollo Hospital and Sir Ganga Ram Hospital. It was found that AIIMS had conducted only three transplants and all were unsuccessful and even at Apollo Hospital success rate was very low, with more expenditure. It was at Sir Ganga Ram Hospital that the success rate of the transplant was high with the least expenditure. Accordingly, the petitioner contacted Sir Ganga Ram Hospital and asked for the supply of estimates of the approximate expenditure. The said hospital, vide its letter dated 13.7.2006 (Annexure P/6) provided a package estimate costing Rs.15,50,000/-. In view of the estimate supplied by Sir Ganga Ram Hospital, the petitioner applied to the Government for release of 75% of the advance of the estimates in respect of operation of his daughter. In accordance with the request, the Government of Punjab vide letter dated 8.8.2006 (Annexure P/7) accorded prior CWP NO. 13173 of 2007 3 permission and released a sum of Rs.9,75,000/- as 75% advance towards estimated cost of Rs.15,50,000/- for getting treatment of Ms. Simarroop at the said hospital, on the recommendations of the State Medical Board. Petitioner's daughter Ms. Simarroop got her treatment at Sir Ganga Ram Hospital from 21.7.2006 to 25.7.2006, 26.8.2006 to 29.8.2006, during which the recipient's and donor's evaluation was done and thereafter from 9.9.2006 to 6.11.2006 during which the transplant was done with follow up treatment. The total expenditure bill came about Rs.14,01,624/-. The petitioner submitted his claim for medical reimbursement as per medical certificate (Annexure P/8),which were considered and on the basis of recommendations of the State Medical Board meeting held on 20.12.2006, ex post sanction was accorded for a total amount of Rs.9,66,275/- at AIIMS rate only, as admissible under the policy. Hence the present writ petition. Respondents upon notice filed a reply. It has been stated that as per Medical Reimbursement Policy dated 13.2.1995 (Annexure P/1) permission has been given to its employees and pensioners to get indoor treatment from any recognised private hospital but the reimbursement has to be made at AIIMS New Delhi/ Government rates only. It has further been stated that in the case of the petitioner, as per policy, the admissible rates have been duly paid to the petitioner. It has also been stated that the request of the petitioner for release of 75% advance of the package estimate (Annexure P/6), of the cost to be incurred for liver transplant at Sir Ganga Ram Hospital, was placed before the State Medical Board in its meeting held on 1.8.2006 and the opinion of the Medical Board was that 75% advance be given at AIIMS/ Government rates only. Since at CWP NO. 13173 of 2007 4 that time the AIIMS/Government rates for liver transplant were not available, therefore, keeping in view the urgency of the matter, a sum of Rs.9.75,000/- was released towards such 75% advance demanded. After the submission of medical bills by the petitioner, the State Medical Board in its subsequent meeting held on 20.12.2006 has recommended the payment of medical reimbursement at the rates admissible as per policy. We have heard learned counsel for the parties. Learned counsel for the petitioner has contended that the respondents had released 75% advance to the tune of Rs.9,75,000/- on the estimated cost of Rs.15,50,000/- since no Government rates were available, therefore, they are bound to sanction and release full expenditure incurred on treatment of the daughter of the petitioner, on the principle of estoppel. On the other hand, learned Senior Deputy Advocate General has submitted that the medical reimbursement towards treatment has been done strictly as per policy dated 13.2.1995(Annexure P/1) and further at no point of time any promise was held out to the petitioner for grant of full medical reimbursement for treatment at a private hospital. After giving our thoughtful consideration, we are of the opinion that the action of the respondents in sanctioning the medical reimbursement for the treatment of petitioner's daughter at a private hospital, at AIIMS rate is strictly as per policy and no fault can be found with the same. It is undisputed that at the time of granting prior permission for getting treatment by Ms. Simarroop from Sir Ganga Ram Hospital, no Government rates were prescribed since no liver transplant was being conducted in any Government hospital. Further a careful reading of CWP NO. 13173 of 2007 5 Annexure P/7, whereby 75% advance on the estimated cost of liver transplant at Sir Ganga Ram Hospital to the tune of Rs.15,50,000/-,was sanctioned discloses that Rs. 9,75,000/- given as advance money does not come out to be 75% of Rs.15,50,000/- (as 75% of Rs.15,50,000/- would be Rs. 11,62,500/-). Moreover, this sanction was subject to condition no.2 that this advance for getting treatment from a private hospital according to Government policy shall be limited to 75% of the estimated reimbursable amount. Therefore, the contention being raised by the learned counsel for the petitioner that the respondents are bound by principle of equitable estoppel de hors the policy and on the basis of the factum of prior sanction of 75% of advance on the submitted estimated cost of Rs.15,50,000/- is wholly mis-conceived. It is further not disputed that for treatment at a private hospital, the reimbursement has to be as per reimbursable policy at Government/ AIIMS rate. We further find that AIIMS Delhi was not/is not offering any package for a liver transplant. However, as per letter dated 24.11.2004 (Annexure R/3) issued by AIIMS Delhi, the estimated cost/expenditure for a liver transplant at AIIMS has been estimated for a sum of Rs.6 lacs minus the medicines including special medicines for patients admitted in private wards; post operative maintenance and immunosupressive drugs are to be borne by the patient. In the present case, keeping in view the over all expenditure, the State Medical Board has sanctioned Rs. 9.66,275/- (Annexure P/10), which is much more than the rates prescribed by AIIMS ,Delhi. Therefore, in our considered opinion the petitioner is not entitled to reimbursement at the claimed rate. CWP NO. 13173 of 2007 6 No arguments have been addressed to challenge the validity of the reimbursement policy dated 13.2.1995 (Annexure P/1) In view of this, we find no legal infirmity either in the impugned order dated 30.7.2007 (Annexure P/10) or policy dated 13.2.1995 (Annexure P/1). Hence the present writ petition fails and is hereby dismissed. No costs. (Jaswant Singh) Judge 27.8.2008. (Jasbir Singh) joshi Judge