CWP 9892/06 //1// In the High Court of Judicature for Rajasthan Jaipur Bench ** Civil Writ Petition No.9892/2006 Dev Kr. Sanghi Versus State & Ors. Date of Order ::: 18/02/09 Hon'ble Mr. Justice Ajay Rastogi Mr. Mukesh Agrawal, for petitioner Mr. Chetan Bairwa, Addl. Govt. Counsel, for respondent State Petitioner while serving as Private Secretary in Rajasthan Taxation Tribunal has retried on attaining age of superannuation on 28/02/1998 and is a member of Rajasthan State Pensioners Medical Concession Scheme (“Scheme”) & residing in Jaipur. As alleged in the petition, he felt major heart attack besides chest pain, thereby his family members took him to SMS Hospital where doctors advised him for angiography which was got done on 29/06/2006, as per report (Ann.2) whereof, 80%-90% blockage were found in his heart arteries which required immediate angioplasty but due to fault in Kath Lab. of SMS Hospital, angioplasty was not being done at SMS Hospital, Jaipur as is evident from Ann.3 and that apart, his consulting doctor vide letter dt.04/07/06 (Ann.4) recommended for constitution of Board to refer petitioner for angioplasty out of State of Rajasthan, which resulted in procedural delay and his condition was CWP 9892/06 //2// deteriorating, the petitioner had no option but to get angioplasty at Government Hospital, Udaipur and his attending family member alongwith petitioner reached Udaipur and got angioplasty done on 05/07/06 as is evident from discharge ticket (Ann.5) and after discharge therefrom, submitted medical bills incurred of Rs.2,08,324/- as is evident from letter dt.11/08/06 (Ann.6) but his claim to the extent of Rs.1,10,880/- was finally allowed as is evident from letter dt. 13/09/06 (Ann.7) without disclosing any reason for rejecting balance amount of medical reimbursement claim – against which he submitted representation on 31/10/06 claiming payment of Rs.97444/- and despite legal notice served, nothing has been responded. Hence this petition. Counsel submits that petitioner is a retired Government servant and a member of Rajasthan State Pensioners Medical Concession Scheme and since there was fault in Kath Lab., in SMS Hospital, Jaipur; in a critical condition, he was immediately taken to Govt. Hospital, Udaipur where he was surgically operated for angioplasty; for which the bills were submitted in accordance with medical Scheme; as such non-disclosure of reasons for non-payment and reimbursement of total amount claimed despite the fact that petitioner CWP 9892/06 //3// got angioplasty done at Government Hospital, Udaipur in the circumstances not beyond his control, is arbitrary and non-payment of total amount claimed for medical treatment undertaken in Government hospital, is not sustainable. In reply, respondents have inter-alia averred that since the petitioner undertook treatment of angioplasty surgery at Maharana Bhupal Government Hospital, Udaipur, for which under the Scheme, reimbursement is provided only maximum to Rs.35,000/- in case of PTCA and for treatment of stunt, maximum amount payable is of Rs.75,000/-, which has already been sanctioned and paid to him. I have considered contentions of both the parties and with their assistance, pondered over material on record. This fact remains undisputed that due to condition having been deteriorated of petitioner as is evident from angiography report (Ann.2) and on account of fault at Kath Lab. In SMS Hospital, Jaipur, his consulting doctor vide letter dt.04/07/06 (Ann.4) also recommended for medical Board of referral, he was taken to Government Hospital, Udaipur (supra) in an emergent situation, and was surgically operated for angioplasty on being diagnosed, for which he incurred expenses as is evident from letter CWP 9892/06 //4// (Ann.6). In the reply, respondents averred that against claim of reimbursement sum of Rs.2,08,324/-, an amount of Rs.1,10,880/- has been paid to petitioner vide cheque No.487478 dt. 04/09/2006. Under Pensioner's Scheme, all pensioners as defined in Para 3(2), are entitled to free medical attendance & treatment in Government hospitals being an indoor & outdoor patient as per para 4(i) which reads ad infra:- “4. Free medical attendance & treatment – (i) Free attendance and treatment in Government Hospital/Clinic/Sanitarium/ Institute as indoor and outdoor patient, shall be provided to State Pensioners and his family to the extent hereinafter provided.” Para 4(ii) of the Scheme relates to Government servants who are retired from service on pension contributory provident fund benefits. Para 4A of the Scheme deals with treatment of a disease for which treatment is not available in the Government hospitals of the State. At the same time, Para 4B of the Scheme provides for grant of financial assistance to the extent of specialized treatments taken in Government hospital within the State of Rajasthan on the scales and conditions as applicable to the State Government employees as CWP 9892/06 //5// per R.3 of Rajasthan Civil Services (Medical Attendance) Rules, 1970 (“Rules, 1970”). However, under para 4B of the Scheme, pensioner & members of his family duly covered by para 3(5) are entitled to grant of financial assistance to limited extent of specialized treatment but drugs & medicines are also free of costs available to pensioner under Scheme. In instant case, petitioner submitted medical bills for reimbursement, which included treatment charges of angiography & angioplasty which he took in Government Hospital, Udaipur; and additional bills were raised in respect of medicines and drugs having been purchased by him for his treatment. However, actual payment has not been released and only part payment has been made vide cheque No.487478 dt.04/09/2006 for the specialized treatment taken in Government hospital within State of Rajasthan. Respondents have completely over-looked that specialized treatment charges are fixed; while medicines & drugs are to be purchased by patient or pensioner from market that will certainly be in addition to charges which he has paid for treatment in Government Hospital and that has to be taken care of and looked into by the authority while examining medical bills furnished by petitioner for its reimbursement. CWP 9892/06 //6// . In the reply, respondents have only laid much stress that charges for specialized treatment for PTCA & stunt are covered in terms of para 4B (ii) (b) & (c) of the Scheme and not beyond amount prescribed for reimbursement thereunder. But it goes without saying that as regards medicine & drugs, for which bills were raised by petitioner, they are also available under free medical attendance & treatment to pensioner under para 4B (7) of Scheme, which has completely been overlooked by respondents. No reasonable justification has come forward even in the reply filed by respondents as to why his balance payment towards medical bills were withheld. Taking note of material on record, this Court is of the opinion that medical bills furnished by petitioner have not been examined in terms of Para 4 read with 4B of the Scheme in regard to its reimbursement. Consequently, writ petition succeeds and is hereby allowed. Respondents are directed to consider for reimbursement of medical bills furnished by petitioner taking note of para 4 read with 4B of Scheme and make payment whereof as reimbursable to the petitioner after its due computation alongwith interest @9% per annum from the date of medical bills submitted till actual CWP 9892/06 //7// payment, after adjustment of amount already paid to him. All exercise in compliance of this order, be completed within three months. No costs. (Ajay Rastogi), J. FRB/K.Khatri/p.7/9892CW06Fb18-4ERjAl.doc