CWP 4155/07 //1// In the High Court of Judicature for Rajasthan Jaipur Bench ** Civil Writ Petition No.4155/2007 Murarilal Bansal Versus State & (3) Ors. Date of Order ::: 14/11//08 Hon'ble Mr. Justice Ajay Rastogi Mr. Ravi Chirania, for petitioner Mr. JK Agrawal, Addl. Govt. Advocate, for respondent State Petitioner retired from service holding post of Jt. Director (Agriculture) on attaining age of superannuation on 31/03/2000 and being subscriber of Rajasthan Pensioner's Medical Fund is a life member of Pensioners' Concession. On 12/08/2005, he felt respiratory problem besides chest pain, thereby his family members took him to SMS Hospital Jaipur where as alleged, since he was not properly being responded in an emergent & critical state of his health, inasmuch as there being long waiting list of cardiac surgery patient which might take about 2-4 months for surgery to take place in SMS Hospital, his family members took him to Santokbha Durlabhji Hospital, Jaipur where he was admitted in Intensive Care Unit on 14/08/05 and upon angiography done besides other pathological tests his condition was found deteriorating as there were 99%, 90% & 80% artery blocked, so was diagnosed of severe double vessel coronary artery disease, unstable angina, hyper- CWP 4155/07 //2// tension & diabetes and medically treated for CABG – 4(OPCAB) and LAD and after surgical operation, was discharged from Santobkba Durlabhji Hospital on 16/08/05 & bill of Rs.1,36,136/- was raised. Petitioner submitted bills total medical expenses incurred Rs.1,65,411/- (including for medicines of Rs.29,275/- as is evident from letter dt.15/06/06 (Ann.4) & dt.05/07/06 (Ann.5) which were transmitted by Finance Department to respondent NO.4 vide letter dt.10/07/06 (Ann.6) but despite legal notice served, his claim through medical reimbursement bills for aforesaid amount has not be considered by respondents. Hence this petition. In reply to writ petition, it has been inter-alia averred that petitioner is not entitled to reimbursement of his medical bills on the premise that the patient undertook treatment in private Hospital (supra) which is not recognized & approved by Government. Counsel submits that petitioner is a retired Government servant and a member of Rajasthan State Pensioners Medical Concession Scheme and in a critical condition, when he was not provided proper medical care in Govt. Hospital, he was immediately taken to private Hospital where he was surgically operated; for CWP 4155/07 //3// which the bills which he raised are in accordance with medical Scheme; as such very rejection of bills for reimbursement on the premise that Santokbha Durlabhji Hospital is not recognized/ approved by Government, cannot be sustainable under law. However, 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.). 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 Santokba Durlabhji Hospital (supra) in an emergent situation, and was medically treated and surgically operated for CABG – 4 (OPCAB) & LAD on being diagnosed of severe double vessel coronary artery disease, unstable angina, hyper-tension & diabetes, he was kept as an indoor patient in Santokba Durlabhji Hospital and medically treated for which he incurred expenses as is evident from letters (Ann.4 & 5). In State Vs. Mithulal Gupta (supra) this CWP 4155/07 //4// 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.” CWP 4155/07 //5// In instant case, petitioner took treatment from a hospital in State of Rajasthan, which is not recognised hospital duly approved by Government. Paras 4A of Pensioner medical 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. No provision has been brought to the notice of this Court in regard to cases where treatment of heart 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 4-E of the Scheme, deals with treatment undertaken by member of the Scheme from a hospital/institution 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. In view of what has been observed above, CWP 4155/07 //6// 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. Respondents are directed to make payment of medical bills raised by petitioner in terms of Rule 4E of the Scheme with interest @ 9% p.a., 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.6/4155CW074E-1411Raj.doc