CWP 7825/07 //1// In the High Court of Judicature for Rajasthan Jaipur Bench ** Civil Writ Petition No.7825/2007 Ghanshyam Lal Somani Versus State & (2) Ors. Date of Order ::: 24/11/08 Hon'ble Mr. Justice Ajay Rastogi Mr. Sunil Samdaria, for petitioner Mr. JK Agrawal, Addl. Govt. Advocate, for respondent State Petitioner while working as Personal Assistant in Police Department took voluntary retirement from service on 31/03/1997 and thereafter has been residing at Ajmer. When he went to meet his relative at New Delhi, on 19/02/07, he had a chest pain, thereby his family members & relatives took him to nearby Gangaram Hospital, New Delhi, where he was admitted as indoor patient of unstable angina; as alleged, since his condition was deteriorating, he was diagnosed having coronary artery disease with double vessel 90% & 75% blockade and medically treated for coronary angiography & angioplasty on 20/02/07 as is evident from Ann. 1 & 2 and after surgical operation, was discharged from Gangaram Hospital on 24/02/07 & bill of Rs.2,16,290/- was raised. Petitioner submitted bills of Rs. 2,16,290/- raised by Gangaram Hospital, New Delhi vide application dt.03/04/07 (Ann.6) and his claim CWP 7825/07 //2// through medical reimbursement bills for aforesaid amount was rejected by respondents vide order dt. 30/05/07 (Ann.9) 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 when his condition was deteriorating due to unstable angina, he was immediately taken to nearby private Hospital where he was surgically operated; for which the bills which he raised are in accordance with medical Scheme; as such very rejection of bills for reimbursement on the premise that Gangaram 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 CWP 7825/07 //3// that while petitioner was away from his home town to New Delhi where he had a sudden chest discomfort and was taken to nearby private Gangaram Hsopital being in a critical condition, and his condition became deteriorated, ultimately he was diagnosed of having coronary artery disease with 90% & 75% blockade in his double vessels and in an emergent situation, was operated medically treated for coronary angiography & angioplasty, for which he incurred expenses as raised vide application (Ann.6). 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 CWP 7825/07 //4// 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.” In instant case, petitioner took treatment from a private Gangaram hospital out 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 CWP 7825/07 //5// undertaken by a member of pensioners medical scheme from a hospital out of State of Rajasthan which is not a recognized hospital. 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 medical Board and thus makes him entitlement of payment of medical expenses as per Schedule chart referred to therein. It would be appropriate that in absence of any provisions to the contrary, in such cases, where members of the Scheme undertake treatment from a hospital which is not recognised by the Government, atleast be made entitled to claim reimbursement under para 4-E of the Scheme. Consequently the writ petition succeeds and is hereby allowed. Order impugned dt.30/05/07 (Ann.9) 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% 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.5/7825CW07-4E-2411Del.doc