1 IN THE HIGH COURT OF JUDICATURE FOR RAJASTHAN AT JODHPUR O R D E R S.B. CIVIL WRIT PETITION NO.1494/2006 (Kishan Lal Vs. State of Raj. & Anr.) Date of order : 16.7.2008 P R E S E N T HON'BLE MR. JUSTICE GOPAL KRISHAN VYAS Mr. L.D. Khatri, for the petitioner. Mr. Rameshwar Dave, Dy. Govt. Counsel. Heard learned counsel for the parties. In this writ petition, the petitioner has prayed for directions to the respondents to pay medical claim of the petitioner to the tune of Rs.1,50,025/- along with interest at the rate of 12% per annum from the date of filing application which is 6.9.2002. The petitioner is retired Executive Engineer of respondent Department and getting pension as per rules. The case of the petitioner is that in emergent situation when he was residing at Ahmedabad, 2 all of sudden on 2.8.2002, due to pain in chest he was admitted in Sterling Hospital, Ahmadabad. In that hospital, he was advised by the Doctors that earliest coronary artery bypass grafting surgery is required to be made to save the life and for said purpose, issued a certificate in which approximate expenses were shown as Rs.1,65,000/-. According to the petitioner, in emergent situation, he was operated in the said hospital for bypass surgery and due to said reason, the petitioner was not in position to obtain sanction from the State Government, so also, it is was not possible for him to get reference or permission from the State Government to go for bypass surgery and he was required immediate treatment. Therefore, in emergent situation, he underwent for angiography so also for bypass surgery in the Sterling Hospital, Ahmedabad. The petitioner after bypass surgery filed an application along with medical bills for reimbursement before the respondent No.3 and all the relevant papers and bills were submitted by the petitioner on 6.9.2002. Vide order dated 10.10.2002, the claim of the petitioner was refused on the ground that name of Sterling Hospital, Ahmedabad is not in the list of authorised hospitals as per rules and no medical board has recommended for treatment outside State and some documents are missing as per requirement of para 4A (4) proviso (iii) (iv) and (v) of the Rajasthan 3 Pension Medical Concession Rules. After receiving the said letter of refusal, again all the formalities were completed for medical claim and sent to the respondent No.2 and 3 on 25.10.2002 but no response received from the respondents by the petitioner. Thereafter repeatedly, petitioner is knocking the doors of the respondents by way of sending legal notice through his advocate. However, till today, he has not been reimbursed the medical bills which he has spent for bypass surgery. Learned counsel for the petitioner has invited my attention towards the judgments rendered by Hon'ble Apex Court reported in (2001) 9 SCC 217 (State of Punjab & Ors Vs. Mohan Lal Jindal), JT 1996 (2) SC 28 (Surjit Singh Vs. State of Punjab & Ors.) and the judgment rendered by Hon'ble Division Bench of this Court reported in 2005 (7) RDD 2360 (Raj) (DB) (Kendriya Vidyalaya Sangathan & Ors. Vs. The Central Administrative Tribunal Bench Jodhpur & Anr.) and the judgment reported in 2005 (2) RLR 433 (Anil Kumar Surolia Vs. State of Raj. & Ors.). Learned counsel for the petitioner has also invited the attention of this Court towards the order issued by Finance Department of the State Government dated 19.12.2004, in which, it is provided that if any employee or pensioner took treatment outside the State in emergent situation, then, he will be made medical reimbursement in accordance with the said order. 4 Per contra, learned Dy. Govt. Counsel argued that the case of the petitioner was not referred by any Medical Board of the State and the petitioner went Ahmedabad for treatment without any reference, therefore, the State Government is not under obligation to reimburse the medical bills of the petitioner. Further, it is argued that according to Rules 1970 without any reference the petitioner is not entitled to get any amount for medical treatment, therefore, the petitioner is not entitled for any payment as claimed by him because the said claim is available for the Government servant or pensioner who had taken treatment from the authorized hospital after obtaining the sanction from the Medical Board. Therefore, this writ petition may be dismissed. I have perused all the pleadings of the case. The petitioner is claiming reimbursement of medical bills being retired government employee under Rajasthan State Pensioners Medical Concession Scheme and under the Rules. Upon perusal of record, it is revealed that the petitioner went to Ahmedabad to meet with his relatives in the month of July, 2002 and on 2.8.2002 due to pain in chest, he was admitted in the Sterling Hospital at Ahmedabad where in emergent situation, 5 bypass surgery was performed by the Doctors in which Rs.1,65,000/- was incurred. The case of the petitioner is that in emergent situation to save his life, it was necessary to get medical treatment at Ahmedabad and there was no time to get reference or any opinion of Doctors in the State. Therefore, as per the aforesaid judgments cited by learned counsel for the petitioner, he is entitled for medical reimbursement. I agree with the contention made by learned counsel for the petitioner that due to emergent condition it was not possible for the petitioner to get reference from the Medical Board and in emergent situation, he was operated at Ahmedabad, therefore, in my opinion, the petitioner is entitled for medical reimbursement in view of the judgment rendered by this Court cited by learned counsel for the petitioner, so also now after issuance of the notification on 19.12.2004, the respondents are required to consider the case of the petitioner in the light of the said notification because in emergent situation, the petitioner got treatment at Ahmedabad. The controversy is squarely covered with the judgment of this Court in case of State of Rajasthan & Ors. vs. Surendra Kumar Kalra reported in 2008 (3) RLW 1953 (Raj.) in which Division Bench of this Court has held in para Nos. 14 to 17 as follows : “14. This Court in the case of Anil 6 Kumar Surolia has, thus, relied that in an emergent situation, the government cannot insist upon a government servant to get himself treated at government recognized institution. In our considered view a government servant having suffered a severe cardiac problem or heart attack cannot wait for being taken to a government hospital as for him every second is precious and delay of few minutes in the treatment may be fatal. We find ourselves in agreement with the view of the Division Bench that in the situation like this where a government servant is required to be treated in a emergency, the government cannot insist upon its employee to get himself treated at the government hospital. As has been laid down in the case of Anil Kumar Surolia, the government must reimburse the concerned employee at the rates that may be applicable in the recognized/approved government institutions/hospitals. We concur with this view. 15. In the case of Suman Rakheja vs. State of Haryana and another (2004) 13 Supreme Court Cases 562), the government servant's wife had to undergo treatment in a private hospital which was not recognized/approved at that time. The rejection of the application for reimbursement led to the litigation that ultimately traversed to the Supreme Court. The Supreme Court held that patient was admitted in an emergent condition in the hospital and accordingly, she would be entitled to 100% medical expenses at the AIIMS rates and 75% of the expenditure in 7 excess thereto. The Supreme Court held thus: “4.Counsel for the appellant submitted that in similar case (Annexure P-4) i.e. by the order of the High Court of Punjab and Haryana in Sant Prakash vs. State of Haryana wherein in an emergency case the patient had to be immediately admitted in hospital, the relief has been granted. In the present case also the appellant's husband had to be rushed to the private hospital because he had developed a paralytic stroke on the left side of the body, as there was blood clotting on the right side of the brain and therefore, was admitted in an emergency condition in the hospital. In the present case the discharge certificate also shows that the case was an emergency one. In Sant Prakash case the Division Bench held that the petitioner therein would be entitled to 100% medical expenses at the AIIMS rates and 75% of the expenditure in excess thereto.” 16. That the present respondent was admitted in the Tongiya Hospital in an emergency condition does not seem to be in doubt in view of the undisputed facts. In the circumstances, the State Government ought to have exercised its power under Rule 12 by allowing to the respondent the reimbursement of the medical treatment bill at the rate of approved/recognized government hospital. By not doing so, the government acted unreasonably and unfairly. 17. That the respondent (writ petitioner) is entitled to the reimbursement at the rates applicable in the government recognized hospital is clearly established. However, we find that the Single Judge has directed the reimbursement to the respondent (writ petitioner) as per the bills submitted by him. This direction needs clarification. If the medical bills submitted by the writ petitioner exceeds the rates of the 8 recognized/ approved government institutions/ hospitals, needless to say that his claim shall be restricted to such rates. On the other hand, if medical bills submitted by the writ petitioner are less than the rates that are applicable to the treatment at the recognized/ approved government institutions/hospitals, obviously, the writ petitioner shall be reimbursed all the medical bills as submitted by him.” In this view of the matter, this writ petition is allowed. The respondents are directed to finalize the claim of the petitioner for medical reimbursement as per rates of Government recognized and notified Hospitals as per Scheme and Rules within a period of three months from the date of receipt of certified copy of this order. (GOPAL KRISHAN VYAS), J. arun