IN THE HIGH COURT OF KERALA AT ERNAKULAM PRESENT : THE HONOURABLE MR. JUSTICE P.R.RAMACHANDRA MENON MONDAY, THE 1ST AUGUST 2011 / 10TH SRAVANA 1933 WP(C).No. 25293 of 2003(J) -------------------------- PETITIONER: --------------- SMT. O..A RUKIYA, AGED 41 YEARS, W/O LATE T.K. SIDHIQUE, (U.D. CLERK, ERNAKULAM GOVERNMENT PRESS), FLAT NO. 2 A, 10/112, N.G.O. QUARTERS, COCHIN - 21 BY ADV. MR. P.K.IBRAHIM MRS. SHIBI RESPONDENTS: --------------- 1. THE STATE OF KERALA, REPRESENTED BY THE SECRETARY, HIGHER EDUCATION (H) DEPARTMENT, THIRUVANANTHAPURAM. 2. THE DIRECTOR OF PRINTING, GOVERNMENT CENTRAL PRESS, THIRUVANANTHAPURAM BY GOVERNMENT PLEADER MR. M.H. HANIL KUMAR THIS WRIT PETITION (CIVIL) HAVING BEEN FINALLY HEARD ON 01/08/2011, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING: W.P.(c) NO. 25293 OF 2003 APPENDIX PETITIONER'S EXHIBITS : EXT. P1 : TRUE COPY OF THE GOVERNMENT ORDER NO. G.O. (Rt) NO. 1461/99/H.Edn. DATED 14.12.1999 EXT. P2 : TRUE COPY OF THE COMMUNICATION NO. MH2 - 11957/2001/DHS DATED 01.03.2001 OF THE SECOND RESPONDENT. EXT. P3 : TRUE COPY OF THE COMMUNICATION NO. CA 44/01/DME DATED 22.11.2001 FROM THE DIRECTORATE OF MEDICAL EDUCATION TO THE PETITIONER. EXT. P4 : TRUE COPY OF THE GOVERNMENT ORDER NO. G.O. (RT) NO. 321/02/H.EdN. DATED 23.03.2002 EXT. P5 : PHOTOCOPY OF THE LETTER NO. 37695/99/A15 DATED 07.05.2002 FROM THE 2ND RESPONDENT TO THE PETITIONER. EXT.P6 : PHOTOCOPY OF THE REPRESENTATION DATED 12.07.2002 FROM THE PETITIONER BEFORE HON'BLE CHIEF MINISTER. EXT. P7 : TRUE COPY OF THE COMMUNICATION NO. 19404/H3/03/H.Edn. DATED 11.02.2003 FROM THE 1ST RESPONDENT TO THE PETITIONER. EXT. P8 : PHOTOCOPY OF THE LIST OF REIMBURSABLE ALLOPATHIC MEDICINE AS APPROPVED IN OGVERNMENT ORDER NO. G. O. (P) NO. 307/2000/H&FWD DATED 23.11.2000 EXT. P9 (a) :PHOTOCOPY OF THE CLAIM APPLICATION AND ITS ANNEXURES RETURNED BY THE RESPODNENTS REFUSING REIMBURSEMENT. EXT P9 (b) : PHOTOCOPY OF THE CLAIM APPLICATION AND ITS ANNEXURES RETURNED BY THE RESPONDENTS REFUSING REIMBURSEMENT. /TRUE COPY/ P.A. TO JUDGE P.R. RAMACHANDRA MENON J. ~~~~~~~~~~~~~~~~~~~~~~~ W.P (C) No . 25293 of 2003 ~~~~~~~~~~~~~~~~~~~~~~~ Dated, this the 1st August , 2011 JUDGMENT This matter involves the claim for reimbursement of the medical bills towards the expenses incurred by the petitioner in connection with the treatment of her minor son, who is suffering from a disease known as 'Growth Hormone Deficiency Dwarfism'. 2. The petitioner was working as a U.D. Clerk in the Government Press at Ernakulam. Master Shabeer, the minor son of the petitioner, was suffering from serious disorders and the disease was identified as 'Growth Hormone Deficiency Dwarfism'. The son of the petitioner was advised to have continuous treatment for nearly 2 ½ years, by providing hormone injection, which costs nearly Rs, 7,266/- for one catridge containing medicine for 6 days. The Government sanctioned Rs.50,000/- as interest free loan for the treatment of her minor son, as per Ext. P1 order dated 14.12.1999. After analysing the facts and figures, the respondents sanctioned different amounts at different points of time towards medical reimbursement claimed by the petitioner. W.P. (C) No. 25293 of 2003 : 2 : 3. However, some bogus complaints were preferred by some persons behind the curtain, who were allegedly having personal animosity to the petitioner, which made the first respondent to call for a report from the second respondent as to the genuineness of the treatment and the bills submitted by the petitioner in this regard. The second respondent conducted an enquiry and on satisfying the actual facts and figures, submitted Ext. P2 report dated 01.03.2011, recommending the case of the petitioner, making it clear in unequivocal terms that, no cheaper medicines were available in the market in respect of the aforesaid disease . The certificate in respect of the reimbursement claim was recommended as a special case and the original proceedings including the testimonials received from the concerned doctor - Dr. M. V. Muraleedharan, Professor of Medicine, Medical College Hospital, Thrissur were also forwarded to the first respondent. 4. In the course of further proceedings, the second respondent issued Ext. P3 communication dated 22.11.2011, directing the petitioner to appear before the Expert Committee of the Directorate of Medical Education (DME) Office on 21.12.2001 at 11 A.M. along with the patient child and the relevant documents as specified therein. W.P. (C) No. 25293 of 2003 : 3 : Pursuant to the said notice, the petitioner produced the child before the Expert committee on the scheduled date i.e. on 21.12.2001 and after a detailed examination, the Expert committee allegedly opined that the treatment can be put to an end to, in view of the nature disease and the extent of relief that could be expected. 5. It is seen that, the petitioner had already submitted 3 different claims/bills; the first one for a total of Rs. 2,18,899/- and the other two, for Rs. 1,09,033.47 and Rs. 1,09,041.40 as given in Ext. P9 (a) dated 17.01.2002 and Ext. P9(b) dated 01.01.2002. Pursuant to the medical report obtained from the Expert committee, the first respondent considered the matter and issued Ext. P4 order dated 23.03.2002, sanctioning a sum of Rs. 2,18,899/- in respect of the first claim, without any reference to the other bills which are already pending, however, observing that, no further claims for medical reimbursement will be entertained in connection with the treatment of the minor son of the petitioner and that the interest free loan sanctioned vide Ext. P2 shall be finally adjusted from the same. 6. Met with the situation, the petitioner preferred Ext. P6 representation dated 12.07.2002 before the then Chief Minister of the State, pointing out the grievance, which was stated as forwarded to the W.P. (C) No. 25293 of 2003 : 4 : Department and after considering the same, the first respondent passed Ext. P7 order dated 11.02.2003, holding that, the claims for medical reimbursement could not be considered in view of the condition specified in Ext. P4 proceedings dated 23.03.2002, holding that, 'Hormone Deficiency Dwarfism' is a congenital one and not curable by medicine. 7. Smt. Shibi, the learned counsel for the petitioner submits that the petitioner is constrained to approach this Court to quash the impugned proceedings, for the reason that, the claims forming the subject matter of Exts. P9(a) and P9(b) were already pending consideration before the Government, when Ext. P4 order was issued and hence that the decision of the respondents, not to entertain 'any further claim' could not have been made applicable to the claims already preferred, more so, when the petitioner has already incurred huge expenses, which is far beyond her reach. 8. The learned Government Pleader appearing for the respondents, with reference to the contents of the counter affidavit, submits that, the course and procedure pursued by the respondents are perfectly within the four walls of the law and that the claim of the petitioner in respect of Exts. P9 (a) and P9 (b) is not liable to be W.P. (C) No. 25293 of 2003 : 5 : entertained. The learned Government Pleader submits that the decision taken by the Government in respect of disease of the minor son of the petitioner, is based on the Expert opinion and since the said disease is a congenital one and not curable by medicines, there is no point in entertaining any further claim. 9. However, on going through the counter affidavit, it is seen that, the second respondent has specifically conceded that the amount of Rs. 2,18,899/- sanctioned by the first respondent towards the medical reimbursement vide Ext P4 was pursuant to the examination of the child by the Expert committee on 21.12.2001. It is also conceded in paragraph 10 of the counter affidavit, that when the Government ordered not to allow any 'further reimbursement claims', the two claims dated 18.01.2002 and 01.01.2002 in two medical bills of Rs 1,09,033.47 and Rs. 1,09,041.40 were pending in the department. The reason for not sanctioning the said two claims is attributed to Ext. P4 Government Order and nothing else. 10. In view of the admitted position as above, it remains a fact that the two claims vide Exts. P9 (a) and P9 (b) preferred were in respect of the treatment availed and the medicines purchased during the period from 20.06.2001 to 22.12.2001 (i.e. before the examination W.P. (C) No. 25293 of 2003 : 6 : of the child by the Expert committee on 22.12.2001), as borne by the “Essentiality Certificate” issued by the concerned authority and forming part of Ext. P9(a) / P9 (b) claims. In other words, the said bills are not in respect of the subsequent treatment provided after the examination by the Expert committee; nor does it make any bar as contemplated in Ext. P4 which is dated 23.03.2002. There is absolutely no explanation for the respondents as to why the said bills which were admittedly pending were not considered and sanctioned when Ext. P4 was passed. There is no case for the respondents that Exts. P9 (a) and (b) claims preferred by the petitioner were bogus in any respect or that the amounts shown therein are not liable to be paid in terms of Ext. P8 Government Order enlisting the medicines eligible for reimbursement. The subsequent turn of events, holding that, disease is not curable by medicines, but a congenital one cannot stand in the way of consideration of the claims already preferred by the petitioner vide Exts. P9(a) and (b), which were admittedly pending consideration when the other claim was considered and passed vide Ext. P4. In the above facts and circumstances, Ext. P7 impugned in the writ petition is set aside. The first respondent is directed to consider medical reimbursement claim preferred by the petitioner vide Exts. P9 W.P. (C) No. 25293 of 2003 : 7 : (a) and P9(b) in respect of the treatment expenses already incurred by the petitioner prior to 21.12.01, the date of examination by the Expert Committee and the eligible amount shall be disbursed to the petitioner, as expeditiously as possible, at any rate within 'three months' from the date of receipt of a copy of this judgment. The decision of the Government that the particular disease of the minor son of the petitioner is not curable by medicines and is a congenital one and hence that no future claims shall be entertained after examination of the child by the Expert committee held on 21.12.01 is upheld. The Writ Petition is allowed to the said extent. Sd./- P. R. RAMACHANDRA MENON, JUDGE kmd