- 1 - S.B.CIVIL WRIT PETITION NO.5065/2005 (Mandroop Ram vs. State of Rajasthan & Raj.) DATE OF ORDER : 7/8/2008 HON'BLE JUSTICE GOPAL KRISHAN VYAS REPORTABLE Mr.Deep Chand Sharma, for the petitioner. Mr.Rameshwar Dave, Deputy Government Counsel. In this petition, petitioner has prayed for quashing Annex.8, whereby, the claim of petitioner for reimbursement of his medical bills was rejected by the Government so also it is prayed that respondents may be directed to make payment of expenses incurred on his treatment while undergoing bypass surgery at Escorts Heart and Research Institute on 20/1/2004. According to brief facts of the case, petitioner while working on the post of Assistant Engineer in the respondent department suffered serious heart disease and during examination it was found that there is a blockage in the coronary artery and due to said disease, on 11/1/2004 petitioner sustained serious heart attack and admitted to Mahatama Gandhi Hospital, Jodhpur, where he was treated by the doctors and he was discharged on 16/1/2004 with the advise to have further treatment (Angiography) at SMS Hospital, Jaipur but no formal order was made for reference of petitioner's case to the SMS - 2 - Hospital, Jaipur to get treatment of heart disease. On 16/1/2004, petitioner left Jodhpur but his condition became very serious and, therefore, in emergent situation it was felt necessary by the family members of petitioner to bring petitioner at Escorts Heart Institute, New Delhi, therefore to save life, petitioner was brought to the Escort Heart Institute, New Delhi on 17/1/2004 where on very same day Angiography was done and petitioner was advised for immediate coronary heart bypass surgery. The condition of the petitioner became very serious, therefore, in emergent situation to save the life bypass surgery was performed on 20/1/2004 at Escorts Heart Institute, New Delhi, which is evident from Annex. 1 and 2. After bypass surgery, petitioner was discharged from Escort Heart Institute, New Delhi on 27/1/2004 and advised for complete rest for three months. In the treatment at Escort Heart Institute, New Delhi Rs.2,09,304/- was incurred as medical expenses, therefore, being a government employee petitioner is entitled for reimbursement of medical expenses incurred on his treatment and for that purpose on 2/6/2006 medical bills were submitted by petitioner to Chief Engineer, PHED, through proper - 3 - channel to make payment but vide impugned order Annex.8, the claim of petitioner was rejected by the Deputy Secretary (Administration) stating therein that Escort Heart Institute, New Delhi is a private hospital, therefore, no sanction could be granted for reimbursement of medical bills for the treatment. The claim of the petitioner has been rejected on hyper technical ground, which is totally erroneous. The facts of the case clearly speak that in emergent situation to save the life of petitioner the family members took petitioner to Escort Heart Institute, New Delhi, where bypass surgery was performed. Therefore, the reason for denial of reimbursement of medical expenses that the Escort Heart Institute is a private hospital is totally erroneous and petitioner is very much entitled for reimbursement of medical expenses incurred on treatment of heart disease. Learned counsel for the petitioner vehemently argued that order Annex.8 is illegal and contrary to the verdict of this Court and Hon'ble Supreme Court, whereby, this Court has held that in emergent situation the condition of making reference is required to be ignored and employee shall be entitled for medical reimbursement according to Rules. Learned counsel for the petitioner has invited my attention towards the following judgments :- - 4 - (i) Harbir Kaur vs. State of Rajasthan (2004 (4) WLC 865) (ii) Laxman Taneja vs. State of Rajasthan and others (2005 (3) WLC (Raj. 451 (iii) State of Punjab vs. Mohinder Singh Chawla (AIR 1997 SC 1225) (iv) Surjit Singh vs. State of Punjab ( (1996) 2 SCC 336) (v) B.L.Gaur vs. Chief Secretary and others (2007 WLC (Raj.) UC 469) (vi) Shanker Lal vs. State of Rajasthan (2000 (3) RLR 596). The Division Bench of this Court in State of Rajasthan & Ors. vs. Surendra Kumar Kalra reported in 2008 (3) RLW 1953 (Raj.) held that in emergent situation a Government employee can take treatment at a Hospital where his life can be saved without reference of his case by the competent medical authorities. Relevant paras 14, 15, 16 and 17 of the above judgment are as follows: “14. This Court in the case of Anil 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 - 5 - 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 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 - 6 - 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 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.” Per contra, learned counsel for the respondents vehemently argued that order Annex.8 passed by the Deputy Secretary (Administration) Government of Rajasthan is in consonance with the provisions of Rules of 1970. Further it is submitted that under Rule 6 of the Rules of 1970 there is a provision for making payment of one attendant with the patient so also matter should be referred to Escort Heart Institute, New Delhi by any competent authority of Government hospital of Rajasthan. In case of petitioner although his case was not referred by the MGH, Jodhpur but he was advised to take treatment at SMS Hospital, Jaipur but he has directly taken treatment of bypass surgery from Escort Heart Institute, New - 7 - Delhi without there being any proper approval from the State Government and thereafter he has submitted the medical bills for the expenses incurred at Escort Heart Institute, New Delhi. As per respondents, SMS Hospital, Jaipur is a recognized hospital for heart disease in Rajasthan and after duly verified/approved by the SMS Hospital, Jaipur payment could be made to an employee. Further, in this case, it is submitted that petitioner was repeatedly asked to submit the original bills of expenses incurred by him at New Delhi, therefore, petitioner is not entitled to get any relief from this Court. As per respondents, according to Rule 7 of the Rules of 1970 payment of expenses incurred on treatment could only be made when treatment is taken from any recognized hospital outside the State of Rajasthan, if the State Government refers the patient to such institute. Admittedly, in this case neither petitioner was referred by any Doctor nor any approval was given by the Government to get treatment at Escort Heart Institute, New Delhi. Further it is submitted that Escort Heart Institute is not a recognized Institute by the State Government, therefore, for want of reference by any competent authority, petitioner is not entitled for any reimbursement of his medical bills. Hence, this writ petition may be dismissed. - 8 - I have considered the rival submissions made by both the parties. In this case admittedly, petitioner was suffering from heart disease and petitioner got treatment at Escort Heart Institute, New Delhi where huge amount was incurred on bypass surgery, therefore, facts with regard to treatment are not disputed. However, it is disputed by the respondents that case of petitioner was not referred by any competent doctor for treatment outside the State of Rajasthan. In this regard relevant provision of law i.e. Rule 7 of the Rules of 1970 provides that a government servant can take treatment outside the State but only rider is that there must be certification by the competent authority to take such treatment outside the State in any notified hospital. But as per the verdict of Hon'ble Supreme Court and this Court in so many cases, in emergent situation if any treatment is taken outside the State then also employee can claim medical reimbursement @ applicable in the government recognized hospital, therefore, according to the facts of the case, admittedly, petitioner was brought to Escort Heart Institute, New Delhi in emergent situation without reference by any competent doctor. It is true that he was advised by the doctors at Mahatama Gandhi Hospital, Jodhpur to take further treatment at SMS Hospital, Jaipur but due to emergent situation and serious condition of petitioner he was immediately brought to the Escort Heart Institute, New Delhi where he was immediately given - 9 - treatment so also bypass surgery was conducted by the experts of the Hospital. In this view of the matter, in my opinion, as per the judgment in case of Surendra Kumar Kalra (supra) petitioner cannot be denied reimbursement of medical bills on the ground that his case was not referred by any competent authority of the State. In view of the above, this writ petition is allowed and order Annex.8 dated 15/6/2004 passed by the Deputy Secretary, PWD, Jaipur is hereby quashed and respondents are directed to reimburse the medical bills of the petitioner for the treatment taken by him at Escort Heart Institute, New Delhi forthwith in accordance with the Rules of 1970 while ignoring the fact that petitioner's case was not referred by any medical authority of MGH, Jodhpur within a period of two months from the date of receipt of certified copy of this order. (GOPAL KRISHAN VYAS),J . pb