SBCWP No.8315/06. 1 IN THE HIGH COURT OF JUDICATURE FOR RAJASTHAN BENCH AT JAIPUR. O R D E R S.B. CIVIL WRIT PETITION No.8315/2006. Prem Chand Jain Vs. State of Rajasthan & Ors. Date of Order:- February 27, 2009. HON'BLE MR.JUSTICE MOHAMMAD RAFIQ Shri Rajesh Kala for the petitioner. Shri Zakir Hussain, Additional Government Counsel. ****** BY THE COURT:- This writ petition has been filed with a prayer to direct the respondents to reimburse the medical bills for the treatment which he received at Escorts Heart Hospital Delhi for undergoing Coronary Artery Bye-pass Grafting (C.A.B.G.). 2) Learned counsel for the petitioner has argued that petitioner is a retired government from the post of Lecturer from Government Hospital Jhalawar. Petitioner developed heart ailment for which he was subjected to Angiography in SMS Hospital, Jaipur in 28/7/2004 where it was SBCWP No.8315/06. 2 discovered that there was blockage in his coronary artery. Principal of the SMS Medical College Jaipur constituted a medical board vide his order dated 31/7/2004. Medical Board was consisting of Dr.R.M. Mathur Professor of CT Surgery, Dr.Anoop Jain, Associate Professor of Cardiology and Dr.S.M. Sharma, Professor of Cardiology. After examining the petitioner, all the doctors advised Coronary Artery Bye-pass Grafting (C.A.B.G.) and on his request, referred him to Escorts Heart Institute, New Delhi vide order dated 2/8/2004. 3) Petitioner accordingly underwent surgery at Escorts Heart Institute, New Delhi on 16/8/2004. He had to incur total expenses of Rs.2,15,405/- however, when the bills were submitted to the respondents for reimbursement, respondents sanctioned only Rs.48,000/- as against Rs.2,15,405/- leaving balance amount of Rs.1,60,505/- unpaid. 4) Learned counsel appearing for the State opposed the writ petition and submitted that as per clause 4(E)(b) of the Rajasthan Pensioners Medical Concession Scheme (Amended upto 10/3/2005), the petitioner is entitled to get only Rs.48,000/- and he has rightly been paid the said sum according to that scheme of the Government of Rajasthan. It is SBCWP No.8315/06. 3 stated that petitioner on his own has taken the treatment outside the State at Escorts Heart Institute, New Delhi and incurred the aforesaid expenses whereas the facility of C.A.B.G. was available in the SMS Hospital Jaipur. The aforesaid sum was reimbursable only in case the medical board advised him for treatment outside the State of Rajasthan. The medical board never recommended case of the petitioner for being treated outside the State of Rajasthan and it was on the request of the petitioner that he was referred to the Escort Hospital. As per para 4(E)(b) of the Rajasthan Pensioners Medical Concession Scheme, petitioner is entitled to only Rs.48,000/- which has already been paid to him. This amount could have been reimbursed if he would have undergone surgery at SMS Hospital Jaipur. Learned Additional Government Counsel referred to clause 4(E)(b) of the Rajasthan Pensioners Medical Concession Scheme and submitted that even in case where treatment is taken outside the State, 80% of the charges incurred in Escort Heart Institute, New Delhi or Rs.1,20,000/-, whichever is less, was payable. 5) Upon hearing learned counsel for the parties and perusing the documents forming part of the record, I find that the fact is that petitioner SBCWP No.8315/06. 4 had undergone surgery of C.A.B.G. on being recommended by the medical board constituted by the Principal SMS Hospital Jaipur and that he actually underwent surgery at Escort Heart Institute, New Delhi. All India Institute of Medical Sciences, New Delhi is one of the reputed hospitals for the government servants and retired government servants and even according to clause 4(E)(b) of the Scheme, in case a pensioner undergoes by-pass surgery of heart, (Cardio Thoracic Surgery) in any recognised hospital outside the State in emergent circumstances without any recommendation of the Medical Board, he may be allowed 80% of the hospital expenses, limited to Rs.48,000/- i.e. 80% of the General Ward charges of AIIMS, New Delhi provided that he submits a Certificate from a Cardiologist who holds a degree of D.M. in Cardiology or MCH in Cardio Thoracic Surgery stating that petitioner's condition was such that immediate treatment was essential. 6) Learned counsel for the petitioner in support of his arguments, placed reliance on the judgment of this Court in V.D. Saxena Vs. State of Rajasthan & Ors. : RLR 2003(3) 629 as well as Division Bench judgment of this Court in State of Rajasthan & Ors. Vs. Surendra Kumar Kalra : 2008 SBCWP No.8315/06. 5 (2) WLC (Raj.) 430 and submitted that learned Single Judge of this Court in V.D. Saxena supra allowed the similar claim of the petitioner whereas the Division Bench in Surendra Kumar Kalra supra dismissed the special appeal filed by the State upholding the judgment of the learned Single Judge allowing writ petition of the writ petitioner Surendra Kumar Kalra. In V.D. Saxena supra, the co-ordinate Bench of this observed in para 6 of the judgment, as under:- “A Division Bench of this court in the case of Shanker Lal Vs. State of Raj., (2000) 3 RLR 596 = 2000(3) WLC 585, has also observed that denial of reimbursement of expenses incurred on medical attendance and treatment bonafide and genuinely by the public servant for availing treatment for himself or any member of his family at recognised hospital/institution in the circumstances like the present case on such technical grounds shall be clearly arbitrary, unreasonable and unjust”. 7) Having regard to the facts of the case, the action of the respondents in paying Rs.48,000/- as against Rs.2,15,405/- incurred by the petitioner cannot be justified. 8) In the result, the writ petition is partly allowed. In the light of the judgment of the co-ordinate Bench of this Court rendered in V.D. Saxena supra, the petitioner is held entitled to SBCWP No.8315/06. 6 receive amount of reimbursement of the medical bills /expenses as per norms of All India Institute of Medical Sciences, New Delhi for undergoing Coronary Artery Bye-pass Grafting (C.A.B.G.). Compliance of the judgment shall be made within a period of two months from the date its copy is produced before the respondents. (MOHAMMAD RAFIQ) J. anil