1 SBCivil Writ Petition No.1695/2008 Dr. Yashwant Kumar Boyla v. State of Rajasthan & Ors. Date of Order :: 22 nd December, 2010 HON'BLE MR.JUSTICE GOVIND MATHUR Mr. Sandeep Shah, for the petitioner. Mr. Y.P.Khileree, Additional Government Counsel, for the respondents. .... The Rajasthan Civil Service (Medical Attendance) Rules, 1970 (hereinafter referred to as “the Rules”) were framed while exercising powers conferred by proviso to Article 309 of the Constitution of India with an object to provide medical assistance as defined under Rule 2 (x) of the Rules to the persons referred in sub-rule(1) of Rule 2 of the Rules. As per Rule 7 of the Rules, a Government servant and the members of his family suffering from a disease for which treatment is not available in any Government hospital in the State shall be entitled to medical attendance and treatment to the extent indicated in sub-rule(2) of Rule 7 in a Hospital/Institution outside the State recognised by the Government, provided that it is certified by the 2 Principal of a Medical College/Director of Medical & Health Services on the basis of opinion of the Authorised Medical Attendant to the effect that treatment of a particular disease from which the patient is suffering is not available in any Government Hospital in the State and it is considered absolutely essential for the recovery of the patient to have treatment at a hospital outside the State. As per sub-rule(3) of Rule 7 the facility of medical attendance and treatment in the type of cases mentioned in sub-rule(1) can be availed at any of the Hospitals/Institutions mentioned in Appendix 11. The Bombay Hospital, Mumbai is a hospital enlisted in Appendix 11, as a person referred in Rule 2(1), if avails medical attendance and treatment in accordance with Rule 7 of the Rules at Bombay Hospital, Mumbai, he/she is entitled to get reimbursement of medical expenses incurred in such attendance and treatment. The petitioner, Professor in Department of Medicine, Ravindranath Taigore Medical College, Udaipur, claimed reimbursement of a sum of Rs.2,91,417.92 against the expenses incurred in treatment of his wife at Bombay Hospital, Mumbai, but out of that only a sum of Rs.92,000/- is reimbursed to him, thus, this petition for writ is preferred. 3 In brief, facts of the case are that Smt. Snehaprabha, wife of the petitioner, being suffered with Metabolic disorder and acute renal failure, undergone treatment at RNT Medical College, Udaipur, wherefrom she was referred to avail necessary medical attendance and treatment at Bombay Hospital, Mumbai. Necessary recommendation for making such reference was made by an authorised medical attendant on 4.5.2002 and by acting upon that the Principal and Controller under an office order dated 4.5.2002 certified that the disease suffered by Smt. Snehaprabha is not having any treatment in medicine department and the medical colleges in the State of Rajasthan. He further certified that for recovery of the patient, specialised treatment/investigation at Bombay Hospital, Mumbai is absolutely essential. In the circumstances referred above Smt. Snehaprabha availed treatment of Hypothyroidism-obesity-Metabolic Disorder and acute renal failure at Bombay Hospital, Mumbai in the month of May, 2002, however, while availing treatment at Bombay Hospital, Mumbai she was incidently diagnosed to have Subclavian Artery Thrombosis, an accepted rare complication of cannulation for haemodialysis, a life threatening critical condition that warranted immediate intervention. Accordingly, as a rescue measure an emergency cardio-vascular interventional surgery i.e. complicated embolectomy with subclavian artery stent placement was performed by the medical attendants at 4 Bombay Hospital, Mumbai. The fact about treatment availed by Smt. Snehaprabha was confirmed by a medical board consisting of three professors of the RNT Medical College, Udaipur and the medical board aforesaid was of the opinion that the treatment and emergency surgery performed at Bombay Hospital, Mumbai was extremely necessary and life saving for the patient. After availing medical attendance and treatment as aforesaid the petitioner submitted an application with all necessary details for getting the medical expenses incurred in the treatment aforesaid reimbursed as per the provisions of the Rules. The Deputy Secretary to the Government of Rajasthan, Department of Medical & Health Services, Jaipur sought certain clarifications from the Principal and Controller, RNT Medical College, Udaipur under a letter dated 9.8.2002 and those were satisfied by the Principal and Controller, RNT Medical College, Udaipur under a communication dated 19.10.2002. The explanation given by the Principal in the communication aforesaid reads as follows:- “1.Regarding point no.1 report of Medical Board constituted of three doctors (Dr.B.S.Bomb, Dr.D.P.Singh) & Dr. Y.N.Verma) before reliving order of dt.4.5.2002 is enclosed. 5 2.Regarding point no.2 and 4 of the above referred letter comments of Chairman of both the boards Dr.B.S.Bomb, Prof. & Head (Medicine) is enclosed. 3.Regarding point no.3 as per your instruction letter was moved to Principal, S.M.S. Medical College, Jaipur for providing information regarding availability of facility & estimated expenditure. The Principal, SMS Medical College, Jaipur vide his letter No.27858/MC/02 dt.7.9.2002 has informed the charges for emblotectomy Rs.12000/- & for Angiography stent placement Rs.80000/- total Rs.92000 which comes under “D.S.A.” charges shown in claim submitted earlier. But it does not include associated charges like medicines, investigation etc.” It is pertinent to note that the explanation was submitted by the Principal on basis of the recommendations made by a medical board and also on basis of the definite findings given by the Professor and Head of the Department of Medicine, RNT Medical College, Udaipur. The respondents instead of making the payment of entire medical expenses incurred in treatment of Smt. Snehaprabha, allowed a sum of Rs.92,000/- only, on basis of the expenses statement given relating to Sawai Man Singh Hospital, Jaipur, hence this petition for writ is preferred. The submission of counsel for the petitioner is that as per the Rules the petitioner is entitled 6 for entire medical expenses incurred in the treatment of the petitioner's wife but the respondents for no just reason allowed only a sum of Rs.92,000/-. As per the respondents the petitioner went to Bombay Hospital, Mumbai as per his choice, therefore, in view of the Government of Rajasthan circulars dated 31.12.1998 and 3.3.1999 the petitioner could have received an amount as reimbursement of medical expenses equivalent to the expenses incurred on availing the treatment at Sawai Man Singh Hospital, Jaipur. Reference is also given to a circular dated 6.3.2002 issued by the Deputy Secretary to the Government of Rajasthan, Department of Medical & Health Services, wherein also it is mentioned that if a government servant avails medical attendance outside the State, then he shall be entitled for medical expenses equivalent to the probable expenses that would have been occurred in availing treatment at a Government Hospital in the State. Heard counsel for the parties. The facts regarding disease of the petitioner's wife and availing treatment at Bombay Hospital, Mumbai are not at all in dispute. It is also not in dispute that the treatment availed by the petitioner's wife for her disease at initial stage was not available in the State of Rajasthan. It is also 7 not in dispute that the case of the petitioner was recommended and certified by the competent authorities as per the Rules for having medical attendance and treatment at Bombay Hospital, Mumbai. The only objection of the respondents is that the Bombay Hospital, Mumbai was chosen by the petitioner, therefore, he cannot claim for the reimbursement of entire medical expenses in view of the circulars issued by the Government of Rajasthan time to time. The Rajasthan Civil Services (Medical Attendance) Rules, 1970 were framed with an object to provide medical assistance to the persons referred in sub-rule(1) of Rule 2 in various circumstances. Rule 7 of the Rules in specific terms prescribes that a government servant and his family members may avail medical attendance and treatment in hospital out of State of Rajasthan, if such treatment is not available in Government Hospitals of the State. In the present case the treatment for disease suffered by the patient was not available in the State of Rajasthan and, therefore, she was referred to a hospital outside the State. The hospital to which she was referred is enlisted as a recognised hospital in Appendix 11 to the Rules. In such circumstances, merely on the count that an option was given by the petitioner to avail medical attendance and treatment at a specific hospital cannot be a reason to deny 8 reimbursement of medical expenses. The position would have been absolutely different if the Bombay Hospital, Mumbai would have not been among the hospitals referred in Appendix 11. The hospitals mentioned in Appendix 11 as a matter of fact forms one class and a choice is available to the patient to get himself/herself treated at any of these hospitals. In such circumstances the choice made by the petitioner to avail treatment of his wife at Bombay Hospital, Mumbai in no manner disentitles him from getting reimbursement of medical expenses as per Rule 7 of the Rules. Accordingly, this petition for writ succeeds and, therefore, the same is allowed. The respondents are directed to reimburse the complete expenses incurred by the petitioner for medical attendance and treatment of his wife at Bombay Hospital, Mumbai. The respondents are directed to make the payment of a sum of Rs.2,91,417.92 to the petitioner by adjusting the amount of a sum of Rs.92,000/-, already paid to him. The remaining amount of the expenses is required to be paid with interest @ 4.5% per annum within a period of three months from today. No order to costs. ( GOVIND MATHUR ),J. kkm/ps.