Delhi High Court
Rattan Lal Gupta vs Uoi & Ors on 9 August, 2010
Author: Veena Birbal
* HIGH COURT OF DELHI AT NEW DELHI
% Judgment delivered on: 9th August, 2010
+ W.P.(C) 4790/2007
RATTAN LAL GUPTA ..... Petitioner
Through : Mr. R.M. Sinha, Adv.
versus
UOI & ORS ..... Respondents
Through : Mr. B.V. Niren, CGSC for R-1
CORAM:
HON'BLE MS. JUSTICE VEENA BIRBAL
1. Whether the Reporters of local papers may be allowed to
see the judgment?
2. To be referred to the Reporter or not? Yes
3. Whether the judgment should be reported in Digest? Yes
Veena Birbal, J.
Petitioner retired as a Civilian Staff Officer from the Ministry of
Defence, Central Government and is getting a regular pension. Being
a retired Central Government employee, the petitioner is a life
beneficiary of the Central Government Health Services (CGHS)
Scheme. A copy of the CGHS card issued in favour of the petitioner is
annexed with the petition. It is stated that on 29.08.2003, the
Director (CGHS) had granted permission to the petitioner for
implantation of the Pacemaker (dual chamber) through Apollo
Hospital, Sarita Vihar, New Delhi. The petitioner was admitted in the
said Hospital on 30.08.2003 and the Pacemaker (dual chamber) was
implanted on the same day. The petitioner was discharged on
02.09.2003. At the time of discharge from the hospital, the petitioner
was handed over a bill amounting to Rs.1,82,650/- and was asked to
pay Rs.45,830/- as the hospital could claim only Rs.1,36,820/- from the
CGHS as a result of which petitioner had to pay Rs.45,830/- from his
pocket. The said amount was paid by the petitioner as there was a
difference between the actual cost of the pacemaker implanted and
the cost of the pacemaker permitted by CGHS. Further, the bill also
included Rs.16,160/- towards procedural cost of pacemaker also. The
doctor who had implanted the pacemaker had also given a certificate
to the effect that the pacemaker implanted was an essential one for
the proper treatment of the petitioner. Petitioner made a
representation dated 29.09.2003 claiming the said amount from
respondent. Respondent sent a cheque of Rs.16,160/- only to the
petitioner against the reimbursement of Rs.45,830/-.
By way of present petition, the petitioner has prayed for an
issuance of a writ of Mandamus/any other order directing the
respondent to pay the balance amount of Rs.29,220/-, paid by the
petitioner to the hospital incurred in the implantation of Pacemaker
(dual chamber) along with interest @ 12% p.a. with cost of litigation.
Respondent has opposed the present petition by filing a reply
wherein it is admitted that the petitioner underwent implantation of
Pacemaker (dual chamber) in Apollo Hospital after taking approval
from Director (CGHS). It is stated that the ceiling for the Pacemaker
(dual chamber) is Rs.1,15,000/- as per O.M. dated 12.06.1996. The
said amount was reimbursed to Apollo Hospital. The package rate for
procedure of implantation is Rs.16,160/- and the same is also the
approved rate which is also reimbursed to the petitioner. The stand of
the respondent is that reimbursement is done as per CGHS rates as
such nothing is due for payment to the petitioner. It is stated that the
difference of the amount over and above the CGHS rate was to be
borne by the beneficiary himself.
The question for consideration is whether the petitioner is
entitled for the difference in cost of Pacemaker (dual chamber) which
has been charged from him by the Apollo Hospital than the rate
prescribed in OM mentioned above. The difference claimed by the
petitioner is Rs. 29,220/-.
There is no controversy with regard to the amount incurred
and spent by the petitioner for the implantation of Pacemaker (dual
chamber).
The stand of the respondent is that the petitioner is governed by
OM dated 12.06.1996 and has been paid accordingly.
Perusal of record shows that Joint Director (CGHS) had given
the permission for Pacemaker (dual chamber) to the petitioner and a
letter dated 29.08.2003 in this regard was sent by the CGHS to
Medical Superintendent, Apollo Hospital. In the OM dated
12.06.1996, rates are prescribed wherein maximum ceiling in respect
of Dual Chamber Pacemaker is fixed at Rs. 1,15,500/-. The petitioner
was operated on 29.08.2003. It is a matter of common knowledge
that with the passage of time, the rates have gone high. Apollo
hospital is also one of the approved hospitals of the Government.
Learned counsel for petitioner has also pointed out that petitioner is
80 years of age.
In V.K. Gupta v. Union of India & Anr.; 97 (2002) DLT 337
petitioner therein was referred to Escorts Heart Institute and
Research Centre Ltd. (EHIRC) for the treatment. The Office
Memorandum of 18.09.1996 was the subject matter of adjudication
and this court had granted reimbursement of full expenses incurred at
the EHIRC to the petitioner over and above the rates given in
aforesaid O.M. The relevant portion of the aforesaid judgment is as
under:-
"The cost of medical treatment has been rising over a
period of time and respondents cannot deny the actual
reimbursement from a Hospital recognised by them for
treatment on the basis of applying the rates as per the
previous memorandum which were intended for a period of
two years and were subject to revision. Reference is also
invited to a decision of a Coordinate Bench of this Court in
Civil Writ No. 5317/1999 titled M.G. Mahindru v. Union
of India and Another, decided on 18.12.2000, wherein
the learned Single Bench relying on the decisions of
Narendra Pal Singh v. Union of India and Others, 79
(1999) DLT 358, as well as State of Punjab and Others v.
Mohinder Singh Chawla etc., JT 1997 (1) SC 416,
directed reimbursement of the full expenses incurred. In
the instant case, it is not in dispute that the said facility or
treatment was not available at CGHS or RML Hospital and
the petitioner was referred after due permission to a
speciality hospital duly recognised by the respondents. The
respondents cannot, therefore, deny full reimbursement to
the petitioner by placing reliance on an earlier
memorandum of 1996 wherein the rates given were
applicable and intended for a period of two years on the
ground that the said rates have not been revised."
The court directed reimbursement of full expenses on the
treatment.
In M.G. Mahindru v. Union of India and Another; 92
(2001) DLT 59 wherein it has been held that full reimbursement of
medical expenses to a speciality hospital, which was on an approved
list of CGHS, cannot be denied to a retired Government servant.
In K.S. Mathew v. Union of India & Anr.; 122 (2005) DLT
450 wherein also despite restrictive and ceiling limit fixed by the
O.M. to reimburse medical expenses, petitioner was granted full
reimbursement for expenses incurred at EHIRC.
It is also the stand of the petitioner that doctor who had
implanted the Pacemaker had given a certificate that the Pacemaker
implanted was essential one for the proper treatment of the
petitioner.
Further, it is not the stand of the respondent that the
Pacemaker (dual chamber) of the rate fixed within the ceiling limit
was available. Respondents are therefore not justified in not
reimbursing the balance amount of Rs.29,220/- to the petitioner.
In view of above discussion, it is held that the petitioner is
entitled to the reimbursement of entire expenses incurred by him at
the time of treatment. Respondents are therefore directed to pay the
balance amount of Rs. 29,220/- to the petitioner within a period of
four weeks from today.
Petition is allowed in the above terms with no order as to costs.
VEENA BIRBAL, J.
th
August 9 , 2010
kks
