Punjab-Haryana High Court
Anita Chaudhary vs State Of Haryana And Others on 5 August, 2024
Neutral Citation No:=2024:PHHC:099317
CWP-2792-2023 (O&M) - 1-
IN THE HIGH COURT OF PUNJAB & HARYANA
AT CHANDIGARH
106
CWP-2792-2023 (O&M)
Date of decision: 05.08.2024
Anita Chaudhary
....Petitioner
Versus
State of Haryana and Others
...Respondents
CORAM: HON'BLE MR. JUSTICE AMAN CHAUDHARY
*****
Present:- Mr. Manoj Chahal, Advocate for the applicant-petitioner
Mr. Harish Nain, AAG Haryana
*****
AMAN CHAUDHARY. J. (ORAL)
1. The prayer in the present petition is for directing the respondents to
reimburse the full medical claim raised by the petitioner on account of her
husband Liver Transplant Surgery in an emergency situation.
2. Learned counsel submits that the claim of the petitioner for full
medical reimbursement on account of her husband having undergone Liver
Transplant Surgery in an emergency situation has been wrongly declined and only
an amount of Rs.10,07,652/- has been granted, while the total bill amounted to
Rs.25,22,686/-. The petitioner is serving as Principal at Government Elementary
Teacher Training Institute, Morni Hills, District Panchkula and her husband
suffered from Chronic Liver Disease for 12 years and in the year, 2021 was
diagnosed with HPS and was advised to undertake liver transplant. Samples of son
and her daughter did not match and there was no deceased donor available in
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North India and therefore, he was registered with Vellammal Medical College and
Hospital, Madurai, Tamil Nadu, which is a super specialty hospital registered
under NABH (National Accreditation Board for Super Specialty Hospitals and
Healh Care) and also on the panel of Tamil Nadu State Government. Finally, the
transplant took place on 27.10.2021, which is planned on emergency basis.
Certificate regarding, it being conducted in emergency treatment given by Civil
Surgeon, Panchkula on 15.03.2022, Annexure P-4. He submits that his case is
squarely covered by the judgment passed by this Court in Roshan Lal Garg vs.
State of Haryana and Others in CWP-19105-2021, decided on 08.07.2024,
however, with regard to the room rent, the same on instructions from the petitioner
submits that it be reimbursed at the rate of PGIMER, Chandigarh as per
entitlement in view of the judgment of this Court in Kamla Devi vs. State of
Haryana and Others in CWP-10015-2015, decided on 23.01.2024. Relevant
paras of Roshal Lal Garg (supra) read thus:
"7. The only point involved in the present case is as to
whether the petitioner is entitled for grant of full medical
reimbursement on the basis of the facts and circumstances of
the present case or will he be entitled for partial reimbursement
of PGI, Chandigarh rates in accordance with the policy of the
Government of Haryana (Annexure R-1) which provides that
when a patient is treated in an unapproved hospital even in
emergency condition then he will be entitled for
reimbursement according to PGI rates.
8. The facts and circumstances of the present case make it
crystal clear that son of the petitioner is a handicapped person
as per Annexure P-1 and as per learned counsel for the
petitioner he is also a mentally challenged person. There is no
dispute that he was suffering from severe abdominal pain on
06.12.2019 at the time when he was shifted to the aforesaid
hospital which is an unapproved hospital and on the date of
admission, he was operated upon and was discharged on the
next date i.e.07.12.2019. This Court had an occasion to deal
with in such like situation in CWP No.10669 of 2017 titled as
Raghbir Singh Vs. Chief Administrator and others wherein
this Court while referring to the judgment of Hon'ble Supreme
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Court in "Shiva Kant Jha Vs. Union of India", (2018) 16
SCC 187 held that the petitioner was entitled for full
reimbursement in the light of Article 21 of the Constitution of
India. The relevant portion of the aforesaid judgment of
Hon'ble Supreme Court in Shiva Kant Jha's case (Supra) is
reproduced as under:-
"13. Further, the writ petitioner was admitted in
emergency condition with complaint of breathlessness
on 11.11.2013 in Fortis Escorts Health Institute, which
was a non-empanelled hospital at the relevant time. He
underwent angiography on 12.11.2013 which revealed
diffused disease in left anterior descending coronary
artery 50-60%. He had been implanted the CRT-D
device (Combo) as part of cardiac resynchronization
therapy (CRT) on 12.11.2013. The hospital charged an
amount of ₹11,56,293/- for the said treatment, out of
which, an amount of 10,70,000/- was for the cost of the
unlis ₹ ted cardiac implant (CRT-D) and an amount of
3,19,950/- ₹ was paid by the Insurance company directly
to the hospital.
17. It is a settled legal position that the Government
employee during his life time or after his retirement is
entitled to get the benefit of the medical facilities and no
fetters can be placed on his rights. It is acceptable to
common sense, that ultimate decision as to how a patient
should be treated vests only with the Doctor, who is well
versed and expert both on academic qualification and
experience gained. Very little scope is left to the patient
or his relative to decide as to the manner in which the
ailment should be treated. Speciality Hospitals are
established for treatment of specified ailments and
services of Doctors specialized in a discipline are availed
by patients only to ensure proper, required and safe
treatment. Can it be said that taking treatment in
Speciality Hospital by itself would deprive a person to
claim reimbursement solely on the ground that the said
Hospital is not included in the Government Order. The
right to medical claim cannot be denied merely because
the name of the hospital is not included in the
Government Order. The real test must be the factum of
treatment. Before any medical claim is honoured, the
authorities are bound to ensure as to whether the
claimant had actually taken treatment and the factum of
treatment is supported by records duly certified by
Doctors/Hospitals concerned. Once, it is established, the
claim cannot be denied on technical grounds. Clearly in
the present case, by taking a very inhuman approach, the
officials of the CGHS have denied the grant of medical
reimbursement in full to the petitioner forcing him to
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approach this Court.
18. This is hardly a satisfactory state of affairs. The
relevant authorities are required to be more responsive
and cannot in a mechanical manner deprive an employee
of his legitimate reimbursement. The Central
Government Health Scheme (CGHS) was propounded
with a purpose of providing health facility scheme to the
central government employees so that they are not left
without medical care after retirement. It was in
furtherance of the object of a welfare State, which must
provide for such medical care that the scheme was
brought in force. In the facts of the present case, it
cannot be denied that the writ petitioner was admitted in
the above said hospitals in emergency conditions.
Moreover, the law does not require that prior permission
has to be taken in such situation where the survival of
the person is the prime consideration. The doctors did
his operation and had implanted CRT-D device and have
done so as one essential and timely. Though it is the
claim of the respondent-State that the rates were
exorbitant whereas the rates charged for such facility
shall be only at the CGHS rates and that too after
following a proper procedure given in the Circulars
issued on time to time by the concerned Ministry, it also
cannot be denied that the petitioner was taken to hospital
under emergency conditions for survival of his life
which requirement was above the sanctions and
treatment in empanelled hospitals."
9. The facts of the present case suggest that it has not
been disputed by the respondent-department that son of the
petitioner was taken to the aforesaid hospital in an emergency
condition which is also supported by a certificate issued by the
aforesaid hospital and also by the Civil Surgeon, Gurugram.
Whenever a patient is suffering from an emergency condition
then the entire focus is always on saving the life of the patient
and in case there is some pain then the focus is also to relieve
the pain. It would be inhuman to say that whenever such like
emergency situation arises then an employee should keep on
searching the list of approved hospitals and should first go to
an approved hospital or a government hospital by ignoring the
developing pain and at the risk of life. It would be not only
perverse but it will also be violative of Right to Life guaranteed
under Article 21 of the Constitution of India.
10. In view of the aforesaid facts and circumstances of
the present case, present petition is allowed. The respondents
are directed to pay full medical reimbursement of Rs.75,037/-
to the petitioner after deducting the amount already paid to the
petitioner within a period of three months from today."
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3. Learned State counsel has been unable to controvert the factual
position and draw out any distinctive aspects in the aforementioned judgments or
cite any contrary law.
4. In wake of the aforesaid, the present petition is disposed of in terms
of the judgment passed in Roshal Lal Garg (supra).
(AMAN CHAUDHARY)
JUDGE
05.08.2024
M.Kamra
Whether speaking/reasoned : Yes / No
Whether reportable : Yes / No
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