Punjab-Haryana High Court
Roshan Lal Garg vs State Of Haryana And Others on 8 July, 2024
Author: Jasgurpreet Singh Puri
Bench: Jasgurpreet Singh Puri
Neutral Citation No:=2024:PHHC:085117
CWP-19105-2021 (O&M) 1
105+241
IN THE HIGH COURT OF PUNJAB & HARYANA
AT CHANDIGARH
CWP-19105-2021 (O&M)
Date of Decision:08.07.2024
Roshan Lal Garg
......Petitioner
Versus
State of Haryana and others
......Respondents
CORAM: HON'BLE MR. JUSTICE JASGURPREET SINGH PURI
Present:- Mr. Manoj Kaushik, Advocate for the petitioner.
Mr. Kapil Bansal, DAG, Haryana.
Mr. Amit Jaiswal, Advocate for respondent-department.
*****
JASGURPREET SINGH PURI J.(Oral)
CM-2675-CWP-2024
Application is allowed as prayed for. The accompanying
document as Annexure R-1 is taken on record subject to just all exceptions.
Main case
1. The present petition has been filed under Articles 226/227 of the
Constitution of India seeking issuance of a writ in the nature of mandamus
directing the respondents to release and reimburse the entire payment of the
medical expenses incurred by the petitioner for a period from 06.12.2019 to
07.12.2019 due to emergency treatment of his son.
2. The facts of the present case are that the petitioner was working
in the office of respondent-HUDA (now Haryana Shehri Vikas Pradhikaran)
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and retired on 31.12.2016 as Sub Divisional Engineer after having rendered a
continuous service of about 38 years. The son of the petitioner namely
Abhinav Garg is stated to be a mentally challenged person with a disability of
50% regarding which a medical certificate of the competent authority is
attached as Annexure P-1. On 06.12.2019 when son of the petitioner was
suffering from abdominal pain, he was diagnosed with Acute Calculus
Cholecystitis (stone in the Gall Bladder) and in this emergency condition he
was taken to W-Ratiksha Hospital, Sector-56, Gurugram (Haryana). The
medical history and discharge summary of the son of the petitioner is annexed
as Annexure P-2 which shows that he was operated upon in this regard by the
doctor of the aforesaid hospital. The date of admission and operation of son
of the petitioner in the hospital was 06.12.2019 and he was discharged from
the hospital on 07.12.2019. Thereafter, the petitioner raised a total bill
amounting to Rs.75,036/- which he paid to the aforesaid hospital on account
of aforesaid surgery and other charges. However, the respondent-department
sanctioned and disbursed only an amount of Rs.12,988/- out of the aforesaid
total bill raised by the petitioner. The claim of the petitioner is that he should
be given the entire full medical reimbursement as per the bills which he has
actually paid.
3. Learned counsel for the petitioner submitted that son of the
petitioner is a mentally challenged person and his disability is to the extent of
50% as per the medical certificate vide Annexure P-1. The son of the
petitioner suffered an acute abdominal pain and he was shifted to the
aforesaid hospital on 06.12.2019 in an emergency condition and he was
operated upon on the same day and was discharged on next day i.e. on
07.12.2019 regarding which the bills and the discharge summary have been
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attached alongwith the present petition.
4. He further submitted that with regard to the fact that son of the
petitioner was admitted in an emergency condition, the relevant emergency
certificate issued by the aforesaid hospital has been attached alongwith the
present petition as Annexure P-6. Apart from the above, even the aforesaid
factum was got verified from the Civil Surgeon, Gurugram and vide
Annexure P-7, the Civil Surgeon, Gurugram has also issued a letter to the
Executive Engineer of respondent-department, that the son of the petitioner
was treated in an emergency condition. He further asserted that, however, the
aforesaid full amount has not been disbursed to the petitioner on the ground
that there are some Government instructions to state that when an employee
or his dependent is admitted in an unapproved hospital even in an emergency
condition then the medical reimbursement is to be paid on the basis of the
PGI, Chandigarh rates. He further submitted that the aforesaid hospital is an
unapproved hospital and that is why he has been granted the medical
reimbursement of the amount of Rs.12,988/- on the basis of calculations of
PGI, Chandigarh rates. Learned counsel further submitted that when the son
of the petitioner who is mentally challenged person suffered acute abdominal
pain due to a stone in his gall bladder, the petitioner had no option but to take
him to the hospital where such facility was available without even thinking
that as to whether the aforesaid hospital was an approved hospital or not
because the focus of the petitioner at that point of time in the state of
emergency was only on saving the life of his son without even considering
the consequences as to whether he will be given full medical reimbursement,
partial reimbursement or even no reimbursement. Learned counsel further
submitted that the day on which the son of the petitioner was admitted i.e. on
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06.12.2019 he was operated upon regarding which there is no denial by the
respondent-department nor it has been denied that the son of the petitioner
was not shifted to the hospital in an emergency condition particularly in view
of the certificate given by the Civil Surgeon that son of the petitioner was
admitted in an emergency condition. He further contended that his basic
rights under Article 21 of the Constitution of India have been violated in view
of the application of the aforesaid action of the respondents and therefore he
is entitled to full reimbursement of the medical expenses incurred by him
during the treatment of his son.
5. On the other hand, learned counsel for respondent-department
submitted that the son of the petitioner was undoubtedly admitted in an
unapproved hospital and was operated upon for Gall Bladder stone and it is
not disputed by the respondents that the son of the petitioner was shifted to
the hospital in an emergency condition in view of the certificate issued by the
hospital and also by Civil Surgeon, Gurugram. He, however, submitted that
the petitioner is not entitled for full medical reimbursement in view of the
instructions issued by the Government of Haryana vide Annexure R-1 and
while referring to the aforesaid Annexure R-1, it has been so clearly provided
in Clause No.4 (a) that 'the reimbursement for the treatment taken in an
emergency in an unapproved hospital will be allowed equal to PGI,
Chandigarh rates with the approval of the Administrative Department' and
since son of the petitioner was taken to the hospital in an emergency and to an
unapproved hospital, the petitioner was entitled for reimbursement only to the
limited extent of the aforesaid PGI rates instead of full medical
reimbursement and therefore the amount which has been given to the
petitioner is in accordance with the policy of the Government.
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6. I have heard learned counsels for the parties.
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 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
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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 unlisted
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,
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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
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
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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.
(JASGURPREET SINGH PURI)
JUDGE
08.07.2024
shweta
Whether speaking/reasoned : Yes/No
Whether reportable : Yes/No
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