M L KAMRA Vs. LT GOVERNOR

JUDGEMENT

(1.) . This writ petition is filed under Article 226 of the Constitution of India for issue of a writ of mandamus directing the respondents 1 to 4 to reimburse the medical claim of Rs.1,30,238.90 of the petitioner incurred on his treatment and coronary bypass surgery in Indraprastha Apollo Hospital, New Delhi with interest @ 24% per annum and issue or writ in the nature or certiorari quashing the order of the respondent bearing no.705 dated 9.8.1998 by which reimbursement claim was declined.

(2.) . Material facts, in brief, are that the petitioner is working as a trained Graduate Teacher in Dau Dayal Arya Vedic Senior Secondary School, Naya Bans, Delhi which is a Government aided school, and is governed by the Civil Services (Medical Attendance) Rules in the matter of medical attendance and reimbursement of claim for treatment. The petitioner was suffering from (CAD) triple vessel coronary artery disease. On 1.9.1996 angiography was done on him in G.B.Pant Hospital (a Delhi Government Hospital). His condition was round stable and he was discharged with instructions "to attend cardiology clinic room No.7 on Monday/Friday and to collect final CAG Report from Ex.11 Lab and report after three days." The claim for expenses incurred on medicine and angiography done in the said hospital was later on reimbursed to the petitioner. It is alleged in the petition that after a fortnight the condition or the petitioner started deteriorating and he had to undergo elaborate medical check up. He consulted Dr.M.P.Gupta on 5.10.1996 and 9.10.1996. He also consulted Dr.R.C.Bhatia of Swamy Dayanand Hospital, who is a cardiologist and who advised him to have immediate coronary bypass surgery as he was complaining or re-current chest pain and dysponea. The petitioner tried to take an early date for his surgery in AIIMS but could not succeed. His family then rushed him to Indraprastha Apollo Hospital on 14.10.1996 where he was put under observation for surgery on account of his critical condition. A coronary by-pass surgery was then performed on him on 17.10.1996 since his case required an emergency treatment. He was discharged from the said hospital on 25.10.1996. On 11.1.1997 the petitioner submitted medical bills to the Department of Education of the Govt. of NCT of Delhi for reimbursement of the medical expenses totalling Rs.1,30,238.90 incurred by him on the surgery and treatment at Indraprastha Apollo Hospital. Out if it Rs.1,28,020/- was for treatment and operation in the hospital and the balance of Rs.2,218.90 was the expenditure incurred on medicine. Despite repeated reminders and legal notice dated 21.9.1999 the respondents have failed to reimburse the claim. Contrarily the respondents have rejected the claim of the petitioner on 9.8.1998 vide letter No.704 addressed to the Principal of the School, where the petitioner was working, without assigning any reason. Hence the petition.

(3.) . On noticing, Mr.V.K.Sharma, Deputy Director of Education has filed a counter affidavit on behalf of respondents 1 to 3 i.e. Lt. Governor of Delhi, Govt. of NCT of Delhi, Director of Education and Deputy Director of Education (North). In the counter affidavit it was averred that the petitioner had started taking treatment from G.B. Pant Hospital and he was advised to collect angiography report after 7 days and to take an early date for operation from CTVS Department of the hospital but instead of following it up the petitioner preferred to get his treatment from a private hospital of his own sweet will. Therefore, he is not entitled to reimbursement of the medical claim submitted by him since he was neither referred to the said hospital by G.B. Pant Hospital nor any other government hospital. There are three referral hospitals as per circular no.F.27/9/97/H&FW dated 26.9.1997 read with circular No.F.27(9)/93-97/M&PH/PF dated 15.9.1999 of the Government of National Capital Territory of Delhi (Health and Family welfare Department) which are (1) Batra Hospital and Medical Research Centre ; (2) Escort Health Institute and Research Centre ; and (3) National Heart Institute and Research Centre. There is no rule under which a government employee of the Govt. of NCT of Delhi can claim reimbursement for treatment taken by him in a private hospital of his own. The petitioner himself is to blame for not following the advice of doctors at G.B.Pant Hospital and not reporting there on the scheduled date. the petitioner was not interested in his treatment in G.B.Pant Hospital because of his false psychological impression that he would not be treated/operated well there. He of his own went to M.C.D. Hospital again for advice for which respondent no.2 is not bound to reimburse the claim. The case of the petitioner was considered without undue delay in accordance with Central Services (Medical Attendance) Rules. Indraprastha Apollo Hospital is a private hospital and is not recognised for treatment for Delhi government employees. The claim of the petitioner was not found tenable. The representation made by the petitioner was considered by the Director of Education and was referred to Director of Health Services for expert opinion since the case of the petitioner was that the treatment was taken at Indraprastha Apollo Hospital in emergency. The Director of Health Services after obtaining the reports from G.B.Pant Hospital where coronary angiography of the petitioner was conducted earlier was of the view that the petitioner had not followed the advice given to him by the doctors of G.B.Pant Hospital since he was asked to collect the angiography report after 7 days and take an early date for operation from CTVS Department of the said hospital. Instead of following this advice the petitioner preferred to get treatment at the private hospital without being referred to by any doctor of any government hospital on the ground of emergency. The State Government employees are provided medical attendance and facilities in various hospitals and dispensaries and in certain specified cases as per the prescribed rules, the doctors of the government hospital refer typical and emergent cases to listed/recognised hospital for which reimbursement facility is available subject to prescription of such cases to these private hospitals also. The claim of the petitioner was rejected in accordance with the Civil Services (Medical Attendance) Rules.