RAM NIWAS JAIN Vs. CENTRAL GOVT HEALTH SCHEME

JUDGEMENT

(1.) It was April 25, 2002. The petitioner, little knowing what was ordained for him, went to attend a function at a relative's house. While he was there he felt pain in his chest and became unconscious. This was unforeseen emergency and called for emergent action. He was rushed to Escorts Heart Institute and Research Centre (EHIRC) where he underwent bypass surgery and remained admitted as an indoor patient from April 25, 1992 till May 10, 2002. He escaped death alright but not what was to follow.

(2.) The petitioner had retired from the post of Upper Division Clerk from the office of Central Public Works Department (CPWD) on March 31, 2002. A card No.058538 was issued to him on May 30, 2002 on the basis of which he and his wife became entitled to medical treatment in semi private wards of all the hospitals approved by the Central Government under the Central Government Health Scheme. It appears that under the said scheme, some Office Memorandums were issued by the Central Government from time to time.

(3.) One such Memorandum is dated September 18, 1996. It recognised number of private hospitals/diagnostics centres mentioned therein for different specialties and provided that the CGHS beneficiaries taking treatment in those hospitals would become entitled for reimbursement as per package deal rates mentioned therein. The next relevant Memorandum is dated 7.9.2001. By this Memorandum, more private hospitals were recognised for the purpose of reimbursement and besides that the rates as contained in the Memorandum of September, 1996 were revised. It also provided that the recognised hospitals/diagnostic centres will not charge more than the package rate from the beneficiaries. This, it seems, was not acceptable to Escorts hospital.