JAI PRAKASH Vs. UNION OF INDIA (UOI)

JUDGEMENT

(1.) THE present writ petition has been filed by the petitioner praying inter alias for directions to the respondent to reimburse the the petitioner for full amount paid by him to the National Heart Institute (hereinafter referred to as 'the Institute') for an open heart surgery conducted on the petitioner and consequently, to pay the balance amount of Rs. 50,875/ - to the petitioner.

(2.) THE undisputed facts of the case are that the petitioner, who is a Daftari posted in the Ministry of Commerce and Industries, is a subscriber of the Central Government Health Scheme (CGHS). The petitioner underwent medical treatment for his heart ailment at the Institute for which permission was granted by the respondents on 12th March, 1999. The petitioner underwent a coronary angiography test in the said Institute for which he was granted an advance of Rs. 10,800/ -. Upon completion of the tests, he was advised to undergo an open heart surgery at the Institute which is duly recognized by the Government for its employees to take specialized treatment. The Institute submitted an estimate of Rs. 1,35,000/ - for performing the surgery on the petitioner. The petitioner applied to the respondent for medical advance of the said amount. He was reimbursed a sum of Rs. 89,100/ - as against the claim of Rs. 1,35,000/ -. The petitioner underwent the operation at the Institute on 1st June, 1999 and thereafter submitted a medical reimbursement bill of Rs. 1,39,975/ - along with all relevant documents duly verified by the Managing Director of the Institute. After being discharged, the petitioner continued undergoing treatment at the Institute and represented to the respondent that he is entitled to full reimbursement of the expenses incurred on the surgery undertaken by him. The matter was referred by the concerned Ministry to the CGHS for obtaining their comments. However, vide order dated 18th October, 2002, the Ministry informed the petitioner that his request could not be accepted by the department. Aggrieved by the aforesaid rejection, the petitioner has filed the present writ petition.

(3.) COUNSEL for the petitioner submits that the petitioner being a Government servant, is entitled to treatment free of charge at such a Government hospital or near the place where he fell ill, as can in the opinion of the authorised medical attendant, provide necessary and suitable treatment. In this regard, he relies on Rule 6(1)(A) of the Central Services (Medical Attendant) Rules. He further submits that the Institute is a recognized hospital for specialized treatment for cardiac disease and open heart surgery and is an approved hospital as per the Office Memorandum dated 18th September, 1996 and that once the petitioner was permitted to obtain treatment from the Institute, the respondent cannot deny actual reimbursement of the treatment. Reliance has also been placed on a judgment of this Court in the case of V.K. Gupta v. Union of India and Anr. WP (C) No. 4305/2001 decided on 5th April, 2002, to state that the case of the petitioner is identical to the facts of the aforesaid case where directions were sought by the petitioner therein to the respondent for reimbursement of the full amount paid to a private recognized hospital for an open heart surgery undergone by the said petitioner. After considering the case of the parties therein, the court held that the petitioner was entitled to full reimbursement of the expenses incurred on the speciality hospital where he was referred for specialized treatment after the respondent had accorded permission. Counsel for the petitioner also submitted that once an approved package rate has been arrived at between the respondent and the concerned hospital, in case the hospital charged amounts over and above the said package rate, the respondent was under an obligation to pay such charges and it was between the respondent and the hospital to sort out the said issue and that the petitioner could not be held liable to pay the difference from his own pocket. In support of the aforesaid contention, the counsel for the petitioner places reliance on the following judgments: