PREM MAHALWAL Vs. GOVT. OF NCT OF DELHI

JUDGEMENT

(1.) THE petitioner, Ms. Prem Mahalwal seeks reimbursement of the medical treatment bills from the Government of NCT of Delhi. She suffered a stroke in April, 2006 and was referred to the Nephrology Department, Rockland Hospital, a private recognized hospital, by the Chief Medical Officer (CMO), Directorate of Health Service, Government of NCT of Delhi. The petitioner has placed on record the reference certificate issued by the CMO dated 19th April, 2006. The petitioner claims that the said reference certificate is valid and binding on the respondents as the CMO is the authorized medical attendant (AMA) for referral purposes. In this regard, counsel for the parties have drawn my attention to the Clause 10 (ii) of the office memorandum dated 25th October, 2007, which reads as under: ii. The authorized medical attendant (AMA) for referral pruposes will be the CMO/MO Incharge of the dispensary/hospital where the beneficiary is attached.

(2.) THE respondent have stated that the reference was made in April, 2006 i.e. before office memorandum dated 25th October, 2007 and on the relevant date reference from Head of the Department was required. Even if this is correct, in the present case, undisputedly reference was made by the doctor employed by the respondents. It was equally the responsibility of the respondents to ensure that reference was made after following the prescribed procedure. Moreover the doctor concerned should have asked and warned the petitioner to follow the procedure. Technicalities should not come in way when it is accepted that treatment in a private recognized hospital was required.

(3.) AS noticed above, the petitioner was asked to approach a private recognized hospital by the CMO vide his recommendation dated 19th April, 2006. Thereafter, she has been taking treatment in the Rockland Hospital. No doubt Clause 10 (A) requires recommendation/advice of the concerned AMA after period of 6 months at each instance, but the question is whether reimbursement should be denied, when otherwise specialist treatment in a private recognized hospital was required and necessary. As noticed above, the office memorandum was issued on 25th October, 2007 i.e. after recommendation/advice for treatment at the private recognized hospital was already given. Approval if justified and was required can be given subsequently and expost facto. Reimbursement of medical expenses, which was necessary and required, should not be rejected on technical grounds unless there is an express prohibition. A liberal approach is required. Clause 10 (A) prohibits reimbursement of expenses/bills of private non -recognized or un -empanelled hospitals. There is no such express prohibition in case advise is not obtained every six months. It will be appropriate for the respondents to examine the case of the petitioner for post facto approval. While examining the case of the petitioner for post facto approval, the respondents will keep in mind the prescription, diagnostic reports and medical treatment, which the petitioner had to undergo. The respondents will also keep in mind the first prescription of the CMO dated 19th April, 2006 by which the petitioner was referred to Nephrology Department, Rockland Hospital.