JYOTSNA RAJGURU Vs. MPTRIFAC

JUDGEMENT

(1.) This petition under Article 226 of the Constitution of India is filed, being aggrieved by the partial reimbursement of medical expenses incurred by the petitioner for the treatment of her late husband Narendra Rajguru at Nanawati Hospital, Mumbai and for further direction to the respondents to make good the difference of amount of medical expenses.

(2.) The petitioner is the widow of deceased employee Narendra Rajguru, who worked as Senior Assistant with respondent No.2/Audhyogik Kendra Vikas Nigam Limited (AKVN), which is a subsidiary of M.P. Trade and Investment Facilitation Corporation Limited (MPTRIFAC). It is not in dispute that the government employee incurred breathing trouble and heaviness in the chest on 13.06.2017 and got himself checked by Dr. B.S. Yadav, Professor and Head of Gandhi Medical College and Hamidia Hospital, Bhopal who advised further test. He submitted a medical leave application on 14.06.2017 to respondent No.2/AKVN. He was thereafter admitted on 14.06.2017 in the government approved Bansal Hospital, Bhopal, wherein he was diagnosed with unstable angina and underwent coronary angiography on 15.06.2017. He was diagnosed with Ischemic Heart Disease (IHD) and Critical Triple Vessel Disease with Acute Coronary Syndrome on 15.06.2017 and advised early CABG. Due to the urgency and risk involved in the operation, he was immediately admitted to the Nanawati Hospital, Mumbai on 16.06.2017, where on 17.06.2017, he underwent CABG surgery and Recab surgery. Unfortunately, he developed complications, multiple infections and was put on ventilator and VA ECMO. Due to the complications, he was put on dialysis and also had to undergo Trechostomy, Colostomy, Laparotomy operations. Unfortunately, he could not recover from his serious conditions and died on 02.09.2017. The entire expenses incurred for the treatment, surgery, investigations, drugs etc. came to Rs. 84,36,784/-.

(3.) After the demise of her husband, petitioner applied for reimbursement of Rs.84,36,784/- incurred during the treatment of her late husband. The medical bills alongwith the relevant documents were forwarded to the Dean, Gandhi Medical College, Bhopal for necessary action, who referred the same to the Professor and Head of the Department of Cardiology. The Dean of Gandhi Medical College vide letter dated 07.02.2018 informed the respondent No.2/Corporation to reimburse the amount as per rules at its own level. The claim of petitioner was thereafter put up before the respondent/Corporation. The M.D., AKVN after consulting the Corporation Doctor and as per the Rules applicable, proposed reimbursement to the tune of Rs. 60,06,486/- as against the bills of Rs. 84,36,784/- and placed the matter before the Board of Directors, MPAKVN in its meeting No.111 dated 20.03.2018 for approval. The Board, though relaxed the condition of prior approval for treatment outside the State, however, granted approval for reimbursement of Rs.8,37,550/- only on the anvil that it was the maximum amount reimbursable as per circular issued by the Medical Education Department No. F-18-68/2000/1/55 dated 14.08.2015 for open heart surgery and in view of Rule 7(2) and (3) of M.P. Civil Services (Medical Attendance) Rules, 1958 (hereinafter referred to as 'the Rules of 1958').