AYOUDHIA PRASAD DUGGAL Vs. CAT, CHANDIGARH AND OTHERS

JUDGEMENT

(1.) The Petitioner, who retired as a Superintendent from the Customs and Central Excise Department, Chandigarh, seeks issuance of a Writ in the nature of Certiorari for quashing/setting aside the impugned order dated 11.9.2015 (Annexure P-6) passed by the Ld. Central Administrative Tribunal, Chandigarh Bench, Chandigarh, as also the earlier order dated 31.1.2014 (Annexure A-12) passed by Respondent No. 4, on behalf of Respondent No.3, in which, the petitioner's request for reimbursement of the amount charged by the Fortis Hospital (Respondent No. 5), which was over and above the CGHS rate, was rejected, 'as the consent given by the close blood relations of the patient during emergency implies to be the consent given by the patient.'

(2.) The factual background happens to be that immediately after his superannuation, the Writ Petitioner became a member of the Central Government Health Scheme (in short "CGHS"). He suffered a massive Heart Attack and was rushed to the Fortis Hospital, which is an empanelled Hospital under CGHS On 03.08.2013. The Petitioner was informed by the Doctors that he had to undergo Permanent Pacemaker Implantation (P.P.I) and the Doctors advised MRI Compatible DDDR Pacemaker (Permanent). On 05.08.2013, the Petitioner underwent P.P.I. He was discharged on 08.08.2013. It is his case that he was charged a sum of Rs. 1,24,500/- by Fortis Hospital i.e. Respondent No. 4 despite being member of CGHS. Thereafter, he submitted a representation on 16.09.2013 to Respondent No. 3 to reimburse the above amount which he paid to the Fortis Hospital. Again the Petitioner was hospitalized on 20.09.2013 in Emergency and he underwent CAT+PTCA+Stent to LAD. This time also the Petitioner paid an amount of Rs. 1,40,557/- as patient's share over and above the amount paid by the CGHS. Vide another representation dated 28.09.2013, he asked for reimbursement of above amount. When the same was not decided, he served a Legal Notice dated 29.10.2013. Vide order dated 31.01.2014, his claim was rejected. He therefore, filed his Original Application in the Central Administrative Tribunal.

(3.) It was contested on behalf of the Respondents, who filed their separate Written Statements. While the Respondent Nos. 1 to 3 alleged that the Petitioner was admitted in the Fortis Hospital from 1.8.2013 to 8.8.2013 and then from 20.9.2013 to 22.9.2013, yet their contention was that he had chosen the Pacemaker of a superior quality than that permissible under CGHS and he had also submitted an undertaking to pay the additional amount, over and above the Ceiling Limit of CGHS, as paid by official Respondents to the Fortis Hospital. So he is not entitled to any benefit. The amount paid by the Petitioner for better Pacemaker & Stents could not be reimbursed under the said Scheme, therefore, request of the Petitioner was rejected vide the impugned order.