Punjab-Haryana High Court
Waryam Singh vs State Of Punjab on 12 April, 1996
Equivalent citations: (1996)113PLR339
Author: Sarojnei Saksena
Bench: Sarojnei Saksena
JUDGMENT G.S. Singhvi, J.
1. To some people State is essentially a class-structure, an organization of one class dominating over the other classes; others regard it as an organization that transcends all classes and stands for the whole community. They regard it as a power-system. Some view it entirely as a legal structure, either in the old Austrinian sence which made it a relationship of governors and governed, or, in the language of modern jurisprudence, as a community, ' organized for action under legal rules'. Some regard it as no more than a mutual insurance society, others as the very texture of all our life. Some class the state as a great ' corporation' and others consider it as indistinguishable from society itself.
(Mac Iver, "The Modern State")
2. During recent times, the concept of State has undergone drastic changes. Today, State cannot be conceived of simply as a coercive machinery wielding the power of authority for simply collecting tax or for enforcing law and order. It now carries out multifarious activities affecting the lives of the individuals. State also renders varied kind of services to the people. According to Mac Iver- "if we clearly grasp the character of the State as a social agent, understanding it rationally as a form of service and not mystically as an ultimate power, we shall differ only in respect of the limits of its ability to render service."
3. Part III of the Constitution of India gives a picture of various fundamental rights available to citizens of India whereas Part IV indicates the areas in which the State has to render service to the people in general and the weaker sections in particular.
4. The interplay of part III and part IV has been considered by the Courts in various decisions. In one of the earliest decisions-in The State of Madras v. Champakam Dorairajan, A.I.R. 1951 SC 226 - fundamental rights were held pre- eminent vis-a-vis Directive Principles but since then there has been a perceptible shift in the Court's approach to the inter-play of Fundamental Rights and Directive Principles. In the Kerala Education Bill, A.I.R. 1958 SC 956 a Special Bench of the Supreme Court speaking through S.R. Das, C.J., while affirming the primacy of Fundamental Rights, qualified in with the following words :-
"Nevertheless, in determining the scope and ambit of the fundamental rights relied upon by or on behalf of any person or body, the Court may not entirely ignore these directive principles of State Policy laid down in Part-IV of the Constitution but should adopt the principle of harmonious construction and should attempt to give effect to both as much as possible."
5. In Keshavananda Bharti v. State of Kerala A.I.R. 1973 SC 1461, various Judges constituting the larger Bench expressed themselves on the inter relationship of the fundamental rights and the directive principles. Hedge and Mukherjee, JJ., observed :-
"The Fundamental Rights and Directive Principles constitute the 'conscience' of the Constitution.......... To ignore part IV is to ignore the sustenance provided for in the Constitution, the hopes held out to the nation and the very ideals on which our Constitution is built... There is no anti-thesis between the Fundamental Rules and the Directive Principles.....one supplements the other."
Shelat and Grover, JJ, in their judgment observed :-
"Both Parts II and IV....have to be balanced and harmonised.... then alone the dignity of the individual can be achieved.....They (Fundamental Rights and Directive Principles) were meant to supplement each other."
Mathew, J. while adopting the same approach remarked :-
"The object of the people in establishing the Constitution was to promote justice, social and economic liberty and equality. The modus operandi to achieve these objectives is set out in parts III and IV of the Constitution, Both Parts III and IV enumerate certain "moral rights. Each of these Parts represents in the main the statements in one sense of certain aspirations whose fulfillment was regarded as essential to the kind of society which the Constitution-makers wanted to build. Many of the articles, whether in Part III or Part IV, represent moral rights which they have recognised as inherent in every human being in his country. The task of protecting and realising these rights is imposed upon all the organs of the State, namely, legislative, executive and judicial. What then is the importance to be attached to the fact that the provisions of Part HI are enforceable in a Court and the provisions in Part IV are not ? Is it that the rights reflected in the provisions of Part III are somehow superior to the moral claims and aspirations reflected in the provisions of Part-IV ? I think not, Free and compulsory education under Article 45 is certainly as important as freedom of religion under Article 25 - Freedom from starvation is as important as right to life. Nor are the provisions in Part III absolute in the sence that the rights represented by them can always be given full implementation."
Y.V. Chandrachud, J. (as he then was) put the same idea in the following words.-
"As I look at the provisions of Parts III and IV, I feel no doubt, that the basic object of conferring freedoms on individuals is the ultimate achievement of the ideas set out in Part-IV... May I say that the directive principles of State Policy should not be permitted to become 'a mere rope of sand.' If the State fails to create conditions in which the fundamental freedoms can be enjoyed by all, the freedom of the few will be at the mercy of the many and then all freedoms will vanish."
In U.P.S.C. Board v. Harishankar, A.I.R. 1979 SC 65, it was observed :
"Addressed to courts, what the injunction (Article 37) means is that while courts are not free to direct the making of legislation, courts are bound to evolve, affirm and adopt principle of interpretation which will further and not hinder the goals set out in the Directive Principles of State Policy. This command of the constitution must be ever-present in the minds of the Judges while interpreting statutes which concern themselves directly or indirectly with matters set out in the Directive Principles of State Policy." This is on the view that the 'State' in Article 36 read with Article 12 includes the judiciary as well."
6. In Randhir Singh v. Union of India, A.I.R. 1982 SC 879, the Supreme Court read the principle of "equal pay for equal work' enshrined in Article 39(d) as a part of Articles 14 and 16 of the Constitution of India.
7. In Unni Krishnan, J.P. v. State of Andhra Pradesh, (1993) 1 SCC 745, B.P. Jeevan Reddy, J., speaking for himself and on behalf of S.R. Pandian, J. made reference to the various previous decisions and observed thus :-
"It is thus well established by the decisions of this Court that the provisions of Parts III and IV are supplementary and complementary to each other and that Fundamental rights are but a means to achieve the goal indicated in Part-IV. It is also held that the Fundamental Rights must be construed in the light of the Directive Principles."
8. Article 21 speaks of protection to life and personal liberty. Article 41 requires the State to make effective provision within the limits of its economic capacity and development for securing the right to work, to education and to public assistance in cases of unemployment, old age, sickness etc. Article 47 declares that raising of the level of nutrition and the standard of living of its people and the improvement of public health as among primary duties of the State. These three Articles can usefully be quoted below :-
"Article 21. Protection of life and personal liberty: -
No person shall be deprived of his life or personal liberty except according to procedure established by law.
Article 41. Right to work, to education and to public assistance in certain cases: The State shall, within the limits of its economic capacity and development, make effective provision for securing the right to work* to education and to public assistance in cases of unemployment, old age, sickness and disablement, and in other cases of undeserved want.
Article 47. Duty of the State to raise the level of nutrition and the standard of living and' to improve public health: The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavour to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs which are injurious to health."
9. What is the meaning of scope of term "life" used in Article 21? Does it merely connote animal existence? Is it confined to mere freedom from bodily restraint or it means some thing more? During the debate in Constituent Assembly, one of its member Shri K.T. Shah presented a lucid paper on the scope of term "life". He said that expression "life" has a much wider meaning. It does not merely connote animal existence and a continued drudgery through life but it would include one's livelihood, reputation and all those finer graces of human civilization which make life worth living.
10. At this stage, it would be profitable to note the forward march made by the Supreme Court in giving new dimensions to the meaning of expression "Life and personal liberty". In Maneka Gandhi v. Union of India, A.I.R. 1978 SC 597, a Constitution Bench of the Supreme Court referred to the following observations of Gran-villa Austin (The Indian Constitution - Corner Stone of a Nation) :-
"These Fundamental Rights and their deep root in the struggle of independence and they were included in the Constitution in the hope and expectation that one day the tree of true liberty would bloom in India".
Their Lordships then went on to reject the argument that the expression "personal liberty" in Article 21 should be so interpreted as to avoid overlapping between that Article and Article 19(1) and in law depriving a person of personal liberty has to stand the test of Fundamental Rights conferred under Article 19.
11. In Bandhua Mukti Morcha v. Union of India, A.I.R. 1984 SC 802, a new meaning came to be given to the expression "life". A three Judges Bench of the Supreme Court observed:-
"It is the fundamental right of everyone in this country, assured under the interpretation given to Article 21 by this Court in Francis Mullin's case (AIR 1980 SC 849) to live with human dignity, free from exploitation. This right to live with human dignity enshrined in Article 21 derives its life breath from the Directive Principles of State Policy and particularly clauses (e) and (f) of Article 39 and Articles 41 and 42 and at the least, therefore, it must include protection of the health and strength of workers, men and women, and of the tender age of children against abuse, opportunities and facilities for children to develop in a healthy manner and in conditions of freedom and dignity, educational facilities, just and humane conditions of work and maternity relief. These are the minimum requirements which must exist in order to enable a person to live with human dignity and no state - neither the Central Government nor any State Government - has the right to take any action which will deprive a person of the enjoyment of these basic essentials." The Court went on to observe:-
"Since the Directive Principles of State Policy contained in clauses (e) and (f) of Article 39, Articles 41 and 42 are not enforceable in a court of law, it may not be possible to compel the State through the judicial process to make provision by statutory enactment or executive fiat for ensuring these basic essentials which go to make up a life of human dignity, with concrete reality and content, the State can certainly be obligated to ensure observance of such legislation for inaction on the part of the State in securing implementation of such legislation would amount to denial of the right to live with human dignity enshrined in Article 21, more so in the context of Article 256 which provides that the executive power of every State shall be so exercised as to ensure compliance with the laws made by Parliament and any existing laws which apply in that State."
12. In Olga Tellis v. Bombay Municipal Corporation, A.I.R. 1986 SC 181, the provisions of Article 21 came to be interpreted in the context of the provisions contained in the Bombay Municipal Corporation Act, 1888. The Supreme Court was called upon to answer - whether the right to live includes the right to livelihood. Argument on behalf of the petitioner was that if they are evicted from their slum and pavement dwellings they would be deprived of their livelihood. While upholding the plea of the petitioner, their Lordships observed :-
"We see only one answer to that question, namely, that it does. The sweep of the right of life conferred by Article 21 is wide and far-reaching. It does not mean merely that life cannot be extinguished or taken away as, for example, by the imposition and execution of the death sentence, except according to procedure established by law. That is but one aspect of the right to life. An equally important facet of that right is the right to livelihood because, no person can live without the means of living, that is, the means of livelihood. If the right to livelihood is not treated as a part of constitutional right to life, the easiest way of depriving a person of his right to life would be to deprive him of his means of livelihood to the point of abrogation. Such deprivation would not only denude the life of its effective content and meaningfulness but it would make life impossible to live. And yet, such deprivation would not have to be in accordance with the procedure established by law, if the right to livelihood is not regarded as a part of the right to life. That, which alone makes it possible to live, leave aside what makes life livable, must be deemed to be an integral component of the right to life. Deprive a person of his right to livelihood and you shall have deprived him of his life."
13. The same view has been expressed by some of the Judges constituting the Constitution Bench in Delhi Transport Corporation v. Delhi Transport Corporation Mazdoor Congress, A.I.R. 1991 SC 101, and D.K. Yadav v. J.M.A. Industries, 1993(4) SLR 126.
14. In Pt. Parmanand Katara v. Union of India, A.I.R. 1989 SC 2039, a two Judge Bench gave another dimension to the expression "life" when it observed: -
"Article 21 of the Constitution casts the obligation on the State of preserve life. The provision as explained by this Court in scores of decisions has emphasized and reiterated with gradually increasing emphasis that position. A doctor at the Government hospital positioned to meet this State obligation is, therefore, duty-bound to extend medical assistance for preserving life. Every doctor whether at the Government hospital or otherwise has the professional obligation to extend his services with due expertise for protecting life. No law or State action can intervene to avoid/delay the discharge of the paramount obligation cast upon members of the medical profession. The obligation being total, absolute and paramount, laws of procedure whether in statutes or otherwise which would interfere with the discharge of this obligation cannot be sustained and must, therefore, give way."
15. In Unni Krishnan, J.P. v. State of A.P. (supra) a Constitution Bench of the Supreme Court considered the question - whether right to education is a fundamental right. By a majority judgment, the Supreme Court held that "right to receive education upto the age of 14 years as enshrined in Article 45 of the Constitution of India is a part of right to life under Article 21". In his judgment Mohan, J., made reference to the provisions of Articles 14, 19, 21, 25 and 26 and observed that" there is no need to provide a right to life in a positive manner because right to life and property inheres in every man and quoted with approval the following observations in Pathumma v. State of Kerala, A.I.R. 1978 SC 771 :-
"Attempt of the Court should be to expand the reach and ambit of the fundamental rights rather than accentuate their meaning and content by process of judicial construction.... Personal liberty in Article 21 is of the widest amplitude."
Mohan, J., also quoted the following observations of the Supreme Court in State of M.P. v. Pramod Bhartiya, 1992 A.I.R. SCW 3142 :-
"Because clause (d) of Article 39 spoke of "equal pay for equal work" for both men and women it did not cease to be part of Article 14. To say that the rule having been stated as a directive principle of State Policy, and not enforceable in court of law is to indulge in sophistry. Parts IV and III of Constitution are not supposed to be exclusionary of each other. They are complementary to each. The rule is as much a part of Article 14 as it is of clause (i) of Article 16."
16. His Lordship then proceeded to enumerate various types of rights which form part of Article 21 by making reference to the judgments of the Supreme Court. Para 31 of the judgment of Mohan, J., can usefully be quoted below:-
"31. The following rights are held to be covered under Article 21.
1. The Right to go abroad - Satwant Singh v. A.P.O., New Delhi, (1967) 3 SCR 525 : (AIR 1967 SC 1836).
2. The right to privacy - Govinda v. State of M.P. (1975)9 SCR 946 : (AIR 1975 SC 1378).
In this case reliance was placed on the American decision in Griswols v. Connecticut, (1965) 381 US 479 at 510.
3. The Right against solitary confinement - Sunil Batra v. Delhi Administration, (1978)4 SCC 494 at 545 ; (AIR 1975 SC 1675 at P.1710).
4. The Right against Bar fetters. - Charles Sobraj v. Supt. Central Jail, (1979) 1 SCR 512: (AIR 1978 SC 1514).
5. The Right to legal aid - Hoskot v. State of Maharashtra, (1979)1 SCR 192 : (AIR 1978 SC 1548).
6. The Right to speedy trial - Hussaina Khatoon v. State of Bihar, (1975) 3 SCR 165 : (AIR 1975 SC 1360).
7. The Right against Handcuffing - Prem Shankar v. Delhi Administration, (1980) 3 SCR 855: (AIR 1980 SC 1535).
8. The Right against delayed execution - T.V. Vatheswaran v. State of Tamil Nadhu, AIR 1983 SC 361(2).
9. The Right against custodial violence - (1983) 2 SCC 96 : (AIR 1983 SC 378) Sheela Bharse v. State of Maharashtra.
10. The Right against Public hanging - A.G. of India v. Lachmadevi, AIR 1986 SC 467.
11. Doctor's Assistance - Parmananda Katara v. U.O.I. (1989)4 SCC 286: (A.I.R. 1989 SC 2039).
12. Shelter - Santistrar Builder v. N.K. Totame, (1990)1 SCC 525 : (AIR 1990 SC 630.)"
In the ultimate analysis, Mohan, J., held:-
"If really Article 21, which is the heart of fundamental rights has received expanded meaning from time to time there is no justification as to why, it cannot be interpreted in the light of Article 45 wherein the State is obligated to provide education up to 14 years of age, within the prescribed time limit."
17. B.P. Jeevan Reddy, J. who delivered judgment on behalf of himself and S.R. Pandian, J., held :-
"The right to education which is implicit in the right to life and personal liberty Guaranteed by Article 21 must be construed in the light of the Directive Principles in Part-IV of the Constitution."
18. We may also take notice of two more judgments dealing with the subject. In Vincent v. Union of India, A.I.R. 1987 SC 990, a Division Bench of the Supreme Court while commenting upon the import of the provisions contained in a Part-IV of the Constitution observed :-
"In a welfare State, therefore, it is the obligation of the State to ensure the creation and the sustaining of conditions congenial to good health........... In a series of pronouncements, during the recent years, this court has culled out from the provisions of Part-IV of the Constitution, the several obligations of the State and called upon it to effectuate them in order that the resultant picture by the Constitution fathers may become a reality."
(Underlying is ours)
19. In Francis C. Mullin v. Administrator, Union Territory of Delhi, A.I.R. 1981 SC 746, the Supreme Court elaborated on the scope of Article 21 and held :-
"But the question which arises is whether the right to life is limited only to protection of limb or faculty or does it go further and embrace some thing more. We think that the right to life includes right to live with human dignity and all that goes along with it viz., the bare necessities of life such as adequate nutrition, clothing and shelter and facilities for reading, writing and expressing oneself in diverse forms, freely moving about the mixing and commingling with fellow human being. Of course, the magnitude and content of the components of this right would depend upon the extent of the economic development of the country, but it must in any view of the matter, include a right to the basic necessities of life and also the right to carry on such functions and activities as constitute the bare minimum expression of the human self."
20. From the above discussion, it is clear that the Courts have unhesitatingly read the provisions of Part-IV of the Constitution as integral part of various fundamental rights enumerated in Part-Ill of the Constitution. Therefore, it must be held that Article 47 of the Constitution which declares that raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties as well as Article 41 which obliges the State to make effective provision for securing among other things public assistance in cases of sickness and disablement within the limits of its economic capacity and development forms part of Article 21 of the Constitution. It is the duty of the State to provide adequate assistance to the people in cases of sickness. Various finer aspects of life would be rendered meaningless if one cannot get adequate medical attention. In fact, providing of medical assistance to sick and disabled is an integral part of the obligations of the State to improve public health. Therefore, every provision made by the State legislature or executive for providing medical assistance will be deemed to have their source in Articles 21, 41 and 47 of the Constitution and in appropriate case the citizen will be entitled to enforce such provisions and it will be no answer to such a claim that the provisions of Articles 41 and 47 are not enforceable by virtue of Article 37. After having given effect to the provisions contained in Part-IV of the Constitution, the State cannot back track and deny the benefit of the legislative measure or executive orders passed by it for giving effect to the contents of the Directive Principles of the State Policy, which as already held above, form part of the right to life enshrined in Article 21 of the Constitution.
21. We shall now refer to the administrative instructions issued by the Government on the issue of re-imbursement of medical expenses. One of the earliest set of instructions was issued by the Government of Punjab vide letter dated 27.5.1987 but that is not very much relevant for the purpose of these cases. Instructions which were issued vide letter No. 17/7/85-5HBV/2498 dated 25.1.1991, letter No. 7/7/85-HBV/34001 dated 8.10.1991, letter No. 12/217/94-5HBV/27721 dated 9.9.1994, letter No. 12/193/94-5HB-5/5251-54 dated 13.2.1995 and letter No. 12/316/94-5HBV/646-49 dated 8.1.1996 are reproduced below :-
"Letter dated 25.1.1991:
Subject: Reimbursement of Medical expenses-Police regarding.
Sir/Madam, In supression of Punjab Government letter No. 7/7/85-3HBV/13855 dated 2nd May, 1979, the President of India is pleased to lay down the following policy for reimbursement of medical expenses incurred on medical treatment taken abroad and in hospital other then the hospitals of the Government of Punjab (both outride and in the State of Punjab) :-
(i) All categories of employees whether retired or" serving of All India Service/State Government/Judges of Punjab and Haryana High Court/M.L.As. will be governed by this policy.
(ii) The person who is in need of medical treatment outside India or in any hospital other than the Government of Punjab (both outside and in the State of Punjab), as the case may be, may make an application for getting treatment in these hospitals directly to the Director, Health and Family Welfare two months advance, duly accompanied by the C.M.O./Medical Superintendent indicating that treatment for the disease mentioned is not available in the Hospitals of the Government of Punjab. In case of Emergency duly authenticated by C.M.O./Medical Superintendent the application can be made 15 days in advance.
(iii) Director Health and Family Welfare, Punjab will place the application of the concerned employees before the Medical Board within 15 days on the receipt of application. In case of emergency, if immediate meeting of Medical Board cannot be convened, such application may be circulated to all the members of the Medical Board and decision taken thereof.
(iv) The Medical Board shall consist of the following officers :-
1. Director, Health and Family Welfare, Punjab.....Chairman
2. Director, Research & Medical Education, Punjab. ...Member
3. Specialist of the desired line treatment from PGI, Chandigarh OR A.I.I.M.S., New Delhi.....Member
4. Senior most specialist from Medical Colleges, Patiala, Amritsar and Faridkot.....Member
5. Deputy Director/Assistant Director, Incharge of the P.M.H. Branches office of Director Health and Family Welfare. ...Member Secretary The Board may co-opt any other specialist to assist it whenever and wherever necessary. The headquarters of the Board shall be at Chandigarh.
Three members including one specialist should be present and will form the quorum of the Board. The Board shall examine the concerned employees who is desirous of availing of medical treatment and recommend his treatment either abroad or in any of the hospitals other than Punjab Government. In case treatment is to be taken abroad, the medical Board should categorically state that such treatment is not available in India and treatment abroad is necessary.
(v) The Board shall ensure the correctness of disease, necessity of treatment abroad and to consider and decide as to whether or not satisfactory level of treatment is available in India. The Board may recommend treatment in any of the hospitals in India, if they are of the opinion that arrangements are available in India. In such cases treatment abroad may not be allowed and the Board may record such findings and authorise such treatment in Medical Institution within India whether Government or privately recognised (list to be supplied by Director, Health Services).
(vi) The Medical Board, if. satisfied that in the interest of person concerned it is essential to do so, may recommend one attendant to accompany the patient. The attendant will be allowed T.A. as admissible to the patient.
(vii) The reimbursement on account of diet, stay or, attendant and stay of patient in hotel/hospital will not be allowed.
(viii) If a person gets medical treatment abroad without prior approval of the Medical Board, no reimbursement shall be allowed except with the permission of Finance Department.
(ix) The person concerned will bear 10% of the expenditure excluding such travelling fare subject to a maximum of Rs. 25,000/- if treatment is taken abroad. The Head of Department will be competent to reimburse such medical bills to the tune of Rs. 10,000/- the Administrative Department will be competent to the tune of Rs. 25,000/- for such medical treatment and beyond Rs. 25,000/- the powers lie with finance Department. The person concerned will be entitled to 75% advance to be sanctioned by the Head of Department of the total estimated expenditure which would be subject to adjustment at the time of total reimbursement. This should be adjusted within 3 months.
(x) The case of investigation/medical check up and follow up will also be governed under this policy.
(xi) In case of treatment taken abroad, the scale of expenditure and the eligibility for treatment the person concerned is entitled shall be identical to the scale of expenditure and the eligibility of an officer/official of the Indian Foreign Services of corresponding grade in the Ministry of External Affairs under any Assistance Medical Attendance Scheme for the time being in force.
(xii) The Health Department in consultation with Director, Research and Medical Education will prepare a list of diseases for which specialised treatment is not available in Punjab Government Hospitals/Clinics of repute where necessary treatment is available. This list will, however, be subject to variation in future.
(xiii) The Punjab Medical Attendant Rules, 1940 may be considered to have been modified accordingly.
(xiv) This issue with the concurrence of the Department of Finance conveyed vide I.D. No. 8/532/86-5FEII/3456, dated the 6th December, 1990.
Yours faithfully, Sd/-
Under Secretary, Health.
"Letter dated 8.10.1991:
Subject : Reimbursement of medical expenses incurred by Punjab Government Employees/Pensioners on treatment taken abroad and in private hospitals-policy regarding.
Sir, I am desired to refer to Punjab Government circular letter No. 7/7/85-5HBV/2499 dated the 25th January, 1991 on the subject cited above, vide which policy for reimbursement of medical expenses incurred on medical treatment taken abroad and in hospitals, other than those of the Government of Punjab, both within and outside the State, was laid down. However, as per the 12th item of these instructions, a list of those diseases for which specialised treatment was not available in the Government Hospitals, was to be prepared in addition to identifying medical institutions hospitals/clinics of repute where such specialised treatment was available.
2. Government has now prepared a list of those diseases for which the specialised treatment is not available in Punjab Government Hospitals but is available in certain identified private hospitals, both within and outside the State. It has, therefore, been decided to recognize these hospitals for the treatment of the disease mentioned against them in the enclosed list for Punjab Government employees/ pensioners and their dependents.
3. The terms and conditions contained in letter under reference will remain applicable. Government can however revise the list, in future.
4. This issues with the concurrence of the Finance Department received vide I.D. No. 8/7/89-5FEII/3246 dated 11th September, 1991.
List of diseases and of private Institutions located outside and Inside Punjab which have been recognised for treatment of Punjab Governments employees/pensioners and their dependants.
Sr. Name of the disease for which Name of the Private
No. the treatment is not available in Hospital/Institution.
Punjab Govt. Hospitals.
1. Open Heart Surgery 1. Escort Heart Institute,
New Delhi.
Christian Medical College,
Ludhiana
Appollo Hospital. Madras.
2. Total replacement of joints 2. Jaslok Hospital, Bombay,
other than knee
Nilrattan Sarcan Medical
College, Calcutta.
3. All types of Carcinoma 3. Christian Medical
College, Ludhiana
Mohan Dai Oswal Cancer
Institute, Ludhiana
4. Vitrectomy & complicated cases 4. Shanker Nehrala, Madras,
of retinal detachment.
5. Reimplantation of served limb. 5. Christian Medical College,
Ludhiana.
6. Ring external fixation of bones 6. D.M.C. Ludhiana.
(Volkov-ognaseyan apparatus).
7. Hand Surgery for Laprosy 7. Appolo Hospital, Madras.
8. Dental treatment.
1. Prosthetic - denture/tooth Nair, Dental Hospital,
implants, Bridge in plants Bombay.
Ceramic & maxillo facial Dental College & Hospital,
prostheesis. Lucknow.
2. Oral Surgery: Nair Dental College & Hospital,
surgical orthodontics. Bombay.
Dental College, Bombay.
Government Dental College,
Ahmedabad.
& in private hospitals Delhi,
Bombay & Ahmedabad.
Letter dated 9.9.1994.
Subject: Reimbursement of Medical Expenses incurred by Punjab Govt. Employees/Pensioners on treatment taken abroad & in private Hospitals - Policy regarding.
Sir, I am directed to refer to Punjab Government Circular letter No. 7/7/85-5HBV/34001 dated 8.10.91 on the subject cited above vide which Govt. has decided to recognise some Private Hospitals both within and outside the State of Punjab for taking treatment. This matter has again been considered with Fiance Department and it has been decided to withdraw the above referred letter. According to this letter is withdrawn.
It has now been decided for taking treatment in Govt. Hospitals & Private Hospital outside the State or Govt. Hospitals in the State, the prior approval of the Medical Board be taken.
This issues with the concurrence of the Department of Finance Department conveyed vide I.D. No. 8/93/93-5 FEII/5822 dated 19.8.1994.
Sd/- B.S. Sudan, Joint Secretary, Health, Pb.
Letter dated 13.2.1995 Subject : Punjab Services (Medical Attendance) Rules, 1940- Reimbursement facilities to Punjab Government employees and Pensioners.
Sir, The question of revising some of the facilities to Punjab Government employees/pensioners, has been engaging he attention of the State Government and consequently following decisions have been taken:-
1. Treatment at AIIMS, New Delhi, in Private Hospital and treatment Abroad :
As per instructions issued, vide Punjab Government letter No. 7/7/85-5HCV/2498, dated the 25th January, 1991 the policy regarding reimbursement of medical expenses incurred on medical treatment taken abroad and in hospitals other than the hospitals of the Government of Punjab (both outside and inside the State of Punjab) was laid down. The Government has reviewed the decisions taken in the above said letter and it has not been decided as under:-
(a) Treatment at AIIMS :- District Civil Surgeons shall be competent to permit treatment of a particular disease at AIIMS, New Delhi, on the basis of recommendations of the District Level Standing Medical Board provided the treatment is not available in the Government Hospital of the State.
The expenditure on reimbursable items on such a treatment in AIIMS, New Delhi, shall be reimbursed to Government employees/pensioners. The composition of the District Level Medical Board shall be as under:-
(1) Civil Surgeon ... Chairman
(2) Assistant Civil ... Member.
Surgeon
(3) Two specialists ... Members,
of the concerned speciality.
For the purpose of Punjab Government employees posted at Chandigarh and pensioners residing here at Chandigarh the composition of the District Level Medical Board shall be as under:-
(1) Officer Incharge ... Chairman
of the concerned branch of the
Directorate of Health and Family
Welfare, Punjab.
(2) Senior Medical ... Member
Officer, Incharge,
Civil Hospital, Mohali.
(3) Two specialists of the concerned ... Members
specialists from Civil Hospital
Mohali.
This board shall meet in the Directorate of Health and Family Welfare, Punjab on the second Monday of each month and in case of holiday and Board will sit on the next working day.
(b) Treatment in Private Hospitals in the Country :-
It has been decided that employees and pensioners should be given freedom to get treatment in any private institute/hospital (of their own choice), in the country provided that he/she gives an undertaking out of his/her free will and in unambiguous terms that he/she will accept reimbursement of expenses incurred by him/her on his/her treatment to the level of expenditure as per rates fixed by the Director, Health and Family Welfare, Punjab for a similar treatment package or expenditure whichever is less. The rate of for a particular treatment would be included in the advice issued by the District/State Medical Board. A Committee of technical experts shall be constituted by the Director, Health and Family welfare, punjab to finalise the rates of various treatment packages and the same rate list shall be made available in the offices of the Civil Surgeons of the State.
However, this permission would be granted by the Director, Health and Family Welfare, Punjab on the advice of State Medical Board in case of the treatment in private Hospitals outside the State and the District Medical Board in case of Treatment in private hospitals within the State.
(c) Treatment Abroad :
The treatment of a disease in a country abroad would be permitted in extremely rare cases where satisfactory treatment is not available in the country. Such treatment and follow up should be recommended by the STATE MEDICAL BOARD Prior approval of the State Medical Board shall be pre-requisite in such cases. All efforts should be made by the concerned employee/pensioner to take prior approval of the State Medical Board.
The composition of the State Medical Board for all purposes, will be as follows :-
(1) Director, Health and ... Chairman
Family Welfare, Punjab.
(2) Specialist of the ... Member
desired line of treatment from
P.G.I., Chandigarh.
(3) Senior Most Specialist from ... Member
State Medical Colleges
(4) Deputy Director/Assistant ... Member
Director, Incharge of PMH
Branches O/o Director, Health
and Family Welfare, Punjab.
(Note: But in case if a specialist of the concerned line from P.G.I, Chandigarh is not available, there should be Specialists from two of the State Medical Colleges instead of only one).
The State Medical Board as well as District Medical Board shall meet on the FIRST WEDNESDAY of each month so that the applicants for treatment are not harassed and do not have to wait indefinitely. In case this day happens to be a holiday, the Board will meet on the next working day. All requests/applications would be considered by the Standing Medical Board which would be received by 10th of previous month. The other terms and conditions contained in letter No. 7/7/85-5HB-5/2498 dated the 25th January, 1991, will remain unchanged.
2. Reimbursement of expenses incurred on disposable items used during treatment as Inpatient: It has been decided to allow reimbursement of expenses incurred on disposable items connected with inpatient treatment of any ailment. The cases already decided will not be reopened.
3. Reimbursement of Tests got done from Private Hospital/Organisations: The reimbursement of any test/treatment got done from private hospitals/organisations for which facilities are not available in Government Hospitals/PGI will be made on the specific recommendations of the District Level Medical Board as per rates fixed by Director, Health and Family Welfare.
4. Reimbursement of Medical Expenses for outpatient Treatment of Chronic Diseases:
As per instructions contained in Punjab Government letter No. 10/12/90-88-5HB-5/66, dated 1st January, 1991 the authorised Medical Attendant in allopathy is competent to issue chronic disease certificate. Now, it has been decided that a specialist in the desired line of treatment would be competent to issue a certificate of chronic disease for first three months only.
Thereafter, the certificate will be issued by the District Medical Board which will be valid for a maximum of three years. Afterwards, the applicant will have to get himself/herself reexamined from the District Medical Board every three years. The Director, Health and Family Welfare, Punjab will prepare a revised list of chronic diseases, in this regard.
5. This issues with the concurrence of the Department of Finance conveyed, vide I.D. No. 8/142/93-5FE-2/8068, dated 2nd December, 1994.
Sd/-B.S. Sudan Joint Secretary, Health."
Letter dated 8.1.1996.
Subject: Grant of Medical Faculties to Punjab Govt. employees/pensioners & their dependents etc. Reimbursement of cost of knee replacement & cost of Hip Joint Implants.
Sir, I am directed to invite your attention to this department's" letter No. 10.12.(141)88/5HBV/196, dated 1.1.192 on the subject cited above vide which it has been decided to reimburse the cost of knee replacement Rs. 20,000/- (per knee) to the Punjab Govt. employees and Pensioners. The matter regarding to enhance the cost of knee replacement was under consideration of the Punjab Government. It has now been decided to enhance the cost of Artificial Knee (Component) from Rs. 20,000/- to Rs. 35000/- to the cost of other Hospital charge, cost of Medical charge, Injection and Reimbursement etc. (without expenditure regarding Diet money and Air conditioner) is to be reimbursement in addition to this amount.
In this connection attention is invited to this Deptt. letter No. 12/63/89-5HBV 5/6464, dated 12.3.91 vide which instructions regarding reimbursement regarding cost of Hip Joint implants Rs. 12000/- to the Punjab Government Pensioners/employees has been made. It has now been decide to enhance the cost of Hip Joint implants from Rs. 12000/- to Rs. 20000/- the cost of medicine and other Hospital charge is to be reimbursable in addition to this amount.
Sd/- S.S. Dhilon Joint Secretary, Health."
22. Some of these instructions have become subject matter of interpretation by this Court in large number of cases. In Sadhu R. Pall v. State of Punjab, 1994(1) RSJ 335, a Division Bench made reference to the Circulars dated 25.1.1991 and 8.10.1992 and held that a person, who has undergone by-pass surgery at Escort Heart Institute and Research Centre, New Delhi, cannot be denied reimbursement only on the ground that the institute was not recognised for the purpose of reimbursement and the petitioner had ignored the channel of Government Medical Institutions. The Division Bench held:-
"There is no reason nor any has been pointed out to restrict the right of the petitioner to get the best Medical treatment available in the country from an Institute recognised by the State Government. Since provision of free medical treatment or reimburse"ment in lieu thereof is a beneficial act of the welfare State for its employees, the rules/instructions have to be construed liberally in favour of the employees, for granting them the relief, rather than adopting a wooden attitude to deprive a person of his due. The respondents appear to have patently used excuses in refusing full reimbursement, when the factum of treatment and the urgency for the same has been accepted by the respondents by reimbursing the petitioner the expenses incurred by him, which he would have incurred in the A.I.I.M.S., New Delhi, We cannot loose sight of factual situation in the A.I.I.M.S., New Delhi, i.e. with respect to the number of patients received there for heart problems. In such an urgency, one cannot sit at home and think in a cool and calm atmosphere for getting medial treatment at a particular hospital or wait for admission in some Government medical institute. In such a situation decision has to be taken forthwith by the person or his attendants if precious life has to be saved." The Division Bench further held:-
"In view of the observations made above, we do not find force in the contention raised by the respondents. It is ridiculous to suggest that for a disease like heart trouble, particularly in the facts and circumstances of this case, the petitioner should have first appeared before the Medical Board and got their prior approval for treatment from a recognised institute. The very defence put forth by the respondents in view of the fact is frivolous. Taking the State's contention to its logical end, it would mean that a person who suffers a heart attack, should first get recommendation from the Medical Broad by appearing before it personally etc. before getting himself treated he should first get an approval for treatment from the medical board. In such circumstances as revealed in the instant petition, the petitioner would have never made it to the Medical Board as he in all probability would have died before the medical board could meet and examine him. In such diseases and situations timely medical aid is of paramount consideration.
We are of the considered view, by reading the instructions dated 8.10.1991 in pith and substance that the instructions do not authorise the respondents to refuse reimbursement as suggested by them. The instructions are meant for human being s and have to be read liberally and with an object to serve the purpose and the persons for whom they are meant. The defence taken by the respondents is nothing else but a frivolous defence which cannot be sustained in the eye of law. The very act of the respondents is arbitrary and an attempt at defeating justice."
23. The same issue was again considered in Ravi Mohan Duggal v. State of Punjab and other, 1995(3) RSJ 399, and it has been held:-
"Once the Escort Heart Institute, new Delhi and Apollo Hospital, Madras are recognised institutions and the Government has authorised the Government servant to go for treatment to these Institutions, the State cannot refuse reimbursement of the expenditure incurred by a Government servant for it is the bona fide duty of the Government to pay for the beneficial act of an employee as it is Welfare State. All the rules and regulations are to be considered in favour of the Government employee liberally and to the benefit of the Government employee and the State is not permitted to have an iron heart in such matters. The State has admitted the full expenditure to have been incurred by the petitioner in both the hospitals. The treatment and urgency for the same has been accepted by the respondents. They no where claimed that such an amount has not been incurred by the petitioner for his treatment. Once the petitioner was suffering from a serious heart attack he could not consult the doctor in Government hospital and sit at his home or wait for the permission of the Government to seek the treatment in a recognised hospital lest that would cause danger to his life and in many cases it could even cause death. In such a situation it was quite justified for the petitioner to take treatment in a recognised hospital and save his life."
24. In K.L. Kohli v. State of Punjab 1995(3) P.L.R. 88, another Division Bench held that one exfacto sanction was given by the Government then mere absence of prior approval of the Medical Board could not be a ground to refuse reimbursement.
25. In G.S. Randhawa v. State of Punjab, 1995(1) R.S.J. 853, another Division Bench followed the judgment in Sadhu R. Pall v. State of Punjab (supra) and upheld the claim for reimbursement.
26. In Mrs. Surya Pandit v. State of Punjab, 1995(4) RSJ 670, I had an occasion to deal with the argument raised by the respondents that when approval is granted for treatment in a private recognised institute but the reimbursement is limited to expense which would have been incurred for similar treatment in the All India Institute of Medical Sciences, the employee cannot get more than that. While rejecting the argument, it has been held:-
"Once the Government of Punjab has taken a policy decision to recognise the Hospital and Medical Institutes other than All India Institute of Medical Sciences, New Delhi and others also within the State of Punjab for the purpose of treatment of its employees, there can be no justification for limiting the reimbursement of expenses at the rates of All India Institute of Medical Sciences. May be that the expenses incurred for a heart surgery at the All India Institute of Medical Sciences are less than those incurred for similar operation at Escorts Heart Institute and Research Centre, New Delhi or the Apollo Hospital, Madras the employees, who undergo treatment at these institutes and incur expenditure, cannot be denied to claim the total medical reimbursement. Heart ailment is of such a nature which at times requires emergent treatment and, therefore, a patient cannot be expected to wait in the queue for months together for by pass surgery or similar treatment in All India Institute of Medical Sciences. In the very nature of things, the emergency compels the patient to get the treatment at the earliest available opportunity."
27. We may also take note of the order passed on 2.6.1993 in Civil Petition No. 16145 of 1992 (Dr. Prem Nath Garg v. State of Punjab and others) by which a Division Bench allowed medical reimbursement even where the treatment was taken abroad at Sh. Lukes Hospital, Houston. In Civil Writ Petition No. 13792 of 1993 (K.K. Malhotra v. State of Punjab and Ors.) decided on 10.5.1994, a Division Bench of which one of us (G.S. Singhvi, J.) was a member, the observations made in Sadhu R. Pall's case were quoted with approval and it was further observed:-
Although that decision was rendered by this Court in a case where the petitioner had been operated at Escorts Heart Institute and Research Centre, New Delhi, after issue of Circular dated 8th October, 1991 but in our opinion the observations made by the Court in that case are fully attracted and can appropriately be applied to the case of the petitioner. Thus, we do not find any justification in the Government's action to decline full medical reimbursement to the petitioner for the treatment which he received at Apollo Hospital, Madras.
We would also like to observe that as and when application is made by an employee for receiving medical treatment at a hospital/institute outside the State, the concerned authority must apply its mind with great urgency and take a decision at the earliest so that complications like the one which has arisen in the present case do not arise' in future and the employees are not compelled to come to the Court for seeking relief in matters like medical reimbursement. The Government authorities must adopt a more rationale and humanist approach in these matters."
28. In a recent decision in Surjit Singh v. State of Punjab and Ors., JT 1996(2) SC 28, their Lordships of the Supreme Court have also considered the instructions issued on 25.1.1991 and 8.10.1991 after making reference to the various judgments of the Division Benches and Single Benches of this Court including ones to which reference has been made above, the apex Court held:-
"All the aforementioned judgments of the High Court have a common factual basis, i.e. each receipt of the relief from the High Court had in fact been treated in the Escorts and had borne expenses. The other common factor is that the High Court believed each writ petitioner pleading emergency to go to Escorts in the given fact situation. But this factor by itself is not the core of the views of the High Court. Hypothetically, the appellant says, he too may be considered to have been treated in the Escorts, more so, when he is being treated to have been operated upon in AIIMS without actually having been so, and had a choice to go either to the AIIMS or Escorts or Christian Medical, College Madras. The appellant in these circumstances cannot be said to be far too wrong in choosing the Escorts amongst the three recognised hospitals for open heart surgery available in the North. The AIIMS being governmental and the other two being private hospitals.
XX XX XX XX XX It is otherwise important to bear in mind that self preservation of one's life is the necessary concomitant of the right to life enshrined in Article 21 of the Constitution of India, fundamental in nature, scared, precious and inviolable. The importance and validity of the duty and right to self preservation has a species in the right of self defence in criminal law. Centuries ago thinkers of this Great Land conceived of such right and recognised it."
29. Even though the various judgments of this Court would have been enough for the Government to have accepted the claim made by all the petitioners and similarly situated persons but what has happened is that in a large number of cases, the employees (serving and retired) who have received treatment in the hospitals and institutions recognised by the Government have been forced to seek intervention of the Court for issue of a mandamus to the Government to reimburse the expenses incurred by them. It is disquietening that the Government should have adopted a purely ministerial approach in these matters and where a more humanistic approach should have been adopted, the Government has by and large resisted the claims on hypertechnicalities. It should be a matter of great concern for all those who run the Government that these matters should also come to the Court Frequently inspite of the observations made by a Division Bench of which one of us (G.S. Singhvi, J.) was a party. While allowing the Civil Writ Petition No. 82761 of 1994 (Smt. Devki Rani v. State of Punjab) on 30.8.1994, the Division Bench observed:-
"Before parting, we are constrained to point out that it is highly unfortunate that the petitioner had to approach this Court to seek its help by filing a writ petition to get reimbursement of the medical expenses incurred on the treatment of her deceased husband and all this is because of the apathy shown by the officers concerned who are public servants and from whom a better human approach is expected. It is being noticed by this Court that quite often writ petitions are filed to obtain redress in the matter of reimbursement of medical expenses particularly by those who have either retired from service or by the heirs of a deceased official which is a sad commentary indeed on the working style of the concerned departments and particularly of the head of those departments who must own responsibility for the indifference and delays in this regard. We, therefore, direct the Chief Secretary of the State Government to issue necessary instructions to all the departments including the finance department to dispose of all the pending medical reimbursement bills within a period of three months from the date of receipt of a copy of this order and it is further directed that such bills when received in future should also be disposed of expeditiously but not later than three months from the date of receipt thereof by the concerned department."
30. When Civil Writ petition No. 16570 of 1995 came before the Division Bench on 16.11.1995, the Court issued a notice to the respondents to show cause as to why a direction may not be issued to the Government to decide all pending matters of medical reimbursement. In pursuance of the order dated 16.11.1995, the learned Government counsel produced before the Court a list of cases pending in 57 departments/offices of the Government of Punjab. These lists show that over 20000 cases involving claim of medical reimbursement are pending in the various departments/offices of the Government. In some cases, the claim is for as small amount as of Rs. 10/- and as high as of Rs. 1,75,000/-. These lists also show that some cases of medical reimbursement are pending for last more than six years. In other cases, the duration of pendency is less. Reasons given in majority of the cases are absence of sanction or paucity of funds.
31. On our direction, learned Advocate General impressed upon the Government to enhance the medical reimbursement. Consequently, the State Government is said to enhance the amount and vide letter No.l/65/95-2FE.II/1002, dated 29.1.1996, the Government has written to the Advocate General, Punjab, that payment of pending medical reimbursement would be made before 31.3.1996. This shows that the Government has made an attempt to wash off the stigma of not being sensitive in a purely humanitarian matter.
32. We shall now deal with individual cases, which have come before us.
CWP No. 16570 of 1995.
The petitioner retired from service on 28.2.1994. After retirement, he started living at Ludhiana. On 31.3.1994, he felt pain in Chest and was rushed to nearly Khosla Nursing Home. He was referred to the Christian Medical College and Hospital, Ludhiana. Angiography test was done at Christian Medical College and Hospital, Ludhiana, and as a result of this 'Triple Vessels Disease' was established. He was advised to undergo heart surgery. The petitioner incurred expenses of Rs. 19,097/- for Angiography. Again in May, 1994 he felt breathing trouble and acute pain in chest while he was in Delhi. He was admitted in the Escorts Heart Institute, New Delhi, and was operated for heart. He is said to have incurred Rs. 1,64,137/-. The petitioner submitted application for reimbursement and after having been convinced about the futility of his efforts to persuade the authorities to reimburse the expenses incurred by him, he has knocked the doors of the Court.
C.W.P. No. 14120 of 1995 :
This petition has been filed for reimbursement of the expenses incurred by the petitioner for the replacement of knee joint of his wife, Smt. Rajinder Kaur. It is alleged in the writ petition that his wife remained an indoor patient at Post Graduate Institute of Medial Science and Research, Chandigarh, from 2.9.1993 to 31.10.1993 for replacement of knee joints. It is further stated that a sum of Rs. 1,33,657.25 was incurred on her treatment. The petitioner submitted his bills and by the time of filing of the writ petition, the Government had sanctioned only a sum of Rs. 40,000/-. The petitioner made representation against the denial of total medical reimbursement. During the pendency of the writ petition, learned Government Advocate made a statement that the total amount of expenses incurred by the petitioner for treatment of his wife has been sanctioned.
C.W.P. No. 15705 of 1995:
While serving as Sub-Inspector (CID), the petitioner developed heart ailment. He underwent angiography at the Escort Heart Institute and Research Centre, New Delhi, in March, 1993 and was operated for by pass surgery in May/June, 1993. He submitted bill for reimbursement of Rs. 1,62,642.10 but no steps have been taken by the respondents to reimburse the medical expenses. Letter Annexure P-l dated 6.10.1994 written by the Civil Surgeon, Ferozepur, to the Senior Medical Officer Incharge, Primary Health Centre, Kot Ise Khan, shows that the Government has sanctioned his treatment only at All India Institute of Medical Sciences, New Delhi, and therefore, his case cannot be forwarded for reimbursement of expenses incurred for treatment taken at Escorts Heart Institute.
C.W.P. No. 398 of 1996:
While he was serving as Assistant Geologist at Hoshiarpur in the Department of Agriculture, the petitioner was granted permission to go abroad (U.S.) where his brother was living. The petitioner was sanctioned leave between 9.7.1990 and 28.9.1990. Before going abroad, the petitioner got himself medically examined at Dayanand Medical College and Hospital, Ludhiana. The petitioner underwent by pass surgery at Bakersfield, California. After return to India, he applied for reimbursement but his bill has not been sanctioned. As per the information furnished by the learned Government counsel, the case of the petitioner was processed at different levels. In its meeting held on 12.8.1993, the Medical Board recommended that ex-post facto permission be granted to the petitioner but reimbursement may be allowed at the rate of the All India Institute of Medical Sciences, New Delhi. It has been given out that the matter is still under process.
C.W.P. No. 959 of 1996:-
The petitioner retired as Under Secretary from the Punjab Vidhan Saha Secretariat on 31.12.1992. He was being treated at P.G.I. Chandigarh for heart ailment. While on a visit to New Delhi, he suffered acute pain on his chest and was admitted at the Escorts Heart Institute and Research Centre, New Delhi on 10.4.1995. He applied on 14.4.1995 to the Punjab Vidhan Sabha Secretariat for expost facto sanction for the expenses incurred on angiography and for undergoing heart by pass surgery. He did not receive any communication from the respondents and due to emergency he had to undergo bypass surgery at Escorts Heart Institute on 10.5.1995. Therefore, he submitted his application for reimbursement. The Medical Board granted ex-post facto approval to the undergoing of angiography and bypass surgery, but the reimbursement has been restricted to the rates of All India Institute of Medical Sciences, New Delhi.
C.W.P. No. 1010 of 1996:
While working as Professor and Head of Psychiatry Department, Medical College, Amritsar, the petitioner suffered massive attach of anterior Myocardiac infarction. The Principal, Medical College, Amritsar, Constituted a Board of three doctors and he was advised to shift to Cardiac Centre for Artery Bypass Surgery. On 7.7.1992, he was referred to the Escorts Heart Institute and Research Centre, New Delhi. On 17.7.1992, the petitioner applied through Principal, Medical College, Amritsar, to the Director, Research and Medical, Punjab, Chandigarh for approval to get angiography etc. done. His condition deteriorated and he was shifted to the Escorts Heart Institute and Research Centre, New Delhi. Angiography was done on 29.7.1992 and bypass surgery was performed on 4.8.1992. Thereafter the petitioner submitted his application for reimbursement, but vide letters Annexures P-7 and P-8, the petitioner was informed that the petitioner should have undergone surgery in any nearest Government Hospital with the facility of a coronary care unit. The petitioner applied for review of his case, but no action has been taken by the respondents.
33. The averments made in these cases go to show that in each of these cases except in the case of Shri D.S. Sandhu, the petitioners had to undergo coronary angiography and/or heart bypass surgery. The time gap between the discovery of heart disease and the angiography and the heart bypass surgery shows that in each of these cases, the petitioners were required urgent medical treatment, At the cost of repetition, we would like to emphasise that the petitioners could not have been made to wait for treatment till the receipt of the formal approval/permission by the Medical Board. In each of these cases except of the case of Gurmail Singh Bhogal, the petitioners have undergone angiography and heart bypass surgery at the Escorts Heart Institute. In two of the cases, even ex-post facto approval has been granted but reimbursement has been ordered to be made at the rates of the All India Institute of Medical Sciences. In our considered opinion, there is no reason or justification for the Government to withhold the reimbursement actually in- curred by the petitioners in the recognised hospital. Having recognised the private institute and hospitals for treatment, the Government has no legal justification to say that the expenses would be limited to the rates prescribed by the All India Institute of Medical Sciences. This back tracking by the Government form its own policy of recognising the private hospitals and institutes for treatment of its employees is wholly unjustified.
34. In our opinion, in each of these cases, the petitioners are entitled to the reimbursement of actual expenses incurred by them for undertaking angiography and heart bypass surgery at Escorts and other recognised institutions. In case of Gurmail Singh Bhogal, he is also entitled to the expenses equivalent to the expenses which are normally incurred for taking similar treatment at the Escorts Heart Institute. This would be in accordance with the judgment of the Supreme Court in Surjit Singh's case (supra)
35. Now the question which needs determination is whether the petitioners are entitled to be paid interest. In most of the cases decided earlier, this Court has awarded interest to the petitioners. This is because the Court has taken the view that the Government and its functionaries have unjustifiably withheld the reimbursement. We do not find any reason to deviate from the earlier decisions. In addition to the reasons given to the decisions to which reference has been made above, we deem it necessary to add that it is extremely agonising for a person to wait for months and years to receive reimbursement of the expenses incurred by him for treatment. The very nature of ailment like heart disease changes the life style of a human being and if he is under mental strain of paying back the amount incurred for medical treatment and the Government, it only increases risk to his life in future. Wholly unjustifiable approach on the part of the Government forcing these persons to approach the Court cannot also be ignored. One can reasonably assume that three months' time is sufficient for the Government to make an inquiry into the genuineness of the bill submitted by an employee for reimbursement. Therefore, it would be just and proper to direct the payment of interest with effect from expiry of three months' of the submission of the application for reimbursement.
36. We also feel that after having taken note of the pendency of large number of cases involving claims of the employee for reimbursement of the medical expenses and having given notice to the Government of this issue, it would be appropriate to issue general directions to the Government to settle the pending claims of reimbursement within a specified time frame so that the employees are not compelled to move this Court for similar relief.
37. We, therefore, allow the writ petitions and direct that:-
1. The petitioners except Gurmail Singh Bhogal and D.S. Sandhu are directed to be paid the amount of reimbursement incurred by them within a period of three months of the submission of certified copy of this order. Petitioner Gurmail Singh Bhogal is also directed to be paid amount equivalent to the amount which are normally incurred for open heart by-pass surgery at the Escorts Heart Institute, New Delhi. This payment is also to be made within three months.
2. All the petitioners shall get interest at the rate of 15% per annum. This interest shall be paid for the period between a date, commencing from expiry of three months of the submission of the application for reimbursement till the date of payment.
3. All cases of reimbursement of medical expenses pending in all the departments of the Government shall be taken up by the concerned departmental authorities and the competent authorities are directed to make payment in the following manners :-
i) Where the amount of reimbursement claimed by the employee is less than Rs. 1,000/-, the payment shall be made by the concerned departmental authority within one month from today.
ii) Where the amount of reimbursement exceeds Rs. 1,000/- but is less than Rs. 10,000/-, they payment shall be made by the departmental authority within a period of two months ; and
iii) Where the amount exceeds Rs. 10,000/- the payment shall be made within three months.
The Government of Punjab is directed to send a report to this Court about the compliance of these directions within four months and the matter shall be placed before the Court on 16.8.1996 for perusal of the report and for issue of other directions, if any, required.