Central Administrative Tribunal - Ernakulam
C V Santhosh vs The Secretary Ministry Of Defence Navy ... on 13 February, 2024
CENTRAL ADMINISTRATIVE TRIBUNAL
ERNAKULAM BENCH
O.A.No.180/00728/2019
Tuesday, this the 13th day of February, 2024
CORAM:
HON'BLE Mr. JUSTICE K. HARIPAL, JUDICIAL MEMBER
C.V. Santhosh, aged 56 years, S/o Varkey Electrician Highly
Skilled-I,/ Office of the Assistant Garrison Engineer/ Military
Engineering Services/ Naval Armament Depot/Aluva-683 563
Residing at: Chirappanath House, Champanoor, Angamaly South
P.O, Ernakulam District, PIN: 683 573 - Applicant
[By Advocate: Mr. T.C.Govindaswamy, Mrs.Kala T Gopi]
Versus
1. Union of India represented by the Secretary to the
Government of India, Ministry of Defence (Navy), South
Block, New Delhi-110 011.
2. The Engineer-in-Chief Integrated Head Quarters, Ministry
of Defence (Army), Kashmiri House, Rajaji Marg, New
Delhi-110 011.
3. The Chief Engineer (Naval Works) Naval Base P.O.
Kochi-682 004.
4. The Garrison Engineer (Naval Services) Military Engineer
Services Kataribagh, Naval Base P.O, Kochi-682 004
5. The Senior Accounts Officer, Area Accounts Office (Army)
Kataribagh, Naval Base P.O., Kochi-682 004
- Respondents
[By Advocate: Mr. N.Anilkumar, SPC]
O.A No.728/2019 2
The application having been heard on 24.01.2024 the Tribunal on
13.02.2024 passed the following:
ORDER
Applicant is working as Electrician HS-I in the office of the 4 th respondent. He is aggrieved by Annexure-A4 order passed by the 5 th respondent rejecting medical reimbursement claims for Rs.4,98,547/- made by him for the treatment of his son, for the period from 20.06.2018 to 13.09.2018. The applicant claims that his son Sanal Santhosh is suffering from a rare decease called Benign Recurrent Intrahepatic Cholestasis, BRIC for short, which is stated to be a recurrent jaundice. Justification for making such a claim can be seen from Annexure-A5, extracted below:
"There is a previous history of the same decease ie, due to usage of Azithromycin at the age of 3 and he was treated by the Gastroenterologist Dr.Philip Augustine then. So this time he consulted him again at Ernakulam Medical centre, Ernakulam and the treatment was done by Dr.Cyriac Abby Philips under his direction. The treatment was continued till 04 Aug 2018 but the condition got deteriorated. So he was referred to Dr.Charles Panackel of Aster Medicity Liver O.A No.728/2019 3 transplant unit. There a biopsy and MRCP were done and started further treatment. But they cannot review the case as the hospital got shut down for a week due to flood and he was further referred to Christian Medical College, Vellore as a special case and the same treatment is available there. On 24/08/2018 the patient was admitted in CMC, Vellore and treatment started. On improvement of health he got discharged on 13/09/2018 and is on medication till now. The treatment was done in these Private hospitals due to the serious condition of the patient and the Doctors consulted were specialists............."
2. It is stated that when the son had shown symptoms of jaundice, he was first taken to Ernakulam Medical Centre as an outpatient on 20.06.2018, where he was admitted on 29.06.2018 for plasma transmission and was discharged on 07.07.2018. As the condition of the son did not improve, as referred from Ernakulam Medical Centre, he was taken to Aster Medcity. Annexure-A1 reference letter of 04.08.2018 reads thus:
" Herewith referring Mr Sanal Santosh who is a case of severe intrahepatic cholestatic jaundice secondary to drug induced liver injury (Azithromycin) with congenital unconjugated hyperbilirubinemia. He has progression of O.A No.728/2019 4 disease post plasma exchange and steroid pulse therapy and may require liver transplantation in the near future if there is development of vanishing bile duct syndrome. I would be obliged if you could manage him further with close monitoring from the liver transplant unit should the need for such decisions arise."
3. But his treatment in Aster Medcity could not be continued in the backdrop of the grim flood situation and closure of the hospital for a week. Thus he was referred to CMC Vellore with Annexure-A2 reference letter as extracted below:
"Referring Mr. Sanal Santhosh, 24 year with cholestatic hepatitis. He has a history of inherited jaundice now aggravated by ?drug induced cholestasis. We have done a biopsy and MRCP, but unfortunately we cannot review them because of current flood situation here. He also has a coexisting coagulation disorder,? Factor XII deficiency which needs further evaluation. Our hospital is shut down for a week due to flood. Referring to you for needful. Will forward you all the results, once we start functioning."
Thus he was taken to CMC Velloor and was admitted there on 24.08.2018 and was discharged on 13.09.2018. Aggregate expenses of treatment in all these three hospitals comes to Rs.4,98,547/-, which claim was rejected by O.A No.728/2019 5 the impugned order.
4. The son of the applicant was born on 02.07.1993. While undergoing inpatient treatment in Ernakulam Medical Centre, on 02.07.2018 he completed 25 years of age and thus for dual reasons the respondents argue that the medical claims cannot be reimbursed. Firstly, that he had attained 25 years age on 02.07.2018, the claim for treatment expenses of a dependent son after attaining 25 years cannot be entertained. Moreover, Ernakulam Medical Centre is not an approved hospital for Government employees. Secondly, even though Aster Medcity is an empanelled hospital, by the time he was taken there for treatment he had crossed 25 years. The same impediment has been raised with regard to the treatment in CMC Vellore also. Further, the respondents have opposed the prayer stating that there was no emergency situation for taking him to Ernakulam Medical Centre, that the treatment could have been done in Government Medical Colleges or empanelled hospitals.
5. I heard the learned counsel on both sides.
6. Learned counsel for the applicant submitted that the treatment of his son had started before he had attained the age of 25 O.A No.728/2019 6 years, even now the son is wholly depending on the applicant, the son does not have any avocation or independent source of income. Therefore, merely for the reason that he had attained the age of 25 years during the course of treatment, the expenses cannot be denied. According to the learned counsel, even now the treatment is continuing. He also invited my attention to the ex post facto sanction, Annexure-A3, granted by the Commander Works Engineer for reimbursing the amount of Rs.4,98,547/-. Still the 5th respondent has taken a technical stand and rejected the claim illegally. He also placed reliance on the decisions reported in Union of India and another v. Joginder Singh [2023 DHC 3138] and Mahendra Kumar Verma v. Government of NCT of Delhi and others [2023 DHC 131] of the Delhi High Court. Referring to the communication dated 22.02.2018 of the Railway Board, he said that the upper age limit for granting medical facilities for a dependent son, provided he is wholly depending on and resides with the Railway employee stands removed and this principle can be borrowed for the present circumstance.
7. On the other hand, the learned Standing Counsel opposed the O.A No.728/2019 7 prayer. According to him, no emergency situation had arisen for obtaining treatment in a non-empanelled hospital. Again, when he was treated in Aster Medcity and CMC, Vellore, he had crossed 25 years of age and therefore, the respondents have no liability to reimburse the claim. The learned Standing Counsel also pointed out that in Annexures-A5 or A3 the fact that the son had crossed 25 years was not considered.
8. It is true that the applicant has not produced any document to show expressly that the son had required treatment on an emergency basis. But the history of the treatment and the reference letters extracted above would give clear indication of the ailment of the son. At first, he was treated as an outpatient in Ernakulam Medical Centre. Later, he was admitted there and underwent plasma transmission, which did not improve the condition. Later, he was referred to Aster Medcity in an acute medical condition, apprehending imminent liver transplantation. His treatment in Aster Medcity could not be continued due to adverse flood situation and thus he was referred to CMC Vellore in a critical condition. In CMC Vellore he had underwent inpatient treatment from 24.08.2018 to O.A No.728/2019 8 13.09.2018.
9. In my assessment, the emergency medical situation is writ large in the documents produced by the applicant. The gravity of the situation can be deciphered from these medical records. Secondly, ex post facto sanction was granted by the Commander Works Engineer as claimed by the applicant despite the fact that there were impediments in sanctioning the amount. At the same time, I may hasten to say that both in Annexure-A3 and A5 the fact that the son of the applicant had crossed 25 years of age on 02.07.2018 is not adverted to.
10. The medical condition of the applicant was critical. The respondents could not suggest that treatments like plasma transmission or liver transplantation is available in any approved hospital at that time. There are also reasons to think that the medical condition was congenital, from the age of 3 years. The learned counsel for the applicant submitted that Ernakulam Medical Centre is an approved hospital, but for Orthopedic ailments only. Whatever it may be, when he had started treatment there, the condition of the son was not satisfactory.
11. In this connection, it is appropriate to extract the following O.A No.728/2019 9 observations of the Hon'ble Supreme Court in Shiva Kant Jha vs Union of India [(2018) 16 SCC 187].
"...............Speciality Hospitals are established for treatment of specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive a person to claim reimbursement solely on the ground that the said Hospital is not included in the Government Order. The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment. Before any medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by Doctors/Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds................"
That means, if the factum of treatment is proved in reimbursing the claim, the respondents are expected to take a holistic approach. Here, the gravity of situation in which the treatment was obtained, the fact that the Commander Works Engineer had approved so much amount despite treatment was obtained from unempanelled hospitals are matters O.A No.728/2019 10 advancing the case of the applicant.
12. Regarding the contention that the applicant had obtained treatment in an 'unauthorised' hospital, the following observations of the Delhi High Court in Joginder Singh, quoted supra, is apposite.
"12. The medical claim for treatment undertaken in emergency should not be denied for reimbursement merely because the hospital is not empanelled. The test remains whether the claimant had actually undertaken the treatment in emergent condition as advised and if the same is supported by record. Preservation of human life is of paramount importance. The State is under an obligation to ensure timely medical treatment to a person in need of such treatment and a negation of the same would be a violation of Article 21 of the Constitution of India. Administrative action should be just on test of fair play and reasonableness. Accordingly, keeping into consideration the constitutional values, the executive instructions need to be applied than rejecting the claim on technical ground of undertaking treatment in a non- empanelled hospital, since the CGHS/State is responsible to ensure proper medical treatment in an emergent condition and further cannot escape the liability, if the treatment undertaken is genuine. Any denial of claim by the authorities in such cases only adds to the misery of the Government servant by further forcing him to resort to Court of O.A No.728/2019 11 law.
Observations of the Hon'ble Apex Court in Shiva Kant Jha (supra), as reflected in paras 17, 18 & 19 may also be beneficially reproduced:-
"17. It is a settled legal position that the Government employee during his life time or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the Doctor, who is well versed and expert both on academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality Hospitals are established for treatment of specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment............"
13. Turning to the question regarding the attainment of 25 years of age on 02.07.2018, in my considered opinion, it is not a valid reason for rejecting the claim for the treatment made after 02.07.2018. The documents produced by the applicant indicate that at that time, the son of the applicant was admitted in Ernakulam Medical Centre for plasma transmission. Thereafter, since the condition did not improve, he was referred to Aster Medcity and then to CMC Vellore. So, it was unwholesome on the part of the respondents to reject the claim on the O.A No.728/2019 12 technical ground that the son had attained the age of 25 years during the course of treatment. The respondents have no case that the son has any independent source of income or that he is not depending on his father for his livlihood.
14. There is also no justification having regard to the seriousness of the ailment to compartmentalize the treatment upto 02.07.2018 and post 02.07.2018. On the day he attained 25 years old, he was undergoing plasma transmission treatment in Ernakulam Medical Centre. In the circumstance, it is unethical to say that he should be granted claims only upto 02.07.2018. In my opinion, the entire spell of treatment obtained from 20.06.2018 till 13.09.2018 can be taken together for the purpose.
15. The circular issued by the Railway Board is not applicable in the facts of the case, because it pertains to Railway employees. But since the course of treatment had initiated prior to 02.07.2018 and he had attained the upper age limit when the treatment was progress in a critical situation, it is unwholesome and illegal to reject the expenses made beyond 25 years.
16. It is made clear that, it does not mean that the applicant is O.A No.728/2019 13 entitled to claim reimbursement of treatment expenses of the son even after this spell of treatment since the treatment had commenced on 20.06.2018. To sum up, it is declared that the applicant is entitled to get the treatment expenses incurred till 13.09.2018.
17. Consequently, the respondents are directed to reimburse the sum of Rs.4,98,547/-, within a period of 60 days from the date of receipt of a copy of this order.
The Original Application is allowed as above. No costs.
(Dated this the 13th February, 2024) JUSTICE K. HARIPAL JUDICIAL MEMBER ds O.A No.728/2019 14 List of Annexures Annexure-A4: True copy of letter bearing No.AAO(Army)/Med.Corr/T1 dated 31.05.2019, issued from the office of the 5th respondent Annexure-A1: True copy of reference letter dated 04.08.2018 issued by the Consultant, The Liver Unit, Ernakulam Medical Centre addressed to the Specialist Doctor, Integrated Liver Care, Aster Medcity, Ernakulam Annexure-A2: True copy of reference letter issued from the Integrated Liver Care unit of Aster Medcity, Kochi, addressed to the Professor of Hepatology CMC, Vellore dated 23 Aug 2018. Annexure-A3: True copy of ex-post-facto sanction granted for reimbursement of medical expenses incurred by the applicant by the Commander Works Engineers, Kochi, at the three different hospitals bearing No.10212/634/EIP dated 26th March 2019.
Annexure-A5: True copy of Statement of case for obtaining sanction for refund of expense incurred on account of medical treatment in other than authorised hospital in an emergency situation dated 10th October 2018 submitted by the Assistant Garrison Engineer, addressed to the Commander Works Engineers for grant of ex-post-facto sanction.
Annexure-A6: True copy of Government of India instructions dealing with the Concessions for families in the matter of medical attendance and treatment as contained in pages 130 to 141 of Swamy's Compilation of Medical Attendance Rules, 2013, and defined in CS (MA) Rules, O.A No.728/2019 15 1944.
Annexure- R-1: True copy of the letter dated Dated 15 July 2014 Annexure-R-2: True copy of the letter dated 31 May 2007.
*******