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[Cites 2, Cited by 2]

Gujarat High Court

Chanrakant Kantilal Dave vs State Of Gujarat Through Chief ... on 18 September, 2018

Author: A. S. Supehia

Bench: A.S. Supehia

         C/SCA/2736/2013                                        JUDGMENT




            IN THE HIGH COURT OF GUJARAT AT AHMEDABAD

             R/SPECIAL CIVIL APPLICATION NO. 2736 of 2013

FOR APPROVAL AND SIGNATURE:

HONOURABLE MR.JUSTICE A.S. SUPEHIA                       Sd/-

==========================================================

1 Whether Reporters of Local Papers may be allowed to Yes see the judgment ?

2 To be referred to the Reporter or not ? Yes 3 Whether their Lordships wish to see the fair copy of the No judgment ?

4 Whether this case involves a substantial question of law No as to the interpretation of the Constitution of India or any order made thereunder ?

========================================================== CHANRAKANT KANTILAL DAVE Versus STATE OF GUJARAT THROUGH CHIEF SECRETARY ========================================================== Appearance:

MR ANAND B GOGIA(5849) for the PETITIONER(s) No. 1 MS KAJAL L KALWANI(6623) for the PETITIONER(s) No. 1 MS MUSKAN A GOGIA(6624) for the PETITIONER(s) No. 1 MR.UTKARSH SHARMA, AGP (1) for the RESPONDENT(s) No. 1 RULE SERVED(64) for the RESPONDENT(s) No. 2,3 ========================================================== CORAM: HONOURABLE MR.JUSTICE A.S. SUPEHIA Date : 18/09/2018
1. The   present   writ­petition   is   filed   by   a   Senior  Citizen,   claiming   his   medical   reimbursement   of  Rs.1,76,000/­   who   suffered   from   a   heart   attack   and  had   to   undergo   bypass   surgery   in   an   emergent  situation.
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C/SCA/2736/2013 JUDGMENT
2. The present petitioner underwent Coronary Artery  Bypass Surgery (CABG) on 13.06.2011. The hospital in  which   he   took   the   aforesaid   treatment   had   issued  medical  bill   of  Rs.1,76,000/­.  The   State   Government  only sanctioned an amount of Rs.66,000/­ against the  package bill of Rs.1,76,000/­ incurred by the present  petitioner.   The   petitioner,   thereafter,     issued   a  notice to the respondent­authorities on 05.05.2012 to  reimburse   him   an   amount   of   Rs.1,76,000/­,   but   no  decision was taken on the aforesaid notice. Since the  respondent­authorities   did   not   reimburse   the  outstanding amount, the petitioner was constrained to  approach this Court.
3. Mr.Gogiya,   learned   advocate   for   the   petitioner  has invited attention of this Court to the Resolution  dated 09.09.2005. He has submitted that the present  petitioner under took the treatment at Sal Hospital  which also figures in the list of approved hospitals  in   the   aforesaid   resolution.   He   has   submitted   that  the petitioner underwent the treatment in the Year­ 2011,   whereas   the   respondent­authorities   while  placing   reliance   on   the   aforesaid   resolution   dated  09.09.2005   has   reimbursed   the   amount   of  Rs.66,000/­  as mentioned therein. He has submitted that the State  Government   is   required   to   revise   the   policy   as   per  prevalent charges of the hospital mentioned therein. 

He   has   submitted   that   it   is   not   the   case   of   the  respondent­authorities   that   the   petitioner   has  concocted   the   aforesaid   medical   bills   of  Rs.1,76,000/­.

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C/SCA/2736/2013 JUDGMENT

4. In   support   of   his   submissions,   reliance   is  placed   by   learned   advocate   Mr.Gogia   upon   the  decisions   of   Apex   Court   in   the   case   of  K.P.Singh  versus Union of India, reported in 2001(10) SCC 167  and   in   the   case   of  Shiv   Kant   Jha   versus   Union   of  India,   reported   in   2018(3)   SLR   328   (S.C.).   He   has  submitted   that   as   per   the   observations   made   by   the  Apex   Court   the   State   Government   is   bound   to   revise  the   rates   from   time   to   time   so   that   beneficiary  receive   the   reimbursement   as   per   the   expenses  incurred by the concerned employee. He has submitted  that in the case of Shiv Kant Jha (Supra)  the Apex  Court has directed the respondents to reimburse the  amount,   as   claimed   by   the   claimant   even   though  treatment   was   taken   by   him   from   the   hospital   which  was not approved by the State Government. 

5. Learned   advocate   for   the   petitioner   has   also  relied upon the judgment dated 26.03.2012, passed by  this   Court   in   Special   Civil   Application   No.624   of  2002 for claiming interest.  

6. In   response   to   the   submissions   advanced   by  Mr.Gogia,   learned   advocate   for   the   petitioner,  Mr.Utkarsh   Sharma,   learned   Assistant   Government  Pleader for the respondent­authorities has submitted  that   as   per   the   policy   of   the   State   Government  promulgated   vide   Resolution   dated   09.09.2005,   the  petitioner   is   entitled   to   an   amount   of   Rs.66,000/­  only.   The   attention   of   this   Court   is   drawn   to   the  Condition No.1 envisaged in the aforesaid resolution  Page 3 of 9 C/SCA/2736/2013 JUDGMENT which   signifies  that   an  employee/pensioner   would   be  entitled to minimum rate, as prescribed in the common  package or as per the rate prescribed in the appendix  to   the   aforesaid   resolution.   He   has   stated   that  present   petitioner   has   been   paid   an   amount   of  Rs.66,000/­   towards   reimbursement,   as   prescribed   in  the aforesaid appendix. 

7. As regards the submissions advanced by Mr.Gogia,  learned   advocate   for   the   petitioner,   Mr.Utkarsh  Sharma,   learned   Assistant   Government   Pleader   has  submitted that the petitioner is not entitled for an  amount of Rs.1,76,000/­  since he has not challenged  the aforesaid Resolution dated 09.09.2005. 

8. In the present case, it is undisputed fact that  the   petitioner   has   undergone   Bypass   Surgery   at   the  age   of   74   years.   The   petitioner   having   fallen  seriously   ill,   was   advised   to   for   immediate   and  urgent bypass surgery. The petitioner, under medical  advice, was taken to the Sal Hospital, Ahmedabad for  such   surgery/treatment   wherein   considering   the  seriousness   of   the   petitioner,   he   was   operated   for  Coronary Artery Bypass Surgery (CABG) and remained as  indoor   patient   in   the   hospital   for   the   period   from  13.06.2011 to 23.06.2011. For the said treatment and  surgery,   the   Sal   Hospital   has   issued   total   package  bill   of   Rs.1,76,000/­.   The   State   Government,   after  following resolution dated 09.09.2005 has reimbursed  the   amount   of   Rs.66,000/­   in   favour   of   the  petitioner.  Thus,   the   petitioner,   who   had   undergone  surgery   in   the   Year­2011   has   been   paid   the  Page 4 of 9 C/SCA/2736/2013 JUDGMENT reimbursement   as   per   the   policy   of   the   Year­2005  which is 6 years prior to the date of his surgery. It  is also reported that the aforesaid rates are not yet  revised   and  the   same   are  prevalent   as  on   date.   The  Apex   Court   in  the   judgment   rendered  in   the  case   of  K.P.Singh   (Supra)  has   observed   in   Paragraph   No.6  that:­  "6. The last grievance, and it is of some note,  is that a beneficiary of the Scheme will receive  reimbursement   only   at   the   rate   approved   by   the  CGHS,   regardless   of   the   fact   that   in   his  particular   town   or   city   there   are   only   private  hospitals and no Government Hospital; there is,  therefore,   no   option   to   him,   but   to   enter   a  private hospital for such treatment. It is also  submitted   that   the   approved   rates   are   not  updated   by   the   CGHS   from   time   to   time   so   that  what   the   beneficiary   receives   by   way   of  reimbursement,   can   be   substantially   less   than  the   cost   that   has   actually   been   incurred   upon  his   hospitalization   while   there   is,   we   think,  merit   in   the   submission,   it   is   not   for   us   to  dictate what should be done. We direct the Union  of   India,   immediately   to   consider   this   aspect  and   give   appropriate   directions   thereon.   It  would   clearly   be   appropriate   for   it   to   update  its   approved   rates   on   an   annual   or,   at   least,  be­annual basis."  

9. The Apex Court though has observed that there is  merit in the submissions of revising the rates time  Page 5 of 9 C/SCA/2736/2013 JUDGMENT to   time,   however,   ultimately   directed   the   Union   of  India   to   consider   this   aspect   and   gave   appropriate  directions thereon. 

10. The Apex Court, in the recent  decision, in the  case of Shiv Kant Jha versus Union of India, reported  in 2018(3) SLR 328 (S.C.) has observed thus:­  "13)   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  11  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.   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  Page 6 of 9 C/SCA/2736/2013 JUDGMENT 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.   Clearly,   in   the   present  case,   by   taking   a   very   inhuman   approach,   the  officials 12  of the CGHS have denied the grant  of   medical   reimbursement   in   full   to   the  petitioner forcing him to approach this Court."

11. In   the   case   before   the   Apex   Court   the  employee had taken treatment  in a hospital  which  was   not   at     all   recognized   or   approved   by   the  State   Government   or   it   was   not   included   in   the  Government   Order.   The   Apex   Court   has   observed  thus:­  "14)   This   is   hardly   a   satisfactory   state   of  affairs.   The   relevant   authorities   are  required to be more responsive and cannot in  a   mechanical   manner   deprive   an   employee   of  his   legitimate   reimbursement.   The   Central  Government   Health   Scheme   (CGHS)   was  propounded with a purpose of providing health  facility   scheme   to   the   central   government  employees  so that  they  are not left without  medical   care   after   retirement.   It   was   in  furtherance of the object of a welfare State,  Page 7 of 9 C/SCA/2736/2013 JUDGMENT which must provide for such medical care that  the scheme was brought in force. In the facts  of the present case, it cannot be denied that  the writ petitioner was admitted in the above  said   hospitals   in   emergency   conditions.  Moreover, the law does not require that prior  permission has to be taken in such situation  where the survival of the person is the prime  consideration. The doctors did his operation  and had implanted CRT­D device and have done  so as one essential and timely. Though it is  the   claim   of   the   respondent­State   that   the  rates   were   exorbitant   whereas   the   rates  charged   for   such   facility   shall   be   only   at  the   CGHS  13   rates   and   that   too   after  following   a   proper   procedure   given   in   the  Circulars   issued   on   time   to   time   by   the  concerned Ministry, it also cannot be denied  that   the   petitioner   was   taken   to   hospital  under   emergency   conditions   for   survival   of  his   life   which   requirement   was   above   the  sanctions   and   treatment   in   empanelled  hospitals." 

12. The   Apex   Court   has   noted   the   submissions  advanced   by   the   respondent­State   that   "the   rates  were   exorbitant   whereas   the   rates   charged   for   such  facility shall be only at the CGHS 13 rates and that  too after following a proper procedure given in the  Circulars   issued   on   time   to   time   by   the   concerned  Ministry".   The   Apex   Court   has   observed   that   the  Page 8 of 9 C/SCA/2736/2013 JUDGMENT petitioner   was   taken   to   hospital   under   emergency  conditions   for   survival   of   his   life   which  requirement was above the sanctions and treatment in  empanelled   hospitals.   The   Apex   Court   directed   the  respondent­State to pay balance amount to the writ­ petitioner towards his medical reimbursement.

13. In   light   of   the   law   enunciated   by   the   Apex  Court, this Court is of the opinion that the present  petitioner,   who   is   now   aged   about   82   or   83   years  cannot   be   relegated   back   to   the   respondent­ authorities   to   re­examine   his   case   for   medical  reimbursement. 

14. In   light   of   the   observations   made   by   the   Apex  Court,   the   respondent­authorities   shall   pay   the  balance  amount   of   Rs.1,10,000/­  along   with   interest  of   9%   from   the   date   of   filing   of   present   writ­ petition to the present petitioner within a period of  four weeks from the date of receipt of the copy of  the   present   order.   The   State   Government   is   also  directed to further consider the aspect of updating  their   approved   rates   from   time   to   time   and   issue  appropriate directions thereon on an annual basis.

With the aforesaid observations and directions,  present writ­petition is allowed and is accordingly,  disposed   of.   No   order   as   to   cost.   Rule   is   made  absolute.  

Sd/-

(A. S. SUPEHIA, J) Girish Page 9 of 9