Central Administrative Tribunal - Delhi
Smt. Shanti Devi vs Union Of India on 11 December, 2014
CENTRAL ADMINISTRATIVE TRIBUNAL PRINCIPAL BENCH O.A.NO. 3058 OF 2013 New Delhi, this the 11th day of December, 2014 CORAM: HONBLE SHRI RAJ VIR SHARMA, JUDICIAL MEMBER . Smt. Shanti Devi, Widow of late Sh.Chidda Singh Sharma, R/o 839, Sector 9, Ghaziabad (UP).. .. Applicant (By Advocate: Mr.P.S.Khare) Vs. 1. Union of India, through the General Manager, Northern Railway,Baroda House, New Delhi 110001 2. Chief Medical Superintendent, Northern Railway, Divisional Hospital,Delhi. 3. The Chief Medical Director, Northern Railway,Baroda House, New Delhi Respondents (By Advocate: Shri A.K.Srivastava) . ORDER
In this Original Application filed under Section 19 of the Administrative Tribunals Act, 1985, the applicant has prayed for the following relief:
8.1 to allow the present OA and to grant to the applicant reimbursement of medical expenses of Rs.2,57,254 incurred by him of the treatment together with interest @ 18%.
8.2 to grant any other or further appropriate relief as deemed fit and proper by this Tribunal as per facts and circumstances of the case.
8.3 to grant the cost of proceedings in favour of the applicant.
2. Brief facts of the applicants case are as follows:
2.1 The applicant is the widow of late Shri Chidda Singh Sharma. Shri Sharma, while working as Office Superintendent in the Northern Railway, had retired on superannuation on 31.5.1992. He had deposited Rs.19524/- as one time fee for getting medical assistance for self and his wife. A medical card had been issued to him under the Railway Employees Liberalized Health Scheme (RELHS).
2.2 The applicant, aged 77 years old, suffered from various ailments. On 4.10.2012 she suddenly felt severest life threatening pain in chest and was writhing in extreme anguish, pain and agony. Her son immediately shifted him to the nearest hospital, i.e., Shivam Hospital, Ghaziabad, in emergency condition for treatment to save her life. The said Shivam Hospital is a well known and reputed hospital having all diagnostic and specialized instruments and facilities. After obtaining medical treatment from the said hospital, the applicant submitted the bills along with all papers and Emergency Certificate to the concerned Health Unit on 4.12.2012 (Annexure A/3). The concerned Health Unit forwarded the bills along with all medical papers to the concerned authority for reimbursement. The Senior Divisional Medical Officer, Northern Railway Divisional Hospital, vide letter dated 25.3.2013 (Annexure A/2), asked the applicant to furnish certain clarifications as to obtaining treatment from the said hospital. Being aggrieved thereby, the applicant made an appeal/representation dated 16.4.2013 (Annexure A/4) to the Chief Medical Superintendent, Northern Railway Divisional Hospital, New Delhi. The Chief Medical Superintendent, vide letter dated 10.5.2013(Annexure A/1), rejected the applicants claim without application of mind.
2.3 Hence, the applicant has filed the present O.A. praying for the reliefs as referred to earlier.
3. The respondents have filed a counter reply wherein it is stated that the applicants medical claim was rejected because on perusal of the medical papers it was found that the applicants condition at the time of admission to the said hospital was stable, that the applicant could have attended either Railway Health Unit at Ghaziabad as it was OPD time, or at any of the empanelled hospitals at Ghaziabad, which are situate at a similar distance from applicants residence, and that the applicants condition was not life threatening. It is also stated by the respondents that there is no scope for any beneficiary under the RELHS to go to any private hospital on his/her own volition, except in case of real emergency. As per the Railway Boards circular dated 30.1.2007 (Annexure R/1), emergency means any condition or symptom resulting from any cause arising suddenly and if not treated at the early convenience, be detrimental to the health of the patient or will jeopardize the life of the patient, such as, road accidents, other types of accidents, acute heart attack, etc. It is also stated by the respondents that the applicants case being a case of respiratory distress with h/o hypertension, DM, PUO and chest infection as mentioned in the Emergency Certificate, was not a case of emergency and therefore, the bill submitted by the applicant was rejected. In view of this, the respondents have prayed for dismissal of the O.A.
4. Refuting the stand taken by the respondents, the applicant has filed a rejoinder reply.
5. I have perused the records and heard the learned counsel appearing for the parties.
6. The learned counsel appearing for the applicant submitted that the proposition of law is well settled that it is the duty of the State to preserve health of citizens, that in emergency situation the beneficiary under the Health Scheme can obtain treatment from private hospital, and that reimbursement of expenses incurred in connection with treatment obtained from private hospital in emergency situation cannot be denied. To buttress his submissions, the learned counsel has placed reliance on the decision of the Bombay Bench of the Tribunal in Bipinchandra N. Mistry v. Union of India and others, 2013(1) SLJ 95 (CAT).
7. Per contra, the learned counsel appearing for the respondents submitted that the medical papers submitted along with the medical claim show that the case of the applicant was not a case of emergency in terms of the Railway Boards letter dated 31.1.2007 and thus, the expenditure incurred by her in connection with the treatment obtained from the private hospital was not reimbursable. Therefore, there is no infirmity in the decision taken by the respondent-departmental authorities rejecting the applicants claim. In support of his contention, the learned counsel referred to the Railway Boards letter dated 31.1.2007. He has also filed copies of the said letter dated 31.1.2007, the advance correction slip to paragraph 648 of IRMM 2000 to ad (3) Para 648(Procedure for treatment under emergency), and the Railway Boards letter No.2006/H-1/13(RTI) dated 17.4.2007.
8. Indisputably, there is scope for a beneficiary under the RELHS to go to any private hospital himself/herself for treatment in case of emergency condition or symptom resulting from any cause arising suddenly, and, if not treated at the earliest convenience, such condition would be detrimental to his/her health or would jeopardize his life. In the Railway Boards letter, some examples, such as, road accidents, other types of accidents, acute heart attack, etc., find mention. Since such examples are not exhaustive, the Railway Board, vide its letter dated 17.4.2007 (which was produced by the respondents counsel along with the Railway Boards letter dated 31.1.2007), clarified that the following conditions are considered as emergency conditions:
(1) Acute Cardiac Conditions/Syndromes including Myocardial Infraction, Unstable Angina, Ventricular Arrhythmiss, Paroxysmal Supra-ventricular Tachycardia, Cardiac Tamponade, Acute Left Ventricular Failure/Severe congestive Cardiac Falure, Accelerated hypertension, Complete dissection.
(2) Vascular Catastrophes including Acute limb ischemia, Rupture of aneurisms, medical and surgical shock and peripheral circulatory failure.
(3) Cerebra-Vascular Accidents including Strokes, Neurological Emergencies including coma, carbora meningeal infections, convulsions, Acute paralysis, Acute visual loss.
(4) Acute respiratory Emergencies indulging respiratory failure and decompensate lung disease.
(5) Acute abdomen including acute obstetrical and gynecologist emergencies.
(6) Life threatening injuries including Road traffic accidents, Head injuries, Multiple Injuries, Crush Injuries and Thermal Injuries.
(7) Acute poisoning and Snake bite.
(8) Acute endocrine emergencies including Diabetic Kato-acidosis.
(9) Heat stroke and cold injuries of Life threatening nature.
(10) Acute Renal Failure.
(11) Severe infections, leading to life threatening sequel-including Septicemia, disseminated TB.
(12) Any other condition, in which delay could result in loss of life or limb.
The Emergency Certificate dated 13.10.2012 issued by the Medical Superintendent, Shivam Hospital, Ghaziabad, shows that the applicant was admitted in the Hospital on 4.10.2012 at 12.10 P.M. and she was diagnosed to have suffered from respiratory distress with h/o hypertension, DM, PUO and chest infection. On the basis of the above Emergency Certificate, no man can entertain any doubt that the condition of the applicant could have resulted in loss of life or limb, as mentioned in the Railway Boards letter dated 17.4.2007. Besides, the presence of symptoms of respiratory distress with h/o hypertension, DM, PUO and chest infection with the applicant at the time of admission in the hospital on 4.10.2012 is suggestive of the emergency condition of the applicant, as outlined in the Railway Boards letter. In view of this, I find much force in the contention of the applicant that the respondent-departmental authorities rejected her medical claim without application of mind.
9. In Surjit Singh v. State of Punjab & others, 1996(2)SCC 336, the appellant was ailing with heart disease while in London during his visit to his son residing there and had to undergo an emergency operation at the Escorts Heart Institute recognized for such treatment. The Honble Supreme Court held that had the appellant remained in India, he could have gone to the Escorts like many others did to save his life and that it is fair and just that the respondents pay to the appellant the rates admissible for Escorts.
9.1 In Suman Rakheja v. State of Haryana and another, 2006 SCC (L&S) 890, the Honble Supreme Court held thus:
In the present case also the appellants husband had to be rushed to the private hospital because he had developed a paralytic stroke on the left side of the body, as there was blood clotting on the right side of the brain and therefore, was admitted, in an emergency condition in the hospital. In the present case the discharge certificate also shows that the case was an emergency one. In Sant Prakash case the Division Bench held that the petitioner therein would be entitled to 100% medical expenses at the AIIMS rates and 75% of the expenditure in excess thereto. 9.2 In Vasu Dev Bhanot v. Union of India & others, 2008(4) SLR 114, the Honble High Court of Punjab & Haryana held thus:
It is settled law that right to health is an integral to right to life. Government has constitutional obligation to provide the health facilities. If the Government servant or his dependant has suffered an ailment which requires emergency treatment, it is but the duty of the State to bear the expenditure incurred by the Government servant. Expenditure thus incurred by the Government servant, while in service or after retirement, requires to be reimbursed by the State to the employee. 9.3 In Smt. Gouri Sengupta v. State of Assam, 2000 (1) ATJ 582, the Honble High Court at Gauhati held that denial of reimbursement of medical expenses on the ground the petitioner got the treatment in a private nursing home which is not recognized by the Government is not justified.
9.4 In Bipinchandra N.Mistry v. Union of India and others, 2013(1) SLJ 95 (CAT), the applicants wife had severe intolerable chest pain and was taken to a private hospital for treatment. The medical claim was rejected on the ground of the applicant not availing of medical treatment from recognized hospital. Relying on the decisions in Surjit Singhs case(supra), Suman Rakhejas case(supra), Vasu Dev Bhanots case (supra), Smt. Gouri Senguptas case (supra) and some other decisions and referring to the Railway Boards letter dated 5.4.2000, which permits treatment in private hospital in emergency condition, the Bombay Bench of the Tribunal held that denial of reimbursement of expenses incurred in connection with medical treatment was not justified and accordingly, directed the respondents to reimburse the medical expenses to the applicant.
10. In the light of the above discussions, I hold that rejection of the applicants claim by the respondents, vide letter dated 10.5.2013 (Annexure A/1), is unsustainable. Accordingly, the respondents are directed to reimburse, within three months from today, the medical expenses to the applicant at the rates approved by the Northern Railway for the recognized private hospitals, vide Paragraph 648(3) of IRMM 2000,
11. In the result, the O.A. is allowed to the extent indicated above. No costs.
(RAJ VIR SHARMA) JUDICIAL MEMBER AN