Central Administrative Tribunal - Lucknow
Ram Swaroop Jaggi Son Of Late Mool Raj ... vs Union Of India Through Director General on 3 March, 2015
Central Administrative Tribunal ,Lucknow Bench, Lucknow. Original Application No. 332/00447/2014 Reserved on 9.2.2015 Pronounced on 3.3.2015 Honble Sri Navneet Kumar, Member (J) Ram Swaroop Jaggi son of late Mool Raj Jaggi aged about 76 years r/o MD 20 Sector C, Aliganj, Lucknow-226024. Applicant By Advocate:R.K. Porwal Versus 1. Union of India through Director General, Health, Directorate of Health, Railway Board, Rail Bhawan, New Delhi-110001. 2. General Manager, NE Railway, Gorakhpur-273012. 3. Chief Medical Director, NE Railway, Gorakhpur-273012. 4. Chief Medical Superintendent, NE Railway Hospital, Badshah Nagar, Lucknow-226006. Respondents By Advocate: Sri Rajendra Singh ORDER
By Honble Sri Navneet Kumar, Member (J) The present O.A.is preferred by the applicant under Section 19 of the AT Act with the following reliefs:-
i) Quash /set-aside the impugned order dated 19.2.2014 issued by the Chief Medical Superintendent, NE Railway rejecting the reimbursement claim of the applicant.
ii) Direct the respondents to reimburse the amount as per entitlement to the applicant.
iii) Any other order or direction, which this Honble Tribunal may deem just fit and proper in the circumstances of the case, also be passed in the interest of justice.
iv) Award the cost of the original application to the applicant
2. The brief facts of the case are that the applicant superannuated from the office of respondents on 31.12.1996 as IOW, Survey, Gorakhpur, from N.E. Railway and opted to avail Railway Medical Health Facilities as applicable to retired railway employees and their eligible family members/dependents. Health Identity Card was issued for availing medical facilities for the applicant along with his wife. The learned counsel for the applicant categorically indicated that the applicants wife was suffering from various health diseases and Chronic Sever Inflammatory Arthritis with severe Osteoporosis for more than 20 years and was getting treatment in the Railway Hospital, Badshahnagar, Lucknow and she has also been admitted as Indoor patient by the concerned medical officer for treatment. In 2013, the applicant took his wife to Arthritis Department of Gandhi Memorial and Associated Hospital, King George Medical University, Lucknow for acute knee pain and on examination, she was advised for replacement of both knees. The applicant was also advised to take his wife to Jagjivan Ram Hospital, Mumbai for knee replacement surgery but the applicant took his wife to Vivekananda Polyclinic and Institute of Medical Sciences Hospital for treatment where she was admitted and diagnosed as Bilateral Severe Osteoarthiritis knee and also advised surgery of both knees. It is also pointed out by the applicant that he admitted his wife in the Vivekananda Polyclinic and got surgery done and after that he submitted a verified claim for reimbursement of Rs. 3,35,293/-.The same has been rejected by the Chief Medical Officer. The applicant preferred the revision petition and the Chief Medical Director, N.E. Railway, Gorakhpur also rejected the same. Hence the present O.A. is preferred by the applicant.
3. The learned counsel for the applicant has also relied upon the Railway Board Circular which provides the General Managers power to got the medical claim reimbursed upto a limit of one lakh and the same was modified vide order dated 13.12.2012 to the tune of Rs. two lakhs and has indicated that despite that the admissible amount has not been paid to the applicant. Not only this, it is also emphasized by the learned counsel for the applicant that the applicant got her wife admitted in the Vivekananda Polyclinic Hospital in an emergent situation, as such the admissible claim is to be reimbursed to the applicant. Not only this, it is also vehemently argued by the learned counsel for the applicant that the discharge certificate shows that the applicant got her wife admitted in emergency and on account of severe pain on 9.10.2013, the applicant took her for admission. As such, the impugned order , rejecting claim of the applicant is illegal and is liable to be quashed.
4. On behalf of the respondents , detailed counter reply as well as Supplementary Counter reply is filed which is taken on record. Learned counsel for the respondents has categorically indicated that the appeal so submitted by the applicant was rejected by the authorities but the applicant has not challenged the appellate order. Not only this, it is also indicated by the learned counsel for the respondents that the applicant has not informed the authorities at the time when he took his wife for admission in the Vivekananda Polyclinic. Not only this, it is also argues that applicant being a railway beneficiaries can got his wife successfully operated at Jagjivan Ram Hospital, Mumbai as his wife was earlier referred to Arthritis Department of Gandhi Memorial and Associated Hospital, King George Medical University, Lucknow. The doctors advised the applicants wife for knee replacement but she did not avail facility of knee replacement for the reasons best known to them. Not only this, the applicant was also referred to Jagjivan Ram Hospital, Mumbai but instead of approaching the above two hospitals, the applicant chosen to got his wife admitted in the Vivekananda Polyclinic for replacement of both knee by the doctors of Vivekananda Polyclinic. It is also argued by the learned counsel for respondents that the Ortho Surgeons of Jagjivan Ram Hospital, Mumbai have successfully done knee replacement in various severe cases since long time and the applicant has planned to get his wife operated at Vivekananda Polyclinic, Lucknow as the same is evident from the letter dated 12.9.2013 of the applicant wherein he sought permission to get her operated at Vivekananda Polyclinic, Lucknow. Not only this, it is also vehemently argued by Sri Rajendra Singh, learned counsel for respondents that applicants wife was admitted for elective operation replacement of knee for chronic osteoarthritis which can not be treated as an emergency and the applicant was also fully aware of this fact that the same is not under the reimbursement rules of Railways.
5. Through Supplementary Counter Reply, it is indicated by the learned counsel for the respondents that the reimbursement claim of the applicant was rejected as per para 648(1) of Indian Railway Medical Manual and from bare perusal rejection order, it is crystal clear that the reimbursement claim of applicant was rejected after carefully considering the case as knee transplantation of applicants wife is not a disease which occurred suddenly and not come under the purview of emergency. The knee transplantation of Smt. Santosh Jaggi (wife of the applicant) is elective operation and not a lifesaving operation for an emergent condition which appeared suddenly.
6. On behalf of the applicant, Rejoinder Reply is filed and through Rejoinder Reply, mostly the averments made in the O.A. are reiterated and contents of counter reply are denied. However, it is once again indicated by the learned counsel for the applicant that applicant got his wife admitted in Vivekananda Polyclinic in emergency, as such rejecting the medical reimbursement claim of the applicant is against the rule and it requires interference by this Tribunal.
7. Heard the learned counsel for the parties and perused the records.
8. The applicant is retired Railway employee and his wife suffered from Chronic Severe Inflammatory Arthritis with severe Osteoporosis and she has been receiving treatment at Railway Hospital, Badshah Nagar, Lucnow. However, there was need for expert advice. Therefore, she was referred to K.G.M.C University, Lucknow where she was advised for replacement of both knees. She was also advised ,if so desired to got to Jagjivan Ram Railway Hospital, Mumbai. The applicant did not get surgery done at either places. Instead, he planned to get his wife operated at Vivekananda Polyclinic, Lucknow and applied for permission by means of letter dated 12.9.2013. The applicant was advised vide letter dated 30.9.2013 that Vivekananda Polyclinic, Lucknow was not a recognized hospital of Railway that K.G.M.C. or Jagjivan Ram Hospital, Mumbai were much better option for knee replacement. However, the applicant got admitted his wife in Vivekananda Polyclinic, Lucknow on 9.10.2013 and got her knee replacement done and got her wife discharged on 19.10.2014. Therefore, relying on the provisions contained in para 648(1) of Indian Railway Medical Manual, the railway Board Medical Policy to the effect A beneficiary can avail medical facilities in emergency at a Govt. Hospital or a recognized Hospital or a dispensary run by Philanthropic organization. The applicant claimed reimbursement of the expenses incurred on surgery of replacement of knees at Vivekananda Polyclinic. The Chief Medical Director, N.E. Railway, Gorakhpur rejected the claim by order dated 19.2.2014 on the ground that it was not a emergency surgery and finally General Manager, N.E. Railway also rejected the claim of the applicant by an order dated 9.7.2014.
9. The applicant claims that he admitted his wife in an emergency, as such a surgery was done and this cannot be treated as elective operation of knee replacement and it was not justified for him to get surgery done at a place which was neither a Govt. hospital nor a recognized hospital of Railway. However, once the applicants request for surgery at Vivekananda Polyclinic, Lucknow was categorically refused, the applicant was not justified in claiming the medical reimbursement for the treatment at Vivekananda Polyclinic, Lucknow. Not only this, it is also to be indicted that the applicant was referred to KGMC, Lucknow and has also been advised to get his wife operated at Jagjivan Ram Hospital, Mumbai of Railway Hospital where the doctors have successfully done knee replacement in various cases. The Railway Board circular dated 31.1.2007 in regard to Reimbursement of Medical Expenses procedure of disposal reads as under:-
As per extant rules, a railway beneficiary must report to Railway Medical Officer for his/her and dependents medical treatment. The authorisied Medical Officer , will make necessary arrangements for medical treatment through Railway Hospital/ Govt. Hospital/ Pvt. Hospital. In exceptional situations, CMDs of Zonal Railways can obtain special permission from Railway Board for treatment in any private hospital on case to case basis. Hence there is no scope on their own volition , except incase of real emergency situation.
Emergency shall mean 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. Some examples, are Road accidents, other types of accidents, acute heart attack etc. Under such conditions, when the Railway beneficiary feels that there is no scope of reporting to his/her authorized Railway Medical Officer and avails treatment in the nearest and suitable private hospital, the reimbursement claim are to be processed for sanction, after the condition of the emergency is confirmed be the authorized Railway Medical Officer ex-post facto.
10. It is to be indicated that once the authorities have categorically refused to got his wife admitted in the Vivekananda Polyclinic, the applicant was not justified in claiming medical expenses for treatment in Vivekananda Polyclinic, Lucknow. In the situation, the authorities have rightly rejected the claim of the applicant for treatment at Vivekananda Polyclinic. Moreover, the question is whether the applicant can be denied the expenses incurred on the scale of expenses of Govt. hospital. It is also to be indicated that applicant got his wife admitted in the Vivekananda Polyclinic, Lucknow on 9.10.2013 and the date of discharge is 19.10.2013 but the applicant has not informed the authorities about the emergency admission of his wife at Vivekananda Polyclinic, Lucknow at the time of admission. On the other hand , the learned counsel for respondents while referring to catena of decisions have contended that as per Railway Board letter dated 31.1.2007 regarding reimbursement of medical expenses incurred by railway beneficiary in private hospital, he is not entitled for the same.
11. It is to be pointed out that the applicant has only challenged the rejection order dated 19.2.2014 and has not challenged the appellate order and despite this fact that the applicant was informed by the respondents through their letter dated 30th September, 2013 that Vivekananda Polyclinic, Lucknow is not a recognized hospital of Railways and apart from this, knee replacement is an elective surgery and applicant on his own got his wife admitted in Vivekananda Polyclinic, Lucknow , as such considering the submissions made by the parties, I do not find any ground to interfere in the present O.A.
12. Accordingly, the O.A. is dismissed. No order as to costs.
(NAVNEET KUMAR) MEMBER (J) HLS/-