Central Administrative Tribunal - Delhi
Ishwar Singh Saini vs Union Of India Through on 24 January, 2011
Central Administrative Tribunal Principal Bench, New Delhi O.A. No.1149/2010 Monday, this the 24th day of January 2011 Honble Dr. K.B. Suresh, Member (J) Ishwar Singh Saini H.No.745/26 West Ram Nagar, Near Maya Chand Diary Sonepat (Haryana) ..Applicant (By Advocates: Shri Shrigopal Aggarwal & Ms. Bimla Devi) Versus Union of India through 1. General Manager Northern Railway Baroda House, New Delhi 2. Divisional Railway Manager Northern Railway Division State Entry Road, New Delhi 3. Chief Medical Director Head Qtr. Office Northern Railway Baroda House, New Delhi ..Respondents (By Advocate: Shri Rajender Khatter) O R D E R (ORAL)
Heard the learned counsel for the parties at length.
2. The applicant seeks reimbursement of medical expenses incurred by him following brain hamerage, which he has suffered. Apparently, he was taken to the railway hospital, which referred him to Dr. Ram Manohar Lohia Hospital, New Delhi as it lacked the facility to deal with this. Dr. Ram Manohar Lal Hospital also was unable to admit him and thereupon, he was referred to the All India Institute of Medical Sciences. When the said Institute also was unable to look after him, he was taken to Sir Ganga Ram Hospital, New Delhi.
3. There were earlier two rounds of litigations in which this Tribunal had directed the respondents to look into the matter and pass an appropriate order. Thereupon and following the judicial pronouncements in this regard, as stated by the learned counsel for the respondents, the issue at Annexure A-1 by which on the calculated amount of `2,65,100/- an amount of `1,83,883/- was found to be admissible as per the CGHS rates. A scrutiny statement was also provided, which was examined in close concert with both the learned counsel for the parties and each and every entry therein were looked into.
4. I have gone through these amounts also and on the basis of parallel inquiries, which are available through the internet, I could find that the rates charged were substantially reasonable, except in the case of room rent and for the CAT-scan. In the second operation, the theater charges seem to be fully excluded as not admissible. No hospital in the world is going to work on these premises. It is also not known whether the CGHS have fully understood the scope of this objection when they projected it.
5. Constitutional mandate indicates that it is the duty of the State to provide adequate health care but at the same time, the practical aspect of the situation makes administrative and judicial authorities to view the relief of the Government also even though the health care is the primary duty of the welfare society.
6. Learned counsel for applicant would rely upon several judgments of the Honble Supreme Court, including the decision in State of Punjab & others v. Ram Lubhaya Bagga etc. etc., (1998) 4 SCC 117, which would indicate that in an emergent situation, the totality of the payments claimed must be paid over to the applicant. Learned counsel for respondents would also rely on the said decision of the Apex Court by stating that there is changing situation, as the policy change had taken place wherein the Government has taken a decision that AIIMS rates may be taken as a sufficient yardstick. AIIMS is a totally Government funded hospital and the rates, which they charge, may not be an adequate yardstick of what the private hospitals might have charged. Taking a situation in New Delhi, it is brought to my notice by the Bar of this Tribunal that it is quite possible that lot of benefits are being made available to those private hospitals by way of allocation of free land, reduction in electricity service charges and other tax benefits, etc., which are not seen or reflected in the bills they charge from the patients before them. It is also stipulated that many of the hospitals have agreed to a package rates of the treatment, which they are not made applicable to the patients even when it becomes apparent that they are or were government servants. The result is that the Government is made to shell out unnecessary amount for the bills, which the poor patients may have actually paid also. In this connection, it may be noted that the efforts of the Government and the agencies in this regard had been totally negligent and they ought to have been in tune and in consonance with the constitutional mandate and made up specific schemes to bring in the private hospitals also in a universal and transparent pattern, so that over billing could have been avoided. The Government also must fix rational and logical rates, so that the patients may not suffer because of their miscalculation. Even though the rates fixed by the private hospitals for treating the working government servants or the former government servants may not be a commercially reflective one, the Government should make it reflective of what benefits are conferred on them by its various policies. Having been negligent in it, they cannot now come and say that they have fixed a policy of giving according to the CGHS rates and, therefore, the Government policy decision may not be assailed.
7. Whatever policy, whether it be an economy or any other sphere the Government takes, must be in consonance with the constitutional mandate. That being so, all policies are subject to the law of the land.
8. Learned counsel for applicant would rely upon a decision of the Apex Court in Ram Lubhaya Baggas case (supra), on which the learned counsel for respondents would also rely. Since their Lordships have clearly stated the scope and ambit of constitutional mandate, vis-`-vis the State, no more illustration is required. The Apex Court held on the facts of the case that there was necessity for the patient in that case of being admitted to Escorts hospital and directed the payment of the amounts mentioned in that. The applicant would rely on the rationale of the decision but at the same time, the stand taken by the learned counsel for respondents that given the situation in 2006 the reasonable amount was given in the case of the first hospitalization at `1000/- per day seems to be reasonable. The CAT-scan had claimed `10,500/- and the reimbursable amount according to the CGHS rates is `500/-. Both these calculations seem to be unreasonable, as going by the normal rates available in those periods, an amount of `6000/- could be made payable. In the second hospitalization, the amount claimed for CAT-scan seems to be reasonable. Barring this, due to the emergency nature of the treatment requirement and the way the patient was referred by a Railway hospital and the need for him to be taken to the private hospital and in the background of the Honble Apex Courts order, I feel it appropriate to quash the Annexure A-1 order and direct the Railways to re-compute the entire matter in the light of the observations made above and make available the payment due on the bills of the applicant within a period of two months next.
9. The OA is allowed to the extent noted above. No costs.
( Dr. K.B. Suresh ) Member (Judicial) /sunil/