Central Administrative Tribunal - Delhi
N K Gupta vs Indian Council Of Agricultural ... on 13 March, 2024
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Item No. 45/Court-5
O.A. No. 475/2022
Central Administrative Tribunal
Principal Bench, New Delhi
O.A. No. 475/2022
Reserved on : 05.03.2024
Pronounced on : 13.03.2024
Hon'ble Dr. Anand S. Khati, Member (A)
Narendra Kumar Gupta
(Aged 70 years)
(Retd.) Assistant Administrative Officer
S/o (Late) Radhey Lal Gupta
R/o Q-77, Pallavpuram Phase-2
Modipuram-250110
Meerut (U.P.)
..Applicant
(By Advocate: Mr. M.D. Jangra)
Versus
1. The Indian Council of Agricultural Research
Through its Secretary
Krishi Bhawan
New Delhi-110 001.
2. The Director
ICAR - Central Potato Research Institute
Shimla-171001 (H.P.)
3. The Joint Director
Central Potato Research Institute Campus
Modipuram-250110, Meerut (U.P.)
...Respondents
(By Advocate: Mr. Nagesh)
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Item No. 45/Court-5
O.A. No. 475/2022
ORDER
The present O.A. has been filed by the applicant, who retired as Assistant Administrative Officer from the respondent No.3, i.e. Central Potato Research Institute, Modipuram, seeking reimbursement of medical claim with respect to his wife. It is submitted that on 19.08.2020, his wife, viz. Mrs. Sudha Gupta, complained of acute stomach ache and was, therefore, admitted in an emergency situation in CCU Ward of a private hospital, i.e. Nutema Hospital, Meerut and remained there as an indoor patient and got treatment upto 27.08.2020. Subsequently, the applicant submitted the medical claim to the tune of Rs.1,67,644/- towards the expenses incurred on the stay and medication of his wife to the respondent No.3 in the prescribed format alongwith emergency certificate issued by the medical authorities, bills, lab tests, final bill etc.
2. The Administrative Officer, CPRI Campus, Meerut vide letter dated 22.10.2020 asked for certain clarifications to take further action and the applicant, in turn, vide his letter dated 04.11.2020 clarified that his wife was under
treatment since 2018 relating to kidney ailment by Dr. Sandeep Kumar Garg and due to acute pain in stomach, when he contacted the Doctor, the Doctor advised him to bring his wife in Nutema Hospital for treatment and, in such 3 Item No. 45/Court-5 O.A. No. 475/2022 an emergent situation, it was not possible for him to take her in any Government/empanelled hospital and he has already submitted all the requisite papers and emergency certificate along with the medical claim. However, the Administrative Officer, without taking permission of the competent authority, returned the medical claim on the ground that the same does not fall in the category of emergency as provided under C.S. (M.A.) Rules. The applicant also made representation dated 21.12.2020 followed by reminders by placing reliance upon the decisions of the Hon'ble Supreme Court in similar cases, but to no avail. Feeling aggrieved, he has filed the present O.A. seeking the following relief(s):
"i) Quash or set-aside the orders/letters No. 2-
4/Med./2020-21/2771 dated 07.12.2020 and No. 2-4/Med./2020-21/4148 dated 08.03.2021 issued by the Administrative Officer, ICAR-Central Potato Research Institute Campus, Modipuram, Meerut returning original papers of medical claim to the applicant by mentioning that as per CS (MA) Rule your case did not come within the purview of emergency case;
ii) Direct the respondents 1 and 2 to dispose of the representation dated 25.05.2021 of the applicant relating to medical claim under emergency in the light of decisions of the Hon'ble Tribunal, the High Court and the Hon'ble Supreme Court by way of reimbursing the medical claim to the tune of Rs. 1,67,644/- within a period of 8 weeks;
iii) Award the costs in favour of the applicant.
iv) Pass any order or direction in favour of the applicant and against the respondents as this Hon'ble Tribunal may deem fit and proper in the larger interest of Justice and equity."
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3. The learned counsel for the applicant has placed reliance on various judgments passed by this Tribunal and, more particularly, the decision of the Hon'ble Supreme Court in the case of Shiva Kant Jha vs. Union of India, (2018) 16 SCC 187, wherein medical reimbursement claim of a retired employee who had taken treatment in a private hospital was considered; and a recent judgment dated 03.01.2024 passed by the Hon'ble High Court of Delhi in Jasbir Singh vs. Union of India & Ors. in WP(C) No. 2823/2016, wherein in similar facts and circumstance, the Hon'ble High Court has directed the respondents to reimburse complete medical claim with 7% interest.
4. Per contra, the learned counsel for the respondents opposed the O.A. and submitted that the ratio decidendi of the judgment relied upon by the applicant in Shiva Kant Jha (supra) is not applicable to the facts and circumstances of the present case, as in the judgment itself, the Hon'ble Supreme Court clarified that the decision shall be confined to that case only. Further, instead of answering to the queries raised by the respondents, the applicant continued to repeat that since her wife was undergoing treatment from Dr. Sandeep Garg, she was taken to the hospital advised by the Doctor but failed to furnish the requisite documents/medical reports pertaining to preliminary 5 Item No. 45/Court-5 O.A. No. 475/2022 investigation, as instructed by the respondents. The respondents are bound to ensure as to whether there was any emergent situation necessitating one to undertake treatment from non-empanelled hospital, however, the applicant failed to substantiate or justify his claim that her wife was admitted in private hospital in medical emergency/necessity. Though a government hospital was also available near the same location but the applicant opted for treatment of her wife at a non-empanelled hospital. The decision was undertaken by him after telephonic discussion and instruction of the Doctor to bring the patient to a hospital convenient and best suited to him, and not because of any prevalent emergent situation. Hence, his claim does not qualify for reimbursement in relaxation of the rules regarding emergent cases under CS (MA) Rules, which provides as under:
"(1) Circumstances to justify treatment in private medical institution:-
In emergent cases involving accidents, serious nature of diseases etc. the person/persons on the spot may use their discretion for taking the patient for treatment in a private hospital, in case no government or recognized hospital is available nearer than the private hospital. The Controller Authority / Department will decide on the merits of the case whether it was a case of real emergency necessitating admission in a private institution. If the Controlling Authorities / Departments have any doubt, they may make a reference to the Director-General of Health Services for opinion."6
Item No. 45/Court-5 O.A. No. 475/2022
5. Learned counsel for the respondents vehemently argued that it is an admitted fact that there was a government hospital nearby to Nutema Hospital, where the applicant's wife got treatment, and there was also found to be a time lag between the medical emergency and admission of patient, which he failed to explain and justify. The representation dated 21.12.2020 preferred by the applicant was duly forwarded to respondent No.2 before taking any final decision, however, the same was not acceded to.
6. In rejoinder, the learned counsel for the applicant submitted that the applicant is a retired person of more than 70 years of age. The medical authority/doctors examined the wife of the applicant and got her admitted in emergency in the hospital for the aforesaid diseases. During pandemic Covid-19, it was neither feasible nor possible for the applicant to search the nearby panel hospital and take her wife there to save her life. The applicant is not claiming for any special treatment, but the action of the Administrative Officer in returning the medical papers without taking prior permission of the competent authority is highly arbitrary, illegal, discriminatory, unjust and without having any authority of law and, hence, liable to be quashed in terms of the guiding principles laid down by the Hon'ble Supreme Court in Shiva Kant Jha (supra).
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7. Heard Mr. M.D. Jangra., learned counsel for the applicant and Mr. Nagesh, learned counsel for the respondents and perused the pleadings/judgments on record.
8. The applicant is a pensioner and submitted the medical claim in respect of treatment of his wife in a private hospital in the year 2020, i.e. during the pandemic period. However, the respondents returned his medical claim twice vide orders dated 07.12.2020 and 08.03.2021, on the ground that the same does not fall in the category of 'emergency' as per the provisions of the C.S. (M.A.) Rules. It is also noted that the claim of the applicant has been rejected primarily on the ground that the similar treatment is available at nearby Government Hospital, whereas the applicant opted to go to a non-empanelled hospital. In this regard, a number of judgments have been passed by the Hon'ble Apex Court, however, the ratio laid down in the case of Shiva Kant Jha (supra) makes it abundantly clear that a Government employee during his lifetime or after his retirement will entirely get the benefit of medical facilities and no fetters can be placed on his rights. The relevant portion of the judgment reads as under:
"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 8 Item No. 45/Court-5 O.A. No. 475/2022 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. 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. Clearly, in the present case, by taking a very inhuman approach, the officials of the CGHS have denied the grant of medical reimbursement in full to the petitioner forcing him to approach this Court.
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, 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 CRT-D device and have done so as one essential and timely. Though it is the claim of the respondent-State that the rates were exorbitant whereas the rates charged for such facility shall be only at the CGHS 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.
15) In the present view of the matter, we are of the considered opinion that the CGHS is responsible for 9 Item No. 45/Court-5 O.A. No. 475/2022 taking care of healthcare needs and well being of the central government employees and pensioners. In the facts and circumstances of the case, we are of opinion that the treatment of the petitioner in non-empanelled hospital was genuine because there was no option left with him at the relevant time. We, therefore, direct the respondent-State to pay the balance amount of Rs. 4,99,555/- to the writ petitioner. We also make it clear that the said decision is confined to this case only." The Supreme Court after expressing its dissatisfaction as to the state of affairs had observed that the relevant authorities are responsible for taking care of healthcare needs and well being of the central government employees/pensioners and cannot act in a mechanical manner to deprive the employees of their legitimate reimbursement. From the above, it is self explanatory that reimbursement of medical expenses is a mandatory relief.
9. In the facts and circumstances of the present case, I am of the considered opinion that the treatment of the wife of the applicant, who is a pensioner, in a non-empanelled hospital was genuine, because he had no other option but to follow the advice of the concerned Doctor, at the relevant point of time.
10. Resultantly, the O.A. is allowed and the impugned orders dated 07.12.2020 and 08.03.2021 are quashed and set aside. The respondents are directed to reimburse the medical claim amounting to Rs. 1,67,644/- preferred by the applicant for treatment of his wife, as expeditiously as 10 Item No. 45/Court-5 O.A. No. 475/2022 possible but not later than six weeks from the date of receipt of a copy of this order. However, there shall be no order as to costs.
(Dr. Anand S. Khati) Member (A) /jyoti/