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HONBLE MRS. RAJWANT SANDHU, MEMBER(A):-

1. This OA has been filed under Section 19 of the Administrative Tribunals Act, 1985, seeking the release of medical reimbursement claim of Rs. 5,78,825/- with interest in respect of Cochlear implantation surgery undertaken by the daughter of the applicant.
2. The background of the matter is that Ms. Harjit Kaur, daughter of the applicant who is posted as Sation Master Chhajali, is suffering from hearing and speaking impairment since infancy. The applicant contacted ADMO Dhuri on 18.7.2011 for the treatment of his daughter and she was thereafter referred to DMO(Physician), Ambala for further treatment vide OPD Slip No. 3869 dated 18.7.2011 having Reference No. 113 dated 19.7.2011 (Annexure A-3). The applicant was referred to PGI by Dr. Atit and reference slip was countersigned by Dr. I.P. Sharma, Chief Medical Superintendent, Northern Railways, Ambala Cantt (Annexure A-5). The applicant alongwith his daughter visited PGI on 26.7.2011 and continued to visit the Institute thereafter with gaps of fifteen days to one month for testing vide Central Registration No. 3276644 of PGI. On 27.9.2011, the Head of Department of ENT, PGIMER, recommended Ms. Harjit Kaur for Cochlear implantation surgery. Ms. Harjit Kaur was admitted in PGI on 6.1.2012 and underwent surgery for Cochlear implantation. She was discharged on 17.1.2012 and directed to come for follow up treatment at PGI on the dates advised (Annexure A-7). The applicants daughter is continuing to visit PGI for follow up treatment. The expenditure incurred on the treatment was Rs. 5,78,825/- and the applicant arranged for this huge amount by pledging his house for Rs. 6,00,000/-. When the bill for reimbursement of medical expenses was submitted to the Chief medical Superintendent, Ambala Cantt on 24.2.2012, objections had been raised on the same and till date no payment had been released on this account. Hence, this OA.
3. In the written statement filed on behalf of the respondents, it has been stated that the reimbursement of medical expenses to the Railway employees and their family members is governed by the Railway board guidelines dated 31.12.2009 (Annexure R-2). As per clinical practice, Cochlear implantation surgery is usually performed on prelingually deaf children below five years of age, whereas patient Ms. Harjit Kaur was 18 years old. Beyond five years of age, the outcome of surgery declines, as the brain loses its natural plasticity. Speech development after surgery also becomes poor if done after five years of age. Railway Board guidelines (Annexure R-2) for reimbursement lay down an age limit of ten years for Cochlear Implant surgery in case of prelingually deaf children. Before the Railway employee goes in for the said treatment for which reimbursement is to be claimed, the proposal for the surgery is to be sanctioned by Railway Board. Besides, satisfying the conditions laid down in Annexure R-2, the proposal should, inter alia contain report and recommendation of Medical Board, with at least one member being a Railway Medical officer having Post Graduate Qualification in ENT Branch. The proposal should be duly recommended by Chief Medical Director and concurred by Associate Finance before being sent to Railway Board for sanction.
4. It has further been stated that the patient was referred to PGI only once on 19.7.2011 for evaluation (not for surgery), but attended PGI 7 days later on 26.7.2011 in violation of instructions that require that the patient must attend the referred hospital within three days in non-emergency cases. The patient was not admitted in PGI on 26.7.2011 and was asked to go for PTA test. She did not report back to the Railway hospital alongwith the estimated cost of treatment in PGI for further recommendation by the Railway hospital as required by the mandatory instruction No. 2 in Annexure R-1. After a gap of nearly six months of being referred to PGI on 19.7.2011, the patient got admitted in PGI on 6.1.2012, underwent Cochlear Implant Surgery on 11.1.2012 without being re-referred by the concerned Railway doctor in terms of instruction No. 2, 5 dated 03.02.2014 (Annexure R-1) and the Railway Board Circular dated 31.12.2009 (Annexure R-2). The patient was discharged from PGI on 17.1.2012 and asked to come back for follow up treatment. She failed to report to the Railway doctor as required by instruction No. 5 which reads as under:-

10. In the case of Ms. Harjit Kaur, the prescribed procedure had not been followed and the applicant and his daughter decided to go ahead with the Cochlear implantation surgery on their own. He further stated that as per letter dated 31.12.2009, there were some approved centres for Cochlear implantation surgery and this list did not include PGIMER, Chandigarh. Hence, the reimbursement claim filed by the applicant is not admissible.

11. We have given our thoughtful consideration to the matter. From the material on record, it is clear that as per the guidelines of the Government of India/Railway Board issued vide letter dated 31.12.2009 (Annexure R-2), the daughter of the applicant being pre-lingual and eighteen years of age was not an eligible person for Cochlear implantation. The applicant and his daughter went ahead with the surgery although as per the instructions on the reverse page of referral slip dated 19.7.2011, the applicant was required to get in touch with the Railway medical authorities from time to time before actually going in for the surgery. The approval for the surgery had to be obtained from the Chief Medical Director/Railway Board and the surgery could only be conducted at the centres approved for Cochlear implantation as per the Circular of 31.12.2009. PGIMER was not one of these centres. The applicant has incurred heavy expenditure on the Cochlear implantation most of which was on account of the device, but since the surgery took place without requisite approvals reimbursement of the medical expenses on this account is clearly inadmissible. Hence, this OA, being devoid of merit, is rejected.