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2004 DIGILAW 1823 (RAJ)

Himmat Singh v. State of Rajasthan

2004-12-22

ASHOK PARIHAR

body2004
Judgment Ashok Parihar, J.-Petitioner has retired from the Government service on attaining the age of superannuation on 28.02.1998. Petitioner been regular subscriber of the Rajasthan Pensioners Medical Fund, has been a member of the Rajasthan State Pensioners Medical Concession Scheme. The petitioner suffered a major heart attack on 18.09.2002 around 8.00 AM. The members of the family of the petitioner took the petitioner to SMS Hospital, Jaipur immediately, however, in absence of any immediate response, in emergent circumstances, the family members took the petitioner to the nearby Tongia Heart & General Hospital. After getting immediate respite coronary Angiography and Angioplasty was done in the Tongia Heart & General Hospital on the very next day and, subsequently, the petitioners was discharged from the hospital on 19.09.2002. The reimbursement of the amount of medical treatment expenditure incurred in the above ailment has been refused by the respondents only on the ground that the treatment was not received from any Government hospital. Hence, the present petition for getting necessary directions from this Court for reimbursement of the medical expenditure so incurred. 2. There is no dispute that under the Rajathan State Pensioners Medical Concession Scheme financial assistance is provided at the rate of 80% of the hospital expenditure or Rs. 1,20,000/-, whichever is less, where no treatment is available in any Government Hospital in the State of the particular disease. However, a condition has been imposed that the treatment should have been taken in a hospital/public institution either out side the State or within the State recongnized by the State Government and only after recommendations of the Principal of a Medical College/Director of Medical & Health Services as per the opinion of the Medical Board . Similar benefit has been given in case of heart ailment also. 3. After having considered the submissions of learned Counsel for the parties, I have carefully gone through the material on record, relevant provisions of the Scheme as also the Judgment s referred at the Bar. 4. So far as the discrepancy in the date of ailment is concerned, in the letter written to this Court in Hindi, the date has clearly been mentioned as 18.09.2002. It is only in the English translation of the petition that there may be some typing error and the date has been mentioned as 18.02.2002. 4. So far as the discrepancy in the date of ailment is concerned, in the letter written to this Court in Hindi, the date has clearly been mentioned as 18.09.2002. It is only in the English translation of the petition that there may be some typing error and the date has been mentioned as 18.02.2002. Be that as it may, time and again, the Apex Court as also this Court and various other High Courts have expressed their anxiety over denial of such reimbursement in exceptional cases. In the case of saving of a human life at a given point of time it is not expected of an attendant to look into the list and then hunt for the recongnized hospital which is contained therein. Such procedure should not be expected to be followed in an emergency by the attendant of the patient. In case of grave emergency whichever hospital comes to the mind of the attendant and which hospital is considered just for saving the life of the patient is the prime consideration. Such decisions some times crucial for saving the life of an individual. If the conditions imposed by the respondents in their Scheme are applied so strictly, the end result may be disastrous and in the situation the patient may even die. It is only in normal circumstances the procedure prescribed should be followed but the procedure should also not be made so cumbersome that one may get frustrated in adhering to such procedure. Emergency knows no law and no procedures. The emergency act when required to be committed should not be weighed in terms of money especially when human life is at stake .In such circumstances, even the ultimate responsibility of the State cannot be washed out. A Division Bench of this Court at Principal Seat at Jodhpur in D.B. Civil Special Appeal No. 457/2001 “State of Rajasthan vs. Navratan Mal Mehta” decided on 11.05.2004, has also observed that preserve health and obtain medical aid in furtherance of self preservation is part of right of life under Article 21of the Constitution of India and, in the given circumstances, the petitioner is also entitled for reimbursement of medical expenses irrespective of the place where the treatment has been recived. Even this Court, in the case of “V.D. Saxena vs. State of Rajasthan” 2003 (3) RLR 629 , had held that denial of reimbursement on technical grounds is nothing but arbitrary, unreasonable and unjust. 5. In a welfare State, the welfare of the people is frustrated just because of bureaucratic approach of the concerning authorities. A person having put in whole life in the services of the State till he attains the age of superannuation always requires human considerations. Technicalities of rules and regulations are not required to be followed just in a mechanical manner so as to frustrate the very purpose of the Scheme. Each case has to be examined on its own facts before taking any final decision. While granting such benefits under beneficial schemes financial constraints are also always secondary. 6. In the present case also, the petitioner suffered unbearable pain in the chest on 18.09.2002 in the morning. Though, he was immediately taken to Government hospital, however, failing to get proper response, out of anxiety, family members had no option but to take the petitioner to nearby private hospital where he could get the required treatment immediately. There is nothing on record to show on behalf of the respondents that at the relevant time SMS Hospital, Jaipur or any Government Hospital in the State had the efficient emergency facilities for heart operations including angiography and angioplasty. Conditions of Government Hospitals in the State are well known and there is always a reasonable apprehension in the mind of the patient and family members in regard to best of treatment to save the life of person at the relevant time. 7. There cannot be any doubt on bona fide of the petitioner and genuineness of the bills submitted by him for reimbursement can also not be disbelieved. Thus, in my opinion, denial of reimbursement as per the Scheme is wholly unreasonable and unjust. 8. In the present case, the petitioner is entitled for reimbursement at the rate of 80% amount of expenditure on his treatment as per the bills submitted by him or Rs. 1,20,000/-whichever is less as per the Scheme after due verification of the bills. Necessary payments be made within 30 days from the date of receipt of certified copy of this order. 1,20,000/-whichever is less as per the Scheme after due verification of the bills. Necessary payments be made within 30 days from the date of receipt of certified copy of this order. For verification, the petitioner may also file an affidavit duly attested by an Oath Commissioner certifying the correctness of the bills for reimbursement as submitted by him alongwith the certified copy. 9. Since, wholly unreasonable and unjust stand has been taken by the respondents in denying the necessary relief to the petitioner, the respondents are also directed to pay a cost of Rs.5,000/-(Rupees Five Thousand only) to the petitioner alongwith amount as ordered above. 10. The writ petition is disposed of accordingly.