Research › Search › Judgment

Delhi High Court · body

2006 DIGILAW 1736 (DEL)

ROSHAN LAL KAPOOR v. UNION OF INDIA

2006-09-28

MANJU GOEL

body2006
JUDGMENT Manju Goel, J.-The writ petition prays for a mandamus directing the respondents to reimburse the petitioner of the sum of Rs. 65,250/- which was part of the bill of treatment obtained by the petitioner from the Escorts Heart Institute and Research. Centre. The petitioner retired from the post of Assistant Director General. Group A Officer in the Department of Telecommunications, Ministry of Communications, Sanchar Bhavan, New Delhi on 31.3.2001 and was entitled to CGHS facilities by virtue of a token issued to him on ,12.11.2001. The petitioner suffered heart ailment. An angiography was done on him on 28.2.2002. He was advised CABG. He approached his dispensary which permitted him for CABG operation at Escorts Heart Institute and Research Centre, Okhla Road, New Delhi-25. The Escorts Heart Institute and Research Centre is a recognized hospital under the Central Government Health Scheme. The petitioner underwent the CABG operation on 15.3.2002. He was discharged from the hospital on 20.3.2002 and thereafter reviewed on 28.3.2002. The Escorts Heart Institute and Research Centre raised a bill being No. C-4996 dated 20.3.2002 for Rs. 1.79,100/-. Out of this amount, only Rs. 1.13.850/- was reimbursed. The petitioner requested the respondents for full reimbursement of the expenses, The respondents have refused to pay anything more than Rs. 1,13,850/which was paid to the petitioner. In the counter affidavit it is stated that the petitioner was entitled to undergo CABG operation at Escorts Heart Institute and Research Centre but that reimbursement was available only under the Department of Health OM dated 18.9.1996 and as per rates prescribed by the OM. The OM dated 18,9,1996 permitted reimbursement to the extent of Rs. 99.000/- for semi-private and Rs. 1,13,850/- for private ward. It is contended on behalf of the respondents that although the respondents made all efforts to provide the best medical facilities to the pensioners, it cannot pay the entire bill of the hospital since that is beyond the policy declared in the OM dated 18.9.1996. 2. The respondents Counsel relies upon the judgment of the Supreme Court in the case of State of Punjab and Others v. Ram Lubhaya Bagga and Others. III (1998) SLT 464=1 (1998) CLT 178 (SC)= (1998) 4 SCC 117 in which the challenge was to the change in the policy in respect of reimbursement of medical expenses. 2. The respondents Counsel relies upon the judgment of the Supreme Court in the case of State of Punjab and Others v. Ram Lubhaya Bagga and Others. III (1998) SLT 464=1 (1998) CLT 178 (SC)= (1998) 4 SCC 117 in which the challenge was to the change in the policy in respect of reimbursement of medical expenses. The earlier policy promulgated in 1991 permitted reimbursement of medical expenses charged by certain designated hospitals like Escorts, Apollo, etc. According to the new policy promulgated on 13.2.1995, treatment could be had from any hospital but reimbursement of medical expenses was restricted to the level of expenditure as per rates fixed by the Director, Health and Family Welfare, Punjab for similar treatment packages or actual expenditure, whichever was less. The Supreme Court held that the new policy was consistently followed. It directed that the Court would dissuade itself from entering into the realm of policy formations which belong to the executive. Further it stated that no State or country can have unlimited resources to spend on any of its projects and that the same holds good for providing medical facilities to its citizens including its employees. 3. As against this, the petitioner is relying upon the judgments of this Court in the cases of V.K. Gupta v. Union of India & Anr., 97 (2002) DLT 337=2002 III AD (DELHI) 631; M.G. Mahindra v. Union of India, 92 (2001) DLT 59=IV 2001 AD (DELHI) 631 ;P.N. Chopra v. Union of India, III (2004) DLT 190 as well as on a very recent judgment in the case of J.C. Sindhwani v. Union of India & Anr., 124 (2005) DLT 513=2005 VIII AD (DELHI) 565. In all these judgments after taking into consideration the Supreme Court judgment in the case of Ram Lubhaya Bagga s case (supra) it was directed to make full payment of medical expenses as incurred for undergoing treatment in similar hospitals. In the case of J.C. Sindhwani (supra) the petitioner therein had obtained treatment at the Escorts Heal1 Institute for cardiac problems. 4. There is no conf1ict between the case of the petitioner and the judgment of the Supreme Court in the case of Ram Lubhaya Bagga (supra).For the Supreme Court has held in the case of Ram Lubhaya Bagga (supra), the new policy was constitutionally valid. 4. There is no conf1ict between the case of the petitioner and the judgment of the Supreme Court in the case of Ram Lubhaya Bagga (supra).For the Supreme Court has held in the case of Ram Lubhaya Bagga (supra), the new policy was constitutionally valid. The policy under consideration in that judgment was similar to the policy in the present case. The Supreme Court also observed that the State cannot be made to have unlimited provision for medical expenses either for the ordinary citizen or for its own employees. The fact of the matter here is that when the policy was adopted in 1996, the rates fixed had a nexus to the actual treatment cost charged by those hospitals. When the treatment was taken by the petitioner in the year 2002, the reimbursement offered was at the same rates. In the meantime. the hospitals have raised their rates. The hospitals cannot be blamed for having raised their rates because the various components of the treatment have become costlier in the meanwhile. While the Government has adopted a policy of reimbursement for treatment in those hospitals, it will be arbitrary on the part of the Government not to revise the rates from time-to-time to keep the balance even between the rates charged by the hospitals and the reimbursement offered to the beneficiaries. 5. For similar reasons this Court in its latest judgment in J.C.Sindhwani s case (supra) has directed the Union of India & Others to process the bills of the CGHS beneficiary for full reimbursement. I find no reason to differ with this judgment. 6. Accordingly, the petition is allowed. The respondents are directed to process the claim of the petitioner and ensure full reimbursement of all the bills submitted towards the medical treatment in question and release the payment within two months hereof. 7. Respondents will do well to revise the rates of reimbursement once a year for the treatment of the CGHS beneficiaries from the recognized hospitals so that such beneficiaries do not have to rush to this Court for such reliefs. Petition allowed.