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Rajasthan High Court · body

2006 DIGILAW 2921 (RAJ)

Farooq Hasan through L. R. v. Union of India

2006-10-18

DALIP SINGH

body2006
Honble SINGH, J.–This writ petition has been filed by the late Shri Farooq Husan, retired Judge of this Court. He has prayed for a direction to the respondents to reimburse the amount of expenses incurred by the petitioner on account of the surgery which he underwent at the Escorts Heart Institute and Research Centre, New Delhi (hereinafter shall be referred to as ``the Escorts Hospital) where he was admitted on 5.7.1996 for this purpose and was discharged after surgery on 8.8.1996 after the treatment. The certificate to that effect has been filed as Annexure 10 issued by the Escort Hospital. (2). The petitioner being a retired Judge of this Court was a member of the Central Government Health Scheme (hereinafter shall be referred to as `the C.G.H.S.) applicable to the retired Judges. (3). The petitioner first approached the S.M.S. Hospital at Jaipur and vide Annexure-7 dated 11.6.1996, the petitioner was advised by the S.M.S. Hospital to go to Escorts Hospital for C.A.B.G. as he has been suffering from CAD - TUD and that facilities for the same are not available in any Government Hospital in Rajasthan. (4). On the expression of the above opinion by the S.M.S. Hospital that facilities for the above treatment were not available at the relevant time in the Government Hospital in Rajasthan, as is evident from (Annexure 7), the petitioner approached the concerned Medical Officer of the C.G.H.S. at Jaipur and the Medical Officer of the C.G.H.S., Jaipur also vide Annexure-8 dated 15.6.1996 sent a communication to the Medical Superintendent, Escorts Heart Institute, New Delhi wherein it was mentioned as under:- ``The patient whose particulars are given below may please be admitted to your Hospital/Centre immediately. The bill in respect of his/her hospitalization may please be sent to the Directorate General of Health Services, New Delhi, direct in duplicate for payment along with this Memo, after completing the details required on the reverse. (5). Copy of this letter was also sent to the Director General of Health Services (C.G.H.S. Statistical Section), New Delhi for information. The said letter has been filed as Annexure -8. (6). Along with the above, the petitioner was issued an office order dated 15.6.1996 by the office of Additional Director, C.G.H.S., Jaipur which authorized the admission of the petitioner to the Escorts Hospital and sanction to that effect was issued by the aforesaid letter Annexure 9. (7). The said letter has been filed as Annexure -8. (6). Along with the above, the petitioner was issued an office order dated 15.6.1996 by the office of Additional Director, C.G.H.S., Jaipur which authorized the admission of the petitioner to the Escorts Hospital and sanction to that effect was issued by the aforesaid letter Annexure 9. (7). The case of the petitioner is that since there was no time to get the amount sanctioned by way of advance from the C.G.H.S., the petitioner directly approached the Escorts Hospital and was asked to deposit the amount of Rs. 2,00,000/- and only after depositing the amount he was admitted to the Hospital on 5.7.1996 where he eventually underwent the required surgery on 15.7.1996 and remained hospitalized till he was discharged on 8.8.1996. A certificate to that effect was issued by the Escorts Hospital on 3.10.1996 which has been filed as Annexure 10. The case of the petitioner is that in the first instance, the bills for reimbursement were submitted to the office of the respondent No. 2, as mentioned in para 11 of the writ petition, in the month of September 1996 but certain objections were pointed out and ultimately the required formalities were completed and an application was filed on 15.01.1997 which has been submitted as Annexure 12 to the writ petition. It is submitted that in spite of the above bills having been submitted for reimbursement, along with the bill of Escorts Hospital dated 8.8.1996 and the receipts of the payment amounting to Rs. 2,00,000/-, the petitioner has not received the reimbursement of the aforesaid amount. Consequently, the petitioner was constrained to file this writ petition for reimbursement of the amount which has been paid by the petitioner for the medical treatment to the Escort Heart Institute and Research Centre, New Delhi. (8). A reply to the writ petition was filed by the respondents and the learned counsel for the respondent has submitted that, as has been mentioned in the reply, the petitioner has rushed to this court for the reimbursement of the amount whereas the case of the petitioner has so far not been finally decided. The attention in this behalf was drown to the contents of para 3 of the reply to the writ petition which read as follows:- ``Moreover, the claim has not been refused so far. The attention in this behalf was drown to the contents of para 3 of the reply to the writ petition which read as follows:- ``Moreover, the claim has not been refused so far. The petitioner has brought this petition before this Honble High Court even before a decision could be taken by the competent authority on the medical claim presented after three months. Therefore, the writ petition is premature and deserves to be dismissed on this count alone. (9). Attention was also drawn to the contents of para 21 of the reply to the writ petition, wherein it has been stated by the respondent, as follows:- ``The reimbursement in reference to the medical claim of the petitioner is under process and the competent authority is yet to decide in accordance with the relevant rules and policy laid down by the Government of India. Therefore, the writ petition deserves to be dismissed on this count alone. (10). The respondents have also raised objection to the effect that the bills were not submitted by the petitioner in time and also that the petitioners card was not renewed. The said objection has been raised in para 11 of the reply to the writ petition which reads as under:- ``... that the petitioners Card was renewed by the petitioner on 5.1.1997 whereas it should have been got renewed by the petitioner before 31.12.1996 for which it was valid. (11). On the basis of the above, it was sought to be submitted that the petitioner is not entitled to the reimbursement as the petitioner did not get his C.G.H.S. Card renewed in time and hence, he is not entitled to the reimbursement. (12). I may take up the case so far as the renewal of the C.G.H.S. Card is concerned. As has been quoted above from the reply submitted by the respondents, as contained in para 11 of the reply to the writ petition, the card of the petitioner was valid upto 31.12.1996 and was renewed on 5.1.1997 and at the relevant time when the petitioner was admitted and underwent the surgery at the Escorts Hospital, the petitioners C.G.H.S. Card was valid. The objection that it was renewed after 5.1.1997 and, therefore, the petitioner is not entitled to the reimbursement cannot be accepted. The objection that it was renewed after 5.1.1997 and, therefore, the petitioner is not entitled to the reimbursement cannot be accepted. The currency of the card has to be in respect of the time of treatment and not at the time of the submission of the bills, as is sought to be contended by the learned counsel for the respondents. Therefore, so far as the above objection of the respondents is concerned, the same is rejected. (13). Since the respondents main case is that the petitioners case is premature, the respondents were, therefore, by order of this Court dated 18.8.2006 directed to inform this court as to whether or not a decision has been taken by the respondents in the matter of the petitioners claim as the matter has remained pending for nearly 10 years as the reply was filed before this court on 30.04.1998. (14). Even today, the learned counsel for the respondents is not in a position to submit whether or not a final decision in the matter has been taken. It is contended that so far as the respondents are concerned, they have paid an amount of Rs. 89,000/- to the petitioner on 10.6.1998 and has drawn the attention of the court to the order passed on the stay application to that effect. Be that as it may, the fact remains that he claim of the petitioner with regard to the bill for an amount of Rs. 2,00,000/- which had been paid by him at the time of admission to the Escorts Hospital remains outstanding and even if the amount of Rs. 89,000/- which has been paid by the respondent it taken into account an amount of Rs. 1,11,000/- still remains outstanding. (15). Admittedly, the petitioner has undergone the required surgery at the Escorts Hospital. The admission of the petitioner to the Escorts Hospital was on account of the fact that the S.M.S. Hospital at Jaipur had given a certificate to the effect that the aforesaid treatment is not available in any of the Government Hospitals in Rajasthan, as is evident from the letter of the Principal and Controller of the S.M.S. Hospital (Annexure- 7) dated 11.6.1996. On account of the aforesaid, the petitioner approached the Medical Officer at the C.G.H.S., Jaipur and the Medical Officer of the C.G.H.S. issued a letter dated 15.6.1996 (Annexure 8) for the admission of the petitioner to the Escorts Hospital, New Delhi and a sanction in that behalf was also issued by the C.G.H.S. which is Annexure-9 to the writ petition also dated 15.6.1996. Thus, the Escorts Hospital, New Delhi was the hospital for which the sanction was given by the Medical Officer of the C.G.H.S. and the Additional Director vide Annexure-8 and 9 and the petitioner has undergone the treatment and surgery at the Escorts Hospital, New Delhi recognized for the purpose for C.G.H.S. by the Government. That being so, on account of non- availability of the treatment in Rajasthan the petitioner has availed the treatment at Escorts Hospital, New Delhi which is approved for the said treatment by the C.G.H.S. by the Government of India and as directed by the Medical Officer of C.G.H.S. at Jaipur vide Annexure 8 and 9 dated 15.6.1996. (16). The case of the petitioner is that after obtaining the sanction, the petitioner was not in a position owing to his condition and ailment to obtain the advance amount which he would otherwise have been entitled to and the petitioner had, therefore, rushed to the Escorts Hospital, New Delhi for being admitted for necessary treatment on 4.7.1996 itself. In such kind of emergency, it is not expected of the petitioner to have obtained the advance amount from the C.G.H.S. In the present case as per the bills of the Escorts Hospital and the receipts Annexure 2 to 5, it is clear that the petitioner deposited an amount of Rs. 2,00,000/-, as directed by the Hospital, as advance, which is not in dispute and stands proved by the bill and receipts on record. (17). In view of the above, the petitioner, in my view, having been admitted to the approved Hospital under the C.G.H.S. and under the necessary directions and sanctions of the C.G.H.S., is entitled to reimbursement of the amount which has been spent by his in getting the aforesaid treatment. (18). (17). In view of the above, the petitioner, in my view, having been admitted to the approved Hospital under the C.G.H.S. and under the necessary directions and sanctions of the C.G.H.S., is entitled to reimbursement of the amount which has been spent by his in getting the aforesaid treatment. (18). Learned counsel appearing on behalf of the respondents has also sought to content that the reimbursement limits have been fixed by the C.G.H.S., as provided by the Ministry of Health and Family Welfare vide their O.M.No. D. 12015/3/91-CGHS (P) dated 20.7.1994 which has been filed as Annexure R/1. On the basis of the above, it is submitted that the limit for CABG has been fixed as Rs. 89,000/- and, therefore, the petitioner cannot be entitled to received any amount over and above the aforesaid amount even though the petitioner may have paid an amount of Rs. 2,00,000/-, as submitted by the petitioner. (19). So far as the above submission is concerned, suffice it to say that the aforesaid document Annexure R/1 also contains stipulation in para 2(ii) which reads as follows:- ``(ii) The hospitals will not charge over and above the package deal rates mentioned above from the CGHS beneficiaries. (20). The para 2 (iii) of the aforesaid document Annexure R/1 reads as under:- (iii) The hospitals should provide credit facilities to Pensioners and after the treatment is over, submit the claim to the concerned Additional Director, CGHS of the city concerned for reimbursement. (21). The para 2(v) of the aforesaid document Annexure R/1 reads as under:- ``(v) Reimbursement in respect of CGHS beneficiaries including Pensioners will be made at the above mentioned rates or the rates charged by the hospital, whichever is less. (22). The para 3 of the aforesaid document Annexure R/1 reads as under:- ``3. All the private recognised hospitals mentioned in annexure-I are requested to confirm within one month form the date of issue of this office Memorandum that they accept the above conditions and are willing to provide treatment at the above revised rates failing which it will be presumed that the terms and conditions are acceptable to them. (23). All the private recognised hospitals mentioned in annexure-I are requested to confirm within one month form the date of issue of this office Memorandum that they accept the above conditions and are willing to provide treatment at the above revised rates failing which it will be presumed that the terms and conditions are acceptable to them. (23). As has been stated above, the petitioner after having been advised by the S.M.S. Hospital, Jaipur to undertake the treatment at the Escorts Hospital, New Delhi approached the respondent No. 2 and was issued the necessary sanction for treatment at the Escorts Hospital, New Delhi by the respondent No. 2. Thus, it is clear that the Escorts Hospital, New Delhi where the petitioner was admitted for treatment was an approved institute for the aforesaid treatment under the Scheme and in accordance with the circular of the Government for the purpose of Annexure R/1. If the approved institute insists in a particular case for the patient to be admitted, only after advance deposited, the patient at the given time owing to his condition cannot be said to run between the C.G.H.S. and the Government for getting the necessary sanction and resolving of the dispute. The condition No. 2 (ii) and 2(iii), mentioned in Annexure R/1, clearly postulate that hospital concerned has been saddled with the responsibility not to charge over and above the package deal from the C.G.H.S. Beneficiaries and even to provide credit facilities to the Pensioners and submit the claim to the concerned Additional Director, C.G.H.S. But for a patient, it is difficult at the relevant time to insist upon the aforesaid conditions being complied with looking to the condition of the patient (the petitioner) and the patient in a given case, as in the case of the petitioner, would have no option but to accept the conditions which are imposed by the institute/hospital and deposit the charges as any delay in the matter would be fatal. When the case of the petitioner has been come to the light of the respondents that the institute/hospital in the presence case has charged the petitioners and C.G.H.S. Beneficiaries, the matter lies between the respondents and the institute/hospital concerned and if any amount is to be recovered on account of the fact that the institute/hospital has charged a C.G.H.S. Beneficiary over and above the approved rates, then the respondents would be free to realize the aforesaid amount from the said institute/hospital concerned. In my view, the patient, as in the case of the petitioner, cannot be denied the reimbursement of the amount for the bill on account of the charges which the petitioner has had deposited and for which he has submitted the bills and receipts. In my view, therefore, even if the rates which have been prescribed under the Annexure R/1 are exceeded on account of the amount being charged by the approved hospital, the petitioner cannot be allowed to suffer and the respondents are liable to reimburse the amount, as the petitioner has gone to the hospital only on account of the fact that such hospital is recognized for the aforesaid purpose under the C.G.H.S. and if the recognized hospital has accepted the terms and conditions which are provided under Annexure R/1, the circular and order dated 20.7.1994 as per para 3 of the same and have charged the petitioner over and above the approved rates the petitioner cannot be denied reimbursement by the respondents and the respondents are liable to reimburse the petitioner to the full extent of the bill submitted by the petitioner for the aforesaid treatment. The remedy for the respondent lies in recovering excess amount from the Hospital concerned. But the C.G.H.S. Beneficiary or pensioner who is a member of the Scheme cannot be denied reimbursement when the genuineness of the bills is not disputed. (24). Consequently, I would allow this writ petition and direct the respondents to pay the balance amount after deducting the amount of Rs. 89,000/- which has been paid to the petitioner before the court on or about 10.6.1996. The petitioner would be entitled to the aforesaid amount to be paid within a period of two months of the receipt of the certified copy of this order with interest @ 6% per annum from the date of submission of the bill. (25). 89,000/- which has been paid to the petitioner before the court on or about 10.6.1996. The petitioner would be entitled to the aforesaid amount to be paid within a period of two months of the receipt of the certified copy of this order with interest @ 6% per annum from the date of submission of the bill. (25). It may be mentioned here that the petitioner unfortunately died during the pendency of this writ petition in the year 1999 and his legal representative and widow Smt. Zahida Khatoon, has been impleaded as party to this writ petition and she would be entitled to receive the aforesaid amount.