Research › Search › Judgment

Punjab High Court · body

2007 DIGILAW 1592 (PNJ)

Mehraj Hussain v. U. T. Administration

2007-09-05

HEMANT GUPTA

body2007
Judgment Hemant Gupta, J. 1. The son of the petitioner, namely Sakib Hussain, who was born on 16.12.2004 was suffering from heart ailment "Trauma-Arterosis". He was taken to General Hospital, Sector 16, Chandigarh on 09.02.2005. But the petitioner was advised to take the child to the PGI. It is the case of the petitioner that doctors in PGI referred the child to Max Devki Devi Hospital, New Delhi as he required emergency surgery. In terms of the reference made by the doctors of PGI, the petitioner took his two and a half months old child at Delhi hospital in February, 2005 where the child had undergone surgery i.e. "VSD Closure" and "Tissue Conduit" but unfortunately the son of the petitioner died on 06.03.2005. 2. It is also pointed out that earlier a girl child of the petitioner was born on 16.10.2001. She also suffered from same disease called "Trauma-Arteriosis". The child was referred for surgery to All India Institute of Medical Sciences in New Delhi by the PGI doctors where she was to undergo surgery for "Conduit Repair" but before the surgery could be performed the daughter of the petitioner died. 3. The petitioner has produced final bill dated 06.03.2005 (Annexure P-9) in the sum of Rs. 1,50,226/- in respect of the surgery performed on the son of the petitioner. The details of the amount claimed by the petitioner read as under : "VSD Closure : 1,10,000/- Tissue Conduit : 40,000/- Blood Bank Charges : 7,200/- Pathology : 500/- Consultation : 400/- Consumable : 1,976/- Draw sheet : 150/- Gross Total : 1,60,226/- Discount : 10,226/- New total : 1,50,000/- Less Advance : 1,40,000/- Amount to be paid/refund : 10,000/-" 4. As a book binder in Punjab and Haryana High Court, Chandigarh, the petitioner is entitled to reimbursement of medical expenses. The petitioner submitted the bills for medical reimbursement. However, vide letter dated 20.05.2005, a sum of Rs. 48,385/- only was ordered to be paid to the petitioner towards medical reimbursement by the Chandigarh Administration. The subsequent representations claiming the balance amount remained unsuccessful. It is the claim of the petitioner that he is entitled to reimbursement in terms of the charges fixed by the All India Institute of Medical Sciences, New Delhi vide Annexure P-15 dated 13.01.2004 for VSD Closure, the general ward patient is charged Rs. 55,000/- and for Conduit repair, the charges are Rs. 65,000/-. It is the claim of the petitioner that he is entitled to reimbursement in terms of the charges fixed by the All India Institute of Medical Sciences, New Delhi vide Annexure P-15 dated 13.01.2004 for VSD Closure, the general ward patient is charged Rs. 55,000/- and for Conduit repair, the charges are Rs. 65,000/-. Thus, it is alleged that payment of Rs. 48,385/- is not as per the rates fixed by All India Institute of Medical Sciences, New Delhi, in respect of surgeries carried out on the child of the petitioner. 5. In reply, it was pointed out that admissible amount of medical reimbursement as per rates of All India Institute of Medical Sciences, New Delhi, has been given. It was also pointed out in Annexure R-2/2 that for VSD Closure with Graft, the charges are Rs. 48,000/-. The other charges paid to the petitioner include Rs. 60/- for medicines, Rs. 250/- for lab attendant and Rs. 75/- for one unit of blood transfusion. 6. Learned counsel for the petitioner vehemently argued that VSD Closure and Tissue Conduit are two separate surgeries in respect of which separate charges are charged by the hospital and it is so reflected in the AIIMS circular (Annexure P-15) but the petitioner has not been reimbursed the expenses in terms of the said circular. Even the bill issued by the Hospital where the son of the petitioner has undergone surgery charged for both the procedures separately. 7. Today, Mr. Malhotra has filed an additional information signed by the Director, Health Services, Chandigarh, pointing out that Tissue Conduit Repair, VSD Closure and VSD Closure with Graft are separate packages. It is, however, pointed out that if two procedures are not carried out independently, then the package charge having higher amount reimbursed. It is also stated that there are no separate instructions in this respect but as there are certain procedures which are common in bath surgeries therefore, the reimbursement has been made of the procedure which is more expensive. Thus, the reimbursement granted to the petitioner is in terms of the Rules. 8. As per the additional information furnished on record, the VSD Closure and Conduit Repair are two separate procedures. All India Institute of Medical Sciences, New Delhi, specifies separate treatment packages for both procedures. Even the petitioner has been charged separately for both VSD Closure and Tissue Conduit Repair by the Hospital. 8. As per the additional information furnished on record, the VSD Closure and Conduit Repair are two separate procedures. All India Institute of Medical Sciences, New Delhi, specifies separate treatment packages for both procedures. Even the petitioner has been charged separately for both VSD Closure and Tissue Conduit Repair by the Hospital. Therefore, to arrive at the conclusion that higher amount claimed in respect of one package alone is to be awarded, is not based upon any logic nor is supported by a circular issued by the All India Institute of Medical Sciences, New Delhi. Therefore, the action of the respondents in restricting reimbursement to the extent of Rs. 48,000/- for VSD Closure with Graft only is unjustified. 9. It may be noticed that respondents have calculated the said charges of Rs. 48,000/- on the basis of the circular issued by the Institute in the year 2000. The All India Institute of Medical Sciences, New Delhi, has since revised its charges on 13.01.2004. This fact is not disputed by the respondents but it is asserted that circular dated 13.01.2004 has not been adopted by the Chandigarh Administration, therefore, reimbursement of medical expenses is to be made on the basis of the circular issued by the Institute in 2000. 10. The fact that medical reimbursement has to be made to the employees in terms of the rates fixed by the AIIMS is not disputed. Once the said facts not disputed, the rates fixed by the AIIMS, as applicable on the date of surgery, have to be reimburse irrespective of the fact whether such circular has been adopted by the Chandigarh Administration or not. The adoption of circular may be a ministral act required to be performed by the administration but that will not effect the rights of the petitioner to claim reimbursement in terms of the policy decision of the administration. 11. Learned counsel for the respondents has pointed out that the blood transfusion charges claimed are Rs. 7,200/- whereas, as per instructions, Rs. 250/- per unit of blood is the amount which is permissible. It is pointed out only one unit of blood transfusion charges have been reimbursed and there is typographical mistake in Annexure R-2/2 wherein 14 units is mentioned. 12. 7,200/- whereas, as per instructions, Rs. 250/- per unit of blood is the amount which is permissible. It is pointed out only one unit of blood transfusion charges have been reimbursed and there is typographical mistake in Annexure R-2/2 wherein 14 units is mentioned. 12. In view of the said stand, I deem it appropriate to permit the petitioner to produce documents to the effect that more than one unit of blood was transfused to the child. If such document is reproduced, the petitioner shall be reimbursed in respect of the units of blood transfused to the child. 13. Thus, the action of the respondents restricting Rs. 48,000/- as reimbursement charges for the procedures conducted on the son of the petitioner is set aside. It is held that the petitioner is entitled to Rs. 55,000/- for VSD Closure and Rs. 65,000/- for Conduit Repair in terms of the AIIMS Circular Annexure P-15. In view of the above, the present writ petition is allowed with direction to the respondents to reimburse medical expenses of Rs. 55,000/- towards VSD Closure and Rs. 65,000/- towards Conduit Repair along with other permissible charges due to the petitioner. The petitioner is also entitled to costs which are assessed at Rs. 5,000/-.