JUDGMENT 1. - Petitioner has retired from service on 31.07.1991 on attaining age of superannuation. On contribution towards Rajasthan Pensioner's Medical Fund ('RPMF') during service tenure, he has been a member of Rajasthan State Pensioners Medical Concession Scheme ('Scheme'). When he came to meet his brother at Jaipur all of a sudden due to neuro-problem became unconscious and in critical serious condition, was taken to SMS Hospital where Intensive Care Unit was not vacant, therefore, was taken and admitted at Santokbha Durlabhji Hospital, Jaipur on 17.10.05 where he remained hospitalized in intensive care unit (ICU) upto 27.10.05 and after discharge therefrom, submitted bills for reimbursement of Rs. 53,667.69p. as is evident from Annexure 1. Medical Bills raised by petitioner for reimbursement have not been disputed but his claim was rejected by respondent vide communication dated 19.01.06 (Ann. 2) that he got himself medically treated at Santokbha Durlabhji Hospital, Jaipur which is hospital not recognised by State Government. 2. Counsel for petitioner submits that when petitioner was taken to SMS Hospital in a critical and unconscious state of condition on account of neuro problem, but there was no room available in intensive care unit at SMS Hospital, family members attendant had no option except to rush for private Hospital nearby viz., Santokbha Durlabhji Hospital and got him admitted in intensive care unit where he remained hospitalized continuously in ICU from 17.10.05 to 27.10.05 and undertook medical treatment for which the bill which he raised are in accordance with medical Rules, particularly in terms of R.4A; the reasons assigned for rejection of his claim in instant case that he undertook medical treatment at Santokbha Durlabhji Hospital which is a private hospital and not recognised by State Government, is totally arbitrary and petitioner is entitled for release of payment of his bills in terms of Scheme, itself. In support of. contention, Counsel placed reliance upon decision of this Curt in State of Rajasthan v. Kailash Prasad Gupta, D.B. Civil Special Appeal (Writ) No. 546/2005 decided on 19.09.2005 . 3.
In support of. contention, Counsel placed reliance upon decision of this Curt in State of Rajasthan v. Kailash Prasad Gupta, D.B. Civil Special Appeal (Writ) No. 546/2005 decided on 19.09.2005 . 3. Respondents have filed reply and only objection raised is that in terms of Scheme, reimbursement is allowed only in case of pensioner being undertaken medical treatment in a hospital duly recognised by State Government and since petitioner took medical treatment in a private hospital not recognised by State Government and straight away proceeded to take treatment in Santokbha Durlabhji Hospital without prior permission from the Board and that being so, his claim has rightly been rejected. 4. I have considered contentions of both the parties and with their assistance, pondered over material on record. Pensioner especially being patient of critical diseases always remains in the hands and at the wisdom of family members and otherwise also at critical time he is not in a position to suggest anything nor his family members are expected of having prior knowledge of recognised hospital other than Government. 5. Prime consideration in case of grave emergency which comes in the mind of family members is to save the life of patient and at that point of time whatever hospital comes to their mind and considered just is felt as the best because emergency knows no law and no procedure and when human life is at stake in such situation ultimate responsibility of the State cannot be washed out. Technicalities of Rules and regulations under the Scheme are not required to be followed just in a mechanical manner so as to frustrate very purpose of the Scheme because a person having put in his whole life in the service of the State till attains age of superannuation always require human considerations. 6. In instant case, this fact remains undisputed that petitioner undertook medical treatment at Santokbha Durlabhji Hospital, Jaipur where his family members got him admitted in a critical and his unconscious state of condition in intensive care unit on 17.10.05 and discharged on 27.10.05. In such situation, it can be presumed that in case of grave emergency and critical condition, when petitioner was taken to SMS Hospital, no room in intensive care unit was not being provided to him in SMS Hospital, which constrained medical attendant family members of petitioner to immediately rush to nearby hospital viz.
In such situation, it can be presumed that in case of grave emergency and critical condition, when petitioner was taken to SMS Hospital, no room in intensive care unit was not being provided to him in SMS Hospital, which constrained medical attendant family members of petitioner to immediately rush to nearby hospital viz. Santokbha Durlabhji Hospital, Jaipur that certainly amounts to non-availability of treatment in the Government Hospital-in that eventuality, Rule 4A of the Scheme would apply. Division Bench of this Court in State v. Kailash P. Gupta (supra) has also examined similar like situation where pensioner's wife initially went to SMS Hospital but since medical assistance was not properly afforded to her in emergent Ward; there was no option for her family to shift immediately to private Hospital viz. Santokbha Durlabhji Hospital where she was operated but died on 21.06.03. Division Bench of this Court in State v. Kailash P. Gupta, ibid , considered argument of Additional Advocate General that even in case of diseases for which treatment is not available in Government hospitals or the State, ceiling is 80% of hospital expenses or Rs. 1,20,000/- whichever is less as provided in Rule 4-A of the Scheme and finally observed as under : "8. In our view not taking proper care in case of grave emergency amounts to non-availability of treatment in the Government Hospital and Rule 4A would apply. The petitioner has claimed reimbursement of .Rs. 3,05,643.83 p. which cannot be allowed to the petitioner as per Rule 4A according to which petitioner is entitled for Rs. 1,20,000/- with interest @9%." In view of what has been observed above, instant petitioner is also entitled for reimbursement of actual hospital expenses bill, which he has furnished in, terms of Rule 4-A of the Scheme. 7. Consequently, the writ petition succeeds and is hereby allowed. Order impugned dated 19.01.06 (Ann. 2) is quashed & set aside. Respondents are directed to make payment of medical bills raised and furnished by petitioner in terms of Rule 4A of the Scheme with interest @ 9% per annum from the date of presentation of bill till actual payment. All exercise in compliance of aforesaid order be made within two months. No order as to costs.Writ Petition Allowed. *******