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2008 DIGILAW 1403 (PNJ)

Om Parkash Goyal v. State Of Haryana

2008-08-19

JITENDRA CHAUHAN, M.M.KUMAR

body2008
Judgment Jitendra Chauhan, J. 1. In the instant writ petition, the petitioner has sought quashing of Annexure P-6, with further prayer of issuing a writ of mandamus directing the respondents to reimburse full amount of the actual bill raised by the respondent No. 4, or alternatively, to direct respondent No. 4 to modify the bill according to the rates of PGI as per instructions dated 14. 10.2004 (Annexure P-l) of the Haryana Government. 2. The petitioner is working as Under Secretary to the Government of Haryana (Class-I Officer). The wife of the petitioner met with an accident on 10.4.2005 and suffered multiple fractures and was advised surgery. She was admitted in the PGI, Chandigarh where she remained admitted up to 12.5.2005. However, on failure to provide required treatment by the PGI doctors, the petitioner was constrained to approach respondent No. 4, which after examination of the petitioners wife, submitted an estimated bill of Rs. 1,43,600/-on 13.5.2005, annexed with the petition as Annexure P-2. 3. The petitioner was sanctioned Rs. 1,07,000 as medical advance in pursuance to the estimate of Rs. 1,43,600/- approximately vide Annexure .P-2. This advance amount was 75% of the estimated cost of treatment advanced by respondent No. 4 in connection with the medical treatment of petitioners wife. However, respondent No. 4, The Silver Oaks Hospital, raised the final bill amounting to Rs. 1,83,659/-, Annexure P-5. On submission of the final bill for medical reimbursement by the petitioner, the respondent conveyed to the petitioner that according to the rates of the Post-Graduate Institute of Medical Education and Research, Chandigarh (PGI), an amount of Rs. 93,358/- could be reimbursed. Out of total bill of Rs. 1,83,659/-. The petitioner was further directed to deposit the excessive amount of Rs. 14,342/- (Rs. 1,07,000 minus Rs. 93,358) in the Government Treasury, vide Annexure P-6. 4. The State of Haryana vide its letter dated 14.10.2004 (Annexure P-1) brought respondent No. 4-The Silver Oaks Hospital on the approved list of the Haryana Government for treatment of its employees and their dependents. 5. On the basis of the estimated bill of Rs. 1,43,600/-, on request of petitioner, an amount of Rs. 1,07,700/- being 75% of the total estimated amount of medical expenses, was sanctioned on 19.5.2005 vide Annexure P-3. The wife of the petitioner was operated upon at respondent No. 4-The Silver Oaks Hospital and thereafter discharged on 28.5.2005, i.e., after stay of sixteen days. 1,43,600/-, on request of petitioner, an amount of Rs. 1,07,700/- being 75% of the total estimated amount of medical expenses, was sanctioned on 19.5.2005 vide Annexure P-3. The wife of the petitioner was operated upon at respondent No. 4-The Silver Oaks Hospital and thereafter discharged on 28.5.2005, i.e., after stay of sixteen days. At the time of discharge, respondent No. 4 raised final bill of Rs. 1,83,659/- as against, the estimated bill of Rs. 1,43,600/- issued on 13.5.2005. The petitioner had submitted the bill dated 28.5.2005 (Annexure P- 5) issued by respondent No. 4 in the office of respondent No. 2. In response to Annexure P-5, respondent No. 2 intimated vide letter dated 23.11.2005 (Annexure P-6) to the petitioner that he was entitled only to the amount of Rs. 93,358/- as per PGI rates. The petitioner was further directed to refund the excess amount paid to him beyond Rs. 93,358/-; i.e., Rs. 14,342/-in the Government Treasury. On receiving the said letter, the petitioner made a detailed representation (Annexure P-7) on 28.11.2005 mentioning that respondent No, 4 had raised the bill of Rs. 1,83,659/-. Respondent No. 2 sought the opinion of respondent No. 4. The Silver Oaks Hospital, which, vide Annexure P-8, explained as to how the bill had been calculated. 6. It is not in dispute that respondent No. 4-The Silver Oaks Hospital is on the approved list of the Haryana Government for treatment of its employees, and their dependents. The bill (Annexure P-2) was a tentative/estimated bill on the basis of eight days stay of patient in the hospital. It is also admitted position that before making estimated bill, respondent No. 4 had examined the patient and accordingly,.calculated the amount of expenditure on the treatment of the petitioners wife. 7. As per respondent No. 4, the bill escalated on account,of the fact that the patient was examined by super specialist doctors and was operated upon by renowned surgeons and as against estimated stay of eight days in the hospital the patient had to stay for sixteen days. 8. As per the written statement filed on behalf of respondent Nos. 1 to 3, the case of the petitioner for full reimbursement was referred to the Health Department which is the competent authority for grant of relaxation in rules to make full payment vide letter dated 10.1.2006. Accordingly, the case was examined as per instructions dated 14.10.2004. 8. As per the written statement filed on behalf of respondent Nos. 1 to 3, the case of the petitioner for full reimbursement was referred to the Health Department which is the competent authority for grant of relaxation in rules to make full payment vide letter dated 10.1.2006. Accordingly, the case was examined as per instructions dated 14.10.2004. The competent authority has conveyed that the petitioner is entitled to get the reimbursement of Rs. 93,358/-, which is at par with PGI rates and is not entitled to get full reimbursement. 9. It is admitted fact that doctors in respondent No. 4 Hospital had examined the patient before admission in the hospital. All the reports pertaining to the status of the health of the patient were examined by the doctors in respondent No. 4 Hospital, who were in complete knowledge of the nature of treatment to be administered to the patient. At the end of submissions, the counsel for the State has brought to our knowledge that by notification dated 12.8.2008 respondent No. 4.The Silver Oaks Hospital stands de-recognised. However, this would not affect the present case as it pertains to the year 2005. 10. We have heard the counsel for the parties and perused the record. 11. The bill in question was inflated on account of longer stay of the patient and on the ground that the patient was treated by super-specialists and renowned surgeons. 12. However, we feel this is totally a lame excuse and respondent No. 4 cannot be allowed to burden the petitioner with additional cost of treatment, as respondent No. 4 had itself decided cost of treatment. These were the concerns which should have been kept in mind by respondent No. 4 at the time of preparing the estimated bill particularly when they were briefed in detail regarding the history and medical reports of the patient. If at all someone is to be blamed, it is respondent No. 4, which failed to properly foresee the required treatment. Respondent No. 4 failed to convey to the petitioner or the state that it was an approximate amount, which was likely to be increased or decreased up to a particular extent depending upon the respons.e of the patient to the treatment. 13. Respondent No. 4 failed to convey to the petitioner or the state that it was an approximate amount, which was likely to be increased or decreased up to a particular extent depending upon the respons.e of the patient to the treatment. 13. Since there was an agreement between the State of Haryana and respondent No. 4-The Silver Oaks Hospital to treat Haryana Government employees and their dependents at par with PGI rates, it is for them to settle the dispute regarding the payment with respondents No. 1 to 3. The petitioner cannot be made party to the same and denied the medical reimbursement in view of the instructions (Annexure P-1). If the State has any grouse against the excess bill, it can resort to appropriate action against respondent No. 4. However, under no circumstances, the petitioner can be allowed to suffer. 14. The petitioner is admittedly an employee of the Haryana Government and in view of understanding reached between the State of Haryana and respondent No. 4, the petitioner is entitled to the treatment at PGI rates. The initial bill of Rs. 1,43,600 was merely an estimate whereas the subsequent bill dated 28.5.2005 (Annexure P- 5) was the actual and final bill raised by respondent No. 4. The State of Haryana should have got clarified from respondent No. 4 as to what extent the tentative bill could be raised by respondent No. 4. 15. In view of this, we are of the considered view that the demand raised by the State vide letter dated 23.11.2005 (Annexure P-6) is wholly misconceived and against the policy of the State. Accordingly, Annexure P-6 dated 23.11.2005 is quashed and the respondents are directed to reimburse the petitioner full amount incurred on account of the treatment. However, if the State feel aggrieved by the enhanced demand made by respondent No. 4, it is at liberty to proceed agai fist respondent No. 4, as per law.