Research › Search › Judgment

Gujarat High Court · body

2011 DIGILAW 846 (GUJ)

Jaswantsinh C. Gohil v. Commissioner of Medical Service (Health), Gandhinagar

2011-12-19

C.L.SONI

body2011
JUDGMENT : C.L. Soni, J. The claim in this petition is for reimbursement of the medical expenses incurred by the petitioner for getting himself medically treated and having undergone the angiography and by-pass surgery at Apollo Hospital, Chennai, which is indisputably a recognized hospital for the purpose of grant of medical reimbursement. The petitioner has placed on record the schedule showing the medical expenses incurred by him, issued by the Apollo Hospital Chennai, as per which, the total amount spent during the treatment at the said hospital comes to Rs. 1,75,440/-. The genuineness of this bill is not doubted by the respondent. In fact, as per the Government Resolution dated 26.3.1999, which is found at Annexure-'F' (page 24), the medical treatment is permissible in recognized hospitals, outside the State of Gujarat. 2. It is the case of the petitioner that on the basis of the advice and recommendation of Dr. V.C. Chauhan, Cardiologist, the petitioner was required to undergo necessary medical treatment, including angiography and bypass surgery and, therefore, the petitioner made application on 25.7.1999 to the competent authority, i.e. Additional Director, Medical Services (Health Department) at Gandhinagar for necessary permission to have medical treatment outside the State of Gujarat in Apollo Hospital at Chennai. In his application, the petitioner has stated that he had already undergone bypass surgery on 30.1.1990, but after about 9 years, i.e. 1999, again he started feeling trouble and therefore, consulted Dr. V.C. Chaudhary, immediately. This application was not given attention immediately by the competent authority and the petitioner felt it necessary to get immediate medical treatment at Apollo Hospital, Chennai. The petitioner got himself admitted in the Apollo Hospital, Chennai on 5.8.1999 and got operated for bypass surgery on 11.8.1999 and remained till 23.8.1999 in the Hospital for post surgery treatment. As stated above, for this treatment, in the hospital, the expenses incurred by the petitioner, as certified by Apollo Hospital, is Rs. 1,75,440/-. 3. Learned advocate for the petitioner submitted that to get the medical expenses reimbursed, the petitioner presented the medical bill before the respondent and requested to reimburse the entire medical bill as per the schedule given by the Apollo Hospital, Chennai. 1,75,440/-. 3. Learned advocate for the petitioner submitted that to get the medical expenses reimbursed, the petitioner presented the medical bill before the respondent and requested to reimburse the entire medical bill as per the schedule given by the Apollo Hospital, Chennai. The petitioner was not given any reimbursement for his medical expenses and instead, by order dated 19.8.1999, the Additional Director, Medical Services, Gandhinagar rejected the application of the petitioner for permission to get treatment in the hospital outside the State of Gujarat, on the ground that the petitioner has not produced any certificate from the authorized Medical Officer. It is this order which is challenged in this petition and further prayer is made though couched as interim prayer, but it could only be a main prayer to the effect that the respondent authority may be directed to sanction the medical expenses incurred by the petitioner in approved hospital in connection with his bypass surgery to the tune of Rs. 1,75,440/-. 4. The petition was admitted and respondent No.1 was directed to file reply by order dated 11.10.2000. Respondent No.1 had accordingly filed reply dated 31.3.2001, opposing the petition and the main thrust of the opposition is to the effect that the petitioner is not entitled to full reimbursement of the medical expenses on the basis of the Government Resolution dated 26.3.1999, because the petitioner did not produce recommendation from the authorized Medical Officer and also did not obtain prior permission from the competent authority before getting treatment from the hospital, outside the State of Gujarat. It is pertinent to note here that neither the genuineness of the medical bill is disputed nor the status of Apollo Hospital, Chennai, a recognized hospital, is disputed. It is also pertinent to note here that this very petitioner had undergone bypass surgery in 1990 and at that time, the competent authority had granted sanction to the petitioner. Therefore, it clearly appears that it was a genuine and immediate requirement on the part of the petitioner when he felt some trouble and consulted Dr. V.C.Chauhan, who advised him for medical bypass surgery or angioplast. It is a matter of common knowledge that in respect of chronic diseases or heart diseases, whenever there is advice from any doctor for immediate treatment, nobody would wait to go through the procedure of getting certificate from authorized doctor or for permission from the competent authority. V.C.Chauhan, who advised him for medical bypass surgery or angioplast. It is a matter of common knowledge that in respect of chronic diseases or heart diseases, whenever there is advice from any doctor for immediate treatment, nobody would wait to go through the procedure of getting certificate from authorized doctor or for permission from the competent authority. At least, here is not a case that the petitioner has not made any application for prior permission from the competent authority, but even if the petitioner had not waited for making application for prior permission, then also, the petitioner would have been justified to immediately rush to Government hospital to get him operated, as advised by Cardiologist Dr. V.C. Chauhan. In last part of para 3 of the affidavit-in-reply, it is stated that the petitioner has not obtained any certificate from the Civil Hospital, Ahmedabad and therefore, he is not entitled to get reimbursement for the expenses to the tune of Rs. 1,75,440/- towards the medical treatment. However, the petitioner is entitled to receive fixed amount of Rs. 78,000/- as per the Government Resolution dated 26.3.1999. Thus, as per this reply also, the respondent believes that the petitioner is entitled to the amount of Rs. 78,000/- as per the Government Resolution for medical expenses incurred by him. This shows that the respondent is not doubting or disputing the medical expenses incurred by the petitioner as per the schedule produced by the petitioner from Apollo Hospital, but the respondent objects for grant of full medical reimbursement to the petitioner on the basis of the said Government Resolution. 5. Learned advocate Mr. Joshi for the petitioner has, while relying on the schedule from the Apollo Hospital for medical expenses incurred by the petitioner as also while relying on the very Government Resolution, vehemently argued that it was genuine need of the petitioner to get himself immediately operated at Apollo Hospital, Chennai and the respondent, therefore, ought not to have taken technical objection of non production of the recommendation from the authorized Medical Officer and of not obtaining prior permission before getting himself operated at Apollo Hospital. He relies on one judgment passed in Special Civil Application No.5041 of 1999 and argued that in a similar kind of case, where there was no recommendation from the authorized Medical Officer, then also, this Court while relying on earlier judgment, in the case of Madhavdas Ghagwandas Khushiramani v. State of Gujarat, reported in 2000(1) GLH 509 and Surji Singh v. State of Punjab, reported in AIR 1996 SC 1388 , had allowed the said petition and directed the respondent authorities to fully reimburse the medical bill of the Government servant. On the other hand, learned Assistant Government Pleader Mr. Dave has strenuously pointed out that since the petitioner did not comply with the requirement of the Government Resolution by not producing the recommendation from the authorized Medical Officer and by not obtaining the prior permission from the competent authority, the petitioner is not entitled to get full reimbursement of the medical expenses and the respondent authority is justified in granting fixed amount of Rs. 78,000/- as per the Government Resolution dated 26.3.1999. 6. I have gone through the record of the case, the schedule of expenses from Apollo Hospital, at page 20, the contents of the Government Resolution dated 26.3.1999 and considered the judgment cited by learned advocate Mr. Joshi. After having heard learned Assistant Government Pleader Mr. Dave, I am of the view that the petitioner is entitled to full reimbursement of the medical expenses though the petitioner has not strictly adhered to the requirement of the Government Resolution dated 26.3.1999. This Court has in the judgment cited by learned advocate Mr. Joshi (supra), considered somewhat similar argument advanced by learned Assistant Government Pleader in that case and has held that when genuineness of the medical bill is not doubted and when there was a requirement on the part of the Government Servant to get treatment outside the State of Gujarat from a recognized hospital, the claim of Government servant cannot be rejected simply on the ground of non-production of the recommendation from the authorized Medical Officer. It is pertinent to note here that the scheme for medical reimbursement is floated with a specific purpose to see that Government servant genuinely required immediate treatment from recognized hospital outside the State of Gujarat, may be fully helped by the Government itself in the matter of taking full reimbursement of medical expenses incurred by Government servant. It is pertinent to note here that the scheme for medical reimbursement is floated with a specific purpose to see that Government servant genuinely required immediate treatment from recognized hospital outside the State of Gujarat, may be fully helped by the Government itself in the matter of taking full reimbursement of medical expenses incurred by Government servant. If such is a benevolent and good purpose behind the Government Resolution, then by not granting full reimbursement of the medical expenses when genuineness of the bill is not doubted, the very purpose of providing full reimbursement of the medical expenses would be frustrated and therefore, in the facts of the case, though the recommendation was not made by authorized Medical Officer for getting treatment outside the State of Gujarat, but looking to the history of the case of the petitioner, especially his prior bypass surgery in the year 1990 and the schedule from Apollo Hospital showing medical treatment for a period from 5.8.1999 to 23.8.1999 and genuine intention of the petitioner to make application in advance, asking for prior permission from the competent authority, I am of the opinion that the petition is required to be accepted in toto and the respondent is required to be directed to fully reimburse the medical expenses incurred by the petitioner as per the schedule placed by the petitioner on record, i.e. Rs. 1,75,440/-. 7. Accordingly, the petition is allowed. The respondent is directed to fully reimburse the medical expenses incurred by the petitioner as per the schedule placed by the petitioner at page 20, to the tune Rs. 1,75,440/- (though in the prayer clause, the petitioner has quantified the amount of Rs. 1,74,440/-, which appears to be a typographical mistake). The respondent is directed to pay the abovesaid amount of Rs. 1,75,440/- (Rupees One Lac Seventy Five Thousand Four Hundred Forty only) within a period of two months from the date of receipt of the copy of the order by the respondent. Rule is made absolute accordingly. Direct service is permitted. Petition allowed.