JUDGMENT 1. - The petitioner is a retired employee of the department of Medical and Health, State of Rajasthan and has laid the instant writ petition under Article 226 of the Constitution of India for claiming under mentioned reliefs:- It is, therefore, most humbly and respectfully prayed that this writ petition may kindly be allowed with costs and by a writ, order or direction this Hon'ble Court may kindly be pleased to quash and set aside the said letters Annexure-3 (25.08.2007) & Annexure-5 (29.05.2007) and the respondents may kindly be directed to make payment of the amount of entire bills as mentioned above as expeditiously as possible. Any other appropriate order or direction which may be deemed just and proper in the facts and circumstances of the case may also kindly be passed in favour of the petitioner. 2. For claiming the aforementioned reliefs, it is, inter alia, alleged in the writ petition that at the threshold of his service career, the petitioner was appointed as Medical Officer w.e.f. 14th February, 1970 and continued with the said position uptil his voluntary retirement from the service w.e.f., 30th Floating Frame November, 1999. After retirement, the petitioner is getting regular pension and is also in receipt of medical facilities as per rules. The petitioner has averred in the writ petition that on 24th January, 2007, at Ladnu, he suffered cardiac problem and as per advice of the Medical Officer of Ladnu Govt. Hospital, he was shifted to Jaipur for specialised treatment at Jaipur. As per advice tendered by Senior Medical Officer of Ladnu, he has availed the medical services of a private hospital namely Tongia Heart & General Hospital, Jaipur. At Tongia Heart & General Hospital, Jaipur, which is a private hospital, necessary tests were conducted and thereafter keeping in view the blockage in the artries/heart, angioplasty was performed on 25.01.2007. The petitioner remained hospitalized as indoor patient for about four days and thereafter he was discharged on 28.01.2007. After his treatment, the petitioner applied for reimbursement of medical expenses to the tune of Rs. 1,55,350/- only in the prescribed proforma. However, the request of the petitioner was turned down by the second respondent precisely on the ground that the treatment was undertaken by the petitioner at a private hospital which is not recognised by the Govt. of Rajasthan. 3.
1,55,350/- only in the prescribed proforma. However, the request of the petitioner was turned down by the second respondent precisely on the ground that the treatment was undertaken by the petitioner at a private hospital which is not recognised by the Govt. of Rajasthan. 3. The petitioner has further averred in the writ petition that the requisite angioplasty was an imminent need for saving his life and he made another attempt by annexing the medical bills with his letter dated 12th November, 2007 which was addressed to the second respondent. However, according to the petitioner, the said attempt also proved to be futile inasmuch as his claim for medical reimbursement was once again declined by a letter dated 29th February, 2007. The petitioner has termed the communication dated 29th February, 2007 (Ann.5) as arbitrary, unreasonable and unjust and has prayed for quashing the adverse communications to him. 4. Resisting the petition preferred by the petitioner, a detailed reply was submitted by the respondents. It was submitted in the reply that in case of retired State employees, Rajasthan State Pensioners Medical Concession Scheme is applicable and the said scheme of reimbursement is permissible if the pensioner has undertaken the treatment in a Govt. Hospital or a duly recognised hospital by the State Govt. In the reply, the respondents have also referred two clauses 4E of the Scheme. In sum and substance, the objection raised on behalf of the respondents are confined to certain technical reasons for denial of medical reimbursement. 5. The learned counsel for the petitioner has contended that providing free medical facilities to the pensioners is an obligation of the welfare State and welfare State is not expected to show apathy towards the life of an individual. The learned counsel has urged that protecting the life of a citizen as enshrined under Article 21 of the Constitution of India is the legal obligation of a welfare State and therefore, denial of medical reimbursement is wholly unjust, unfair and against the basic tenets of law. In support of his contentions, the learned counsel has placed heavy reliance on the following authoritative legal precedents, Raj Laxman Taneja v. State of Raj., RLW 2005 (2) Raj. 1271 , Tulcha Ram v. State of Raj. & Ors., 2005 (2) WLC (Raj.) 250 and Ganesh Raj v. State of Rajasthan, 2005 (2) WLC (Raj.) 259 6.
In support of his contentions, the learned counsel has placed heavy reliance on the following authoritative legal precedents, Raj Laxman Taneja v. State of Raj., RLW 2005 (2) Raj. 1271 , Tulcha Ram v. State of Raj. & Ors., 2005 (2) WLC (Raj.) 250 and Ganesh Raj v. State of Rajasthan, 2005 (2) WLC (Raj.) 259 6. Relying on the aforementioned judgment, the learned counsel for the petitioner has sought direction against the respondent for reimbursement of the entire amount. 7. Per contra, the learned counsel for the respondents, Mr. Bissa, has urged that the claim for medical reimbursement of the petitioner was rightly declined because the treatment of angioplasty was available at SMS Hospital at Jaipur. According to the submission of Mr. Bissa, the petitioner at his own volition undertook the treatment of his cardiac problem at private hospital and therefore, he is not entitled for reimbursement in accordance with the scheme. While buttressing his submission, the learned counsel for the respondents has placed heavy reliance on clause 4E of the Scheme. Clause 4E of the scheme is reproduced as infra: "4E. Treatment of heart ailment in recognised hospital outside the State (with or without the recommendation of the Medical Board). (a) In case it is recommended by the Medical Board that by-pass surgery for heart is indicated, the pensioner can get himself operated in any of the hospital recognised by the Medical Board for this purpose. Such pensioner may be allowed 80% of the hospital expenses limited to Rs. 44,000/- being 80% of General Ward charges of All India Institute of Medical Sciences, New Delhi. (b) In case a pensioner undergoes by-pass surgery of heart (Cardio thoracic surgery) in any recognised hospital outside the State in emergent circumstances without any recommendation of the Medical Board, he may be allowed 80% of hospital expenses limited to Rs. 44,000/- i.e., 80% of General Ward Charges of AIIMS, New Delhi provided that he submits a certificate from a Cardiologist who holds a degree of D.M. In Cardiology or MCH in Cardio Thoracic Surgery stating the petitioner's condition was such that immediate treatment was essential." 8. Thus in totality, the learned counsel for the respondent has vehemently opposed the prayer of the petitioner for medical reimbursement. 9. I have given my thoughtful consideration to the arguments advanced by the rival parties and perused the materials on record. 10.
Thus in totality, the learned counsel for the respondent has vehemently opposed the prayer of the petitioner for medical reimbursement. 9. I have given my thoughtful consideration to the arguments advanced by the rival parties and perused the materials on record. 10. There is no quarrel in the factual position that the petitioner has suffered cardiac problem and for saving his life angioplasty was need of the hour and he has undergone the treatment at private hospital of Jaipur. Taking treatment from a private hospital itself cannot be construed as a valid ground to deny the reimbursement of medical expenses which is permissible to a retired employee of the Govt. A welfare State is not expected to cite technical reasons for declining just prayer of a pensioner. The petitioner has served the State Government for almost two decades - during his hay days, it is not expected from the State to leave him in lurch during evening phase of his life. A legitimate amount which is prescribed for treatment in Govt. hospital or a hospital recognised by the State Government for a particular ailment ought to have been reimbursed to the petitioner in the given circumstances. By not acceding to the request of the petitioner for reimbursement of the legitimate amount of angioplasty as per the Rajasthan State Pensioners medical Concession Scheme, the respondents have shown total callous and stubborn attitude, which is liable to be deprecated in the given circumstances. A welfare State is not expected to show such an apathy towards human life. My this view is fortified from a judgment of Hon'ble Apex Court rendered in the case of State of Punjab & Ors. v. Ram Lubhaya Bagga, (1998) 4 SCC 117 , wherein the Hon'ble Apex Court has held that the State can neither urged nor say that it has no obligation to provide medical facility. If that were so, it would be ex-facie violative of Article 21 of the Constitution. While adverting to fixing any rate vis-a-vis an ailment the Hon'ble Supreme court has observed as infra:- "No State of any country can have unlimited resources to spend on any of its projects. That is why it only approves its projects to the extent it is feasible. The same holds good for providing medical facilities to its citizens including its employees. Provision of facilities cannot be unlimited.
That is why it only approves its projects to the extent it is feasible. The same holds good for providing medical facilities to its citizens including its employees. Provision of facilities cannot be unlimited. It has to be to the extent finances permit. If no scale or rate is fixed then in case private clinics or hospitals increase their rate to exorbitant scales, the State would be bound to reimburse the same. Hence we come to the conclusion that principle of fixation of rate and scale under this new policy is justified and cannot be held to be violative of Article 21 or Article 47 of the Constitution of India." 11. The Hon'ble Apex Court in its latter pronouncement in case of State of Rajasthan v. Mahesh Kumar Sharma, (2011) 4 SCC 257 while dealing with the subject matter has reiterated the ratio decidendi of the judgment referred to supra and held that reimbursement of medical expenses cannot be allowed to a Govt. employee/pensioners dehors the rules or the scheme. In this verdict, the Hon'ble Apex Court has held in para 8 as infra:- 12. In this connection it will be profitable to refer to the judgment of a Bench of three Judges of this court in State of Punjab and Others v. Ram Lubhaya Bagga and Others, reported in (1998) 4 SCC 117 where the Bench has laid down that the Government would be justified in limiting the medical facilities to the extent it is permitted by its financial resources. In the instant case, the Government has formulated necessary rules permitting the reimbursement of medical expenses in certain situations and upto a certain limit. The Government has been reimbursing the necessary expenditure as permitted by the rules uniformly. It will, therefore, not be proper for a Government employee or for his relatives to claim reimbursement of medical expenses otherwise that what was provided in the Rules."In these circumstances, the writ petition preferred by the petitioner is partly allowed and the respondents are directed to reimburse the medical expenses incurred by the petitioner for his angioplasty in accordance with scheme and the impugned communications 25.08.2007 and 29.02.2007 are quashed and set aside and the respondents are directed to reexamine the matter forthwith and pay the requisite amount of expenses incurred by the petitioner for his angioplasty in accordance with the scheme within a period of two months from today. 13.
13. If the requisite amount is not paid within two months, the petitioner shall be entitled for interest at the rate of 6% per annum on the said amount. 14. There is no order as to costs.Petition Partly Allowed. *******