Research › Search › Judgment

Bombay High Court · body

2013 DIGILAW 399 (BOM)

Jeevan Vikas Kendra v. Government of Maharashtra, Through Office of Govt. Pleader

2013-02-18

A.S.OKA, R.D.DHANUKA

body2013
JUDGMENT R.D. Dhanuka, J. By this petition under Article 226 read with Article-21 of the Constitution of India, petitioner seeks a Writ of Mandamus or any other Writ, direction or order for quashing and setting aside the impugned decision taken in meeting of the Monitoring Committee on 30th April 2012 and seeks permission to use the accumulated funds in the Indigent Patients Fund (for short 'IPF') maintained by the petitioner for the purpose of replacing dialysis machine and x-ray machine in its hospital. Petitioner also seeks a direction against the respondents to reconsider the application of the petitioner on merits under clause 19 of the Scheme framed by this Court in Writ Petition (PIL) No.3132 of 2004. 2. In the year 1971, the petitioner trust started a hospital for providing medical services at reasonable cost or free to poor persons. The petitioner is a trust registered under the provisions of Bombay Public Truct Act 1950 and manages a 62 bed hospital by name “Sadanand Banait Hospital”. On 14th October 2005, this Court constituted an Expert Committee in W.P.(PIL) 3132 of 2004, to give recommendations on all aspects under the provisions of Section 41AA of the Bombay Public Trusts Act, 1950 (for short ' the said Act'). The Expert Committee submitted its report to this Court making various suggestions for formulation of Scheme. By an order dated 17th August 2006, this Court, after considering the report of the Expert Committee and considering all relevant aspects and objectives of Section 41AA of the said Act, approved the Scheme under Section 41AA for treatment of indigent patients and weaker section patients. Some of the relevant provisions of the said scheme are as under: "2. The public Charitable Trust covered by aforesaid clause 1 shall be under legal obligation to reserve and earmark 10% of the total number of operational beds for indigent patients and provide medical treatment to the indigent patients free of cost and reserve and earmark 10% of the total number of operational beds at concessional rate to the weaker section patients as per the provisions of section 41AA of the B.P.T. Act. 3. In emergency, the Charitable Hospitals must admit the patient immediately and provides to the patient “Essential Medical Facilities” for all life saving emergency treatment and procedure till stabilization. Further transportation to the public hospital would be arranged by such Charitable Hospital, if necessary. 3. In emergency, the Charitable Hospitals must admit the patient immediately and provides to the patient “Essential Medical Facilities” for all life saving emergency treatment and procedure till stabilization. Further transportation to the public hospital would be arranged by such Charitable Hospital, if necessary. The Charitable Hospitals shall not ask for any deposit in case of admission of emergency patients. 4. That each public charitable hospital shall create separate fund which may be called Indigent Patients' Fund (for the sake of brevity, hereinafter referred to as “IPF”) and shall credit two per cent of gross billing of all patients (other than indigent and weaker section patients) without any deduction. 5. Donations that may be received by the charitable hospitals from individuals or other charitable trusts or from any other source for providing medical treatment to the indigent and weaker section patients shall be credited to IPF Account. 6. The account of IPF shall have to be earmarked under the head of IPF and same shall be reflected under the earmarked fund in the annual balance Sheet (Schedule VIII Rules 7(1) of the B.P.T. Rules). 7. The amount credited to the IPF Account shall remain at the disposal of the respective Charitable Hospital and that amount shall be utilized only for providing medical treatment to the indigent and weaker section patients as provided herein after. 8. The Charitable Hospitals shall provide following non-billable services free to the indigent patients as well as weaker section patients:- (a) Bed (b) RMO Services (c) Nursing Care (d) Food (if provided by the hospital) (e) Linen (f) Water (g) Electricity and (h) Routine Diagnostics as required for treatment of general specialties. (i) House Keeping services. 9. In case of indigent patients, the Charitable Hospitals shall provide medical examination and treatment in its each department totally free of cost. The indigent patient's bill of billable services shall be prepared at the rates applicable to the lowest class of the respective hospital. The medicines, consumables and implants are to be charged at the purchase price to the hospital. If Doctors forego their charges, then the same shall not be included in the final bill of the indigent patients. The bill so prepared shall be debited to IPF Account. The Charitable Hospitals shall not ask for any deposit in case of admission of indigent patients. 11. If Doctors forego their charges, then the same shall not be included in the final bill of the indigent patients. The bill so prepared shall be debited to IPF Account. The Charitable Hospitals shall not ask for any deposit in case of admission of indigent patients. 11. The Charitable Hospitals shall physically transfer 2% of the total patients' billing (excluding the bill of indigent and weaker section patients) in each month to IPF Account. The amount available in the IPF Account shall be spent to provide medical treatment to maximum number of indigent and weaker section patients. In case of surplus or shortfall in the IPF Account of the month, the same shall get adjusted in the subsequent months. In case there is imbalance in the credit of the IPF Account and the expenditure incurred in the treatment of indigent and weaker section patients for more than six months, such Charitable Hospital may bring this aspect to the notice of the Monitoring Committee who may issue appropriate directives to the concerned hospital. 14. The Charitable Hospitals shall admit indigent or weaker section patients coming to their hospitals from any source or through Government Hospitals, Municipal Hospitals, etc. The procedure for admission of patients shall be as provided in subsequent clauses. 15. The Charitable Hospitals shall admit indigent patients to the extent of 10% of their operational beds/average occupancy for medical examination and treatment. So also, the Charitable Hospitals shall admit weaker section patients to the extent of 10% of their operational beds/average occupancy for medical examination and treatment coming to their hospitals from the sources referred to in clause 14. The Charitable Hospitals shall verify the economic status of the patients from their Medical Social Worker on the basis of scrutiny of any one of the following documents produced by the concerned patients: (I) Certificate from Tahsildar; (ii) Ration Card/Below Poverty Line Card. 18. In case of the breach of the Scheme and/or the terms and conditions of Section 41AA by any Charitable Hospitals, besides the penal action as is provided under Section 66 of the B.P.T. Act, the Charity Commissioner shall make report to the State Government recommending withdrawal of the exemption granted to the concerned hospitals during the next preceding year in payment of contribution towards P.T.A. Fund and the amount of contribution towards P.T.A. Fund be recovered from the said hospital. The Charity Commissioner may also request the Government to withdraw any other concessions/benefits given to the said hospital. 19. The Charitable Hospitals which face individual difficulties in meeting objectives/obligations under this Scheme shall be at liberty to apply to the Charity Commissioner with all supporting documents who may consider suitable modifications, if a case for relief is made out. 3. Section 41AA of the said Act reads as under: 41AA. Power of Charity Commissioner and State Government to issue directions in respect of hospitals, etc. 3. Section 41AA of the said Act reads as under: 41AA. Power of Charity Commissioner and State Government to issue directions in respect of hospitals, etc. to earmark certain beds etc., for poorer patients to be treated free of charge or at concenssional rates:- (i) Notwithstanding anything contained in any law for the time being in force or in any instrucment of trust or in any contract or in any judgment, decree or order of any Court, Tribunal, Charity Commissioner or other competent authority, in the case of any State aided public trust, whose annual expenditure exceeds five lakhs of rupees, or such other limit as the State Government may, from time to time, by notification in the Official Gazette, specify, with a view to making essential medical facilities available to the poorer classes of the people, either free of charge or at concessional rates, it shall be lawful for the Charity Commissioner, subject to such general or special order as the State Government may, from time to time, issue in this behalf, to issue all or any of the following directions to the trustees of, or persons connected with, any such trust, which maintains a hospital (including any nursing home or maternity home), dispensary or any other centre for medical relief (hereinafter in this section referred to as “ the medical centre”) namely:- (a) Having regard to the accommodation and facilities available to keep admission to the medical centre open to any person without any discrimination on the ground of religion, race, caste, sex, place of birth, language or any of them; Provided that, where a medical centre is exclusively for females, treatment for any males at such centre shall not be insisted upon; (b) to reserve and earmark ten per cent of the total number of operational beds and ten per cent of the total capacity of patients treated at such medical centre, for medical examination and treatment in each department of the medical patients seeking admission or treatment, who shall be medically examined and treated and admitted, as the case may be, free of charge; (c) to reserve and earmark ten per cent of the total number of operational beds and ten per cent of the total capacity of patients treated at such medical centre, for medical examination and treatment in each department of the medical patients seeking admission or treatment, who shall be medically examined and treated and admitted, as the case may be, free of charge. (d) to comply with such other incidental or supplemental requirements as may be specified in the directions or in any general or special order issued thereunder: Provided that while issuing any directions as aforesaid the Charity Commissioner shall take into consideration such facilities as are already made available by any such medical centre and having regard to the availability of such facilities may give appropriate directions if any, consistent with and subject to the percentage specified in clauses (b) and (c). (2) (a) It shall be lawful for the officer duly authorised by the State Government in this behalf, or for the Charity Commissioner by himself or through his representative duly authorised by him in this behalf, to verify implementation of the directions given under sub-section (1) to any medical centre, and for that purpose, visit, inspect and call for information and returns periodically or otherwise. (b) It shall be the duty of every trustee of, or person connected with, such medical centre to comply with the directions issued under sub-section (1) and to afford all reasonable facilities and assistance required by the said officer or the Charity Commissioner or his representative for verification of the implementation of such directions under clause (a) and to comply with the requirements thereunder. (c) In case there arises any dispute relating to the interpretation, implementation or any matter whatsoever in respect of any direction issued under sub-section (1), it shall be referred to the State Government, through the Charity Commissioner, for appropriate directions. (3) Nothing in sub-sections (1) and (2) shall prejudicially affect any medical facilities of whatever nature which any such State-aided public trust has provided by virtue of any condition subject to which any grant, exemption, concession, etc. referred to in clause (a) of sub-section (4) has been granted or received by it or otherwise and such medical facilities which are in operation on the date of commencement of the Bombay Public Trusts (Amendment) Act, 1984 (Mah. VIII of 1985), shall continue as before if they exceed the percentage of reserved and earmarked category. referred to in clause (a) of sub-section (4) has been granted or received by it or otherwise and such medical facilities which are in operation on the date of commencement of the Bombay Public Trusts (Amendment) Act, 1984 (Mah. VIII of 1985), shall continue as before if they exceed the percentage of reserved and earmarked category. (4) For the purposes of this section (a) “State-aided public trust” means a public trust exclusively for medical relief or for medical relief and other charitable purposes, which maintains a hospital (including any nursing home or maternity homes), dispensary or any other centre for medical relief, and which - (i) has received any grant of land or building, either on ownership basis or on lease or leave and licence, at a nominal or concessional rate, from the State Government or the Central Government or any local authority; or (ii) has been given by the State Government any exemption or permission to continue to hold any vacant land under section 20 or 21 of the Urban Land (Ceiling and Regulation) Act, 1976, (XXXIII of 1976); of (iii) has been given any concessions or exemption or relaxation of a substantial nature from the Development Control Rules by any competent authority for the purposes of the trust; or (iv) has received any loan or guarantee or any non-recurring grant-in-aid or other financial assistance or is receiving any recurring grant-in-aid or other financial assistance from the State Government, the Central Government or any local authority; (b) “indigent person” means a person whose total annual income does not exceed three thousand and six hundred rupees or such other limit as the State Government may, from time to time, by notification in the Official Gazette, specify; (c) “person belonging to the weaker sections of the people” means a person who is not an indigent person, but whose income does not exceed fifteen thousand rupees per annum or such other limit as the State Government may, from time to time, by notification in the Official Gazette, specify; (d) it shall be the duty of the governing body (by whatsoever name called) of every medical centre to get the category of a patient duly verified and recorded in a register kept for the purpose in the prescribed form before he is admitted or treated as a patient within the reserved fund earmarked percentage under sub-section (1). If there is any dispute as to the category of a patient, it shall be referred to the State Government, through the Charity Commissioner, for appropriate direction. (5) Notwithstanding anything contained in the foregoing provisions of this section, any person, who desires to undergo an operation for sterilization or an intraocular operation or who desires to undergo any operation or medical treatment specified by the State Government in this behalf, shall not be entitled, and shall not be allowed, to seek admission in any hospital or other medical centre in the reserved or earmarked quota provided under this section. 4. It is the case of the petitioner that pursuant to approval of the said Scheme by this Court, petitioner also created IPF and offered free treatment to the economically backward patients. The petitioner accumulated balance amount of Rs.26.5 lacs in its IPF which is lying unutilized. It is the case of the petitioner that in last six years, only 14 indigent patients sought admission in the petitioner hospital. 5. According to the petitioner, due to less number of admission by indigent patients, the accumulated balance of Rs.26.5 lacs was not fully utilized on treatment of such indigent patients. The petitioner sought to replace the medical equipments which are being used for the purposes of providing free/low cost services to all patients including economically backward patients to enable the petitioner to continue providing the free services. It is the case of the petitioner that petitioner is faced with financial crunch and is unable to replace the said machines as the cost of replacement of such machines would be in crores. It is the case of the petitioner that in addition to cost of replacement of the equipments and machinery, the petitioner also required to incur expenses of about Rs.21 lacs per month in running the hospital. The petitioner, accordingly made an application on 12th March 2012 to the Charity Commissioner for suitable modification of the Scheme by invoking Clause 19 of the Scheme and sought permission to use the said IPF amount for replacing the old dialysis machine and x-machine by new machines which would be used for treatment of economically backward patients. The petitioner, accordingly made an application on 12th March 2012 to the Charity Commissioner for suitable modification of the Scheme by invoking Clause 19 of the Scheme and sought permission to use the said IPF amount for replacing the old dialysis machine and x-machine by new machines which would be used for treatment of economically backward patients. The Monitoring Committee, in its meeting held on 30th April 2012 rejected the said application made by the petitioner on the ground that under Clause 7 of the Scheme approved by this Court, the IPF could be used only for 'treatment' of indigent patients. 6. Being aggrieved by the said decision of the Monitoring Committee, the petitioner has impugned the said decision by filing this petition. 7. The learned counsel appearing for the petitioner submits that there is no specific provision in the said Scheme to deal with this type of peculiar situation. Though the amount in IPF is accumulated and there are no such patients coming forward for free treatment under the said Scheme approved by this Court, the petitioner hospital, petitioner who is unable to replace the equipments and machines due to economical crunch, is not allowed to use the unutilized amounts in IPF for the purposes of medical equipments, which would be ultimately used for providing services to indigent patients. The learned counsel submits that the impugned order has been passed by the Monitoring Committee without rendering any hearing to the petitioner and without recording any reasons and has disposed of the said application mechanically. The learned counsel submits that the permission sought by the petitioner for utilizing the amount in IPF for the purposes of replacing equipments and machines, was for the purposes of its use for treatment of indigent patients and the same was in harmony with the object and purpose of the said Scheme. The petitioner is ready to undertake that if they are allowed to use the said accumulated IPF to replace the dialysis machine and x-ray machines, no indigent patient shall be refused by the hospital on the ground of lack of funds and the indigent patients shall not be charged for the use of such machines. It is submitted that the impugned decision of the Monitoring Committee is in ignorance of the provisions of clause 19 of the Scheme approved by this Court and is contrary to the object and purpose of the Scheme. It is submitted that the impugned decision of the Monitoring Committee is in ignorance of the provisions of clause 19 of the Scheme approved by this Court and is contrary to the object and purpose of the Scheme. It is submitted that there was no complaint by any party against the petitioner for non compliance of the said Scheme. 8. The learned A.G.P supports the rejection of application by the Monitoring Committee. Perusal of Section 41AA of the said Act indicates that with a view of making essential medical facility available to the poorer classes of the people either free of charge or at concessional rate, the Charity Commissioner, subject to general and special order of the State Government, is empowered to issue directions to the trusts or persons connected with any said trusts, whose annual expenditure exceeds Rs.5 lacs, having regard to the recommendations and facilities available to reserve and total number of essential beds and 10% of total capacity of patients to be treated at such medical center free of charge, to reserve and/or total number of reserved bed for weaker sections of people seeking medical examination and treatment to be charged according to said rates as the Government may by general or special order determine. Section 41AA(ii) obligates the duty of every trustee or person connected with such medical centre to comply with directions issued by the Charity Commissioner under Section 41AA(i) and to offer all reasonable facilities and assistance required by the said officer or the Charity Commissioner. Section 41AA (iv)(b) defines 'indigent person'. Section 41AA (iii)(c) defines 'person belonging to weaker section'. 9. The expert Committee in its Report suggested that the Charitable Hospital shall provide various non-billable services free to the indigent patients as well as weaker section patients. It was also recommended that Charitable Hospitals shall admit indigent patients to the extent of 10% of their operational beds/average occupancy for medical examination and treatment and shall also admit weaker section patients to the extent of 10% of their operational beds/average occupancy for medical examination and treatment. This Court, in the Scheme approved vide order dated 17th August 2006, directed each Public Charitable Hospital to create a separate fund 'Indigent Patient Fund' and directed to credit 2% of gross billing of all patients (other than indigent and weaker section patients) to such fund. This Court, in the Scheme approved vide order dated 17th August 2006, directed each Public Charitable Hospital to create a separate fund 'Indigent Patient Fund' and directed to credit 2% of gross billing of all patients (other than indigent and weaker section patients) to such fund. The Charitable Hospitals have been directed to physically transfer 2% of the total patients' billing excluding the bill of indigent and weaker section patients in each month to IPF Account. It is categorically provided that the amount available in the IPF Account shall be spent to provide medical treatment to maximum number of indigent and weaker section patients and in case of surplus or shortfall in the IPF Account of the month, the same shall get adjusted in the subsequent months. It is further provided that in case there is in balance in the credit of the IPF Account and the expenditure incurred in the treatment of indigent and weaker section patients for more than six months, such Charitable Hospital may bring this aspect to the notice of the Monitoring Committee who may issue appropriate directives to the concerned hospital. Clause 19 granted liberty to the Charitable Hospitals in case of any individual difficulties in meeting objectives/obligations to apply to the Charity Commissioner with all supporting documents who may consider suitable modifications if case for relief is made out. Clause 7 of the Scheme categorically provides that the amounts credited to the IPF Account shall remain at the disposal of the respective Charitable Hospital and that amount shall be utilized only for providing medical treatment to the indigent and weaker section patients as provided in the said scheme. Clause 8 provides for various non billable services free to the indigent patients as well as weaker section patients. Clause 11 provides for transfer of 2% of the total patients' billing excluding the bill of indigent and weaker section patients in each month to IPF Account which shall be spent to provide medical treatment to maximum number of indigent and weaker section patients. Clause 18 provides for action to be taken by the Charity Commissioner under the provisions of Section 66 of the B.P.T. Act in case of breach of the Scheme and/or the terms and conditions of Section 41AA of the said Act. Clause 18 provides for action to be taken by the Charity Commissioner under the provisions of Section 66 of the B.P.T. Act in case of breach of the Scheme and/or the terms and conditions of Section 41AA of the said Act. Clause-14 of the Scheme categorically provides that the human service for which they came into existence, each time they provide treatment and health services to the indigent and weaker section patients. 10. From the perusal of the Scheme approved by this Court, it is clear that various benefits/exemptions which are granted to a Public Charitable Trust, are subject to certain obligations and duties cast on such trusts set out in Section 41AA of the Act. In the approved Scheme, it was made clear that trusts would deduct 2% from the total patients' bills excluding bills of indigent patients and weaker section patients, which shall be utilized only for providing medical treatment to the indigent and weaker section patients as provided therein. This Court directed the Charitable Hospitals to provide non-billable services free as set out in Clause 8 of the Scheme. 11. In our view, the amount deducted from the bills of the patients of the petitioner and earmarked for the purposes of utilizing for providing medical treatment to indigent patients and weaker section patients and for the non-billable services free as set out in Clause 8 of the said Scheme, cannot be utilized for any other purposes other than for providing medical treatment to the indigent patients and weaker section patients and for non-billable free services. If the application of the petitioner is allowed, the same would be in violation of the purpose and object of Section 41AA and the Scheme approved by this Court. The petitioner had deducted the amount from the total patients' bills (excluding indigent and weaker section patients) and credited the same to the IPF Account for a specific purpose which, in our view, cannot be diluted to or violated. The amounts which are deducted from the bills of the patients have to be utilized for the services to be provided free to the indigent patients and weaker section patients. In our view, the petitioner cannot be allowed to use the said fund for the purposes of purchasing machineries and equipments. The amounts which are deducted from the bills of the patients have to be utilized for the services to be provided free to the indigent patients and weaker section patients. In our view, the petitioner cannot be allowed to use the said fund for the purposes of purchasing machineries and equipments. It is not in dispute that petitioner has been admitting patients other than the indigent patients and weaker section patients and the machineries and equipments of the petitioner were being used also for such treatments which are permitted under the Scheme. In our view, the impugned order passed by the Monitoring Committee is right and is in conformity with the purpose and object of the Scheme framed by this Court and also in compliance to Section 41AA and no infirmity can be found with the impugned decision taken by the Monitoring Committee. Petitioner cannot be allowed to be deviated from the purpose of the approved Scheme and the provisions of Section 41AA. We do not find any merits in the submissions of the petitioner and therefore pass the following order. 12. Writ Petition is dismissed. No order as to costs.