1. The petitioner while working as Senior X-Ray Technician, Govt. Medical College, Jammu applied to respondent No.4 for leave for a period of five days with permission to leave the Station, w.e.f., 11.05.2007 to 15.05.2007 in order to attend one of his relatives at Jallandhar, who was hospitalized there. Leave was, accordingly, sanctioned for the said period. While the petitioner was attending the patient at Jallandhar, he himself suddenly fell ill on 14.05.2007 and was admitted in Pruthi Hospital Lajpat Nagar, Jallandhar, a premier Heart Surgery Center. The petitioner was diagnosed as HT, Coronary Artery Disease and he had to undergo Coronary Angiography (CAG) and Coronary Angioplasty (PTCA) on 14.05.2007. He was discharged on 17.05.2007. This fact is evident from the certificate dated 17.05.2007 issued by Dr. Rohit Modi Consultant Cardiology and Interventionist, Pruthi Hospital Jallandhar. During treatment, the petitioner had to incur medical expenses to the tune of Rs.2,25,000/-. The petitioner joined his duties only on 01.06.2007, after which respondent No.4, under whom the petitioner was working, addressed a communication to the Medical Superintendent C.D. Hospital, Jammu for settling the period of absence on medical leave, i.e., from 16.05.2007 to 31.05.2007, so that the claims towards the medical allowances could be reimbursed to the petitioner. 2. On receipt of communication, the Administrative Department vide letter dated 15.02.2008 asked respondent No.2 to furnish a certificate from the Director Health Services, Jammu to the effect that (i) the beneficiary had suddenly fell ill outside the State and was not already suffering from it before departure from home; and (ii) copy of order whereunder the petitioner was allowed to leave the station. 3. Despite the fact that post-facto leave stood sanctioned in favour of the petitioner from 16.05.2007 to 31.05.2007, treating the petitioner on medical leave and completing all the requisite formalities by the petitioner, the respondents herein did not settle his case for medical reimbursement. 4. Aggrieved, the petitioner filed a writ petition bearing SWP No. 392/2008, which came to be finally disposed of vide order dated 09.08.2010 with a direction to the Director Health Services, Jammu to record his findings regarding sudden illness of the petitioner while he was temporarily outside the State within two months and, in case such certificate is issued, the respondents were directed to release medical reimbursement claim of the petitioner within two months thereafter.
When the respondents failed to release the medical reimbursement claim of the petitioner, he was compelled to file a contempt petition bearing COA (OW) No. 357/2010. 5. During the pendency of the Contempt Petition, respondent No.2 issued impugned Order No. AHJ of 2011 dated 28.03.2011 rejecting the medical claim of the petitioner on the ground that under Sub Rule 5 of Rule 6 of J&K Civil Services (Medical Attendance and Allowances) Rules, 1990 (hereinafter, for short, Rules of 1990), Director Health Services had to specifically certify that the beneficiary suddenly fell ill while outside the State, but, the certificate so issued by the Director Health Services was not as per the aforesaid requirement. It is this order, which is called in question in the present writ petition on the grounds taken in the petition. 6. On notice, respondent No.2 filed objections. It would be profitable to reproduce paragraphs No. 2 to 5 of the reply hereunder:- 2. That in reply to paras 2,3 and 4 of the petition, it is submitted that the petitioner was working as Sr. X-Ray Technician and has filed a writ petition bearing SWP No. 392/08 titled Popinder Singh v. State before this Hon'ble Court for seeking reimbursement of Medical Expenditure for the treatment which the petitioner has taken at Pruthi Hospital Lajpat Nagar, Jalander. The Hon'ble Court has issued interim direction to the respondents to consider the claim of the petitioner on the touchstone of the rules governing the field. Further, it is stated that the matter was taken up by the respondent No.1 vide No. ME/Leg/NG/29/2010 dated 09.07.2010, it rejected the claim of the petitioner as not being covered under the rules 6(5) of J&K Medical Attendance and Allowance Rules, 1990. 5- That in reply to paras-5 to 19, it is stated that the said writ petition No.392/08 came to be disposed off vide order dated 09.08.2010 wherein the Hon'ble Court had directed the Director Health Services to record his findings regarding sudden illness of the petitioner while he was temporarily out of State within a period of two months and in case such certificate is issued then the respondents were again directed to release Medical reimbursement in favour of the petitioner within another two months thereafter.
In compliance to the direction of the Hon'ble Court, the Director Health Services considered the case of the petitioner and gave its findings vide his communication No. dated 25.09.2010 which is reproduced here as under :- "That the treatment received by the petitioner is genuine so far as his well being before his departure from his home town is concerned, it is submitted that this office cannot certify that the beneficiary has suddenly fallen ill out side the state and was not already suffering from it before departures from home town as he has past history of multiple diseases and is known case of RH disease since 1998 with hypertension and type II DM as evidence from case history of petitioner given by Pruthi Hospital Lajpat Nagar, Jallandar." On the bass of these findings of the Director Health Services, the claim of the petitioner was again re-considered in view of the Medical Attendance and Allowances Rules, 1990 and vide order dated 28.03.2011, his claim was again rejected having been not covered under the said rules. 7. I have heard learned counsel for the parties and perused the record. 8. The controversy whether the petitioner before admitting to Pruthi Hospital, Jallandhar was already suffering from the disease for which he was treated in the aforesaid Hospital, has already been settled by this Court in SWP No. 392/2008, wherein it has been held as under :- "While analyzing the stand of the respondents that the petitioner suffered disease prior to the date he was admitted in the hospital at Jallahdar, reliance has been placed on the case history/discharge certificate issued by the Pruthi Hospital Lajpat Nagar, Jallandhar where the patient was treated. The said certificate discloses that the patient's case is of hypertension and many other diseases indicated therein. This certificate does not indicate that the petitioner was already suffering from the disease prior to his admission. It only certified that on clinical examination of the petitioner, he was found to be suffering from above said disease. It cannot be assumed that the petitioner was aware that he was suffering from such diseases. The certificate does not indicate that he was aware of the disease, which was diagnosed by the Hospital at Jallandhar. The respondents have not placed anything on record to indicate that prior to 14.05.2007, the petitioner was already suffering from this disease.
It cannot be assumed that the petitioner was aware that he was suffering from such diseases. The certificate does not indicate that he was aware of the disease, which was diagnosed by the Hospital at Jallandhar. The respondents have not placed anything on record to indicate that prior to 14.05.2007, the petitioner was already suffering from this disease. One cannot say that the disease diagnosed by the hospital at Jallandhar was in the knowledge of the petitioner, as such I do not accept the contention of the respondents." 9. It be noted that this Court in clear and unambiguous terms has already rejected the contention of the respondents that the petitioner was suffering from the disease prior to the date he was admitted in the Hospital at Jallandhar. Therefore, in view of this observation of the Court, respondent No.2 at this stage cannot be allowed to say by the medium of impugned order dated 28.03.2011 that for want of certificate issued by the Director Health Services, certifying that the petitioner suffered the disease while he was temporarily outside the State, medical reimbursement claim of the petitioner could not be accepted. The petitioner was outside the State on authorized leave when he suddenly fell ill and in order to save his life he had every right to take whatever possible treatment outside. Moreso, the disease, which was diagnosed, was not earlier detected and there was nothing on the record to suggest that the petitioner had ever any history of the same disease (i.e. HT, Coronary Artery Disease). Therefore, it can safely be said that the said disease was sudden, therefore, the petitioner was not in a position to take prior permission either from the Administrative Department or Principal Govt. Medical College, Jammu. 10. It is stated that exception to Sub Rules 5 of Rule 6 of Rules of 1990, envisages that in case of emergency, the person who is temporarily residing outside the State and suddenly falls ill, will be entitled to medical expenses incurred by him for such treatment, provided it is recommended by the Director Health Services that the petitioner suddenly fell ill outside the State and was not already suffering from the disease before departure from his home town.
Therefore, it was for the Director Health Services to take a clear stand whether the petitioner was suffering from the disease before he left the State or he suddenly fell ill outside the State. If the Director has shown his inability to issue such certificate after examining/verifying the facts, the petitioner herein cannot be made to suffer for the same. The Director Health Services in terms of the rules governing the field was required to issue such certificate, which he failed to do so. Therefore, the certificate of Director Health Services in terms of exception to Sub Rules 5 of Rule 6 of Rules of 1990 though is vague, yet can be relied upon for coming to the conclusion that the petitioner at the time he left the State was not aware of the ailment, which he suddenly developed out side the State and in view of the ailment, was to be treated emergently. 11. Further, it appears that the Medical Reimbursement Verification Committee after going through the medical reimbursement claim had observed that the treatment received by the patient was genuine, therefore, the amount be reimbursed after obtaining post-facto permission from the Administrative Department. Therefore, the contention of the respondents that the Director Health Services had to specifically certify that the beneficiary suddenly fell ill outside the State is not well founded. 12. It is not in dispute nor the same has been brought on record by the respondents that the petitioner was suffering from the ailment at the time he left the State, or was hospitalised in the State of J&K and was taking regular treatment before he left the State on account of attending his relatives, who was undergoing treatment at Jallandhar, as claimed by the petitioner. It is also not in dispute that the petitioner was treated for his coronary artery disease and had undergone angiography (CAG) in Pruthi Hospital, Jallandhar. 13. In view of these circumstances, it cannot be said that the petitioner was aware of his ailment and had gone to Jallandhar for treatment without availing the same in the State of Jammu and Kashmir. The certificate issued by the Director Health Services, Jammu has to be read in this context. The petitioner has, therefore, successfully brought his case within exception to Sub Rule 5 of Rule 6 of Rules of 1990, therefore, is entitled to the reimbursement of medical claim. 14.
The certificate issued by the Director Health Services, Jammu has to be read in this context. The petitioner has, therefore, successfully brought his case within exception to Sub Rule 5 of Rule 6 of Rules of 1990, therefore, is entitled to the reimbursement of medical claim. 14. In view of what has been stated hereinabove, I allow this petition. Order impugned No.20-AHJ of 2011 dated 28.03.2011 is quashed. Respondents are directed to reimburse the amount of Rs.2,25,000/- along with interest @ Rs.6% p.a. from 2008 to the petitioner. 15. Disposed of as above along with connected CMA(s).