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2014 DIGILAW 36 (MAN)

Ningthoujam Kiranjit Singh v. State of Manipur

2014-04-07

N.KOTISWAR SINGH

body2014
JUDGMENT N. Kotiswar Singh, J. Heard Mr. Ashinikumar, learned counsel for the petitioner and also Mr. A. Vasum, learned GA appearing for the State respondents. The present writ petition has been filed by the petitioner seeking for a direction to the respondents for reimbursement for a sum of Rs. 2,46,462/- which was claimed to have been incurred for treatment of the petitioner's father at a private hospital, which the authorities refused on the ground the private hospital was not licensed to give the particular treatment received by him. 2. According to the petitioner, the petitioner's father namely, Ningthoujam Thoiba Singh, collapsed in his house at around 1.30 p.m. on 2.5.2010 and he was immediately rushed to the Regional Institute of Medical Sciences (RIMS), a government hospital. He was admitted to the intensive care unit and doctor informed that the petitioner's father had suffered heart attack, which in medical terminology is known as Complete Heart Block (CHB), and was advised temporary pace maker implantation. Accordingly, he was taken to the operation theatre for necessary operation. However, it was found that the Image Intensifier which was required for the operation was found to be not functional. Accordingly, the doctor referred the petitioner's father to a centre where the said facility was available. The RIMS authority accordingly issued the discharge slip on the same day. In the said discharge slip the ailments from which the petitioner's father was suffering were mentioned. It was stated that he was suffering from Complete Heart Block and other related ailments and was discharged on request as the Image Intensifier in the RIMS was not working and referred to a centre where the facility is available. According to the petitioner, after discharge of the petitioner's father, they proceeded to the Jawaharlal Nehru Institute of Medical Sciences (JNIMS) Porompat, another government hospital, for the operation and further treatment. However, he was informed by the JNIMS authority that the facility for implantation of Pace Maker was not available. Accordingly, as there was no other option, the petitioner got his father admitted in the Shija Hospitals and Research Institute, Langol. He was admitted there at about 7 p.m. of 2.5.2010 where he was examined and was diagnosed. As per the diagnosis in the said hospital, the petitioner's father was found to be suffering from ailment of Complete Heart Block (CHB) including dilated LV, Severe systolic function, mild AR, MR. He was admitted there at about 7 p.m. of 2.5.2010 where he was examined and was diagnosed. As per the diagnosis in the said hospital, the petitioner's father was found to be suffering from ailment of Complete Heart Block (CHB) including dilated LV, Severe systolic function, mild AR, MR. with Type-2 diabetes mellitus with hypertension. Accordingly, as per the medical advice, the petitioner's father was operated on the same day for temporary Pace Maker implantation. Thereafter, a major operation was conducted on 4.5.2010 for permanent Pace Maker Implantation after obtaining the Pace Maker from Kolkata at a cost of Rs. 1,55,000/-. After successfully undergoing temporary and permanent Pace Maker Implantations on 2.5.2010 and 4.5.2010 respectively the petitioner's father was discharged from the Shija Hospitals and Research Institute, Langol on 18.5.2010 and in the process, petitioner claims to have incurred an expenditure of Rs. 2,41,462/- for the treatment of his father. 3. As the petitioner was entitled to be reimbursed for the medical expenses, the petitioner submitted an application to the Commandant, 1st BN Manipur Rifles, Imphal on 2.6.2010 for grant of ex post facto approval for the treatment for reimbursement by submitting necessary documents and the Commandant, 1st BN Manipur Rifles, in turn requested the Inspector General (Adm) Manipur, for obtaining ex-post facto approval from the concerned authority. Accordingly, the Inspector General of Police (Adm), Manipur requested the Director, Medical and Health Services, Manipur on 15.6.2010 for taking a decision by the State Medical Board for giving ex-post facto approval. However, the Director, Medical and Health Services, Manipur, vide letter dated 14.7.2010 informed the Inspector General of Police (Adm), Manipur, that the Medical Board did not grant ex-post facto approval for treatment of the petitioner's father who was suffering from CHB, dilated LV, severe systolic function, mild AR, MR. with Type-2 diabetes mellitus with hypertension as the Shija Hospitals and Research Institute was not recognized for treatment of such diseases. Being aggrieved by the decision of the authorities in not granting ex-post facto approval, the petitioner has filed the present writ petition. 4. The State respondents filed their affidavit in opposition on 17.12.2010 opposing the claim of the petitioner. with Type-2 diabetes mellitus with hypertension as the Shija Hospitals and Research Institute was not recognized for treatment of such diseases. Being aggrieved by the decision of the authorities in not granting ex-post facto approval, the petitioner has filed the present writ petition. 4. The State respondents filed their affidavit in opposition on 17.12.2010 opposing the claim of the petitioner. Though the factum of the petitioner's father's ailment was not disputed, nor the treatment received at the Shija Hospitals and Research Institute, Langol, it was contended that there is no separate cardiology and cardio-thoracic surgery unit at Shija Hospitals and Research Institute, Langol and no such unit has so far been registered under the Manipur Nursing Home & Clinic Registration Act, 1992 and as such, to carry out cardiac operation where such facilities are not available, is illegal and unethical on the part of the Shija Hospitals and Research Institute, Langol. Therefore, the State Medical Board did not grant ex-post facto sanction for treatment for the ailment as mentioned above. According to the State respondents, even though treatment of a patient at private hospital is relaxed in certain conditions like emergent cases, in the present case, as treatment of the patient was in private hospital where there is no facility for treatment of such cardiological cases, the State Medical Board declined to give any post-facto approval. 5. The petitioner filed a rejoinder affidavit in which it was stated that the petitioner came to know that the State respondents had sought for explanation from the Shija Hospitals and Research Institute, Langol, and the said hospital had explained that though the hospital was not granted registration for cardiological treatment by the Government of Manipur, the patient was admitted as an emergency case as the facilities of C-arm which is required for the Pacemaker implantation was not available in both RIMS Hospital and JN Hospital, Porompat as per information furnished by the patient's family. It was stated that the Shija Hospitals and Research Institute, Langol admitted the patient to save his life even though the hospital did not have any cardio thoracic surgeon and took permission from the RIMS authority to allow one Dr. Ksh. Kala Singh, a cardiac surgeon to render his expertise to save the life of the patient. Accordingly, it was stated by the Shija Hospitals and Research Institute, Langol that the patient was admitted and treated on humanitarian ground. Ksh. Kala Singh, a cardiac surgeon to render his expertise to save the life of the patient. Accordingly, it was stated by the Shija Hospitals and Research Institute, Langol that the patient was admitted and treated on humanitarian ground. 6. In the additional affidavit filed on behalf of the State respondents it was stated that the State Government had issued the Office Memorandum dated 26.3.2011 where it has been mentioned that the Government employee can claim full medical reimbursement within the ceiling limit of Rs. 20,000/- per annum for each employee. It is also stated that the State Government employee can claim medical reimbursement of 100% if the amount is within Rs. 20,000/- and if the amount is more than Rs. 20,000/- the claim of the medical reimbursement will be 50% only. As per an earlier Office Memorandum dated 5.8.2006, the ceiling limit was Rs. 25,000/-. In response to the additional affidavit of the State respondents, the petitioner filed an additional affidavit on 14.11.2013 by annexing a copy of another Office Memorandum dated 16.5.2011. The said Office Memorandum provides for full medical reimbursement in respect of certain ailments/diseases/specialized treatments mentioned in para 2 of the said Office Memorandum. At Sl. No. 2 of the said list, Cardio-Vascular Disease, is mentioned as one such ailment which includes the following treatments: 2. Cardio-Vascular Diseases- (a) Coronary Artery Diseases requiring: (i) Coronary Angiography, (ii) Coronary Angioplasty, (iii) By-Pass Surgery. (b) Valvular Heart Disease requiring valve replacement, (c) Constructive Pericarditis requiring pericardiectomy, (d) Any cardiac diseases requiring interventional procedure. It is further clarified in para 3 of the said Office Memorandum that in respect of ailments/diseases/specialized treatment, not covered in Para 2, the ceiling of Rs. 20,000/- per annum for each employee shall be applicable for full reimbursement of eligible claims. In respect of eligible claim beyond the ceiling of Rs. 20,000/-, the medical reimbursement will be 50% of the claim over and above the ceiling of Rs. 20,000/-. 7. The State respondents by filing an additional affidavit on 20.2.2014 have stated that even if the name of ailment/diseases had been identified for entitlement to full reimbursement, the petitioner is not entitled to the claim for reimbursement as the petitioner's father had received treatment from a hospital which was not licensed to give such treatment. 20,000/-. 7. The State respondents by filing an additional affidavit on 20.2.2014 have stated that even if the name of ailment/diseases had been identified for entitlement to full reimbursement, the petitioner is not entitled to the claim for reimbursement as the petitioner's father had received treatment from a hospital which was not licensed to give such treatment. It was stated that the real issue involved in the present writ petition is the question of recognition of the hospital in which the petitioner's father received treatment. It has been stated that the Shija Hospitals and Research Institute, Langol is not recognized as a referral hospital for cardiology till date and there is no such facility available in the said hospital for treatment of cardiology related ailments. Accordingly, it was stated that the said Memorandum dated 16.5.2013 relied by the petitioner is of no help to the petitioner as the said hospital is not recognized as a referral hospital for cardiology. 8. From the above pleadings, what is evident is that the fact that the petitioner's father had undergone treatment of temporary and permanent Pace Maker implantations on 2.5.2010 and 4.5.2010 respectively at Shija Hospitals and Research Institute, Langol, has not been disputed. The case of the petitioner is that the petitioner's father had to seek treatment at Shija Hospitals and Research Institute, Langol, as the RIMS hospital as well as the JN Hospital which are public hospitals could not give treatment to the petitioner's father due to lack of equipments and facilities and he had to ultimately seek treatment from Shija Hospitals and Research Institute, Langol where these were available. It was contended by the petitioner that considering the emergent situation, the Doctor in RIMS had advised for implantation of Pace Maker to save the life of the petitioner's father which was ultimately performed in the Shija Hospital and Research Institute, Langol Hospitals. The only objection of the respondent authority is that in view of the fact the hospital where the treatment was obtained is a private hospital, which is not recognized by the competent authority for giving treatment relating to cardiology, the petitioner is not entitled to claim medical reimbursement. Therefore, the issue which has arisen before this Court for consideration is whether the petitioner is entitled to medical reimbursement for obtaining medical treatment from a private hospital which was not authorized to render treatment in cardiology. 9. Therefore, the issue which has arisen before this Court for consideration is whether the petitioner is entitled to medical reimbursement for obtaining medical treatment from a private hospital which was not authorized to render treatment in cardiology. 9. As we proceed to examine the issue, it may be pertinent to note certain facts about the said Shija Hospitals and Research Institute. The said Shija Hospitals and Research Institute, had been authorized to carry on treatment of outpatients and in-patients of General Surgery, Medicine, Paediatrics, Obstetrics, Gynaecology, ENT, Ophthalmology, Orthopaedics, Plastic surgery, Neurosurgery, Surgical-gastroenterology, Urology, Neurology, Anaesthesiology, with facilities for conducting surgical procedures related to these specialties only, and pathological and radiological investigations as per the registration certificate issued on 29.10.2007 under Section 5 of the Manipur Nursing Homes and Clinics Registration Act, 1992. The said hospital is recognized by the State Government as an approved referral institute/hospital as per Government order dated 26.08.2006 for the purpose of medical treatment of government employees and family members for investigations and treatment relating to neurological surgery and other ailments for which proper and suitable facilities are not available in the government hospital in Imphal. In the said Government order it has been also provided that treatment should be undertaken on a reference by the State Medical Board and the State Medical Board should identify emergent cases where ex-post facto approval of the State Medical Board may be allowed. Thus, the said Shija Hospitals and Research Institute, Langol, is already an approved referral hospital for Neurological surgeries and other ailments for which proper and suitable facilities are not available in the Government Hospitals in Imphal. 10. Therefore, as we go through the pleadings and consider the contentions raised, the issue seems to be confined as to whether the Shija Hospital and Research Institute, Langol, though was recognised/approved by the State Government as a referral hospital for treatment of neurology and other ailments, but was not licensed by the competent authority for giving treatment relating to cardiology, can give treatment to the petitioner's father for cardiology related ailments and whether, petitioner can get reimbursement for such treatment received from such a hospital. It is to be noted that even if the State Government had vehemently objected to the claim for medical reimbursement on the ground that the said hospital was not recognized for giving treatment in cardiological ailments, nowhere it has been mentioned by the State authority of any other hospital which could give the said treatment to the petitioner's father, which the petitioner's father did not avail of. It is also not the case of the State respondents that the ailment which the petitioner's father was suffering from was not an emergency case and could have been referred to other hospitals recognized by the authority outside the State for treatment. The other two private hospitals which are located outside Manipur State, which are approved Institutes/Hospitals for treatment of State Government employees and their families as per the Government order dated 26.8.2006 are (1) Sitaram Ram Bhartia Institute of Sciences & Research, New Delhi and (2) Max Health Care, New Delhi. 11. The specific case of the State respondents is that no medical reimbursement is permissible for getting treatment from the Shija Hospital, as it did not have the permission/license to provide treatment in cardiology related ailments. The State Government by saying so, seems to suggest that the petitioner's father ought to have obtained treatment from either of the two hospitals located in New Delhi, in which case, the claim of medical reimbursement would have been entertainable as there was no other government hospital in Manipur at that time which could render such medical service to the petitioner's father. Though, this approach of the State respondents seems to be in accordance with the Rules and procedures, it ignores the practicability. Because of emergency involved, it was perhaps not possible for the petitioner's father to go outside Manipur to get the required treatment. Further, it would have also involved a very high cost for the transportation and treatment in Delhi. 12. It is a well known fact that the Government managed hospitals in the State of Manipur, either because of lack of machinery or Specialists or other facilities are sometimes not able to give the much needed emergency medical treatment. Further, it would have also involved a very high cost for the transportation and treatment in Delhi. 12. It is a well known fact that the Government managed hospitals in the State of Manipur, either because of lack of machinery or Specialists or other facilities are sometimes not able to give the much needed emergency medical treatment. In the present case it seems that the ailment which the petitioner's father was suffering from was an emergency case for which immediate implantation of Pace Maker was needed, which could not be treated by any government hospital, which is also not disputed by the State respondents. It is also not the case of the State respondents that there were other government hospitals in Manipur which would give treatment to the petitioner's father in respect of the ailments he was suffering from and that the petitioner consciously went on his own to the Shija Hospital by ignoring such Government hospitals. Since the authorities are not able to mention any alternative Institution or Hospital where the petitioner's father could get the required treatment, it will be unreasonable to deny the reimbursement merely on the ground that Shija Hospital was not licensed to give the cardiological treatment. 13. It may be stated that though it may be technically correct that Shija Hospital was not given the license or authorization by the competent authority for providing treatment and other medical service relating to cardiology, it cannot be denied that the Shija Hospital is an approved hospital where government has permitted treatment relating to neurological surgery and other ailments for which proper and suitable facilities are not available in the government hospitals in Imphal. In other words, Shija Hospital is one of the recognized and approved private hospitals by the State Government for treatment of other ailments for which suitable facilities are not available in the Government Hospitals. As such, it was competent to provide medical treatment, except for the fact that it was not licensed to do so in respect of cardiological ailments of which the petitioner was not apparently aware of. 14. Though Shija Hospital may not have been licensed to give the treatment to the petitioner's father in terms of the Rules, it is not the case of anybody that the said treatment was given without adequate medical facility. 14. Though Shija Hospital may not have been licensed to give the treatment to the petitioner's father in terms of the Rules, it is not the case of anybody that the said treatment was given without adequate medical facility. From the records it seems that the said hospital possessed all necessary facilities required for the treatment which was needed except for the lack of cardiac surgeon whose service was obtained from the RIMS after getting permission from the RIMS authority. In the end, the petitioner's father successfully received the required treatment from the Shija Hospital without any hitch and he has survived. It may be stated that whether the Shija Hospital was licensed to render medical service/treatment in respect of ailments relating to cardiological problems is an issue between the hospital authority and the competent authority in which the patient seeking treatment has no role to play. It is also not the case of the State respondents that the petitioner fully knowing that Shija Hospital was not competent to give the treatment in cardiology related ailments in absence of necessary certification from the competent authority had sought treatment from there. It may be also observed that even if the Shija Hospital had misrepresented to the petitioner that they were competent to render medical service sought for by the petitioner, the petitioner cannot be made to suffer for any misrepresentation on the part of the Shija Hospital. It has been also noted from the records that the State authorities have initiated certain proceedings against the Shija Hospital regarding the treatment rendered to the petitioner's father for the cardiological ailments without proper license and as such, it may not be proper for this Court to make any comment on the same which is yet to be decided by the competent authority. Nevertheless, this Court cannot help but appreciate the service rendered by the Shija Hospitals and Research Institute, in giving timely medical assistance to the petitioner's father who was in emergent need of treatment due to complete heart block and other ailments he was suffering from, which could have proved fatal if timely treatment was not provided. 15. Nevertheless, this Court cannot help but appreciate the service rendered by the Shija Hospitals and Research Institute, in giving timely medical assistance to the petitioner's father who was in emergent need of treatment due to complete heart block and other ailments he was suffering from, which could have proved fatal if timely treatment was not provided. 15. Therefore, in the facts and circumstances of the case as noted above, this Court is of the view that as the petitioner could not be faulted at all for having obtained the medical treatment from the Shija Hospitals & Research Institute under the emergent circumstance, and since no malafide or impropriety on the part of the petitioner could be attributed and since Shija Hospital is not a totally unapproved hospital, as mentioned above, where certain kind of ailments are allowed to be treated for which proper and suitable facilities are not available in Government hospitals, it will be highly unfair and unjust to deny the benefit of medical reimbursement to the petitioner, if the case of the petitioner is otherwise covered by the Rules. It is to be noted that the petitioner approached the Shija Hospital only after it was found that proper and adequate facilities were not available in Government hospitals in Imphal for treatment of the petitioner's father and after being referred by the doctor for getting treatment from any other hospital having the facilities. Considering the emergent nature of the case, it was not expected of the petitioner to verify from the competent authority or from the hospital as to whether Shija Hospital, which, otherwise, was authorized to provide medical treatment in respect of a large number of ailments, was also authorized to render treatment in respect of cardiological ailments. It is also a fact that the State Government is not able to state that there were other hospitals where proper and suitable facilities were available for treatment of the petitioner's father where he could have been treated. 16. This Court has observed that Government of Manipur had issued the Office Memorandum dated 16.5.2011 in which it has been provided that full reimbursement may be given in respect of those cardio vascular diseases requiring interventional procedure. It is well known that operation of Pace Maker implantation involves interventional procedure. 16. This Court has observed that Government of Manipur had issued the Office Memorandum dated 16.5.2011 in which it has been provided that full reimbursement may be given in respect of those cardio vascular diseases requiring interventional procedure. It is well known that operation of Pace Maker implantation involves interventional procedure. Therefore, this Court is of the view that the petitioner is entitled to reimbursement in terms of Office Memorandum dated 16.5.2011 read with Government order dated 26.8.2006, since the emergent nature of the operation and medical treatment have not been disputed by the respondent authorities and the fact that proper and adequate facilities were not available in any of the Government hospitals. 17. It may be observed that the purpose of notifying certain Government hospitals as approved referral hospital for treatment of Government servants is to ensure that the employees get treatment from recognized and tested hospitals and also to curve huge expenditures which are likely to be incurred in the event of getting treatment from private hospitals/institutions which normally charge higher fees in all respects than government hospitals. In appropriate cases, the various Hon'ble High Courts as well as the Supreme Court have permitted reimbursement of medical expenditure from private hospitals if these are found to be of emergent nature in order to save the lives of the patients. It has been held by the Supreme Court in a number of cases including in State of Punjab & Ors Vs Mohinder Singh Chawla & Ors: (1997) 2 SCC 83 and Surjit Singh Vs State of Punjab & Ors: (1996) 2 SCC 336 that right to health is integral to the right to life guaranteed under Article 21 of the Constitution of India and in that context had allowed medical reimbursement in respect of treatment obtained from private hospitals which are not recognized by the authorities if the treatments are of emergent nature. In the present case, even if the Shija Hospital might not have been licensed to render medical treatment relating to cardiological ailments, it is not shown that it did not possess the facility required for rendering the required medical treatment to the petitioner's father and it risked the life of a patient. On the contrary, proper treatment was given to the petitioner's father successfully. On the contrary, proper treatment was given to the petitioner's father successfully. As such, the decision of the petitioner to get his father treated from the said hospital in an emergent situation cannot be assailed and the right of the petitioner to get necessary reimbursement for the said treatment cannot be denied only on the technical ground that Shija Hospital was not licensed at the relevant time to provide such treatment. If the Hon'ble Supreme Court had allowed reimbursement of medical expenses incurred in getting treatment from unapproved private hospital because of the overwhelming Constitutional mandate to the State to provide proper and timely medical treatment, there is no reason why the similar principle cannot be applied in the present case, even if the Shija Hospital did not have the requisite permission/license from the concerned authority to render such treatment in cardiological illness, since the treatment was successfully provided on humanitarian ground and it was of emergent nature and the Shija Hospital had managed the technical requirements for providing such treatment while no other government hospital could provide it. The mandate of Article 21 in rendering timely and appropriate medical treatment would overshadow the procedural and technical requirement regarding lack of possession of permission/license by the Shija Hospital for rendering such treatment. Saving life was more important for anyone at that time than to verify whether the Shija Hospital had the requisite license or not. Accordingly, in the facts and circumstances of the case and for the reasons discussed above, this Court is of the view that petitioner is entitled to reimbursement of the expenses incurred for his father's treatment at Shija Hospitals and Research Institute, Langol. Accordingly, the petition is allowed. The respondent authorities are directed to examine the claim of the petitioner in terms of the Office Memorandum dated 16.5.2011 by referring to the State Medical Board for the purpose of grant of ex-post facto approval for the treatment received by the petitioner's father at the Shija Hospitals and Research Institute, in connection with the ailment of Complete Heart Block (CHB) and other ailments as mentioned above. The aforesaid exercise will be undertaken by the authorities within a period of two months from today and release the payment of the admissible claim amount to the petitioner after proper scrutiny of the claim to the petitioner within a period of two months thereafter, failing which, it will carry an interest @ 18% per annum for the delayed payment.