P. M Deendayal v. Vice-Chairman & Managing Director, APSRTC, Mushirabad, Hyderabad
2016-08-09
P.NAVEEN RAO
body2016
DigiLaw.ai
ORDER : P. NAVEEN RAO, J. Petitioner retired from service of respondent Corporation on attaining the age of superannuation on 31.05.2008 At the time of retirement, petitioner was an Assistant Manager (T), which is in the Supervisory cadre. The respondent Corporation introduced scheme called the APSRTC Retired Employees Medical Facilities Scheme, 2003 (Scheme). Petitioner enrolled into the said scheme for provision of medical facilities as specified therein to the retired officers. It appears, the daughter of the petitioner lives in Bangalore in the State of Karnataka. To spend time with his daughters family, petitioner travelled to Bangalore in 2nd week of March, 2010. While in Bangalore, petitioner developed cardiac problem and was admitted to hospital in Bangalore and he was operated on 01.04.2010 He was discharged from hospital on 07.04.2010 According to petitioner, he has incurred an expenditure of Rs. 2,83,019/- approximately towards said treatment. After recouping from the ailment, petitioner traveled back to his place. On 08.06.2010, petitioner submitted a representation seeking for reimbursement of the expenditure incurred by him. He has submitted a further representation on 21.06.2010 After waiting for considerable time, petitioner instituted this writ petition claiming for a direction to the respondents to reimburse the medical expenses incurred by him. 2. Heard learned counsel for the petitioner and learned Standing Counsel for the respondent Corporation. 3. Learned counsel for the petitioner submits that as per the Scheme, petitioner is entitled to seek reimbursement and even according to the scheme, no facilities are available for provision of treatment for heart surgery in the hospitals run by the Corporation and therefore, refusal to grant reimbursement is illegal. He further submits that corporation cannot insist petitioner to undergo treatment in the hospital of the Corporation or in private hospital only on a recommendation of the Superintendent. Learned counsel further submits that heart ailment requires urgent medical attention and surgical intervention and as the petitioner was in Bangalore, he could not travel down to Hyderabad for a reference by the Medical Superintendent to take treatment and to undergo surgery. Learned counsel further submits that having regard to the seriousness of ailment, reimbursement ought to have been granted and rejection to grant reimbursement on the ground that petitioner did not consult the Superintendent of the respondent Corporation Hospital and that his treatment in Bangalore was not preceded by a reference by the Superintendent of the respondent Corporation hospital is erroneous.
Learned counsel further submits that having regard to the seriousness of ailment, reimbursement ought to have been granted and rejection to grant reimbursement on the ground that petitioner did not consult the Superintendent of the respondent Corporation Hospital and that his treatment in Bangalore was not preceded by a reference by the Superintendent of the respondent Corporation hospital is erroneous. 3.1 He would contend that in emergency and when the life of person is involved, the person must be given the liberty/freedom to choose a hospital or a doctor of his choice for treatment as in medical field, confidence on the doctor/hospital is paramount. In support of said contention he placed reliance on the decision of the Division Bench of this Court in the case of T.V Rajagopala Rao v. Additional Director, Central Government Health Scheme (W.P No. 2572 of 2003 dated 04.04.2003). 4. Learned Standing Counsel for the respondent Corporation submits that since the petitioner has not fulfilled the condition imposed in the Scheme, he is not entitled to seek reimbursement. According to learned counsel, to claim reimbursement in accordance with Clause 5(ii) of the scheme, there must be reference by the Superintendent and CMO of Tarnaka Hospital and unless such a reference is made, no reimbursement can be granted. In the instant case, there was no reference and the petitioner on his own took treatment in a private hospital. He further submits that at any rate, petitioner is entitled to reimbursement to an extent of Rs. 1 lakh only for such ailment imposed in the scheme and the petitioner is bound by said limitation. 5. The point for consideration in this writ petition is whether the petitioner is entitled to seek reimbursement for the treatment undergone by him in Bangalore. 6. To appreciate the rival contentions, it is necessary to consider the scope of Clause 5 of the Scheme. Clause 5(i) and (ii) of the Scheme reads as under; 5. Medical Facilities available under the Scheme: (i) All the employees including officers retired on attaining the age of superannuation, are eligible for free treatment including in patient services, Diagnosis, Investigations, Surgeries, supply of medicines etc., at APSRTC Hospital, Tarnaka, Hyderabad and APSRTC dispensaries wherever available on the same scale as provided to the in-service employees except referring them to the notified/private hospitals.
(ii) However, for providing specialist treatment in the fields of Heart, Kidney, Brain surgery and cancer in other hospitals, the Superintendent & CMO, Tarnaka Hospital will be the authority designated to direct them and arrange payment to the hospitals concerned subject to a maximum of Rs. 1 lakh during the life time of each member. In the event the expenditure on account of the above exceeds Rs. 1.00 lakh, the retired employee has to bear such expenditure on his own. 6.1 A reading of Clause 5(ii) of the Scheme would show that in the field of heart surgery, it is permissible to take treatment outside the respondent Corporation Hospital. It provides that the Superintendent and the CMO of Tarnaka Hospital is the competent authority to permit member of the scheme to take treatment in any other hospital and arrange payment to the hospital concerned subject to maximum of Rs. 1 lakh. 7. It is not in dispute that petitioner traveled to Bangalore and he has undergone surgery and has incurred an expenditure of Rs. 2,83,019/-. Thus, the only ground on which the claim is not accepted is there was no reference by Medical Superintendent as per Clause 5(ii) of the Scheme. 8. Heart ailment requires an urgent medical attention and if necessary, open-heart surgery or other mode of removing the blocks. Any delay in attending to the treatment would be fatal. Thus, when petitioner was in Bangalore, he could not have traveled down to Tarnaka in Hyderabad, consult the Superintendent and CMO and seek his reference for treatment. 8.1 Every person, including a former employee of the respondent Corporation has a right to live and to take treatment to save his life. Right to life is a fundamental right guaranteed under Article 21 of the Constitution. When the life is in danger, the technicalities cannot come in the way of taking treatment. If procedural aspects are pitted against the right of a person to his life, such right shall prevail and all other subsidiary aspects should be subservient to such right. 9. Provision in Clause 5(ii) has to be understood as applicable in ordinary circumstances, where the person lives in Hyderabad or is able to reach the hospital in Hyderabad, undergoes medical examination and having found that patient requires specialized treatment, patient is referred to private hospital for treatment.
9. Provision in Clause 5(ii) has to be understood as applicable in ordinary circumstances, where the person lives in Hyderabad or is able to reach the hospital in Hyderabad, undergoes medical examination and having found that patient requires specialized treatment, patient is referred to private hospital for treatment. It does not deal with emergency situation as in the instant case. On closure reading of the clauses in paragraph 5 of the scheme, it does not prohibit obtaining treatment in private hospitals in emergency. It cannot be assumed that draftsmen of the scheme were not aware of medical emergency. The scheme has not spelt out, consciously, the treatment taken in medical emergency and does not prohibit. If situation is of so grave, it is permissible for the person to take treatment without such a formal reference and to claim reimbursement. 10. The clauses in paragraph 5 have to be understood to mean the intention of the respondent corporation to streamline medical reimbursement claims and to avoid fraudulent claims. It therefore fixes responsibility on the Medical Superintendent and Chief Medical Officer to deal with each case independently before suggesting treatment in private hospital. This procedure is applicable in ordinary circumstances. 11. When claim for reimbursement is made after undergoing treatment in private hospital without a reference by Medical Superintendent of Tarnaka hospital, what is required is to verify the authenticity and genuineness of such a claim and once the competent authority satisfied that the claim is valid, the reimbursement as per the scheme has to be granted and refusal to grant the benefit of reimbursement on the specious ground that there was no prior consultation or formal reference by the superintendent and the CMO of Tarnaka Hospital is not valid. 12. In identical circumstances, in T.V Rajagopal Rao this Court held that even if medical facilities are available for particular disease in Hyderabad, taking treatment in Mumbai cannot be faulted since trust and confidence in a hospital or a doctor in taking treatment is paramount. It was also a case of cardiac problem and the city of Hyderabad, even by the year 2002-2003, was well known to have the best hospitals for cardiac treatment. However, the concerned person choose to take treatment in Mumbai and the same was upheld. However, with reference to the amount of claim, the Court restricted it to the extent such a claim is permissible in Hyderabad city.
However, the concerned person choose to take treatment in Mumbai and the same was upheld. However, with reference to the amount of claim, the Court restricted it to the extent such a claim is permissible in Hyderabad city. 13. Accordingly, I hold that the decision of the respondent Corporation in not granting the reimbursement is erroneous. However, as seen from the scheme, even on a reference by Medical Superintendent for treatment in private hospital, the person is only entitled to Rs. One lakh towards treatment, irrespective of the amount of expenditure incurred. This being the limit stipulated in the scheme, petitioner is entitled to reimbursement only to that extent. This Writ Petition is disposed of, directing the respondent Corporation to release an amount of Rs. 1,00,000/- (Rupees one lakh only), as admissible under the Scheme, to the petitioner, within a period of four weeks from the date of receipt of a copy of this order. There shall be no order as to costs. Miscellaneous petitions, if any, pending in this writ petition, shall stand closed.