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2020 DIGILAW 39 (TRI)

Uttam Hrishi Das v. State of Tripura

2020-02-28

ARINDAM LODH

body2020
JUDGMENT Arindam Lodh, J. - Heard Mr. G. K. Nama, learned counsel appearing for the petitioner. Also heard Mr. D. Bhattacharjee, learned G.A. appearing for the State-respondents. 2. By means of filing this writ petition, the petitioner has prayed for reimbursement of the amount incurred for the treatment of his father at ILS Hospital, Agartala, Tripura. Mr. Nama, learned counsel appearing for the petitioner has submitted that the petitioner under compelling circumstances had to admit his father in the ILS Hospital, Agartala. The father of the petitioner had undergone treatment w.e.f. 24.07.2013 to 03.08.2013 and cost of Rs. 1,23,347/- (one lakh twenty three thousand three hundred forty-seven) was incurred due to treatment. 3. Mr. Nama, learned counsel appearing for the petitioner has further submitted that the petitioner being a judicial officer under the Tripura Judicial Service had applied to the Law Department for reimbursement of medical expenses which he incurred for the purpose of the treatment of his father. But, the same was rejected by the State-respondents vide order dated 12.05.2015 (Annexure-5 to the writ petition). On the other hand, Mr. Bhattacharjee, learned G.A. appearing for the State-respondents has submitted that the medical reimbursement bill was declined by the State-respondents for the reason that ILS Hospital at that relevant point of time was not in the list of referral hospitals. 4. I have given my thoughtful consideration to the submissions and the grounds taken by the learned counsel appearing for the parties to the lis. As I said earlier, the petitioner under compelling circumstances and also considering the seriousness of his father, had to admit his father, namely, Sri Suban Hrishi Das at the ILS Hospital, Agartala. 5. It is admitted fact that the father of the petitioner was initially admitted to the AGMC & GBP Hospital on 17.07.2013. His father was suffering from Pulmonary Tuberculosis along with Asthma prior to admission in that hospital. His father was discharged on 21.07.2013 on the advice of the attending doctor of that hospital as his father was found to be fit. But, just after two days, having seen deteriorating condition of his father, the petitioner took his father to a doctor's chamber and after proper examination the doctor advised him to take his father immediately to the ILS Hospital, Agartala, for better treatment. But, just after two days, having seen deteriorating condition of his father, the petitioner took his father to a doctor's chamber and after proper examination the doctor advised him to take his father immediately to the ILS Hospital, Agartala, for better treatment. In the ILS hospital the patient was treated in the Special Intensive Care Unit (SICU) for four days w.e.f. 24.07.2013 and was discharged on 03.08.2013. For that purpose, the petitioner had to incur a cost of Rs. 1,23,347/-. 6. The petitioner presented the bills, claiming the medical expenses he incurred due to the treatment of his father at ILS hospital, Agartala, but, his prayer for reimbursement of medical expenses was declined by the State-respondents. Thereafter, he submitted representation stating inter alia that he was entitled to get medical reimbursement for the treatment of his father, but, that was also declined. Hence, this writ petition. 7. From the aforesaid facts, it reveals that father of the petitioner was initially treated at AGMC & GBP Hospital, Agartala. Again, just after two days of discharge, his father again became seriously ill and he was taken to a doctor's chamber, who is a doctor of IGM hospital, Agartala, which is also a Government hospital, and the said doctor suggested the petitioner to immediately admit his father in the ILS hospital considering the seriousness of the health condition of his father. 8. This Court is not unmindful to various shortfalls the GBP Hospital suffers to facilitate the treatment to the patients. Everyday many patients are being referred to different hospitals outside the State of Tripura. The Government doctors of AGMC & GBP Hospital discharged the petitioner's father, and just after two days of discharge, his father again fell seriously ill. He had no other alternative but to take his father at first to a Government doctor who advised him to admit his father immediately to ILS hospital, Agartala. Accordingly, under emergent situation, the petitioner admitted his father at ILS hospital, Agartala. 9. The petitioner is a judicial officer serving under the Tripura Judicial Service. As per memorandum dated 02.09.1985 issued by the Finance Department, Government of Tripura, petitioner has a substantive right under the Central Civil Services (MA) Rules, 1944, as adopted by the State Government for reimbursement of the cost of medical treatment. 9. The petitioner is a judicial officer serving under the Tripura Judicial Service. As per memorandum dated 02.09.1985 issued by the Finance Department, Government of Tripura, petitioner has a substantive right under the Central Civil Services (MA) Rules, 1944, as adopted by the State Government for reimbursement of the cost of medical treatment. Relevant portion of the said notification may be reproduced herein below: "(iii) Reimbursement of the cost of medical treatment in cases covered by (i) and (ii) above is to be made as per the Central Civil Services (MA) Rules, 1944, as adopted by the State Government from 21.01.1972 subject to adoption and modification, if any, made thereafter by the Government." 10. It is further case of the petitioner that just after two days of completion of his father's treatment, ILS hospital was approved as one of the referral hospital and in that respect, the State-respondents had also issued a notification dated 03.10.2013 and the same was also communicated to the Registrar General, High Court of Tripura, Agartala. 11. I am convinced to the fact that the release of the petitioner's father, when he was initially admitted to the AGMC & GBP Hospital, was quite indicative of the casual approach of the doctors of GBP Hospital. since the father of the petitioner had fallen ill just after two days and in that situation the petitioner had no other alternative but to abide by the advice of the doctor who suggested the petitioner to admit his father immediately in the ILS hospital, a super speciality hospital in the State of Tripura. 12. Mr. D. Bhattacharjee, learned G.A. appearing for the State-respondents has drawn my attention to Annexure-7 to the writ petition, wherein it is found thatthe State-respondents had issued an order dated 19.09.2013 and relying upon the said order, learned G.A. has tried to persuade this Court that the case of the petitioner is not covered and he is not entitled to get medical reimbursement because the disease asthma is not related to cardiac problem. 13. I have perused the said order dated 19.09.2013 issued by the Additional Chief Secretary, Government of Tripura. Learned G.A. has particularly refer to para-3 of the said order, which may be reproduced herein below: "3. 13. I have perused the said order dated 19.09.2013 issued by the Additional Chief Secretary, Government of Tripura. Learned G.A. has particularly refer to para-3 of the said order, which may be reproduced herein below: "3. Package rates for different producers approved by CGHS for super speciality hospitals covered under this category are Cardiology and Cardio-thoracic Surgery, Gastroenterology & GI Surgery, Joint replacement Surgery, Arthroscopy & Arthroscopic Surgery, Spinal diseases & Trauma and complicated limb injuries by Department of Orthopedic. Nephrology & Urology selective cases for which treatment facilities are not available in Govt. Hospital. The rate chart can be uploaded from the website of www. mohfw. nic. in/cghsnew/index. of CGHS." 14. The submission of learned G.A. appearing for the State-respondent leads this Court to peruse the order dated 19.09.2013, issued by the Additional Chief Secretary, Government of Tripura, Annexure-7 to the writ petition, is as under: "Enlistment of ILS Hospital, Agartala as referral centre for treatment/investigation of Tripura patients duly referred by the Standing Medical Board, Agartala, Order issued.HEALTH & FAMILY WELFARE DEPARTMENT G.O. No. 230/RT/2013 Dated, Agartala, the 19.09.2013 [File No. 2(10-43A)-DHS/Estt./MR/2012] Read: GO No. 2, dated 30th August, 2007 [File No. 2(10-43A)-MS/Estt./MR/07] ORDER The matter of empanelment of the ILS Hospitals, Agartala as a referral centre being a Super Specialty Hospital treatment centre having most modern treatment and diagnostic facilities was under consideration of the Government. 2. After careful examination and taking into consideration of all related aspects in this regards, the Governor, Tripura is pleased to enlist ILS Hospitals, Agartala at package rates of CGHS for super specialty hospital. The existing procedure of referral of patients by the Standing Medical Board will be followed except in acute emergency cases where the concerned physician and surgeon may refer such cases and the justification should be recorded in such emergency cases. 3. Package rates for different producers approved by CGHS for super speciality hospitals covered under this category are Cardiology and Cardio-thoracic Surgery, Gastroenterology & GI Surgery, Joint replacement Surgery, Arthroscopy & Arthroscopic Surgery, Spinal diseases & Trauma and complicated limb injuries by Department of Orthopedic. Nephrology & Urology selective cases for which treatment facilities are not available in Govt. Hospital. The rate chart can be uploaded from thewebsite of www.mohfw.nic.in/cghsnew/index. of CGHS. 4. Nephrology & Urology selective cases for which treatment facilities are not available in Govt. Hospital. The rate chart can be uploaded from thewebsite of www.mohfw.nic.in/cghsnew/index. of CGHS. 4. Rates of MRI approved for M/S Winmark Unit of GBP Hospital, Agartala and rates of Radiological Investigation approved for Sethi Diagnostic & Medicare Unit at IGM Hospital and M/S Winmark Unit of GBP Hospital Agartala will also applicable for ILS Hospital. 5. ILS Hospitals should enter into an agreement and also undertake not to charge higher than approved rates from the referred patients. 6. This shall come into force with immediate effect. By order of the Governor SD/- Additional Chief Secretary Government of Tripura." 15. It is apparent that ILS hospital is a super speciality hospital having most modern treatment facilities. It is stated that earlier requirement of referral of patients by the Standing Medical Board will be followed except in acute emergency cases, where the concerned physician and surgeon may refer such cases and the justification should be recorded in such emergency cases. This Court already averred that the disease of the father of the petitioner was related to heart and it is due to cardiological ablation and also lung. The circular dated 19.09.2013 further contains the names of some diseases including cardiology. In the instant case, the father of the petitioner was admitted to the ILS hospital under an emergent situation at the advice of registered physician as the father of the petitioner was in precarious condition. 16. The father of the petitioner was suffering from pulmonary tuberculosis along with asthma prior to the admission in AGMC & GBP Hospital on 17.07.2013. I am surprised to note that in the counter affidavit the State-respondents have stated that "this kind of disease is not acute emergency case and same do not come under the purview of the order dated 19.09.2013 (Annexure-7 to the writ petition)". This statement aptly proves the conduct and the kind of treatments which were provided to the father of the petitioner by the AGMC & GBP Hospital, Agartala. I have seen the discharge summery report issued by the ILS hospital annexed to the writ petition. The doctors of ILS hospital diagnosed the patient with the following complaints, which are as follows: "Present Complaints: Difficulties in Breathing for 7 days Cough and blood along with sputum. Generalised weakness with slurring of speech. I have seen the discharge summery report issued by the ILS hospital annexed to the writ petition. The doctors of ILS hospital diagnosed the patient with the following complaints, which are as follows: "Present Complaints: Difficulties in Breathing for 7 days Cough and blood along with sputum. Generalised weakness with slurring of speech. Pain in the back with difficulties in walking. Final Diagnosis : Lower respiratory tract infection [sputum(+) Klebsiella] Past Medical History : H/O Pulmonary tuberculosis." 17. I have also taken note of the advice of the concerned physician, Dr. Bijoy Paul, MBBS, MD, Medicine, IGM, Hospital dated 24.07.2013 wherein, he observed that the patient was admitted in AGMC with bronchitis and discharged on 21.07.2013. The said doctor further observed that the patient was "not responding to surroundings" and advised "to attend ILS hospital for necessary management." For the aforesaid circumstances, the petitioner was compelled to admit his father in ILS Hospital. After discharge, the petitioner submitted medical bills for reimbursement. The said medical bills were forwarded to the competent authority of the Finance Department, Government of Tripura through Law Department, Government of Tripura. But, the claim of the petitioner was rejected by the State Finance Department and communicated to the petitioner through the learned District and Sessions Judge vide communication dated 12th May, 2015 (Annexure-5) which is reproduced herein below for reference: "Sir, With reference to your letter Nos. F.2(d)/(31)(A)-DJ/W/2010-14/5058-59 dated 21.05.2014 & F. 2(d)(31)(A)-DJ/W/2010-14/4850-51 dated 13.05.2014, I am directed to inform you that the Government in the Finance Department under their U.No.1801/Fin(G)/15 dated 28.01.2015 has regrets its inability to concur the proposal. Yours sincerely, (Sopan Chaudhuri) Deputy Secretary, Law, Government of Tripura." 18. I am surprised to note that in the counter affidavit, the State-respondents have averred that "this kind of disease is not acute emergency case and same do not come under the purview of the order dated 19.09.2013 (Annexure-7 to the writ petition)". It is further averred in the writ petition that the petitioner undertook treatment at ILS Hospital prior to its empanelment as empanelled hospital under the State Government. It is further stated that the father of the petitioner was suffering from Pulmonary Tuberculosis along with Asthma and admitted to in GBP hospital on 17.07.2013 and he was discharge on 21.07.2013 with remarks'improved'. 19. It is further stated that the father of the petitioner was suffering from Pulmonary Tuberculosis along with Asthma and admitted to in GBP hospital on 17.07.2013 and he was discharge on 21.07.2013 with remarks'improved'. 19. In course of hearing, learned G.A. has submitted that the disease Asthma cannot be treated to be a cardiac disease and therefore, it does not come within the purview of order dated 19.09.2013 which does not speak about the disease Asthma. On the basis of aforesaid submission, this Court has to decide the entitlement of medical reimbursement as claimed by the petitioner. 20. In the instant case, it is admitted fact that the father of the petitioner was admitted on 17.07.2013 at GBP Hospital with the complaint of Pulmonary Tuberculosis along with Asthma and discharged on 21.07.2013 with remarks "improved". It is clear that the father of the petitioner was not cured completely. Resultantly, the father of the petitioner had fallen ill again. He was taken to a doctor and on his advice; the petitioner had to admit his father at ILS hospital for necessary management as he was not responding to the surrounding. The order dated 19.09.2013 clearly says that under acute emergency case, the concerned official may refer such cases without following the procedure of referral of patient by the Standing Medical Board. The concerned doctor has recorded his justification to refer the father of the petitioner to ILShospital at Agartala for better management. Under that emergent situation, the petitioner admitted his father in the ILS hospital. 21. The State-respondents most mechanically rejected the medical reimbursement bills raised by the petitioner due to the treatment of his father at ILS hospital, Agartala. As I said earlier, the father of the petitioner was suffering from respiratory problems and also suffering serious breathing problems, needless to say that, those are related to heart. However, Asthma is an inflammatory disease of the lung. According to new research, active asthma can double the risk of a cardiovascular event like a heart attack, stroke, or related condition, as such, I repel the submission of learned G.A. that the disease Asthma is not related to any cardiac problems. 22. I may profitably refer a decision of the Apex Court in Secretary to the Govt. According to new research, active asthma can double the risk of a cardiovascular event like a heart attack, stroke, or related condition, as such, I repel the submission of learned G.A. that the disease Asthma is not related to any cardiac problems. 22. I may profitably refer a decision of the Apex Court in Secretary to the Govt. of Haryana & Others VS Vidya Sagar reported in 2009 AIR (SCW) 5839; AIR 2010 SC 196 ; (2009) 14 SCC 652 , wherein it transpires that the respondent who was a retired employee of State of Haryana, suffered heart attack on 15.08.2002 and he then took treatment at Fortis Heart Institute and Multi Specialty Hospital, Mohali which has been recognized by the Haryana Government vide circular Letter No. HD.HR.No.2/82/98-IHB-III dated 31.10.2002 for the treatment of Haryana Government Employees/Pensioners/Family Pensioners (i.e. after the period of treatment). 23. The respondent in the said case claimed for a sum of Rs. 187,907.65/- only, but the concerned department sanctioned payment for a sum of Rs. 1,62,298/-only. Being aggrieved with that order, the respondent filed writ petition before the High Court of Punjab & Haryana on the ground that subsequently a circular dated 28.05.2003 issued by the Government of Haryana brings within its umbrage reimbursement of whole expenses not only the expenses incurred for the treatment of chronic disease outdoor but also indoor and the High Court allowed the writ petition holding that "having considered the entire matter, we are convinced that the petitioner is entitled to reimbursement of the entire expenses incurred by him in his treatment at Fortis Hospital, Mohali and the decision of the respondents to pay only 75% thereof is legally unsustainable." 24. Thereafter, being aggrieved of the said order passed by the High Court, the State Respondents challenged the said order before the Apex Court, and finally, the Apex Court upheld the judgment of the High Court holding that "we see no reason to differ with the views of the High Court. Although the circular dated 28.05.2003 does not expressly supersede the circular dated 30.11.1993, but the latter having been issued subsequent to the former and in relation to a particular category of disease, namely, the chronic disease, shall prevail over the earlier general circular. The said circular dated 28.05.2003 brings within its umbrage not only the expenses incurred for the treatment of chronic disease outdoor but also indoor. The said circular dated 28.05.2003 brings within its umbrage not only the expenses incurred for the treatment of chronic disease outdoor but also indoor. In that view of the matter, the impugned judgment must be sustained." 25. Since the fact of the cited case related to the period of treatment and issuance of circular subsequent to the date of treatment providing better facilities to an employee to get reimbursement of whole expenses of treatment are similar and identical to the factual aspects of the present case, in the instant case also, the ILS hospital was duly recognized and approved as referral hospital after few days of the treatment of the father of the petitioner therein. 26. I have no hesitation to state that the approach of the doctors of GBP hospital who treated the father of the petitioner was found to be very casual, particularly, when he was discharged without proper care; resultantly, his father had fallen ill just after two days. We also cannot lose sight of the facts that AGMC & GBP Hospital being situated in the capital city of Agartala is always over crowded with the number of patients and even there is serious dearth of accommodation due to shortage of beds, etc. Many patients are found to be lying on the floor and verandah of the hospital, even the staircases are not spared. In that situation, it was not possible for the petitioner to admit his father at GBP Hospital considering the seriousness of his father. 27. The petitioner has every right to take steps in self-preservation at such an emergent situation and it was not possible for the petitioner to wait for examining his father by the Standing Medical Board constituted by the Government for obtaining referral certificate. ILS Hospital is a super speciality hospital and was brought under the empanelled hospitals of the State-respondents for providing better medical facilities to the eligible employees under the State-Government. Complying the ratio in the case of Vidya Sagar (supra), the benefit must be extended in the case of the petitioner for the reason that the petitioner admitted his father just few days prior to its recognition as one of the empanelled hospitals of the State-Government. 28. Complying the ratio in the case of Vidya Sagar (supra), the benefit must be extended in the case of the petitioner for the reason that the petitioner admitted his father just few days prior to its recognition as one of the empanelled hospitals of the State-Government. 28. Situated thus, this Court is of the considered opinion that the medical expenses incurred by the petitioner should be reimbursed in view of the fact that the father of the petitioner was admitted to the ILS hospital under compelling circumstances, and also due to the fact that the said ILS Hospital was given approval as referral hospital just after few days of the treatment of the father of the petitioner. In this respect, if necessary, the "Standing Medical Board" shall give post-facto approval of the treatment to the father of the petitioner at the ILS Hospital, Agartala. The petitioner is entitled to reimburse the medical bill in its entirety. The entire exercise shall be completed within a period of three months from the date the petitioner shall furnish the copy of this order. 29. In the result, the instant petition stands allowed and disposed of. Pending application(s), if any, also stands disposed of.