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2021 DIGILAW 134 (TRI)

Ranadhir Debbarma v. State of Tripura & Others

2021-08-24

ARINDAM LODH

body2021
JUDGMENT By way of filing the present writ petition, the petitioner has raised his grievance for his application for reimbursement of medical bills being arbitrarily rejected by the respondents. The facts are that, the mother of the petitioner was suffering from acute cancer. Considering the eligibility of the petitioner being an employee under the State-respondents, his mother was referred to TATA Medical Centre, Kolkata by an authorized Medical Board of the Government of Tripura as she was suffering from cancer. The mother of the petitioner was treated there in the hospital. After completion of treatment, she was advised to follow-up action. Thereafter, the petitioner came back to Agartala leaving his mother in Kolkata. After few days, the petitioner was informed by his mother about her further complications. Accordingly, the petitioner went to Kolkata and he took his mother to TATA Medical Centre for treatment. It is pertinent to mention here that from the discharge summary dated 10.05.2018, it is revealed that the mother of the petitioner was advised to consult with Cardiology Unit of AMRI hospital preferably with Dr. Manojit Lodha/ Dr. Subhasish Roy Choudhury. Accordingly, his mother was consulted with the doctors of AMRI hospital. Thereafter, from assessment date 03.09.2018 (Annexure 5 to the writ petition) it is revealed that the mother of the petitioner was advised “Adjuvant RT to Right Breast followed by a Tumor cavity boost; and Left Chest wall with Left SCF at other center as we do not have slots for RT”. From the above “patient summary” it reveals that since TATA Medical Centre had no slot and on their advice that the patient has to be treated “at other Centre”, the petitioner was compelled to shift his mother to Apollo Gleneagles Hospitals, Kolkata. Accordingly, the mother of the petitioner underwent necessary surgery at Apollo Gleneagles Hospitals, Kolkata. Thereafter, the petitioner raised bills for such treatments of his mother at AMRI and Apollo Gleneagles for an amount of Rs. 2,50,742.19/-. The mother of the petitioner was brought to Agartala where after few days she breathed her last. After overcoming the grief and sorrow state of affairs the petitioner suffered due to death of his mother, the petitioner had submitted medical bills for reimbursement of the same to the respondents with an application thereof. 2,50,742.19/-. The mother of the petitioner was brought to Agartala where after few days she breathed her last. After overcoming the grief and sorrow state of affairs the petitioner suffered due to death of his mother, the petitioner had submitted medical bills for reimbursement of the same to the respondents with an application thereof. Though the first bill of the petitioner relating to the treatment of his mother at TATA Medical Centre, Kolkata was paid, but, the expenditure he incurred for treatment of his mother at AMRI hospital and Apollo Gleneagles Hospital, Kolkata were rejected by the respondents. Thereafter, the petitioner submitted representation requesting the respondents to reimburse the bills raised for the treatment of his mother at AMRI hospital and Apollo Gleneagles Hospitals, Kolkata, but in vain, compelling the petitioner to file the instant writ petition. Heard Mr. PK Ghosh, learned counsel for the petitioner as well as Mr. PK Dhar, learned senior GA assisted by Ms. Sarama Deb, learned counsel for the respondents-State. The learned counsel appearing for the respondents have relied upon the statement made in the counter affidavit submitted by the respondents. During the course of hearing, the learned counsel for the respondents has defended the action of the respondents mainly on the following grounds: (i) The petitioner had taken his mother to TATA Medical Centre, Kolkata subsequently without any referral certificate. According to the learned counsel for the respondents, it was the obligation of the petitioner to obtain referral certificate for the next visit to the hospital; and (ii) The petitioner did not submit the medical bills within six months from the date of raising bills by the concerned hospitals. I have gone through the records of the case and the related guidelines issued time to time by the Government of Tripura, which are undisputed. It is seen from the discharge summary dated 10.05.2018 (Annexure 2 to the writ petition) that the mother of the petitioner was advised to shift at Cardiology Unit at AMRI hospital by the competent authorities of TATA Medical Centre. In this regard, the government guideline is that if a person claiming reimbursement of medical bills visits the referral hospital within six months for two times, then, there would be no need to obtain referral certificate afresh. In this regard, the government guideline is that if a person claiming reimbursement of medical bills visits the referral hospital within six months for two times, then, there would be no need to obtain referral certificate afresh. So, the first contention of the respondents that the petitioner had taken his mother to TATA Medical Centre, Kolkata for the second time without referral certificate is repelled on the ground that the petitioner as per advice of TATA Medical Centre had visited the said hospital within six months from the date of her first visit and discharge. Now, coming to the second ground of rejection as stated here-in-above, it is noticed that it was under compelling circumstances and, particularly, on the advice of TATA Medical Centre, the petitioner went to AMRI hospital for consultation with the concerned doctor, as indicated in the “advice” note itself since there was no slot at the said referred hospital. In this circumstance, in my opinion, there is no reason to discard the bills, as raised by AMRI hospital for treatment of his mother therein. Thereafter, as per advice of TATA Medical Centre, as emanated in the “Patient Evaluation Summary” dated 03.09.2018, the petitioner was compelled to shift his mother to Apollo Gleneagles Hospital, Kolkata for RT as there was no slot in TATA Medical Centre, Kolkata. Accordingly, the mother of the petitioner was treated there. In view of this, in my opinion, there is no reason for the respondents to discard the bills, as raised by Apollo Gleneagles Hospital, Kolkata for treatment of the mother of the petitioner. A conspectus of the above facts clearly demonstrates that the petitioner is entitled to reimburse his medical bills, as submitted by him to the respondents. There was no fault of the petitioner to get his mother treated at AMRI hospital and Apollo Gleneagles Hospitals, Kolkata. A question is raised that the petitioner had submitted medical bills after expiry of six months in violation of government guidelines. The main purpose and object of providing medical reimbursement bills, as legislated by the government are that to extend financial support to its employees. This limitation of time for furnishing medical bills for reimbursement is to prevent any malpractice, which is directory in nature. It is incumbent upon the concerned Executives to verify the genuinity and authenticity of the bills, as raised by a person having taken the benefit of the scheme. This limitation of time for furnishing medical bills for reimbursement is to prevent any malpractice, which is directory in nature. It is incumbent upon the concerned Executives to verify the genuinity and authenticity of the bills, as raised by a person having taken the benefit of the scheme. True it is, that discretion lies upon the Officers. But discretion is to be exercised in consonance with objectives of the scheme what the government wanted to achieve. In furtherance thereof, this limitation clause in the scheme has to be given purposive interpretation. In a genuine case, it is within the discretionary power upon the Executives to allow reimbursement of medical bills even if the same are furnished after expiry of six months, if they are convinced that the bills are genuine. Indeed, it is always within the realm of their power to verify and ask for clarification of the bills from the hospitals concerned, if they have any reason to doubt the genuinity of the bills. In the instant case, the respondents have never doubted the bills, as submitted by the petitioner. The grounds taken by the respondents are found to be inconsistent with the scheme for reimbursement of medical bills. Having viewed thus, I direct the respondents to make payment of the medical reimbursement bills, as raised by the petitioner for treatment of his mother at AMRI hospital, Kolkata and Apollo Gleneagles Hospitals, Kolkata within a period of 3 (three) months from the date the petitioner shall furnish a copy of this order to the respondent/authorities concerned. With the aforesaid observations and directions, the instant writ petition stands allowed and thus disposed of. Pending application(s), if any, also stands disposed.