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2022 DIGILAW 214 (GAU)

K. Thangliankhuma S/o Kawlkhuma v. State of Mizoram

2022-03-02

NELSON SAILO

body2022
JUDGMENT : NELSON SAILO, J. 1. Heard Mr. Samuel Vanlalhriata Chhangte, the learned counsel for the petitioner. Also heard Mrs. H. Lalmalsawmi, the learned Government Advocate appearing for the respondents. 2. By filing this writ petition under Article 226 of the Constitution of India, the petitioner has raised his grievance for not being reimbursed with the expenses for the medical treatment he had undertaken in a hospital which according to the respondents was not a recognized hospital at the relevant time of his admission to the hospital. 3. Brief facts of the case essential for disposal of the writ petition is that the petitioner is working as Sub-Divisional Officer (TC), National Highways Division-III under the Public Works Department, Government of Mizoram. On 20.11.2020, he was rushed to Trinity Hospital, Silaimual, Melthumkawn, Mizoram on medical emergency. Upon reaching the hospital, he was admitted and after necessary medical investigation was conducted, he was found to be suffering from acute kidney failure with chronic diabetic kidney disease with hypertension and celebellar ataxia. After receiving medical treatment in the said hospital, the petitioner was finally discharged on 23.12.2020. The petitioner then submitted his bills to the authority concerned for medical reimbursement which amounted to Rs. 4,74,566/- on 12.1.2021. The same was forwarded to the Chief Executive Officer, Mizoram State Health Care Society, Government of Mizoram (respondent No. 6). However, the same was rejected on the ground that the hospital concerned was not empanelled with the State Government at the time of admission of the petitioner to the hospital. The medical reimbursement bill was then returned to the petitioner on 02.03.2021 by the respondent No. 6 through the respondent No. 7. 4. Against the rejection, the petitioner submitted his representation to the respondent No. 6 on 04.03.2021 stating inter-alia that he was admitted to the said hospital due to the emergency and that he had no choice at the relevant time but to get immediate treatment to save his life. The respondent No. 7, therefore, resubmitted the medical reimbursement bill of the petitioner to the respondent No. 6, but the same came to be rejected again through Communication dated 12.04.2021 which was addressed to the respondent No. 7 with a copy to the petitioner. Aggrieved, the petitioner is before this Court. 5. Mr. The respondent No. 7, therefore, resubmitted the medical reimbursement bill of the petitioner to the respondent No. 6, but the same came to be rejected again through Communication dated 12.04.2021 which was addressed to the respondent No. 7 with a copy to the petitioner. Aggrieved, the petitioner is before this Court. 5. Mr. Samuel Vanlalhriata Chhangte, learned counsel submits that the petitioner on 20.11.2020 due to medical emergency had to be rushed to Trinity Hospital and there was no time for the petitioner and for those who had assisted him to first find out which hospital was recognized by the State Government, so as to take him there for his treatment. As it was an emergency, the petitioner was rushed to the Trinity Hospital and where he was accordingly, admitted immediately to receive his treatment. Referring to Notification dated 23.12.2020 (Annexure-VIII of the writ petition), the learned counsel submits that Trinity Hospital came to be recognized by the State Government w.e.f. 27.11.2020 while the petitioner was admitted to that hospital on 20.11.2020. It is not the case of the respondents that the hospital concerned till date is not a recognized hospital but in fact, it is duly recognized w.e.f. 27.11.2020. Therefore, merely because the petitioner got admitted on 20.11.2020, the same cannot be a ground to reject his application for medical reimbursement. 6. The learned counsel further submits that in appropriate cases, the State Government in the Department of Health and Family Welfare and also in the Police Department has been granting Expost Facto permission for getting medical treatment in hospitals outside the State. In this connection, the learned counsel has drawn the attention of this Court to the permission given by the authorities concerned, which are annexed as Annexure IX and X in the writ petition. He submits that in the present case as well, the petitioner had to be admitted on emergency basis and his case deserves to be treated similarly. He also submits that the respondents themselves have not disputed the fact that the petitioner had to be admitted to Trinity Hospital due to the emergency. He submits that in the present case as well, the petitioner had to be admitted on emergency basis and his case deserves to be treated similarly. He also submits that the respondents themselves have not disputed the fact that the petitioner had to be admitted to Trinity Hospital due to the emergency. The learned counsel in support of his submission has referred to the following decisions: (1) Suman Rakheja vs. State of Haryana and Another, (2004) 13 SCC 562 (2) Chhotu Ram Yadav vs. State of Haryana, (2005) 13 SCC 393 (3) Buta Ram vs. State of Haryana and Others, 2006 SCC Online P&H 1691 7. Mrs. H. Lalmalsawmi, the learned Government Advocate appearing for the respondents by referring to the affidavit-in-opposition filed on 10.02.2022 submits that Trinity Hospital was not an empanelled hospital at the time of admission of the petitioner to that hospital. In fact, there were others empanelled hospital which was closer to the residence of the petitioner such as Civil Hospital, Care Hospital, BN Hospital, Alpha Hospital etc. Therefore, in the absence of any indication that the empanelled hospitals were not able to treat the petitioner at their hospital, the petitioner could have easily gone to the hospital empanelled and recognized by the State Government. She submits that the screening and checking of medical reimbursement claims has been entrusted to the Mizoram State Health Care Society, vide Finance Departments OM No. D. 12015/1/2002-FEA dated 01.03.2018. In order to streamline the process and make clear demarcation to segregate medical reimbursement claims of the Government servant within each financial year, the date of admission in a hospital is taken as a defining timeframe. Hospitalization of the petitioner at Trinity Hospital was one continuous event, the beginning of the event being the date of admission and the end of the event being the date of his discharge. At the time of his admission to the hospital i.e. 20.11.2020, the hospital was not an empanelled hospital under the State Government and therefore, the claims of the petitioner for medical reimbursement was rightly rejected. The learned Government Advocate further submits that reimbursement of medical expenses under Civil Service (Medical Attendance) Rules, 1944 was made effective vide OM No. D. 12015/1/2019-FEA dated 08.01.2021, if the Government employee or their dependent family members are admitted to Government recognized hospital including Trinity Hospital which came to be recognized or empanelled from 27.11.2020. The learned Government Advocate further submits that reimbursement of medical expenses under Civil Service (Medical Attendance) Rules, 1944 was made effective vide OM No. D. 12015/1/2019-FEA dated 08.01.2021, if the Government employee or their dependent family members are admitted to Government recognized hospital including Trinity Hospital which came to be recognized or empanelled from 27.11.2020. As the petitioner was admitted at an earlier point of time, his claim was accordingly rejected. Under the circumstance, the learned Government Advocate submits that the writ petition has no merit and should be dismissed. 8. I have heard the submissions made by the learned counsels for the rival parties and I have perused the materials available on record. 9. Facts undisputed are that the petitioner was in a state of medical emergency on 20.11.2020 and for which he had to be taken to a hospital. It so happened that the petitioner was taken to Trinity Hospital due to the emergency. A perusal of the counter affidavit filed by the respondents, more particularly, at paragraph 4 would indicate that the fact of the petitioner requiring emergency treatment for having suffered from acute kidney failure has not been denied. Another important facts which can be seen is that the Trinity Hospital was empanelled with the State Government w.e.f. 27.11.2020, vide Notification dated 23.12.2020. It is not the case of the respondents that the said hospital is not empanelled with the State Government. The only reason for rejection as can be seen is that admission to the hospital was done on 20.11.2020 while the hospital was empanelled from 27.11.2020. 10. In Buta Ram vs. State of Haryana and Others (Supra), the question which came for consideration before the Division Bench of the Punjab and Haryana High Court was that whether the claims for medical reimbursement of the Government employee or his dependent could be rejected merely on the ground that treatment had been taken on the hospital which is not in the approval list of Haryana Government. The High Court by referring to the earlier decisions rendered on the subject held that in case of saving the human life at a given point of time, it is not expected of an attendant to look into the list of approved hospitals for getting such treatment. The High Court by referring to the earlier decisions rendered on the subject held that in case of saving the human life at a given point of time, it is not expected of an attendant to look into the list of approved hospitals for getting such treatment. Therefore, availing treatment from hospital which is not recognized by the Government, in an emergency, will not debar the Government employee or it’s dependents to claim its reimbursement as per the Rules. Accordingly, a time frame was given for granting the medical reimbursement with a further direction that if such reimbursement was not done within the time frame, the same would further carry interest @ 7½% from the date of submission of the bill. 11. In Chhotu Ram Yadav vs. State of Haryana (Supra), the issue raised was more or less similar and the Apex Court was of the view that the application for medical reimbursement should be processed as per the laid down policy of the Government i.e. to process the application on individual basis or case to case basis. 12. In the case of Suman Rakheja vs. State of Haryana and Another (Supra), the Apex Court by accepting the decision already made by the Punjab and Haryana High Court in San Prakash vs. State of Haryana (CWP No. 588 of 1998) wherein the Government servant concerned had to be admitted to the hospital in an emergency condition held that the medical expenses incurred would have to be reimbursed as per the entitlement in terms of the relevant Rules. 13. Coming to the present case, it may be seen that the petitioner was taken to Trinity Hospital on account of the medical emergency and in such condition, one can hardly expect the petitioner to first look into the list of approved hospitals and then proceed to get medical assistance. The authorities relied upon as discussed above is found applicable to the case of the petitioner. 14. In the result, I find merit in the writ petition and the impugned Communications dated 02.03.2021 and 12.04.2021 are hereby set aside. 15. The authorities relied upon as discussed above is found applicable to the case of the petitioner. 14. In the result, I find merit in the writ petition and the impugned Communications dated 02.03.2021 and 12.04.2021 are hereby set aside. 15. The petitioner shall submit his application for medical reimbursement through the proper channel within a period of 10(ten) days from today and the respondents shall process the matter without delay and the amount to be reimbursed as entitled to the petitioner should be made available to him by the respondents within a period of three months from the date of receipt of the application for medical reimbursement by the respondent No. 6. 16. Before parting with the records, it is also provided herein that the direction given here should not be taken as a precedent and that consideration and decision in this regard will have to be made on case to case basis and depending on the nature of the medical emergency claimed. 17. With the above observation and direction, the writ petition stands disposed of. No cost.