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2022 DIGILAW 2472 (RAJ)

Rajkumar Saraf v. State Of Rajasthan

2022-09-19

KULDEEP MATHUR

body2022
JUDGMENT Kuldeep Mathur, J. - By way of the present writ petition, the petitioner has prayed for reimbursement of expenses qua the Liver Transplant Surgery involving deceased liver donor undergone by him. 2. Brief facts of the case are that the petitioner was suffering from chronic liver cirrhosis and was taken to SMS Hospital, Jaipur; there the petitioner was advised and referred by the doctors to AIIMS, New Delhi. The doctors at AIIMS, New Delhi advised the petitioner to get operated at Apollo Hospital, Chennai due to non availability of treatment. The petitioner in dire need of liver transplant operation was operated on 21.04.2014 and discharged on 28.04.2014 from Apollo Hospital, Chennai. A sum ofRs.26,02,500/- was incurred as expenditure for the above-mentioned treatment/surgery. An application was submitted by the petitioner claiming medical reimbursement of expenses incurred qua the liver transplant surgery. The respondent-authorities vide order dated 29.05.2017, accepted the claim partially to the tune ofRs.6,00,000/-. The petitioner being aggrieved by partial acceptance of medical reimbursement claim, has preferred the present writ petition. 3. Learned counsel for the petitioner submitted that in an emergent condition, the petitioner was admitted in Apollo Hospital, Chennai due to non-availability of treatment in the parent state therefore, petitioner is entitled to the entire reimbursement amount claimed. Counsel vehemently submitted that denial of full reimbursement of medical bills is also discriminatory as complete reimbursement has been made in favour of employees who have undergone similar specialised treatment. 4. Per contra, learned counsel for the respondents submitted that the application submitted by the petitioner claiming reimbursement of expenses incurred qua the treatment was considered in consonance with the Rajasthan Civil Services (Medical Attendance) Rules, 2013. Counsel further submitted that the petitioner has undergone liver transplant operation on 21.04.2014 and the State Government vide notification dated 30.04.2015 prescribed ceiling rates for reimbursement for Liver Transplant Surgery, therefore, a subsequent notification does not apply to the present case. Counsel urged that the order dated 29.05.2017, accepting partial claim of the petitioner should not be interfered with. 5. Heard learned counsel for the parties and perused the material available on record. 6. Indisputably, the petitioner was a diagnosed patient of HCV related de-compensated chronic liver disease, Genotype IIIa child B, MELD-15. The petitioner was being treated at SMS, Jaipur where the doctors referred him to AIIMS, New Delhi. 5. Heard learned counsel for the parties and perused the material available on record. 6. Indisputably, the petitioner was a diagnosed patient of HCV related de-compensated chronic liver disease, Genotype IIIa child B, MELD-15. The petitioner was being treated at SMS, Jaipur where the doctors referred him to AIIMS, New Delhi. The facility of Liver Transplant Surgery at the relevant time was neither available in SMS Hospital, Jaipur nor in AIIMS, New Delhi, because of which the petitioner had to get operated at Apollo Hospital, Chennai. Subsequently, he underwent 'Liver Transplant Surgery' on 21.04.2014. 7. The Medical Board constituted by the respondents to assess genuineness of treatment after examining petitioner vide its report dated 13.01.2016 stated that the treatment taken by the petitioner was as per medical protocol, which is genuine. It was recommended that reimbursement in favour of petitioner may be made as per the Government Rules. While the application submitted by the petitioner for reimbursement of the medical bills was pending, the Finance Department issued an order dated 30.04.2015 bearing No. F.(2)FD(Rules)/2013 Pt-II, whereby in exercise of the powers conferred under Rule 20 of RCS (MA) Rules, 2013 and as per the decision of the Health Benefit Empowerment Committee, the State Government decided following ceiling rates of reimbursement for 'Liver Transplant Surgery' in government and approved private hospitals in the State and in referral hospitals:- "(a) The package rate for Liver Transplantation surgery involving live liver donor shall be as follows: Rs. 11,50,000/- (Rupees Eleven lakh fifty thousand only) + pre transplant evaluation of donor and recipient, Rs. 2,50,000/- (Rupees Two lakh fifty thousand only). (b) The package rate for Liver Transplantation surgery involving deceased liver donor shall be: Rs. 11,00,000/- (Rupees Eleven lakh only. This includes the cost of consumables during the organ retrieval and the cost of preservative solution etc." 8. The Hon'ble Supreme Court has declared right to self-preservation of life as a necessary concomitant of the right to life enshrined in Article 21 of the Constitution of India, fundamental in nature, sacred, precious and invaluable. 9. Apparently, when the treatment was taken, the said facility was neither available at SMS Hospital, Jaipur nor at AIIMS, New Delhi, therefore, the petitioner, having a medical emergency, cannot be expected to think of an alternative hospital. 10. 9. Apparently, when the treatment was taken, the said facility was neither available at SMS Hospital, Jaipur nor at AIIMS, New Delhi, therefore, the petitioner, having a medical emergency, cannot be expected to think of an alternative hospital. 10. The Government of Rajasthan in order to provide relief to the pensioners itself had issued order dated 30.04.2015, bearing No. F. 6(2)FD(Rules)/2013 Pt-II, prescribing the ceiling rates of reimbursement for liver transplant surgery. Obviously, prior to issuance of aforesaid order, the ceiling rates for the surgery in question were not provided, therefore, at the time of settling the medical bills of the petitioner for reimbursement, the ceiling rates of reimbursement prescribed for liver transplant in Government and approved hospitals in State of Rajasthan ought to have been kept in mind by the respondent-authorities. It is also noticed that reimbursement of actual medical expenditure was allowed by respondent-department in favour of one Dr. Rakesh Sharma vide order dated 30.10.2016 for similar treatment. 11. The Hon'ble Supreme Court in the case of State of Rajasthan v. Mahesh Kumar Sharma reported in (2011) 4 SCC 257 held as under:- ".....The Government would be justified in limiting the medical facilities to the extent it is permitted by its financial resources. In the instant case, the Government has formulated necessary rules permitting the reimbursement of medical expenses in certain situations and upto a certain limit. The Government has been reimbursing the necessary expenditure as permitted by the rules uniformly. It will, therefore, not be proper for a Government employee or for his relatives to claim reimbursement of medical expenses otherwise than what was provided in the Rules." 12. In view of law enunciated by the Hon'ble Supreme Court, the medical facilities and healthcare can be restricted in favour of employees to the extent permitted by the financial resources of the Government and as governed by the Rules. The respondents therefore, cannot be directed to make complete reimbursement of the medical bills submitted by the petitioner. However, in view of the fact that the claim of the petitioner has been found to be valid by the Medical Board vide report dated 13.01.2016, it would be unjust if the reimbursement for Liver Transplant Surgery is not allowed in favour of the petitioner as per the ceiling rates prescribed by the State Government vide order dated 30.04.2015. 13. However, in view of the fact that the claim of the petitioner has been found to be valid by the Medical Board vide report dated 13.01.2016, it would be unjust if the reimbursement for Liver Transplant Surgery is not allowed in favour of the petitioner as per the ceiling rates prescribed by the State Government vide order dated 30.04.2015. 13. In the result, the writ petition is partly allowed and the respondents are directed to pay the balance amount of the package rate for liver transplant surgery involving deceased liver donor prescribed by order dated 30.04.2015 within a period of three months from the date of this order, failing which, the amount shall carry an interest @ 4%. 14. No order as to costs.