Samuel K. Mathai, S/o. Mathai v. State of Kerala, Represented by its Principal Secretary to the Government, Health and Family Welfare Department, Government Secretariat
2024-01-30
DEVAN RAMACHANDRAN
body2024
DigiLaw.ai
JUDGMENT : The petitioner seeks a directions to respondents 1 to 4 to reimburse him an amount of Rs.3,44,774/-, which he says was the amount he has expended for “diagnosing and treating Prostate Cancer” (sic) in a private hospital. 2. The petitioner edifices his claim on Ext.P1 -“Cancer Care Policy”, which is promoted by the National Savings Department, Government of Kerala, through 'Indira Vikas Patra' deposits. He asserts that, as is evident from Ext.P2, the members of the afore scheme had been promised “all tools of diagnosis and treatment for cancer”(sic), but that, contrary to this, when he approached the Medical College Hospital, Kottayam - when there was a suspicion of him having developed carcinoma in the prostate - he was asked to undergo a 'TRUS Guided Prostate Scan', which could not be done there because they did not have the facility for the necessary MRI scan. 3. The petitioner asserts that, as is medically recognised and therefore, without requirement of further expatiation, a 'TRUS Guided Prostate Scan' can be done only after the area is identified through an MRI scan and that; subsequent to this, the patient also may have to undergo a whole body 'PET-CT Scan' to verify the extend of the metastasis. He asserts that, since it was certified, on his request, by the Superintendent of the Medical College Hospital, Kottayam, through Ext.P5, that the said Institution did not have an MRI Scan machine of its own and that since no 'PET-CT' facility either was available, he was constrained to seek such support and facilities from a private hospital. He adds that, as is further evident from Ext.P5, the Superintendent of the Medical College Hospital also certified that no Robotic Surgery facilities are available in its department of Radio Diagnosis; and adds that he was thus constrained to approach a private hospital and to expend the afore amount, which according to him, is now obligatory on the part of the respondents to reimburse, under ambit of Ext.P1 scheme. 4. Sri.
4. Sri. Jomy K. Jose – learned counsel for the petitioner, argued that, when it became impossible for his client to obtain an effective diagnosis and treatment from the Medical College Hospital, Kottayam, the condition in Ext.P1 scheme - that his treatment must be confined to such an Institution became an impossible event to perform; and hence, that under the Doctrine of 'lex cogit ad impossibilia', he is fully justified in having approached this Court, seeking reimbursement of amounts which he had to spend treatment at the private hospital. He explained that his client could not even wait to think about and assess the other options, if any, because, his disease was fast gripping him, thus requiring immediate and imminent medical attention and intervention, which he was constrained to avail in a private hospital. 5. After asserting as afore, Sri. Jomy K. Jose then submitted that when the Government gave an assurance in Ext.P2, that all requirements for diagnosis and treatment of cancer would be provided in the empanelled hospital, they have acted in breach of their solemn promise in not equipping the Medical College Hospital with 'MRI scan', 'Robotic Surgery' facilities and 'PET-CT' scan. He argued that, therefore, it is not his client who has acted in breach of the Policy, but the Government, in not having provided any facility; but still promising citizens of the best possible care. He, thus prayed that the reliefs sought for in this Writ Petition be granted. 6. Sri. Sunil Kumar Kuriakose – learned Government Pleader responded to the afore submissions of Sri. Jomy K. Jose that, as is evident from Ext.P1 itself, what is promised to the petitioner was only facilities for cancer treatment “available in the Cancer Care Centre of the Medical College Hospital, Kottayam” (sic). He submitted that, the policy thus renders it indubitable that the members of the scheme will get access to the “available facilities”; and therefore that, it construes that, if any component of the treatment is not so available, then they may have to avail such alone from other institutions or hospitals.
He submitted that, the policy thus renders it indubitable that the members of the scheme will get access to the “available facilities”; and therefore that, it construes that, if any component of the treatment is not so available, then they may have to avail such alone from other institutions or hospitals. He added that, if the petitioner had done so, perhaps, it would have been a different case; and he may have had the opportunity of claiming the reimbursement of such components – without conceding to it in any manner under the policy; but that is the case at hand, he pointed out that the petitioner did not continue the treatment at all in the Cancer Care Centre/Medical College Hospital, but switched over to a private hospital and then now seeks reimbursement of the expenses, which is impermissible. He concluded saying that the obligations of official respondents are contractual in nature, governed by the specific covenants in Ext.P1 policy; and therefore, that the petitioner cannot seek anything more than that, or claim any deviation therefrom. He, thus, prayed that this Writ Petition be dismissed. 7. I have carefully evaluated and examined the afore syllogistic contentions, on the backdrop of the various documents on record. 8. Indubitably, Ext.P1 policy luculently declares that the member thereunder is entitled to receive “cancer treatment facilities available in the Cancer Care Centre of Medical College Hospital, Kottayam free of charge” (sic). It is edified on the word “available that” the learned Government Pleader says that any component which is not so available, will stand excluded. 9. The afore argument of learned Government Pleader perhaps would have been repelled by this Court, based on the submissions of Sri. Jomy K. Jose as recorded above, that no person can be compelled to do what is impossible. 10. To paraphrase, had the petitioner continued with the treatment at the Cancer Care Centre of the Medical College Hospital, Kottayam, but to avail certain components for the purpose of diagnosis and for treatment outside, then it would have been a case where this Court could have considered whether such expenses also should have been ordered to be reimbursed as part of the Policy covenants. This is because the Policy in question is one uberrima fidei and its promises cannot be facile.
This is because the Policy in question is one uberrima fidei and its promises cannot be facile. When it is expressly admitted to be a Cancer Care Policy, the absence of even basic diagnostic tools in the sole hospital empanelled therein, could surely be construed to be an affront to the purpose behind it. 11. But this Court is not called upon to do to consider the afore conclusively because, it is conceded, without any reservation, by the petitioner, that all being diagnosed with the possibility of Prostate Cancer and on being informed through Ext.P3, by the Oncologist in the Medical College Hospital, Kottayam, that he will have to undergo a 'TRUS Guided Prostate Scan', he chose to shift his treatment to a private hospital, Ernakulam; and explains that this is because he received information by them, through Ext.P5, that the former hospital did not have either MRI or PET-CT scan, much less Robotic Surgery facilities. 12. However, it must be borne in mind that Ext.P5 is dated 31.10.2019; while Ext.P6 - which is the first medical transcript issued by the private hospital qua the petitioner, suggesting a 'TRUS Biopsy' and a possible 'PET-CT' scan report – dated 13.08.2019. It is therefore more or less explicit that the petitioner had decided to shift his treatment to the private hospital, presumably because, as conceded by his learned counsel, he found it more confident to do so, rather than he treated by the Medical College Hospital. 13. Therefore, the argument of the petitioner, that he shifted to the private hospital on obtaining information from the Medical College Hospital, Kottayam, through Ext.P5, cannot find my favour. Of course, the explanation of Sri. Jomy K. Jose to this is that his client was aware that there were no such facilities in the Medical College Hospital earlier; and that, it is only to substantiate then and fortify the same, that he had made a formal application, which was responded only on 31.10.2019. 14. Be that as it may, even if the afore explanation of Sri.
14. Be that as it may, even if the afore explanation of Sri. Jomy K. Jose is accepted, the question remains as to why the petitioner shifted his treatment fully to the private hospital, rather than have obtained the MRI scan, to have undergone a subsequent 'TRUS guided Biopsy Scan' at the Medical College Hospital itself; and perhaps then to have relied upon a another institute for 'PET-CT scan'; had such been decided to be done by the Doctors in the Medical College Hospital. There are no answers to these questions, except that the petitioner asserts that he did not trust the Medical College Hospital with his life; and that he wanted better treatment, which he anticipated could be available only in the hospital, where he finally completed it. 15. In the conspectus of afore factual factors, when one examines the claim of the petitioner, he seeks reimbursement of the expenses which he had to suffer in the private hospital, within the ambit of Ext.P1 Policy. 16. It is here that the petitioner faces a problem because, as rightly argued by Sri. Sunil Kumar Kuriakose – learned Government Pleader, the covenants of the Policy renders it perspicuous that a member under it can receive treatment facilities free of cost only in the Cancer Care Centre of the Medical College Hospital, Kottayam. When this has been indited without any ambiguity, the petitioner could have obtained any relief from this Court, only had he been able to establish that he had undergone the treatment at the Cancer Care Centre of the Medical College Hospital, Kottayam, except qua some components which were not available there; and consequently, the doctrine of necessity could have been impelled to seek reimbursement of such amounts also. 17. What this Court means to say is that if, as stated in Ext.P5, the Medical College Hospital, Kottayam, did not have the MRI scan facility, the petitioner certainly would have been justified to avail it from another institution, the expenses for which he may have then been able to seek as disbursement under the Policy.
17. What this Court means to say is that if, as stated in Ext.P5, the Medical College Hospital, Kottayam, did not have the MRI scan facility, the petitioner certainly would have been justified to avail it from another institution, the expenses for which he may have then been able to seek as disbursement under the Policy. Whether this could have been allowed or otherwise, is a different matter; but from the standpoint of the question that has been impelled before this Court, I must say that the petitioner cannot seek reimbursement of the entire treatment cost which he suffered in a private hospital, particularly when he says that he did not trust the Medical College Hospital for an effective treatment. In the afore circumstances, this Court cannot find favour to the petitioner; and am hence constrained to dismiss this Writ Petition for the afore reasons. This Writ Petition, therefore, will stand closed.