In the High Court of Judicature for Rajasthan Jaipur Bench **
Civil Writ Petition No.11501/2010 GS Gupta Versus State & Anr Date of Order ::: 10/08/2011 Hon'ble Mr. Justice Ajay Rastogi Mr. RP Garg, for petitioner.
Ms Sunita Satyarthi, Addl.Govt. Counsel, for respondents Instant petition has been filed seeking reimbursement of medical bills having been partly allowed to a sum of Rs.1.20 lacs vide order dt.25/01/2010 as against claim raised of Rs.3,65,287/- for treatment of Smt. Sushila Gupta W/o Shri GS Gupta (pensioner) on the premise that SK Soni Hospital, Jaipur where his wife undertook treatment is not a recognized/ approved hospital for treatment of State Pensioner.
Petitioner while holding the post of Accounts Officer retired from service and is a member of Rajasthan Pensioners Medical Concession Scheme ("Pensioners Scheme"). As alleged, all of a sudden, on 30/06/2008, since his wife (Smt.Sushila Gupta) had a severe heart attack having deteriorating condition, she was taken to SK Soni Hospital, Jaipur being situated nearer to her residence in Vidhyadhar Nagar, Jaipur where she was admitted as indoor patient and undertook treatment from 30/06/2008 to 12/07/2008 and incurred expenses for surgical operation & medicines for a total sum of Rs.3,65,287/- - claim for reimbursement whereof was raised being a member of Pensioner medical Scheme; against which finally, Sub-Committee of the Board of Trustees granted sanction of Rs.1.20 lacs towards reimbursement of medical bills in favour of petitioner vide order dt.25/01/2010.
Counsel for petitioner submits that in emergent situation due to severe heart attack, wife of petitioner was shifted to nearby SK Soni Hospital where she undertook surgical operation for saving her life; and it has been included in list of approved hospitals vide Order dt.15/02/2010, which makes him entitled for reimbursement of medical bills in terms of Circular dt.16/12/2009 laying down Schedule of charges admissible issued in exercise of power U/R.4 read with R.8(2) of Rajasthan Civil Service (Medical Attendant) Rules, 2008 ("Medical Rules, 2008").
Reply to the writ petition has been filed by respondents and it has been averred that the hospital was not approved, but medical bills presented for reimbursement as per prevalent rates were approved & Order dt. 16/12/2009 has no application since rates prescribed by Government are become applicable from 16/09/2008 and not prior thereto and in case of petitioner for reimbursement, what he was entitled for has been paid by sanction of Rs.1.20 lacs issued vide order impugned.
This Court has considered rival contentions of the parties and with their assistance, examined material on record. Indisputably, earlier Rajasthan Civil Service (Medical Attendance) Rules, 1970 were in force and after it stands superseded, for serving State Government servants, Rajasthan Civil Service (Medical Attendant) Rules, 2008 ("Medical Rules, 2008") came into force w.e.f. 16/09/2008 and retired personnels are entitled for their medical reimbursement in terms of Rajasthan Pensioner Medical Concession Scheme.
But, to streamline the on going disputes regarding reimbursement of medical bills, the State Government vide Circular dt. 06/02/2009 laid down rates of the charges admissible regarding costs of implants, medical attendance & treatment of State Government servant in private hospitals within the State, w.e.f. 16/09/2008. But it appears that upon representations made by State Govt. servants, vide order dt.27/11/2009, State Government allowed expenses incurred on medical attendance & treatment taken prior to 16/09/2008 in emergent circumstances in private/charitable hospitals within the State by Govt. servants, at the following scale:
(i)100% costs of reimbursement drugs & medicines;
(ii)80% of the rate of Government hospitals for tests, investigations and diagnosis charges at that time;
(iii)Hospital charges (inclusive of consultation, surgery and all other miscellaneous charges) at the rates of cottage charges admissible in Government hospitals as per entitlement of the employee at that time; and
(iv)Cost of implants at the prevailing rates of SMS Hospital, Jaipur at that time, as may be prescribed/certified by SMS Hospital, Jaipur or State Govt.
The emergent nature of hospitalization in private or charitable hospitals has to be established by an affidavit of the employee supported by a certificate of the treating doctor.
It further appears that representations were thereafter made by State Pensioner/Family Pensioners for grant of parity in regard to reimbursement of medical bills and taking note thereof, the State Government decided vide its order dt.21/12/2009 to extend the facility of medical attendance & treatment to State Pensioner/Family pensioners, as well in private hospitals as applicable to State Govt. servants under order dt.27/11/2009 pertaining to the period prior to 19/06/2009.
From Orders, ibid., it depicts that the scale of charges as provided vide order dt. 27/11/2009 became applicable to the State Govt. servants/State pensioner & family pensioners for reimbursement of medical bills for medical attendance & treatment being taken in emergent circumstances in a private/charitable hospitals pertaining to the period prior to 16/09/2008, as well.
It is relevant to record that to further streamline litigations coming to the Court of law regarding reimbursement of medical bills, State Government in exercise of powers U/r 4 read with R.8(2) of Medical Rules, 2008 vide order dt.16/12/2009 laid down scale - to the extent of which expenses of medical treatment are reimbursable on or after 16/09/2008 in the form of schedule of charges; however, there is a rider appended thereto that drugs & medicines shall be payable in terms of R.8(2) of Rules, 2008 and the medical treatment undertaken in emergent circumstances, prior to 16/09/2008 are reimbursable in terms of the scale having been notified vide orders dt. 06/02/2009 & 27/11/2009 irrespective of the fact that one is a State Government servant or State Pensioner/family pensioner who are made at par vide order dt.21/12/2009.
It is further relevant to record that State Government in exercise of powers U/r 3(7) of Rules, 2008 further published a list of approved private hospitals including SK Soni Hospital Jaipur vide Order dt.15/02/2010 which reads ad infra:
"On the recommendation of the Health Benefit Advisory Committee constituted as per the provisions contained in item (ii) Rule 4 of Rajasthan Civil Services (Medical Attendance) Rules, 2008, the State Government hereby includes the following three hospitals, as "Approved Hospitals" as defined in Rule 3(7) of the aforesaid rules, in the Appendix -I of Rajasthan Civil Services (Medical Attendance) Rules, 2008:
1.Santokba Durlabhji Hospital, Jaipur.
2.SK Soni Hospital, Jaipur
3.Gheesibai Memorial Mittal Hospital and Research Centre, Jaipur Note:
(1) The reimbursement of the expenses of treatment in above hospitals will be subject to ceilings issued vide State Govt Order No.F.6(4)/FD/Rules/2003/Pt./ dt.16/12/2009.
(2) The rates of various treatments in the above hospitals can be seen on the Finance department website http://www. finance.rajasthan.gov.in (3) Santokba Durlabhji Memorial Hospital Jaipur has agreed to provide 10% discount to State Government employees.
In the instant case, petitioner is a State pensioner and his wife took medical treatment as indoor patient from 30/06/2008 to 12/07/2008 in SK Soni Hospital, Jaipur and incurred expenses of surgical operation & medicines for a total sum of Rs.3,65,287/-, against which sanction of Rs.1.20 lacs was accorded by the authority.
Thus, in the opinion of this Court, if treatment has been undertaken by State Govt. servant/State Pensioner/family pensioner prior to 16/09/2008 in emergent circumstances in a private/charitable hospitals within the State, reimbursement of costs of implants, medical attendance & treatment could be allowed only in terms of scale provided vide orders dt. 06/02/2009 & 27/11/2009 respectively.
As regards emergent circumstances of hospitalization of his wife in private hospital (SK Soni Hospital) having remained indoor patient from 30/06/2008 to 12/07/2008 cannot be ruled out and since wife of the petitioner has undertaken treatment in emergent circumstances in private hospital at the relevant time, within the State prior to 16/09/2008 and being State pensioner, he became entitled for reimbursement of medical bills for treatment of his wife in terms of orders dt.27/11/2009 (supra). Since part payment was made to the petitioner against medical bills raised, he is not entitled for interest for additional amount if payable in terms of orders (supra).
Consequently, writ petition succeeds and is hereby allowed. Respondents are directed to reconsider case of the petitioner for reimbursement of medical bills furnished for treatment of his wife in the light of orders dt.06/12/2009 & 27/11/2009; and after due adjustment of payment of Rs.1.20 lacs already made vide Order dt.25/01/2010, the additional balance amount payable may be paid to the petitioner after its due computation within three months - details whereof may also be communicated to the petitioner. No costs.
(Ajay Rastogi), J.