JUDGMENT
Gopal Krishan Vyas, J.
1. In this case, the petitioner has prayed for directions to the respondents to reimburse the medical claim of the petitioner which has been paid by him for treatment of his heart disease in S.K. Soni Hospital Private Ltd., Jaipur. It is also prayed that the rejection order dated 19.5.2006 (Annexure-6) issued by the respondent No. 2 may be quashed and set aside.
2. As per the facts stated in the writ petition, the petitioner while working as Additional Chief Engineer, Bikaner had a meeting with Chief Secretary, Govt. of Rajasthan at Jaipur. After completion of meeting, he left for Bikaner on 29.1.2006 by a private taxi car and in between the way, he suffered severe pain in chest, therefore, he was taken to the Govt. Hospital, Khatu Shyamji. The concerned doctor of the Hospital told the petitioner that pain belongs to heart attack as such he advised to take medicines of heart disease and it was also suggested by the Doctor at Govt. Hospital Khatu Shyamji to take treatment in the Sikar Govt. hospital. As per the advise of the doctor at Govt. Hospital Khatu Shyamji, the petitioner was immediately taken to the Govt. hospital at Sikar. But as per the assertion of the petitioner made in para No. 4 of the writ petition, the hospital time was over and as such the petitioner rushed to the private hospital namely Dr. Mittal Nursing Home at Sikar and took treatment and thereafter looking to the gravity of the disease, the petitioner was referred to Jaipur as such after reaching Jaipur due to emergent situation, the petitioner was admitted to the S.K. Soni Hospital, Jaipur which is private hospital and got treatment
3. After taking treatment from S.K. Soni Hospital with regard to heard disease, more specifically after undergoing the operation of angiography, the petitioner was discharged from the Hospital and the petitioner paid a sum of Rs. 2,29,000/- in advance and thereafter a sum of Rs. 67,000/- was also deposited by the petitioner in the said hospital, which was arranged from the relatives of the petitioner. It is further stated that a sum of Rs. 17,248/- for other medicines were also paid by the petitioner and in all Rs. 3,13,248/was paid by the petitioner for his treatment.
4. The petitioner submitted all the medical bills along with the application for reimbursement but unfortunately, the claim of the petitioner was rejected vide order Annexure-6 dated 19.5.2006 in which it is stated that as per the Rajasthan Civil Services (Medical Attendance) Rules, 1970, the petitioner is not entitled to get the medical reimbursement on the ground that he has not taken treatment from the Govt. hospital. In this writ petition, the petitioner has challenged the validity of order dated 19.5.2006.
5. Learned Counsel for the petitioner first of all invited my attention towards certain judgments of this Court in which it has been held that even if an employee got medical treatment in the private hospital, has been held entitled for medical reimbursement at the rate which is applicable in the recognized Govt. hospitals/institutions as per the Rules of 1970, if treatment is taken in emergent condition. Therefore, in present case also the petitioner has got medical treatment in the private hospital at Jaipur in emergent situation, therefore, he is entitled for medical reimbursement at the rate which is prescribed in the notified hospitals under the Rules.
6. Therefore, the petitioner has restricted his claim with the prayer that the amount which is prescribed in the Government hospitals recognized under the Rules of 1970 may kindly be ordered to be reimbursed to the petitioner. It is also submitted that in emergent situation and serious condition of the petitioner, he was taken to S.K. Soni Hospital, Jaipur where he was treated by the doctors. Further it is submitted that a huge amount of Rs. 3,13,248/- was paid by the petitioner but he has been denied the medical reimbursement of the said expenses on the ground that the petitioner got treatment in the private hospital. It is accepted by the learned Counsel for the petitioner that his case was not recommended or referred by any medical board, so also, the petitioner was in serious condition, therefore he was taken to the private hospital for treatment. As per the verdict of this Hon’ble Court in various cases, the petitioner is entitled for reimbursement of medical expenses at the rate which is prescribed in the Rules of 1970 as applicable in the recognized hospitals/institutions under the said rules. In support of above contention, learned Counsel for the petitioner has relied upon the judgment reported in 2005 (6) RDD 2029 (Anil Kumar Surolia v. State of Raj. and Ors.), 2006 (7) RDD 3753 (Rambubu Gupta v. State of Raj. and Ors.) and 2006 (1) RDD 232 (Raj) (DB) (V.P. Saxena v. State of Raj. and Ors.).
7. Per contra, learned Dy. Govt. Counsel argued that no concession can be allowed to those employees who had violated the Rules of 1970, so also, the petitioner is higher official of the State, was required to follow the rules framed by the State Government for medical treatment but he has violated rules, therefore, he is not entitled for any medical reimbursement because he was treated in the private hospital at Jaipur knowingly well that in S.M.S. Govt. Hospital, Jaipur, the treatment of heart disease is available. Therefore, the petitioner is not entitled to claim any medical reimbursement as such this writ petition may be dismissed with cost.
8. I have considered the rival submission made by both the parties.
9. In case of Anil Kumar Surolia v. State of Ral. (supra), Hon’ble Division Bench of this Court has held that in emergent situation, employee can avail medical treatment outside Rajasthan. Para 6 and 8 of the aforesaid judgment is as follows:
6. In the factual background as detailed above, we are of the firm view that even if the required treatment was available in SMS Hospital at Jaipur or other approved hospitals in the State of Rajasthan, the petitioner was indeed entitled to medical reimbursement if he had got the treatment elsewhere necessitated on account of circumstances beyond his control. Self preservance is the first instinct in every human being. Person having suffered heart attach is not expected to await treatment at a far off distance as time is the essence in saving valuable life in such matter. There is every risk of a person breathing his last if he has to await treatment of heart attack. In the circumstances, even if such medical treatment as obtained by a Government employee be available in the State itself, he shall be still entitled to medical reimbursement for the treatment obtained elsewhere if the same is necessitated on account of circumstances beyond his control. In emergent situation thus it is not incumbent for a patient to obtain medical treatment only in approved hospitals of the Government. We would have discussed the matter in further details as per provisions of the Rajasthan Civil Services (Medical Attendant) Rules but it is conceded during the course of arguments that if the petitioner was to obtain medical treatment at SMS Hospital at Jaipur or the other Government approved hospitals in the State of Rajasthan, he would have been paid the same amount for the treatment he ultimately got from Krishna Heart Institute. If that be a fact, and which as mentioned above, is conceded, we are of the view that the stand taken by the State Government is obdurate and wholly uncalled for. We could imagine if perhaps the petitioner had spent far more and was claiming the same while getting treatment in a non- approved hospital. Government in any case had to pay the same amount spent by the petitioner at Krishna Heart Institute even if the petitioner was to get treatment in SMS Hospital or other approved hospital in the State of Rajasthan. This Court cannot but deprecate the attitude of the Government in rejecting justified claims in teeth of the recommendations made by this Court. Registrar General of this Court indeed supported the cause of the petitioner but the favourable recommendations made by this Court have been turned down on wholly untenable grounds.
8. The preliminary objections raised by the State as have been noted above need to be straightaway rejected. Delay in this case has actually been caused by the State in refusing a justified claim despite repeated recommendations made by this Court. In so far as right of petitioner for reimbursement of mediclaim is concerned, it could not be disputed during the course of arguments that a Government employee is entitled to the same. Simply because the right of a Government employee for medical reimbursement may not be a fundamental right it cannot be said that writ petition would not be competent. Once such a right is recognised, denial thereof would certainly entitle a citizen to invoke jurisdiction of this Court under Article 226 of the Constitution of India.
10. In similar type of case, the Division Bench of this Court has held in D.B. Civil Special Appeal No. 874/2006 (State of Raj. and Ors. v. Thomas T.), decided on 12.12.2006 that:
It is highly unjust to insist upon a patient suffering from heart attack with high risk to his life not to reach the nearest available medical centre where his ailment can be attended to and his life is saved but to insist to reach distant centre after waiting for referral exercise and risk his life. In the case of heart attack immediate and earliest possible aid is the need. If the State has not or cannot provide medical facility to meet such contingencies at more and more centre, it cannot insist upon the suffering civil servant not to avail nearest medical facility where he can reach early and save his life at the threat of denying him reimbursement of medical expenses to which he is otherwise entitled to.
In this connection reference is made to State of Punjab v. Ram Lubhaya Bagga and Ors. (1988) 4 SCC 117 in which the Supreme Court approved the principle that in case of emergency the medical treatment obtained by an incumbent in service at any private hospital, the reimbursement can be claimed at the rate prevalent in the AIIMS. The reimbursement policy of the State to reimburse the medical expenses of treatment taken at private hospital at the rate at which such treatment is available at AIIMS was upheld by the Court inter alia on the ground that decision of the appellant State to restrict the financial assistance to the employees for medical treatment within the resources of the State was not violative of Article 21 of the Constitution, which was in the light of new Policy stated by the State Government according to which treatment could be taken from any hospital but reimbursement of medical expenses was to be restricted to such amount, which for like treatment is to be incurred if the treatment were to be taken at AIIMS.
Wherever the State Policy of reimbursement of medical expenses requires strait jacket procedural requirement to be fulfilled before obtaining treatment from Government or designated hospital, the same has not been approved by the Supreme Court. It was observed that procedure laid down for the same was very onerous, sometime not workable specially in emergency cases. The procedure which is required is that an application seeking approval for such treatment in desired hospital has to be made to the Director of Health and Family Welfare two months in advance duly recommended by CMO/Medical Superintendent indicating that treatment for such disease is not available in the Government hospital. It also required that in case of an emergency such application is to be authenticated by CMO/MS to be made 15 days in advance. The court observed that such procedure deprive persons from getting better treatment at other places. Some of the serious diseases to not knock or warn through bell giving them time. Emergency cases require immediate treatment and if with a view to comply with the procedure one has to wait then it could be fatal. One may not in such cases life, if such a procedure is strictly followed. Thus, while the Supreme Court approved the principle to the extent State policy restrict the reimbursement of medical expenses with reference to designated hospital rates, denial of reimbursement of medical expenses altogether merely on the basis of the place where treatment has been taken because of not following the procedure laid down for securing such treatment was not approved.
11. In my opinion, although the petitioner got medical treatment in the private hospital but it is also admitted position of the case that he got treatment in emergent situation and paid huge amount for his treatment. Therefore, in the interest of justice, I deem it just and proper to direct the respondents to reimburse medical bills of the petitioner at the rate, which is applicable in the recognized hospital/institution notified under the Rules of 1970. It is also made clear that the petitioner will be entitled for medical reimbursement only for those expenditures which are enumerated in the Rules of 1970.
12. Accordingly, this writ petition is allowed. The respondents are directed to reimburse the medical bills to the petitioner at the rate which is applicable in the recognized Govt. hospitals/institutions notified under the Rules of 1970 within a period of three months from today.