JUDGMENT
Anil Dev Singh, J.
1. By this Letters Patent Appeal the appellant challenges the order of the
learned Single Judge dated May 1, 2002 in Civil Writ Petition No. 6717/99. By that
order the learned Single Judge declined to issue direction to the respondents to
reimburse the medical claim of the appellant in connection with his coronary bypass
surgery at Indraprastha Apollo Hospital, New Delhi, and consequently dismissed the
writ petition. The facts leading to the appeal are as follows:
2. The appellant is employed as a Trained Graduate Teacher in the senior
scale at Dau Dayal Arya Vedic Senior Secondary School, Naya Bans, Delhi. The
school is an aided school within the meaning of Delhi School Education Act, 1973.
On September 17, 1996, the appellant was diagnosed by the G.B. Pant Hospital,
Department of Cardiology, New Delhi, as a case of tipple vessel disease (TVD).
After the test, on September 19, 1996 he was discharged from the G.B. Pant Hospital
as his condition was found to be stable. The discharge summary of the appellant
prepared by the hospital, inter alia, revealed as follows-
“xx xx xx
Provisional CAG Report AO 146/80 LVEDP/
LM Osteal 50-60% Stenosis
LAD Proximal 75% Distal 90% Stenosis
Lex After XM 100% Block
RAC Dominent mild Plaquing in mid RCA
LV Angio Normal Contraclity
Condition of Discharge STABLE”
3. As per the investigation report of the aforesaid hospital, early surgical
revescularisation was recommended. It is claimed in the writ petition that after a
fortnight of his check up at G.B. Pant Hospital the condition of the appellant
deteriorated which necessitated a detailed medical check up. He is stated to have
been examined by one Dr. M.B. Gupta on October 5, 1996, and Dr. R.C. Bhatia of
Swami Dayanand Hospital, Shahdara, Delhi, on October 9, 1996. According to the
appellant, Dr. Bhatia advised immediate coronary bypass surgery. The appellant is
stated to have made an attempt for seeking an early date for his operation at the All
India Institute of Medical Sciences (AIIMS), but he did not succeed. On October 14,
1996, he was rushed to Indraprastha Apollo Hospital by his relatives. The doctors at
the Indraprastha Apollo Hospital admitted the appellant as an indoor patient on
October 14, 1996 as if was found that he needed an early surgery for his ailment. On
October 17, 1996 the appellant was operated upon at the Indraprastha Apollo Hospital
for coronary artery bypass grafting. After the operation the appellant was kept in the
aforesaid hospital for post operative care for about eight days.
4. On October 25, 1996 the appellant was discharged from the
Indraprastha Apollo Hospital. The total expenses for the treatment and operation at
Indraprastha Apollo Hospital including bills for medicines came to Rs. 1,30,238.90
which the appellant paid. On January 11, 1997, the appellant asked the respondent
for reimbursement of expenses incurred by him in connection with his operation and
treatment at Indraprastha Apollo Hospital. On July 27, 1997, the bills were returned
to the appellant without any action being taken in regard thereto by Department of
Education, Government of NCT of Delhi. The appellant again submitted the bills to
the Education Department of the Government of NCT of Delhi on July 29, 1997. The
Department of Education rejected the claim of the appellant for reimbursement on
August, 9, 1998. The decision was communicated by the Department of Education to
Dau Dayal Arya Vedik Senior Secondary School, which in turn transmitted the
aforesaid decision to the appellant on August 27, 1998.
5. On September 21, 1999 the appellant sent legal notices to the second
respondent-Director of Education, the third respondent-Deputy Director of Education
(North), and the fourth respondent-Chairman/Manager, Dau Dayal Arya Vedic Senior
Secondary School, asking them to pay a sum of Rs. 1,30,238.90, being the
expenditure incurred by the appellant on his treatment at Indraprastha Apollo Hospital.
The respondents did not respond to the legal notices sent on behalf of the appellant as
a result thereof he filed a writ petition, being CWP No. 6717/99. The learned Single
Judge, inter alia, came to the conclusion that Indraprastha Apollo Hospital was not a
hospital recognised by the Govt. of NCT of Delhi for treatment of C.G.H.S.
beneficiaries for coronary bypass surgery, and consequently rejected the writ petition
and claim of the appellant for reimbursement of the amount spend by him on his
treatment at Indraprastha Apollo Hospital, New Delhi. Aggrieved by the order
passed by the learned Single Judge, the appellant has filed the instant letters patent
appeal.
6. We have heard the learned counsel for the parties at some length. It was
vehemently argued by the learned counsel for the appellant that Indraprastha Apollo
Hospital has been accorded recognition for specialised and general purpose treatment
and diagnostic procedure for the C.G.H.S. beneficiaries, and since the appellant was
a C.G.H.S. beneficiary he was entitled for being treated at Indraprastha Apollo
Hospital. The learned counsel also contended that the appellant was taken to the
Indraprastha Apollo Hospital on October 14, 1996 by his relatives in view of the
medical emergency which arose due to his recurrent chest pain and dysponea and in
view of the fact that he was advised immediate operation. It may be recalled that the
AIIMS did not give an early date for operation to the appellant and in the
circumstances the appellant had to be rushed to the Indraprastha Apollo Hospital for
immediate treatment. It was also canvassed that the appellant has a fundamental
right under Article 21 of the Constitution of self preservation and he was entitled to
take treatment at a hospital in which he had full faith and confidence.
7. In contrast, the learned counsel for the respondents submitted that the
following three private hospitals were recognised for securing coronary bypass
surgery in the case of C.G.H.S. beneficiaries in Delhi:-
1. Batra Hospital and Medical Research Centre.
2. Escorts Health Institute and Research Centre.
3. National Heart Institute and Research Centre.
He also submitted that the persons covered by the Central Services (Medical
Attendance) Rules can get themselves treated for TVD at the following government
hospitals:-
1. Willingdon Hospital, New Delhi.
2. Safdarjung Hospital, New Delhi.
3. The All India Institute of Medical Sciences, New Delhi.
4. G.B. Pant Hospital, New Delhi.
8. In so far as the AIIMs is concerned it was submitted that the same was a
referral hospital and in the event of the appellant not wanting his surgery to be
performed at G.B. Pant Hospital, etc., he could have got his case referred to the
performed at G.B. Pant Hospital, etc., he could have got his case referred to the
AIIMS or any of the aforesaid three private hospitals. It was also submitted that
there was no emergency, which necessitated immediate admission of the appellant to
the Indraprastha Apollo Hospital. It was argued by the learned counsel for the
respondents that since the appellant was treated at a hospital which was not
recognised for the treatment of TVD, the appellant cannot claim reimbursement of the
amount spent by him for coronary bypass surgery and the claim was rightly declined
by the Government of NCT of Delhi.
9. We have considered the submissions of the learned counsel for the
parties. It appears to us that there was no need for long drawn arguments in the case
since the solution of the matter is a simple one.
10. It is the case of the respondents that the appellant could have got himself
treated at any of the three private hospitals, namely, Batra Hospital & Medical
Research Centre, Escorts Health Institute and Research Centre, and National Heart
Institute and Research Centre. It was also not disputed that in case the appellant
would have got the surgery performed at any of the aforesaid three hospitals, he
would have been reimbursed for the expenses incurred by him for his treatment.
This being so, it appears to us that the respondents should have been concerned only
with the fact whether or not the appellant got himself operated upon and whether or
not he incurred an expenditure of Rs. 1,30,238.90 on his treatment.
11. The respondents do not dispute the fact that the appellant was admitted
in the Indraprastha Apollo Hospital for coronary bypass surgery and he paid a sum of
Rs. 1,30,238.90 for the operation and medicines. According to the respondents, the
appellant could have availed of the facilities at Batra Hospital & Medical Research
Centre, Escorts Health Institute and Research Centre, and National Heart Institute
and Research Centre for his coronary bypass surgery. Keeping that in view the
respondents could have reimbursed the appellant to the extent of allowable expenses
for coronary bypass surgery at any of the aforesaid three hospitals. This seems to be
a reasonable view as once put into action it will not impose any extra financial
burden on the Government of NCT of Delhi, and at the same time it will remove the
hardship of the appellant who actually underwent coronary bypass surgery at
Indraprastha Apollo Hospital to save and preserve his life.
12. We may also note that it is not claimed by the respondents that the Govt.
of NCT of Delhi is holding any shares or financial interests in any of the hospitals,
namely, Batra Hospital & Medical Research Centre, Escorts Health Institute and
Research Centre, and National Heart Institute and Research Centre. As against this,
it is not disputed that the Government of NCT of Delhi is a major shareholder in the
Indraprastha Apollo Hospital. Therefore, we fail to appreciate as to why the
Government of NCT of Delhi declined the claim of the appellant when he took
treatment in the hospital in which the Government of NCT of Delhi has a share and a
abiding financial interest.
13. That apart, our attention has been drawn to the Government of India,
Ministry of Health and Family Welfare, O.M. No. S11011/16/94-CGHS/Desk-II/CMO(D)/CGHS(P),
dated September 18, 1996. This O.M. contains a list of
recognised private hospitals/diagnostic centres under C.G.H.S. in Delhi for
specialised and general purpose treatment and diagnostic procedure. This OM was
in operation when the appellant was operated upon on October 17, 1996. As already
noted, as per the stand of the Government of NCT of Delhi, Batra Hospital and
Medical Research Centre, Escorts Heart Institute and Research Centre, and National
Heart Institute and Research Centre are the ones recognised for coronary bypass
surgery. At this stage, it will be appropriate to quote from the aforesaid O.M. to the
extent it has a bearing on the subject in question:-
“xx xx xx
Batra Hospital and Medical Research Centre:-
Both specialized and General purpose treatment and diagnostic
procedure except MRI, Lithotripsy and Transplantation.
xx xx xx
18. Indraprastha Apollo Hospital:-
Specialized and General purpose treatment and diagnostic
procedures.
xx xx xx
23. Escorts Heart Institute & Research Centre:-
Cardiology, Cardiothoracic and Vascular Surgery.
24. National Hearth Institute & Research Centre:-
Cardiology, Cardiothoracic and Vascular Survey.
xx xx xx”
14. According to the O.M., both Batra Hospital and Medical Research
Centre and Indraprastha Apollo Hospital are recognised for specialised and general
purpose treatment. While in the case of Batra Hospital and Medical Research
Centre it is the stand of the respondents that it is recognised for the purpose of
coronary bypass surgery, in the case of Indraprastha Apollo Hospital it is stated that it
is not so recognised for the said procedure. We do not appreciate this distinction. In
case the stand of the Government of NCT of Delhi that Batra Hospital and Medical
Research Centre has been accorded recognition for treatment of CGHS beneficiaries
for coronary diseases, on the same analogy it has to be held that the CGHS
beneficiaries are entitled for treatment at Indraprastha Apollo Hospital for coronary
diseases as well since both the hospitals are recognised for specialised and general
purpose treatment. If in the case of Batra Hospital and Medical Research Centre
specialised and general purpose treatment includes ‘coronary bypass surgery’, there is
no reason why the same expression when used for Indraprastha Apollo Hospital
should not be given the same meaning.
15. For the foregoing reasons, we are of the view that the appellant is
entitled to reimbursement on account of money spent by him for coronary bypass
surgery and medicines at the Indraprastha Apollo Hospital, New Delhi, to the extent
of the expenses which he would have incurred for similar treatment at the Escorts
Heart Institute and Research Centre not exceeding Rs. 1,30,238.90. We order
accordingly. Accordingly, the appeal is allowed and the order of the learned Single
Judge is set aside.