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State Of Punjab And Others v. Mohinder Singh Chawla And Others
Factual and Procedural Background
The judgment consolidates three civil appeals arising out of writ petitions decided by the Punjab and Haryana High Court. In each matter a Punjab government employee (or pensioner) suffered a serious cardiac ailment that required specialised surgery unavailable in State-run hospitals. Acting on recommendations of a Medical Board, the employees were permitted—sometimes ex post facto—to undergo treatment at tertiary institutions outside Punjab (AIIMS, New Delhi and Escorts Heart Institute, New Delhi). After successful surgery, each employee sought full reimbursement of medical expenses. While the State reimbursed costs of surgery and related treatment, it disallowed the component representing room rent charged by the hospitals, invoking a 25-1-1991 Government Resolution that excluded “stay of patient in hotel/hospital” from admissible reimbursement. The High Court directed the State to reimburse the disallowed room rent, prompting these appeals by special leave to the Supreme Court.
Legal Issues Presented
- Whether, under the Punjab Government’s medical reimbursement policy and the constitutional right to health, room rent paid during authorised in-patient treatment at an approved hospital constitutes an integral part of “expenses for treatment” and must therefore be fully reimbursed.
- Whether the State can lawfully limit reimbursement of room charges to the tariff of another institution (AIIMS) when the employee actually underwent treatment in a different but Government-recognised private hospital (e.g., Escorts Heart Institute).
Arguments of the Parties
Appellant-State’s Arguments
- Government policy letter dated 25-1-1991 expressly declares that expenses on “diet, stay of attendant and stay of patient in hotel/hospital” are non-admissible; room rent must therefore be excluded from reimbursement.
- Even if reimbursement is allowed, it should be capped at the room rent rates charged by AIIMS, not the higher charges of a private hospital, so as to avoid an excessive fiscal burden and to preserve resources for general patients.
Respondents’ Arguments
The opinion does not contain a detailed account of the respondents’ legal arguments.
Table of Precedents Cited
No precedents were cited in the provided opinion.
Court's Reasoning and Analysis
The Court rejected the State’s reliance on the 1991 Resolution, holding that once the Medical Board authorised treatment at an identified specialised hospital, every expenditure “inevitably and intrinsically connected” with that treatment — including room rent during in-patient stay — forms part of the treatment cost. The Court relied on three principal strands of reasoning:
- Integral nature of room rent: Admission to hospital is inseparable from the surgical procedure; without accommodation the treatment could not be administered. Therefore, room rent cannot be carved out from “treatment expenses”.
- Constitutional obligation: Citing the settled proposition that the right to health is integral to Article 21’s right to life, the Court emphasised the State’s duty to provide and finance necessary medical care for its employees.
- Policy consistency and non-discrimination: The government itself had recognised specific private hospitals (e.g., Escorts Heart Institute) for open-heart surgery because such facilities were absent in Punjab. It would be incongruous and arbitrary to reimburse at AIIMS rates when the patient never availed AIIMS services.
The fiscal argument advanced by the State was acknowledged but ultimately outweighed by the constitutional imperative and the government’s own policy decisions approving external specialised treatment.
Holding and Implications
All three appeals were dismissed or otherwise disposed of in favour of the employees. The Supreme Court affirmed the High Court’s directions requiring the State of Punjab to reimburse the full room rent (e.g., Rs 20,000 in one appeal) incurred during authorised treatment.
Implications: The ruling clarifies that, for Punjab government employees who receive duly authorised specialised treatment at recognised hospitals, room charges constitute a reimbursable component of medical expenses. Although the judgment is confined to the facts and the State’s existing policies, it reinforces the broader constitutional principle that financial limitations cannot dilute the State’s obligation to ensure comprehensive medical care for its employees.
Order
In CA No. 16979 of 1996 @ SLP (C) No. 12472 of 1996
1. Leave granted.
2. This appeal by special leave arises from the judgment and order of the Division Bench of the Punjab and Haryana High Court, made on 8-8-1996 in CWP No. 15942 of 1995.
3. The respondent had a heart ailment which required replacement of two valves in the heart. Since the facility of the treatment was not available in the State hospitals of Punjab, permission was given by the Director, with the approval of the Medical Board, to get the treatment outside the State. The respondent was sent for and had treatment in the AIIMS at New Delhi. The respondent submitted his medical bill on 21-9-1994 for reimbursement. While granting reimbursement for the actual expenses incurred in the sum of Rs 1,29,000, the appellants rejected his bill for room rent paid to the hospital as inadmissible. The respondent filed a writ petition stating that when he had undergone the treatment in the hospital as an in-patient, the payment of the room rent is an integral part of the expenses for treatment and, therefore, he is entitled to the reimbursement of the room rent paid. The Division Bench directed payment of the said amount. Thus, this appeal by special leave.
4. It is contended for the appellant-State that the Government have taken decision, as a policy in the Resolution dated 25-1-1991 made in Letter No. 7/7/85/5HBV/2498, that the reimbursement of expenses on account of diet, stay of attendant and stay of patient in hotel/hospital will not be allowed. Permission given was subject to the above resolution and, therefore, the High Court was not right in directing the Government to bear the expenses for the stay in the hotel/hospital contrary to para (vii) of the Resolution of the Government. We find no force in the contention. It is an admitted position that when specialised treatment was not available in the hospitals maintained by the State of Punjab, permission and approval having been given by the Medical Board to the respondent to have the treatment in the approved hospitals and having referred him to the AIIMS for specialised treatment where he was admitted, necessarily, the expenses incurred towards room rent for stay in the hospital as an in-patient are an integral part of the expenses incurred for the said treatment. Take, for instance, a case where an in-patient facility is not available in a specialised hospital and the patient has to stay in a hotel while undergoing the treatment, during the required period, as certified by the doctor, necessarily, the expenses incurred would be an integral part of the expenditure incurred towards treatment. It is now settled law that right to health is integral to the right to life. Government has a constitutional obligation to provide health facilities. If the government servant has suffered an ailment which requires treatment at a specialised approved hospital and on reference whereat the government servant had undergone such treatment therein, it is but the duty of the State to bear the expenditure incurred by the government servant. Expenditure, thus, incurred requires to be reimbursed by the State to the employee. The High Court was, therefore, right in giving direction to reimburse the expenses incurred towards room rent by the respondent during his stay in the hospital as an in-patient.
5. The learned counsel then contends that the State would be saddled with needless heavy burden, while other general patients would not be able to get similar treatment. We appreciate the stand taken that greater allocation requires to be made to the general patients but unfortunately due attention for proper maintenance and treatment in government hospitals is not being given and mismanagement is not being prevented. Having had the constitutional obligation to bear the expenses for the government servant while in service or after retirement from service, as per the policy of the Government, the Government is required to fulfil the constitutional obligation. Necessarily, the State has to bear the expenses incurred in that behalf.
6. The appeal is accordingly dismissed. No costs.
In CA @ SLP (C) No. 12945 of 1996 — State of Punjab v. Waryam Singh
7. Leave granted.
8. Heard learned counsel on both sides.
9. While the respondent was a government servant, he had developed sudden coronary ailment. After required angiography and other reports of triple vessels disease was diagnosed in CMC Hospital, Ludhiana and he was recommended by the said hospital to go over to Escorts Heart Institute, New Delhi for urgent treatment. On its basis, the respondent had had the treatment. The Medical Board granted by its proceedings dated 12-1-1969, ex post facto sanction for treatment with one attendant. The appellant had granted reimbursement of a sum of Rs 1,03,267 less the rent paid for the room in the hospital for the period of stay. It is the Government's stand that the reimbursement could be allowed as per rates charged by the All India Institute of Medical Sciences. Accordingly, a sum of Rs 20,000 paid as rent was deducted. When the respondent filed the writ petition, the High Court, by judgment dated 12-4-1996 in CWP No. 16570 of 1995, the Division Bench allowed the writ petition. Thus, this appeal by special leave.
10. It is contended for the State that though the Government had granted ex post facto sanction through the Medical Board and permitted the patient to undergo treatment outside the State with the policy, for reimbursement of medical expenses incurred and the medical treatment taken in the hospital to the government servant/pensioners or dependants, as per rules, the Government has imposed a condition to pay room rent at the rates charged by the AIIMS for stay in the hospital. The reimbursement will be given at those rates. The Government, therefore, is not obliged to pay the actual expenses incurred by the patient while taking the treatment as in-patient in the hospital, for rent.
11. We are unable to agree with the stand taken by the Government. It is seen that the Government had decided in the proceedings dated 8-10-1991 to reimburse the medical expenditure incurred by the Punjab Government employees/pensioners and dependants on treatment taken abroad in a private hospital. It is stated in paragraphs 2 and 3 that the Government has prepared a list of those diseases for which the specialised treatment is not available in the Punjab Government hospitals but it is available in certain identified private hospitals, both within and outside the State. It was, therefore, decided to recognise these hospitals for treatment of the diseases mentioned against their names in the enclosed list for the Punjab Government employees/pensioners and their dependants. The terms and conditions contained in the letter under reference would remain applicable. The Government can, however, revise the list in future. The name of the disease for which the treatment is not available in the Punjab Government hospitals is shown as Open Heart Surgery and the name of the private hospital is shown as Escorts Heart Institute, New Delhi as one of the approved hospitals/institutions. Thus, for open heart surgery or heart disease the Escorts Heart Institute is an authorised and recognised institution by the Government of Punjab. Consequently, when the patient was admitted and had taken the treatment in the hospital and had incurred the expenditure towards room charges, inevitably the consequential rent paid for the room during his stay is an integral part of his expenditure incurred for the treatment. Consequently the Government is required to reimburse the expenditure incurred for the period during which the patient stayed in the approved hospital for treatment. It is incongruous that while the patient is admitted to undergo treatment, he is refused the reimbursement of the actual expenditure incurred towards room rent and is given the expenditure of the room rent chargeable in another institute whereat he had not actually undergone treatment. Under these circumstances, the contention of the State Government is obviously untenable and incongruous. We hold that the High Court was right in giving the direction for reimbursement of a sum of Rs 20,000 incurred by the respondent towards the room rent for his stay while undergoing treatment in Escorts Heart Institute, New Delhi.
12. The appeal is disposed of accordingly. No costs.
In CA @ SLP (C) No. 18828 of 1996
13. Leave granted.
14. Heard counsel for the parties.
15. The appeal is disposed of in terms of order passed in CA No. 16980 of 1996 @ SLP (C) No. 12945 of 1996.
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