M.A. Haque (Dr.) v. Union Of India

Full Medical reimbursement and denial thereof on the ground that medicines and accommodation are to be deducted and not to be treated as part of the medical reimbursement, is the claim of applicant.

2. The factum of emergency and treatment of applicant in Escorts Heart Institute for angiographies and angioplasty is not disputed. Applicant was reimbursed a sum of Rs.99,805/- from out of a claim of Rs.1,59,412/-. The legal notice on 10.08.2006 was responded to on the ground that room charges, consultation fees and medicines, above the package rates, are not admissible and hence not paid.

3. Learned counsel of applicant states that in a decision by the High Court of Delhi in J.K. Saxena v. Govt. of N.C.T. of Delhi (WP(C) No.5015/2003) decided on 16.12.2004, having granted full reimbursement, Ministry of Health and Family Welfare notification dated 29.06.2006 re-iterates that no orders have been passed pursuant to the decision of the High Court by the Ministry of Health and Family Welfare.

4. Learned counsel relies upon a decision of the Apex Court in Suman Rakheja v. State of Haryana and another, (2004) 13 SCC 562 to contend that full medical reimbursement has to be accorded as the paramount importance is preserving ones life under Article 21 of the Constitution of India. Reliance is also placed on a decision of the Apex Court in Surjit Singh v. State of Punjab, (1996) 2 SCC 336.

5. Respondents have been confronted with the aforesaid position to comment upon on 5.11.2007. As the aforesaid has not been done, despite accord of an opportunity, when not availed of, reply reiterated Ministry of Health letters dated 18.09.96 and 13.06.99 where the package rates exclude the cost of medicines, accommodation etc. It is stated that the rejection was rightly done as per the rules and being a CGHS beneficiary applicant is bound by the CGHS rules.

6. I have carefully considered the rival contentions of the parties and perused the material on record.

7. Right to life is paramount under Article 21 of the Constitution of India. Government as a welfare employer cannot be absolved of their obligation to grant medical reimbursement in the light of the scheme framed. The package rates and inclusion of the cost of medicines etc. has been a subject matter before the High Court in J.K. Saxena (supra) where full medical reimbursement has been accorded. Ministry of Health and Family Welfare despite several decisions of the High Court having failed to implement the directions by issuing an administrative order vide OM and their endeavor to challenge them by way of SLP, being a legal right bestowed upon, would not absolve them from complying with the directions. Applicant, who is similarly circumstanced is certainly entitled to extension of the benefit of the decision in J.K. Saxena (supra). Moreover, in Suman Rakheja (supra) the Apex Court even in a case of non-recognized and non-approved CGHS hospital, in case of emergency, accorded full reimbursement to the extent stated therein, applicant herein cannot be denied full reimbursement on that count alone.

8. In the result, for the foregoing reasons, OA is allowed. Respondents are directed to reimburse to applicant the remaining amount in the context of his claim of Rs.1,59,412/- within one month from the date of receipt of a copy of this order. No costs. (Shanker Raju) Member (J) San.