Whether government can refuse to reimburse medical claim of its employee if hospital in which he has taken treatment is not included in government order?

It is a settled legal position that the Government employee during his life time or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the Doctor, who is well versed and expert both on academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality Hospitals are established for treatment of specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive a person to claim reimbursement solely on the ground that the said Hospital is not included in the Government Order. The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment. Before any medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by Doctors/Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds. Clearly, in the present case, by taking a very inhuman approach, the officials of the CGHS have denied the grant of medical reimbursement in full to the Petitioner forcing him to approach this Court. {Para 13}

14. This is hardly a satisfactory state of affairs. The relevant authorities are required to be more responsive and cannot in a mechanical manner deprive an employee of his legitimate reimbursement. The Central Government Health Scheme (CGHS) was propounded with a purpose of providing health facility scheme to the central government employees so that they are not left without medical care after retirement. It was in furtherance of the object of a welfare State, which must provide for such medical care that the scheme was brought in force. In the facts of the present case, it cannot be denied that the writ Petitioner was admitted in the above said hospitals in emergency conditions. Moreover, the law does not require that prior permission has to be taken in such situation where the survival of the person is the prime consideration. The doctors did his operation and had implanted CRT-D device and have done so as one essential and timely. Though it is the claim of the Respondent-State that the rates were exorbitant whereas the rates charged for such facility shall be only at the CGHS rates and that too after following a proper procedure given in the Circulars issued on time to time by the concerned Ministry, it also cannot be denied that the Petitioner was taken to hospital under emergency conditions for survival of his life which requirement was above the sanctions and treatment in empanelled hospitals.

 IN THE SUPREME COURT OF INDIA

Writ Petition (Civil) No. 694 of 2015 (Under Article 32 of the Constitution of India)

Decided On: 13.04.2018

Shiva Kant Jha Vs. Union of India (UOI)

Hon'ble Judges/Coram:

R.K. Agrawal and Ashok Bhushan, JJ.

Author: R.K. Agrawal, J.

Citation: AIR 2018 SC 1975,MANU/SC/0369/2018.

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Whether family members of accused can directed to bear medical expenses of accused?

 Learned counsel for the petitioner stated that the
injection costs about Rs. 10,000/- and at some places, on
account of discount, it is available for almost Rs. 8000/-,
however, the family of the petitioner is asked to supply the
said injection and other medicines by the Hospital
Authorities. This situation cannot be countenanced. It is the

duty of the State to take care of the petitioner who is in their
custody.
5. In Pt. Parmanand Katara vs. Union of India and
ors. - (1989) 4 SCC 286, the Hon'ble Supreme Court has
held that Article 21 of the Constitution casts the obligation
on the State to preserve life. The patient, whether he be an
innocent person or be a criminal liable to punishment under
the laws of the society, it is the obligation of those who are in
charge of the health of the community to preserve life.
6. In Rama Murthy vs. State of Karnataka – (1997) 2
SCC 642, the Hon'ble Supreme Court, after reference to the
recommendations in the Mulla Committee report has held
that the society has an obligation towards prisoner's health
for two reasons. First, the prisoners do not enjoy the access
to the medical expertise that free citizens have. Their
incarceration places limitation of such access; no physician
of choice, no second opinion, and few if any specialists.
Secondly, because of the conditions of their incarceration,
inmates are exposed to more health hazards than free

citizens. Prisoners therefore, suffer from a double handicap.
7. Even recently, in Re-Inhuman Conditions in 1382
Prisons – (2017) 10 SCC 658, the Hon'ble Supreme Court
has reiterated that providing medical facilities to inmates in
prisons is a human right. The State Governments were
directed to state the availability of the medical assistance to
the prisoners and take remedial steps wherever necessary.
8. Taking into consideration the aforesaid legal position
enunciated by the Hon'ble Supreme Court, we were unable
to accept the approach of the respondents in the present
case. The record indicates that the Doctors who are treating
the petitioner have themselves advised that the petitioner
must be administered certain medications. The State, in such
circumstances, cannot avoid its responsibility or require the
petitioner or his relatives to arrange for such medicines,
particularly when there is material on record which indicates
that neither the petitioner nor his relatives are really in a
position to afford such medicines. In this view of the matter,

by order dated 13.3.2018 passed by this Court, it was
directed that adequate arrangements be made to see that
the petitioner is provided the injections as well as other
medicines required by him as advised by the doctor at State
cost. In order to see that this order is complied with, we had
adjourned the matter from time to time.
IN THE HIGH COURT OF JUDICATURE AT BOMBAY
CRIMINAL APPELLATE JURISDICTION
CRIMINAL WRIT PETITION NO. 5301 OF 2017

Ajaysingh Kuvarsingh Dahiya Vs The State of Maharashtra & Anr. 


CORAM : SMT. V.K. TAHILRAMANI, Acting C.J. &
M.S. SONAK, J.
DATE : JUNE 18, 2018.

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