1996 JTR(SC) 2181
1997 AIR(SC) 1225 ; 1997 AIR(SCW) 1260 ; 1997 91 FJR 332 ; 1997 1 JT 416 ; 1997 3 LLN 262 ; 1997 1 RSJ 681 ; 1997 1 Scale 135 ; 1997 2 SCC 83 ; 1997 SCC(Cri) 294 ; 1997 SCC(L&S) 294 ; 1996 Supp10 SCR 279 ; 1997 1 SCT 716 ; 1997 2 SLJ 25 ; 1997 1 SLR 745 ; 1997 KHC 692 ; 1997 1 KLT(Online) 1084 ; 1997 1 Supreme 546
1997(1) Supreme 546
SUPREME COURT OF INDIA
K. Ramaswamy and G. B. Pattanaik, JJ.
State of Punjab & Ors. -Appellants
versus
Mohinder Singh Chawla etc -Respondents
Civil Appeal No. 16979 of 1996
(Arising out of SLP (C) No. 12472 of 1996)
With
Civil Appeal Nos. 16980-81 of 1996
(Arising out of SLP (C) Nos. 12945 and 18828 of 1996)
Decided on 17-12-1996
Counsel for the Parties :
For the Appearing Parties : D.V. Sehgal, Sr. Advocate, H.S. Munjral, Manoj Swarup, M.K. Dua, Ms. Monika Gusain, P.N. Aggarwal, S. Bagga, A. Sharan, A.P. Singh, Advocates.
Act
Referred
:CONSTITUTION OF INDIA : Art.21
SERVICE LAW : .
(A) The right to health as an integral component of the right to life under Article 21 of the Constitution creates a constitutional obligation on the State to bear necessary medical expenses for government servants requiring specialized treatment not available in state hospitals. The Government Resolution dated January 25, 1991, which sought to deny reimbursement for room rent and attendant stay, cannot override this fundamental obligation when specialized treatment is sought and approved under the medical referral system. The provisions of the service law interact with constitutional rights, requiring the State to fulfill its duty to provide healthcare infrastructure by reimbursing actual expenses incurred for inpatient treatment, including room rent, when such treatment is essential and authorized.
(B) Key legal principles include: the constitutional right to health under Article 21, the State's obligation to reimburse necessary medical expenses for government servants, the integration of room rent as part of essential treatment costs, and the invalidity of administrative policies that deny such reimbursement when specialized care is availed.
Facts of the case:
The respondent, a government servant, suffered from a heart ailment requiring valve replacement. Since specialized treatment was unavailable in Punjab state hospitals, permission was granted to undergo treatment at AIIMS, New Delhi. The respondent submitted the medical bill for reimbursement; while actual expenses were reimbursed, the appellants rejected reimbursement for room rent. The respondent contended that room rent is an integral part of treatment expenses. The Division Bench directed reimbursement of the room rent, leading to this appeal.
Findings of Court:
The court held that when specialized treatment is not available in state hospitals and the patient is referred to an approved private hospital, expenses incurred for room rent during inpatient treatment are an integral part of the treatment expenditure. The state cannot deny reimbursement merely because the costs are incurred at a different rate than another institution, as this would defeat the purpose of providing necessary medical care. The High Court was correct in directing reimbursement of the room rent.
Issues:
Whether the state is obligated to reimburse room rent for inpatient treatment when specialized medical care is sought outside state hospitals under a medically approved referral? Whether a government policy denying such reimbursement overrides constitutional rights to health under Article 21?
Ratio Decidendi:
The constitutional right to health under Article 21 imposes a duty on the State to bear the cost of necessary medical treatment, including room rent, when specialized care is not available domestically and the treatment is approved through official channels. Administrative policies denying reimbursement of integral treatment expenses are invalid against fundamental rights.
Result:
The appeal is dismissed, and the order of the Division Bench directing reimbursement of room rent is upheld. No costs are awarded.
(A) The right to health as an integral component of the right to life under Article 21 of the Constitution creates a constitutional obligation on the State to bear necessary medical expenses for government servants requiring specialized treatment not available in state hospitals. The Government Resolution dated January 25, 1991, which sought to deny reimbursement for room rent and attendant stay, cannot override this fundamental obligation when specialized treatment is sought and approved under the medical referral system. The provisions of the service law interact with constitutional rights, requiring the State to fulfill its duty to provide healthcare infrastructure by reimbursing actual expenses incurred for inpatient treatment, including room rent, when such treatment is essential and authorized.
(B) Key legal principles include: the constitutional right to health under Article 21, the State's obligation to reimburse necessary medical expenses for government servants, the integration of room rent as part of essential treatment costs, and the invalidity of administrative policies that deny such reimbursement when specialized care is availed.
Facts of the case:
The respondent, a government servant, suffered from a heart ailment requiring valve replacement. Since specialized treatment was unavailable in Punjab state hospitals, permission was granted to undergo treatment at AIIMS, New Delhi. The respondent submitted the medical bill for reimbursement; while actual expenses were reimbursed, the appellants rejected reimbursement for room rent. The respondent contended that room rent is an integral part of treatment expenses. The Division Bench directed reimbursement of the room rent, leading to this appeal.
Findings of Court:
The court held that when specialized treatment is not available in state hospitals and the patient is referred to an approved private hospital, expenses incurred for room rent during inpatient treatment are an integral part of the treatment expenditure. The state cannot deny reimbursement merely because the costs are incurred at a different rate than another institution, as this would defeat the purpose of providing necessary medical care. The High Court was correct in directing reimbursement of the room rent.
Issues:
Whether the state is obligated to reimburse room rent for inpatient treatment when specialized medical care is sought outside state hospitals under a medically approved referral? Whether a government policy denying such reimbursement overrides constitutional rights to health under Article 21?
Ratio Decidendi:
The constitutional right to health under Article 21 imposes a duty on the State to bear the cost of necessary medical treatment, including room rent, when specialized care is not available domestically and the treatment is approved through official channels. Administrative policies denying reimbursement of integral treatment expenses are invalid against fundamental rights.
Result:
The appeal is dismissed, and the order of the Division Bench directing reimbursement of room rent is upheld. No costs are awarded.
ORDER
In. CA No. 16979/96 @ SLP (C) No. 12472 of 96 :
Leave granted.
2. This appeal by special leave arises from the judgment and order of the Division Bench of the Punjab & Haryana High Court, made on August 8, 1996 in CWP No. 15942/95.
3. The respondent had 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 September 21, 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 writ petition stating that when he had undergone the treatment in the hospital as an inpatient, 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 appellants-State that the Government have taken decision, as a policy in the Resolution dated January 25, 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 inpatient are an integral part of the expenses incurred for the said treatment. Take, for instance, a case where an inpatient 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 integral part of the expenditure incurred towards treatment. It is now settled law that right to health is an integral to right to life. Government has constitutional obligation to provide the 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 of 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 inpatient.
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 the 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 fulfill 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. 12945/96 - State of Punjab & Ors. v. Waryam Singh :
7. Leave granted.
Heard learned counsel on both sides.
8. While the respondent was a Government servant, he had developed sudden coronary ailment. After required angiography and other reports of tripple vessets disease was diagnosed in CMC Hospital, Ludhiana and he was recommended by the said hospital to go over no Escorts Hearts Institute, New Delhi for urgent treatment. On its basis, the respondent had had the treatment. The Medical Board granted by its proceedings dated January 12, 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 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 April 12, 1996 in CWP No. 16570/95, the Division Bench allowed the writ petition. Thus, this appeal by special leave.
9. 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 dependents, as per rules, the Government has imposed a condition to pay room rent at the rates charges 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 inpatient in the hospital, for rent.
10. We are unable to agree with the stand taken by the Government. It is seen that the Government had decided in the proceedings dated October 8, 1991 to reimburse the medical expenditure incurred by the Punjab Government employees/pensioners and dependents on treatment taken abroad in private hospital. It is stated in paragraph 2 and 3 that the Government has prepared a list of those diseases for which the specialised treatment is not available in Punjab Government Hospitals but it is available in certain identified private hospitals, both within and outside the States. 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 dependents. 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 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 hospital/institution. Thus, for open heart surgery or heart disease the Escort Heart Institute is 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 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 and 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.
11. The appeal is disposed of accordingly. No costs.
In CA @ SLP (C) No. 18828/96 :
Leave granted.
Heard counsel for the parties.
The appeal is disposed of in terms of order passed in CA No. 16980/96 @ SLP (C) No. 12945/96.
Appeal dismissed/disposed of accordingly.
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