Gurugram: Patients facing life-threatening emergencies cannot be expected to wait for admission at overburdened empanelled hospitals, and therefore they cannot be denied reimbursement for treatment at non-empanelled facilities, the Punjab and Haryana High Court has held.
Rejecting the Haryana government’s formula of reimbursing medical expenses at AIIMS rates, Justice Sandeep Moudgil directed the state government on 16 January to pay over Rs 4.2 lakh to a government employee whose wife underwent emergency surgery at a private hospital in Delhi, observing that the right to life under Article 21 mandates timely and effective medical care.
“In emergent and life-threatening situations, a patient or attendant has no real or meaningful choice to wait for admission or treatment at PGIMER,” Justice Moudgil said, adding that while PGIMER and AIIMS are premier institutions, they are often overburdened with critically ill patients, resulting in long waiting periods.
The court was hearing a petition filed by Suresh Kumar, who incurred medical expenses of Rs 4,63,770 on emergency treatment of his wife, Poonam, at Indraprastha Apollo Hospital in Delhi in August 2014. She was admitted to the obstetrics and gynaecology department in critical condition, and her uterus and gallbladder had to be removed. She also underwent hernia surgery.
The Haryana government sanctioned only Rs 43,005 in May 2020 — nearly six years after the treatment — arguing that the hospital was not empanelled and reimbursement could only be made at PGIMER/AIIMS rates.
Justice Moudgil rejected this stand as “wholly misconceived, arbitrary, and unsustainable in law”.
“Denial of full reimbursement of the actual expenditure incurred amounts to penalising the petitioner for circumstances not attributable to him and defeats the very object and purpose of the medical reimbursement policy,” the judge observed.
The high court observed that the petitioner was compelled by circumstances to get emergency treatment for his wife.
Even after obtaining the required emergency certificate from the Civil Surgeon, Karnal, in August 2015, and complying with all objections raised by the authorities, his claim remained unprocessed for years.
Kumar filed an earlier writ petition in 2017, which he withdrew in 2019 with liberty to file a fresh one.
The state contended Kumar was not entitled to relief beyond what was sanctioned under the Medical Reimbursement Policy and that he was attempting to circumvent policy provisions.
But Justice Moudgil held that once the fact of treatment was established, reimbursement cannot be denied on technical grounds.
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The precedents
Citing the Supreme Court’s judgment in the 2018 Shiva Kant Jha v. Union of India case that medical reimbursement cannot be denied merely because treatment was taken in a non-empanelled or private hospital, the court said the real test is whether the claimant actually underwent bona fide treatment.
The court also referred to landmark Supreme Court judgments in the State of Punjab v. Mohinder Singh Chawla and Paschim Banga Khet Mazdoor Samity v. State of West Bengal cases, emphasising that the right to medical reimbursement flows from the fundamental right to life.
In the 1997 State of Punjab v. Mohinder Singh Chawla case, the court held that the right to health is integral to the right to life under Article 21. Similarly, in the 1996 Paschim Banga Khet Mazdoor Samity v. State of West Bengal case, the court ruled that failure of government hospitals to provide timely treatment violates Article 21.
“The 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 whereas the Government servant had undergone such treatment therein, it is but the duty of the State to bear the expenditure,” the court said.
Justice Moudgil also pulled up the authorities for the prolonged delay in issuing the reimbursement. “The petitioner has suffered undue and prolonged delay of several years in obtaining reimbursement of his legitimate medical expenses, solely on account of the callous and indifferent approach of the authorities,” the judge observed.
The court directed the state to pay the remaining amount of Rs 4,20,766 along with 6 percent interest from the date it fell due till actual realisation, within four weeks.
(Edited by Sugita Katyal)