MUNICIPAL CORPORATION OF DELHI vs O P KACHRU

THE Counsel for the respondent has appeared on his own and has argued the matter and as such the appeal is being decided on merits.

ADMITTEDLY respondent is a life time member of medical scheme facilities for retired employees launched by the appellant. Respondent suffered heart disease and was admitted in the Hindu Rao Hospital. However, Hindu Rao Hospital referred it to another recognized hospital namely Escorts Heart Institute for treatment. There he incurred expenses of Rs. 2,25,465. However, he was reimbursed only Rs. 1,55,000 as per the terms of the scheme. Feeling aggrieved the respondent filed the instant complaint before the District Forum seeking payment of the balance amount. Vide impugned order dated 6. 3. 2007 the District Forum has directed the appellant to reimburse the entire amount of the medical claim incurred by the respondent i. e. , Rs. 2,25,465 excluding the amount of Rs. 1,55,000 which had already been paid to the respondent by the appellant and pay Rs. 20,000 as compensation by way of damages and Rs. 5,000 as cost of litigation.

Through this appeal the impugned order has been assailed mainly on the ground that as per Corrigendum dated 23. 10. 2001 whereby the beneficiary was allowed to take treatment in private hospitals including the Escort Heart Institute but subject to condition that the reimbursement will be restricted to package rates approved by the Ministry vide its OM No. S. 11011/16/94cghs (P) dated 18th September, 1996 and OM No. Rec. 24/2001/jd (M)/chgs/delhi/cghs (P.) dated 7th September, 2001 and as per the package rates, the respondent was entitled only for amount of Rs. 1,55,000.

THE District Forum relied upon the decision of the Delhi High Court in the case of Mr. J. K. Saxena v. Government of NCT of Delhi reported in 117 (2005) DLT 451, wherein the facts of the case were almost identical and it was held that under Central Services (Medical Attendance) Rules, Government servant is entitled for treatment free of charge at Government Hospital or empanelled hospital for special treatment and is entitled to full reimbursement of the amount spent on his treatment. The Notification of the Government relied upon by the appellant is mainly in the nature of limiting the package rates notified by the Ministry which is more or less an administrative decision and, therefore, cannot supersede the statutory rules namely Central Services (Medical Attendance) Rules which provide that every Government servant is entitled for treatment free of charge at Government Hospital or empanelled hospital for special treatment and is entitled to full reimbursement of the amount spent on his treatment. In our view, once the Government or any public authority or statutory authority decides to bring private hospitals on their panel may be for any reason then it has no power to limit the expenses in these hospitals under the garb of package rates. To us it appears that these hospitals are empanelled to get the treatment in case of emergency or in case where the satisfactory or effective treatment is not available in the Government Hospital or hospital run by an Organisation of which the employee is member of the scheme like Central Govt. Health Scheme or medical benefit of retired scheme.

SOMETIMES the package rates are abysmally low than the actual rates, the empanelled hospitals thereby put the beneficiary or the employee in jeopardy making him pay from his own pocket in spite of the fact that he under the rules is entitled to treatment free of charge irrespective of whether he receives treatment of Govt. Hospital or private empanelled hospital. We even go to the extent that such an employee who under Central Services (Medical Attendance) Rules is entitled for free treatment is entitled for reimbursement to the entire expenses incurred by him at the said hospital if he lands in any hospital irrespective of the fact whether it is on the panel or not. Rules have statutory force whereas administrative guidelines or institutions are directory and have no mandatory value. Instructions or guidelines cannot have precedence over the Rules. In the instant case, the hospitals on panel are of very high repute and charging very huge fees even from ordinary patients. There are Sir Ganga Ram Hospital, Escort Heart Institute, Indraprastha, Apollo Hospital, Batra Hospital, etc. To deny the beneficiary of the scheme, the expenses incurred by him at these hospitals and restrict the expenses by way of some administrative decision by prescribing the package rates, is illegal, arbitrary and against the interests of the employee and is violative of the statutory rules namely Central Services (Medical Attendance) Rules.

IF a person lands in emergency in nearby or highly equipped hospital including the empanelled hospital and is fighting for life and is told that whatever be the expenses he would be paid according to the package rates he may die instantly due to shock and to expect such an employee to leave in the midst of the treatment and go to a hospital where he would be charged as per the package rates is inhuman and against the concept of ''free treatment''.

IN our view, the purpose and objective of bringing the private hospitals on the panel is to lighten the burden of Govt. Hospitals and for better protection of health of the employee and to subject a patient/employee to recommendation of the Government Hospitals or the reference by Government dispensary is against the very object for which the private hospitals are empanelled. In case of emergency, a person may not be able to go to Govt. Hospital or a dispensary for seeking a reference before being taken to the empanelled hospital or the nearby hospital to save his life. To restrict the benefit of statutory Rules by administrative instructions is not permissible. Such instructions or Memos or Office Memorandums are to be in the nature of putting the life of employee at risk.

Once an organization or an employer extends the medical benefits to its employees free of charge it has to reimburse the entire expenses incurred by him particularly when he receives a treatment at the empanelled hospital.

FOREGOING reasons persuade us to dismiss the appeal being misconceived and misdirected. The impugned order shall be complied with within one month from the date of receipt of this order.

BANK Guarantee/fdr, if any furnished by the appellant, be returned forthwith. A copy of this order as per the statutory requirements be forwarded to the parties free of charge and also to the concerned District Forum and thereafter the file be consigned to Record Room. Copy of order be sent to Presidents of all the District Fora. Appeal dismissed.