S. Karunamoorthy vs The Chairman Chennai Port Trust, The Chennai Port Trust and Balaji Dental and Craniofacial Hospital

T. Raja, J.—The Petitioner-S. Karunamoorthy has filed the present Writ Petition seeking for the issuance of a Writ of Mandamus, directing

Respondents 1 to 3 to pay the bill amount of Rs. 3,50,000/-vide Bill No. 2025 dated 26.05.2010 raised by the fourth Respondent Hospital herein

for the Cleft Maxillary Distraction treatment done on the Petitioner''s son Master.K. Ganesh.

Learned Counsel appearing for the Petitioner submitted that the Petitioner is working as Office Superintendent in the office of the first

Respondent, viz., the Chennai Port Trust. The Chennai Port Trust Hospital was established by the Port Trust for the purpose of giving treatment to

its employees and their family members. Though most of the facilities are available in the Hospital, if any special treatment is required, which is not

available in the Hospital, the employees are entitled to take treatment at the Speciality/Private Hospitals. In such a situation, the employee has to

obtain the quotation from the Hospitals and get necessary sanction from the authorities of the Port Trust, and only after grant of proper sanction,

the private Hospital would do the necessary medical treatment and thereafter, the medical treatment bills would be submitted to the Chennai Port

Trust and the same would be paid by the Port Trust directly to the said Speciality Hospital, as per Regulation 8(a) of the Madras Port Trust

Employees'' (Medical Attendance in the Trust''s Hospital and Reimbursement of Hospital Charges) Regulations, 1994. While so, the Petitioner''s

son Master K. Ganesh, who was aged about 16 years and struggling for life due to Bilateral Cleft Lip and Palate deformity, was taken to the

Chennai Port Trust Hospital for treatment. As specialised treatment required for treating the above said deformity and the same was not available

with the Chennai Port Trust Hospital, the said Hospital referred the Petitioner''s son for taking treatment from the Guest Hospital, Chennai. After

taking preliminary treatment there, the Petitioner approached Balaji International Dental Craniofacial Hospital & Reserach Institute, the fourth

Respondent herein, after getting proper sanction from the competent authority. A certificate was also issued by Dr. S.M. Balaji, stating that he

examined the Master K. Ganesh, S/o.S. Karunamoorthy, for the ailment i.e., Bilateral Cleft Lip and Palate, and advised him to admit in Isabel

Hospital, Chennai - 4, for surgery. The said Doctor further stated that the patient needs ten days'' hospitalisation and estimated the cost for all

expenses about Rs. 32,000/-in his letter dated 21.04.2001. Subsequently, by another communication issued by the Chennai Port Trust dated

04.05.2001 Isabel Hospital Chennai-4 has show that after completing the second and third stages, the Petitioner finally took his son to the fourth

Respondent viz., Dr. S.M. Balaji, Balaji Dental and Craniofacial Hospital, after getting estimation on 10.05.2007. Thereafter, the Petitioner also

made a written request on 15.05.2007 to the first Respondent for granting permission to refer his son for surgery to the fourth Respondent''s

Hospital and also to meet the entire expenses to be incurred in this regard, by duly enclosing a copy of the estimation given by the Dr. S.M. Balaji.

The Respondents also granted permission for taking treatment of Maxillary Distraction Surgery in the fourth Respondent''s hospital by

communication dated 29.04.2008. Pursuant to the approval granted, the Petitioner''s son was given pre-operative treatment on 25.06.2008.

Finally, after removing the distraction and suture on 05.10.2010, the fourth Respondent''s hospital raised the bill on 26.05.2010 for a total sum of

Rs. 3,50,000/-and the same was sent to the third Respondent, viz., the Chief Medical Officer, Chennai Port Trust Hospital, Chennai, for making

payment. Thereafter, the Respondents declined to honour the bill on the ground that it is for the Petitioner to make the payment first and thereafter,

he has to make an application to the Respondents 1 to 3 seeking to reimburse the entire amount only thereafter, the Respondents 1 to 3 shall

reimburse as per the Rules. At this juncture, the Petitioner has come to this Court.

Learned Counsel appearing for the Petitioner, by referring to Regulation 8 (a) stated that as per the conditions, the Petitioner took the treatment

for his son from the private hospital only after getting the sanction from the Respondents 1 to 3. Regulation 8 (a) specifically says that the

Respondents are bound to make direct payment on receipt of the necessary bill duly certified by the Trust Medical Officer. Contrary to the same,

they declined to honour their own Regulation 8 (a) by wrongly relying upon the Regulations 8 (b) and also 9 (1) thereby, serious prejudice has

been caused to the Petitioner and it had become very difficult for the Petitioner''s son to take up further follow up treatment from the same hospital.

Therefore, by stating that when Regulation 8 (a) is contemplating direct payment to the hospital and the inaction or refusal by the Respondents is

illegal, on that basis, learned Counsel placed that a positive direction may be issued to the Respondents to honour the bill in terms of Regulation 8

(a).

Learned Counsel appearing for the Respondents submitted that if any employee is unable to get specialised treatment from the Madras Port

Trust Hospital, for getting the specialised treatment from any super speciality hospital in the city of Chennai or even out side the city, the person

should get prior permission from the Respondents and only after getting proper sanction, the person seeking any treatment from the hospital

concerned himself should make his first payment directly to the Hospital and thereafter by approaching the Respondents and if proper bills along

with request for reimbursement is placed, then the Respondents will consider the request for reimbursement. While so, the case of the Petitioner

alone cannot be considered as a special case. He has also relied upon the communication dated 29.04.2008 issued by the Chennai Port Trust. As

per the said communication, the Chennai Port Trust will pay all charges including diet towards his treatment. Bills in duplicate may also be sent to

the Chennai Port Trust Office within one week from the date of discharge of the patient for arranging payment. In case of prolonged treatment,

interim bill along with the progress of the patient to be sent fortnightly. The learned Counsel further says that the patient may be discharged and

transferred to this hospital for further management as soon as his condition is stable and the referral letter is valid for one time only. Subsequently,

by drawing attention of this Court to a letter dated 15.10.2010, issued by the Chennai Port Trust, the learned Counsel appearing for the

Respondents further argued that the patient was already advised by the Chennai Port Trust office to pay the hospital charges towards the Cleft

Maxillary Distraction surgery directly to the hospital and the original bills was also returned therewith advising him to make a proper application

seeking reimbursement. But the Petitioner has not even addressed to the Respondents in this regard for reimbursement even though the Petitioner''s

son was discharged on 26.05.2010. With these submissions, he has also relied upon Regulations 8 (b) and 9 (1) and (2) and by relying upon

Regulations 9 (1) and 9 (2) he further stated that the Petitioner has got alternate remedy to approach the Chairman of the Port Trust without

exhausting the alternate remedy, the Petitioner has straight away come to this Court.

This is a case where the Petitioner was admittedly granted sanction for his son''s treatment in the fourth Respondent''s Hospital and the re-

joinder filed by Respondents 1 to 3 clearly shows that the Petitioner''s son was referred to Balaji International Dental Craniofacial Hospital for

Maxillary Distraction Surgery on 29.04.2008. Paragraph 4 of the re-joinder admits the case of the Petitioner that there was a sanction granted in

favour of the Petitioner for his son to take treatment from the fourth Respondent''s hospital, thereby, the case of the Petitioner is squarely falling

within the ambit of Regulation 8 (a) of the Madras Port Trust Employees'' (Medical Attendance in the Trust''s Hospital and Reimbursement of

Hospital Charges) Regulations, 1994.

It is relevant to extract below Regulations 8 (a), 8(b), 9(1) and 9(2):

Conditions For Reimbursement:

(a) Reimbursement of Hospital Charges in respect of cases referred to by the Trust.

The hospital charges in respect of cases referred to by the Trust''s Chief Medical Officer to any of the approved hospitals listed below (hospitals

indicated at S. No. 7 to 17 of Appendix II) or any other private hospitals with the sanction of Deputy Chairman/Chairman shall be paid by the

Board direct to the concerned hospitals on receipt of necessary bill, duty certified by the Trust''s Chief Medical Officer:

(i) Government Mental Hospital, Madras

(ii) Government Kasturba Gandhi Hospital for Women and Children, Madras

(iii) Government Hospital for Women and Children Madras

(iv) Government Stanley Hospital, Madras

(v) Government General Hospital, Madras

(vi) Government Royapettah Hospital, Madras

(vii) Government Kilpauk Medical College Hospital, Madras

(viii) Government Opthalmic Hospital, Madras

(ix) Government Raja Sir Ramaswamy Mudaliyar''s Lying-in-Hospital, Madras

(x) Arignar Anna Government Hospital of Indian Medicines, Madras

(xi) Government Dental College Hospital, Madras

(b) In cases where the employees and/or their family members undergo treatment in any of the approved hospitals listed in Appendix II other than

those mentioned in Clause (a) above to which a reference was made by the Trust''s Chief Medical Officer, the hospital charges in respect of all

such cases shall be reimbursable to the employee concerned provided the entire amount due to the Hospital is paid by the employee concerned

before a claim for death of an employee while under treatment in such an approved Hospital, which is not covered under Clause (a) above, the

Chairman may at his discretion sanction an advance to meet the hospital charges based on the recommendations of the Chief Medical Officer and

also subject to fulfillment of other conditions laid down under these regulations.

Procedure for sanctioning claims for reimbursement of Hospital charges:

(1) Claims for reimbursement of hospital charges covered under Regulation 8 (b) above shall be submitted by the employee concerned in the

prescribed form to the Head of the Department concerned within 90 days from the date of completion of treatment. In case the treatment is

prolonged and continued, claims may be submitted in stages for a period of not less than 30 days.

(2) Delay in submission of the claim beyond the prescribed time limit may be condoned by the respective Head of the Department based on merits

of each case.

A close reading of Clause 8 (a) goes to show that the first Respondent is required to make direct payment to the Hospital, the fourth Respondent

herein, on receipt of the necessary bill, of course, duly certified by the Trust''s Chief Medical Officer. In the case on hand, the Petitioner''s son has

undergone surgery for correcting the nose and for bone grafting in a private hospital viz., the fourth Respondent''s hospital, as admitted by the

Respondents 1 to 3 on the basis of granting sanction by them for taking treatment from the fourth Respondent''s hospital. When the Petitioner''s

son had taken treatment only after granting sanction by the Respondents, from a private hospital as claimed by the Petitioner, the case of the

Petitioner is squarely covered by Regulation 8 (a) of the Madras Port Trust Employees'' (Medical Attendance in the Trust''s Hospital and

Reimbursement of Hospital Charges) Regulations, 1994.

Therefore, the contentions raised by the learned Counsel appearing for the Respondents-Port Trust that Regulation 8 (b) will apply to the case

of the Petitioner does not merit consideration, because neither Regulation 9 (1) nor Regulation 8 (b) will apply to the case of the Petitioner.

Admittedly, the Petitioner''s case is squarely covered Regulation 8 (a). The Respondents have not disputed the surgery underwent by the

Petitioner''s son in the fourth Respondent''s hospital. The only dispute is that the Petitioner did not make an application for reimbursement of the

amount of Rs. 3,50,000/-. Regulation 8 (a) specifically says that if a person after getting sanction from the Chennai Port Trust takes any treatment

from private hospital, the Respondent is duty bound to settle the hospital expenses by directly making payment to the private hospital.

In view of Regulation 8 (a), the Writ Petition stands allowed by directing the Respondents to make payment as claimed by the Petitioner without

directing the Petitioner to submit any application for reimbursement. Though the learned Counsel appearing for the Respondents submitted that the

Petitioner, after getting final treatment for his son from the fourth Respondent''s hospital, has not approached Respondents 1 to 3 till today with due

application for making the payment, his submissions will not stand to scrutiny for two reasons. Firstly, it is an admitted case of the Petitioner that

the Petitioner''s son was born with Cleft Maxillary Distraction. The said deformity was brought to the notice of the Respondents, whereupon, the

Chennai Port Trust also granted sanction and subsequently, on three occasions, the Petitioner''s son also underwent treatment and surgery and the

fourth stage was a very crucial one. In order to complete the crucial stage of the treatment/surgery, he had to take treatment in a super speciality

hospital run by the fourth Respondent. Therefore, the Respondents cannot be allowed to say that the Petitioner had not approached the

Respondents at every stage. The very purpose of grant of sanction by the first Respondent is for removing the deformity suffered by the

Petitioner''s son. Therefore, in such circumstances, the Respondents are not justified in sticking to any technicalities. Resultantly, the Respondents

are directed to pay directly the bill amount of Rs. 3,50,000/-vide Bill No. 2025 dated 26.05.2010 as governed by the Regulation 8 (a) of the

Madras Port Trust Employees'' (Medical Attendance in the Trust''s Hospital and Reimbursement of Hospital Charges) Regulations, 1994, within a

period of three weeks from the date of receipt of a copy of this order. No costs.