Shanti Lal Chhajerh vs State Of Rajasthan And Ors

Sangeet Lodha,J

By way of this writ petition, the petitioner has challenged the action of the respondents in rejecting his claim of medical reimbursement on the

ground that under Rajasthan Civil Services (Medical Attendance) Rules, 1970 (as amended in 2008) (‘the Rules of 1970’), the claim is not

reimbursable.

The petitioner, a Judicial Officer, retired from the post of District and Sessions Judge, Bhilwara, on 30.6.02. The petitioner and his wife Smt. Kala

Chhajerh were suffering from disease of Osteoarthritis for last so many years. They undergone the treatment known as “Sequentially Programmed

Magnetic Field (SPMF) Therapy†at SPF Healthcare Private Limited, Mumbai. The treatment was taken for 21 days in the month of September-

October, 2012. The petitioner submitted the claim for reimbursement of medical expenses quantified at Rs.2,65,834/-alongwith essentiality certificate,

treatment and discharge summary, the bills of hospital, medicines and investigations. The claim of the petitioner for reimbursement was forwarded by

respondent no.3-the District and Sessions Judge, Chittorgarh to respondent no.2-the Registrar General, Rajasthan High Court for further action and

sanction. However, the respondent no.2 put an objection to the claim in terms that the SBF Healthcare is not an approved hospital. The petitioner vide

communication dated 10.4.13, explained the position with the reference to Rule 5 of the Rajasthan Judicial Officers (Medical Facilities) Rules, 2008

[‘the RJO (MF) Rules, 2008], which permits a Judicial Officer to take treatment in any hospital other than notified hospitals and there is no ceiling

on reimbursement. The respondent no.2 vide letter dated 8.5.13, directed the respondent no.3 to examine the case in light of Rule 5 (iii) and 5(iv) of

the RJO (MF) Rules, 2008. The respondent no.3 wrote a letter to SMS Hospital, Jaipur, about the treatment wherefrom reply in negative was

received. The respondent no.2 referred the matter to the Principal Secretary, Law and Legal Affairs, Government of Rajasthan, for clarification

regarding admissibility of the claim. The Principal Secretary, Law, after taking advice from the Department of Finance, opined that the claim of the

petitioner deserves rejection as SPMF (RFMQR) therapy does not fall within the definition of “treatment†as per the Rules of 1970, as revised in

the year 2008. The decision was conveyed by the respondents no.2 & 3 to the petitioner vide communication dated 3.6.14 and 18.6.14 respectively. In

the meantime, the respondent no.2 partly sanctioned the reimbursement claim to the extent of cost of medicine and paid Rs.24,344/- and thus, the

claim for Rs.2,41,490/- remained due.

Hence, this petition.

A reply to the writ petition has been filed on behalf of the respondent taking the stand that as per Rule 4 of RJO (MF) Rules, 2008, Judicial Officers

are entitled to same medical facilities as are admissible to the members of Rajasthan Legislative Assembly from time to time and for the present, the

members of the Rajasthan Legislative Assembly are entitled to the same medical facilities as are available to the Officers of the State Government

under the Rules of 1970, which stand revised vide Rajasthan Civil Services (Medical Attendance) Rules, 2008 [‘RCS (MA) Rules, 2008’].

According to the respondents, the treatment undertaken by the petitioner does not fall within the definition of “treatment†set out under Rule 2(13)

of RCS (MA) Rules, 2008, which reads as under :

“Rule 2(13) “Treatment†means the use of medical and surgical facilities for curing the disease, from which the patient suffers, by the

Authorised Medical Attendant at Government/approved hospital or at residence of the Government servant, in the case of illness which compels the

patient to be confined to his residence, at includes :

(i)the employment of pathological, bacteriological, radiological or any other methods, as are considered necessary by the Autorised Medical Attendant.

(ii)dental treatment where the diagnosis of the pathological or other disease from which a patient is suffering indicates that the teeth are the real

source of such disease, but it excludes Surgical operations needed for the removal of Odontomes including the oral surgery of the mouth.

(iii)use of such medicines, vaccines, sera or other therapeutic substances but excluding medicines or other consumables/non consumables, which are

regarded as food, toiletary preparation, tonics having more food value, disinfectants and other similar preparations.

(iv)confinement in Government hospital/approved hospital and pre-natal and post-natal treatment of wife of a Government servant and a female

Government servant.

(v)provision of accommodation in Government or approved hospitals on the scale as prescribed in these rules.

(vi)consultation fee charged by the Authorised Medical Attendant from Government servant for attendance at residence of the patient as prescribed in

these rules and also fee charged by Compounder/Nurse for administering injection at the residence of the Government servant as per rates prescribed

in these rules.

It is however clarified that “treatment†shall not include treatment undertaken for efficiency improvement like growth of height, cosmetic/plastic

surgery to shape up some part of body/face, lippo-suction, weight reduction, dentures, use of spectacles/contact lens etc.

It is also clarified that implants, used for improvement of efficiency of any organ or part of the body, from its normal natural state, at the age of the

government servant, other than those, which are specifically permitted based on the recommendation of the Advisory Committee, shall also not be

included in the “treatmentâ€​.â€​

It is submitted that treatment SPMF (RFMQR) therapy is not available in State of Rajasthan and no Government servant can undergo a treatment

without reference. It is further submitted that if treatment is not available in the State of Rajasthan, the patient can be referred for treatment after

examination and certificate issued by the Principal of the Medical College on the basis of the opinion of the Medical Board. Accordingly, it is

submitted that the expenses incurred by the petitioner upon SPMF (RFMQR) therapy is not reimbursable.

A reply to the writ petition has been filed on behalf of the State as well taking the stand that the expenditure incurred by the petitioner is not

reimbursable for the reason that SPMF (RFMQR) therapy is not included in the definition of “treatment†as provided under RJO (MF) Rules,

2008. In this regard, the reliance is also placed on Kelley’s text book of Rheumatology, Delisa’s text of PMR 1094, wherein such kind of

therapy has not been recommended for Osteoarthritis.

Learned counsel appearing for the petitioner contended that the contention sought to be raised that SPMF (RFMQR) therapy is not a treatment, is

absolutely not tenable. Learned counsel submitted that the said therapy is administered by a machine called AKTIS SOMA and by the rays targeted

at the knees and damaged cartilages start regenerating, thus reducing the pain and healing the disease. Drawing the attention of a copy of the letter

alleged to have been written by the former President of India to Dr. Vashista, learned counsel submitted that the treatment is highly appreciated.

Learned counsel submitted that as per Rule 4, the Judicial Officers are entitled to same medical facilities as are admissible to members of Rajasthan

Legislative Assembly from time to time. Learned counsel submitted that it is true that as mentioned in Rule 4, the members of the Rajasthan

Legislative Assembly are entitled to the same medical facilities as are available to the Officers of the State Government under the Rules of 1970, but

there are exceptions and modifications provided under Rule 5 of RJO (MF) Rules, 2008, and as per Rule 5(iii) thereof, the Judicial Officer is entitled

for reimbursement of the expenses incurred by himself or for his family members for medical attendance and treatment obtained by them in any

hospital/dispensary other than maintained or notified by the State Government to the same extent as they are entitled under the Rules for

reimbursement of the expenses incurred by them for medical attendance and treatment obtained in notified Hospital or Dispensary, inclusive of the

charges for accommodation. Further, as per Rule 5(iv), there shall not be any ceiling on reimbursement except to the extent of in patient room

entitlement, in patient room entitlement shall be as admissible to the Government employees and thus, the requirement of obtaining reference and

certificate of Principal, Medical College, does not apply to Judicial Officers. Learned counsel submitted that since the Judicial Officers are entitled for

medical reimbursement in respect of the treatment obtained by them in the hospital other than notified hospitals, the definition of “Authorised

Medical Attendantâ€​ as set out in Rule 3(i) of the RCS(MA) Rules, 2008 is not attracted in the matter.

On the other hand, learned counsel appearing for the State reiterating the stand taken in the reply to the writ petition contended that the expenses

incurred in treatment taken by the Judicial Officers in the hospital other than notified hospitals without reference and certificate issued by the Principal,

Medical College, are not reimbursable. Learned counsel submitted that by virtue of Rule 4 of RJO (MF) Rules, 2008, since the Judicial Officers are

entitled for reimbursement of the medical claim at par with Members of Legislative Assembly and the Members of the Legislative Assembly are

entitled for the medical facilities available to the Officers of the Government under Rules of 1970, which stand revised vide RCS (MA) Rules, 2008,

the treatment administered to the petitioner being not covered by the definition of “treatment†set out in the Rule 2(13) RCS (MA) Rules, 2008,

the petitioner’s claim for reimbursement has rightly been rejected.

Learned counsel appearing for the High Court has adopted the arguments advanced by the learned counsel appearing on behalf of the State.

We have considered the rival submissions and perused the material on record.

Indisputably, the reimbursement of the medical expenses incurred by the Judicial Officer for medical attendance and treatment obtained by him and

his family members is governed by RJO (MF) Rules, 2008. As per Rule 4, the Judicial Officers are entitled to same medical facilities as are admissible

to the Members of Rajasthan Legislative Assembly, who are entitled to the same medical facilities as are available to the Officers of the State

Government under the Rules of 1970. Since, the Rules of 1970, stand revised vide RCS (MA) Rules, 2008, the Judicial Officers shall also be entitled

to the same facilities as are available to the Officers of the Government under the said Rules. But then, the medical facilities available to the Judicial

Officer under Rule 4 as aforesaid, is subject to exception and modification set out in Rule 5 of RJO (MF) Rules, 2008, which may be beneficially

quoted :

“5. Exception and modification : Judicial Officers shall be entitled to the medical facilities contained in Rule 4 of these rules, subject to the following

exceptions and modifications namely :-

(i)The Judicial Officer shall also be entitled to claim expenses incurred by them for medical attendance and treatment obtained by him and his family

members in private hospital/Dispensaries, notified by the State Government in each city, District Headquarter and Sub-Divisional Headquarter for the

medical treatment of Judicial Officers and members of their family. The expenses shall be inclusive of the Charges for accommodation in the place

where such treatment is taken;

(ii) For the purpose of medical treatment of Judicial Officers and member of his family, Doctor of any notified hospital and dispensary shall also be

considered as the authorized medical attendant;

(iii) The Judicial Officers shall be entitled to reimbursement of expenses incurred by them for himself or for his family members for the medical

attendance and treatment obtained by them in any place other than in a Hospital or Dispensary maintained and/or notified by the State Government, to

the same extent as they are entitled to under these rules for the reimbursement of expenses incurred by them for medical attendance and treatment

obtained in notified Hospital or Dispensary. Expenses shall be inclusive of charges for accommodation;

(iv)There shall not be any ceiling on reimbursement except to the extent of in patient room entitlement, in patient room entitlement shall be as

admissible to the State Government employees; and

(v) There shall not be any ceiling on reimbursement of expenditure for treatments like kidney transplant, open heart surgery etc. on any disease

notified by the Government.â€​

A bare perusal of Rule 5(iii) makes it abundantly clear that the Judicial Officers are entitled for reimbursement of the expenses incurred by him for

himself or his family members for the medical attendance and treatment obtained by them in any place other than in a Hospital or Dispensary

maintained and/or notified by the State Government to the same extent as they are entitled to under the RCS (MA) Rules, 2008. In this view of the

matter, the claim of the Judicial Officers for reimbursement of the expenses incurred on the treatment being taken in the hospital other than notified

hospital, has to be reimbursed to the extent they are entitled for the reimbursement for such treatment and medical attendance including

accommodation charges under the RCS (MA) Rules and the same cannot be disallowed on the ground that the treatment was taken by the Judicial

Officers in the hospital not maintained or notified by the State Government. In view of the unequivocal provisions contained in Rule 5 of the RJO (MF)

Rules, 2008, the Judicial Officers are not required to obtain reference recommendation or essentiality certificate from the Principal of the Medical

College, as claimed by the respondents before proceeding with the treatment in the hospital other than notified hospitals.

Coming to the contention of the respondents that the treatment of SPMF (RFMQR) therapy is not reimbursable, it is noticed that the definition of

“treatment†as set out under Rule 2(13) of RCS (MA) Rules, 2008, is very wide and it does not restrict the employment of various treatments

administered by adopting different methods. As a matter of fact, as per the clarification attached to Rule 2 (13), only the treatments which are

undertaken for efficiency improvement like growth of height, cosmetic plastic surgery to shape up some part of body/face, lippo-suction, weight

reduction, dentures, use of spectacles/contact lens etc. Obviously, if some new treatment of any disease is invented and the Judicial Officer or the

Government Servant, as the case may be, opts for such treatment under the medical advise, the treatment unless specifically not covered or

specifically restricted, the reimbursement cannot be denied. It is relevant to note that Rule 2(13) (i) includes the employment of pathological,

bacteriological, radiological or any other methods as are considered necessary by the Authorised Medical Attendant and therefore, the contention

sought to be raised that SPMF (RFMQR) therapy is not included within the definition of “treatmentâ€, cannot be countenanced by this Court. As a

matter of fact, SPMF (RFMQR) therapy is now a known technology which directs laser rays at arthritis affected part for a specified period which

helps regrow the generated tissues that cause arthritis. In this view of the matter, in the considered opinion of this Court, the action of the respondents

in denying the reimbursement of the medical expenses claimed by the petitioner on the ground that the treatment administered is not covered under

Rule 2 (13) of the RCS (MA) Rules, 2008, is not sustainable in the eyes of law.

It is pertinent to note that when the Judicial Officers are permitted to take the treatment in the hospitals other than the hospitals maintained/notified

by the State Government, if they have taken the treatment under the advise of the Medical Attendant of the hospital concerned, they cannot be denied

the reimbursement on the ground that the treatment is not authorised by the Authorised Medical Attendant as defined under Rule 3(1) of the

RCS(MA) Rules, 2008. Moreover, it is not disputed before this Court that the facility of treatment of SPMF (RFMQR) therapy is not available in the

State of Rajasthan and thus, even otherwise, the petitioner could not have obtained the said treatment within the State.

In view of the discussion above, the writ petition deserves to be allowed.

Accordingly, the writ petition is allowed. The communications dated 3.6.14 & 18.6.14 (Annexure 25 & 26), rejecting the claim of the petitioner for

medical reimbursement are quashed. The respondents are directed to consider the claim of the petitioner for medical reimbursement afresh in

accordance with the Rules.

Needless to say that the claim of the petitioner for reimbursement shall not be denied on the ground that the same is not covered under Rule 2(13)(i)

of the RCS (MA) Rules, 2008. The claim of the petitioner for reimbursement shall be determined and the amount due shall be paid to him

expeditiously, in any case, within a period of two months from the date of this order. No order as to costs.