AI Structured Summary
Facts, law points, precedents, ratio and the final ruling — distilled from the full judgment
AI Structured Summary
Facts, law points, precedents, ratio and the final ruling — distilled from the full judgment
Facts
The petitioner, Sri Pannalal Paul, an Officer-in-charge of Map Printing in the Directorate of Land Records and Settlement, Government of Tripura, and a B-Grade officer, suddenly fell sick in the night of 02.02.2008 with severe chest pain. On the next morning he contacted Dr. Bijoy Paul, M.D., who advised him to go to a sophisticated Cardiac Care Center outside the State for necessary investigations and treatment. As his condition deteriorated, he proceeded immediately for treatment outside the State and could not approach the authority for referring his case. He went to Apollo Hospital, Chennai as an outdoor patient, suffered a stroke on the same day, was admitted there on 07.02.2008, and ultimately underwent bypass surgery on his heart to save his life. Before proceeding to Chennai, he first applied for 24 days earned leave, later took more leave, and the leave was converted into commuted leave sanctioned by the authority. On return, he submitted his medical reimbursement bills and T.A. bill, but these were denied on the ground that before undertaking the journey and treatment outside the State he had not taken reference from the Medical Board of Tripura. Hence he filed the writ petition for directing the respondents to reimburse his medical claims and T.A. bills towards treatment outside the State with interest. The State-respondents filed a counter affidavit stating that the petitioner underwent coronary artery bypass surgery and left multiple pleural biopsies at Apollo Hospital, Chennai without the mandatory referral certificate from the Standing Medical Board, that he had time from 03.02.2008 to 05.02.2008 at Agartala to contact the Medical Authority, and that he proceeded outside the State on 06.02.2008 only on the advice of Dr. Bijoy Paul, M.D. (Medicine). The State further stated that Group-A and Group-B officials are eligible for reimbursement for treatment outside the State at the rate of the referral hospital only when referred by the Standing Medical Board, and since the petitioner was not so referred, medical reimbursement and travelling expenses were not admissible under G.O. 8 dated 25.09.2004 of the Health and Family Welfare Department, Government of Tripura.
Law Points
Whether the petitioner, a B-Grade officer, is entitled to reimbursement of his medical claims and T.A. bills for treatment undertaken outside the State without prior reference by the Standing Medical Board. Whether refusal of reimbursement on the ground that he did not take reference from the Medical Board of Tripura is sustainable. Whether the State's reliance on G.O. No. 8 dated 25.09.2004 disentitles the petitioner because he was treated outside the State while not on official work. Whether the case is covered by the decisions cited on behalf of the petitioner.
Acts & Articles
No statute, section or constitutional article is specifically named in the judgment. The judgment refers to G.O. No. 8 dated 25.09.2004 and the revised G.O. No. 8 dated 25.09.2004 of the Health and Family Welfare Department, Government of Tripura, and to the scheme of the Government.
Judgments Referred
Harendra Chandra Das v. State of Tripura and Others, W.P. (C) No. 208 of 2008, a decision of the learned Single Judge of the Gauhati High Court, Agartala Bench, was cited and followed. In that case the claim for medical reimbursement had been denied on the ground that the petitioner did not proceed for cardiac treatment with prior approval of the Standing Medical Board; the learned Single Judge allowed reimbursement, and the present Court held that the petitioner's case is covered by that decision. Surjit Singh v. State of Punjab and Others, a Supreme Court decision, was referred to in Harendra Chandra Das in support of the view that refusal by the State Authorities to reimburse the costs of medical treatment on the ground of not being referred by the Medical Board cannot be sustained. Modan Mohan Bhowmik v. State of Tripura and Others, a decision of the Gauhati High Court, Agartala Bench, was cited and followed for the observation that denial of reimbursement of medical bills to an employee on a mere technical ground is denial of the right to life, which includes the right to health. Amal Barua v. State of Tripura and Others, a decision of this Court, was cited and followed; it observed that neither in the Government hospital nor in the Government medical college was treatment of cardiac problems available, that at present there is a private hospital where cardiac treatment is available but a patient has to wait for a specialist from outside, that reference by the Standing Medical Board to a referral hospital cannot itself be a ground for not granting medical reimbursement, that the Government should see whether the employee took treatment outside the State which was not available in Tripura, that the Government should not deny medical reimbursement merely on a technical ground, and that the claim was genuine as the petitioner was a Group-B Gazetted Officer who went for open heart surgery.
Obiter Dicta
Not discussed in this judgment.
Ratio Decidendi
The ratio decidendi is that a government employee's claim for reimbursement of medical expenses incurred outside the State cannot be rejected merely on the technical ground that there was no prior referral by the Standing Medical Board, particularly where the treatment required, such as cardiac surgery, was not available in the State and the employee had to go outside the State to save his life. Denial of reimbursement on such a technical ground is treated as denial of the right to life, which includes the right to health; the Government should examine whether the employee took treatment outside the State which was not available in Tripura and should not deny medical reimbursement merely on a technical ground. In the present case, the claim was held to be covered by the decisions cited, and reimbursement was directed at the rate of the referral hospital.
Final Ruling
The writ petition is allowed. The respondents are directed to allow the medical reimbursement to the petitioner and make payment of the same at the rate of referral hospital within a period of three months from the date of receipt of this order. No order as to costs. The operative direction refers to medical reimbursement; the judgment does not expressly deal separately with the T.A. bill in the final order.
Plain-Language Gist
The petitioner, a government officer, had to undergo heart bypass surgery outside Tripura without first getting referred by the State Medical Board, and the State refused to reimburse his medical expenses for that reason. The High Court allowed his writ petition and directed the State to pay the medical reimbursement at the rate of the referral hospital within three months, following earlier decisions that such a technical objection cannot defeat a genuine claim where the required treatment was not available in the State.
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Judgment
Utpalendu Bikas Saha, J.—The instant writ petition is filed by the petitioner, Sri Pannalal Paul, an Officer-in-charge of Map Printing in the Directorate of the Land Records and Settlement, Government of Tripura, for directing the respondents to reimburse his medical claims and T.A. bills towards his treatment outside the State along with interest.
Heard Mr. A. Sengupta, learned counsel appearing for the petitioner as well as Mr. D.C. Nath, learned State counsel for the State-respondents.
The facts needed to be discussed are as follows:
The petitioner, a B-Grade officer, while working as an officer-in-charge, Map Printing, Directorate of the Land Records and Settlement, Government of Tripura, had suddenly fallen sick in the night of 02.02.2008 with severe chest pain. On the next morning, the petitioner contacted Dr. Bijoy Paul, M.D. while the doctor advised him to go to sophisticated Cardiac Care Center outside the State for necessary investigations and treatment. As his condition was deteriorated, the petitioner had to proceed immediately for treatment outside the State and as such, he could not approach the authority for referring his case for treatment outside the State. The petitioner moved towards Apollo Hospital, Chennai and appeared there being an outdoor patient. But he got attacked with stroke on that day itself and then and there he was admitted to the said Hospital on 07.02.2008 and ultimately to save his life, Bypass Surgery was conducted on his heart.
It is further stated that before proceeding towards Chennai, the petitioner first prayed for 24 days earned leave and thereafter he took more leave and ultimately the aforesaid leaves were converted to commuted leave which was sanctioned by the authority. The petitioner being a B-Grade Officer of the Government of Tripura, as per normal procedure, is entitled to medical reimbursement. Accordingly, on return, he submitted his medical reimbursement bills as well as the T.A. bill to the appropriate authority, but the same was denied on the ground that before undertaking the journey and treatment outside the State, the petitioner did not take reference from the Medical Board of Tripura. Hence, the instant writ petition.
The State-respondents by filing counter affidavit stated that the petitioner went to Apollo Hospital, Chennai and conducted coronary artery Bypass Surgery + Left Multiple Pleural Biopsies without taking referral certificate from the Standing Medical Board, which is mandatory. It is also stated that there was enough time to contact with the Medical Authority to refer him outside the State during his stay at Agartala from 03.02.2008 to 05.02.2008, but the petitioner did not avail that scope and proceeded outside the State on 06.02.2008 only as per advice of Dr. Bijoy Paul, M.D. (Medicine). It is further stated that when referred by the Standing Medical Board a Group-''A'' and ''B'' officials are eligible to get medical reimbursement for treatment/investigations undertaken outside the State at the rate of the referral hospital. Since the petitioner was not referred by the Standing Medical Board, medical reimbursement and travelling expenses are not admissible to the petitioner as per provision of G.O. 8 dated 25.09.2004 of the Health & Family Welfare Department, Govt. of Tripura.
Mr. Sengupta, learned counsel for the petitioner, while urging for the relief sought for, would contend that the petitioner was denied the reimbursement of his medical bills on the ground that he had left for medical treatment on his own without being referred by the Standing Medical Board of the State to a referral hospital. He further submits that admittedly in the State hospital, there is no facility for cardiac treatment except in a private hospital recently established in the State, but at the relevant time, the said private hospital was also not established in the State of Tripura. So, finding no other alternative, the petitioner had to go outside the State for his treatment on his own to save his life. He has also contended that when life of a person is in danger, he cannot wait to follow the official formalities like appearing before a Medical Board for his treatment.
Mr. Sengupta has further contended that one Sri Harendra Chandra Das, a Head Clerk of the Tripura State Electricity Corporation, filed one writ petition being W.P. (C) No. 208 of 2008(Sri Harendra Chandra Das V. State of Tripura & ors.) as his claim for medical reimbursement was denied on the ground that he did not proceed for cardiac treatment with prior approval of the Standing Medical Board and the learned Single Judge of the Gauhati High Court, Agartala Bench after hearing the parties allowed the prayer for medical reimbursement holding that "Having regard to the above decision of the Supreme Court in Surjit Singh Vs. State of Punjab and Others, I find that the refusal by the State Authorities to reimburse the costs of medical treatment on the ground of not being referred to by the Medical Board cannot be sustained and accordingly, I am of the view that the petitioner is entitled to obtain reimbursement of costs of medical treatment, incurred by him for his medical treatment at Kolkata". In the aforesaid case the learned Single Judge also directed the respondents therein to process the claim for reimbursement of costs of medical treatment made by the petitioner expeditiously and grant him the reimbursement at the appropriate rate as per the scheme of the Government. In the instant case also the claim of the petitioner is for medical reimbursement which was denied on the ground that he did not proceed for treatment in Apollo hospital, Chennai with prior permission of the Standing Medical Board like the petitioner in the aforesaid case. Therefore, the case of the present petitioner is covered by the decision in Harendra Chandra Das (supra). He has finally contended that the case in hand is also fully covered by a decision of the Gauhati High Court, Agartala Bench in Modan Mohan Bhowmik Vs. State of Tripura and Others, wherein it has been noted that denial of reimbursement of medical bill to an employee on mere technical ground is denial of right to life which includes right to health.
He has also referred to a decision of this Court in Amal Barua Vs. State of Tripura and Others wherein the State-respondents returned the medical reimbursement bill and ultimately this Court after hearing the parties has observed that admittedly, neither in the Government hospital nor in Government medical college, treatment of cardiac problems is available though at present there is a private hospital where the cardiac treatment is available and for that also, a patient has to wait when a specialist comes from outside. Reference by the Standing Medical Board to a referral hospital itself cannot be a ground for not granting medical reimbursement to him, rather the Government should see whether the employee (patient) took treatment outside the State which is not available in the State of Tripura. In such a situation, the Government should not deny the medical reimbursement of its employee merely on the technical ground. This Court has also observed that the claim of the petitioner is a genuine one as he was admittedly a Group-B Gazetted Officer at the relevant time and went for open heart surgery.
Mr. Nath, learned State counsel has submitted that the medical reimbursement bill of the petitioner was returned on the basis of the revised G.O. No. 8 dated 25.09.2004 of the Government of Tripura, Health & Family Welfare Department, wherein it is stated that excluding referral cases by the Standing Medical Board, those Government employees are entitled to medical reimbursement facility to whom requires medical treatment while being outside normal duty station in connection with official works. In the instant case, the petitioner was treated outside the State while he was not in official work. Thus, the petitioner is not entitled to medical reimbursement as prayed for.
This Court has considered the submissions of Mr. Sengupta as well as Mr. Nath, learned counsel for the parties, and is of the opinion that this case is fully covered by the decision of the Gauhati High Court, Agartala Bench as well as the decision of this Court as referred by Mr. Sengupta.
In view of the above, the respondents are directed to allow the medical reimbursement to the petitioner and make payment of the same at the rate of referral hospital within a period of three months from the date of receipt of this order.
In the result, the writ petition is allowed. No order as to costs.