Sri Amar Sutradhar vs The State of Tripura

“5.

That, Bina Rani Sutradhar (now late), wife of the Petitioner got admitted in IGM Hospital under ENT Department on 26/05/2020 for undergoing treatment & accordingly she was discharged on 06/06/2020. Later on, she was again admitted in Govinda Bhallav Panth Hospital & Agartala Government Medical College for carrying out operation. But, the operation couldn't be done as patient party refused to give High Risk consent & the patient was discharged accordingly from the Govinda Bhallav Panth Hospital & Agartala Government Medical College on 07/07/2020 (Annexure-3 to the Writ Petition).

8.

That, thereafter, the Engineering Officer to the Chief Engineer, PWD(R&B) vide Letter No.F.6(15)-PWD(E)/2019(P-II)/3393-94 dated 25/06/2021 (Annexure-9 to the Writ Petition) had returned the Medical Bill along with relevant documents with a direction to re submit the same as per existing rules as stated in Memorandum No.F.5(10)-FIN(G)/75-1 dated 09-08-2005 issued by the Finance Department, Government of Tripura.

As directed the Petitioner further re-submitted the Medical Bill for reimbursement which was forwarded by the SDO Hrishyamukh Sub-Division, PWD(R&B) vide letter No.F.1(9)/SDO(PWD)/HRM/440 dated 01/02/2022 (Annexure-8 to the Writ Petition).

Further, it is submitted that the matter was communicated to the Secretary, Finance vide U.O No.1084, Secretary, PWD, dated 14/07/2022 for their views regarding the admissibility of the Medical Claim as submitted by Shri Amar Sutradhar, Work Assistant, Group-C, Technical (Non Gazetted) in respect of wife Bina Rani Sutradhar (now late) who has undergone treatment of Cancer at Apollo Gleneagles Hospital, Kolkata w.e.f 13/07/2020 to 15/07/2020 & at Salt Lake City Medical Centre w.e.f 15/07/2020 to 20/07/2020 without being referred by the Standing Medical Board.

Further, the matter was examined by the Finance Department, Government of Tripura & had returned the file vide U.O No. NIL dated 16/08/2022 with observation that "The Department is requested to take the view of the Health Department regarding admissibility of the MR Claim of Shri Amar Sutradhar, Work Assistant, O/o the Assistant Engineer, Hrishyamukh Sub-Division, PWD (R&B) (Matai) Belonia, Tripura for an amount of Rs. 3,85,763/- only which was incurred for treatment purpose of his wife at Appollo Gleneagles Hospital, Kolkata and Salt Lake City Medical Centre, Kolkata without being referred by the Standing Medical Board, Tripura".

As directed by the Finance Department, Government of Tripura to take up the matter with the Health Department, Government of Tripura to settle down the issue & the Administrative Department has already taken the lenient views of the Health Department, Government of Tripura communicated vide U.O No. 487/R/D/DHS dated 08/04/2021. Accordingly, Engineering Officer to the Chief Engineer, PWD(R&B) vide Letter No.F.6(15)-PWD(E)/2019(P-II) (shadow)/18068-69 dated 28/11/2022 (Annexure-11 to the Writ Petition) had returned the Medical Bill along with relevant documents in respect of Shri Amar Sutradhar, Work Assistant, O/o the Assistant Engineer, Hrishyamukh Sub-Division, PWD (R&B).

9.

That, with regard to statements made in paragraph 23 to 35 of the Writ Petition, I say that, the Finance Department Government of Tripura vide Memorandum No.F.5(10)-FIN(G) /75-1 dated, Agartala 09^th August, 2005 (Annexure-16 to the Writ Petition) under the subject captioned as Medical Reimbursement facility to Group-'C' & 'D' Government employees for treatment as referred case outside the State and also for treatment of Cancer in the Cancer Hospital of the State directed that "Consequent upon issue of G.O. No. 08 dated 25-09-2004 from the file No. 2(10-23A)-MS/Estt/MR/2002 (Part-III) of the Health & Family Welfare Department, a considerable number of cases are referred to the Finance Department from various Departments seeking concurrence / approval regarding admissibility of claims of medical reimbursement facilities of Group C & D category of employees as cases of special dispensation even when the cases are referred by the State Medical Board in terms of para (i) of the said memo. On the other hand, certain clarifications were issued in the past from the Finance Department about admissibility of medical reimbursement claim of Group C & D employees under a few special exigencies.

2.

Now it felt that for quick disposal of the claims of medical reimbursement of Group C & D employees admissible under aforesaid G.O. and circulars issued from the Finance Department, certain clarifications need be issued. to Accordingly, the undersigned is directed to issue following clarifications to facilitate quick disposal of the medical reimbursement claims of Group C & D employees and for removing the ambiguities:-

A. (i) When a Group-C/Group-D Government employees himself / herself suffering from disease other than cancer is referred to Medical Institution / Hospital to which he / she is referred to the cost of treatment in that Institution / Hospital excluding the cost of journey is admissible for reimbursement. This benefit is not admissible in respect of any member of the family of such a Government employee.

(B)

When a Group-C/Group-D Government employee himself /herself or any member of his/her family suffers from cancer and is referred to a medical Institution / Hospital outside the State by the Standing Medical Board, the cost of treatment in such Institution / Hospital inclusive of admissible journey expenses only up to referred Institution / Hospital (both ways) is admissible for reimbursement. Journey expenses of the escort, it any recommended by the Standing Medical Board, is also admissible for reimbursement.

(iii)

Group-C/ Group-D Government employee shall continue to get reimbursement of the cost of treatment of cancer for himself/herself and his/her members of the family for treatment in Cancer Hospital in the State vide Memo No. F.5(2)-FIN(G)/93 dated 14.06.1996".

Further, the Health Department, Government of Tripura vide Memorandum No. F.2(10-35A)-DHS/ESTT/MR/2017 Dated, Agartala 22/11/2019 (Annexure-18 to the Writ Petition) directed that "In accordance with the existing provisions of Finance Department Memorandum No. F.5(2)-FIN(G)/93 dated 1994, for bonafide claim of re-imbursement for treatment of cancer patients who had taken treatment outside the State without being referred, and wherever the signatures and certificates of the attending doctor of Hospital outside the State cannot be obtained in the specific Form of Medical Reimbursement claim, a member / members of State Medical Board should meticulously examine such prescriptions and vouchers of the claim to satisfy himself about correctness and genuineness before countersigning the certificates in the claim Form and all relevant vouchers / money receipts etc. The claim for re-imbursement will be entertained on the basis of such certificates".

In the instant case, wife of the Petitioner was admitted for undergoing treatment of Cancer at Regional Cancer Centre, Agartala on 23/05/2020 & later on she was admitted at IGM Hospital under ENT Department on 26/05/2020 for undergoing treatment of cancer & accordingly she was discharged on 06/06/2020. Further, she was also admitted at Govinda Bhallav Panth Hospital & Agartala Government Medical College for carrying out operation of parotidectomy on view of facial paralysis.

But, the operation couldn't be done as patient party refused to give High Risk consent & the patient was discharged accordingly from the Govinda Bhallav Panth Hospital & Agartala Government Medical College on 07/07/2020.

From the above discussion it is revealed that, the necessary operation of Bina Rani Sutradhar (now late) W/o Shri Amar Sutradhar couldn't be conducted as patient party refused to give High Risk consent & before being discharged from the Govinda Bhallav Panth Hospital, the Petitioner had given a consent on 16/06/2020 for parotidectomy on view of facial paralysis to carryout operation, but later on 06/07/2020 the Petitioner put his signature that he refused to give High Risk Consent. Now the question arise when a patient is got admitted into a Government Hospital at his/her own wish & thereafter without taking the proper treatment/advice of the consultant doctor, if the patient is taken out himself/herself from the Hospital then the question of further referral to outside state for better treatment as per Memorandum dated 09/08/2005 doesn't arise.

From the above mentioned two paragraphs it can be said that, one could have get the benefit of reimbursement of Medical Bill for cancer treatment at a medical Institution / Hospital outside the State after getting refer by the Standing Medical Board for which admission in Government Hospital for the treatment of cancer is mandatory. However 'one could have also get the benefit of reimbursement of Medical Bill for cancer treatment at a medical Institution / Hospital outside the state without being referred by the by the Standing Medical Board provided that upon completion of treatment genuineness of Medical Reimbursement claim shall meticulously be examined by the member/ members of State Medical Board. But in the instant case Bina Rani Sutradhar (now late) wife of the Petitioner got admitted in G.B.P Hospital on 03/06/2020 for carrying out operation of parotidectomy on view of facial paralysis. But, she was discharged from G.B.P Hospital on 07/07/2024 as the as patient party refused to give High Risk consent & without attending the ABV Regional Cancer Centre, Agartala or without referred by the State Medical Board she got admitted at Apollo Gleneagles Hospital, Kolkata w.e.f 13/07/2020 to 15/07/2020 & at Salt Lake City Medical Centre w.e.f 15/07/2020 to 20/07/2020. Hence, the claim for Medical Reimbursement doesn't arise in light of Memorandum dated 09/08/2005. Further, if Bina Rani Sutradhar (now late) wife of the Petitioner would be admitted directly at Apollo Gleneagles Hospital, Kolkata or elsewhere for the treatment of Cancer without attending OPD at Regional Cancer Centre, Agartala on 23/05/2020 for diagnosis of Muco-epidermoid Carcinoma in the neck region, or, without admitting at ENT Department of IGM Hospital on 26/05/2020, or, without admitting at G.B.P Hospital from 03/06/2020 to 07/07/2020 etc. then in that case claim for Medical Reimbursement may be considered without being referred in light of Memorandum dated 22/11/2019. But, the benefit of claim for Medical Reimbursement shall not be considered if one has carried out the treatment of Cancer at Medical Institution/Hospital of outside state at his/her own wish without being referred after attending so many Government Hospitals in light of Memorandum dated 22/11/2019.”

“17.

It is a settled legal position that the government employee during his lifetime or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the doctor, who is well versed and expert both on academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality hospitals are established for treatment of specified ailments and services of doctors specialised in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in speciality hospital by itself would deprive a person to claim reimbursement solely on the ground that the said hospital is not included in the government order. The right to medical claim cannot be denied merely because the name of the hospital is not included in the government order. The real test must be the factum of treatment. Before any medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by doctors/hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds. Clearly, in the present case, by taking a very inhuman approach, the officials of CGHS have denied the grant of medical reimbursement in full to the petitioner forcing him to approach this Court.”

From the observation made by the Hon’ble Apex

“11.

I have also perused the memo dated 22.12.2022 issued by the Health Department wherein it is mentioned that the Group-A and Group-B employees of the State Government and their family members may avail treatment in any enlisted referral hospital inside/outside the State approved by the State Government without referral of the Standing Medical Board subject to condition that ex-post facto approval shall be given only in case of emergency or acute illness arising while the Govt. Servant is staying outside the State with station leave permission. In such a case certificate from the treating hospital be obtained and if any treatment is undertaken re-imbursement would be at per CGHS rate. From the aforesaid clause of memorandum dated 22.12.2022 it appears that in the said memorandum it was decided by the Government that ex-post facto approval should be obtained. Here in the case at hand the petitioner after returning back prayed for ex-post facto approval but that was dishonored on the ground that such treatment was available at Agartala. This High Court in WP(C)No.1479 of 2017 in para Nos. 7, 16, 17, 19, 20, 21 and 22 observed as under:

“[7] Counsel for the petitioner submits that in terms of the guidelines laid down by the State Govt., for admissibility of medical expenses to the State Govt. officials for treatment outside the State although has to be referred by the Standing Medical Board to the prescribed medical institutions as indicated in para-A ordinarily has to seek permission for taking treatment to be referred by the Standing Medical Board but is not always possible in the course of urgency like that in the case of the petitioner, he had a stroke during office hours on 15th February, 2017, initially went to take medical assistance in the Agartala Govt. Medical College & GBP Hospital but nothing revealed and as he was still feeling uncomfortable, proceeded to Fortis Hospital, Kolkata on 20th February, 2017 and consulted all Neuro Surgeons and there he found that he had been attacked with stroke twice but unable to find out any reason of his disorder in his body.

[16] It is also equally true that no State can have unlimited resources to spend on any of its project and that is why the only approves its projects to the extent it is feasible and same holds good for providing medical facilities to its citizen including its employees and expenses of medical assistance cannot be unlimited. It has to be to the extent finance permit. This has been extensively examined by the Apex Court in the case of the medical reimbursement taking note of the precedents as to what extent medical expenses are reimbursable keeping in view the circular/guidelines/rules of the State Govt. for reimbursement of the medical expenses. The Apex Court in State Of Karnataka and Another v. Sri R. Vivekananda Swamy, reported (2008) 5 SCC 328 has observed that if an employee obtains treatment from a hospital of his choice can be made limited and his entitlement will remain within the parameters of the medical scheme introduced by the Govt. for reimbursement of the medical expenses.

[17] Based on the principles laid down by the Apex Court of which reference has been made one of the coordinate Bench in WP(C) No. 228 of 2013 [Sri Ajit Kumar Paul v. The State of Tripura & Others, dt. 01.07.2016] has observed that if the cardiac facilities are not available in the Govt. Hospitals nor in Govt. Medical College in the State, obviously the patient has to proceed for specialized treatments to avail medical facilities from the approved/private hospitals outside the State and in such exigencies if the patient has to wait and to first take the recommendation from the Standing Medical Board is impracticable and to the extent the employee take treatment from a approved/private hospital outside the State of Tripura, it is indeed reimbursable.

“15.

Admittedly, neither in the Govt. hospital nor in Govt. 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 Page 9 of 14 by the standing Medical Board to a referral hospital itself cannot be a ground for not granting medical reimbursement to him, rather the Govt. should see whether the employee (patient) took treatment outside the State which is not available in the State of Tripura. In WP(C) 228 of 2013 Page 9 of 9 such a situation, the Govt. should not deny the medical reimbursement of its employees merely on the technical ground. This Court is of the further opinion that the claim of the petitioner is a genuine one as he is entitled to medical reimbursement and admittedly RTIICS, Kolkata is a referral hospital of the Government of Tripura.

[19] Although, the hospital from where the petitioner has taken treatment i.e. Apollo Speciality Hospital, Chennai is an approved hospital by the Govt. but that facility is available to Tripura Health Assurance Scheme for Poor as revealed from the notification dt. 19th October 2015 (Annexure-4) and such facilities are not extended to Group-B officers of the State of Tripura for which he has to seek permission from the Standing Medical Board and that can be ex-post-facto permission to regularize the medical treatment & expenses incurred for reimbursement.

[20] It is true that if a reference would have been obtained by Standing Medical Board constituted by the Govt. seeking permission ordinarily was advisable for the employee to attempt but the medical treatments which are not available in the State of Tripura and sometime the procedure laid down to first take permission from the State Medical Board and only thereafter to proceed for taking treatment from approved hospital or the hospital of his own choice, may not be possible and appears to be onerous and not workable specially in the emergency cases and in such exigencies, if condition of taking first referral from the Standing Medical Board for taking treatment from the approved hospital/private hospital under the notification dt. 25th October 2013 where time is an essence and not possible for the patient even to wait for an hour or for a day, still in the procedure as prescribed by the Govt. under its notification dt. 25th October 2013 has to be mandatorily followed there is full possibility that the family may lose the patient and it goes without saying that prompt and better medical treatment is of utmost priority not only for a citizen but of the State and his authorities.

[21] In my considered view, the precondition of seeking referral from the Standing Medical Board before to proceed in availing medical treatment from the approved hospital/private hospital outside the State if any, under the notification dt. 25th October 2013 is directory in character subject to fulfillment of the conditions prescribed in availing reimbursement of medical expenses under the Govt. notification dt. 25th October 2013, where a patient has taken treatment from an approved hospital or the hospital of his choice (Other than the approved hospital) is entitled for reimbursement of medical expenses incurred to the extent of such medical expenses if incurred in taking treatment from the approved hospital or from a private hospital where he has taken treatment whichever is lower taking note of the restrictions imposed by the Govt. under its notification dt. 25th October 2013 extending financial assistance to its employees for availing medical facilities, which is a social obligation of the State.

[22] In the instant case, looking to the kind of ailment which the petitioner and his wife were suffering this Court can take a judicial notice that such medical facilities are not available in the State of Tripura and there was no option left except to take treatment either from the hospital which is approved by the Govt. under its notification dt. 25th October 2013 or from a private medical hospital of own choice, but he would be entitled for reimbursement of the medical expenses incurred which is admissible under the approved medical hospital or from a private hospital from where he has taken treatment whichever is lower under notification dt. 25th October 2013 and in the given circumstances, the decision of the Govt. holding that the medical expenses incurred by the petitioner is not admissible for reimbursement because of not being referred by the Standing Medical Board under its communication dt. 17th August, 2017 (Annexure-3) is not sustainable in law and needs to be set aside.”

12.

Similarly another Co-ordinate Bench of this Court in WP(C)No.830 of 2019 dated 05.12.2029 in the relevant portion observed as under:

“The Supreme Court in case of Surjit Singh vs. State of Punjab and others reported in (1996) 2 SCC 336 had in somewhat similar circumstances made following observations:

“11.

It is otherwise important to bear in mind that self preservation of one's life is the necessary concomitant of the right to life enshrined in Article 21 of the constitution of India, fundamental in nature, sacred, precious and inviolable. The importance and validity of the duty and right to self-preservation has a species in the right of self defence in criminal law. Centuries ago thinkers of this Great Land conceived of such right and recognised it. Attention can usefully be drawn to verses 17 18, 20, and 22 in Chapter 16 of the Garuda Purana (A Dialogue suggested between the Divine and Garuda, the bird) in the words of the Divine:

17 Vinaa dehena kasyaapi canpurushaartho na vidyate Tasmaaddeham dhanam rakshetpunyakar maani saadhayet Without the body how can one obtain the objects of human life? Therefore protecting the body which is the wealth, one should perform the deeds of merit.

18 Rakshayetsarvadaatmaanamaatmaa sarvasya bhaajanam Rakshane yatnamaatishthejje vanbhaadraani pashyati One should protect his body which is responsible for everything. He who protects himself by all efforts, will see many auspicious occasions in life.

20 Sharirarakshanopaayaah Kriyante sarvadaa budhaih Necchanti cha punastyaagamapi kushthaadiroginah The wise always undertake the protective measures for the body. Even the persons suffering from leprosy and other diseases do not wish to get rid of the body.

22 Aatmaiva yadi naatmaanama hitebhyo nivaarayet Konsyo hitakarastasmaa-daatmaanam taarayishyati If one does not prevent what is unpleasant to himself, who else will do it? Therefore one should do what is good to himself.

12.

The appellant therefore had the right to take steps in self preservation. He did not have to stand in queue before the Medical Board, the manning and assembling of which, barefacedly, makes its meetings difficult to happen. The appellant also did not have to stand in queue in the government hospital of AIIMS and could go elsewhere to an alternative hospital as per policy. When the State itself has brought Escorts on the recognised list, it is futile for it to contend that the appellant could in no event have gone to Escorts and his claim cannot on that basis be allowed, on suppositions. We think to the contrary. In the facts and circumstances, had the appellant remained in India, he could have gone to Escorts like many others did, to save his life. But instead he has done that in London incurring considerable expense. The doctors causing his operation there are presumed to have done so as one essential and timely. On that hypothesis, it is fair and just that the respondents pay to the appellant, the rates admissible as per Escorts. The claim of the appellant having been found valid, the question posed at the outset is answered in the affirmative. Of course the sum of Rs.40,000 already paid to the appellant would have to be adjusted in computation. Since the appellant did not have his claim dealt with in the High Court in the manner it has been projected now in this Court, we do not grant him any interest for the intervening period, even though prayed for. Let the difference be paid to the appellant within two months positively. The appeal is accordingly allowed. There need be no order as to costs.”

Judgment dated 18.08.2016 in case of Sri Kallol Roy vrs. The State of Tripura & others in WP(C) No.277 of 2016, judgment dated 04.05.2018 in case of Sri Uttam Pal vrs. The State of Tripura & others in WP(C) No.1479 of 2017 and judgment dated 27.03.2019 in case of Sri Subal Das vrs. The State of Tripura & others in WP(C) No.895 of 2018.

In the result, the impugned order dated 07.12.2018 is set aside. The respondents are directed to pay the petitioner‟s medical bills in question as permissible. Such payment shall carry simple interest @ 7.5% from the date of completion of 3(three) months of presentation of bills till actual payment. Entire payment be made within a period of 2(two) months from today.

Petition is disposed of accordingly.

13.

It is the admitted position that each case has got its own pattern and every case is to be decided according to its own merit. Sometimes in some cases it is found that the subject matters are same and in some cases although issues are the same but the facts differs from one case to another case. Here in the case at hand it is the admitted position that the petitioner went to Kolkata on 10.01.2023 and as he developed chest problem he had to attend R N Tagore Hospital where coronary angiography was done on 11.01.2023 „PTCA with stenting to LAD done on 13.01.2023‟.”

“24.

In view of the aforementioned settled principles of law there cannot be any doubt that the Rules regarding reimbursement of medical claim of an employee when he obtains treatment from a hospital of his choice can be made limited. Such a rule furthermore having been framed under the proviso to Article 309 of the Constitution of India constitutes conditions of service in terms whereof on the one hand the employee would be granted the facility of medical aid free of cost from the recognized government hospitals and on the other he, at his option, may get himself treated from other recognized hospitals/institutions subject of course to the conditions that the reimbursement by the State therefore would be limited.”

“15.

Admittedly, neither in the Govt. hospital nor in Govt. 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 Govt. should see whether the employee (patient) took treatment outside the State which is not available in the State of Tripura. In WP(C) 228 of 2013 Page 9 of 9 such a situation, the Govt. should not deny the medical reimbursement of its employees merely on the technical ground. This Court is of the further opinion that the claim of the petitioner is a genuine one as he is entitled to medical reimbursement and admittedly RTIICS, Kolkata is a referral hospital of the Government of Tripura.”

“GOVERNMENT OF TRIPURA AGARTALA

Enlistment of referral centers for treatment/investigation of Tripura patients duly referred by the Standing Medical Board, Agartala. Order issued.

HEALTH & FAMILY WELFARE DEPARTMENT

G.O. No. 236/RT/2013 Dated, Agartala, the 25/10/2013 [File No. 2(10-43A)-DHS/Estt/MR/2013]

Read : GO No. 8, dated 25th September, 2004.

[File No. 2(10-23A)-Ms/Estt/MR/2002-(P-III)]

NOTIFICATION

Issues relating to various operational difficulties in implementing guidelines contained in G.O. 08, dated 25-09- 2004, had been brought to our attention and then were examined by the Health & Family Welfare Department in consultation with concerned Departments. Now the Governor, Tripura is pleased to lay down following guidelines with regard to admissibility of medical reimbursement expenses to State Government Officials for treatment outside the State on being referred by the Standing Medical Board.

a)

The Standing Medical Board is required from time to time to refer patients outside the State for treatment/investigation(s) of various ailments for which facilities do not exist here and in such situations, the Standing Medical Board shall refer patients only to the following Medical Institutions.

1.

SSKM Hospital, Kolkata.

2.

Institute of Post Graduate Medical Education & Research, Kolkata.

3.

School of Tropical Medicine, Kolkata.

4.

Cancer Centre and Welfare Home, Thakurpukur, Kolkata

5.

Silchar Medical College & Hospital.

6.

Sankar Deva Netralaya, Guwahati.

7.

CMC Hospital, Vellor.

8.

Care Hospital, Hyderbad.

9.

National Institute of Mental Health & Neuroscience, Bangalore.

10.

AIIMS, New Delhi.

b)

Group-A and Group-B Officials when referred by the Standing Medical Board to the listed Institutions shall be eligible to get medical reimbursement for treatment/investigation(s) undertaken at rates of the referred institutions. They will also be entitled to get reimbursement of traveling expenses as per existing pattern.

c)

In case where the above category of officials do not undertake treatment/investigations at the referred institutions and instead receives treatment/undergoes investigations for which referral was made, at an health institution of their own choice at any place, treatment/investigation(s) expenses shall be reimbursed at the rate fixed by the hospital to which referral was made or the actual treatment/investigation expenses whichever is lower. They will be entitled to get travelling expenses also as per existing pattern but up to the referred institute only, whichever is lower.

d)

When Cancer patients referred by the State Medical Board for treatment/investigation to the Cancer Centre and Welfare Home, Thakurpukur, Kolkata receive treatment/investigation at any other Cancer treatment institution of their own choice, treatment/investigation expenses shall be reimbursed at the rate fixed by CC&WH, Thakurpukur, Kolkata or the actual treatment/investigation expenses, whichever is lower. They will be entitled to get reimbursement of traveling expenses also as per existing pattern but up to the referred institute only.

e)

In case of Government employee who is entitled to medical reimbursement facility, while being outside normal duty station in connection with official works, requires medical treatment, he would be eligible to obtain it at the nearest health institution where he fell ill and will be eligible to get reimbursement of treatment expenses at the rate fixed by SSKM Hospital, Kolkata or the actual treatment expenses, whichever is lower.

f)

This order shall taken immediate effect and is issued in supersession of G.O. No. 08, dated 25.09.2004 [File No. 2(10-23A)-MS/Estt/MR/2002(P-III)] as also in suitable modification of instructions issued by the Health & Family Welfare Department, Government of Tripura in this regard from time to time.

By order of the Governor SD/-Additional Chief Secretary Government of Tripura”

“ ….. Coming to the question of referral by the Medical Board, similar issue has come before this Court on several occasions. In a case like the present one where the government employee was travelling for entirely unrelated reason and was suddenly detected with a serious ailment it would be too much to expect him to present himself before Medical Referral Board before taking such treatment outside the State. At that moment he and his family would be most concerned about saving his life rather than reimbursement of the expenditure for the medical treatment.

In a recent judgment dated 05.12.2019 in case of Sri Samar Bhusan Chakraborty Vrs. The State of Tripura & others [W.P(c) No.830/2019] following observations were made:

”It can thus be seen that initial symptoms of the disease were that the petitioner suffered rapid weight loss coupled with drastic depletion of level of Hemoglobin in his blood. The petitioner lost close to 20 kgs of weight in a short span. With these complaints when the petitioner approached the GBP Hospital, the medical opinion was that the petitioner was suffering from iron deficiency anemia. The petitioner thereafter noticed that he was passing blood in the stool upon which he once again approached the GBP Hospital on 11.11.2014 when he was advised colonoscopy which was performed on 19.11.2014. The colonoscopy revealed that the petitioner had possible colon cancer. Under the advice of friends and well-wishers, therefore, he immediately rushed to the TATA Memorial Hospital at Mumbai for availing best treatment of cancer. He was operated on 09.12.2014 and 12 cycles of chemotherapy were administered between 28.01.2015 to 21.07.2015.

The respondents do not dispute

the medical expenditure. They only argue that because prior referral order from the Medical Board was not obtained, such bills cannot be passed. In my opinion, in facts of the present case, such objection is totally invalid. As

noted, initially the petitioner suffered from weight loss and low hemoglobin in his blood. The fact that he was suffering from cancer was not detected at that stage. When he went back to the doctors with a complaint of passing blood in his stool, colonoscopy was advised which when performed revealed that he was suffering from colon cancer. Considerable time thus was already lost between the petitioner reporting early symptoms of a possible serious ailment and actual detection of the fact that he was suffering from cancer. He, therefore, had every reason to rush for best medical advice and treatment for such life threatening and dreaded disease. At such stage to expect him to apply, await and appear before the Medical Board and obtain a referral order before proceeding for the treatment is an unreasonable expectation. The respondents do not even dispute that had he appeared before the Medical Board, such reference would have been made. They only argue that the petitioner did not obtain a prior order of reference. The fact that on each subsequent occasion when the petitioner had the opportunity he applied to the Medical Board and referral orders were duly passed itself is an evidence of the justification of the petitioner obtaining medical treatment from outside State hospital.

The Supreme Court in case of Surjit Singh vs. State of Punjab and others reported in (1996) 2 SCC 336 had in somewhat similar circumstances made following observations:

“11.

It is otherwise important to bear in mind that self preservation of one's life is the necessary concomitant of the right to life enshrined in Article 21 of the constitution of India, fundamental in nature, sacred, precious and inviolable.

The importance and validity of the duty and right to self-preservation has a species in the right of self defence in criminal law. Centuries ago thinkers of this Great Land conceived of such right and recognised it. Attention can usefully be drawn to verses 17 18, 20, and 22 in Chapter 16 of the Garuda Purana (A Dialogue suggested between the Divine and Garuda, the bird) in the words of the Divine:

17 Vinaa dehena kasyaapi canpurushaartho na vidyate Tasmaaddeham dhanam rakshetpunyakar maani saadhayet Without the body how can one obtain the objects of human life? Therefore protecting the body which is the wealth, one should perform the deeds of merit.

18 Rakshayetsarvadaatmaanamaatmaa sarvasya bhaajanam Rakshane yatnamaatishthejje vanbhaadraani pashyati One should protect his body which is responsible for everything. He who protects himself by all efforts, will see many auspicious occasions in life.

20 Sharirarakshanopaayaah Kriyante sarvadaa budhaih Necchanti cha punastyaagamapi kushthaadiroginah The wise always undertake the protective measures for the body. Even the persons suffering from leprosy and other diseases do not wish to get rid of the body.

22 Aatmaiva yadi naatmaanama hitebhyo nivaarayet Konsyo hitakarastasmaa- daatmaanam taarayishyati If one does not prevent what is unpleasent to himself, who else will do it? Therefore one should do what is good to himself.

12.

The appellant therefore had the right to take steps in self preservation. He did not have to stand in queue before the Medical Board, the manning and assembling of which, barefacedly, makes its meetings difficult to happen. The appellant also did not have to stand in queue in the government hospital of AIIMS and could go elsewhere to an alternative hospital as per policy. When the State itself has brought Escorts on the recognised list, it is futile for it to contend that the appellant could in no event have gone to Escorts and his claim cannot on that basis be allowed, on suppositions. We think to the contrary. In the facts and circumstances, had the appellant remained in India, he could have gone to Escorts like many others did, to save his life. But instead he has done that in London incurring considerable expense. The doctors causing his operation there are presumed to have done so as one essential and timely. On that hypothesis, it is fair and just that the respondents pay to the appellant, the rates admissible as per Escorts. The claim of the appellant having been found valid, the question posed at the outset is answered in the affirmative. Of course the sum of Rs.40,000 already paid to the appellant would have to be adjusted in computation. Since the appellant did not have his claim dealt with in the High Court in the manner it has been projected now in this Court, we do not grant him any interest for the intervening period, even though prayed for. Let the difference be paid to the appellant within two months positively. The appeal is accordingly allowed. There need be no order as to costs.”

Similar view is expressed by this Court on number of occasions granting relief to the Government servants. Reference in this respect can be made to the following decisions:

Judgment dated 18.08.2016 in case of Sri Kallol Roy vrs. The State of Tripura & others in WP(C) No.277 of 2016, judgment dated 04.05.2018 in case of Sri Uttam Pal vrs. The State of Tripura & others in WP(C) No.1479 of 2017 and judgment dated 27.03.2019 in case of Sri Subal Das vrs. The State of Tripura & others in WP(C) No.895 of 2018.

In the result, the impugned order dated 07.12.2018 is set aside. The respondents are directed to pay the petitioner‟s medical bills in question as permissible. Such payment shall carry simple interest @ 7.5% from the date of completion of 3(three) months of presentation of bills till actual payment. Entire payment be made within a period of 2(two) months from today.

Petition is disposed of accordingly.”