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Judgment
The petitioner claims that he was serving as Programme Executive in the Prasar Bharti (Broadcasting Corporation of India) and superannuated on
28th February, 2011. On 3rd October, 2006, it is stated, while the petitioner was on active duty and was recording an interview of one Prof.
K.L.Bhatia, he suffered brain haemorrhage in the studio of Radio Kashmir Jammu. He was immediately shifted to the Government Medical College
Hospital, Jammu. Keeping in view the critical condition of the petitioner and lack of proper medical facilities to treat the patients of brain haemorrhage,
the doctors in the Government Medical College Hospital, Jammu referred the petitioner for specialized treatment in the Postgraduate Institute of
Medical Education and Research (PGI), Chandigarh. It is submitted that the petitioner remained under treatment in the PGI, Chandigarh from
04.10.2006 to 18.10.2006. Upon discharge the petitioner claims that he returned to his native place Jammu.Â
It is further submitted that in Jammu the petitioner developed some post operational complication for which his family members consulted the
doctors at Chandigarh who advised immediate operation of the petitioner in Jammu through renowned neurosurgeon, Dr. Haroon Salaria. On the
advice of the doctors at PGI, Chandigarh, the petitioner got admitted in a private Nursing Home (Langer Nursing Home) Trikuta Nagar, Jammu
where he was operated for “shunt operation for post operational hydrocephalusâ€. The petitioner after recovery lodged a claim for reimbursement
of medical expenses. The expenses which had been incurred by the petitioner at PGI, Chandigarh to the extent of Rs.65,326/- were reimbursed but his
Travel Allowance claim of Rs.11,400/- which was attached by the petitioner with his medical claim was not sanctioned and was kept pending for
approval of the competent authority. However, the expenses incurred by the petitioner in the private nursing home where he was operated upon by
Dr. Haroon Salaria were not reimbursed to him. After serving a legal notice and finding no response from the respondents, the petitioner filed this
petition.
On being put on notice, respondents filed their objections in which it was stated that the claim of the petitioner for medical reimbursement had been
duly considered and a sum of Rs.65,326/- had been disbursed to the petitioner to which he was found entitled to on account of treatment which the
petitioner received from PGI, Chandigarh. Regarding the expenses claimed on account of travelling, it was submitted that a sum of Rs.2610/- was paid
to the petitioner. From the reply filed by the respondents it further transpires that the amount claimed by the petitioner for reimbursement with regard
to the expenses incurred in the private nursing Home (Langer Nursing Home), Trikuta Nagar, Jammu, however, was not accepted. In the
supplementary affidavit filed by one Sh. Vijay Kumar Sambyal, Station Director, Radio Kashmir Jammu, the respondents have explained as to why the
medical expenses incurred by the petitioner in Langer Nursing Home were not sanctioned in favour of the petitioner. Through the medium of the
supplementary affidavit it was also clarified that the petitioner was not governed by the CGHS scheme as the same was not applicable in Jammu nor
the petitioner was beneficiary in the aforesaid scheme. It is, thus, submitted that the medical reimbursement claim of the petitioner was governed by
the Central Service (Medical Attendance) Rules , 1994.
There is no dispute with regard to the fact that the petitioner suffered brain haemorrhage for which he was initially treated in Government Medical
College Hospital, Jammu. The doctors attending on him, however, referred him to PGI, Chandigarh for specialized treatment. He was operated upon
by the doctors at PGI, Chandigarh and was discharged after recovery. He, however, developed post operational complications for which, as claimed
by him, the petitioner was operated upon by Dr. Haroon Salaria, a neurosurgeon serving in the Government Medical College Hospital, Jammu, in a
private nursing home situated at Trikuta Nagar, Jammu. So far as the medical expenses incurred by the petitioner on account of his treatment at
Chandigarh are concerned, the same have been reimbursed and there is no dispute with regard to the aforesaid expenses. There is, however, dispute
with regard to the travelling expenses of Rs.11,400/-. Against the amount claimed, the petitioner has only been reimbursed a sum of Rs.2610/-, as has
been submitted by the respondents in the reply. No reasons are forthcoming either from the objections or from the supplementary affidavit as to why
the whole of the travelling expenses claimed by the petitioner were not reimbursed to him.
Having heard learned counsel for the parties and perused the record, it would be appropriate to first reproduce Rule 6 of the Central Services
(Medical Attendance) Rules, 1944, which reads thus:-
“MEDICAL TREATMENT
6 (1)- A Government servant shall be entitled, free of charge, to treatment-Â
(a) in such Government hospital at or near the place where he falls ill as can in the opinion of the authorized medical attendant provide the necessary
and suitable treatment; orÂ
(b) if there is no such hospital as is referred to in sub-clause (a) in such hospital other than a Government hospital at or near the place as can in the
opinion of the authorized medical attendant, provide the necessary and suitable treatment;Â
 (2)- Where a Government servant is entitled under sub-rule (1), free of charge, to treatment in a hospital, any amount paid by him on account of
such treatment shall, on production of a certificate in writing by the authorised medical attendant in this behalf, be reimbursed to him by the Central
Government.Â
 Provided that the Controlling Officer shall reject any claim if he is not satisfied with its genuineness on facts and circumstances of each case, after
giving an opportunity to the claimant of being heard in the matter. While doing so, the Controlling Officer shall communicate to the claimant the
reasons, in brief, for rejecting the claim and the claimant ma submit an appeal to the Central Government within a period of forty five days of the date
of receipt of the order rejecting the claim.â€
Sub Rule 1 of Rule 6 of the Medical Attendance Rules, as is apparent from its bare reading, is in two parts. The first part provides that a
government servant shall be entitled to, free of charge, to treatment in such government hospital at or near the place where he falls ill provided in the
opinion of the authorized medical attendant such government hospital has the necessary infrastructure to provide suitable treatment. The second part
of the Rule, however, provides that, if no such government hospital as aforesaid is available in or near the place where the employee falls ill, the
treatment can be had in such hospital other than the government hospital at or near the place where the employee falls ill, which in the opinion of the
authorized medical attendant, is equipped to provide necessary suitable treatment.Â
Obviously, as is apparent from the pleadings, the Government Medical College Hospital, Jammu does have a department of Neurosurgery and a
neurosurgeon of repute, namely, Dr. Haroon Salaria. It is because of this reason and also in view of the emergency the petitioner was immediately
shifted to Government Medical College Hospital, Jammu. However, the doctors attending him at GMC, Jammu referred him to PGI, Chandigarh, a
government hospital of the sort for specialized treatment keeping in view the critical medical condition of the petitioner and lack of requisite advanced
facilities in Government Medical College, Jammu. He was operated upon at PGI Chandigarh and the expenses incurred by the petitioner at PGI,
Chandigarh have been duly reimbursed to him. So far so good. But, as is claimed by the petitioner which is also supported by the medical evidence, the
petitioner suffered post operational complications. The post operational complications i.e. hydrocephalous was well treatable in Government Medical
College Hospital, Jammu. This is so because ultimately, may be at the advice of the doctors in PGI, Chandigarh, the petitioner was operated upon by
Dr. Haroon Salaria, a doctor in the Government Medical College Hospital, Jammu but in a private nursing home .Â
The parties have not disputed before this Court that Dr. Haroon Salaria is a neurosurgeon conducting such operations in Government Medical
College Hospital, Jammu. The petitioner has not been able to give any explanation as to why instead of going to Govt. Medical College Hospital,
Jammu he preferred to be operated in a private nursing home when the operating surgeon at both the places was the same. Going by the provision of
Rule 6 of the Central Services (Medical Attendance) rules, 1944 reproduced herein above and in the absence of opinion of any authorized medical
attendant that the hospitalization of the petitioner in the Hospital/Nursing Home other than the government hospital was necessary to provide suitable
treatment to the petitioner or there was no government hospital capable of providing such treatment in or near the place where the petitioner fell ill, the
petitioner was not entitled to medical reimbursement for having taken treatment at a private nursing home.Â
Learned counsel for the petitioner when confronted with the aforesaid unequivocal position of Rule 6 placed reliance upon the judgment of Supreme
Court in the case of Shiva Kant Jha v. Union of India; AIR 2018 SC 1975. In the aforesaid case, the Supreme Court was dealing with a similar
medical reimbursement claim under Central Government Heath Scheme and the claim of the beneficiary had been denied only on the ground that he
had received treatment in non-empanelled hospital of CGHS. The claim of the beneficiary in the aforesaid case was that it was due to emergency he
had get the treatment from non-empanelled hospital of the CGHS. In the given facts and circumstances of the case, the Supreme Court in paragraph
No.15 held thus:-
 “15. In the present view of the matter, we are of the considered opinion that the CGHS is responsible for taking care of healthcare needs and
well being of the central Government employees and pensioners. In the facts and circumstances of the case, we are of opinion that the treatment of
the petitioner in non-empanelled hospital was genuine because there was no option left with him at the relevant time. We, therefore, direct the
respondent-State to pay the balance amount of Rs.4,99,555/- to the writ petition. We also make it clear that the said decision is confined to this case
only.â€
 However, much stress was laid by the learned counsel for the petitioner on the observations of the Supreme Court made in paragraph No.13 of the
aforesaid judgment, which for facility of reference is reproduced as under:-
“13) It is a settled legal position that the Government employee during his life time 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 specialized 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 the CGHS have denied the grant of medical reimbursement in full to the petitioner forcing him to approach this Court.â€
The case of the petitioner is distinguishable from the facts of the aforesaid case. The petitioner had the facility at Government Medical College
Hospital, Jammu virtually at his doorstep and could have easily availed of the services which were also available in the aforesaid hospital. However,
for the sake of his convenience and the convenience of his attendants, he decided to get the treatment in a private nursing home. As already stated
and reiterated at the cost of repetition, the doctor who operated upon the petitioner was the same who was responsible for conducting such surgeries
in the Government Medical College Hospital, Jammu. Although, I am of the considered opinion that the case of the petitioner is distinguishable and not
covered by the judgment cited by the learned counsel for the petitioner, yet this Court cannot lose sight of the fact that the petitioner had developed
post operational complications and he was actually operated by the doctor though in a private nursing home. He has also incurred expenses in getting
himself treated. The amount claimed by the petitioner on account of operation conducted in the private nursing home is meagre, the breakup of which
is in the following manner:-
i) Room Rent for five days @ Rs.500/-Â Â Rs.2,500/-
ii) Theatre charges     Rs.5,000/-
iii) Anesthesia Professional charges  Rs.2,000/-
iv) Charges of Assistant Surgeon   Rs.2,000/-
v) Medicines      Rs.5,500/- vi) C.T.H.P.+ CEAT     Rs.2,500/-
vii) Nursing charges for five days @ Rs.200/- per day Rs.1,000/-
 Post operational medicines    Rs.1,145.32/-
 Total        Rs.21,945.32
 In addition to the aforesaid amount, the petitioner has also claimed Rs.25,000/-, paid as charges of surgeon, who operated upon him. In all the
petitioner has sought reimbursement of Rs.46,945.32/-.
Strictly speaking, the aforesaid amount is not payable in terms of Rule 6 of the Medical Attendance Rules, yet taking cue from the observations of
the Supreme Court in paragraph 13 of the judgment in the case of Shiva Kant Jha (supra) and keeping in view the special facts and circumstances of
this case, as narrated above, I am inclined to direct the respondents to reimburse the aforesaid amount to the petitioner. So far as travelling expenses
are concerned, the petitioner had claimed Rs.11,400/- but has only been paid Rs.2610/- without giving any reason. Rule 4 of the Medical Attendance
Rules does not put any fetter to grant the travelling allowance as is actually incurred by the beneficiary. The petitioner has submitted the relevant bills
and is, therefore, entitled to the reimbursement of the whole amount.
Accordingly, this petition is allowed and the petitioner is held entitled to the reimbursement of Rs.46,945.32/- incurred by him on account the
operation conducted in Langer Nursing Home, Trikuta Nagar, Jammu. The petitioner is also held entitled to Rs.8790/-, the balance of the travelling
allowance. The aforesaid amount shall be paid to the petitioner within a period of four weeks from the date a certified copy of this order is made
available to the respondents. Since the judgment has been rendered in the peculiar facts and circumstance of the case, therefore, the amount payable
to the petitioner shall not attract any interest nor shall the judgment be treated as precedent. However, there shall be no order as to the costs.