Kerala HC relief to patient, asks Govt to reconsider reimbursement of liver transplant at Apollo Hospital

Kochi: Noting down the situation of healthcare back in 2011 which was not as advanced as it is today, The High Court of Kerala has recently directed the state government to reconsider its decision of rejecting the application of reimbursement in the case of a liver transplant of a patient and non-empanelment of Apollo Hospital, Delhi in the Reimbursement scheme.

Justice Devan Ramachandran observed that "the incident happened in the year 2011 when surely our systems were far behind from what we see today". While considering the petition of the patient, the court observed that the statement given cannot be used against him as he admitted that there were no well-equipped hospitals to conduct liver transplants in Kerala back then when he got his transplant done.

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The patient in his plea stated that finding the facilities improper for his particular illness at the said hospital, he decided to go to another hospital. Since he was not able to find a well-equipped hospital in Kerala, he went to Apollo Hospital, Delhi for his liver transplant, where he was handed over a bill of approximately Rs 20 lakhs as medical expenses.

The aggrieved patient had filed a petition for the reimbursement of the said Rs 20 lakhs of medical expenses to the concerned authorities, but his plea was rejected stating that "Apollo Hospital is not recognized in the medical reimbursement scheme and that no prior permission for the treatment was taken".

It is then, that the aggrieved patient knocked on the doors of the Kerala High Court and prayed through his petition, that "the expenses should be reimbursed by the competent authority in the given time frame fixed by this court".

The government counsel opposing the petition relief on the fact that the petitioner went to Apollo Hospital Delhi on his own accord and was not referred there

"It is doubtful for the reimbursement of the expenses incurred by the Apollo Hospital, Delhi as the petitioner went to avail the treatment as per his choice and was neither referred by any government hospital in Kerala nor by the 'Amrita Institute of Medical Sciences," the government counsel argued

The court, after taking note of all the submissions ruled in favour of the patient, stating that

In the case at hand, the incident happened in the year 2011, when surely our systems were far behind from what we see today. Therefore, no decision could have been taken by the 1 st respondent without making a proper investigation as to whether the treatment availed of by the petitioner was absolutely necessary or whether he had any alternative in Kerala, except to rely on the expertise of the 'Appolo Hospital' in Delhi

The request of the petitioner cannot be used against him because he honestly admits that since there were no hospitals in Kerala equipped to conduct liver transplantation in the year 2011; and that, considering his grave diagnosis, he was forced to approach the 'Appolo Hospital'. This does not ipso facto mean that the choice to go to the 'Appolo Hospital' was his alone and I am certain that this would have been guided by the references and advice offered by the hospitals in Kerala