Relief to Government Doctor: Kerala HC grants Reimbursement Claims for Cancer treatment

Such observation came from the HC bench comprising of Justice Murali Purushothaman as it set aside the Government communication denying reimbursement to the petitioner doctor, who works in a Government affiliated college.

"There is a Constitutional as well a Statutory obligation on the part of the State to bear the expenses for treatment of the government servant and his family. In the backdrop of Article 21 of the Constitution of India and the Rules issued under the proviso to Article 309, it is impermissible for the respondents to reject the claim of the petitioner for reimbursement of the bills for the reasons stated in Ext. P8. Accordingly, Ext. P8 is set aside," noted the bench.

The case concerned the petitioner, who is working as an Assistant Professor at a college. Back in 2018, the father of the doctor, who is solely dependent on him, was taken to the General Hospital, Pathanamthitta. After being diagnosed with Carcinoma Rectum, he was referred to a higher center.

Also Read: Right to health includes affordable treatment: HC comes to rescue of Govt Nurse

Accordingly, he was taken to the Medical and Surgical Oncology Department of a Private hospital in Pathanamthitta. The consultant medical oncologist at the private specialty hospital for cancer treatment had opined that the patient needed to undergo surgery and therefore he was operated upon at the Laparoscopic Department of St. Gregorious Medical Mission Hospital.

The State Government, on the other hand, had issued an order in 2016 where it had empanelled certain private hospitals for treatment to facilitate medical reimbursement benefits under the Kerala Government Servants Medical Attendance Rules, 1960. At the serial no 20 of that list the private hospital where the patient had taken treatment had also been mentioned.

So, the treating hospital was also recognized by the Government for treatment under Rule 8 (3) of the Rules and the Departments recommended include Medical and Surgical Oncology.

For the purpose of the treatment of his father, the petitioner had incurred expenses worth Rs 1,98,311 for the first time the patient had been admitted. Later, more money was spent for this purpose.

Meanwhile, back on June 12, 2020, the Government issued a circular and stated that the medical reimbursement would not be made unless the treatment was availed in Government recognized private hospital. Based on the circular, the Government informed the petitioner that the claimed made by him cannot be allowed since the department of Laparoscopic surgery at St. Gregorious Medical Mission Hospital was not empanelled under the Rules. Accordingly, the applications and the bills were returned.

Challenging this, the petitioner approached the High Court and claimed for the reimbursement of Rs 4,68,038, which was spent for the treatment of his father.

Appearing on the behalf of the petitioner, the counsel Sri Jacob P. Alex contended that the reimbursement of medical claims incurred in the private hospital is admissible under the Rules and from the Government Order it can clearly be seen that the treating hospital was empanelled under the Rules.

The counsel submitted that the doctors in the Oncology department of the Hospital, after considering the nature of Cancer, advanced age and general health condition of the patient, the advantages of shorter length of stay at hospital, faster recovery and lesser operative complications, recommended for Laparoscopic surgery and the Government cannot deny claim for medical reimbursement only for the reason that surgery is performed in Laparoscopic surgery department of the Hospital.

It was further submitted by the petitioner's counsel that the Medical and Surgical Oncology department of the Hospital is recognised and recommended by the Government.

On the other hand, the counsel for the Government, Sri Jimmy George contended that on the basis of the financial constraints, the Government in the circular had decided not to give the reimbursement to patients who had taken treatment from private hospitals other than empanelled one and since the General and Laparoscopic surgery department of St. Gregorious Medical Mission Hospital from where the patient has received the treatment was not recognized by the Government, it was decided to reject the applications for reimbursement.

After considering the contentions, the court noted that being an Assistant Professor in an affiliated College for getting a reimbursement of medical bills under the Rules in respect of his father who is stated to be wholly dependent on him is not disputed. That is why; the genuineness of the claim made in the bills is also not disputed, noted the bench.

"It is for the Doctor to decide how a patient should be treated and which surgical procedure is safer and suitable to the patient. When Medical and Surgical Oncology department of the Hospital has been recognised by the Government in Ext. P2, the respondents cannot reject the claim of the 1st petitioner saying that the General and Laparoscopic surgery department from where the 2nd petitioner has received the treatment is not recognized by the Government. Undergoing Laparoscopic surgery for Carcinoma Rectum will not make the treatment as one done in a department other than the Medical and Surgical Oncology department in the Hospital," the bench also noted in this context.

The bench referred to the Apex Court judgment in the case of Mohinder Singh Chawla, wherein the top court had held that the right to health is an integral part of right to life guaranteed under the Constitution of India and the Government have Constitutional obligation to provide health facilities and bear the expenses incurred by the government servant for the treatment as per the policy of the Government.

At this outset, the bench also referred to the Kerala Government Servants Medical Attendance Rules, 1960, which provided for the reimbursement of the medical expenses incurred by the government servants and their family as defined therein and subject to the conditions provided therein.

As per the Rules, claim for reimbursement is admissible even if the hospital from which the treatment is availed is a private hospital of it is empanelled under the Rules, and satisfied the criteria for recognition.

The bench noted that the treating hospital was listed in the Government Order dealing with empanelment of private hospitals for medical reimbursement.

Thus setting aside the Government communication denying the claims, the bench noted, "There is a Constitutional as well a Statutory obligation on the part of the State to bear the expenses for treatment of the government servant and his family. In the backdrop of Article 21 of the Constitution of India and the Rules issued under the proviso to Article 309, it is impermissible for the respondents to reject the claim of the petitioner for reimbursement of the bills for the reasons stated in Ext. P8. Accordingly, Ext. P8 is set aside."

To read the court order, click on the link below.