Mohinder Pal, J. - (1.) CLAIM in the present writ petition is for quashing the order dated September 12, 2005 (Annexure P -3) vide which claim of petitioner Vasu Dev Bhanot for medical reimbursement on account of the treatment of his wife, namely, Smt. Pushpa Bhanot from Fortis Hospital -Super Speciality in Heart, Mohali, (hereinafter referred to as 'the Fortis Hospital') has been rejected and for issuing a direction to the respondents to make payment of the expenses incurred by the petitioner in connection with the treatment of Smt. Pushpa Bhanot.
(2.) THE petitioner is a Central Government pensioner and member of Central Government Health Scheme ( for short 'CGHS'). Wife of the petitioner, namely, Smt. Pushpa Bhanot, while coming from Kharar (District Mohali) along with the petitioner, felt severe chest pain on February 24, 2005. She was rushed to the Fortis Hospital in an emergency condition with diagnosis of Essential Hypertension, Coronary Artery Disease and Unstable Agnina Coronary. Angiography was done in emergency on February 24,2005, which revealed Double Vessel disease followed by PTCA to LAD and LCX with Integrillin. She underwent Angioplasty. Mounted stent ciper 2.75 x 18 cords and Mounted stent cipher 3.0 x 18 were used to save the life of petitioner's wife. She remained admitted in Fortis Hospital from February 24, 2005 to February 26,2005. The petitioner spent Rs. 3,76,439/ - on the treatment of his wife. The petitioner submitted claim of medical reimbursement of the aforesaid expenses to the respondent -Department, which was rejected. On notice, the respondent -Department contested the claim of the petitioner for medical reimbursement on the ground that the Central Government does not reimburse medical expenses on the treatment taken from private unrecognized hospitals. However, in case where treatment had to be taken in private unrecognized hospital in an emergency, the claims preferred may be referred to CGHS concerned, who after examining each case on merits, would recommend the admissible amount for payment to the beneficiaries. It has been further pleaded that the Medical Certificate (Annexure P -5) issued by the Fortis Hospital, which is a private hospital, not recognised by CGHS, is not valid under CGHS Rules for reimbursement of medical claims. As the petitioner took treatment in a private hospital from February 24, 2005 to February 26, 2006, he was not entitled for reimbursement of medical expenses. It has been further pleaded that the Additional Deputy Director General (HQ), Office of Director General Health Services (CGHS -I Section) (respondent No. 3), had consultations with the Head of Department, Cardiology, Safdarjang Hospital, New Delhi, who opined that the records did not suggest that Angioplasty was required as an emergency case. Use of cipher stunts in LCS artery cannot be justified under CGHS guidelines.
(3.) WE have heard Mr. Suneet Sharma, Advocate, appearing for the petitioner, and Mr. G.K.S. Taank, Advocate, appearing for the respondents and have gone through the records of the case.;