- (1.) We have heard learned counsel appearing for the parties.
(2.) On 17.04.2015, we had passed an order on a letter petition, received from Shri Inderjeet Singh, retired Executive Engineer, Public Health & Works Department, Rajasthan, for providing reimbursement for the treatment of his wife, who is bed-ridden, and is being treated at home.
(3.) The orders, dated 17.04.2015, 28.04.2015, 29.05.2015 and 02.07.2015, passed by this Court, are quoted as below:- "17.04.2015: "This matter has been registered as a writ petition, in public interest, on a letter received from Shri Inderjeet Singh, Retired Executive Engineer, Public Health and Works Department Rajasthan, 61/55, Pratap Nagar, Sanganer, Jaipur dated 03.04.2015, for providing reimbursement for the treatment of his wife, who is bed-ridden, and is being treated at home. He is entitled to medical reimbursement for his wife under the Rajasthan State Pensioners Medical Concession Scheme, 2009. An amendment was made in the aforesaid Scheme on 07.07.2010, providing as follows: "22. Savings:- The Board of Trustees may grant to a pensioner any concession relating to medical treatment and attendance which is not provided in this scheme in individual cases of extreme hardship on merits." It is stated by Shri Inderjeet Singh in his letter that the Board, in its meeting vide agenda item No.15, rejected the request of medical reimbursement on the ground, that in case, such reimbursement is permitted to the applicant for taking the services of nursing attendant, physiotherapy, monitor etc. at the residence, such demands may be made by other government servants/pensioners for providing medical treatment at home, and which is likely to cause heavy financial burden on the State Government. The applicant also prayed for an appointment with Hon'ble the Governor of Rajasthan to explain his difficulty, of which no further details have been given. Considering the importance of the matter, in which the applicant, as a retired Government Servant, is unable to bear the expenses of the treatment of his wife, which are to be reimbursed by the State under the Rules of 2009, and in the frustration of refusal of reimbursement, even partly, he has demanded that she (applicant's wife) may be permitted for end her life, we find it appropriate to hearing and consider the matter. We appoint Shri S.D.Khaspuria, an Advocate of the High Court, as Amicus Curiae, in this matter to assist the Court. The Registry is directed to provide a copy of the petition along with annexures to the Amicus Curiae. Let notices of the petition be served to the State Government by the Registry through Advocate General, in the High Court at Jaipur Bench. The Registry will serve a copy of the petition along with a copy of this order in the office of Advocate General of the State of Rajasthan at High Court, Jaipur Bench. He will take instructions or file a reply within ten days. List again on 28.04.2015." "28.04.2015: "Mr.S.D.Khaspuria, Amicus Curiae, has visited the patient, and has collected the necessary details from Shri Inderjeet Singh, the petitioner. He states that according to Shri Inderjeet Singh, a retired Superintending Engineer, Public Works Department, his wife Smt.Neena Thakkar is terminally ill. She was treated in Fortis Escorts Hospital, which is an approved hospital of the State Government. He submitted a final bill of the hospital expenses, provided to him by the Fortis Escort Hospital for Rs.22,93,714/- for hospitalization, treatment and nursing care, out of which the State Government has reimbursed only Rs.9,61,997/-. It is submtited by Shri S.D.Khaspuria that since Smt.Neena Thakkar was brought home by her husband, as the doctors advised that since she is suffering a brain stroke, which has paralysed a major part of her body, they cannot do much, and that with her age and medical condition, no further treatment is advisable in the hospital. They advised that at best, nursing care can be given at home, and thus in view of the medical advise and looking to the condition of his wife, he brought her home and has given her the best possible nursing care at home, with the available medical equipment. Shri S.D.Khaspuria states that the details of the medical bills of the hospital, which were not found reimbursable, have not been provided to Shri Inderjeet Singh, and further that though Shri Inderjeet Singh is entitled to the full reimbursement of the medical treatment of his wife including the cost of hospitalization, medicines, physiotherapy, nursing care; the Board has not found the nursing care at home to be reimbursable. In this matter, we are required to consider the entitlement of Shri Inderjeet Singh for the treatment of his wife, either in the government hospital or at home. The justification of the deductions from the bills, which have been paid by him for reimbursement to the Fortis Escort Hospital, a Government approved hospital, and the justification of the denial of the expenses for medical treatment including nursing at home, has not been provided. Learned Advocate General appearing in the matter, states that he will seek proper instructions with regard to the deductions in the bill submitted by Shri Inderjeet Singh as well as entitlement of Shri Inderjeet Singh to the expenses for treatment and nursing care at home. Let the State get Smt.Neena Thakker examined by a Board of Doctors, regarding her medical condition and the treatment, which she requires, either in the government hospital or privately at home. A medical report will be submitted, with the opinion of the doctors, within a week. Learned Advocate General will also seek instructions in the matter, with regard to the deductions from the actual cost incurred in medical treatment and the entitlement for reimbursement of the medical bills. The matter will be listed again on 19.05.2015 for orders." 29.05.2015: "The instant public interest litigation has been registered on a letter received from a retired Superintending Engineer for reimbursement of medical expenses incurred in treatment of his wife, who is bed-ridden and is being treated at home. The applicant had stated that he is unable to bear expenses of the treatment of his wife and on the inability of the State to reimburse the expenses, he demanded that his wife may be permitted to end her life. A coordinate bench of this court vide order dated 17.04.2015 had directed Advocate General to seek instructions in the matter and file reply within ten days. Mr. S.D. Khaspuria, Advocate, who has been appointed as Amicus Curiae in the matter has stated that the condition of the patient is rather serious and she has suffered a brain stroke which has paralysed a major part of her body. Keeping in view her age and medical condition, no further treatment is advisable in the hospital although she requires proper nursing care at home for which heavy expenses have to be borne by the applicant. The learned Advocate General has very fairly submitted that the State is considering the case of the medical reimbursement of the applicant's-wife very sympathetically. He has further stated that under Rajasthan State Pensioners Medical Concession Scheme, 2009, a Board of Trustees has been constituted which is headed by the Chief Secretary as its Chairman which shall also examine the case of the applicant's wife for medical reimbursement. In view of the peculiar facts and circumstances of the case, especially the rather unfortunate medical condition of the applicant's wife who herself is a retired Principal, we direct the board of trustees of the Rajasthan State Pensioners Medical Concession Scheme to consider the case of the applicant's wife sympathetically and reimburse the amount which is permissible within a period of one month from today. We further direct the respondent-State to depute one nurse forthwith for providing nursing care at home for the applicant's wife. The respondents shall file compliance report before the next date. List on 01.07.2015." 02.07.2015: "The matter was adjourned yesterday, to enable learned AAG to seek instructions with regard to applicability of the relevant Rules for reimbursement of the medical bills of pensioners of the State Government. Learned Amicus Curiae informs the Court that the Board of Trustees has considered the petitioner's case for reimbursement of the medical bills of Rs.21,43,714/-, against which only Rs.9,61,997/-, was sanctioned and paid under the Rajasthan State Pensioners Medical Concesion Scheme, 2009, by which the Rajasthan Civil Services (Medical Attendance) Rules, 2008 (for short, 'the Rules of 2008'), were made applicable. The Board of Trustees has not given any reason whatsoever to reject the bills of balance amount under various heads. For example, for Diagnostic claim at Rs.32,370/-, only Rs.10,490/- was made admissible; for Doctor charges at Rs.42,175/- no amount was found admissible; for costs of medicines at Rs.12,05,744/- Rs.8,16,070/- was found admissible; for Equipment charges of Rs.56,450/- no amount was found admissible; and for Medical procedure cath lab charges at Rs.1,07,990/-, only Rs.12,351/- was found admissible. A drastic cut has also been made under the heads of investigation, medical consumable and miscellaneous amount. The bills were not found admissible for hip replacement. It is submitted by learned Amicus Curiae that the Rules of 2008, were superseded under Rule 21 of the Rajasthan Civil Services (Medical Attendance) Rules, 2013 (for short, 'the Rules of 2013'), and thus, the Rajasthan State Pensioners Medical Concession Scheme, 2014, which made the Rules of 2013 applicable, for medical reimbursement, will entitle the medical reimbursement to the pensioners, with effect from 16.09.2013, and not with effect from 13.10.2014, when the Scheme was made applicable, as the Rules of 2008 were not in existence, after 16.09.2013. We find substance and agree with the submission and hold that since the Rules of 2008 were superseded by the Rules of 2013, the Rules of 2013, will be applicable to the pensioners with effect from 16.09.2013, and not from the date of enforcement of the Scheme of 2014. We also agree with the submission of learned Amicus Curiae that the Board of Trustees has not considered the reimbursement on each count, and appears to have proceeded on a presumption that since the petitioner's husband retired as Superintending Engineer, Public Works Department, he may have sufficient funds available to him, for treatment of his wife. The entire approach was arbitrary inasmuch as it is not the resources of a person, but the entitlement, as a matter of right of a pensioner for medical reimbursement, which was required to be considered by the Board of Trustees. The consideration of the Board of Trustees does not take into account the rejection of reimbursement of medical bills, item-wise. It has committed a serious error in rejecting the claim on the ground that in case the amounts claimed are reimbursed, similar claims may also be raised before the Board of Trustees. In our opinion, the consideration was entirely misplaced, ill advised and arbitrary. Any claims in future, of similar nature, could be a ground, on which reimbursement on any admissible expenses for treatment of the patient could have been denied. As regards nursing care to the petitioner is concerned, we are informed that on the recommendations of the Board of Trustees, a Nurse has been deputed by the SMS Hospital. She is a new entrant in service who has just completed her training. She has no experience to treat serious patients, and that we are informed that on the very first date, when she attended the patient, she expressed her inability to help for lack of experience. Learned Amicus Curiae has placed before us the documents, to show that in a similar case, on the intervention of the Court, in S.B. Civil Writ Petition No.13044/2013- G.S. Gupta Vs. State of Rajasthan & Ors., the 'Health Benefit Empowered Committee' under the Rules of 2013, recommended for reimbursement of the bills in accordance with the schedule of medical expenses, in which the ICU and ventilator charges @ Rs.1200/- per day; Doctors' visit charges at 40% of actual fee; and the Extent of reimbursement for treatment in private unrecognized hospitals at 40% of actual fee, subject to maximum of Rs.3000/-, was reimbursed. In the present case, the patient was treated in a recognized hospital, and was entitled to reimbursement of medical expenses in accordance with the Rules of 2013. The argument advanced at the Bar, and the documents placed before us, would show that the Board of Trustees does not adopt uniform standards for all the cases for reimbursement. It treats the patient differently on considerations other than consideration under the Scheme for reimbursement of the medical bills in accordance with the applicable Rules for reimbursement. On a offer given by learned Additional Advocate General, to admit the patient in SMS Medical College, an attached Hospital, Jaipur, a reference has been made to the opinion of the Medical Board in the present case of Ms. Neena Thakkar, dated 25.05.2015. The Medical Board, considering the medical history of the patient, has opined that the hospitalization is ill-advised due to possibility of hospital acquired infections. The opinion of the Board giving the entire medical history of the patient, is quoted as below:- "In pursuance of the order No.14877-81/f4()/MC/General/2015, we the members of the board have examined the patient, Mrs. Neena Thakkar, aged 73, W/o Mr. Inderjit Singh. Patient is a known case of Hypertension, Diabetes Mellitus II, Coronary artery disease (post PTCA) on regular treatment including insulin therapy. She had fracture of left femur in August 2013 for which proximal femur nailing was done on 02.08.2013. She developed sepsis after the surgery and debridement with concentrated antibiotic spacer-beads placement was done on 25.08.2013. On 8.05.2014, implant removal and would debridement was done with replacement of antibiotic spacer-beads. She underwent surgery on 29.06.2014 in from of Total Hip Replacement (THR) on left side. In immediate post-operative period, patient was found in altered sensorium with Right hemiplegia and MRI Brain showed left MCA infarct with midline shift. She was managed in ICU with ventilatory support, Inotropes and Supportive care. In view of anticipated prolonged requirement of ventilatory support, tracheostomy was done. During hospital stay, patient developed UTI and chest infection with septic encephalopathy which was managed with antibiotics, antifungal agents and vasopressor support. Also, feeding gastrostomy tube was placed on 18.08.2014. She was discharged on 1.10.2014 with tracheostomy and gastrostomy in-situ, with normal vital parameters. Due to clinical condition of the patient, tracheostomy closure was not possible. Since last seven months patient is under round-the-clock nursing care at home during which she developed grade II bed-sore in the sacral area. In view of tracheostomy and gastrostomy in-situ, grade II bed-sore and diabetic status of the patient, hospitalization is ill-advised due to possibility of hospital-acquired infections. So, the patient may be kept under domiciliary care with anti-platelet agent, anti-hypertensive agents, Insulin, anti epileptic drugs, limb and chest physiotherapy and general nursing care. JUDGEMENT_80_LAWS(RAJ)8_2015_1.html;