Denying Full Reimbursement For Retd Govt Employee's Heart Surgery Violates His Human Rights: Bombay High Court

Refusing full reimbursement of the medical expenses to a public servant, who underwent a critical 'heart transplant' surgery not only violates his fundamental rights but strikes at the very essence of the human rights, said the Bombay High Court while directing Centre to reimburse Rs. 22 Lakhs to a retired Excise and Customs Officer. 

A division bench of Justices Girish Kulkarni and Advait Sethna in its June 6 order noted that the petitioner Anirudh Nansi underwent the heart transplant surgery at a private hospital as all the Central Government empanelled hospitals did not had the facilities available at that time and thus, the government refuse to reimburse the entire amount, he spent towards the surgery. It noted that heart transplant which is a "serious ailment", and for which surgery is critical and urgent.

Notably, the petitioner, who voluntarily retired from Central Excise and Customs, Pune, as an Assistant Commissioner in March 2008, was suffering from Cardiomyopathy since 2009. It was his case that on October 3, 2019, upon a significant deterioration in the Left Ventricle Ejaculation Function (LVEF), which declined to 12–15%, a team of doctors associated with Dr. Anvay Mulay, Heart Transplant Surgeon, advised the petitioner to undergo a heart transplant.

With no facility for heart transplant in various empanelled government hospitals, the petitioner underwent the same in the private hospital and after several communications, the government agreed to pay only Rs 69,000 arguing that the petitioner did not underwent the surgery in an empanelled hospital. 

"The respondents have not come with a case that immediate transplant facility was available or the organ was available for transplant, in any of its empanelled or CGS hospitals. If that be the case, certainly it cannot be said that the petitioner undergoing a heart transplant at a private hospital, where the organ was available and which could be immediately transplanted without any waste of time, was not an emergent and / or wrong decision on the part of the petitioner, and/or nonetheless despite such availability, he ought to have awaited for the heart transplant in the hospital which the CGHS authorities would intend...We are of the clear opinion that in a situation to save his life, the petitioner was certainly entitled to take a decision to have a heart transplant at a private hospital, in the absence of such facilities being readily / timely made available, in all the empanelled hospitals. Hence, the petitioner was required to be granted full reimbursement of all the expenditure, when such expenditure was not in dispute. Not granting full reimbursement, in these circumstances in our opinion, is not only violative of the fundamental rights but strikes at the very root, purpose and essence of these basic human rights as guaranteed by the Constitution, i.e., Right to Life under Article 21," the bench said. 

The bench said that in circumstances when such 'specialised' medical facilities are not available and the empanelled hospitals, the patient public servants can take treatment even at private hospitals. 

"In such situation, the Central Government is under an obligatory position to grant reimbursement on case to case basis. It may be true that for certain ailments, rates are fixed, however, the health issues are such that there cannot be a straight jacket formula in arriving at the rates for reimbursement and in a given situation, the Competent officer or the High Power Committee (HPC) would be required to grant reimbursement considering the treatment as received by the patient/employee," the judges said. 

The bench added that in many of such reimbursements, there may not be any issue or dispute on the amount of reimbursement, however, this would not mean that in very peculiar, serious, specialised cases of medical treatment, the reimbursement needs to be only as per the rates which are pre-determined.

"This would be most unrealistic, unfair and discriminatory as in the present situation. Any employee, merely because he has retired, ought not to be differently treated when it comes to genuine and realistic health expenditure. There is another aspect that the reimbursement rates are not revised from time to time in the absence of which, they are rendered unrealistic," the bench remarked. 

Thus, patients like the petitioner, who is a pensioner, cannot be deprived of benefits of medical reimbursement when he received treatment at private hospital, more particularly, when the petitioner's case is accepted as a genuine case, which the bench opined, was certainly of an urgent nature. The judges noted that the respondent authorities too did not dispute the medical treatment and the expenses, even after verifying the claims but still refused to reimburse entire amount. 

"In these circumstances, to make the petitioner suffer for reimbursement, in our opinion, amounts to travesty of justice and a glaring violation of the fundamental rights guaranteed to a citizen who is the former employee of the Central Government. In such circumstances, in our opinion, the High Power Committee ought to have been humanely sensitive in dealing with the petitioner's case and ought not to have adopted a mechanical and a narrow-minded approach," the bench observed. 

It also cannot be that the rules governing reimbursement are sacrosanct and nothing outside the rules in exceptional/special cases and especially deserving cases, can be considered for reimbursement by the Central Government, the judges said, adding, "A case to case legitimate decision protecting the fundamental rights is expected to be taken by the concerned officers. Such powers are conferred only to be utilized and more particularly when there is a need to exercise such powers not only to protect the fundamental rights but right to life and right to livelihood. Thus, apart from the Office Memorandum dated 15 July 2014 providing for relaxation, the High Power Committee even otherwise could exercise such powers of relaxation and in such deserving case, exercise its discretion to award full medical reimbursement."

While concluding the judgment, the bench emphasised, that the instant case is indisputably a case of heart transplant, which by all standards is a 'serious ailment.'

"Certainly, the surgery is one of urgency and critical importance, and could not have been postponed. It is a special circumstance. It is imperative that such surgeries are expedited in the interest of human life without an embargo of an expenditure which is secondary to human life," the bench underscored. 

With these observations, the bench ordered the Central government to reimburse the full medical expenses of Nansi towards his heart transplant surgery in December 2020 at the Sir HN Reliance Hospital in Mumbai after various empanelled hospitals failed to provide the facility. 

Case Title: Anirudh Prataprai Nansi vs Union of India (Writ Petition 7546 of 2022)

Counsel for Petitioner: Senior Advocate Prakash Shah along with Advocates Anil Balani, Durgaprasad Poojari, Jas Sanghavi, Priyasha Pawar and Vikas Poojary instructed by PDS Legal

Counsel for Respondent: Advocates YR Sharma, Vinit Jain and Ashok Varma

Click Here To Read/Download Judgment