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PETITIONER: SURJIT SINGH

       Vs.

RESPONDENT: STATE OF PUNJAB AND OTHERS

DATE OF JUDGMENT:       31/01/1996

BENCH: PUNCHHI, M.M. BENCH: PUNCHHI, M.M. VENKATASWAMI K. (J)

CITATION:  1996 AIR 1388            1996 SCC  (2) 336  JT 1996 (2)    28        1996 SCALE  (1)648

ACT:

HEADNOTE:

JUDGMENT:                       J U D G M E N T Punchhi, J.      Leave granted.       Is the hypothetical claim of the appellant for medical reimbursement  valid  in  the  facts  and  circumstances  of thiscase  is   the  straight   question  which   falls   for determination in this appeal.        The  appellant,  Surjit  Singh  (now  retired)  while postedas a  Deputy Superintendent  Police,  Anandpur  Sahib, Distt. Roper,  Punjab, developed a heart-condition on 22-12- 1987 and  that very  day went  on a short leave extending it uptill 10-1-1988, on medical grounds. It remains unclarified on the  record of  this case  as to what steps the appellant took thereafter  to meet  his ailment.  However, six  months later he obtained leave from his superiors from 15-6-1988 to 8-9-1988 and  went to  England to  visit his  son. It is the case of the appellant that while in England, he fell ill due to his  heart problem and as an emergency case, was admitted in  Dudley Road, Hospital Brimingham. After diagnosis he was suggested treatment  at a  named   alternate place.  Thus to save  himself   the  appellant,  got  himself  admitted  and operated upon  in Humana  Hospital, Wellington,  London  for aBye-Pass Surgery.  He claims to have been hospitalised from 25-7-88 to 4-8-88. A sum of Rs.3 lacs allegedly was spent on his treatment at London, borne by his son.        On  return  to  India,  the  appellant  on  6-11-1988 submitted a  Bill for  medical reimbursement  claiming  that very sum,  in the  office of  the Senior  Superintendent  of Police, Ropar which was forwarded to the Director General of Police, Punjab,  Chandigarh and  the Home  Department of the State of  Punjab. Some correspondence took place between the appellant and  the department.  As per  office  requirements some more certificates were sent by the appellant in support of his  case. Vide  letter  dated  21-1-93,  the  Department however expressed  its inability  to sanction  the bill  for

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medical reimbursement.  This led to the appellant moving the High Court  of Punjab  and Haryana  at  Chandigarh  in  writ jurisdiction. As  required by  the  High  Court,  the  State responded by  filing its  counter affidavit.  At the time of hearing the  Assistant Advocate  General for  the  State  of Punjab made  a statement  to the  effect that  the State was ready to pay to the appellent the expenses incurred for Bye- pass Surgery  and Angiography  on  the  rates  prevalent  in theAll India  Institute of  Medical Sciences, New Delhi (for short ’AIIMS’). Applying that yardstick, as suggested, a sum of Rs.30,000/-  on account  of Bye-Pass Surgery and a sum of Rs.10,000/- for  Angiography was  thus ordered  by the  High Court to be paid to the appellant within six weeks. The writ petition on  18-4-1995 was  disposed of  on such  terms. The said sum,  as claimed  by  the  State  stands  paid  to  the appellant.       The appellant challenging the orders of the High Court disposing of  the writ  petition in  such manner now pitches before us  his claim  to  payment  on  the  basis  of  rates prevalent in the Escorts Heart Institute and Research Centre (for  short  Escorts’),  reducing  his  high  claim  to  the expenses incurred  for medical treatment in London. There is an inkling  to that  effect  in  the  appellant’s  rejoinder affidavit in  the High Court but it appears that this aspect of the  matter was  not dilated  upon. The  claim  for  such adoption of rates is now made in reiteration.        The  parties counsel  agree that  there is  a  policy regarding reimbursement  of medical  expenses framed  by the State on  25-1-1991, which  has duly  been circulated in all the wings/offices  of the  State. It’s operative portion, so far relevant, is reproduced below :      "Subject   :    Re-imbursement   of      medical expenses - policy      regarding      Sir/Madam,        In  supersession of  Punjab Gover      nment letter No.7/7/85-  3HBV/13855      dated   27-5-1987, the  resident of      India is  placed to  lay  down  the      following policy  for reimbursement      of  medical  expenses  incurred  on      medical treatment  taken abroad and      in   hospitals   other   than   the      hospitals of  the Govt.  of  Punjab      (Both outside and in the State of :      Punjab):      i)   All  categories  of  employees      whether retired  or serving  of All      India Service/State Govt. Judges of      Punjab     and     Haryana     High      Court/M.L.As/Ex  M.L.  As  will  be      governed by this policy.      ii) The  person who  is in  need of      medical treatment  outside India or      in  any  hospital  other  than  the      Govt. of  Punjab (both  outside and      in the State of Punjab) as the case      may be  may make an application for      getting    treatment    in    these      hospitals directly  to the Director      Health and  Family welfare 2 months      advance, duly  recommended  by  the      C.M.O./Medical  Supdt.   indicating      that the  treatment for the disease      mentioned is  not available  in the

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    Hospital of the Govt. of Punjab. In      case     of      emergency     duly      authenticated   by   C.M.O./Medical      Supdt. the  application can be made      15 days in advance.      iii) Director,  Health  and  Family      Welfare,  Punjab   will  place  the      application   of    the   concerned      employee before  the Medical  Board      within 15  days on  the receipt  of      application. In  case of emergency,      if  immediate  meeting  of  Medical      Board,  cannot  be  convened,  such      application may  be  circulated  to      all  the  members  of  the  Medical      Board and decision taken thereof.      iv) The Medical Board shall consist      of the following officers:      i)  Director,   Health  and  Family      Welfare, Punjab - Chairman      ii  Director,   Education,   Punjab      Research and Medical - Member      iii) Specialist of the desired line      of treatment from PG1 Chandigarh or      AIIMS, New Delhi - Member      iv)  Senior  most  specialist  from      Medical Colleges, Patiala, Amritsar      and Faridkot - Member      v)  Dy.  Director/Asstt.  Director,      I/c of  P.M.H. Branches  office  of      the  Director   Health  and  Family      Welfare - Member Secy"      vi)   xxxx      vii)  xxxx      viii) xxxx      ix)   xxxx      xi)   xxxx      xi)   xxxx      xii)     The   Health   Deptt.   in      consultation with Director Research      & Medical  Education will prepare a      list   of    diseases   for   which      specialised   treatment    is   not      available in Punjab Govt. Hospitals      and          indicate           the      Institutions/Hospitals/Clinics   of      repute where necessary treatment is      available. This list will, however,      be subject to variation in future. On 8-10-1991, the above policy has further been explained in so far as the choice of the hospitals is concerned:      "Policy   for    reimbursement   of      medical   expenses    incurred   on      medical treatment  taken abroad and      in hospitals  other than  those  of      the  Government   of  Punjab,  both      within and  outside  he  State  was      laid down. However, as per the 12th      item of  hese instructions,  a list      of   those   diseases   for   which      specialised   treatment   was   not      available   in    the    Government      hospitals was  to  be  prepared  in      addition  to   identifying  medical      institutions/hospitals/clinics   of

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    repute   where   such   specialised      treatment was available.          The Government has now prepared      a list  of those diseases for which      the specialised  treatment  is  not      available  in   Punjab   Government      hospitals  but   is  available   in      certain     identified      private      hospitals, both  within and outside      the State.  It has, therefore, been      decided    to    recognise    these      hospitals for  the treatment of the      disease mentioned  against them  in      the  enclosed   list   for   Punjab      Government employees/pensioners and      their  dependents.  The  terms  and      conditions  contained   in   letter      under   reference    will    remain      applicable,     Government     can,      however,  revise   the   list,   in      future.      Therefore it  has been  decided  to      recognise those  hospitals for  the      treatment  of   diseases  mentioned      against them  in the  enclosed list      issued with  the concurrence of the      Finance Department  dated 11-9-1991      which is as under:      Open Heart  Surgery: Escorts  Heart      Institute,  New   Delhi;  Christian      Medical Colloge,  Ludhiana; Appollo      Hospital, Madras. The purport  of the  above policy is that the Escorts stands duly recognised  by the State for treatment of its employees for  open   heart  surgery,   apart  from   the  other   two institutions i.e.  Christian Medical  College, Ludhiana  and Appollo Hospital,  Madras. The  Finance Deptt’s  concurrence signifies its  willingness  to  entertainment  reimbursement bills in variables depending on where treatment is received.        There  has been  a factual  dispute as to whether the appellant went to the Dudley Road Hospital, Brimingham as an emergency case  and whether  he was  operated upon in Humana Hospital, Wellington,  London in  that condition. Except for the bare  word of  the appellant, no documentary evidence in support or  such plea  had been  tendered by  him before the High Court, or even before us to show that his was a case of emergency requiring  instant operation  and  treatment.  The State of  Punjab on  the other hand has countered before the High Court, as also here, that the case of the appellant was not that  of an  emergency but a planned visit to England to have himself  medically treated  under the  care of his son, without submitting  himself as  per policy,  for examination before the  Medical Board.  This plea  of the  appellant may have been  required to be examined in thorough detail had he stuck to his original claim for medical expenses incurred in England. Since  he has  now brought  down his  claim to  the rates prevalent  in the  Escorts in  place of that of AIIMS, further reference  to emergency  treatment etc. would not be necessary. It  would hypothetically  have to be assumed that the appellant  was in  India, had  not subjected  himself to Medical Board  examination, and  had gone  on his own to the Escorts and  got himself operated upon for Bye-Pass Surgery. The  point   to  be  considered  is  whether  his  claim  is admissible under  the policy  keeping in  view the string of judgments of  the High  Court in  that regard, as well as on

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the  factum   that  the   Stats  has  already  conceded  re- imbursement to  the appellant  on hypothetical  basis as  if treated in AIIMS.      The policy, providing recognition for treatment of open heart surgery  in  the  Escorts,  specifically  came  to  be examined by  a division bench of the Punjab and Haryana High Court at  Chandigarh in  C.W.P. No.13493  of 1992  titled as Sadhu R.  Pall vs.  State of Puniab throuqh Secretary Health and Family Welfare Punjab, Civil Secretariat. Chandigarh and others decided  on 6-10-1993,  wherein the claim of the then writ petitioner  to medical  reimbursement was accepted when in order  to save  his life he had got himself operated upon in the  Escorts, and  the plea of the State that he could be paid rates  as prevalent  in the AIIMS was rejected. Special Leave Petition  No.22024 of  1995 against  the said decision was dismissed by this Court on 2-2-1994, The other judgments of the  High Court following the decision in Sadhu R. Pall’s case are : (1) C.W.P.  No.18562  of  1992  decided  on  10-5-95  titled K.L.Kohil vs. State of Punjab and others (DB) : (2) C.W.P.  No.260 ot  1995, decided on 30-5-1995 titled avi Mohan Duggai vs. State of Punjab and Others (DB); (3) C.W.P.  No.5669 of  1994 decided  on 4-9-94  titled Prem Singh Gill vs. State of Punjab and Others; (4)  1995  (III)  Punjab  Law  Reporter  529  titled  Tarlok (Chander vs. The State of Punjab etc. (SB); and (5) 1995  (III), Punjab  Law Reporter  682 titled Mrs. Surya Pandit vs. State of Punjab and others (SB)      All the aforementioned judgments or the High Court have a common  factual basis,  i.e. each  recipient of the relief from the  High Court had in fact been treated in the Escorts and had  borne expenses. The other common factor is that the High Court  believed each writ petitioner pleating emergency to go  to Escorts  in the  given fact  situation.  But  this factor by  itself is  not the  core of the views of the High Court. Hypotheticallys  the appellant  says, he  too may  be considered to  have been  treated in  the Escorts,  more so, when he is being treated to have been operated upon in AIIMS without actually  having been  so and  had a  choice  to  go either to the AIIMS or Escorts or Christian Medical College, Ludhiana or  Appollo Hospita, Madras. The appellant in these circumstances cannot be said to be far too wrong in choosing the Escorts  amongst the three recognised hospitals for open heart surgery  available  in  the  North,  the  AIIMS  being governmental and  the other two being private hospitals. The division bench in Sadhu R. Pall’s case observed as follows :      "The  respondents  appear  to  have      patently used  excuses in  refusing      full  reimbursement,   when     the      factum of treatment and the urgency      for the  same has  been accepted by      the respondents  by reimbursing the      petitioner the expenses incurred by      him, which  he would  have incurred      in the  AIIMS New  Delhi. We cannot      loose sight of factual situation in      the  AIIMS  New  Delhi,  i.e.  with      respect to  the number  of patients      received there  for heart problems.      In such  an urgency  one cannot sit      at home  and think  in a  cool  and      calm atmosphere for getting medical      treatment at  a particular hospital      or  wait   for  admission  in  some      Government  medical  institute.  In

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    such a  situation, decision  has to      be taken forthwith by the person or      his attendants if precious life has      to be saved." We share the views afore-expressed.        It  is otherwise  important to bear in mind that self preservation of  one’s life  is the necessary concomitant of the  right   to  life   ensbrined  in   Article  21  of  the constitution  of   India,  fundamental  in  nature,  sacred, precious and  inviolable. The importance and validity of the duty and  right to  self-preservation has  a species  in the right  of  self  defence  in  criminal  law.  Centuries  ago thinkers of  this Great  Land conceived  of such  right  and recognised it.  Attention can usefully be drawn to versus 17 18, 20,  and 22  in Chapter  16  of  the  Garuda  Purana  (A Dialogue suggested  between the Divine and Garuda, the bird) in the words of the Divine: 17 -- Vinaa dehena  kasyaapi          Without   the  body how  can onecanpurushaartho na         obtain   the  objects of human vidyate  Tasmaaddeham           life?  Therefore  protecting thedhanam rakshetpunyakar-     body which is the wealth, one maani saadhayet                  should perform the deeds of                               merit. 18 -- Rakshayetsarvadaatmaanamaatmaa  One should  protect his body sarvasya bhaajanam Rakshane     which  is    responsible for yatnamaatishthejje              everything.  He who protects vanbhaadraani pashyati          himself by all efforts, will                                 see     many      auspicious                                 occasions in life. 20 -- Sharirarakshanopaayaah          The  wise  always  undertake Kriyante sarvadaa               the  protective     measures budhaih Necchanti cha           for   the   body.   Even the punastyaagamapi                 persons   suffering     from kushthaadiroginah               leprosy       and      other                                 diseases   do   not  wish to                                 get rid of the body 22 -- Aatmaiva yadi naatmaanama       If one does not prevent what hitebhyo nivaarayet             is unpleasent to    himself, Konsyo hitakarastasmaa-         who  else   will   do    it? daatmaanam taarayishyati        Therefore one should do what                                 is good to himself.       The appellant therefore had the right to take steps in self preservation,  He did not have to stand in queue before the Medical Board the manning and assembling of which, bare- facedly,  makes   its  meetings  difficult  to  happen.  The appellant also  did not  have  to  stand  in  queue  in  the government hospital  of AIIMS  and could  go elsewhere to an alternate hospital  as per policy. When the State itself has brought the Escorts on the recognised list, it is futile for it to contend that the appellant could in no event have gone to the  Escorts and  his  claim  cannot  on  that  basis  be allowed, on  suppositions. We  think to the contrary. In the facts and  circumstances,  had  the  appellant  remained  in India, he  could have  gone to  the Escorts like many others did, to  save his  life. But  instead he  has done  that  in London incurring  considerable expense.  The doctors causing his operation  there are  presumed to  have done  so as  one

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essential and  timely. On  that hypothesis,  it is  fair and just that  the respondents  pay to  the appellantt the rates admissible as per Escorts. The claim of the appellant having been found  valid, the  question  posed  at  the  outset  15 answered  in   the  affirmative.   Of  course   the  sum  of Rs.40,000/- already  paid to  the appellant would have to be adjusted in  computation. Since  the appellant  did not have his claim  dealt with in the High Court in the manner it has been projected  now in  this Court,  we do not grant him any interest for the intervening period, even though prayed for. Let the  difference be  paid to  the  appellant  within  two months positively.  The appeal is accordingly allowed. There need be no order as to costs.