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PETITIONER: STATE OF PUNJAB & ORS.

       Vs.

RESPONDENT: RAM LUBHAYA BAGGA ETC. ETC.

DATE OF JUDGMENT:       26/02/1998

BENCH: S.B. MAJMUDAR, M. JAGANNADHA RAO, A.P. MISRA

ACT:

HEADNOTE:

JUDGMENT:                       J U D G M E N T MISRA, J.      Leave granted.      In these  set of  appeals arising  out of Special leave petitions,  the  common  question  which  has  come  up  for consideration is the entitlement towards medical expenses of the Punjab  government employees  and pensioners  as per the relevant rules  and  the  Government  policy.  In  pith  and substance,  the   scale  at  which  their  reimbursement  is admissible towards  their medical  expenses  incurred  in  a nongovernmental hospital.  It is  not a  new phenomena, such employees  have  been  and  are  still  raising  such  issue repeatedly with the changing scenario, political, social and financial the  policy of reimbursement is not static. In the recent past  in spate  of petitions  dealing with  the  1991 policy of  the State  Government  this  Court  settled  this principle in  the case of Surjit Singh vs. State of Punjab & Ors., (1996  (2) SCC  336 and  State of  Punjab vs. Mahinder Singh Chawla  (1997 (2)  SCC 83. Consequent to the effect of the said  and other  decisions and their resultant impact on the  State   exchequer  and   other  actors  led  the  State Government to  reconsider its  old policy  of 1991 by making necessary  modifications,  deletionsa  through  order  dated 9.9.94 till  it was  substituted through  a new policy dated 13th February,  1995. All  the earlier rulings were based on the aforesaid  old policy  including the clarification dated 8th October,  1991. The  same was partially withdrawn on 9th September, 1994  followed by  placing the new policy on 13th February, 1995. In short respondents grievance, is the claim which was  allowed by this Court earlier when such employees were  admitted   for  heart   ailment  in   escorts  a  non- governmental hospital,  is  now  being  declined  which  was allowed by  this Court  earlier  when  such  employees  were admitted for  heart ailment  in Escorts  a  non-governmental hospital, is now being declined which is in contradiction to the said rulings  of this Court.      In short  in SLP  (C) No. 13167 respondent is said have suffered a  severe heart  attack  on  13th  March,  Research Center in an emergency. On 27th March, 1995 and was taken to the Escorts  Hearts Institute  and  Research  Center  in  an

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emergency. On 27th March he underwent coronary artery bypass graft surgery.  Finally he  was discharged  on  10th  April, 1995.  The  entire  expenses  incurred  for  the  treatment, surgery,  post-operative   check  up   etc.  came   to   Rs. 2,11,758,70. In  May, 1996  he has submitted the bill to the government for reimbursement.      The appellant’s  stand is  that as per new policy dated 13th  February,   1995  the  reimbursement  of  the  medical expenses  incurred   in  any   private  hospital   is   only admissible, if  for such ailment, treatment is not available in any  government  hospital,  and  for  this  no  objection certificate is  obtained from  the Civil Surgeon or Director of Health Services as the case may be. Respondent’s case was not referred  to the Escorts for any treatment by any of the competent authority.  For any  such claim  an employee  must obtain  no   objection  certificate   from   the   concerned authority. In  cases of  emergency if  admitted in a private hospital ex-post   facto approval could be obtained from the concerned  authority   of  course   within  the  permissible parameters. As  the claim relates to surgery conducted after the new  policy and  the reimbursement  amount is claimed on the basis of the bill of the Escorts, the same is, according to appellant  not permissible in as much as the Committee of Technical Experts  has decided  as per  the new  policy that only rates  as prevalent  in All  India Institute of Medical Sciences, New Delhi, will be paid.      The respondents  with vehemence   challenge  this stand and the  new policy  of the  appellant which  has come  into force on  13.2.95 as  the same being violative of Article 21 of the  Constitution of  India. It  is argued this is one of the most  sacred fundamental  rights given  to its  citizen. Since right  to life  is protected  under this Article hence refusing to  pay the amount spent to save one’s life amounts to the curtailment of such right, hence violative of Article 21. In  earlier decisions this Court has said that the right to live  does not mean mere survival or animal existence but includes the  right to  live with  Human dignity.  In  other words, man’s  Life should  be meaningful, worth living. Pith and substance of life is the health, which is the nucleus of all activities  of life  including that  of an  employee  or other  viz.   the  physical,   social,  spiritual   or   any conceivable human  activities. If this is denied, it is said everything crumbles.      This  Court  has  time  and  again  emphasised  to  the Government and  other authorities  for focussing  and giving priority and  other authorities  for  focussing  and  giving priority to the health of its, citizen, which not only makes one’s life  meaningful, improves  one’s efficiency,  but  in turn gives  optimum out put. Further to secure protection of one’s life  is one  of the foremost obligation of the State, it is  not merely  a right enshrined under Article 21 but an obligation cast  on the  State to  provide this  both  under Article 21  and under  Article 47  of the  Constitution. The obligation includes  improvement of  public  health  as  its primary duty. Learned counsel for the appellant on the other hand does  not deny such a right but urges that the same can be placed  within permissible  limits by  rules and policies laid down. The right claimed may be sacrosanct, which has to be given,  but the same can be put within reasonable limits, under  a   policy  which   is  framed   after  taking   into consideration various  factors. Thus  the only  question is, whether the  new policy is arbitrary, unreasonable violative of any  law or  principle to be struck down. Of corse it has to stand  to the  test of reasonableness and not to erode or curtail any  of the Constitutional or Statutory right of any

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employee, If not, the claim cannot go beyond the policy.      Shri Rajeev  Dhawan, learned  senior counsel  appearing for the  appellants submits  with force  that it would be no violation, if  medical facility  in absolute term as desired is not  provided because  of any  financial constraints viz. lack of  financial resources  or for  such other reasons. No right under  the Constitution is absolute in term. It has to be  balanced   with  the  need,  equity  and  the  resources available.      In Vincent Panikurlangara vs. Union of India: (1987 ) 2 SCC 165;      "Para  16   -  In   a   series   of      pronouncement  during   the  recent      years this  court  has  called  out      from the  provisions of  part IV of      the  Constitution   these   several      obligations of the State and Called      upon it to effectuate them in order      that the  resultant pictured by the      Constitution Fathers  may become  a      reality.  As  pointed  out  by  us,      maintenance  and   improvement   of      public health  have to rank high as      these are indispensable to the very      physical   betterment    of   these      depends the building of the society      of which  the  Constitution  makers      envisages.  Attending   to   public      health, in  our opinion, therefore,      is of  high priority  - perhaps the      one at the top."      " The  expression ’life’ assured in      Article 21  does not  connote  mere      animal   existence   or   continued      drudgery through  life.  It  has  a      much wider  meaning which  includes      right   to    livelihood,    better      standard   of    living,   hygienic      conditions in  the work  place  and      leisure       facilities        and      opportunities to eliminate sickness      and  physical   disability  of  the      workmen.  Health   of  the  workman      enables him  to enjoy the fruits of      his labour,  to keep him physically      fit and  human right to protect his      health.   In   that   case   health      insurance,  while   in  service  or      after retirement  was held  to be a      fundamental right  and even private      industries are  enjoined to provide      health insurance to the workmen."      In  Kirloskar   Brothers  Ltd.  vs.      Employees      State      Insurance      corporation, 1996 (2) SCC 682;      "Para   9    -   The   Constitution      envisages the  establishment  of  a      welfare State  at the federal level      as well as at the State level. In a      welfare State  the primary  duty of      the Government  is  to  secure  the      welfare of  the  people.  Providing      adequate medical facilities for the      people is  an essential part of the      obligations  under   taken  by  the

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    Government in  the  welfare  State.      The  Government   discharges   this      obligation by running hospitals and      health   centers    which   provide      medical care  to the person seeking      to  avail   of  those   facilities.      Article 21 imposes an obligation on      the State to safeguard the right to      life of  every person. Preservation      of human  life is thus of paramount      importance.     The      government      hospitals run  by the State and the      medical officers  employed  therein      are duty  bound to  extend  medical      assistance  for   preserving  human      life. Failure  on  the  part  of  a      government  hospital   to   provide      timely  medical   treatment  to   a      person in  need of  such  treatment      results in  violation of  his right      to life  guaranteed  under  Article      21."      In  Paschim   Banga  Khet   Mazdoor      Samity Vs.  State of  West  Bengal,      1996 (4) SCC 36;      "Para 16-  It is no doubt true that      financial resources  are needed for      providing these  facilities. But at      the same  time it cannot be ignored      that  it   is  the   constitutional      obligation of  the State to provide      adequate medical  services  to  the      people. Whatever  is necessary  for      this purpose has to be done. In the      context   of   the   constitutional      obligation to  provide  free  legal      aid to  a poor  accused this  Court      has  held  that  the  State  cannot      avoid its constitutional obligation      in  that   regard  on   account  of      financial  constraints.   The  said      observations   would   apply   with      equal, if not greater, force in the      matter     of      discharge     of      constitutional  obligation  of  the      State has to be kept in view."      On the  basis of  last decision reference to above, the question is,  whether  such  a  right  is  absolute  and  no financial constraints could be pleaded or if it could be, to what extent? This we would be adverting little later.      Learned counsel  for the appellants fairly submits that in respect  of any  such claim of reimbursement for a period prior to  the new policy, the old policy of 1991 as modified before the new policy would be applicable. so far as the old policy  goes   the  law  is  well  settled  through  various decisions of  this Court  about  which  there  is  not  much dispute.      Before proceeding  further we  would like to refer to a preliminary objection  raised by  learned  counsel  for  the respondent  that  under  this  new  policy  when  the  State Government   denied   such   claim   of   an   employee   in circumstances similar to the present case, the said employee filed a writ petition which was allowed by the High Court in the case  of Varian  Singh vs. State of Punjab (1996 (4) SLR 177) against that judgment the State filed SLP (C) No. 12954

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of 1996 and it was dismissed by this Court on 17th December, 1996. Hence  it is  contended for  the respondent  that  the State cannot  take up the same stand which has become final. We are  informed and  it  is  not  disputed  that  the  said dismissal of  the SLP  was not by any reasoned order. Points raised here before us was neither raised nor decided in that SLP by  this Court.  As this  question is  likely to come in future, we  feel it  is necessary  to decide  and settle it. Hence this  preliminary objection  raised by  the respondent has no force.      The validity  of the  claim of the respondents has been upheld by  the High  Court under  the impugned order and the which  respondent   has  been   held   entitled   to   total reimbursement  of   his  expenses   incurred  in  a  private hospital. To  appreciate all this it is necessary to shortly give the periphery of the earlier policy of 1991 and the new policy dated 13th February, 1995.      The old  policy of  1991 was  framed in supersession of the earlier Punjab Government’s letter dated 27th May, 1987. This is  a policy  for  the  reimbursement  of  the  medical expenses incurred on treatment taken abroad or in a hospital other than  the hospitals  of the Government of Punjab (both outside and in the State of Punjab). Relevant portion of the same is quoted hereunder:      "The  person  who  is  in  need  of      medical treatment  outside India or      in any  hospital 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  in      advance, duly  recommended  by  the      CMO/Medical          Superintendent      indicating that  the treatment  for      the  disease   mentioned   is   not      available in  the hospital  of  the      Government of  Punjab. In  case  of      emergency  duly   authenticated  by      CMO/Medical   Superintendent    the      application can  be made 15 days in      advance.      Director,   Health    and    Family      Welfare,  Punjab   will  place  the      application   of    the    employee      concerned 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.      Thereafter on 8th October, 1991, the policy was further clarified so  far as  the choice  of hospitals  is concerned which is also quoted hereunder:-      "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 the  State  was      laid down. However, as per the 12th      item of these instructions, a  list      of   those   diseases   for   which

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    specialised   treatment   was   not      available   in    the    government      hospitals was  to the  prepared  in      addition  to   identifying  medical      institutions/hospitals/clinics   of      repute   where   such   specialised      treatment was available. Open Heart      Surgery; Escorts  heart  Institute,      New   Delhi;    Christian   medical      College, Ludhiana; Apollo Hospital,      Madras."      We find  two significant  points in the said  policy, one the procedural and the  other   nominating  few  designated hospitals other than government hospital for treatment.  The procedure  laid down under this  was very onerous, some times not  workable,  specially  in  emergency cases. Under  it if  one  needs  medical treatment either outside India or in any hospital  other  than  the  Hospital  of Government  of  Punjab,  an  application seeking approval  for such  treatment in such hospital  has to  be  made  to  the Director of  Health and  Family  Welfare two months  in advance  duly recommended by CMO/Medical Superintendent indicating that the  treatment for  such disease is not available  in the  hospital  of  the Government  of   Punjab.  In   cases  of emergency such  application  is  to  the authenticated  by   CMO/MS  to  be  made fifteen days  in  advance.  It  is  this procedure which  deprived  persons  from getting prompt  and better  treatment at other  places.   Some  of   the  serious diseases do  not knock  or warn  through bell giving  them time.  Emergency cases require immediate  treatment and if with a view  to comply with procedure one has to wait  then it could be fatal. One may not  in  such  cases  live,  if  such  a procedure is strictly followed. It seems keeping this in light, the Government in 1991 modified  its policies by including Escorts  Heart   Institute,  New  Delhi; Christian Medical  College, Ludhiana and Appollo Hospital,  Madras,  in  case  of Open heart  Surgery  as  the  designated hospitals   for    treatment   of   such permissible diseases.  Government in its 1991 policy,  also reserved its right to revise the  list in  future. The listing of the  aforesaid  designated  hospitals was with  the approval  of  the  Finance Department. Thereafter on 9th September, 1994  on   the  advice  of  the  Finance Department the aforesaid 1991 policy was again  modified   by   withdrawing   the clarification dated  8th  October,  1991 wherein private  hospitals in  the State and   outside    were   recognised   for treatment.  hence  the  benefit  of  the designated  hospitals   was  no   longer available  to   an  employee  for  being

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reimbursed towards his medical expenses. it is  in this  background present  that the new  policy dated  5th October, 1995 has  come  in  to  force.  The  relevant portion of  the  Said  State  Policy  is reproduced below:-      " As  per instructions  issued vide      Punjab Government letter No. 7/7/85      - 5HBV/2498,  dated  25.1.1991  the      policy regarding  reimbursement  of      medical   emphases    incurred   on      medical treatment  taken abroad  an      din  hospitals   other   than   the      hospitals  of   the  Government  of      Punjab (both outside and inside the      State of Punjab) was laid down. The      Government   has    reviewed    the      decisions taken  in  the  aforesaid      letter and  it has now been decided      as under:-      TREATMENT AT AIIMS -----------------      District Civil  Surgeons  shall  be      competent to  permit treatment of a      particular disease  at  AIIMS,  New      Delhi    on     the    basis     of      recommendations  of   the  District      level   Standing    Medical   Board      provided  the   treatment  is   not      available   in    the    Government      Hospitals of the State.      The  expenditure   on  reimbursable      items on such a treatment in AIIMS,      New Delhi,  shall be  reimbursed to      Government employees/pensioners.      TREATMENT IN  PRIVATE HOSPITALS  IN      THE COUNTRY      -----------------------------------      ---------      It has  been decided that employees      and  pensioners   should  be  given      freedom to  get treatment  in  any,      private   institute/hospital    (of      their own  choice), in  the country      provided  that   he/she  gives   an      undertaking  out  of  his/her  free      will and  in an  unambiguous  terms      that     he/she     will     accept      reimbursement of  expenses incurred      by him/her  on his/her treatment to      the level  of  expenditure  as  per      rates fixed by the Director, Health      and Family  Welfare, Punjab  for  a      similar treatment package or actual      expenditure whichever  is less. The      rate  for  a  particular  treatment      would be  included  in  the  advice      issued   by    the   District/State      medical  Board.   A  Committee   of      technical    experts    shall    be      constituted by  the Director Health      and  Family   Welfare   Punjab   to      finalise  the   rates  of   various      treatment  packages  and  the  same      rate list  shall be  made available

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    in  the   offices  of   the   Civil      Surgeons of the State.      However, this  permission would  be      granted by the Director, health and      Family  Welfare,   Punjab  on   the      advice of  State medical  Board  in      case  of   treatment   in   Private      Hospitals outside the State and the      District Medical  Board in  case of      treatment  in   private   hospitals      within the State.      It is  further submitted that in an      emergent  case   prior   permission      could be  waived from  the  Medical      Board but  Ex-post  facto  approval      from   the    Medical   Board   for      reimbursement of  medical  expenses      is    absolutely    essential    in      accordance  with  the  instructions      dated 5.10.1995.      TREATMENT ABROAD      ------------------      The treatment  of a  disease  in  a      country abroad  would be  permitted      in  extremely   rare  cases   where      satisfactory treatment  and  follow      up should  be  recommended  by  the      State Medical Board. Prior approval      of the State Medical Board shall be      a pre-requisite  in such cases. All      efforts  should   be  made  by  the      concerned   employee/pensioner   to      take prior  approval of  the  State      Medical Board."      Learned counsel  for the respondents strongly relies on the case  of Surjit Singh (supra). The contention is that in that case  the  claim  for  getting  reimbursement  expenses incurred in  Escorts  was  upheld  and  hence  it  would  be impermissible  now   for  the   State  Government   to  deny reimbursement of  expenses incurred  at Escorts on the basis of the alleged new policy. The decision under the new policy to reimburse  expenses only on the basis of the rates at the AIIMS, it is contended illegal. Everyone in order to protect his life  has to  go wherever  best  possible  treatment  is available. If  respondent went  to Escorts  which was once a designated hospital.  The refusal  now to reimburse expenses incurred at Escort has no justifiable ground to stand.      Having heard learned counsel for the parties at length, we find  the Surjit Singh’s case admittedly was based on the old policy.  There  the  medical  reimbursement  claim,  was admissible at  the rate admissible in Escort’s, as Escorts’s was one  of the designated hospitals. In that case denial of such rate  was therefore  rightly rejected.  However, strong reliance has  been placed by the respondent on the following paragraphs of surjit Singh vs. State of Punjab (1996 (2) SCC 336 ) which is as under:      "Para 9  -  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      titled as  Sadhu R.  Pail vs. State      of Punjab  (1994) 1 SLR 283 (P & H)      wherein the  claim of the then writ

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    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 2.2.94."      "Para 12-   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,  barefacedly,      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      alternative   hospital    as    per      policy."      Same argument  is submitted for drawing parity with the said case. Here also it is urged, when one gets heart attack he has  to wait  in a long queue, in the government hospital and may be by the time his turn comes he may not survive. it is hence  argued that the medical facility provided would be futile.      As  aforesaid   the  said   decision  would  render  no assistance to  the respondents.  Under the  old policy there were designated  hospital including  Escorts. That  was  the foundation of  the Said  decision. relevant  portion in this regard is quoted hereunder:-      "When the  State itself has brought      for  it   to   contend   that   the      appellant could  in no  event  have      gone  to   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  Escorts like  many  others      did, to save his life."      (Surjit Singh’s case (Supra).      That was  a case  where the petitioner got heart attack being in  England  and  was  hospitalised  and  operated  in Burminghom hospital  and this  Court held that is as much as Escort was  one of  the designated  hospital under  the  old policy of  the reimbursement  permissible to  the  appellant would be  at the rate as that of Escorts and not of AIIMS as ordered by the State.      The right  of the  State to change its policy from time to  time,   under  the  changing  circumstances  is  neither challenged nor  could it  be. let  us now  examine this  new policy. learned  senior counsel  for the  appellants submits that the  new policy  is more liberal in as much as it gives freedom of  choice to  every employee to undertake treatment in any  private hospital  of his own choice any where in the country. The only clog is that the reimbursement would be to the level of expenditure as per rates which are fixed by the Director, Health  and Family  Welfare, Punjab  for a similar package treatment  or actual expenditure which ever is less. Such rate for a particular treatment will be included in the

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advice issued by the District/State Medical Board for fixing this. Under the said policy a Committee of Technical Experts is constituted  by the  Director to  finalize the  rates  of various treatment  packages and such rate list shall be made available to the offices of the Civil surgeons of the State. Under this  new policy, it is clear that none has to wait in a queue.  One can  avail and  go  to  any  private  hospital anywhere in  India. Hence the objection that, even under the new policy  in emergency  one has  to wait  in a  queue as a argued in Surjit Singh case (supra) does not hold good.      In this  regard Mr.  Sodhi appearing  for the  State of Punjab has  specifically stated  that as  per the Director’s decision under  the new  policy, the present rate admissible to any  employee is  the same  as prevalent  in AIIMS. It is also submitted, under the new policy in case of emergency if prior approval  for treatment in the private hospital is not obtained, the  ex-post-facto sanction  can be obtained later from the  concerned Board  or  authority  for  such  medical reimbursement. After  due consideration  we find these to be reasonable.      Now we  revert to  the last submission, whether the new State policy  is justified  in not  reimbursing an employee, his full  medical expenses  incurred on  such treatment,  if incurred in  any hospital  in India  not being  a Government hospital in Punjab. Question is whether the new policy which is restricted  by the  financial constraints of the State to the rates  in AIIMS  would be  in violation of Article 21 of the  Constitution  of  India.  so  far  as  questioning  the validity of  governmental policy is concerned in our view it is not normally within the domain of any court, to weigh the pros and cons of the policy or to scrutinize it and test the degree of  its beneficial  or equitable  disposition for the purpose of  varying modifying  or  annulling  it,  based  on however  sound  and  good  reasoning,  except  where  it  is arbitrary or  violative of  any constitutional, statutory or any other  provision  of  law.  When  Government  forms  its policy, it is based on number of circumstances on facts, law including constraints  based on  its resources.  It is  also based on  expert opinion.  it would be dangerous if court is asked to  test the  utility, beneficial effect of the policy or its  appraisal based  on facts set out on affidavits. The Court would  dissuade itself  from entering  into this realm which belongs  to the  executive. It  is within  this matrix that it  is to  be seen  whether  the  new  policy  violates Article 21 When it restricts reimbursement on account of its financial constraints.      When we  speak about  a right,  it corelates  to a duty upon another, individual, employer, government or authority. In other  words, the  right  of  one  is  an  obligation  of another. Hence  the right of a citizen to live under Article 21 casts obligation on the State. This obligation is further reinforced under  Article 47,  it is for the State to secure health  to  its  citizen  as  its  primary  duty.  No  doubt government  is   rendering  this   obligation   by   opening Government hospitals  and health  centers, but  in order  to make it  meaningful, it  has to  be within  the reach of its people, as  far as  possible, o  reduce the queue of waiting lists, and  it has  to provide  all facilities  for which an employee  looks   for  at  another  hospital.  Its  up-keep; maintenance and  cleanliness has  to be beyond aspersion. To employ best  of talents  and tone  up its  administration to give effective  contribution. Also  bring  in  awareness  in welfare of  hospital staff for their dedicated service, give them  periodical,   medico-ethical  and   service   oriented training, not  only at  then try  point but  also during the

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whole tenure  of their  service. Since it is one of the most sacrosanct and  a valuable  rights of  a citizen and equally sacrosanct sacred  obligation of the State, every citizen of this welfare State looks towards the State for it to perform its this  obligation with  top  priority  including  by  way allocation of  sufficient funds.  This in turn will not only secure the  right of  its  citizen  to  the  best  of  their satisfaction but in turn will benefit the State in achieving its social,  political and economical goal. for every return there has  to be  investment. Investment needs resources and finances. So  even to protect this sacrosanct right finances are an inherent requirement. Harnessing such resources needs top priority.      Coming back to test the claim of respondents, the State can neither  urge nor  say that  it  has  no  obligation  to provide medical  facility. If  that were  so it  would be ex facie violative of Article 21. Under the new policy, medical facility continues  to be given and now an employee is given free choice  to get  treatment in  any private  hospital  in India but  the amount  of payment  towards reimbursement  is regulated. Without  fixing any specific rate, the new policy refers to  the obligation of paying at the rate fixed by the Director. The words are;      " ....  to the level of expenditure      as  per   the  rate  fixed  by  the      Director,   Health    and    Family      Welfare,  Punjab   for  a   similar      treatment   package    or    actual      expenditure which ever is less."      The new  policy does  not leave  this fixation  to  the sweet will  of the  Director but  it is  to  be  done  by  a Committee of technical experts.      "  The   rate  for   a   particular      treatment would  be included in the      advice issued by the District/State      Medical  Board.   A  Committee   of      technical    experts    shall    be      constituted by the Director, Health      and  Family   Welfare,  Punjab   to      finalize  the   roles  of   various      treatment packages."      No State of any country can have unlimited resources to spend on  any of  its project.  That is why it only approves its projects  to the  extent it  is feasible. The same holds good  for   providing  medical  facilities  to  its  citizen including its  employees. Provision  of facilities cannot be unlimited. It  has to be to the extent finance permit. If no scale or  rate is  fixed then  in case  private  clinics  or hospitals increase  their rate  to  exorbitant  scales,  the State would be bound to reimburse the same. Hence we come to the conclusion  that principle of fixation of rate and scale under this  new policy is justified and cannot be held to be violative of Article 21 or Article 47 of the Constitution of India.      In Vincent vs. Union of India: AIR (1987) SC 990:      " In a welfare State, therefore, it      is the  obligation of  the State to      ensure   the   creation   and   the      sustaining of  conditions congenial      to good  health..... In a series of      pronouncements  during  the  recent      years, this  court has  culled  out      from the  provisions of Part- IV of      the   Constitution,   the   several      obligations of the State and called

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    upon it to effectuate them in order      that the  resultant picture  by the      constitution fathers  may become  a      reality."      The next  question is  whether the  modification of the policy by  the State  by deleting  its earlier  decision  of permitting reimbursement  at the Escort and other designated hospital’s rate  is justified  or not?  This of  course will depend on  the facts and circumstances. We have already held that this  court would not interfere with any opinion formed by the  government if  it is  based on  relevant  facts  and circumstances or based on expert advice.      Any State  endeavor for  giving  best  possible  health facility has  direct co-relation  with finances. Every State for discharging  its obligation  to provide some projects to its  subject   requires  finances.   Article   41   of   the Constitution gives  recognition to this aspect. ’Article 41: Right to  work, to  educate  and  to  public  assistance  in certain cases:  The State  shall, within  the limits  of its economic capacity and development, make effective provisions for securing  the right  to work, to education and to public assistance in  cases of  unemployment, old  age sickness and disablement, and in other cases of undeserved want.’      It is  submitted by  the appellants  that earlier under the 1991  policy, for  bringing in  some of  the  designated Hospital for treatment, sanction from Finance department was obtained. Later  upon an appraisal of its expenditure it was found that  the bulk of the States budget was being taken by few elites for such treatment like Heart ailment etc. to the detriment of  large number  of other employees who suffered. hence on  the advise  of the  Finance department by means of order  dated   9th   September,   1994   the   facility   of reimbursement of  full charges  at designated  hospital  was withdrawn even under the old policy of 1991 from 9.9.94.      Financial constraints on the State is also evident from what is  recorded in the case of Waryam Singh (supra), which is also a case from Punjab:-      "  Para   30  -   When  Civil  Writ      Petition No.  16570  of  1995,  the      Court  issued   a  notice   to  the      respondents to show cause as to why      a direction  may not  be issued  to      the  Government   to  decided   all      pending matters  of  medical  dated      16.11.1995, the  learned Government      counsel produced before the Court a      list  of   cases  pending   in   57      departments/offices     of      the      Government of  Punjab. these  lists      show   that   over   20,000   cases      involving    claim    of    medical      reimbursement  ar  pending  in  the      various departments/offices  of the      Government.  In   some  cases,  the      claim is  for as small amount as of      Rs. 10/-  and as  high  as  of  Rs.      1,75,000/-. these  lists also  show      that   some    cases   of   medical      reimbursement are  pending for last      more  than   six  years.  In  other      cases, the  duration of pendency is      less. Reasons  given in majority of      the cases  are absence  of sanction      of paucity of funds."      Learned Counsel  for the  appellant submits that in the

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Writ petition  filed, the  respondent did  not  specifically challenge the new policy of 1995. If that was done the State would have  placed all  such material  in detail to show the financial strain.  We having  considered the  submission  of both the  parties, on the aforesaid facts and circumstances, hold that the appellant’s decision to exclude the designated hospital cannot  be said  be such  as  to  be  violative  of Article 21  of the  Constitution. No right could be absolute in a welfare State. A man is a social animal. He cannot live without the  cooperation of  large number  of persons. Every article one  uses is  the contribution  of many. Hence every individual right  has to  give way to the right of public at large. Not  every fundamental  right under  Part III  of the Constitution  is   not  absolute  and  it  is  o  be  within permissible reasonable  restriction. This  principle equally applies when there is any constraint on the health budget on account of  financial stringencies.  But  we  do  hope  that government will  give due  consideration and priority to the health budget in future and render what is best possible.      For  the  aforesaid  reasons  and  findings  we  uphold governments new policy dated 13th February, 1995 and further hold  it   not  to   be  violative  of  Article  21  of  the Constitution of India.      In  the  Civil  Appeals  arising  out  of  SLP(C)  Nos. 13167/97 and  12418/97, the surgery at Escorts was after the introduction of  the new  policy and therefore the extent of medical reimbursement  can be  only according  to the  rates prescribed by  AIIMS. However,  the respondents  therein are not entitled  to the  full expenditure  that was incurred at Escorts. We  therefore, allow the appeals in part and direct that the respondents are entitled to reimburse only at AIIMS rate. The appellant will therefore reimburse the respondents to the extent within one month from today.      The appeals  arising out  of SLP  (C) No.  12143/97 and 12144/97 though  the treatment  at Escorts was after the new policy the  amount as  claimed  has  already  been  paid  at Escorts rates.  On the facts and circumstances of this case, we are  not inclined  to interfere and therefore no question of any refund arises. These appeals are dismissed.      So far  as the  appeal  arising  out  of  SLP  (C)  No. 11968/97 is  concerned, we  find that the respondent had the heart attack  on 9th February, 1995 and was advised to go to Delhi on  18th February,  1995 but on account of long strike in the  All India  Institute of  medical sciences (AIIMS) he was admitted  in the  Escorts. On  those facts  we  are  not inclined to  interfere. the respondents has been paid at the admissible are  the  in  AIIMS  but  claims  the  difference between what  is paid and what is admissible rate at Escort. Looking to  the facts and circumstances of this Case we hold that the  respondent in  SLP (C) No. 11968/97 is entitled to be paid  the difference  amount of  what is paid and what is the rate admissible in Escorts then. The same should be paid within one  month from today. We make it clear reimbursement to the  respondents as  approved by  us be  not  treated  as precedent but  has been given on the facts and circumstances of these cases.      For the  reasons and  findings recorded  herein before, the new  policy dated  13th February,  1995 is  upheld.  The impugned High  Court orders  to that  extent are  set aside, Appeals arising  out of  SLP(C) Nos. 13167 and 12418 of 1997 are allowed  to the  extent indicated above and are disposed of accordingly.  Appeals arising  out of SLP (C) Nos. 12143, 12144 and  11968 of  1997  are  dismissed,  subject  to  the further direction given in the appeal arising out of SLP (C) No. 11968 of 1997. There will be no order as to costs.

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