Case Note & Summary
Surjit Singh, a Deputy Superintendent of Police in Punjab, developed a heart condition on 22 December 1987 and initially went on short leave. Six months later, he obtained leave to visit his son in England from 15 June 1988 to 8 September 1988. While in England, he fell ill due to his heart problem and was admitted as an emergency case to Dudley Road Hospital, Birmingham, then underwent bypass surgery at Humana Hospital, Wellington, London, from 25 July 1988 to 4 August 1988. His son bore the expenses of approximately Rs. 3 lakhs. Upon returning to India, he submitted a reimbursement bill on 6 November 1988 to the Senior Superintendent of Police, Ropar, which was forwarded to the Director General of Police and the Home Department. After correspondence and submission of certificates, the State of Punjab by letter dated 21 January 1993 refused to sanction the bill. The appellant then filed a writ petition in the High Court of Punjab and Haryana. At the hearing, the State offered to pay expenses for bypass surgery and angiography at AIIMS rates, and the High Court by order dated 18 April 1995 directed payment of Rs. 30,000 for bypass surgery and Rs. 10,000 for angiography, which was paid. The appellant appealed to the Supreme Court, claiming reimbursement at rates prevalent at Escorts Heart Institute and Research Centre, which was recognized by the State's medical reimbursement policy dated 25 January 1991 and clarification dated 8 October 1991 for open heart surgery. The State opposed, arguing that the appellant's visit to England was planned and not an emergency, and that he did not obtain prior approval from the Medical Board. The Supreme Court observed that since the appellant had reduced his claim to Escorts rates, the emergency aspect need not be examined; hypothetically assuming he was in India and went to Escorts without Medical Board approval, the court considered the policy. It noted that the High Court in Sadhu R. Pall and other decisions had consistently held that employees treated at Escorts for emergency open heart surgery are entitled to reimbursement at Escorts rates, not just AIIMS rates, and that the State could not deny full reimbursement after accepting urgency by paying AIIMS rates. The Supreme Court endorsed the view that in a medical emergency one cannot wait for admission to a government hospital and must act forthwith to save life. It emphasized that self-preservation is a necessary concomitant of the right to life under Article 21 of the Constitution, fundamental and inviolable. Accordingly, the Supreme Court allowed the appeal and held that the appellant was entitled to reimbursement at Escorts Heart Institute rates for the bypass surgery and angiography, not merely at AIIMS rates, and directed the State to pay the differential amount.
Headnote
A) Medical Reimbursement - State Government Policy - Recognition of Private Hospitals for Open Heart Surgery - Punjab Government Medical Reimbursement Policy dated 25-1-1991 and clarification dated 8-10-1991 - Employee who underwent emergency bypass surgery abroad sought reimbursement at Escorts Heart Institute rates, which was recognized by the State for open heart surgery; State had offered only AIIMS rates; High Court had granted AIIMS rates; Supreme Court held that recognition of Escorts entitles employee to reimbursement at Escorts rates where treatment was emergency and prior Medical Board approval was not obtained; no need to prove actual treatment at Escorts when State had already presumed treatment at AIIMS - Held that reimbursement at Escorts rates is admissible under the policy. B) Constitutional Law - Right to Life and Self-Preservation - Article 21 of Constitution of India, 1950 - Self-preservation of life is a necessary concomitant of the right to life, fundamental and inviolable; in medical emergency, a person cannot wait for admission to a government hospital and must take immediate decision to save life; State cannot deny full reimbursement for emergency treatment at recognized private hospital - Held that right to life under Article 21 encompasses duty and right to self-preservation, and emergency treatment at Escorts is reimbursable. C) Precedent - Consistent High Court Decisions on Medical Reimbursement - Punjab and Haryana High Court judgments in Sadhu R. Pall and others - Supreme Court endorsed the consistent view that State cannot use excuses to deny full reimbursement when it has accepted the factum of treatment and urgency by reimbursing at AIIMS rates; employees treated at Escorts for emergency open heart surgery are entitled to Escorts rates, not only AIIMS rates - Held that the High Court decisions correctly apply and State's denial of Escorts rates is arbitrary.
Issue of Consideration
Whether the appellant's hypothetical claim for medical reimbursement at Escorts Heart Institute rates is valid when he underwent emergency bypass surgery abroad without prior Medical Board approval, despite State policy recognizing Escorts for open heart surgery
Final Decision
The Supreme Court allowed the appeal, holding that the appellant was entitled to medical reimbursement at rates prevalent at Escorts Heart Institute for open heart surgery, and not merely at AIIMS rates. The State was directed to pay the differential amount.
Law Points
- State medical reimbursement policy recognizing Escorts Heart Institute for open heart surgery entitles employees to reimbursement at Escorts rates where treatment was emergency and no prior Medical Board approval
- right to life under Article 21 includes self-preservation and requires immediate decision in emergency
- State cannot deny full reimbursement when it has accepted urgency by reimbursing at AIIMS rates
- consistent High Court decisions following Sadhu R. Pall apply
