The High Court
Case Details
IN THE HIGH COURT OF ORISSA AT CUTTACK WP(C) No. 6405 of 2018 Sukadev Sahoo …. Petitioner Mr. Amiya Ku. Mishra-2, Advocate -versus- The Commissioner-cum- Secretary, Govt. of Odisha, Bhubaneswar, Health & Family Welfare Department, and Ors. …. Opposite Parties Mr. Rabi Narayan Mishra, AGA CORAM: THE HON’BLE MR. JUSTICE S.K. SAHOO THE HON’BLE MR. JUSTICE CHITTARANJAN DASH Date of Judgment: 23.09.2024 Chittaranjan Dash, J. 1. Heard Mr. Amiya Ku. Mishra, learned counsel appearing on behalf of the Petitioner and Mr. Rabi Narayan Mishra, learned AGA for the State. 2. By means of this Writ Petition, the Petitioner prays to treat his case as Post-Facto referral for him to avail full reimbursement of his medical bills and other ancillary expenses as incurred in Tata Memorial Hospital, Mumbai, with interest, in view of Annexure-2. 3. The background facts of the case are that the Petitioner, serving as a Superintendent in the office of Opposite Party No. 5, fell ill on 17.03.2015. Despite receiving medical treatment, his condition did not improve, and on 21.04.2015, an MRI diagnosed him with “Obstructive Jaundice.” He was admitted to the Surgical Gastroenterology Department at S.C.B. Medical College & Hospital, Cuttack, where doctors determined that a tumour in his pancreas was causing the Jaundice. The doctors advised an immediate bypass surgery and recommended treatment at Tata Memorial Centre (Cancer Hospital), Mumbai, due to the unavailability of necessary facilities in Odisha. The Petitioner requested a referral to Tata Memorial Centre on 01.05.2015, but faced delays, leading to further deterioration of his health. With no alternative options and fearing imminent coma, his family transported him to Mumbai on 04.05.2015. Upon admission on 05.05.2015, he underwent bypass surgery on 07.05.2015, and a subsequent operation to remove the tumour on 13.07.2015. The total medical expenses amounted to Rs. 5,74,814/-. Despite submitting all required documents and appeals for reimbursement, only Rs. 39,330/- was approved, that the Petitioner contends is unjust and discriminatory and praying for full reimbursement. 4.
Legal Reasoning
17. In Jacob Puliyel vs Union of India and Others 2022 SCC OnLine SC 533 wherein at paragraphs-21 & 23, it has been observed which reads as under: “21. … It is well settled that the Courts, in exercise of their power of judicial review, do not ordinarily interfere with the policy decisions of the executive unless the policy can be faulted on grounds of mala fide, unreasonableness, arbitrariness or unfairness etc. Indeed, arbitrariness, irrationality, perversity policy and mala unconstitutional. It is neither within the domain of the Courts nor the scope of judicial review to embark upon an enquiry as to whether a particular public policy is wise or whether better public policy can be evolved. Nor are the Courts inclined to strike down a policy at the behest of a Petitioner merely because it has been urged that a different policy would have been fairer or wiser or more scientific or more logical. Courts do not and cannot act as appellate authorities examining the correctness, suitability and appropriateness of a policy, nor are Courts advisors to the executive on matters of policy which the executive is entitled to formulate. The scope of judicial review when examining a policy of the Government is to check whether it violates the fundamental rights of the citizens or is opposed to the provisions of the Constitution, or opposed to any statutory provision or manifestly arbitrary. 23. There is no doubt that this Court has held in more than one judgment that where the decision of the authority is in regard to a policy matter, this WP(C) 6405 of 2018 Page 13 of 22 Court will not ordinarily interfere since decisions on policy matters are taken based on expert knowledge of the persons concerned and Courts are normally not equipped to question the correctness of a policy decision. However, this does not mean that Courts have to abdicate their right to scrutinize whether the policy in question is formulated keeping in mind all the relevant facts and the said policy can be held to the pale of discrimination or be beyond unreasonableness, bearing in mind the material on record. In Delhi Development Authority (supra), this Court held that an executive order termed as a policy decision is not beyond the pale of judicial review. Whereas the superior Courts may not interfere with the nitty-gritty of the policy, or substitute one by the other but it will not be correct to contend that the Court shall lay its judicial hands off, when a plea is raised that the impugned decision is a policy decision. Interference therewith on the part of the superior Court would not be without jurisdiction as it is subject to judicial review. It was further held therein that the policy decision is subject to judicial review on the following grounds: a) if it is unconstitutional; b) if it is dehors the provisions of the Act and the regulations; c) if the delegatee has acted beyond its power of delegation; d) if the executive policy is contrary to the statutory or a larger policy. 22. It is settled that policy decision if made by way of piece of beneficial measure is to be construed by taking it broad pedantic approach on the principle of purposive construction otherwise the very purpose of such policy decision will be redundant. Reference in this regard be made to the judgment rendered in the case of State of N.K. Jain & Ors Vs. C.K. Shah& Ors. [(1991) 2 SCC 495], wherein it has been held at paragraph 13 that….The legislative purpose must be noted and the statute must be read as a whole. In our view taking into consideration the object underlying the Act and on reading Sections 14 and 17 in full, it becomes clear that cancellation WP(C) 6405 of 2018 Page 14 of 22 of the exemption granted does not amount to a penalty within the meaning of Section 14(2-A). As already noted these provisions which form part of the Act, which is a welfare legislation are meant to ensure the employees the continuance of the benefits of the provident fund. They should be interpreted in such a way so that the purpose of the legislation is allowed to be achieved….” 23. Further, the Hon‟ble Apex Court in the case of Edukanti Kistamma (Dead) through LRs & Ors Vs. S. Venketareddy (dead) through LRs. & Ors [(2010) 1 SCC 756], at paragraph 26 held as under: “26. ……. Interpretation of a beneficial legislation with a narrow pedantic approach is not justified. In case there is any doubt, the Court should interpret a beneficial legislation in favour of the beneficiaries and not otherwise as it would be against the legislative intent. For the purpose of interpretation of a statute, the Act is to be read in its entirety. The purport and object of the Act must be given its full effect by applying the principles of purposive construction. The Court must be strong against any construction which tends to reduce a statute’s utility. The provisions of the statute must be construed so as to make it effective and operative and to further the ends of justice and not to frustrate the same. The Court has the duty to construe the statute to promote the object of the statute and serve the purpose for which it has been enacted and should not efface its very purpose…” 18. Taking a cue from the observations made by the High Court of Jharkhand, it may be mentioned that denial of medical reimbursement should not be based on technical grounds if the treatment was necessary and undertaken in good faith, especially in emergency situations. The case reinforces the principle that the right to life under Article 21 of the Constitution includes access to timely and necessary medical treatment, and technical lapses, should not override the larger objective of ensuring the health and WP(C) 6405 of 2018 Page 15 of 22 survival of individuals. The legal principles elucidated in the afore- mentioned cases provide a strong foundation to analyse the Petitioner’s claims in light of government policies, in the context of reimbursement for his medical expenses. The power of the High Court enshrined in Article 226 of the Indian Constitution is not only extraordinary but also expansive. The High Court does not ordinarily interfere with executive policies unless the policies can be shown to suffer from mala fide, unreasonableness, arbitrariness, or similar defects. While it does not act as an appellate body over executive decisions or substitute their wisdom for that of the executive, judicial review is still permissible in certain circumstances. The High Court is empowered to scrutinise policies to ensure they are not unconstitutional, ultra vires, or inconsistent with statutory or larger policies. In the instant case, if the policy decision limiting medical reimbursement is found to be unreasonable and unfair in the given circumstances, the High Court has the authority under Article 226 to provide relief. This Court is well within its power to scrutinise whether the policy in question, which restricts the Petitioner’s reimbursement, has been applied fairly and in keeping with constitutional mandates, particularly those grounded in public welfare. Thus, while respecting the executive’s domain in policy formulation, the Court retains its duty to protect individuals from policies that overreach the constitutional mandate, ensuring that such decisions are consistent with fundamental rights, fairness, and the welfare-oriented spirit of the law. A High Court, while deferential to policy, cannot be passive to ensure that such policies are just, reasonable, and not discriminatory. WP(C) 6405 of 2018 Page 16 of 22 19. The policy surrounding medical reimbursements, as a welfare measure, should be construed in a way that serves the intended beneficiaries. Here, the Petitioner sought treatment for “Periampullary Carcinoma” and followed all possible procedures, including request for post-facto approval, given the urgency of his situation. Narrowly interpreting the policy to limit reimbursement to the meager sum of Rs. 39,330/-, when the actual cost incurred far exceeds this amount, would defeat the purpose of the reimbursement scheme. The principle of purposive construction calls for a broader interpretation that accommodates the Petitioner’s compelling circumstances. 20. Denying the Petitioner full reimbursement based on procedural technicalities, despite his good faith efforts and adherence to most of the process, would not align with this judicial principle. Instead, the policy ought to have been applied, in the given circumstances, in a way that ensures the Petitioner receives the necessary support, in keeping with the spirit of welfare legislation. The Courts have a duty to interpret beneficial policies liberally to ensure they fulfill their intended purpose, especially when the Petitioner’s life was at risk and all possible steps were taken to inform the authorities. 21. Furthermore, the Apex Court in Shiva Kant Jha vs Union of India reported in AIR 2018 SC 1975, has held that – “13) It is a settled legal position that the Government employee during his life time or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the Doctor, who is well versed and expert both on WP(C) 6405 of 2018 Page 17 of 22 academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality Hospitals are established for treatment of specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive a person to claim reimbursement solely on the ground that the said Hospital is not included in the Government Order. The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment. Before any medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by Doctors/Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds. Clearly, in the present case, by taking a very inhuman approach, the officials of the CGHS have denied the grant of medical reimbursement in full to the Petitioner forcing him to approach this Court. 14) This is hardly a satisfactory state of affairs. The to be more relevant authorities are required responsive and cannot in a mechanical manner deprive legitimate reimbursement. The Central Government Health Scheme (CGHS) was propounded with a purpose of providing health facility scheme to the central Government employees so that they are not left without medical care after retirement. It was in furtherance of the object of a welfare State, which must provide for such medical care that the scheme was brought in force. In the facts of the present case, it cannot be denied that the writ Petitioner was admitted in the above said hospitals in emergency conditions. Moreover, the law does not require that prior permission has to be taken in such situation where the survival of the person is the prime consideration. The doctors did his operation and had employee his an of WP(C) 6405 of 2018 Page 18 of 22 implanted CRT-D device and have done so as one essential and timely. Though it is the claim of the respondent-State that the rates were exorbitant whereas the rates charged for such facility shall be only at the CGHS rates and that too after following a proper procedure given in the Circulars issued on time to time by the concerned Ministry, it also cannot be denied that the Petitioner was taken to hospital under emergency conditions for survival of his life which requirement was above the sanctions and treatment in empanelled hospitals.” 22. In the Petitioner’s case, when he was admitted to Tata Memorial Hospital, he was in a critical condition and had to immediately undergo surgery one day after his arrival. This fact demonstrates the severity of his situation, further emphasising the need for immediate medical intervention. The hospital was chosen not based on the Petitioner’s preference but on the nature of his condition and the required expertise available there. Denying reimbursement solely because there is a cap in financial reimbursement as per the CGHS 2014 Resolution as annexed in Annexure-C/2 is contrary to the principles of medical necessity and patient care. 23. The Petitioner incurred substantial medical expenses during his treatment, far exceeding the minimal amount of Rs. 39,330/- sanctioned as reimbursement by the respondents. This sum is grossly inadequate when compared to the actual costs incurred by the Petitioner. Furthermore, the request for post-facto approval for his medical reimbursement was forwarded by O.P. No. 5, acknowledging the Petitioner’s claim. Despite this, the authorities adopted a rigid, technical stance, approving reimbursement at CGHS rates without fully considering the emergency nature of the WP(C) 6405 of 2018 Page 19 of 22 treatment or the life-saving necessity of the medical procedures undertaken. 24. In normal circumstance, the mandate of taking a prior approval for referral would have been proper, however, in the Petitioner’s circumstance, where the patient’s survival was hanging on a thin string, and the fact that he was admitted under emergency circumstances reinforces his eligibility for full reimbursement. The mandate does not commensurate to a situation wherein the patient requires an urgent medical attention as it is opposed to the principles of a welfare-driven public policy. Such exigencies demand for immediate and appropriate medical intervention as the well-being and survival of the patient are of paramount consideration. The State cannot adopt a mechanical approach to deny legitimate claims based on the name of the hospital or minor procedural lapses, especially when it is proven that the treatment was life-saving and supported by verified medical records. In this context, denying the Petitioner’s claim for full reimbursement reflects an out and out technical approach, contrary to the welfare objectives of schemes of CGHS itself, which are meant to ensure that Government employees and retirees receive necessary medical care without facing financial hardship. Furthermore, the fact cannot be brushed aside that the Petitioner, despite the critical nature of his health condition, adhered to the procedure by informing the authorities and seeking referral. His treatment records, along with the bills of medical expenses, were duly forwarded to O.P. No. 2 by the Employer after careful scrutiny, ensuring that all necessary documentation was in place. This shows the Petitioner’s bona fide intention to comply with the rules, even though the emergency WP(C) 6405 of 2018 Page 20 of 22 nature of his situation required immediate treatment, leaving little room to follow the referral process in its entirety. Had the Petitioner delayed his treatment to comply with formalities, it is likely that the outcome could have been much worse, potentially costing him his life. Medical emergencies require swift and decisive action, and when the facilities or resources are unavailable locally, seeking prompt treatment elsewhere becomes a matter of life and death. In the Petitioner’s case, the urgency of the situation warranted immediate surgery to stabilise his condition, and any delay could have been irreversibly harmful. Therefore, in such emergency cases, procedural delays cannot be prioritised over the fundamental right to life, which, as enshrined in Article 21 of the Constitution, is both sacred and inviolable. 25. In light of the circumstances surrounding the Petitioner’s medical emergency, it is clear that the minimal reimbursement amount of Rs. 39,330/- sanctioned by the O.P. No. 1 and 2 is grossly inadequate when compared to the actual costs incurred by the Petitioner. The Petitioner followed due process by filing a referral request, and the lack of response from the concerned authorities exacerbated his critical situation. Furthermore, the emergency provisions under the 2014 Government Resolution explicitly allow for treatment in referral hospitals in such cases without prior approval. The treatment he underwent, which included immediate surgery, was necessary to save his life. 26. Given these facts, the Petitioner’s claim merits a more compassionate and holistic view for full reimbursement, rather than mechanically following procedures. The minimal amount WP(C) 6405 of 2018 Page 21 of 22 sanctioned does not reflect the severity of his condition, nor does it consider the actual costs he incurred to ensure his vital treatment. 27. In view of the principles of fairness, the emergency nature of the situation, the treatment provided and the Government’s obligation to provide adequate healthcare to its employees, the Petitioner’s overwhelming medical expenses should be reimbursed fairly and in full, allowing him the full benefit of his entitlement within two months. 28. In light of the discussions above, this Writ Petition is accordingly allowed. (Chittaranjan Dash) Judge (S.K. Sahoo) Judge A.K.Pradhan/Bijay Signature Not Verified Digitally Signed Signed by: ANANTA KUMAR PRADHAN Designation: Jr. Stenographer Reason: Authentication Location: HIGH COURT OF ORISSA Date: 25-Sep-2024 11:22:06 WP(C) 6405 of 2018 Page 22 of 22
Arguments
Mr. A. K. Mishra, learned counsel for the Petitioner submits that the Petitioner, suffering from “Obstructive Jaundice” caused by a pancreatic tumor, was advised by doctors at SCB Medical College & Hospital to undergo immediate bypass surgery and seek further treatment at Tata Memorial Centre, Mumbai, due to the lack of robotic surgery facilities in Odisha. Despite the urgency of his condition and a referral request made on 29.04.2015, no timely WP(C) 6405 of 2018 Page 2 of 22 action was taken by the authorities, forcing the Petitioner’s family to take him to Tata Memorial Centre on 04.05.2015, wherein bypass surgery was performed on 07.05.2015. He further submits that, the Government of Odisha’s Health and Family Welfare Department, through its resolution dated 04.03.2014, provides for reimbursement of medical expenses for Government employees and although O.P. No. 2 acknowledged the need for reimbursement, only Rs. 39,330/- was sanctioned, despite the Petitioner incurring over Rs. 5,74,814/- for his treatment, and there is no justification for the State authorities to restrict reimbursement to such a small amount. He asserts that self-preservation of one’s life is the necessary concomitant of the right to life enshrined in Article 21 of the Constitution of India, and since the Petitioner’s action was to save his own life, there is no reason as to why the State Opposite Parties shall not bear the expenses of the treatment. The learned counsel submits that the State, under the peculiar facts of the present case, is obligated to bear the full expenses incurred by the Petitioner at Tata Memorial Centre. Mr. Mishra concludes his submission that the Petitioner, having acted to save his life due to the authorities’ failure, should be reimbursed for the full medical expenses in post-facto. 5. Mr. R. N. Mishra, learned AGA, argues that this writ petition filed by the Petitioner is neither factually nor legally maintainable and is therefore liable to be dismissed. He submits that the Petitioner’s referral request was processed according to the established procedures outlined in the Government of Odisha’s Health and Family Welfare Department Resolution No. 4246/H dated 04.03.2014. He asserts that the treating physician did not WP(C) 6405 of 2018 Page 3 of 22 advise or recommend the Petitioner to seek treatment at a higher center outside the State in the discharge certificate and the decision to undergo treatment at Tata Memorial Centre, Mumbai, was made solely by the Petitioner, without any formal recommendation from the Head of the Department (HOD) of Surgical Gastroenterology. The government resolution clearly specifies limitations on reimbursement, and without a pre-approved referral, the Petitioner is not entitled to full reimbursement. The reimbursement amount of Rs. 39,330/- was granted based on permissible rates under government norms for the treatment received. He further adds that the Petitioner was admitted on 27.04.2015 with Obstructive Jaundice, diagnosed as Periampullary Carcinoma, and he voluntarily requested a transfer to a higher center, resulting in discharge on 29.04.2015. Although a proposal for post-facto approval was submitted on 22.12.2016, the Government Resolution No. 4264/H dated 04.03.2014 clarified that post-facto approval is no longer required. Following this, the relevant treatment records and expenses were requested on 17.01.2017. The Technical Committee reviewed the documents on 27.07.2017 and determined the surgery to be a “major one,” allowing a maximum reimbursement of Rs. 39,330/- as per Serial No. 509 of the revised 2014 Central Government Health Scheme rate list. Mr. Mishra contends that the reliance on the doctrine of self-preservation under Article 21 of the Constitution does not exempt the Petitioner from adhering to established administrative processes and therefore, the actions of the Opposite Parties were fair and in accordance with the law, and the Petitioner’s claim for additional reimbursement is unjustified and lacks merit. WP(C) 6405 of 2018 Page 4 of 22 6. O.P. No. 5, through the Special Officer (Special Cell), Orissa High Court, Cuttack in their counter affidavit, submits that the Petitioner has claimed reimbursement for medical expenses incurred during his treatment at Tata Memorial Hospital, Mumbai. The referral process for reimbursement is governed by the rules and regulations framed by the State Government/DMET, Odisha, and these rules mandate that prior permission from the State Government/DMET for reimbursement of treatment expenses incurred at a referral hospital. In cases of emergency, post-facto approval from the Government/DMET is essential for the reimbursement of medical expenses in accordance with Government norms. He further submits that the Petitioner has been denied full reimbursement of his claim because the DMET has capped the admissible amount at Rs. 39,330/- as per the letter dated 09.08.2017, and, in reference to the Government Resolution dated 04.03.2014. He asserts that O.P. No. 5 has raised no objection to the Petitioner’s claim, as the Registry had already taken necessary steps to move the O.P. No. 2, through its letter dated 22.12.2016, seeking post-facto referral approval after receiving the Petitioner’s request. It is finally submitted that O.P. No. 5 has no objection to the Petitioner’s claim being reimbursed, provided the same is approved by O.P. Nos. 1 and 2. The role of O.P. No. 5 in this matter is contingent on receiving the necessary instructions and approvals from O.P. Nos. 1 and 2 in accordance with the applicable Government regulations. 7. From the materials on record, it is observed that on 01.05.2015, the Petitioner filed a request with the Superintendent of SCB Medical College & Hospital (SCB MCH) to be referred to WP(C) 6405 of 2018 Page 5 of 22 Tata Memorial Hospital, Mumbai, due to his worsening health condition. This request was forwarded on 13.05.2015 to the Professor and Head of the Department of Surgical Gastroenterology, SCB MCH, for necessary action as per Memo No. 10831. Later, on 28.11.2016, the Petitioner submitted a letter to O.P. No. 5, requesting reimbursement for his medical expenses, accompanied by the relevant medical bills. On 16.12.2016, the Superintendent of SCB MCH issued Letter No. 31647, and in response, the Registrar (Judicial) of the Orissa High Court (OHC) forwarded the Petitioner’s application and treatment records to O.P. No. 2 for post-facto recommendation for reimbursement, as communicated through Letter No. 18496 dated 22.12.2016. Subsequently, on 09.03.2017, the treatment records, final bill, and details of the Petitioner’s medical expenditure at Tata Memorial Hospital were provided to O.P. No. 2 by the Special Officer (Special Cell) of the OHC. On 19.05.2017, O.P. No. 2 responded with Letter No. 4929, stating that Rs. 39,330/- was admissible for the Petitioner’s treatment for Periampullary Carcinoma, but noted that the proper procedural steps had not been followed. This response was forwarded to the Petitioner on 09.08.2017. 8. It can be reasonably argued that the question of following due procedure for the reimbursement is not a primary concern in this case, given the actions taken by the O.P. No. 5 and O.P. No. 2. The Petitioner sought medical treatment outside the State due to his deteriorating health condition, and although the formal referral process may not have been completed in advance, the post-facto referral can be said to have been effectively granted by O.P. No. 5 when the Petitioner’s treatment records were forwarded to O.P. No. WP(C) 6405 of 2018 Page 6 of 22 2. This action indicates that the authorities did recognise the necessity of the treatment and the urgency of the situation, and sought to regularise the Petitioner’s claim, albeit after the treatment had already been undertaken. 9. Before delving into the merit, it is profitable to reproduce the relevant circular of the Government notified through Health & Family Welfare Department vide No. 6246-DC & MA (MA)- 45/2014-H, dated 26.03.2014 as under – “A. Procedure for treatment in Government Health Institution and Other referral Hospitals both inside and outside the State:- 1. State Government employees including their eligible family members can be treated at First instance in CHC/PHC/DHH/MCH and all other Government health institutions. 2. In case of necessity he / she can be referred to any referral hospital inside/outside the State declared as such by State Government only on the following grounds : (a) On non-availability of required treatment in the concerned Medical Colleges/ DHH (b) In ordinate delay in availing the treatment 3. To be treated at a referral hospital stated at (2) above, a Government employee has to be referred from Government Medical College & Hospital or DHH as mentioned at Annexure-'A'. 4. The Medical College/DHH will refer the patients on faculty members/Specialists (not less than three) headed by the Superintendent/ CDMOs with concerned Head of the Department as member. 5. In case of emergency, the Government employees or his family members can get admitted into any of the referral hospitals mentioned at A (2) above without being referred. However, the authority of those hospitals/Government employees themselves will immediately intimate about such admission to Director, Medical Education and Training, Odisha recommendation of a team of WP(C) 6405 of 2018 Page 7 of 22 who after proper assessment of the circumstances leading to such admission will pass appropriate order.” 10. Moreover, the Circular No. I.14019/34/2013-Cash II (Vol.I) by the Ministry of Health & Family Welfare, through the Directorate General of Health Services dated 08.06.2021, says – “It is observed that representations have been received from officers/officials/ of this Directorate requesting ex-post facto approval for medical bill reimbursement after getting treatments/tests from the empanelled Hospitals/Diagnostic Centres without following the guidelines/procedure issued by the Government from time to time. The matter has been decided that no proposal for ex-post facto approval shall be processed towards reimbursement of medical bills other than that of emergency cases. If not a letter for permission, at least a letter of prior information with a copy of prescription may be provided for all elective treatments. Even prior intimation/information by mail accompanied by prescription in-charge would be acceptable. 2. This issues with the approval of competent authority” to officer 11. The circular underscores a strict adherence to procedural guidelines for medical bill reimbursement, with a notable exception for emergency cases. It highlights that the requests for post-facto approval where treatment or tests are undertaken before obtaining the requisite prior approval will not be entertained except in emergencies. This circular, even though reflects an effort to standardise and control the reimbursement process and prevent misuse, ensuring that all claims are processed according to established protocols, but it also highlights a potential rigidity in the system that may not always account for urgent or unforeseen medical circumstances. WP(C) 6405 of 2018 Page 8 of 22 12. In the instant case, the Petitioner falls squarely within the exception mentioned in the circular, as his condition was dire, requiring immediate surgery the day after his admission to Tata Memorial Hospital. Given the urgency of his medical situation, it was not possible to adhere strictly to the prescribed procedure without risking his health. This, therefore, classifies his case as an “emergency,” allowing for the consideration of post-facto approval for his medical reimbursement. Furthermore, the Petitioner did attempt to communicate and follow up with the authorities, as evidenced by the records, making it clear that his situation merited the exception outlined in the circular. In light of these facts, the rejection of his claim on procedural grounds would contradict the provisions of the circular, which was specifically designed to accommodate urgent medical needs where adherence to formal procedures could result in life-threatening consequences. 13. As said, the rigidity of procedural formalities in medical reimbursement cases, while intended to ensure proper governance, can often have devastating consequences for individuals suffering from serious, life-threatening conditions. Serious diseases do not announce their arrival or allow the luxury of time for compliance with formalities. In emergencies, immediate medical intervention is crucial, and adhering strictly to procedures can turn fatal. In the Petitioner’s case, his health had deteriorated to such an extent that, upon admission to Tata Memorial Hospital, the need for surgery was so urgent that it was scheduled for the day after. Had he waited to navigate through the channels of formality, the delay might have cost him his life. It is precisely in these situations that strict compliance with procedure must take a backseat for the higher, WP(C) 6405 of 2018 Page 9 of 22 more fundamental right to life, as embedded in Article 21 of the Constitution. The Petitioner’s situation exemplifies why the system must be flexible in dealing with medical emergencies, where any delay in treatment could lead to irreversible harm. 14. It is pertinent to note that O.P. No. 2, upon receiving the post-facto referral, did not outright reject the Petitioner’s claim for reimbursement, which would have been expected if procedural lapses were of paramount concern. Instead, O.P. No. 2 processed the reimbursement request and approved an amount of Rs. 39,330/- based on the rates applicable under the Central Government Health Scheme (CGHS), Bhubaneswar as considered under the category of “Other Major Surgery,” which further implies that his condition and the treatment he underwent were both acknowledged as significant. The fact that O.P. No. 2 approved any amount at all demonstrates that the authorities were willing to entertain the reimbursement claim, despite the procedural shortcomings, and focused instead on the financial assessment in accordance with established CGHS norms. This approval can be interpreted as an implicit acknowledgment that the Petitioner’s treatment was necessary and justified. Thus, the strict adherence to procedural formalities should not serve as a basis to limit the Petitioner’s claim, especially since his life was at risk, and he sought treatment in a recognised facility under dire circumstances. The referral, although post-facto, was still considered by O.P. No. 5 and sent to O.P. No. 2, which indicates a certain level of compliance with the spirit, if not the letter, of the medical reimbursement procedure. Therefore, the focus should be on the fact that the Petitioner acted in the interest of preserving his life, a right enshrined under Article 21 of the Constitution and the WP(C) 6405 of 2018 Page 10 of 22 procedural lapses should be viewed in light of this compelling necessity rather than used as grounds for denying the full reimbursement claim. 15. The Hon’ble Supreme Court in the matter of Surjit Singh vs. State of Punjab & Ors. reported in 1996 AIR 1388 and re- iterated in The State of Jharkhand through the Secretary, Water Resources Department, Nepal House, P.O. and P.S. Dordanda, District Ranchi vs. Binod Kumar Lal reported in L.P.A. No. 194 of 2021 in the High Court of Jharkhand that – is life “It is otherwise important to bear in mind that self- preservation of one’s the necessary concomitant of the right to life enshrined 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 vidyate Tasmaaddeham rakshetpunyakarmaani saadhayet Without the body how can one obtain the objects of human life? Therefore, protecting the body which is the wealth, one should perform the deeds of merit. 18 Rakshayetsarvadaatmaanamaatmaa bhaajanam vanbhaadraani pashyati One should protect his body which is responsible for everything. He who protects himself by all efforts, will see many auspicious occasions in life. 20 Sharirarakshanopaayaah kriyante sarvadaa budhaih punastyaagamapi kushthaadiroginah Vinaa dehena kasyaapi canpurushaartho na dhanam sarvasya yatnamaatishthejje Necchanti Rakshane cha WP(C) 6405 of 2018 Page 11 of 22 The wise always undertake the protective measures for the body. Even the persons suffering from leprosy and other diseases do not wish to get rid of the body. …. naatmaanamahitebhyo 22 nivaarayet Konsyo hitakarastasmaadaatmaanam taarayishyati If one does not prevent what is unpleasant to himself, who else will do it? Therefore, one should do what is good to himself.” Aatmaiva yadi 16. In the instant case, the Petitioner, suffering from a serious condition, acted in accordance with the right to self-preserve by seeking immediate and necessary medical treatment outside the State when the required facilities were not available locally. This action aligns with the natural and legal right of an individual to safeguard their life, which, as the verses from the Garuda Purana suggest, is a paramount duty. The essence of these ancient teachings emphasises that the body is the foundation for all human endeavors and must be protected by all efforts. Here, the Petitioner’s decision to pursue treatment at Tata Memorial Hospital, Mumbai, despite procedural delays in obtaining a referral, reflects the exercise of his right to protect his body and life. The verses support the view that one must take every possible measure to preserve life and health, even when facing great challenges, as the body is the medium through which a person can perform meritorious deeds and experience life’s auspicious moments. The Petitioner’s circumstances, where no timely referral was provided, compelled him to act in self-preservation. The verses suggest that protecting oneself from harm is not only a right but a responsibility. Thus, the Petitioner’s decision to seek advanced medical treatment without delay, even if it meant circumventing procedural formalities, was in WP(C) 6405 of 2018 Page 12 of 22 line with the right of self-preservation and his fundamental right to life. The Petitioner’s actions were not only justified but necessary, given the nature of his condition. 17. It is further stated in The State of Jharkhand through the Secretary, Water Resources Department, Nepal House, P.O. and P.S. Dordanda, District Ranchi vs. Binod Kumar Lal reported in L.P.A. No. 194 of 2021 in the High Court of Jharkhand that – the render fide will