Reimburse cost of surgery to retd employee: HC to centre

MUMBAI: The Bombay high court on Friday directed the central government to fully reimburse the medical expense of a pensioner who underwent heart transplant in a private hospital in 2019 as hospitals empanelled under Central Government Health Scheme (CGHS) could not provide him the required treatment. The court has granted four weeks to the central government to reimburse the full expenses.
CGHS empanelled hospitals provide healthcare services to central government employees, pensioners and their dependents at affordable rates.
The pensioner, Anirudh Prataprai Nansi, voluntarily stepped down from central government services in 2008. In 2009, Nansi was diagnosed with Cardiomyopathy which aggravated in 2019 when the functioning of his heart's left ventricle significantly deteriorated to 15%, restricting smooth blood flow. Doctors advised Nansi for immediate heart transplant but as CGHS-empanelled government hospitals did not have the necessary license, approvals and expertise,he sought treatment at the privately owned Sir H. N. Reliance Foundation Hospital. Prior to the surgery, he notified CGHS authorities regarding the estimated cost.
After multiple follow ups, CGHS authorities responded to Nansi's reimbursement request in March 2021, stating that they could only provide an amount of ₹69,000 out of the total expense of ₹22 lakh, as per CGHS's Mumbai rate list.
Nansi approached the Bombay high court in 2021. The court appointed committee heard the case in November 2021 and opined that the full expense could not be reimbursed as it did not match CGHS rates. The committee noted that since the heart transplantation was a planned surgery and not an emergency, the reimbursement should be done as per CGHS rules and guidelines.
Nansi again approached the high court in 2022, citing violation of his fundamental right to life and pleading that the full expense be reimbursed to him as government hospitals lacked the required facilities.
On Friday, the division bench of justices G S Kulkarni and Advait Sethna observed that Nansi cannot be deprived of full reimbursement when he had to undergo treatment at a private hospital as the surgery had to be done immediately. In such cases of necessary treatment, the central government is obliged to grant reimbursement on a case to case basis, the court said.
'Not granting full reimbursement is not only violative of the fundamental rights but strikes at the very root, purpose and essence of these basic human rights as guaranteed by the Constitution, i.e., Right to Life under Article 21. Any employee, merely because he has retired, ought not be differently treated when it comes to genuine and realistic health expenditure,' the bench said.

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