Country:
India Region:
Asia
Year: 2007
Court: High Court - Madras
Health Topics:
Chronic and noncommunicable diseases,
Health care and health services,
Health systems and financing,
Hospitals Human Rights: Right to health,
Right to life Tags: Access to treatment,
Emergency care,
Heart disease,
Private hospitals,
Reimbursement,
Secondary care,
Tertiary care
The petitioner, who worked as a Head Constable in Tamil Nadu, filed a case against the Secretary to the Government, Health and Family Welfare Department, Tamil Nadu and others, for rejecting his request for reimbursement under the Tamil Nadu Government Employees’ Health Fund Scheme. The petitioner requested such reimbursement for an angioplasty he underwent on November 19, 2002, in an approved private hospital.
The petitioner had developed a severe cardiac problem during his work at the police station and was rushed to a government hospital for first aid treatment. As per the doctor’s advice, he was sent to a private hospital, where he was admitted as an in-patient due to the seriousness of his disease.
During the process, the petitioner incurred expenses amounting to rupees 1,88,497/-, which the respondents refused to reimburse, objecting that the treatment was not among those covered by the relevant government order and that the petitioner could have been treated in a different hospital. Angioplasty was not covered by the government order dated August 29, 2000, but it was covered by the government order dated November 8, 2011.
The Court held that it was the obligation of the state to ensure the creation of and to sustain the conditions congenial to good health. Citing prior cases, the Court confirmed that the preservation of human life was of the utmost importance and that the rights guaranteed by a civilized society included medical care. Moreover, the Court found that, apart from protecting all the citizens of this country, there was a further obligation on the state to protect its own servants as guaranteed in the constitution.
The Court stated that it was “not unconscious about the limited resources the State has in the matter of reimbursement of medical expenses”, citing prior cases where the Court held that provision of facilities was limited by finances. However, the Court noted that the country had “a long tradition of taking care of the infirm and disabled.”
The Court furthermore debunked the reasons given for non-reimbursement of the petitioner’s claims, namely that the procedure was an emergency procedure, that the petitioner may not have been able to obtain timely treatment at a government hospital, that the addition of angioplasty as a covered treatment should apply retroactively (as such addition was merely a clarification of the prior order) and that “it was not for any person to decide as to where they should get treatment so long as the Government Order provides for reimbursement and the impugned order shows that the Hospital in which the petitioner got treated [had] been included in the list of Hospitals [which had been approved].”
The Court, therefore, directed the Secretary to the Government, Health and Family Welfare Department and its Director to reimburse the claim made by the petitioner for the medical treatment undergone by him.
“5. If we do not protect the man who protects us all the time, then who will protect those protectors. This is a serious question which the State had to address itself. If this is the attitude of the State in protecting the lives of its own constabulary and that too, for a person having served for 25 years of its forces, then it is really a sad state of affairs. The Supreme Court as early as in its decision reported in (1987) 2 SCC 165 [Vincent Panikurlangara vs. Union of India and others] described the obligation of the State in a welfare State regarding the health of its citizen and in paragraph 16 of the judgment, it was observed as follows: Para 16 ‘A healthy body is the very foundation for all human activities. That is why the adage ‘Sariramadyam Khalu dharma Sadhanam’. 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.’”
“8. Apart from protecting all of the citizens of this country, there is a further obligation on the State to protect its own servants as guaranteed in the Constitution.”
“10. While discussing about the obligation of the State in providing health care to all its citizens, more particularly, to the servants of the State, the Court was not unconscious about the limited resources the State has in the matter of reimbursement of medical expenses.”
