Country:
India Region:
Asia
Year: 2009
Court: Central Administrative Tribunal - Delhi
Health Topics:
Health care and health services,
Health systems and financing,
Sexual and reproductive health Tags: Access to healthcare,
Caesarian,
Childbirth,
Emergency care,
Health expenditures,
Health funding,
Health spending,
Maternal health,
Pregnancy,
Reimbursement
Veena Bhatia was an employee of the respondents. In her 35th week of pregnancy, she delivered her child prematurely. The doctor performed an emergency lower segment caesarian section (LSCS) because of fetal distress and antepartum hemorrhage. A normal delivery was not an option because the baby would have died and the mother would have hemorrhaged excessively. A healthy baby was delivered. The respondents denied reimbursement for Ms. Bhatia’s medical expenses beyond the general entitlement because they claimed her surgery did not qualify as an emergency.
The Court held that, pursuant to the policy in which medical reimbursement to a government employee was based on classification as an emergency, an expert in the field must make the classification. A department authority could not decide what constituted an emergency because only a competent doctor could certify whether the treatment was due to a state of emergency or not. Because Ms. Bhatia's doctor certified that the surgery was truly an emergency and the respondents’ medical specialist confirmed this finding, Ms. Bhatia was entitled to reimbursement.
The Court held that limiting reimbursement to certain types of emergencies, such as heart attacks and kidney failure, would be illogical. Instead, classification as an emergency should be considered in light of the situation of the person undergoing treatment.
“According to Medical Reimbursement Rules of C-DOT, medical reimbursement over and above the limit is to be made only in exceptional circumstances. We do not find such exceptional circumstances being defined under the Rules. Restricting this medical emergency to only her on account of failure of kidney, failure of tumor, etc. in the context of intricacy and complicated procedure involved, would not be a logical and rationale conclusion of the respondents. An emergency in medical science is to be viewed with a resultant damage to the person, who is undergoing treatment. The certificate issued to the applicant certainly certifies and reiterated by C-DOT Doctor that had this LSCS not been done in case of the applicant, not only the child would have died but also the mother would have had excessive haemorrhage, which is in common parlance by applying the test of a common reasonable prudent man, is fatal to human life. In such circumstances, denial of medical reimbursement cannot be countenanced in law.” Para. 13.
