Judgments Regarding Medical Charges Reimbursement on account of Expenses in Private Hospitals

There are two Judgments Regarding Medical Charges Reimbursement on account of Expenses in Private Hospitals; the same has been provided us by Mr. Muhammad Saleem for the info of the concerned employees. The detail of the same is as under:

 

 

Judgment Sheet 1 regarding Medical Charges Reimbursement

IN THE PESHAWAR HIGH COURT,

ABBOTTABAD BENCH

 

JUDICIAL DEPARTMENT

 

WP No.1180-A of 2015

JUDGMENT

Date of hearing…………………09/05/2016………………………………….

 

Petitioner (s) (Muhammad Rustam) Petitioner in person………..……

 

Respondent… (Government of KPK etc) by Mr. Muhammad Naeem Abbasi, AAG alongwith representative of the respondents………..

 

****

 

QALANDAR ALI KHAN, J:-   Muhammad Rustam, Private Secretary, Peshawar High Court, Abbottabad Bench (since retired), petitioner, invoked the writ jurisdiction of this Court under Article 199 of the Constitution of Islamic Republic of Pakistan, 1973, for a direction to the respondents, particularly, respondent No.1 i.e. Government of Khyber Pakhtunkhwa, through, Secretary Finance, Finance Department, Peshawar, to make provisions for additional grant under head Medical Charges for reimbursement of medical expenses of Rs.945,486/- borne out by the petitioner on the treatment of his deceased daughter.

  1. The daughter of the petitioner, namely Mehwish Rustam, a student of LLB Final year, fell ill and was treated in the DHQ Hospital, Ayub Medical Complex, Abbottabad as well as in the Institute of Nuclear Medicines, Oncology and Radiology (INOR) Hospital, Abbottabad for “internal infections”; but her condition deteriorated day by day, therefore, she was referred to Shifa International Hospital, Islamabad, for surgery and treatment by the concerned Medical Officer at INOR Hospital on 12.12.2014. The biopsy of the stomach of the daughter of the petitioner was conducted and the material obtained was sent to the laboratory of Shoukat Khanum Memorial Cancer Hospital and Research Centre, Lahore where from the report was received in positive.  Besides all the expert specialized doctors of the Government Hospitals, even the doctors of Shoukat Khanum Memorial Cancer Hospital and Research Centre, Peshawar rejected her in view of her deteriorated critical condition of ailment and proposed / suggested her treatment from Shifa International Hospital, Islamabad.  Thereafter, the patient was straightaway taken to Shifa International Hospital, Islamabad on 22.12.2014, where she was admitted and extended chemotherapy followed by surgery, thus, incurring lot of expenses on her treatment by the petitioner.  The Medical bills were submitted for reimbursement, and the Director General, Health Services, Khyber Pakhtunkhwa, Peshawar, also accorded N.O.C., but when the medical bills were referred to respondent No.1 for allocation of additional grant under head ‘medical charges’, respondent No.1 showed his inability to accede to the proposal, and again expressed his inability to the proposal when the petitioner once again applied for allocation of additional grant under head ‘medical charges’ in the light of circular letter of the Finance department dated 17.09.2015; hence, the instant writ petition.
  2. In their comments, both the respondents contested the writ petition, mainly, on the ground that the medical treatment in private hospital was not covered under the Medical Attendance Rules, 1959, therefore, the request for release of fund under the head of ‘medical charges’ was regretted when the proposal was received through Registrar, Peshawar High Court, Peshawar. The respondents pointed out that there was no provision in the Medical Attendance Rules, 1959 for issuance of Ex-post Facto Sanction by the Director General, Health Services, Khyber Pakhtunkhwa Peshawar, for treatment in private hospitals. It was further pointed out that a certificate from the Medical Superintendent of the concerned Health Institution/Director General, Health Services was required mentioning therein that the treatment facilities were not available in any government hospital, which was not forthcoming in the instant case.  The respondents explained that in the case of Syed Jhafar Shah Bukhari, a student of Engineering University, Peshawar, referred to as a precedent case in the writ petition, the Chief Minister Secretariat had issued directives to the Health department and on approval of the summary by the Chief Minister, moved by the Health department, the Finance Department had allocated funds as ‘Grant- in-Aid’ to Health Department.
  3. Since the local Bar was observing strike, the petitioner in person and learned Additional Advocate General on behalf of the respondents argued the case, and record was also perused.
  4. The rest of the facts including treatment of daughter of the petitioner for her serious ailment of cancer in the Shifa International, are not denied by the respondents; but their resistance to the claim of the petitioner and release of funds under head of Medical Charges is based on the twin grounds of treatment of the patient from a private hospital and absence of any provision in the Medical Attendance Rules, 1959 for issuance of Ex-post Facto Sanction by the Director General, Health Service, Khyber Pakhtunkhwa Peshawar for treatment in private hospitals.
  5. Apart from the fact that N.O.C. was duly accorded by the Director General, Health Services, Khyber Pakhtunkhwa, Peshawar, vide office order dated 18.08.2015, for medical attendance and further treatment of daughter of the petitioner in Shifa International, Hospital, Islamabad, as referred by ATH, Abbottabad, in a recent judgment dated 12.01.2016 in Writ Petition No.3720-P of 2015 by an Hon’ble Division Bench at the Principal seat of this Court, both the issues of treatment in the Shifa International Hospital, Islamabad and competency of the Director General, Health Services to accord Ex-post Facto Sanction under the West Pakistan Government Servants (Medical Attendance) Rules, 1959 were elaborately dealt with and resolved in favour of petitioner in the writ petition, with direction to the respondents to reimburse the medical charges incurred by the petitioner on the treatment of his daughter.
  6. The learned Additional Advocate General, on the other hand, submitted a copy of judgment / order dated 17.03.2016 of this Court in COC No.111-P of 2016 by the petitioner, Tariq Hassan, in the said writ petition No.3720-P/2015, whereby, it was held that the payment of an amount of Rs.7,805,930/- received by the petitioner shall be recoverable from his immovable/ movable properties including his pensionary benefits in case the Supreme Court reversed the order of this Court dated 12.01.2016 rendered in Writ Petition No.3720-/2015 on the Government petition filed before the Apex Court.  In other words, the only contention of the learned Additional Advocate General was that payment of amount of Rs.7,805,930/- to the petitioner in the aforementioned writ petition was made conditional to the decision of the Apex Court in the CPLA filed by the Government before the Apex Court.
  7. It needs be stressed here that not only the amount claimed by the petitioner in the instant writ petition amounting to Rs.945,486/- is paltry as compared to the huge amount of Rs.7,805,930/- claimed by the petitioner in the aforesaid writ petition, but case of the petitioner is squarely at par with the case of the said petitioner. Therefore, on the acceptance of the instant writ petition, the respondents are directed to accord sanction for allocation of additional grant under head ‘medical charges’ for reimbursement of medical expenses of Rs.945,486/- borne out by the petitioner on the treatment of his deceased daughter; subject to the condition that the payment so received by the petitioner shall be subject to return by him in case the judgment/order of this Court in writ petition No.3720-P/2015 dated 12.01.2016 or for that matter this judgment/order of the Court is reversed by the august Apex Court.

 

                                                   J U D G E

 

 

 

Announced.                                     J U D G E

Dt: 09.05.2016.

 

Medical Charges Reimbursement

 

Judgment Sheet 2 regarding Medical Charges Reimbursement

 

IN THE PESHAWAR HIGH COURT,

ABBOTTABAD BENCH.

 

JUDICIAL DEPARTMENT

 

WP No. 686-A of 2015

JUDGMENT

Date of hearing…………………10/05/2016………………………………….

Petitioner(s)…(Abdul Baseer Khan) by Sardar Basharat Khan, Advocate……………….

 

Respondent(s) …(Govt. of Khyber Pakhtunkhwa, through Secretary Finance Department, Peshawar etc) by Mr. Muhammad Naeem Abbasi, AAG ………………..

 

*****

 

QALANDAR ALI KHAN, J:-  Since identical issues are involved in the instant writ petition as well as in Writ Petition No.983-A/2015, this single judgment/order shall also dispose of the said connected writ petition.

  1. In this writ petition, by invoking the constitutional jurisdiction of this Court under Article 199 of the Constitution of Islamic Republic of Pakistan, 1973, Abdul Baseer, an Additional District & Sessions Judge in the Judicial Department of the Government of Khyber Pakhtunkhwa and presently posted at Abbottabad, prayed for a direction to the respondents to reimburse the medical charges in respect of his ailing father under West Pakistan Government Servants (Medical Attendance) Rules, 1959.  It was averred in the writ petition that father of the petitioner was facing problem of gross Hematuria, but the doctors in the Kidney Centre, Peshawar, wrongly diagnosed the same as a minor problem of prostate and advised him to wait for months due to a long waiting list.  The Medical officer specialized in urology at Shifa International Hospital, Islamabad, however, discovered that the patient was not suffering from prostate problem rather he had malignant cancer of urinary bladder, requiring radical Cystectomy on emergency basis.  The Assistant Professor Urology, Ayub Teaching Hospital, Abbottabad, where the petitioner was posted, informed that the procedure could not be conducted in ATH, Abbottabad; and referred father of the petitioner to specialist centre where facilities for the procedure were available. Therefore, while keeping in view the seriousness of the disease and its fast spreading in the body, the surgery was conducted at Shifa International Hospital, Islamabad, on the advice of Medical Superintendent, Ayub Teaching Hospital, Abbottabad, and the expenses incurred there amounted to Rs.715,260/-.  The Director General, Health Services, Khyber Pakhtunkhwa, Peshawar, also accorded
    Ex-post Facto Sanction under Rule 6(1)(b) of the West Pakistan Government Servants (Medical Attendance) Rules, 1959, and after fulfilling the other legal formalities, the bill of medical charges was submitted by the petitioner through the Peshawar High Court to the Secretary Finance, Government of Khyber Pakhtunkhwa, Peshawar, for provision of additional grant under head ‘Medical Charges’; but claim of the petitioner was rejected even after Ex-post Facto Sanction was accorded by the Director General, Health Services, being the competent authority.
  2. In the connected writ petition No.983-A/2015, the petitioner, Ms. Qurrat-ul-Ain Rashid, a Civil Judge/Judge Family Court in the Judicial Department of Khyber Pakhtunkhwa and posted at Abbottabad, claimed her entitlement for reimbursement of medical charges amounting to Rs.373,900/- incurred on account of treatment of her mother, who was brought with chest pain to Ayub Teaching Hospital, Abbottabad, but was referred by Dr. Umar Hayat, Head of Cardiology Department, Ayub Teaching Hospital, Abbottabad, for earliest angiography on 5.12.2014 as Angiography Machine of Ayub Teaching Hospital was non functional and the facility was also not available on emergency basis in the adjoining districts of Mansehra and Haripur; therefore, the appointment was finally secured from
    Col. (Retd) Dr. Najib-ul-Haq in Hearts International (Pvt) Limited, Rawalpindi.  The reference by the Head of Cardiology Department, Ayub Teaching Hospital was, also countersigned by the Medical Superintendent of the hospital, and patient was referred to Hearts International (Pvt) Limited, Rawalpindi, on 8.12.2014, where angiography and angioplasty of mother of the petitioner was done by the said Doctor, where-after the patient was discharged from the hospital on 09.12.2014.  The expenses incurred by the petitioner on the treatment of her mother in the said hospital amounted to Rs.373,900/-, and the medical bills on that account were forwarded through the Registrar, Peshawar High Court, Peshawar, to the Director General, Health Services, Khyber Pakhtunkhwa, Peshawar, for Ex-Post Facto Sanction, which was regretted by the latter on the ground that ban had been imposed on treatment in Private hospitals by the provincial government under the new policy dated 4.12.2014, which was also impugned in the connected writ petition.
  3. In their comments in both the writ petitions, the respondents took the plea that patients in both the cases were not referred to a private hospital as required under clause 6 of the Medical Attendance Rules, 1959 and further that the Director General, Health Services, was not competent to accord Ex-Post Facto Sanction in case of father of the petitioner in the instant case.  The respondents also disputed claims of the petitioners on the ground of receiving treatment of their father and mother, respectively, even before the patients were referred for treatment in other hospitals where the requisite facilities were available.
  4. Arguments of learned counsel for the parties heard, and record perused.
  5. The treatment of the father and mother, respectively, of the petitioners in both the writ petitions, for their serious ailment of cancer of urinary bladder and cardiac problem in private hospitals, namely Shifa International Hospital, Islamabad in the former case and Hearts International (Pvt) Limited, Rawalpindi in the latter case is not denied; but entitlement of the petitioners to reimbursement of the amount incurred by the petitioners on the treatment of their parents is disputed, mainly, on the ground of treatment in private hospitals without prior sanction of the competent authority.
  6. The matter of treatment in private hospitals and Ex-Post Facto Sanction for the purpose came up before this Court at the principal seat in WP No.3720-P/2015 titled Tariq Hassan vs. Govt. of Khyber Pakhtunkhwa, through Chief Secretary, Civil Secretariat, Peshawar, and others, and an Hon’ble Division Bench at Peshawar resolved the issues raised in the writ petition in favour of the petitioner by issuing direction to the respondents to reimburse the medical charges incurred by the petitioner on the treatment of his daughter, vide judgment / order dated 12.01.2016; and following the said judgment/ order, this Bench also accepted Writ Petition No.1180-A of 2015 titled Muhammad Rustam Vs. Govt. of KPK etc vide judgment/order dated 09.05.2016, and directed the respondents to accord sanction for allocation of additional grant under head ‘Medical Charges’ for reimbursement of medical expenses of Rs.945,486/- borne out by the petitioner on the treatment of his deceased daughter; subject to the condition that the payment so received by the petitioner shall be subject to return by him in case the judgment/order of this Court in Writ Petition No.3720-P/2015 dated 12.01.2016 or the judgment/order dated 09.05.2016 in Writ Petition No.1180-A of 2015 were reversed by the august Apex Court.
  7. Needless to say that Rules 3 and 6 of West Pakistan Government Servants (Medical Attendance) Rules, 1959 clearly laid down that Government Servants would be entitled to free of charge medical treatment by Authorized Medical Attendant or otherwise any amount paid by them on account of such treatment shall be reimbursed to them subject to production of a certificate in writing by the Authorized Medical Attendant. Admittedly, in the instant case, Ex-post Facto Sanction was accorded for treatment of ailing father of the petitioner, suffering from malignant cancer of urinary bladder and thus requiring radical Cystectomy  on emergency basis from Shifa International Hospital, Islamabad; while in the connected case (WP No.983-A/2015), the mother of the petitioner was referred by Head of Cardiology Department, Ayub Teaching Hospital, Abbottabad, duly countersigned by the Medical Superintendent ATH, Abbottabad, for angiography and angioplasty, as Angiography Machine of Ayub Teaching Hospital was non-functional, and the angiography and angioplasty of the mother of the petitioner was done by Col.(Retd) Doctor Najib-ul-Haq in the Hearts International (Pvt) Limited, Rawalpindi.  Therefore, there could possibly be no valid objection to treatment in private hospitals simply because the same was disallowed by Secretary Administration vide a letter dated 04.12.2014 to the Director General Health Services, especially, when the rules allowed treatment of the Government Servants and their entitled relations at private hospitals in case of non-availability of the facilities in the Government Hospital(s) and the requisite N.O.C./sanction is also granted by the competent authority under the West Pakistan Government Servants (Medical Attendance) Rules, 1959.  It needs be stressed here that administrative letter/direction cannot override the express provisions of the ibid                                 Rules without amendment in the rules giving effect to such direction.
  8. Anyhow, the provincial government have filed Civil Petition in the august Apex Court against the judgment of this Court dated 12.01.2016 in WP No.3720-P of 2015, therefore, the reimbursement of medical charges incurred by the petitioner in writ petition No.1180-A of 2015 was also made subject to the condition that the payment so received by the petitioner shall be subject to return by him in case the judgment/order in writ petition No.3720-P/2015 dated 12.01.2016 or judgment dated 09.05.2016 in writ petition No.1180-A of 2015 was reversed by the august Apex Court. At this juncture, the learned Additional Advocate General also prayed for making the direction for reimbursement of medical charges in favour of the petitioners in these two writ petitions subject to judgment of the Apex Court in Writ Petition No.3720-P/2015 dated 12.01.2016.
  9. Consequently, on the acceptance of both these writ petitions, the respondents are directed to allocate funds under head ‘Medical Charges’ for reimbursement of medical expenses incurred by the petitioners on treatments of their parents; subject to the condition that the payment so received by the petitioners shall be liable to return by them in case judgments/orders of this Court in this respect are reversed by the august Apex Court.

 

J U D G E

 

 

Announced.                                    J U D G E

Dt.10.05.2016.

 

 

 

One Comment

  1. Mudassar Nawaz says:

    I wanted to raise a query about age relaxation notification , but the concerned notification page is not showing comment posting section ; why ?

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