Holding

Expenses incurred towards room rent for an inpatient stay in an approved specialized hospital are integral to the treatment costs and must be reimbursed by the State.

Summary

A government servant suffering from a heart ailment was permitted to obtain specialized treatment at AIIMS/Escorts Heart Institute because such facilities were unavailable in Punjab state hospitals. He submitted his medical bills for reimbursement, including the actual room rent paid during his inpatient stay, but the State rejected the room‑rent claim citing a policy resolution that excluded such expenses. The respondent filed a writ petition; the Punjab & Haryana High Court directed the State to reimburse the room rent, holding it integral to treatment costs. The State appealed, arguing that the policy barred reimbursement and that the State should not bear the actual rent. The Supreme Court held that when treatment is obtained in an approved specialized hospital, the room‑rent expense is an essential component of the medical expenditure and must be reimbursed, emphasizing the constitutional obligation under Article 21 to provide health care to government servants. Consequently, the Court dismissed the appeal and upheld the High Court’s order.

Issues considered

Whether the reimbursement of room rent paid by a government servant for inpatient stay in an approved specialized hospital is covered under the State's reimbursement policy.
Whether the policy resolution excluding such expenses is valid in view of the constitutional right to health under Article 21.
Whether the State has a constitutional obligation to bear the medical expenses, including room rent, of a government servant undergoing treatment outside the State.

Legislation cited

Constitution of Indias. Article 21

Subjects

right to liferight to healthArticle 21government servantmedical reimbursementroom rentspecialized treatmentconstitutional obligation

Judgment

STATE OF PUNJAB AND ORS. A
v.
MO HINDER SINGH CHAWLA ETC.

DECEMBER 17, 1996
B
[K. RAMASWAMY AND G.B. PATTANAIK, JJ.)

Constitution of India, 1950 : Article 21.

Right to life-Held right to health is an integral to right to life-Govern-
ment servant-Constitutional obligation of Government to provide health C
services and bear the expenses for Government servant during service and after
I
retirement.

Service Law-State of Punjab-povernment employee-Medical expen-
diture-Reimbursement-Employee having heart ailment-Facility of treat- D
ment not available in State Hospitals-l'ennission granted to get specialised
treatment outside the State-Treatment taken at Al/MS-Claim for reimbur-
sement by employee-Claim for actual room rent paid rejected as per Govern~
ment policy decision-Writ by employee-Direction by High Court to
reimburse room rent paid by employee-Appeal by State-Held the expenses E
incu"ed towards room rent for stay in the hospital as an inpatient are an
integral part of the expenses incu"ed for the treatment-Expenditure, thus,
incu"ed requires to be reimbursed by the state to the employee-High Court
was right in giving direction for reimbursement of expenses towards room rent.

Service Law-State of Punjab-Government employee-Suffering F
coronary ailment--Refe"ed to Escorts Hearts Institute for urgent treat-
ment-Ex post facto sanction for treatment-with one attendant
granted-Claim for room rent paid in the Hospital for the period of
stay-<Jovernment stand that reimbursement could only be allowed as per
rates charged by A.l.l.M.S. .and not the actual expenses incurred by
patient-Held the Government is required to reimburse the expenditure in- G
cumd for the period during which fhe patient stayed in the approved hospital
-,
for treatment-it is incongruous that while the patiel!t is admitted to undergo
treatment and he is refused the reimbursement of the actual expenditure
incun·ed towards room rent and is given the expenditure of the room rel!t
chargeable in another institute whereat he had not actually undergone. H
279
280 SUPREME COURT REPORTS(1996) SUPP.10 S.C.R.

A CML APPELLATE JURISDICTION : Civil Appeal No. 16979 of
1996 Etc.

From the Judgment and Order dated 8.8.96 of the Punjab & Haryana
High Court in C.W.P. No. 15942 of 1995.

B D.V. Sehga~ H.S. Munjral, Manoj Swarup, M.K. Dua, Ms. Monika
Gusain, P.N. Aggarwal, S. Bagga, A. Sharan and A.P. Singh for the
appearing parties.

The following Order of the Court was delivered :

C In C4 No. 16979 I 96 @ SLP (C) No. 12472/96:

Leave granted.

This appeal by special leave arises from the judgment and order of
the Division Bench of the Punjab & Haryana High Court, made on August
D 8, 1996 in CWP No. 15942/95.
The respondent had heart ailment which required replacement of
two valves in the heart. Since the facility of the treatment was not available
in the State Hospitals· of Punjab, permission was given by the Director, with
E the approval of the Medical Board, to get the treatment outside the State.
The respondent was sent for and had treatment in the AIIMS at New
Delhi. The respondent submitted his medical bill on September 21, 1994
for reimbursement. While granting reimbursement for the Actual expenses
incurred in the sum of Rs. 1,29,000, the appellants rejected his bill for room
rent paid to the hospital as inadmissible. The respondent filed writ petition
F stating that when he had undergone the treatment in the hospital as an
inpatient, the payment of the room rent is an integral part of the expenses
for treatment and, therefore, he is entitled to the reimbursement of the
room rent pai& The Division Bench directed payment of the said amount.
Thus, this appeal by special leave.
G It is contended for the appellants-State that the Government have
taken decision, as a policy in the Resolution dated January 25, 1991 made
in Letter No. 7n!85/5HBV/2498, that the reimbursement of expenses on
.·
account of diet, stay of attendant and stay of patient in hotel/hospital will
not be allowed. Permission given was subject to the above resolution and,
H therefore, the High Court was not right in directing the Government to
_,

STATE v. M.S. CHAWLA 281
bear the expenses for the stay fu the hotel/hospital contrary to para (vii) A
of the Resolution of the Government. We find no force fu the contention.
It is an admitted position that when specialised treatment was not available
in the Hospitals maintained by the State of Punjab permission and approval
having been given by the Medical Board to the respondent to have the
treatment in the approved hospitals and having referred him to the AIIMS B
for specialised treatment where he was admitted, necessarily, the expenses
fucurred towards room rent for stay in the hospital as an inpatient are an
integral part of the expenses incurred for the said treatment. Take, for
fustance, a case where a~'inpatient facility is not available in a specialised
hospital and the patient has to stay in a hotel while undergofug the
treatment, during the required period, as certified by the doctor, necessari- C
ly, the expenses incurred would be integral part of the expenditure fucurred
towards treatment. It is now settled law that right to health is an futegral
to right to life. Government has constitutional obligation to provide the
health facilities. If the Government servant has suffered an ailment which
requires treatment at a specialised approved hospital and on reference D
whereat the Government servant had undergone such treatment therein, it
is but the duty of the State to bear the expenditure fucurred by the
Government servant. Expenditure, thus, incurred requires to be reim-
bursed by the State to the employee. The High Court was, therefore, right
in giving direction to reimburse the expenses incurred towards room rent
by the respondent during his stay in the hospital as an inpatient. E
I
The learned counsel then contends that the State would be saddled
with needless heavy burden, while other general patients would not be able
to get the similar treatment. We appreciate the stand taken that greater
allocation requires to be made to the general patients but unfortunately F
due attention for proper maintenance and treatment in Government
Hospitals is not being given and mismanagement is not being prevented.
Having had the constitutional obligation to bear the expenses for the
Government servant while in service or after retirement from service, as
per the policy of the Government, the government is required to fulfill the
constitutional obligation. Necessarily, the State has to bear the expenses G
fucurred in that behalf.

The appeal is accordingly dismissed. No costs.

In CA@ SLP (C) No. 12945/96 - State of Punjab & Ors. v. Varyam Singh: H
282 SUPREME COURT REPORTS[l996] SUPP.10 S.C.R.

A Leave granted.

Heard learned counsel on both sides.

While the respondent was a Government servant, he had developed
sudden coronary ailment. After required angiography and other reports of
B tripple vessets disease was diagnosed in CMC Hospital, Ludhiana and he
was recommended by the said hospital to go over ro Escorts Hearts
Institute, New Delhi for urgent treatment. On its basis, the respondent had
the treatment. The Medical Board granted by its proceedings dated
January 12, 1969, ex-post facto sanction for treatment with one attendant.
C The appellant had granted reimbursement of a sum of Rs. 1,03,267 less the
rent paid for the room in the hospital for the period of stay. It is the
Government's stand that the reimbursement could be allowed as per rates
charged by All India Institute of Medical Sciences. Accordingly, a sum of
Rs. 20,000 paid as rent was deducted. When the respondent filed the writ
petition, the High Court, by judgment dated April 12, 1996 in CWP No.
D 16570/95, the Division Bench allowed the writ petition. Thus, this appeal
by special leave.

It is contended for the State that though the Government had granted
ex-post facto sanction through the Medical Board and permitted the
E patient to undergo treatment outside the State with the policy, for reim-
bursement of medical expenses incurred and the medical treatment taken
in the Hospital to the Government servant/Pensioners or dependents, as
per rules, the Government has imposed a condition to pay room rent at
the rates charged by the AIIMS for stay in the hospital. The reimbursement
will be given at those rates. The Government, therefore, is not obliged to
F pay the actual expenses incurred by the patient while taking the treatment
as inpatient in the hospital, for rent.

We are unable to agree with the stand taken by the Government. It
is seen that the Government had decided in the proceedings dated October
G 8, 1991 to reimburse the medical expenditure incurred by the Punjab ·
Government employees/pensioners and dependents on treatment taken
abroad in private hospital. It is stated in paragraphs 2 and 3 that the
Government has, prepared a list of those diseases for which the specialised
treatment is not available in Punjab Government Hospitals but it is avail-
able in certain identified private hospitals, both within and outside the.
H States. It was, therefore, decided to recognise these hospitals for treatment
I
I
STATEv. M.S. CHAWLA 283

of the diseases mentioned against their names in the enclosed list for the A
Punjab Government employees/pensioners and their dependents. The
terms and conditions contained in the letter under reference would remain
applicable. The Government can, however, revise the list in future. The
name of the disease for which th~ treatment is not available in Punjab
Government hospitals is shown as' Open Heart Surgery and the name of. B
the private hospital is shown as Escorts Heart Institute, New Delhi as one
of the approved hospital/institution. Thus, for open heart surgery or heart
disease the Escort Heart Institute is authorised and recognised institution
by the Government of Punjab. Consequently, when the patient was ad-
mitted and had taken the treatment in the hospital and had incurred the
expenditure towards room charges, inevitably the consequential rent paid C
for the room during his stay is integral part of his expenditure incurred for
the treatment. Consequently the Government is required to reimburse the
expenditure incurred for the period during which the patient stayed in the
approved hospital for treatment. It is incongruous that while the patient is
admitted to undergo treatment and he is refused the reimbursement of the D
actual expenditure incurred towards room rent and is given the expenditure
of the room rent chargeable in another institute whereat he had not actually
· undergone treatment. Under these circumstances, the contention of the
State Government is obviously untenable and incongruous. We hold that
. the High Court was right in giving the direction for reimbursement of a
sum of Rs. 20,000 incurred by the respondent towards the room rent for E
his stay while undergoing treatment in Escorts Heart Institute, New Delhi.

The appeal is disposed of accordingly. No costs.

In CA @ SLP (C) No. 18828/96:
F
Leave granted.

Heard counsel for the parties.

The appeal is disposed of in terms of order passed in CA No. G
16980/96 @ SLP (C) No. 12945/96.

T.N.A. Appeal disposed of.