T.V. Rajagopala Rao v. Additional Director of the Central Government Health Scheme

2003 (3) ALD 476; 2003 (3) ALT 632
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Petitioner had health coverage under the Central Government Health Scheme (CGHS).  On January 4, 2000, the petitioner learned that he had blocked arteries and was advised to go to Yashoda hospital, which was a recognized referral hospital under the CGHS. At Yashoda hospital he was instructed to have bypass surgery. After consulting with many doctors, the petitioner was advised by Dr. Bhattacharya at Bceech Candy Hospital (a private hospital) in Mumbai to have the surgery as soon as possible.  The surgery was performed on 10 March, 2000 by Dr. Bhattacharya at Bceech Candy Hospital. Afterwards the petitioner made a claim for reimbursement for his medical expenses but was informed by the respondents that as he had taken the treatment from a hospital of his choice and as he had had sufficient time (about two months between diagnosis and surgery) to get treatment from a recognized hospital under the CGHS he was not entitled to any reimbursement.

The CGHS only allowed for reimbursement for treatment in private hospitals where the patient was properly referred to such hospitals by CGHS-related personnel and for reimbursement of treatment in hospitals in emergency cases.

The court noted that each citizen has a right to preserve his life and to go to a doctor and hospital of his choice.  However, while each patient had the right to go to a hospital or doctor of his choice, a State employer, bound by its own set of financial constraints, was not required to pay the difference in expense between the hospital or doctor chosen by the employer and the hospital or doctor chosen by the patient.

The court held that the petitioner was entitled to reimbursement only up to the amount that he would have incurred had he gone to a recognized referral hospital under the CGHS.

“8 Therefore, we are of the considered view that right to self-preservation being a concomitant right to life also includes a duty and a right of the person to get himself treated for ailments. Since a citizen has the right to preserve his life and get treated by a Doctor in case of disease it follows that he has a right to go to a Doctor of his choice and a hospital of his choice. It is basically a matter of faith for a patient to trust his doctor. . . . But, at the same time, while it can be said that a patient has a right to choose a doctor or a hospital, in cannot be said that the State is bound to pay its employees all expenses incurred by a patient who makes the choice because State has its own financial constraints and commitments.  Either the patient should go to the hospital of the choice of the employer and get himself relieved with the consequential expenses or make a choice of his Doctor and hospital and burden himself with some of the  financial burden.”