Government must fully reimburse privately purchased stents when unavailable during government-hospital treatment.

The respondent, an employee/beneficiary of the appellants, suffered a serious cardiac ailment and was treated at Mathura Das Mathur Hospital, Jodhpur, a Government hospital.

During angiography and angioplasty, four stents were implanted.

The total treatment expenditure was ₹2,73,832, of which the appellants reimbursed ₹1,70,800.

The respondent sought reimbursement of the balance amount.

The learned Single Judge allowed the writ petition and directed reimbursement of the remaining claim.

The appellants challenged that order, contending that reimbursement for more than three stents was impermissible under Appendix IX of the Rajasthan Civil Services (Medical Attendance) Rules, 2013.

Whether the respondent was entitled to reimbursement of the entire expenditure incurred for implantation of four stents, notwithstanding the limitation allegedly prescribed under Appendix IX of the Rajasthan Civil Services (Medical Attendance) Rules, 2013.

Whether, where treatment is undertaken in a Government hospital and the required stents are procured from a private source because they are unavailable through the hospital, the beneficiary is entitled to full reimbursement of the treatment expenses.

The Court applied Appendix IX of the Rajasthan Civil Services (Medical Attendance) Rules, 2013, while holding that medical-reimbursement provisions must be construed liberally where necessary to protect the beneficiary’s right to health.

Relying on State of Rajasthan & Ors. v. Smt. Mohan Kanwar Bhansali, the Court held that a Government hospital must provide the equipment required for treatment; if a consumable item is unavailable, the Government must ensure its availability through an authorised medical store, and if it remains unavailable, the beneficiary may purchase it from the open market and claim reimbursement.

Under Consumer Education & Research Centre v. Union of India, the right to health and medical care is part of the fundamental right to life under Article 21.

Surjit Singh v. State of Punjab recognised self-preservation of life as a necessary concomitant of Article 21.

The Court also relied on In Re: The Proper Treatment of Covid-19 Patients and Dignified Handling of Dead Bodies in the Hospitals etc., which affirmed that the right to health includes access to affordable treatment.

The Court treated the respondent’s treatment in a Government hospital as decisive.

Since the four stents were implanted as part of medically necessary angioplasty and were purchased from a private shop, their procurement was attributable to the unavailability of the required equipment through the Government hospital rather than to any voluntary deviation by the respondent.

Applying Mohan Kanwar Bhansali, the Court held that the beneficiary could not be denied reimbursement merely because the necessary consumable had to be purchased from the open market.

The constitutional guarantee of the right to health under Article 21 further required a liberal construction of the reimbursement provisions.

Accordingly, the alleged restriction concerning more than three stents could not defeat the respondent’s claim for reimbursement of the actual expenditure incurred for the medically necessary treatment.

It held that the respondent was entitled to reimbursement of the complete treatment expenditure of ₹2,73,832, including the cost of all four stents, and upheld the learned Single Judge’s direction to reimburse the remaining amount of ₹1,03,032.

The special appeal was dismissed as devoid of merit.