Non-emergent medical treatment at unrecognized out-of-state hospitals without prior sanction precludes claim for reimbursement.

The petitioner, a Laboratory Technician in the Veterinary Services at Chhindwara, suffered a heart attack and was admitted to a local hospital.

Due to the unavailability of open-heart surgery facilities at Chhindwara, he sought treatment at Dr. K.G. Deshmukh Memorial Centre Hospital, Nagpur—a private, unrecognized medical institution outside the State—where he was operated on April 25, 2014.

The petitioner subsequently applied for post-treatment reimbursement of medical expenses.

His claim was rejected by the Dean, Medical College, Jabalpur, on July 22, 2015, on the grounds that the treatment was not a medical emergency and was obtained from an unrecognized institution without prior sanction.

The petitioner challenged this rejection via a writ of certiorari.

1. Whether the order rejecting medical reimbursement was passed by an authority lacking jurisdiction under the State’s medical policy.

2. Whether the petitioner is entitled to reimbursement for treatment taken in an unrecognized hospital outside the State without prior sanction under the M.P. Civil Services (Medical Attendance) Rules, 1958, and the policy dated May 28, 2013.

The court primarily considered the M.P. Civil Services (Medical Attendance) Rules, 1958, which are silent on post-sanction for treatment outside the State.

State Government Policy/Circular dated May 28, 2013 (Annexure P/12), which provides a framework for post-treatment sanction through a Divisional Level Committee (headed by the Divisional Commissioner) and a State Level Committee.

This policy requires a government servant to obtain prior sanction for treatment outside the State unless the situation is of extreme emergency, and generally mandates treatment at recognized institutions.

The Court examined the jurisdiction of the impugned order and found that while the Dean (Member Secretary) communicated the decision, the decision was actually adjudicated by the Committee headed by the Divisional Commissioner in accordance with the 2013 Policy.

The Court noted that the petitioner failed to produce any evidence, such as a formal reference or recommendation from a State Medical Officer, to prove that his condition necessitated urgent admission to an unrecognized hospital in Nagpur without prior permission.

Since the petitioner treatment was neither categorized as an "emergency" by the committee nor conducted at a State-recognized specialized institution, the Court held that the authorities acted in consonance with the active policy guidelines.

The Court found no grounds for interference under Article 226 of the Constitution of India, as the petitioner failed to satisfy the emergency or prior-sanction requirements of the State policy. The petition was dismissed for lack of merit.