Karnataka High Court Asks Centre To Consider Cashless CGHS Treatment For Emergencies, Critical Care Cases

The Karnataka High Court recently directed the Union of India to examine and consider, at the appropriate administrative level, the feasibility and phased implementation of a cashless medical treatment mechanism under the Central Government Health Scheme, particularly for emergency and critical care. A single judge, Suraj Govindaraj said, “A cashless treatment mechanism, particularly for emergency and life-saving procedures, would significantly mitigate these hardships and align the administration of the CGHS with constitutional values. Such a system would give meaningful effect to the right to health under Article 21, ensure non arbitrary access to medical care under Article 14, and reinforce the State's obligation as a welfare employer.” The court emphasised that “Directing the Respondents to consider the feasibility of such a mechanism does not amount to judicial encroachment into policy-making, but constitutes a constructive institutional suggestion arising from repeated administrative failures.” It added “The absence of a cashless mechanism also results in avoidable litigation, delayed settlements, and administrative inefficiency, burdening both beneficiaries and the State. Presently the scheme follows the reimbursement based model, where beneficiaries are first compelled to incur substantial medical expenditure out of pocket and thereafter pursue reimbursement through prolonged administrative processes. The court said “In cases of emergency and critical care, such a model places an onerous and often insurmountable financial burden upon government servants and pensioners, particularly those who have no independent means beyond pensionary benefits. The court gave the direction while allowing a petition filed by one Ivy Miller Chahal, a retired officer from the Indian Administrative Service from the Madhya Pradesh cadre, who had questioned the communication issued by the authorities refusing to reimburse the amounts paid on the cardiac treatment of her husband, also a retired IAS officer. The authorities rejected the claim stating that experts had opined that the emergency CRT-D was not justified and no reimbursement could be ordered. The bench referred to Supreme Court order in the case of Shiva Kant Jha Vs. Union of India, (2018) 16 SCC 187 and said “The Central Government Health Scheme is one of the incentives which is offered by the State to a Government employee to join the Government services, so that the health benefits are taken care of. Otherwise, the Government servant would have to avail of private insurance when a government servant or his family member obtains Medical treatment. It is but required that the said expenses are taken care of by the State since that is the promise which had been held out by the State when the person joined the Government Service.” Taking note of the facts of the case, it said, “The husband of the Petitioner having expired, it cannot lie for the Respondents to contend that the decision taken by the doctors was not proper and there was no emergency requiring a CRT-D device to be implanted. The facts also indicate that though the CRT-D implant was made on 31.10.2023, he expired on 18.03.2024, it is probably due to the implantation of the CRT-D device that he survived for so many months. It is for the officers of the CGHS to consider any application for reimbursement in a humane manner and act on the same instead of in a technical manner to decide after more than a year that there was no emergency when they were not present and they were not the treating doctors.” The Court held that denial of reimbursement for emergency life-saving treatment, despite eligibility under the scheme, would therefore render the right illusory and defeat the constitutional guarantee of dignified existence.It added, “The right to health and timely medical treatment is now firmly recognised as an integral facet of the right to life guaranteed under Article 21 of the Constitution of India. Medical reimbursement under the Central Government Health Scheme is therefore not a matter of administrative discretion or charity, but a component of the constitutional obligation of the State flowing from Article 21.” Allowing the petition the court said “The constitutional promise of dignity, fairness, and non-arbitrariness demands that health schemes like the CGHS be interpreted and implemented purposively, humanely, and in a manner that advances, rather than frustrates, their underlying object.” Accordingly it directed the respondents to make full reimbursement of the medical costs incurred by the Petitioner for the CRT-D implantation within a period of 30 days from today along with interest calculated from 30.10.2023 when the Petitioner made payment of the due amounts at the rate of 12% per annum within 30 days from the date of receipt of a copy of this order. Appearance: Advocate A MADHUSUDHANA RAO for Petitioner.CGC RESHMA K T, FOR RESPONDENTS.Case Title: MRS. IVY MILLER CHAHAL AND Union of India...

Karnataka High Court Asks Centre To Consider Cashless CGHS Treatment For Emergencies, Critical Care Cases

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