What Happened
Anirudh Nansi, a retired assistant commissioner from Central Excise and Customs Pune, had been battling cardiomyopathy since 2009. He took voluntary retirement in March 2008. By October 2019, doctors advised him to get a heart transplant.
But here’s the catch: none of the hospitals empaneled under the Central Government Health Scheme (CGHS) in Mumbai had the facilities or timely availability for the transplant. So, on December 29, 2020, Anirudh had to get the surgery done at a private hospital that wasn’t on the CGHS panel, but had the required license and facilities.
After the successful transplant, Anirudh applied for reimbursement. The government, however, rejected the full claim of ₹22 lakh and only sanctioned a limited amount based on panel rates. Despite several representations over the next three years, he got no relief.
Finally, in 2022, Anirudh took the matter to the Bombay High Court, demanding full reimbursement. His case was that since empaneled hospitals couldn’t provide timely treatment, he had no choice but to go private for this life-saving procedure.
What Did the Court Say
A bench of Justice Girish Kulkarni and Justice Advait Sethna held that Anirudh Nansi was fully entitled to reimbursement. Denying him the full ₹22 lakh refund, they said, was a “glaring travesty of justice” and a violation of his fundamental rights.
The court said that a heart transplant is “serious and emergent,” and that the man had every right to opt for a private hospital when CGHS empaneled ones didn’t have timely availability. In such urgent cases, they stressed, reimbursement shouldn’t be treated like a rigid formula or denied over technicalities.
They added that just because a person retires doesn’t mean they should be treated differently, especially when the medical need is urgent and genuine. Even if it was a planned surgery, the refund shouldn’t have been rejected outright, especially for a life-saving procedure like this.
Nansi was represented by advocates Anil Balani and Prakash Shah, while the Centre was represented by YR Sharma and advocate Jain.
What Else Did the Court Point Out
The Centre shouldn’t apply a “straitjacket formula” for medical reimbursements in emergency cases. Each case deserves a fair look.
Heart transplants are not routine surgeries; they’re serious and time-sensitive. Delaying them isn’t an option.
Just because a surgery is planned doesn’t mean it isn’t urgent or life-saving.
Retired employees shouldn’t be treated differently in critical healthcare matters.
The court disagreed with the high-powered committee’s stand that full reimbursement wasn’t possible under CGHS guidelines.
It said even without relaxation guidelines, the committee should have used discretion in cases like this.
Reimbursement rules aren’t rigid; the Center must stay flexible in deserving cases like Nansi’s.
(Input From Various Sources)
(Rehash/Pooja Bansal)