Introduction:

In a significant pronouncement reinforcing the primacy of human rights and the constitutional guarantee of the right to life under Article 21, the Bombay High Court has directed the Central Government to fully reimburse medical expenses amounting to Rs. 22 lakhs incurred by a retired public servant who underwent an emergency heart transplant surgery in a private hospital due to lack of facilities in empanelled hospitals. The case titled Anirudh Prataprai Nansi v. Union of India, Writ Petition No. 7546 of 2022, was decided by a division bench comprising Justices Girish Kulkarni and Advait Sethna on June 6, 2025. The petitioner, a former Assistant Commissioner of Central Excise and Customs, Pune, who had voluntarily retired in March 2008, was suffering from a critical heart condition (Cardiomyopathy) since 2009. In October 2019, his condition drastically deteriorated as his Left Ventricle Ejection Function (LVEF) declined to a life-threatening 12-15%, prompting his doctors to recommend an immediate heart transplant. As none of the Central Government Health Scheme (CGHS) empanelled hospitals had the requisite infrastructure or organ availability, the petitioner underwent the transplant at Sir HN Reliance Hospital, a private facility in Mumbai.

Arguments:

The petitioner sought full reimbursement for the medical expenses from the Central Government. However, the authorities sanctioned only Rs. 69,000 on the ground that the surgery was performed in a non-empanelled hospital, despite acknowledging the authenticity and emergency nature of the treatment. Represented by Senior Advocate Prakash Shah along with Advocates Anil Balani and others from PDS Legal, the petitioner contended that the refusal of full reimbursement violated his fundamental right to life and human dignity. The petitioner argued that in situations where life-saving treatment is unavailable in empanelled hospitals, a public servant—retired or otherwise—must be allowed to seek private medical care without being penalized financially. It was also asserted that the denial of the entire reimbursement amount was arbitrary, discriminatory, and reflective of a rigid bureaucratic mindset devoid of human sensitivity.

The Central Government, represented by Advocates YR Sharma, Vinit Jain, and Ashok Varma, argued that the petitioner had not followed the prescribed CGHS rules which require treatment in empanelled hospitals for reimbursement. It was contended that the rules are framed to ensure financial discipline and prevent misuse. The government maintained that while the petitioner was entitled to some compensation, full reimbursement could not be granted as it would contravene CGHS norms, which fix rates for various treatments and do not accommodate surgeries in private institutions unless formally approved.

Judgement:

The High Court, however, dismissed the government’s arguments, holding that procedural formalities cannot override the right to life. The bench emphasized that the state has an obligation to protect the lives and health of its employees, especially in cases where specialized treatment is unavailable in empanelled institutions. The judges observed, “The respondents have not come with a case that immediate transplant facility was available or the organ was available for transplant in any of its empanelled or CGHS hospitals.” They noted that the urgency of the surgery made it imperative for the petitioner to act promptly, and expecting him to await bureaucratic approvals would have endangered his life. The court further remarked that the government’s approach in refusing reimbursement was mechanical, narrow-minded, and a glaring violation of fundamental rights.

The judgment cited the constitutional mandate of Article 21, stressing that the right to life includes the right to timely and adequate medical treatment. The bench noted that heart transplant is a “serious ailment” and that reimbursement policies must be flexible enough to accommodate exceptional circumstances. The judges criticized the failure to revise reimbursement rates periodically, calling the fixed-rate model unrealistic, particularly in the face of rapid advancements in medical technology and rising costs.

Importantly, the court invoked the July 15, 2014 Office Memorandum which allows relaxation in reimbursement rules under special circumstances. The bench held that the High Power Committee (HPC) constituted to examine such cases had the authority to grant full reimbursement but failed to exercise it judiciously. It stated, “The High Power Committee ought to have been humanely sensitive in dealing with the petitioner’s case and ought not to have adopted a mechanical and a narrow-minded approach.”

The judgment makes a critical distinction between general administrative policies and individualized decision-making required in medical emergencies. It also underscores the doctrine that rules and guidelines are tools of governance, not instruments to deny justice. The Court observed that expecting a retired officer to bear the burden of Rs. 22 lakhs for a surgery necessitated by a failing heart and validated by expert opinions amounts to a “travesty of justice.”

In ordering the full reimbursement, the bench not only reaffirmed the centrality of human dignity in public policy but also set a precedent for similar future claims by retired government employees facing life-threatening medical situations. It concluded by stating that expenses on urgent and critical surgeries like heart transplants must not be seen merely through the lens of fixed reimbursements. Rather, they should be addressed with an empathetic, case-specific approach which places the value of life above all.