Thursday, December 4, 2014

ESIC REFUSES TO PAY FOR LIVER-TRANSPLANT OF CRITICALLY ILL 10 YEAR OLD SON OF INSURED PERSON - DELHI HIGH COURT ISSUES NOTICES TO ESIC, GOI, ILBS & GNCTD

The Delhi High Court (Vibhu Bakhru J.) today issued notices to ESIC, Delhi Government, Central Government and Institute of Liver and Biliary Sciences (ILBS) on a petition filed by the father of a 10 year old liver-patient Master Mohd. Shahnawaz though Advocate Ashok Agarwal. Mohd Shahnawaz has been identified as a case of chronic Cholestatic Liver Disease PFIC type 3, urgently requiring a liver transplant.

Shahnawaz’s father Mohd. Kalim works as a helper in a restaurant and earns Rs. 7,000 per month. He has four children, Shahnawaz being the eldest. Both Shahnawaz and the sibling next to him, Master Mohd. Arbaz are suffering from the same disorder. However, Shahnawaz is more critically ill.

Mohd. Kalim is registered as an insured person with ESIC and had been consulting ESI Hospital, Jhilmil for his sons. Shahnawaz was referred by ESI Hospital to empanelled hospital ILBS for treatment. However, when ILBS gave an estimate of Rs. 14 lacs as the initial expenditure for transplant, ESIC refused to sanction the same citing its new guidelines of July 2014 which state that in case of diseases of a genetic origin, if the beneficiary (Shahnawaz here) is born before the date of ESIC registration of the insured person (Mohd. Kalim here), he/she shall not be entitled for coverage. According to the ESI Hospital, Jhilmil, Shahnawaz’s disease is of a genetic origin. In its new guidelines, ESI has also limited its liability to Rs. 10 lacs per beneficiary per year for medical treatment.

Challenging the legality of the said guidelines, Advocate Ashok Agarwal appearing for the petitioner argued that the same are arbitrary, irrational, illogical, unreasonable, illegal and violative of Articles 14, 21, 39, 41 and 47 of the Constitution of India and tend to defeat the very object and purpose behind the ESI Act, 1948.

“Irrespective of the obligation of the ESIC to bear the cost of treatment, ILBS being an autonomous body under the Government of NCT of Delhi has an independent Constitutional obligation to provide free medical treatment to the poor patient in order to save his life”, submitted Mr. Agarwal.

Justice Bakhru, while issuing notices, took a prima facie view that the guidelines are illogical and the date of birth of the patient is irrelevant. The next date of hearing in the matter is 19.12.2014.

Note: Copy of writ petition attached.

Ashok Agarwal, Advocate
02.12.2014
M: 9811101923

1 comment:

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