Suman Jain v. State of Haryana and Others

o o o o o o o o oooo ooooooINoTHEoHIGHoCOURToOFoPUNJABoANDoHARYANAo AToCHANDIGARHoo 247o o o o o o o o oooooo o o o o o o ooooooooooooooooooooooooooooooooCWP-12624-2021o o Dateoofodecision:o25.05.2023o o SUMANoJAINo o o o o o oooo ooooooooo.......Petitioneroo o o o o o ooo oooVERSUSo o STATEoOFoHARYANAoANDoOTHERSoooooooooooooo o oooo.......Respondentsoo o o CORAMo:oHON'BLEoMR.oJUSTICEoVINODoS.oBHARDWAJo o o o o o o *****o o Present:o-oo Mr.oRishabhoJain,oAdvocateoo o o o forotheopetitioner.oo o o o Mr.oVivekoChauhan,oAddl.oA.G.oHaryana.o o o o Mr.oHarshoAggarwal,oAdvocateoo o o fororespondentoNo.3.oo o o o o o o *****oo o VINODoS.oBHARDWAJ,oJ.o(Oral)oo o o o Challengeo ino theo presento Writo petitiono iso too theo ordero datedo

25.06.2020o(AnnexureoP-12)oissuedobyotheorespondentoauthoritiesoinoexerciseo ofo theo powerso conferredo undero Sectiono 2o ofo theo Epidemico Diseaseso Act,oo 1897otootheoextentowherebyotheocompetentoauthorityohadodeniedotheobenefitso ofo theo cappingo ofo theo chargeso too beo demandedo byo theo privateo hospitals/medicalocollegesoinotheoStateoofoHaryanaoforoextendingotreatmentotoo anyoCovid-19opatient.o

2.o o Brieflyosummarizedotheofactsoofotheopresentocaseoareothatotheo mothero ofo theo petitionero remainedo admittedo ino respondento No.3-Hospitaloo CWP-12624-2021oo o o o o o ooooo o oooo-2-o o fromo08.05.2021otoo20.05.2021oonoaccountoofoCovid-19owhereosheobreathedo herolast.oCopyoofotheodeathosummaryoandotheomedicalotreatmentoextendedotoo theomotheroofotheopetitionerohasobeenoattachedoasoAnnexureoP-1.oAsoperotheo aboveo saido dischargeo summary,o theo mothero ofo theo petitionero remainedo admittedoforotreatmentoforoCovid-19oandothereowasonoootheromedicaloproblemo beingo treatedo oro curedobyo theo respondento No.3-Hospital.o Sheo waso havingo PNB-Orientalo Medio Claimo Policyo foro ao covero ofo Rs.o 5,00,000/-.o Theo respondento No.3-hospitalo raisedo ao billo too theo tuneo ofo Rs.6,43,024/-o foro hospitalizationoofo13odays.oAsotheobilloraisedobyorespondentoNo.3-hospitalo exceededotheosumoassuredovalueoofotheoinsuranceopolicyoandowithoaoviewotoo avoido delayo ino deliveryo ofo theo deado bodyo ofo hiso mother,o theo petitionero depositedotheoentireoamountoofoRs.6,43,024/-odemandedobyotheohospital,oono anoassuranceofromotheohospitalothatoinotheoeventoofotheoapprovalograntedobyo theoinsuranceocompany,otheoexcessoamountoreceivedobyotheohospitaloshallobeo refundedotootheopetitioner.oAfterosettlementoofotheoamountofromotheoinsuranceo company,otheohospitalorefundedotheosumoofoRs.o5,58,035/-.oo

3.o o Itohasobeenoaverredothatotheopetitionerobecameoawareofromotheo newspaperothatoaoDistrictoLeveloCommitteeohadobeenoformedotoolookointootheo complaintso ofo overchargingo fromo theo Covid-19o patientso byo theo privateo hospitalsoinoPanchkulaoandomoreoparticularlyoaboutorespondentoNo.3-hospitalo whereinoaobilloofoRs.o7,59,831/-ohadobeenoraisedoandotheoactualoliabilityoofotheo patientowasofinallyoassessedoatoRs.o2.91olacs.ooMoreosuchoandosimilaroarticleso ofoover-chargingobyotheoHospitalsofromotheoCovidopatientsoappearedoinotheo newspaperoduringotheosaidoperiod.oCertainoenquiriesoaboutotheogrievanceso wereoalsooconductedobyorespondentoNo.1o&o2,ohowever,onoostepsowereotakeno CWP-12624-2021oo o o o o o ooooo o oooo-3-o o byotheosaidoofficialsotooprotectopeopleofromobeingofleecedoinosuchohouroofo extremeocrisis,oFinally,otheoauthoritiesoseizedoofotheoissueoandolookedointootheo largeoscaleoreportsoofoexorbitantobillingotooredress,otheogrievanceoespousedobyo theohelplessocitizens.oCovid-19ohavingobeenodeclaredoasoao"NotifiedoDisaster"o videoletterodatedo14.03.2020obyotheoMinistryoofoHomeoAffairs,oUnionoofoIndiao underotheoDisasteroManagementoAct,o2005,otheoprovisionsoofotheoDisastero ManagementoAct,o2005oasowelloasotheoEpidemicoDiseasesoAct,o1897owereo broughtoinoforce.oTheorespondent-authoritiesoaccordinglyopassedoanoorder,o bearingoNo.o2020/2oPM-Pkgo(COVID-19)/3567-3766odatedo23.03.2020oino exerciseoofotheopowersounderotheoHaryanaoEpidemicoDiseaseso(Covid-19)o Reg.2020odatedo11.03.2020ounderotheoActoofo1897owherebyotheyocappedotheo chargesotoobeoleviedobyotheohospitalsoforotheopatientsoadmittedoforotreatmento underoCovid-19.oClauseoCo(1)o(b)oofotheoorder/directionobearingoNo.2020/2o PM-o PKgo (Covid-19)o 3567-3766o datedo 23.03.2020o passedo byo respondento No.1odefinedo"generalopublic"oandocategorizedotheosameoasounder:o "GeneraloPublic:o

(i)o Fullyo insuredo (witho anyo private/Govt.o Insuranceo agency):oratesoasoperotheoinsuranceopolicy.o

(ii)Partiallyo insuredo (ie.o parto paymento iso madeo byo Insuranceoagencyoandopartobyotheoindividual):oRatesotoobeo chargedo shouldo noto moreo thano theo proposedo packageo rates.o

iii)o Uninsured:oRatesotoobeochargedoshouldonotomoreo thanotheoproposedopackageorates."o o o o o o ooooooooo(Emphasisosupplied)o

4.o o Ito iso evidento fromo ao perusalo ofo theo abovesaido ordero datedo

23.03.2020othatotheoratesoforotheofullyoinsuredopersonohadobeenokeptoasoperoVISHAL SHARMA CWP-12624-2021oo o o o o o ooooo o oooo-4-o o theo rateso ofo theo insuranceo policyo whileo foro theo partiallyo insuredo ando theo uninsuredo persons,o rateso couldo noto moreo thano proposedo packageo rates.o Thereafter,ocapsoonotheobillsothatoprivateohospitalsocouldochargedofromoCovido PatientowasoreviewedoandorevisedobyotheorespectiveoStateoGovernmentsofromo timeotootime.oCopyoofosuchoorderoissuedobyotheoStateoofoHaryana,oPunjaboaso welloasoNCToDelhiohadobeenoattached.oo

5.o o Ito iso worthwhileo too pointo outo ato thiso junctureo thato beforeo theo Governmentodeterminedotheochargesotoobeoleviedobyotheoprivateohospitals,oao CommitteeounderoNitioAyogohadobeenoconstitutedotoodetermineotheoratesothato mayobeochargedoforoCOVID-19orelatedotreatmentobyotheoprivateohospitalso withotheoprovisoothatotheoCOVIDobedsowouldobeogivenoatoratesogivenobyotheo Committeeosubjectotooanoupperolimit.oTheoaboveosaidoCommitteeotookostocko ofo theo bedo capacity,o theo facilitieso too beo provided,o theo medicationo too beo administeredoandoallootheroincidentaloexpensesotoobeoincurred.oTheosaidorateso wouldotoobeoinclusiveoasoaopackageoandonotolimitedojustotoobed,ofoodoando othero amenities.o Monitoring,o nurseo care,o doctorso visits/consults,o investigationso includingo imaging,o treatmento aso pero nationalo protocolo foro Covidocareoandostandardocareoforoco-morbidities,ooxygen,obloodotransfusiono etc.ooSignificantly,otheoorderopassedobyotheoGovernmentoofoNationaloCapitalo TerritoryoofoDelhioono20.06.2020oalsoonoticeothatotheopackageorateowouldo includeocostoofomedicalocareoofounderlineoco-morbidoconditionsoincludingo supportiveocareoandocostoofomedicationothereof,oforotheodurationoofocareoforo COVID.oHence,othereowasoanoexerciseoundertakenobyotheoGovernmentobeforeo assessingotheochargesothatomayobeodemandedobyotheoconcernedohospitals.o Similaro clauseso wereo alsoo incorporatedo ino theo ordero issuedo byo theo CWP-12624-2021oo o o o o o ooooo o oooo-5-o o Governmento ofo Punjabo bearingo No.o COVID-19/NHM/PB/20/8477o datedo

11.01.2021oasowelloasotheoChandigarhoAdministration.o

6.o o Ino supersessiono ofo itso earliero ordero datedo 23.03.2020,o theo GovernmentoofoHaryanaopassedoaofreshoorderoono25.06.2020oandotheosameo areoextractedoasounder:ooo o o o oooooooooooooooooooHospitaloratesoperopatientoperodayoofoadmissiono(inoRs.)o TypeoofoHospitalo Isolationobedso ICUowithouto ICUowitho Ventilatorocareo Ventilatorocareo (Non-invasive/invasive)o Non-NABHo 8000/-o 13000/-o 15000/-o accreditedo Hospitalsoo JCI/NABHo 10000/-o 15000/-o 18000/-o accreditedo (includingo Entryo levelo NABH)o Hospitalso o

7.o o Similaroconditionsoaboutoco-morbiditiesoowereoalsooincludedoino theoaboveosaidoorder.oo o o

8.o o Theogrievanceoofotheopetitioneroemanatesofromotheocategorieso excludedofromotheobenefitsoofopriceocappingovideoorderodatedo25.06.2020,o whichohaveobeenoreferredotooinoClauseo3othereof.oo "3)o Theseo orderso areo noto applicableo foro theo followingo categories:o a)oo Theo beneficiarieso ofo PMJAYo Ayushmano Bharato (AB)o o schemeowilloavailotreatmentoonocashlessobasis,oasoperotheo o existingoABoSchemeoatoeveryohospitaloempanelledoundero CWP-12624-2021oo o o o o o ooooo o oooo-6-o o b)oo Theo patients,o whoo areo noto ARo beneficiarieso ando areo o referredobyoconcernedoCiviloSurgeonotoonotifiedoCOVIDo o hospitalo willo availo treatmento ono cashlesso basiso Theo o COVID-19ohospitaloshallochargeoasoperotheopackageorateso o ofoAyushmanoBharatoschemeoandosubmitobillsoagainstotheo o providedotreatmentotootheoconcernedoCiviloSurgeon,ofromo o whereotheopatientohasobeenoreferred.o C)o Personsohavingopersonalofamilyohealthoinsuranceocovero o mayo availo treatmento aso pero theo termso &o conditionso ofo o theoindividualopolicy."o o o o o o oooo ooooooooo(EmphasisoSupplied)o

9.o o Itohasobeenosubmittedothatoonceotheorespondentsohadonotifiedoao priceocaposubjectotootheototalobedocapacityoasonotifiedothereunder,obeingoao citizeno welfareo measure,o theo Stateo couldo noto haveo oustedo oro deniedo theo partiallyoinsuredopersonsofromotheobenefitoofotheosaidopriceocapoespeciallyo whenotheoorderoAnnexureoP-8odatedo23.03.2020ostipulatedothatotheopersono whoowasopartiallyoinsuredowouldobeosubjectotooaorateothatoshouldonotobeomoreo thano theo proposedo packageo rateo ando moreo soo wheno theo mothero ofo theo petitionero fello ino theo categoryo ofo partiallyo insured.o Theo ordero (Annexureooooooo P-12)oexcludedoallopersonsowhoowereocoveredounderoanyoHealthopolicyofromo availingotheobenefitoofotheoGovernmentoorderowithoutoanyoreasonableobasiso and/oroobjectsooughtotoobeoachievedobyoexcludingosuchopersonsofromotheo benefitoofotheosaidoorderoandoleavingothemoatotheomercyoofotheoconcernedo hospitalsotoochargeotheowayothatotheyomayodetermineoinoconsultationowithotheo concernedooInsuranceoCompanies.oTheoratesoatotheorelevantopointoofotimeo wereo beingo chargedo exorbitantlyo ando thereo couldo beo noo discriminationo amongstopersonsoadmittedoforotreatmentoofoCovid-19oandotheyocouldonotobeo CWP-12624-2021oo o o o o o ooooo o oooo-7-o o madeo too suffero ando too payo ao highero pero dayo costo aso comparedo too othero similarlyoplacedopersonsomerelyobecauseotheyohadogototheiroriskopartlyooro fullyocoveredounderoanoInsuranceopolicy.oSuchodiscriminationonotoonlyotendso toodiscriminateotheopetitionersoasoagainstootherosimilarlyosituatedopersonsobuto alsootheosameoisonotolikelyotooadvanceotheoobjectoofotheoorderoaimedotoocurtailo theo patients/personso sufferingo fromo Covid-19o beingo exploitedo oro over-chargedounderotheogivenocircumstances.o

10.o o AoshortowrittenostatementoonobehalfooforespondentoNo.o3ohado beenofiledowhereinoitowasostatedothatotheoHospitalohasobeenoworkingoinotheo fieldoofoHealthoCareowithotheoobjectoofoensuringohealthocareofacilityoforoalloo andoturnoitointooaoreality.oTheorespondentodoesonotodisputeothatoCovid-19owaso notifiedo aso ao disastero undero Theo Disastero Managemento Act,o 2005o video notificationodatedo14.03.2020.oItoisocontendedothatotheoorderoofo23.03.2020o (AnnexureoP-8)owasosupersededobyotheosubsequentoorderodatedo25.06.2020o (AnnexureoP-12)oandothatotheomotheroofotheopetitioneroofelloinotheoexcludedo categoryoofoopersonsoandoasosuch,otheobillothatohasobeenoraisedocannotobeo faulted.oSinceotheoHospitalowasonotogovernedobyotheopriceocaponotifiedobyotheo saidoorderoviz-a-vizotheomotheroofotheopetitioner,ohence,otheochargesohaveo beenoleviedoasoperotheoapplicableoratesounderotheopolicy.oo

11.o o Itoisofurtheroaverredothatomotheroofotheopetitionerowasoadmittedo tootheoHospitaloono08.05.2021owithosymptomsoofofever,ocoughoandoshortnesso ofobreathoandoanoamountoofoRs.o40,000/-owasodepositedoatotheotimeoofotheo admissionoandoparticularsoofotheoPNB-OrientaloMediclaimoPolicy,o2017owereo alsoofurnished.oAfteroinitialoassessmentoandostabilization,osheowasoshiftedotoo Covido isolationo foro furthero management.o Hero labo investigationso wereo CWP-12624-2021oo o o o o o ooooo o oooo-8-o o conductedoono10.05.2021,otheoconditionoofotheopatientohoweverodeterioratedo andosheowasoshiftedotooCovidoICUoandoputoonoOxygenosupportoofo10oliters.o Ono12.05.2021,otheosaturationoofotheopatientowaso79%oonohighoflowomasko whereuponosheowasoputoonoBiPAPosupport.oAntibioticsowereoupgradedoino viewoofosepsiso(TLC-18370)otooInj.oMeropenemo&oInj.oTargocid,ohowever,o heroconditionodeterioratedodespiteotheobestoeffortsobyotheodoctorsoandotheo staff.o Theo guardedo prognosiso waso discussedo witho theo familyo ato regularo intervalsoandoheroantibioticsowereoupgradedoono15.05.2021.oo

12.o o Theo cardiaco consultationo waso alsoo doneo ono 18.05.2021.o Ono

20.05.2021,o hero shocko andohypoxiaobecameo refractoryo ando theo sameo waso explainedotootheoattendants.oAnointubationoandomechanicaloventilatorosupporto wasosuggestedobutotheosameowasonotoconsentedobyotheoattendants.oTheopatiento developedoBradycardiaoHypotensiono(lowobloodopressureodueotoolowohearto rate).oDepsiteoCPRoandoACLSoprotocolsosheocouldonotobeorevivedoandowaso declaredo deado ono 20.05.2021.o Theo billo quao theo treatmento ando itemizedo medicationotootheotuneoofoRs.o6,43,024/-owasohandedooverotootheopetitionero ando theo differentialo amounto waso depositedo byo him.o Theo amounto ofo Rs.5,58,035/-o waso disbursedo byo theo Insuranceo companyo directlyo too theo Hospitalo whereupono refundo waso given.o Ito iso averredo thato theo patiento waso treatedowithodueodiligence,oprudence,outmostocare,ocautionoandowithoutoanyo negligenceoorodeficiencyoinoservice.oTheoprayerowasothusomadeothatotheowrito petitionomayobeodismissedoasothereowasonooillegalityoinotheoactionoofotheo HospitaloandothatotheochargesowereobeingoleviedoasoperotheoapplicableoStateo CWP-12624-2021oo o o o o o ooooo o oooo-9-o o

13.o o oAoseparateoreplyohadoalsoobeenofiledoonobehalfooforespondentso No.1o &o 2o througho Directoro Healtho Services,o Haryanao whereino whileo admittingo allo othero factualo aspectso noticedo above,o theo stando ofo theo respondentsoisoasounder:o "4.oThatotheoGovernmentoofoHaryanaomadeoalloeffortsotoomakeo healthcareoaccessibleotoogeneralopublicobyoprovidingofreeotestingo ando treatmento ino Governmento Hospitalso acrosso theo State.o However,otheodisparityoinotheochargesoacrossovariousoprivateo hospitalso waso hamperingo egalitariano ando equalo accesso foro inpatiento hospitalo care.o Therefore,o ito waso observedo byo theo Governmentothatothereoisoanoimmediateoneedoofostandardizationo ofo rateso foro variouso facilitieso ino privateo hospitals/medicalo collegesoforotreatmentoofoCOVID-19.o

5.oThatoitoisoagainorespectfullyosubmittedothatotheoGovernmentoofo Haryanao ino Departmento ofo Healtho aftero goingo througho theo recommendationso ofo theo committeeo constitutedo byo theo GovernmentoofoIndiaoinotheoDepartmentoofoHealthoandoFamilyo welfareounderotheoChairmanshipoofoDr.oV.K.oPaul,o(Member,o NITIoAayog),oandobyotakingointooaccountotheofinancialoviabilityo ofotheoprivateohospitalsoandobyostudyingotheoprecedentsoinoothero StatesolikeoDelhi,oTamiloNadu,oMaharashtraoandoTelangana,oino exerciseo ofo theo powerso conferredo undero Sectiono 2o ofo theo EpidemicoDiseasesoAct,o1897;omadeoprovisionsothatonooprivateo hospital/medicalocollegeoinotheoStateoofoHaryanaoshallochargeo anyoamountoinoexcessoofothoseoasoprescribedoinotheotableobelow,o forotheotreatmentoofoanyoCOVID-19opatient:-o

1.o Hospitaloratesoperopatientoperodayoofoadmissiono(inoRs.)o Typeo ofo Moderateo Severeo Veryo Severeo Hospitalo Sicknesso Sicknesso Sicknesso o CWP-12624-2021oo o o o o o ooooo o oooo-10-o o bedso Ventilatoro Ventilatoro careo (includingo careo (Non-supportiveo invasive/invasive)o careo ando oxygeno Non-NABHo 8000/-o 13000/-o 15000/-o accreditedo Hospitalo JCI/NABHo 10000/-o 15000/-o 18000/-o accreditedo (includingo Entryo levelo NABH)o Hospitalsoo o a)oTheoprescribedoratesoshallobeoalloinclusiveoasoaopackage.oTheo ratesowilloinclude,obutobeonotolimitedoto,ochargesosuchoas,oallolabo investigations,o charges,o drugs,o consumableso includingo PPE/o masks/o gloves/o etc.o Doctor'so visit/o consultation,o radiologicalo diagnostics,o monitoringo Nursingo care,o physiotherapy,o proceduralo chargeso (sucho aso intubation,o intra-arterial/o necko line,ocatheterizationoofo allotypeso chestotube,osplintage,o cardioo version,oHaemodialysisoorobedsideodialysis,oechocardiography,o etc.),otransfusionoofoBloodo&oitsocomponentsoincludingoBloodo groupingo &o Crosso match,o deployingo ofo equipmento (sucho aso alphao bed,o infusiono pump,o multi-parao monitors,o intermittento pneumatico compressiono (IPC)o devices,o nebulisers,o etc.),o diet,o etc.,oasoperotheoNationaloGuidelinesoforomanagementoofoCOVID-

19.oHowever,othisowillonotoincludeotheoexperimentalotherapieso (e.g.oRemdesivir,oTocilizumab,oetc.).o CWP-12624-2021oo o o o o o ooooo o oooo-11-o o b)oTheoratesowilloincludeotheocostsoofomedicalocareoofounderlyingo co-morbido conditionso includingo supportiveo careo ando costo ofo medicationso thereof,o foro theo durationo ofo careo foro COVID-19o patientso haveo conditionso sucho aso hypertension,o diabetes,o cardiovascularoproblemsoetc.otheochargesoforomedicalocareoofo suchoco-omorbiditiesowillobeoaopartoofotheopackage.o c)oTheseoratesoshalloapplyotoopaediatricopatientsoasowell.o d)oForopregnantowomen,ocostsoofodeliveryo(normal/C-section)o andocareoofonewobornoareonotoincludedoinotheopackageoandomayo beochargedobyotheohospitaloextraoasoperoprevailingoPMJAYorateso oforelevantopackages.o e)oTheoratesowillonotoincludeotheocostoofoCOVID-19odiagnostico testo(s)oasowelloasoIL-6olevels.o f)oTheohospitaloshalloprovideoseamlessoandohassleofreeoserviceso too theo patientso sufferingo fromo COVID-19,o shallo extendo allo normalo courtesieso ando facilitateo admission/o treatment/o counsellingooforelatives/odischargeoetc.otoopatientsowithoutoanyo delayoorodenialoofomedicalofacilities.o g)o Theo hospitalo shallo noto ino anyo caseo compromiseo ono theo standardsoofotreatmentoofotheopatientsowithoCOVID-19.oo

2.oTheseoordersoareonotoapplicableoforotheofollowingocategories:-o a)oTheobeneficiariesoofoPMJAYoAyushmanoBharato(AB)oschemeo willoavailotreatmentoonocashlessobasis,oasoperotheoexistingoABo schemeoatoeveryohospital,oempanelledounderotheoABoscheme.o CWP-12624-2021oo o o o o o ooooo o oooo-12-o o b)o Theopatients,o whoo areo noto Ayushmano Bharato beneficiarieso andoareoreferredobyoconcernedoCiviloSurgeonotoonotifiedoCOVIDo hospitalowilloavailotreatmentoonocashlessobasis.oTheoCOVID-19o hospitalo shallo chargeo aso pero theo packageo rateo ofo Ayushmano Bharatoschemeoandosubmitobillsoagainstotheoprovidedotreatmento too theo concernedo Civilo Surgeon,o fromo whereo theo patiento haso beenoreferred.o c)oPersonsohavingopersonal/familyohealthoinsuranceocoveromayo availotreatmentoasoperotheotermso&oconditionsoofotheoindividualo policy.o d)oItoisoclarifiedothatoalloCOVIDobedsoshallobeoatofixedopackageo rateso subjecto too ano uppero limito ofo 60o pero cento ofo theo totalo hospitalobedocapacity.oo

6.o Thato witho regardo too exclusiono ofo personso havingo theiro individualoorofamilyohealthoinsurance,oitoisosubmittedothatotheo sameowasodecidedoonotheopretextothatoallotheoHealthoInsuranceo Policiesohaveotheiroownotermsoandoconditionsoprescribedoando agreedo too byo theo insurero ando beneficiary;o aso pero guidelineso issuedoandoamendedofromotimeotootimeobyoInsuranceoRegulatoryo &oDevelopmentoAuthorityoofoIndiao(IRDA).o

7.o Thato IRDAo iso ano independento authorityo undero theo Uniono Government,o whicho regulateso variouso insuranceo policieso ando executionsothereof,oconsideringoallotheoprosoandocons,otermsoando conditionsoofosucho insuranceo policies.o Anyointrusionobyo Stateo CWP-12624-2021oo o o o o o ooooo o oooo-13-o o Governmento intoo theo domaino ofo sucho authorityo mayo haveo initiatedo involvingo policyholders,o insuranceo companieso ando IRDAo variouso disputes/litigationso involvingo theo stakeholderso suchoasopolicyoholders,oinsuranceocompaniesoandoIRDAoetc.oo

8.o Thato theo reasono behindo exclusiono ofo beneficiarieso ofo AyushmanoBharatoSchemeoforotheoordersodatedo25.06.2020,owaso thatotheoAyushmanoBharatoSchemeoofoGovernmentoofoIndiaohaso alreadyobeenoimplementedoandobeingorunosuccessfullyoinovariouso StatesoofoIndiaoincludingoHaryana.o

9.o Thatothiso mechanismo wasodevisedotoofacilitateotheo COVIDo patients,oinoviewoofolargeonumberoofopatientsoandotoomakeotheo GovernmentoHealthoFacilitiesomoreoefficient.oHence,otheoofficeo ofoansweringorespondentodidonotohaveoanyobiasedointentionsotoo excludeotheoholdersoofopersonal/familyohealthoinsuranceopolicieso ando beneficiarieso ofo theo Ayushmano Bharato Scheme;o ando theo ordersodatedo25.06.2020owereoissuedoinolargeropublicointerest.oo

10.oThatomoreoverotheorespondentoNo.3owasodirectedotoosubmito theostatusoreportoinoviewoofotheoprovisionomentionedoinosub-parao coofoClauseo2oofotheoguidelinesowhichospeaksothus:-oo "ItoisoclarifiedothatoalloCOVIDobedsoshallobeoatofixedo packageoratesosubjectotooanoupperolimitoofo60opero centoofotheototalohospitalobedocapacity."o CWP-12624-2021oo o o o o o ooooo o oooo-14-o o Theodetailedoreportoreceivedofromotheoconcernedohospitaloi.e.o respondentoNo.3oisoannexedoherewithoasoAnnexureoR-1oforokindo perusaloofothisoHon'bleoCourt.o

11.oThatoprovisionoofoAnnexureoR-1oclearlyogoesotooshowo thatooccupancyoofotheorespondentoNo.2owaso70%oonotheo dateoonowhichotheomotheroofotheopetitionerowasoadmitted.o Moreover,o theo patiento waso admittedo ino theo hospitalo withouto havingo beeno referredo byo theo concernedo Civilo Surgeono ando witho theo declarationo ofo havingo ao healtho insuranceocover.oMeaningothereby,othereocannotobeosaido toobeoanyonon-complianceoofotheoprovisionsoofotheoordero datedo25.06.2020oonotheopartooforespondentoNo.3."o ArgumentsobyotheoPetitionero o

14.o o Learnedo counselo appearingo ono behalfo ofo theo petitionero haso arguedothatotheorespondentsohadonotifiedotheopolicyoforotheoWelfareoofotheo citizensoandotoocapotheopricesowhichohospitalsocouldochargeoforotreatmentoofo Covid-19oduringotheopandemicoareoasonotifiedobyotheoGovernmentoofoIndia,o thereowasonooreasonowhyotheobenefitoofosuchocappingooughtonotobeoextendedo tooallootherosimilarlyoplacedopersons.oHeocontendsothatotheorespondentsohaveo statedo ino theiro shorto reply,o thato theo ordero foro standardizationo ando rationalizationoofotheoratesoohadobeenopassedosooasotooremoveotheodisparityoino theochargesoacrossovariousoprivateohospitalsoandotooprovideoequaloaccessoforo inopatientohospitalocare.oItoisoalsoopointedooutothatoaoCommitteeohadobeeno constitutedobyotheoGovernmentoofoIndiaooinotheoDepartmentoofoHealtho&o FamilyoWelfareounderotheoChairmanshipoofooDr.oV.K.oPaulo(MemberoNitio CWP-12624-2021oo o o o o o ooooo o oooo-15-o o Ayog)oandotheosaidoCommitteeotookointooaccountoandoallotheocircumstanceso includingotheo financialoviabilityo ando allo actualopluso ancillaryo costsoofo theo privateohospitalsoandobyostudyingotheoprecedentsoinootheroStatesolikeoDelhi,o Tamilo Nadu,o Maharashtra,o Telanganao etc.o ando thereaftero determinedo theo pricesotoobeocharged.oSuchopricesowereobasedoonoconsultationowithoallotheo stakeholdersoandoafterotakingoallofactorsointooconsideration.oThereafter,othereo wasonooreasonowhyotheopetitionersooughtotoohaveobeenoexcludedoandowereonoto beokeptoatoparowithootheropatientsowhoowereocoveredoorowereobeneficiariesoofo theoPMJAY-AyushmanoBharatoschemeoand/orothoseowhoowereoreferredotootheo HospitalobyotheoconcernedooCiviloSurgeonotoobeotreatedoonocashlessobasiso especiallyowhenotheoratesounderotheoPMJAY-AyushmanoBharatoschemeoaso alsootheopatientsoreferredobyotheoconcernedoCiviloSurgeonowasolesserothanotheo rateso aso notifiedo undero theo aboveo saido order.o Hence,o outo ofo theo totalo 03o excludedocategories,oratesoquaocategoryoAo&oBowereoalreadyolowerothanotheo ratesonotifiedobyotheoGovernmentovideotheoaboveosaidoorderowhereoasotheo ratesothatowereoapplicableotootheocategoryoofopersonounderocategoryo'C'owereo higherothanotheoratesonotified.oHeocontendsothatotheoaforesaidocategoryohaso beeno seeminglyo exemptedo ono theo premiseo thato thereo iso ao contractualo agreementobetweenotheoInsuranceocompanyoasowelloasotheoinsuredoandotheo hospitaloquaotheoloweroratesoandothatoanyohigherorateoisolikelyotoocomeoino conflictowithotheotermsoandoconditionsoofotheoInsuranceopolicyoandogiveoriseo too litigation,o whereaso theo chargeso wereo actuallyo higher.o Hence,o onlyo theo insuredopersonogetoaorawodeed.ooCounseloforotheopetitionerocontendsothatotheo reasonoforoexcludingotheoaforesaidocategoryofromotheobeneficialoprovisionoofo theoaboveoorderoisoomisconceived.oItoisowellosettledothatoinotheoeventoofoanyo conflict/contradictionoinoaocontractualoclauseoviz-a-vizoanoorderoissuedoanoVISHAL SHARMA CWP-12624-2021oo o o o o o ooooo o oooo-16-o o exerciseoofotheostatutoryopower,otheoprovisionoofotheostatuteohasotoooverrideo theocontractualoclauseoandoallocontractualoarrangementsohaveotoobeoreadoando interpretedoinotermsoofotheostatutoryoprovisions.oFurther,owhenotheoobjectoofo theoorderowasotooimposeoaocapoonotheoratesothatomayobeochargedoforotheo admittedoindoorohospitalization,othereowasonooreasonowhyotheopetitionerooro anyootheropersonowhoohasopartiallyoinsuredooughtotoobeoextendedotheobenefito andoshouldobeodeniedotheosaidoconcessionsobyotheoStateotooaddotootheiromiseryo andosenseoofoloss.oo ArgumentsobyotheoRespondentsoo

15.o o Perocontra,ocounseloforotheorespondentsocontendothatotheopersonso whoohadobeenoexcludedofromotheoaboveosaidocategoryowereoaoclassothatocouldo affordohospitalizationoexpensesounderotheopolicyoandotheopublicoexchequero oughtonototoohaveobeenoburdenedowithosuchoadditionalocosts.oTheyofurthero contendso thato sinceo thereo iso ao contractualo arrangemento ando agreemento betweenotheopartiesoandotheoInsuranceocompanyowasorequiredotoopayoforotheo expensesothatowereoincurred,ohence,oinoorderotoosustainotheofinancialohealtho ando viabilityo ofo theo hospitals,o theo persono whoo wereo insuredo wereo thuso consciouslyo excludedo fromo theo purviewo ofo theo aforesaido ordero ando waso subjectedotootheoagreementoand/orotermsoandoconditionsoofotheopolicy.oItoiso furtherocontendedobyotheocounseloforotheorespondentothatotheopetitionerodido notofalloinotheo60%oofotheohospitalobedocapacityoforotheopurposesoofooavailingo theobenefitounderocategoryo'B'oofotheoaforesaidoorderoandobeingoanoinsuredo person,osheofellounderocategoryo'C'oandowasothusoexcludedofromotheobenefito ofotheoabovesaidoorder.oHeofurtheroarguesothatotheopolicy/ordersoinoquestiono hadobeenoissuedoafterotakingoholisticostockoofotheocircumstancesooinototalityo CWP-12624-2021oo o o o o o ooooo o oooo-17-o o andoalsootheofinancialoconstraintsoofotheoStateoandothatoextensionoofosucho benefitotootheopersonsowhoohaveobeenoexcluded,oisolikelyotoohaveoanoimpacto onotheofinancialocapacityoofotheoStateoandoitsoabilityotoobearotheoincreasedo financialoburden.oo

16.o o AopointedoqueryowasoraisedotootheoStateoCounselotooreferotooanyo materialo ono theo basiso whereofo ito couldobeo determinedo thatosucho financialo assessmento hado beeno doneo ando itso impacto thereofo haso beeno takeno intoo considerationo byo theo Stateo Governmento whileo excludingo theo aforesaido categoryoofopersons.oHowever,onoosuchodetailowasoforthcomingoonotheofileoofo theodepartment,othatohadobeenoshownotootheoStateocounsel.ooCounseloforotheo StateowasoalsooquestionedoasotoowhetherotheorecommendationsoofotheoNitio Ayogo Commmitteeo excludedo theo categoryo ofo insuredo personso oro theo prescribedo rateso wereo universal.o Theo aboveo saido questiono hado beeno specificallyoposedosinceonoosuchoexceptionohadobeenocarvedooutoinotheoordero passedo byo theo Governmento ofo Nationalo Capitalo Territoryo ofo Delhio datedo

20.06.2020owhichohadoadoptedotheoaboveosaidoratesoonotheorecommendationo ofotheoNitioAyogoCommittee.oLearnedoStateocounselocouldonotoreferotooanyo recommendationoofotheoNitioAyogowhichoexcludedotheopersonsocoveredobyo theoInsuranceoPolicy.oFurther,oaospecificoquestionowasoalsooaskedoasotoowhyo theoearlierocategoryoofopartiallyoinsuredo(whichowasooriginallyocoveredoundero theopackageorates)ohadobeenoexcluded,ohowever,ooheocouldonotoreferotooanyo objectiveomaterialothatowasoavailableowithotheoStateoGovernmentooforodenyingo theobenefitotootheopartiallyoinsuredopatients.oAoqueryowasoalsooraisedoasotoo whetherotheoratesoapplicableotootheoPMJAY-oAyushmanoBharatoschemeowereo lowero thano theo rateso applicableo aso pero theo insuranceo policyo oro not,o heooooooooooo CWP-12624-2021oo o o o o o ooooo o oooo-18-o o fairlyo concededo ono instructionso fromo theo officialo presento fromo theo Departmento thato theo rateso applicableo too theo personso undero theo PMJAYo AyushmanoBharatoschemeowereolowerothanotheopackageorates.ooo

17.o o LearnedoseniorocounselorepresentingotheoHospitalohasoreiteratedo theo argumentso raisedo byo theo Stateo Counselo ando haso emphasizedo thato theo HospitalohasoraisedotheobillsoasoperotheoapplicableoorderopassedobyotheoStateo Government.oTheodeceasedosufferedofromovariousoco-morbiditiesoandowaso partiallyoinsuredounderotheomedioclaimopolicy.oHeofurtherosubmitsothatotheo hospitalo havingo alreadyo beeno disbursedo theo claimso undero theo respectiveo insuranceopolicyoshouldonotonowobeenocalledouponotooreduceoitsobillsowhicho hasoalreadyobeenocleared.oMoreosoowhenotheoactoofotheoHospitalocannotobeo statedotoobeoinoviolationoofoanyoapplicableolaws.oHe,ohowever,ocouldonoto disputeotheofactothatomotheroofotheopetitionerowasoadmittedoforotheoCOVID-19o andopassedoawayoasoaoresultothereof.oItowasoalsoonotodisputedothatoallootheroco-morbiditiesowereodulyocoveredounderotheosaidoorderoandohadotoobeomanagedo inotheosaidopriceocapoitself.oTheoquestionsoposedotootheoStateoCounselowereo alsooputotootheocounseloforotheorespondentoNo.3oandoheocouldonotoreferotooanyo materialoonorecordotootheocontrary.oo

18.o o Iohaveoheardotheolearnedocounseloappearingoforotheorespectiveo partieso ando haveo goneo througho theo documentso appendedo alongwitho theo presentopetitionowithotheiroableoassistance.oo

19.o o Evenothough,oitoisonotodisputedothatoinotheomattersopertainingotoo policyoand/oroadministrativeodecisionsoofotheoStateoGovernment,otheoscopeoofo judicialoreviewoisolimitedoandorestricted,ohowever,owhereotheofoundationoofo sucho decisiono ando theo decisiono makingo processo sufferso fromo impropero CWP-12624-2021oo o o o o o ooooo o oooo-19-o o considerationsoand/oroaoconsiderationowhichoisoinvalidoinolaw,otheopoweroofo judicialoreviewoshallobeoavailableoandotheoConstitutionaloCourtoshallohaveotheo authorityotooexamineotheolegalityoofosuchoanoaction.oo

20.o o Theo Hon'bleo Apexo Courto haso alsoo heldo soo ino theo mattero ofo "AmarendraoKumaroPandeyoversusoUnionoofoIndiaoandoothers"oreportedoaso 2022oSCCoOnLineoSCo881,otheorelevantoextractothereofoisoasounder:o o "30.o Theo actiono basedo ono theo subjectiveo opiniono oro satisfaction,oinoouroopinion,ocan,oaudiciallyobeoreviewedofirstotoo findooutotheoexistenceoofotheofactsoorocircumstancesoonotheobasiso ofowhichotheoauthorityoisoallegedotoohaveoformedotheoopinion.oIto iso trueo thato ordinarilyo theo courto shouldo noto Inquireo intoo theo correctnesso oro otherwiseo ofo theo factso foundo excepto ino ao caseo whereoitoisoallegedothatotheofactsowhichohaveobeenofoundoexistingo wereonotosupportedobyoanyoevidenceoatoalloorothatotheofindingoino regardo too circumstanceso oro materialo iso soo perverseo thato noo reasonableo mano wouldo sayo thato theo factso ando circumstanceso exist.oTheocourtsowillonotoreadilyodeferotootheoconclusivenessoofo theoauthority'soopinionoasotootheoexistenceoofomatteroofolawooro facto upono whicho theo validityo ofo theo exerciseo ofo theo powero iso predicated.o

31.oTheodoctrineooforeasonablenessothusomayobeoinvoked.oWhereo thereo areo noo reasonableo groundso foro theo formationo ofo theo authority'so opinion,o judicialo reviewo ino sucho ao caseo iso permissible.o [Seeo Directoro ofo Publico Prosecutionso v.o Head,o [1959]oA.C.o83o(LordoDenning).o

32.oWhenoweosayothatowhereotheocircumstancesooromaterialooro stateoofoaffairsodoesonotoatoalloexistotooformoanoopinionoandotheo actionobasedoonosuchoopinionocanobeoquashedobyotheocourts,oweo meanothatoinoeffectothereoisonooevidenceowhatsoeverotooformooro supporto theo opinion.o Theo distinctiono betweeno insufficiencyo oro inadequacyo ofo evidenceo ando noo evidenceo musto ofo courseo beoVISHAL SHARMA CWP-12624-2021oo o o o o o ooooo o oooo-20-o o borneoinomind.oAofindingobasedoononooevidenceoasoopposedotooao findingowhichoisomerelyoagainstotheoweightoofotheoevidenceoisoano abuseoofotheopowerowhichocourtsonaturallyoareoloathotootolerate.o Whethero oro noto thereo iso evidenceo too supporto ao particularo decisionohasoalwaysobeenoconsideredoasoaoquestionoofolaw.o[Seeo Reg.ov.oGovernoroofoBrixtonoPrison,oArmah,oExoParte,o[1966]o3o WLRo828oatop.o8411."o o o o o

21.o o Theobasisowhichoisoclaimedotoolayotheofoundationoforoaodecisiono shouldo beo reflectedo fromo theo proceedingso thato hado transpiredo oro contemporaneousoevidenceoinotheoabsenceooforeferenceotooanyosuchomaterialo ofoplacingotheosameoonorecordotooestablishoitsoobjectiveoconsideration,osuchoao pleaoisonothingomoreothanoanoafterothoughtoandoanoeye-wash.oItoisoevidentothato theodeterminationoofochargeobyotheorespectiveoStateoGovernmentsowasodoneo byoadoptingotheorecommendationsoofotheoCommitteeocomprisingoofoDr.oV.K.o Paul,oaomemberoofotheoNitioAyog.oTheoStateocouldohaveoeasilyojustifiedoitso decisiono too bringo theo insuredo personso undero theo excludedo categoryo byo referringotootheorecommendationsomadeobyotheoDr.oV.K.oPauloCommitteeo(ifo suchoanoexclusionoexistedoinoitsorecommendations).oSinceotheosameohasonoto beenodoneoeitherobyotheoStateoorobyotheoprivateorespondent,othisoCourtohasonoo optionobutotooinferothatothereowasonoosuchoexclusionoinotheorecommendationo madeo byo theo Committeeo ofo Nitio Ayog.o Undero sucho ao circumstanceo ando especiallyo wheno theo Stateo Governmento hado seeminglyo acceptedo theo recommendationsoofotheoDr.oV.K.oPauloCommittee,oitoshouldohaveoreferredotoo theodeliberationothatotranspiredoforoexcludingotheoinsuredopolicyoholdersofromo theo benefito ofo priceo fixation.o Needlesso too mentiono thato theo Courto iso noto requiredotoogoointoosufficiencyoofocause,ohowever,oexistenceoofoaocauseoando considerationoatotheotimeoofodecisionomakingooughtotoohaveobeenoreferredoto.o CWP-12624-2021oo o o o o o ooooo o oooo-21-o o Theoexplanationoputoforthoatotheotimeoofoargumentsoasowelloasoinotheoreplyo seeminglyo iso noto supportedo ino theo notingso fileso ofo theo Department.o Theo materialothatoweighedowithotheoStateoGovernmentoatotheotimeoofoitsodecisiono makingoisowhatowasorelevantoandonototheoexplanationothatoisobeingoputofortho inotheoproceedingoinstitutedobeforeoaoCourt.oHence,oIoamoofotheoopinionothato theodecisionotakenobyotheorespondentoStateoGovernmentotoodenyotheobenefito ofo priceo fixationo too ao categoryo ofo COVIDo patientso cannoto beo saido too beo beyondotheopowersoofojudicialoreviewovestoinoaoHighoCourtounderoArticleo226o ofotheoConstitutionoofoIndia.oo

22.o o Havingoheldoso,oitoisonowodeemedonecessaryotooperuseotheoorderso datedo 23.03.2020o (Annexureo P-8)o aso wello aso theo ordero datedo 25.06.2020oo (AnnexureoP-12).oo

23.o o Ao perusalo ofo theo orderso datedo 23.03.2020o (Annexureo P-8)o aso wello aso25.06.2020o (Annexureo P-12)oshowso ao mischievouso changeo inotheo exclusionso thato wereo originallyo stipulated.o Whileo theo initialo ordero datedo

23.03.2020ooextendedotheobenefitoofotheopackageoratesotootheopartiallyoinsuredo persons,ohowever,otheoentireocategoryoofoinsuredo(partialoorofullyoinsured)o wereoexcludedofromotheobeneficiariesoinotheosubsequentoorder.oo

24.o o Ito haso alsoo beeno noticedo thato theo cappingo ofo rateso hado beeno issuedoinoexerciseoofotheopowersounderoSectiono2oofotheoEpidemicoDiseaseo Act,o1897.oTheorelevantoprovisionoreadsothus:o o 2.o Powero too takeo specialo measureso ando prescribeo regulationso aso too dangerouso epidemico disease.—(1)o Wheno ato anyotimeotheo[StateoGovernment]oisosatisfiedothato[theoState]ooro anyopartothereofoisovisitedoby,oorothreatenedowith,oanooutbreakoofo anyo dangerouso epidemico disease,o theo [Stateo Government],o ifoo CWP-12624-2021oo o o o o o ooooo o oooo-22-o o [it]othinksothatotheoordinaryoprovisionsoofotheolawoforotheotimeo beingo ino forceo areo insufficiento foro theo purpose,o mayo take,o oro requireooroempoweroanyopersonotootake,osuchomeasuresoand,obyo publico notice,o prescribeo sucho temporaryo regulationso too beo observedobyotheopublicoorobyoanyopersonooroclassoofopersonsoasoo [it]o shallo deemo necessaryo too prevento theo outbreako ofo sucho diseaseo oro theo spreado thereof,o ando mayo determineo ino whato mannero ando byo whomo anyo expenseso incurredo (includingo compensationoifoany)oshallobeodefrayed.o

(2)oInoparticularoandowithoutoprejudiceotootheogeneralityoofotheo foregoingoprovisions,otheoStateoGovernmentomayotakeomeasureso andoprescribeoregulationsofor-o Xxxo xxxxo xxxxo xxxxo xxxxo xxxxo xxxxo xxxxo xxxxo xxxxo o o o o o o o o ooooo(Emphasisosupplied)o oo

25.o o Ao perusalo ofo theo aforesaido Sectiono clearlyo showso thato theo Governmento iso empoweredo too passo sucho orderso ando takeo sucho measureso includingo theo mannero ando byo whomo anyo expenseso incurred,o includingo compensationo ifo anyo iso requiredo too beo defrayed.o Theo contentiono ofo theo respondentothatotheopricesohadotoobeocappedotooavoidoanyofurtherofinancialo burdeno ono theo Stateo iso noto onlyo ao masqueradeo buto ao ruseo thato haso beeno created.oTheocappingoofotheopriceoatotheonotifiedorateoquaotheoinsuredopersono wouldonotohaveoaddedoanyofinancialoburdenoonotheoState.oTheosaidopaymento hado too beo madeo byo theo Insuranceo companyo ando thereforeo noo financialo implicationoofosuchocappingowouldohaveoflownoonotootheoStateoGovernmento andowouldohaveoonlyobenefittedotheoinsuredoasotheyowouldohaveotoopayotheo lesserocostoforoavailingotheosameofacilities.oTheoargumentoitselfoshowsoano eitheronon-applicationoofomindobyotheoconcernedopersonsoandotheyoseemedotoo beorulingounderoimpressionoratherothanoobjectivityoandoinotheirozealotooextendo CWP-12624-2021oo o o o o o ooooo o oooo-23-o o opportunityooforevenueomaximizationotootheohospitalsoinsteadoofoensuringothato theoprotectionoofotheostatueoisoextendedotooall,otheoStateoGovernmentooptedotoo compromiseotheostatuteoandotoogiveoprecedenceotooaocontractualoarrangemento quaotheoratesoresultingoinocreationoofodifferentoclasses.ooTheopersonsowhoohado someocoverounderotheoInsuranceowereodeniedotheoconcessionsothatowereobeingo extendedotooallootherocitizens.oo

26.o o TheoHon'bleoSupremeoCourtohasoheldoinotheomatteroofo"Manisho KumaroversusoUnionoofoIndiaoandoothers"oreportedoaso(2021)o5oSCCo1,oaso under:o o "Itoisowellosettledothatoaolegislatureowhichohasotoo dealo witho diverseo problemso arisingo outo ofo ano infiniteo varietyoofohumanorelationsomust,oofonecessity,ohaveotheo poweroofomakingospecialolawsotooattainoparticularoobjects;o ando foro thato purposeo ito musto haveo largeo powerso ofo selectiono oro classificationo ofo personso ando thingso upono whichosucholawsoareotoooperate.oMereodifferentiationooro inequalityo ofo treatmento doeso noto "pero se"o amounto too discriminationo withino theo inhibitiono ofo theo equalo protectionoclause.oTooattractotheooperationoofotheoclauseoito isonecessaryotooshowothatotheoselectionoorodifferentiationo isounreasonablyoarbitrary;othatoitodoesonotorestoonoanyo rationalo basiso havingo regardo too theo objectso whicho theo legislatureohasoinoview.oThereoisoalwaysoaopresumptionoino favouroofotheoconstitutionalityoofoanoenactmentoandotheo burdenoisouponohimowhooattacksoitotooshowothatothereohaso beeno ao clearo transgressiono ofo theo constitutionalo principles.oo o Aoreasonableoclassificationoisooneowhichoincludeso allowhooareosimilarlyosituatedoandononeowhooareonot.oTheo questiono theno is:o whato doeso theo phraseo "similarlyo CWP-12624-2021oo o o o o o ooooo o oooo-24-o o situated"omean?oTheoanswerotootheoquestionoisothatoweo mustolookobeyondotheoclassificationotootheopurposeoofotheo law.oAoreasonableoclassificationoisooneowhichoincludesoallo personso whoo areo similarlyo situatedo witho respecto too theo purposeoofotheolaw.oTheopurposeoofoaolawomayobeoeithero theoeliminationoofoaopublicomischiefoorotheoachievementoofo someopositiveopublicogood.oo o Theo classificationo musto beo foundedo ono someo reasonableogroundowhichodistinguishesopersonsowhooareo groupedotogetheroandotheogroundoofodistinctionomustohaveo rationalorelationotootheoobjectosoughtotoobeoachievedobyo theoruleooroevenotheorulesoinoquestion.oItoisoaomistakeotoo assumeoaoprioriothatothereocanobeonooclassificationowithino aoclass.oTheoprinciplesowhichogovernotheolegitimacyoofoao sub-classowithinoaoclass,oareobasedoessentiallyoonotheoveryo principlesowhichoareodiscernibleoinoregardotooreasonableo classificationounderoArticleo14oofotheoConstitution.oItoiso clearo thato theo lawo doeso noto interdicto theo creationo ofo ao classowithinoaoclassoabsolutely.oShouldothereobeoaorationalo basisoforocreatingoaosub-classowithinoaoclass,othen,oitoisonoto impermissible.oAoclassowithinoaosub-class,oisoindeedonoto antitheticalotootheoguaranteeoofoequalityounderoArticleo14o ofotheoConstitution."o o o o o o ooooooooo(EmphasisoSupplied)o

27.o o Thus,o whileo classificationo iso permissibleo ino law,o theo testo prescribedoisoreasonableoclassificationoandointelligibleodifferentia.oTheoigniteo factorsoforosuchoreasonablenessoandointelligibleodifferentiaoisotheopurposeooro objectoofotheoStatue/theoStateoaction.oTheoperusaloofotheoordersopassedobyotheo Stateoshowothatotheoobjectobehindoregulatingotheopriceowasotoodispenseowitho theo disparityo ino theo chargeso acrosso variouso privateo hospitalso whicho waso hamperingo egalitariano ando equalo accesso foro impatiento hospitalo care.o TheoVISHAL SHARMA CWP-12624-2021oo o o o o o ooooo o oooo-25-o o intentoofotheoStateoGovernmentowasotoomakeoalloeffortsotooensureothatohealtho careoisoaccessibleotoogeneralopublic,ohence,otheoratesoforovariousofacilitiesoino theoprivateohospitals/medicalocollegesoneededotoobeostandardized.oItoisothuso evidentothatotheoobjectoofotheoorderowasotooensureothatotheohospitalsodoonoto treatotheomiseriesoofotheocommonomanoasoanoopportunityoofoaolifeotimeoando resorto too takingo poundso ofo flesho fromo theo deado ando suffering.o Theo priceo fixationowasonotoaimedotooprovideoforobetterofiscalohealthoofotheohospitalso rather,o theo sameo waso occasionedo aso ao resulto ofo higho handednesso ando arbitrarinessoofotheohospitalsoinoclaimingoratesoandochargesoasoperotheirowill.o Thereoisonoomaterialoavailableoquaotheoreasonsothatoledotoointroductionoofoanyo suchoclassooroevenoasotoowhetherotheoCommitteeoconstitutedobyotheoNitioAyogo wasoseizedoofotheosaidoaspectsooronot.oHence,otheoexplanationoputoforthoforo creationoofoaoclassocannotobeosaidotoobeorationaloororeasonableoasoitoisonotoino furtheranceoofotheoobjectobehindotheoorder.oTootheocontrary,oitodiscriminateso betweenotwooidenticalosetsoofopersonsowhoowereobeingotreatedoatotheosameo timeoforotheosameodiseaseoandounderosameofacilities.o

28.o o AsoaosocialowelfareosovereignoState,otheoobjectoofotheoStateooughto toohaveobeenotooextendotheobenefitsoofoitsoorderoandoschemesotooallopersonso similarlyosituatedowithoutoanyodiscrimination.ooInotheopresentocircumstanceso whenosuchobenefitoofocappingowasobeingoextendedotoopersonsowhoowereonoto inoaopositionotoopayotheomoneyoandotheoGovernmentowasoitselfodefrayingotheo expenses,othereowasonoovalidojustificationoasotoowhyotheobenefitooughtonototoo haveobeenoextendedotheopersonsowhoocouldopayotheocappedoprice.oTheostando ofotheoStateoisocontradictoryowhenotheoCommitteeohadoalreadyotakenointoo considerationoallorelevantofactorsoincludingotheocostothatoareotoobeoincurredo CWP-12624-2021oo o o o o o ooooo o oooo-26-o o andomodelsoofovariousoStatesobeforeonotifyingoaocappingoprice,othereowasonoo tangibleo oro objectiveo datao availableo witho theo respondentso too excludeo theo beneficiariesofromotheosaidoscheme.oo

29.o o Apparentlyotheomischiefoinotheoorderoofoexclusionowasorathero perpetuatedoonoaopremiseothatoitowasomoreobeneficialotootheoinsuredotoobeo admitted/chargedoasoperotheotermsoofotheoInsuranceoPolicy.oTheointentoofotheo orderoasoreflectedofromotheoexclusionsoratherosupportsoaoconclusionothatotheo Stateointendedotoocapotheopriceowhereothereowasonoootheromoreobeneficialo priceo packageo available.o Theo exclusiono categoryo ofo PMJAYo schemeo hado lessero packageo price.o Placingo theo insuredo personso ino theo saido categoryo iso propelledobyoaobeliefothatotheoagreedorateobetweenotheoInsuranceoCompanyo ando theo Hospitalo iso lowero thano theo packageo rateo approvedo byo theo Government.o Ito wouldo noto haveo theo intento too bringo twoo differento setso ofo peopleotogetheroasooneoclassowhereooneocategoryowouldoclaimolowerothanotheo packageopriceonotifiedowhileotheootherocategoryowouldobeoleftotoofilloforohaveo ratherohaveobeenobetteroservedoifosuchoclarificationocouldohaveobeenotimelyo issued.oTheopriceocapoasonotifiedobyotheoStateoGovernmentowasonototheoBencho costo oro chargeo too beo recoveredo byo theo hospital,o rather,o theo sameo waso ao maximumocappingothatocouldobeodone.oTheocontractualoclausesoofotheopolicyo governotheomutualoobligationsosoolongoasotheyoareonotoinoconflictowitholawo andohaveotoobeoinocomplianceothereof.oTheoaforesaidoclarificationowouldonoto haveo broughto theo policyo ino conflicto witho lawo ato anyo pointo ofo timeo andooooooooooooo theo ordero ofo theo Governmento ino exerciseo ofo theo statutoryo powersoooooooooooooooooooo wouldo operateo aso fixingo theo aboveo priceo bar.o Ito seemso thato theooooooooooooooo authoritiesoallowedotheounderlineoobjectotoobeofoggedosoothatotheoviewoisooooooooooo CWP-12624-2021oo o o o o o ooooo o oooo-27-o o notoclear.oItoisoshockingotootheoconsciousoofotheoCourt,othatoclausesoofotheo orderohaveobeenopermittedotoobeomisconstruedotootheoprejudicesoofocitizenso whoosufferedotheoblowoofotheoepidemicoandotheoinstitutionaloinsensitivity.oo o

30.o o Learnedocounseloforotheorespondent,ohowever,oatothisostageoalsoo arguedothatotheorespectiveohospitalsohaveoalreadyoreceivedotheobenefitsofromo theo insuranceo companieso ando aso such,o anyo cappingo ofo theo priceo and/oro reductiono ofo theo billso thato hado beeno chargedo wouldo amounto too givingo premiumotootheoinsuranceocompaniesoandotheoinsuredoandothatotheohospitalo shallobeodeprivedoofotheocostothatohadoincurredoinotheotreatment.oo

31.o o TheoaboveosaidocontentionooforespondentoNo.3ofailsotooinspireo thisoCourtotooagreeowithohimoorotoogiveothemopremiumoforotheirowrongs.ooTheo priceohavingoalreadyobeenocappedobyotheoStateoGovernmentobyoanoorder,otheo hospitalso wereo requiredo too beo compliants.o Furthermore,o theyo cannoto beo permittedo too retaino ao benefito undero ao contractualo agreemento wheno sucho contractualoagreementowasoclearlyoinoconflictowithotheoorderopassedounderoao statuteointendedotooextendotheobenefit.oo oo

32.o o Learnedocounseloappearingoonobehalfoofotheopetitionerocontendso thatoinocaseotheocappingoisoheldoapplicable,otheopetitionerowasoliableotoopayo onlyoaocostoofoRs.o2,34,000/-oandoasoagainstotheosame,otheyohadotoomakeoao paymentoofoRs.o6,43,024/-.oHence,oanoexcessoamountoofoRs.o4,79,000/-ohaso beenochargedofromothemowhichoisomoreothano100%oofotheoamountowhichotheyo wereoliableotoopayounderotheoordersoissuedobyotheogovernmentoinoexerciseoofo theopowersounderoSectiono2oofotheoEpidemicoDiseasesoAct,o1897.ooo

33.o o oHeo furthero contendso thato sinceo theo Insuranceo companyo haso refundedotheobillotootheoextentoofoRs.o5,58,035/-oandotheopetitioneropaidoonlyoao CWP-12624-2021oo o o o o o ooooo o oooo-28-o o sumo ofo Rs.o84,989/-o ando aso theo motheroofotheo petitionero passedo away,o ito wouldonotomakeoanyodifferenceotoohimowhetherotheodifferentialoamountoiso refundedo too theo Insuranceo Companyo oro retainedo byo theo Hospital.o Sucho ao matteromayobeoagitatedobyotheoInsuranceoCompaniesoandoheowouldonotopresso ao claimo foro theo Insuranceo Companyo buto wouldo restricto too theo extento ofooooooooooooo Rs.84,989/-o(whichowouldobeoinoexcessoofoRs.o5,58,035/-orefundedobyotheo Insuranceocompanyoandohadobeenopaidobyotheopetitioner).ooLearnedocounselo foro theo petitionero furthero submitso thato heo doeso noto seeko ao refundo ofo thato moneyoforohimselfoandowouldohaveonoooobjectionoinocaseotheoentireoamountoiso donatedotootheo"PooroPatientsoWelfareoFund'oofotheoPostgraduateoInstituteoofo MedicaloEducationoandoResearcho(PGIMER),oChandigarh",.o

34.o o Ordinarily,othisoCourtowasoinitiallyoinclinedotooimposeoheavyoando exemplaryo costo againsto respondent-hospitalo ando alsoo inclinedo too directo enquiryointootheomanneroinowhichotheochangesohadobeenobroughtoinoandotheo ordersomisconstruedoandomisapplied.ooo

35.o o LearnedoStateoCounsel,ohowever,opleadedoforobeingoexemptedo fromolevyoofocost.oCounseloforotheopetitioneroalsooextendedograciousnessobyo notopressingoimpositionoofotheocost.oHence,otheoconcessionoisobeingoextended.oo

36.o o Takingointooconsiderationotheosaidocircumstances,oclaimoofotheo petitioneroisoallowedoandorespondentoNo.3oHospitaloasowelloasorespondentso No.1o&o2-StateoGovernmentoshallobeojointlyoandoseverallyoliableotoorefundo theo aboveo saido amounto ofo Rs.o 84,989/-o thato nowo becomeso dueo too theo petitioner.o Theo aboveo saido amounto shallo beo depositedo witho theo "Pooro Patientso Welfareo Fund'o ofo theo Postgraduateo Instituteo ofo Medicalo EducationoandoResearcho(PGIMER),oChandigarh"owithinoaoperiodoofo04oVISHAL SHARMA CWP-12624-2021oo o o o o o ooooo o oooo-29-o o weeksooforeceiptoofocertifiedocopyoofothisoorder.oInotheoeventoofofailureotoo depositotheosameowithino04oweeksoasoordered,otheosameoshallocarryointeresto@o 6%op.a.ofromotheodateoofoitsodepositotilloitsodisbursement.ooo o o Theowritopetitionoisoaccordinglyodisposedoof.o oo o oo o o o o o (VINODoS.oBHARDWAJ)oo MAYo25,o2023o o o o o o ooJUDGEo VishaloSharmao o o o Whetherospeaking/reasonedo :o Yes/Noo o o o WhetheroReportableo o :o Yes/Noo