Patient denied cancer treatment, DHC seeks ESIC reply

New Delhi: Satya Vati, 67, who is battling breast cancer, has found a glimmer of hope after the Employees’ State Insurance Corporation (ESIC) scheme denied him treatment, with the Delhi High Court stepping in to seek an explanation from the agency.After hearing the appeal, the court on Tuesday issued a notice to ESIC asking why super specialty treatment (SST) was being denied to patients who required urgent chemotherapy and surgery. The case is now scheduled for April 29.The petition stated that Satya Vati’s diagnosis was confirmed after a series of referrals at the ESIC facility. Her nephew Rajesh Rajora told TOI that she first visited the ESIC dispensary in Nand Nagri two months ago after discovering a lump in her right breast. She was referred to Jhilmil Hospital in east Delhi, where doctors recommended a fine-needle aspiration cytology (FNAC) test. Testing is done in the private sector because testing is not available there.After reviewing the FNAC report, doctors referred her to ESIC Medical College and Hospital in Faridabad, where further tests, including biopsy, were done while a PET scan was done in the private sector. The report confirmed that she had stage one breast cancer, and the doctor recommended surgery after chemotherapy. Chemotherapy is scheduled to start on April 15th.However, when she reached the hospital for admission, the treatment was denied on the grounds that the super specialty treatment clause was not activated, allegedly because her son Gaurav was working for a few months in 2025.“We were given a date for chemotherapy and then suddenly we were told she was not eligible. How can a cancer case refuse treatment? The break was only a few months and she was still a beneficiary.” Her nephew Rajesh Rajora told TOI, “We cannot wait for the documents as the disease does not wait. Since the next court date is at the end of April, we have no choice but to rush her to GTB Hospital to start treatment.”Rajora said Gaurav and his family members were ESIC beneficiaries despite the brief period and the denial of treatment in such circumstances was unreasonable.The petition states that the denial of treatment is in violation of ESIC’s Policy 2024, which requires insured persons and their dependents to receive super-specialty treatment from the first day of employment, subject to assessment on a case-by-case basis.Advocate Ashok Agarwal, appearing for the petitioner, told the court that Satya Vati, a dependent of a insured worker, was refused treatment on the ground of “no right” despite clear medical advice.The defense argued that the refusal was “unlawful and arbitrary” and argued that the refusal to provide life-saving care violated the fundamental right to life and health under Articles 14 and 21 of the Constitution. It also cited previous High Court rulings highlighting the state’s obligation to ensure treatment for serious illnesses such as cancer.After receiving no response to a legal notice sent earlier this month, the family took action in the High Court seeking immediate and uninterrupted treatment.The case is expected to test the implementation of ESIC’s super-specialty treatment framework, particularly in high-risk cases involving families.