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Annual Report of the Ombudsman 2003

Chapter 3 - Midland Health Board - Orthodontic Treatment Refused

Midland Health Board

Orthodontic Treatment Refused

A woman complained to me on behalf of her son who had been assessed by the Midland Health Board for orthodontic treatment and placed on a waiting list which was, at the time, approximately three years in duration. This was due to the difficulties which the Board was experiencing in dealing with the volume of orthodontic cases and the shortage of orthodontists within its area. After waiting for two years, the child's mother decided to bring her son to a private dentist and treatment commenced with the extraction of one tooth. The child was subsequently called by the Board but when it was noticed that private treatment had commenced, his name was removed from the waiting list.

I enquired as to why the child had been refused treatment given that he had a statutory entitlement to it under the Health Act, 1970. The Board clarified for me that it was not its policy to intrude on a private contract given that in orthodontic treatment, each step influences the next, and that a treatment plan may vary from one orthodontist to another. Had the Board taken over where the child's private dentist left off, it claimed that it could not have guaranteed the outcome but would have been responsible for the overall treatment nonetheless. I accepted that the clinical considerations would prevent public orthodontists from taking over a course of treatment which they had not approved or commenced.

However, I was concerned that the complainant had not been made aware of the implications of commencing private orthodontic treatment for her son while on the waiting list. People on the orthodontic waiting list should be made fully aware of the implications of deciding to seek any type of private remedial work and the clinical considerations for health boards if they do. It is only by informing parents of the options open to them that they can make reasoned decisions about their children's treatment. In this case, the complainant had not been advised by the Board that if she commenced private treatment for her son, his name would be removed from the Health Board's waiting list.

I asked the Board to review the case in this context. The Board agreed that, as the complainant had not been made aware of the situation regarding the commencement of private treatment, it would alleviate the financial burden on the family of continuing with the private treatment. It decided to award the complainant an ex gratia payment of €1,000 towards the costs involved. I subsequently wrote to all health boards requesting that they put in place a procedure whereby people are fully advised of the clinical ramifications of commencing private remedial orthodontic treatment while awaiting public treatment. This was to ensure that the policy of fully informing parents of the position in relation to orthodontic treatment was applied consistently and uniformly throughout the individual health boards.

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