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Chapter 3 - Unearthing Hidden Solutions

Chapter Three

Unearthing Hidden Solutions

In the course of examining complaints the Office of the Ombudsman can sometimes unearth innovative solutions to complaints which might have not been apparent at the outset. The next three cases are examples of this.

The Department of Health and Children and the Eastern Health Board - Reimbursement Under the Drugs Payment Scheme

A complainant contacted the Office about his entitlement to be reimbursed under the Drugs Payment Scheme for expenditure he had incurred on a drug he required for a very rare skin disease. The manufacture of his prescribed drug had been taken over by a new company which led to a subsequent rise in price for the product from �11.42 to �222.20 for fifty tablets. The Department had decided therefore, for cost reasons, to remove the drug from the list of drugs covered by the Drugs Payment Scheme. He had been taking the particular drug for twenty-five years because he was unable to take the usual drug used to treat his condition as it caused him to suffer adverse side effects. Following its removal from the list the then Eastern Health Board (EHB) refused to reimburse the complainant for his expenditure.

The Office first took up the matter with the Department which indicated that it recognised that, in certain exceptional circumstances, the reimbursement of costs in respect of unauthorised products might be necessary where that product had been prescribed by a registered medical practitioner and lawfully supplied under the Medical Products (Licensing and Sale) Regulations, 1998. The Department had drawn up a protocol governing the supply of unauthorised medicinal products under the Drug Payments and General Medical Services (GMS) schemes. The protocol set out the circumstances in which a reimbursement payment for such medicinal products may be made. It seemed that the drug in question might fall to be dealt with under the terms of the protocol.

In the light of this the Office took up the matter with the EHB which agreed, in the light of the particular circumstances of the case as outlined to it, that there would be no impediment to the reimbursement of costs to the complainant. In addition he was entitled to recoup the extra expenditure he had incurred since the removal of the drug from the list.

Southern Health Board - Refusal of Mobility Allowance

A woman complained that the Southern Health Board (SHB) had refused her husband's application for Mobility Allowance (MA).

The Office reviewed the SHB's decision and noted that the original decision was that he did not qualify on financial grounds. The couple's combined weekly income placed them above the income limit for eligibility for MA.

The SHB had also reviewed the medical basis of the application when the complainant had appealed the original decision. The medical guidelines for MA state that the applicant must be "unable to walk, even with the use of artificial limbs or other suitable aids, or is in such a condition of health that the exertion required to walk would be dangerous." The applicant's medical examination in the course of his application for a Primary Medical Certificate for disabled drivers some two years earlier indicated that he was ambulant with a walking aid. He would not, therefore, have qualified under the medical criteria at that time, or at any time prior to his 66th birthday (MA is not payable to people over 66 years).

The Office concluded that the SHB's decision was correct in accordance with the terms of the scheme. However, in considering the complaint, the Office noted that the couple had considerable travel expenses as a result of the husband's condition. At this stage he could not avail of his free travel entitlements due to the fact that he was confined to a wheelchair and had to use wheelchair taxis for transport purposes. The Office wrote to the SHB and requested that it consider making a weekly payment under the Supplementary Welfare Allowance (SWA) Scheme to reflect the transport expenses and the fact that the husband was not able to derive any benefit from his eligibility for free travel.

The SHB agreed to pay an SWA travel supplement of �12.70 per week to the complainant. This amount was approximately the same as the MA rate of �54.60 per month.

Department of Education and Science - Danger Arising from School Transport Service

The mother of a boy attending primary school complained that she had been informed, at short notice, that he would no longer be picked up at the usual point by the local school transport service as the particular road was considered dangerous. She said the bus stop in question had been used for the previous thirty years. She was advised that her son would be picked up at another location instead. The complainant maintained that the road which her son and a friend of his had to walk to the new bus stop was very dangerous, a view which she claimed was shared by the local Head of Bus Service. The complainant's son could not walk on the right hand side of the road because there was a very high bank of land at a sharp bend which meant he had nowhere to stand in the event of a car passing. As a result he had to walk on the left hand side of the road.

The Department reported that while the new pick up point involved the complainant's son walking almost a quarter of a mile further to get the bus, the change was introduced on the advice of the Gardaí because of safety concerns. The Bus Éireann vehicle operating the service was a large bus and had to completely block a local main road in order to reverse and turn at the location of the original pick up point. As the main road was extremely busy it was considered unsafe for motorists and the school bus service.

The Department stated that the new pick-up point was a safe place for children to board the bus and that the road was considered no more dangerous than other roads used by children throughout the country. It added that when the service was first introduced it was operated by a mini-bus and vehicular traffic was much lighter. The service was now operated by a large bus and with busier traffic conditions the pick-up point had to be moved on safety grounds.

While the Office was considering the complaint a local public representative wrote in suggesting that there was an ideal turning point for the bus at another location nearby and that the owner of a property there had offered his carpark as a turning point for the bus. This location was also the same distance from the boy's home as the original pick-up point.

The Office asked the Department if consideration had been given to the suggested alternative location and also if the stretch of road which the complainant considered to be dangerous had been inspected by the Department. It was suggested that if no inspection had taken place then one should be arranged. Staff from the Office also met with officials from the Department in an attempt to achieve a resolution to the matter.

The Department re-examined the case and it subsequently accepted that there were safety concerns about the new pick-up point and it also agreed that the suggested alternative location was suitable. The Department, in conjunction with Bus Éireann, agreed to change the pick-up point.

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