Ombudsman: Discretion narrowed for medical cards

There has been a "narrowing" of discretion in the issuing of medical cards but no evidence of maladministration, the Ombudsman said yesterday.

It emerged at this week’s meeting of the Dáil Public Accounts Committee that almost 1,200 discretionary medical cards have been removed since the start of the year.

Ombudsman Peter Tyndall said there had been a problem in getting information from the HSE to work out how a decision to remove a card had been made and why.

His office wanted to compare HSE medical card files because people had complained that their situation had not changed.

In some instances files that would have pre-dated the establishment of the HSE’s Primary Care Reimbursement Service were unavailable. Some files had been lost and some had been shredded.

“So we were not in a position to understand why the original decision was taken,” said Mr Tyndall. He said discretion had been exercised in different ways in the past. Now that it was centralised it was being exercised more consistently.

“What I was looking for and did not find was a complete refusal to exercise discretion because, had I found there was no discretion being exercised then, clearly that would have been maladministration,” he said. “They were exercising discretion but in a much narrower way.”

However, it would have been much easier for him to comment on why the decision had changed if they were able to see why the original decision was made.

“We were able to determine the cases but what we were not able to do was determine why the decision had changed and we were only able to look at whether the decision now had been properly made,” said Mr Tyndall.

“I have to say, to be fair, when we did identify failings in the way the process was being conducted centrally, it was changed, so I have no criticism of the HSE on that front.”

The Ombudsman was able to settle 37 cases last week because the PCRS treated them in the same way as those that had already been through the review process before it was suspended at the end of last month.

Since the PCRS was established in 2011, the Ombudsman has received about 350 complaints, with some kind of settlement reached in about 40% of cases.