Dentists challenge medical card changes in High Court

Two dentists have commenced High Court proceedings aimed at preventing the HSE from implementing changes to the scheme which allows medical card holders avail of dental treatments free of charge.

Dentists Martin Reid and James Turner claim that the changes outlined in a circular issued last April, which they argue radically confines the services they can offer to medical card holders to emergency services and one oral examination in a 12-month period, will have "a dramatic effect on public health."

They also claim the HSE has breached an agreement with dentists to provide dental services for medical card holders. The HSE has denied the claims.

In proceedings before the High Court today the dentists sought injunctions restraining the HSE from giving effect to the circular of April 26 last, issued by the Primary Care Reimbursement Service, which resulted in changes to the Dental Treatment Services Scheme (DTSS).

They are also seeking an injunction preventing the HSE from breaching the agreement between dentists and the HSE for the provision of dental services to medical card holders. If granted, the injunctions are to remain in place pending the full hearing of the action.

In arguing the dentists are not entitled to the injunctions the HSE has claimed that it has acted properly in implementing the changes to the DTSS.

Ms Justice Mary Laffoy, who heard the application, reserved her decision. The judge said she would give judgment next week.

Opening the case Bill Shipsey SC for the dentists said they had brought proceedings because they believe the decision, outlined in the April 26 circular, unilaterally varies the terms of the (DTSS). That amounted to a breach of contract by the HSE, counsel said.

Counsel said that the DTSS was established in 1994 between dentists and the the old health boards in order to provide dental care for those on medical card scheme. The agreement was revised in 1999.

Counsel said that his clients did not accept that the HSE was entitled to amend the DTSS contract due to a provision in the 1999 agreement which states that the HSE has "the right to take whatever measures are necessary to live within budget and statutory obligations".

In view of the current economic difficulties Counsel said the HSE sought to reduce the amount spent on the DTSS from an estimated €88m in 2010 down to 2008 level of €63m.

Both dentists have expressed concern for their practice's future if the changes are implemented. Mr Turner's practice, which he shares with an associate, earned €95,000 under the DTSS in 2009 representing 30% of the practice's income.

In 2009 Mr Reid's practice in Co Donegal earned €230,000 under the scheme, which accounted for some 68% of his practice earnings.

In his affidavit to the court James Turner, who has a dental practice in Blatinglass, Co Wicklow, and is a director of the Irish Dental Association (IDA), said that the changes to the DTSS will have "disastrous consequences" for both dentists who provide services under the scheme and for medical card holders.

He said that changes appeared to have immediate effect, which had lead to confusion and concern among dentists. He added that the HSE had failed to provide guidance to dentists if existing treatment plans should be continued and if dentists would be paid for their services.

Mark Connaughton SC for the HSE rejected that his clients had acted disproportionately, and was entitled to make the changes. Counsel said the HSE had implemented the changes to the DTSS in a "careful, considered and measured" manner. The changes, counsel said, had been implemented after the Government instructed the HSE to cut its costs dramatically.

A replying affidavit from the HSE's Patrick Burke said that the HSE discussed changes to the scheme with the IDA in advance of issuing the circular. He added that the changes to the scheme are essential to enable the HSE to perform its statutory duty.