Medical card appeals


Sir, – I wish to provide follow-up on my letter of February 6th, 2012. It was regarding a patient of mine with multiple illnesses who recently had his full medical card reduced to a doctor visit card and his efforts to appeal the decision on his obvious medical grounds. He has made many phone calls to various HSE offices and forwarded further documentation since, with no satisfactory engagement to date.

The May 24th, 2012, Oireachtas Committee on Health and Children debate on the processing of medical cards reported a marked improvement in the performance of the Finglas office since it opened, which is not disputed. It was also noted that information received from doctors supporting patients’ appeals “was insufficient in many cases” and “sometimes very scatty”. I have no doubt that there is some truth to this in some cases. However, I feel that my letters with my patient’s summarised relevant medical history, current medications and accompanying health technology assessment, measuring the total benefits of granting him his medication for free as opposed to his otherwise non-compliance, do not fit into the scatty category.

I was not impressed when my patient reported to me yesterday that he needed another copy of my letters as he had sent the previous set to the Primary Care Reimbursement Service in Finglas when he should have sent it to Ballyshannon, as it was an appeal. He said he was told by an administrator in Finglas that it was routine policy to dispose of any documentation supporting appeals that arrived there as it was not their job to forward them.

If this astounding claim is true, and I have no reason to suspect that it is not, it explains many of the problems patients are experiencing. Clearly the HSE has not learned from the Tallaght hospital scandal originally exposed in April 2009 by Prof Tom O’Dowd, where GP referrals spent years in piles unopened in the post room, or the famous box in Our Lady of Lourdes Hospital, Drogheda, first written about by Dr Ilona Duffy in June 2007, where it is commonly believed that GP referrals were put unopened and un-triaged when waiting lists became unmanageable.

It also makes a mockery of the HSE’s own code of governance and exposes the lack of interest in providing a patient-centred process. Clearly HSE senior management and public service union representatives assign more value to the 30 seconds it would take of a clerical officer’s time to redirect these envelopes than the value and stress of causing an extra unnecessary consultation in general practice. – Yours, etc,


Cromwellsfort Road,

Walkinstown, Co Dublin.