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Case 1 : Cancer patient treated abroad gets €8,543 in medical bills paid by HSE - Department backdates over €7,000 in illness benefits.

The complainant in this case was a single woman and an only child who came from another EU Member State. She had lived in Dublin City and worked in Ireland for the last several years. In December, 2006 she visited her GP who sent her to the Mater University Hospital for x-rays and blood tests. After subsequent visits and tests (approximately 18 months later) she was diagnosed with Hodgkin’s Lymphoma. She spoke to doctors in both the Mater Hospital and her native country and it was recommended by her hospital consultant that she be treated in her native country, as she had no family or dependants here to assist with her treatment programme. The doctors acknowledged that, whilst the "treatment" in terms of chemotherapy and radiotherapy was available in Ireland, it was felt that she would be weak and sick after the treatment and that she would require significant care from friends or family at home. The complainant had no siblings and her elderly parents did not speak english, so they could not come to Ireland to look after her.

Having travelled back to her native country to receive treatment, the complainant was told by the authorities there that she was required to have completed a form E-112 in Ireland (an E-112 form enables a person to get hospital treatment in the state funded sector in another EU/ European Economic Area member State or in Switzerland). She had never received any information regarding the E-112 form prior to leaving Ireland to begin her treatment. She then applied to the Health Service Executive (HSE) for an E-112 but was refused. She subsequently appealed to the HSE, but her application was refused again. She then contacted my Office for help in July, 2008.

Initially, the HSE stated that the complainant had been refused on first application and on appeal because the treatment required could be provided in this jurisdiction. They also pointed out that the scheme required her to have applied for the E-112 before leaving this country to commence treatment abroad. However, I felt that there were two key arguments to support her case. Firstly, the complainant had not been provided with any information on the E-112 or treatment abroad scheme when her treatment abroad was actively being discussed in the Mater Hospital. Secondly, with regard to the treatment being available in Ireland, advice received by the complainant from her consultants in the Mater Hospital indicated that it would be better if she were to avail of her treatment at home in her native country, where there would be support available for the duration of her treatment.  After extensive correspondence between my Office, the HSE, the Mater University Hospital and the Department of Health and Children, the HSE informed the complainant that it was responsible for all expenses incurred involving her treatment whilst in her native country and it requested all relevant invoices. The HSE subsequently agreed to pay medical bills amounting to €8,543. In addition, following contact by my Office with the Department of Social and Family Affairs the complainant was awarded backdated illness benefit totalling over €7,000.

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