Ms Kelly first applied for a LTI card for her son, Sam, (not child’s real name), in June 2009. Sam was then seven years of age. Her application form contains certification from her GP that Sam was under his care for the “treatment of ADHD and Aspergers.” The GP said that the conditions were being treated with prescribed medication. The application was refused by the HSE’s Acting Senior Area Medical Officer (A/SAMO) in July 2009. When Ms Kelly appealed this decision, she said that the family were finding it extremely difficult to afford the medication of almost €100 a month. The Appeals Officer wrote to her saying that he was of the opinion that the decision to refuse was correct but that he had been informed [by the A/SAMO] that her son might be diagnosed with Autistic Spectrum Disorder,
“...and that should this diagnosis be made then he will be considered for the Long Term Illness scheme...”
When Ms Kelly complained to the Ombudsman (in March 2010, after the Appeals Officer refused her appeal) she said that she was aware of children living in Meath and Dublin “who have only ADHD and they are getting their medication on a long term illness card.” She believed that the refusal of the card to her son amounted to discrimination against him.
In September 2010, Ms Kelly applied for the LTI card once more and supplied evidence from a HSE Consultant Child Psychiatrist that her son had been diagnosed with autism spectrum disorder. This application was also refused. The HSE wrote to her to say that
“Autism and ADHD are not currently eligible under the current list of medical conditions listed for the scheme.”
There followed a lengthy period of correspondence between the Office of the Ombudsman and the Health Service Executive. This resulted in the HSE issuing Ms Kelly with a LTI card for her son in March 2012. This was done, according to the HSE, on the basis of the individual circumstances of her case, it would not serve as a precedent and no recompense would be made for the costs of medications purchased by her for her son since June 2009 (when she had first applied for the card).
In March 2012, the Ombudsman’s Office wrote to the HSE to say that the Ombudsman, when deciding on appropriate redress where maladministration has occurred, seeks to restore the complainant to the position he/she would have been in if the public body had acted properly in the first place. It was put to the HSE that in order to do this, Ms Kelly would have to be reimbursed the expenses of €3,000 she had incurred in the period prior to the issuing of the card to her. The HSE then wrote to Ms Kelly to say that
“... given the ‘good will’ basis and particular circumstances on which the card has been awarded, the issue of retrospective payments does not apply.”
Ms Kelly subsequently provided the Ombudsman’s Office with a document from her pharmacy showing that she had spent over €3,000 on the medication prescribed for her son’s conditions between the time of her application for the LTI card and the issue of a card to her. The document was forwarded by the Ombudsman’s Office to the Health Service Executive. At the time of writing this report, the HSE had taken no further action in the matter.