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Chapter 11 - Findings

  1. Based on the evidence of this investigation, the Ombudsman finds that the NAHB entered into a contractual arrangement with the Roscommon nursing home for the provision of beds to it at a preferential rate.
  2. The Ombudsman finds that the contract of care witnessed by Mrs. Byrne expressly excluded her from any liability in the payment of fees to the Roscommon nursing home in respect of her mother Mrs. Jean Coffey.
  3. The Ombudsman finds that Mrs. Coffey was charged by the NAHB for in-patient services, that those charges were paid by her, and that her daughter Mrs. Byrne holds receipts to show that payment was received by the Health Board.
  4. The Ombudsman finds that the arrangement for payment as set out in the contract of care in this case, taken together with the arrangement between the nursing home provider and the NAHB for the provision of beds, meant that the Nursing Home Subvention Scheme did not apply to Mrs. Coffey.
  5. The Ombudsman finds that to all intents and purposes Mrs. Coffey was a public patient who was placed at the Roscommon nursing home under a contract for the provision of beds.
  6. The Ombudsman finds that the decision of the HSE, through its agent the Scheme Administrator, to refuse repayment of the in-patient charges was a decision based “on erroneous or incomplete information” as well as being a decision taken “contrary to fair or sound administration”.
  7. The Ombudsman finds that the administrative (including payment) arrangements of the NAHB’s Nursing Home Section and Patient Accounts Section, as they related to the placement of Mrs. Coffey in the Roscommon nursing home, were confused and lacking in transparency and thus reflect an undesirable administrative practice as well as being contrary to fair or sound administration.
  8. The Ombudsman finds that the failure of the Appeals Officer to follow up on queries raised about contractual, invoicing, and payment arrangements in this case was contrary to fair or sound administration.
  9. The Ombudsman finds that the decision of the Appeals Officer was based on erroneous or incomplete information. It is now accepted by the HSE that incorrect information was provided to the Appeals Officer.
  10. The Ombudsman finds that the failure of the Appeals Officer to keep records of the oral hearing in the case reflected undesirable administrative practice and was contrary to fair or sound administration.
Previous: Chapter 10 - Responses to the Draft Investigation Report
Next: Chapter 12 - Conclusion
 

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