THE HEALTH Service Executive came in for scathing criticism from Ombudsman Emily O’Reilly at the publication of her annual report yesterday, when she accused the organisation of being riddled with secrecy and acting at times in its own self-interest.
She said her office had considerable difficulty accessing records held by the HSE.
The Ombudsman received 2,873 complaints last year, the highest recorded in over 10 years. This was 86 more than in 2008 and over a quarter were in relation to the HSE and its services.
During one investigation her office was led on an “Alice in Wonderland trip” around the legal system as the HSE tried to prevent a report being published, which she said was a waste of money.
“I think there is a huge issue around the excessive secrecy and legalism of the HSE and it strikes me that it is a cultural thing within the HSE, and it is redolent of a body that looks not to the public interest, which is the only reason it’s there, and seeks at times to protect its own interests and that’s very wrong,” she said.
“It’s as if the HSE lives in a parallel universe,” she added, pointing out that others, including the Minister for Children and the Government, had not been able to secure information from the HSE recently in relation to child deaths in care. “So there is something rotten within that system,” she said.
Some of the cases that came before her for investigation last year, particularly in the social services and public healthcare areas, were “shocking and unacceptable”.
One involved a woman who was deprived of pain relief while giving birth at Waterford Regional Hospital, while another involved a terminally ill man at the Midland Regional Hospital, Tullamore, whose wife complained his prescribed anti-embolism stockings had not been changed for three weeks.
In a further case a woman admitted to Ely Hospital, Wexford, for respite care had to stay in bed for much of her stay as the hospital had no suitable seating available. Her daughter also complained she arrived home badly bruised after her stay. Nursing notes were “deficient and disorganised”.
In another case the HSE decided to stop funding treatment at a private clinic in Dublin for a Clare woman with an eating disorder six months into her treatment. After the Ombudsman intervened the HSE agreed to fund the rest of her treatment and she was now doing “very well”.
A creche in the midlands had to send the HSE a solicitor’s letter before it could find out that a complaint against it centring on child protection had not been upheld.
Responding to Ms O’Reilly’s comments the HSE, in a statement, said its staff made every possible effort to provide information to and co-operate with the Office of the Ombudsman.
“However, due to the HSE’s obligation to comply with laws designed to protect the rights of patients and clients, particularly in relation to childcare, it is not always possible to provide all of the information sought. This has occurred in a limited number of instances.
“The HSE is very disappointed that the Office of the Ombudsman has chosen to so graphically characterise the obligation of HSE staff to comply with these laws as an attempt to block and suppress information,” it said.
“The HSE makes every effort to be as transparent as possible in all areas,” it added.
Other complaints to the Ombudsman last year were about the Civil Service/Government departments in 41 per cent of instances and about local authorities in 30 per cent of cases.
Ms O’Reilly said the recession might have been a factor in the increase in complaints against the Civil Service, as more people tried to access social services.
In one case a decision not to grant a contributory State pension to a person in Co Roscommon was reversed and arrears of over €30,000 were paid following the Ombudsman’s intervention. In another, a widower from Co Meath got a €35,530 payment of pension arrears.
But she could do nothing for a person who claimed he should not have to pay the €200 second home property tax on a house he had built so he could move under the Government’s decentralisation programme before it was scrapped. However, she said it was of concern there was no provision to waive the charge in exceptional circumstances.
She also found “systemic issues” in relation to planning enforcement in Co Meath.
Separately, a review by the HSE last year, following the Ombudsman’s prompting, resulted in refunds to 81 families amounting to €407,000. They had been unnecessarily paying weekly inpatient service charges for family members in community care homes.
Case studies: Ombudsman's Investigations
CASE 1:A woman who complained about the standard of maternity care she received at Waterford Regional Hospital ended up getting private counselling sessions paid for by the hospital and an ex-gratia payment of €1,000 as a goodwill gesture after the intervention of the Ombudsman.
The woman claimed she had been deprived of pain relief during the birth of her child at the hospital in 2007 because the attending midwife had failed to recognise that she was in labour.
Her initial complaint to the hospital had taken two years to be examined, but when it was the investigating team found she had received “sub-optimal care, falling into the category of neglect”. It found this neglect deprived her of the expert care and support of the professional midwife during critical labour hours, of having her partner or mother present at the birth and also, the opportunity to have appropriate pain relief.
The woman could not take a legal case against the hospital because of the amount of time that had lapsed with the hospital’s own investigation. She turned to the Ombudsman, who discussed the complaint with the hospital’s general manager and arrangements were made for staff to meet her and her family.
The meeting did not help to bring a satisfactory conclusion to the issues raised and the Ombudsman contacted the general manager again, who agreed to write the woman a letter of apology, which also outlined improvements that had been made at the hospital on foot of her complaint. He also offered to pay for private counselling sessions for her to help her deal with the trauma of the birth. An ex-gratia payment of €1,000 was also made to her.
CASE 2:A woman who was offered tenancy of a vacant local authority house by Galway County Council in January 2007 complained to the Ombudsman that the offer was subsequently withdrawn in October 2007 without explanation. The house was given to someone else in 2008.
It emerged later that the offer was withdrawn because of allegations of anti-social behaviour at a previous private residence. But these allegations were not put to the woman by the council prior to the withdrawal of the offer of tenancy.
In fact, Ombudsman Emily O’Reilly found they were not raised with her until August 2008, a full 10 months after she was notified that the offer had been withdrawn.
Ms O’Reilly, in her annual report, said proper procedures were not followed in this case and it appeared that the woman was not subject to due process from the outset.
“The information on which the council based its decision was derived from one source [an estate management report]. The allegations of anti-social behaviour were not supported by information which it received from An Garda Síochána,” the report says.
The council was asked to review its procedures to ensure a similar situation did not arise again.
It acknowledged that the woman should have been given the opportunity to be heard before a decision to withdraw the offer of tenancy was made.
The woman was subsequently allocated another tenancy by the council in July 2009.
CASE 3:A Dublin woman applied for carer's benefit in May 2007 in respect of her aunt and uncle. Payment for her uncle was approved, but was disallowed in her aunt's case on the basis that the medical evidence submitted was insufficient to demonstrate that full-time care and attention were needed by the aunt.
The woman appealed the decision to no avail, so she complained to the Ombudsman.
The Ombudsman obtained the relevant papers from the Department of Social and Family Affairs, as it was then known, and from the independent Social Welfare Appeals Office.
On looking at them, it emerged that there was additional medical evidence on the department’s file that differed substantially from the medical evidence examined by both the deciding officer and the appeals officer.
It was clear this had not been referred on to the medical adviser, nor had it been examined by the deciding officer.
The additional information suggested the aunt’s medical condition was more severe than had been described in the medical evidence for the purposes of the original decision and the subsequent appeal.
A review of this new information by the department led to the woman succeeding in her claim for the carer’s allowance.
The payment for the benefit in respect of her aunt was approved and backdated to the date of the original claim.
This resulted in arrears of nearly €12,000 being paid to the woman, which included payment of the respite care grant for 2007 and 2008.