Home > Publications > Selected Cases > Selected Investigations Completed December 2002March 2003 > Case no. E.2162/01-02
Complaint against North Devon Primary Care Trust (the former North and East Devon Health Authority)
Summary of Case
Mr W sustained severe damage to his reproductive system following a road traffic accident, resulting in impotence and poor sperm quality. A consultant urologist advised Mr W that it was unlikely that he and his wife would be able to have a baby without IVF treatment. In support of this, Mr W’s GP applied to the North Devon PCT (the Trust) for funding for IVF treatment. The request was considered in the light of the former Health Authority’s policy (which the Trust was applying at the time) and refused. Mr W appealed against that decision. The appeals panel decided that Mr W did not meet the criteria for exceptional clinical circumstances laid down in the policy. The reasons given were that there were no serious mental health implications and no obvious pain and discomfort that the treatment would alleviate.
Findings
Mr W’s appeal had been considered against two criteria which were the means of identifying the ‘exceptional clinical circumstances’ necessary for a ‘low priority procedure’ to be funded. The first criterion concerned patients with mental illness. The panel did not consider that this criterion was relevant as no issues of mental health had been raised by Mr W’s GP or in the GP records. However, it was quite clear from these records that Mr W did have a history of mental health problems, which predated the accident, and that the accident itself, and the subsequent difficulties in having a second child, had made these worse. As a result of not recognising Mr W’s history of mental health problems, the panel did not seek expert psychiatric opinion as required by the policy. The Ombudsman concluded that the panel was wrong in failing to take that matter into account.
The second criterion concerned the alleviation of pain or discomfort. The panel considered that providing IVF treatment would not address the issue of the discomfort or pain of Mr W’s impotence and low sperm count. Whilst the Ombudsman accepted that this was true of his actual physical problems, she concluded that this was by no means true in relation to the psychological trauma and pain Mr W undoubtedly suffered as a result.
The panel also considered that they were, in effect, being asked to consider treatment for a third party who was not the patient; they did not think that was justified. However, the Ombudsman took the view that IVF is not solely a treatment for women with fertility problems; it is usually, as in this case, a treatment for couples who wish to have children, who for one reason or another have been unable to do so. The outcome of treatment would have been dependent on the involvement of both parties. In her view, therefore, the panel was wrong to have judged Mrs W to be third party in these circumstances.
Remedy
The Ombudsman recommended that the panel reconvene to regard the application as a joint one from Mr and Mrs W, and to consider the case afresh. She also recommended that the Trust review the policy in the light of her report and amend the criteria accordingly to ensure that that these can in future reasonably be applied to requests for IVF treatment.
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