Wednesday, 2 October 2013
Treatment Abroad Scheme
Fáilte tAire, mo chara dílis. I ask the Minister for Health to redirect the €40,000 funding approved under the treatment abroad scheme for a Galway father with colon and liver cancer towards better life-saving treatment in the Memorial Sloan-Kettering Cancer Center, New York, which has the best record for cure and life-saving outcomes in this area.
I will give the Minister of State the background to this request. This story concerns a young father of 40 with three children living in Oranmore. Earlier this year he was diagnosed with colon and liver cancer. He is a very fit man and this was a surprise to everybody. He told me when I met him last week that the tumour growing inside him is so big at this stage that he can feel it. He has been to cancer specialists in Galway and Dublin hospitals, all of whom have worked in Memorial Sloan-Kettering Cancer Center in New York. It is world-renowned and reputed to be the best for cancer treatment in the world. My cousin was treated there and he is alive today.
Further to much research and in consultant with the Irish specialists, their recommendation is that his best chance of survival and securing the best health outcomes, despite undergoing chemotherapy here, is to travel to the Sloan-Kettering hospital in New York. The good news is that following examination he has been deemed an ideal candidate by the hospital. The bad news is the cost of treatment and aftercare, which is approximately $175,000 or €150,000, which includes at least six months follow-on monitoring and trips to the United States for care and attention. The other critical factor is that if the family wait any longer there will not be enough of the liver unaffected by the tumour to accommodate the best recommended treatment, which is the insertion of a chemotherapy pump inside his body.
Funding difficulties and complications have arisen. On application for financial support under the treatment abroad scheme, the Health Service Executive, HSE, has contacted the family and myself to say it will cover the treatment for this cancer condition but only in France, that is, within the European Union boundaries. The family and doctors are grateful for this acknowledgement but on examination the French treatment is an external chemotherapy pump deemed not ideal for this man's condition and, most importantly, this treatment has not achieved the life and health outcomes achieved by the treatment in Sloan-Kettering.
My request on behalf of this family, who travel tomorrow to the US for surgery on Friday to have the chemotherapy pump inserted, is that the funding granted for treatment in France of €40,000 be redirected to the treatment in New York. I am not asking the Minister for additional money but that the money follow the patient, which as the Minister and I know was our promise to the people before the last election. That money will give this man his best chance at life and recovery. The Minister of State may quote rules and regulations about EU boundaries but it is time we put the patient first, regardless of territorial boundaries.
This young family are under enough pressure already without having to be forced to sell their home to pay for the treatment. I want this father to live to see and enjoy his young children growing up. Having researched the French treatment, it would concern them greatly if they had to rely on it. There is less control when the chemotherapy pump is external to the body. They are familiar with a case where the external chemotherapy pump malfunctioned and, unfortunately, the patient died. The track record of success is far less in France. The Minister's goal, and my goal as a Senator, should be to invest the money for patient treatment and care where the outcomes are best.
I ask the Minister of State who is replying for the Minister, Deputy Reilly, to lift the rigid rules of the treatment abroad scheme and allow the €40,000 approved for treatment in France follow this patient to Memorial Sloan-Kettering Cancer Center in New York. Had this funding not been approved we would have a big problem but we are lucky. Everybody is behind this family. His family and friends have set up a trust called For Pete's Sake. They have also set up a huge fund-raising campaign. Thirty of this man's friends have borrowed €1,000 each to let this family get on its way. Everyone has put their shoulder to the wheel. I ask now that the State would put its shoulder to the wheel, think outside the box and redirect the funding that is approved to New York.
I am replying on behalf of the Minister for Health who is unavoidably absent. I recognise and acknowledge the heartfelt case made by the Senator on behalf of this patient who has a disease that unfortunately visits most families in this country. I emphasise that the HSE operates a treatment abroad scheme, TAS, for persons entitled to treatment in another EU-EEA member state or Switzerland under EU Regulation 883/04 and Implementing Regulation 987/09 and in accordance with Department of Health guidelines. Within these governing EU regulations and the Department of Health guidelines, the TAS provides for the cost of approved treatments in another EU-EEA member state or Switzerland through the issue of Form S2.
A decision is made on each application in accordance with this legislation and guidelines and on the basis of a review by clinical experts. The cost of the treatment is not a deciding factor when approving an application. The treatment must not be available in the State or in a time normally necessary for obtaining it.
The treatment abroad scheme allows for an Irish-based medical consultant to refer a patient that is normally resident in Ireland for treatment in another EU-EEA member state or Switzerland where the treatment in question meets certain criteria. Following clinical assessment, the referring consultant certifies that the treatment is medically necessary and will meet the patient's needs; that the treatment is a proven and not an experimental or test form of medical treatment; that the treatment is in a recognised hospital or institution and is under the control of a registered medical practitioner; and that the hospital outside the State will accept EU-EEA form S2. The application to refer a patient abroad must normally be assessed by the HSE within 15 to 20 working days and a determination given before that patient goes abroad. An appointment should not be scheduled prior to a decision being reached on an application.
In the case raised by the Senator, the treatment abroad scheme received an application from the person concerned on 4 September for a referral to a clinic in France for oncology treatment not available in Ireland. The application was processed in accordance with the statutory framework, the EU regulation and the Department of Health's 2008 guidance. An approval for the referral to France for the specified treatment was issued, as the Senator has stated, on 5 September to the patient.
The treatment abroad scheme allows for patients to be referred to another EU-EEA country for treatment not available in Ireland and have the cost of the treatment met by the issuing of model form E112 (IE). The person concerned has approval to attend the competent service in France in line with the consultant's application and the referral letter in accordance with the governing statutory framework.
The option of funding treatment in the USA as an alternative to the approval for the services in France will not be considered under the treatment abroad scheme. The person concerned has been informed of this decision. There is no provision under the treatment abroad scheme to fund treatment outside Europe which, as I said, covers the EU-EEA countries and Switzerland. Unfortunately, treatment is at the moment confined to the countries stipulated in the regulations.
I am disappointed by the Minister of State's response. The patient and his family are listening to the debate and I know that they, too, will be extremely disappointed. They are aware of the decision for treatment in France, but that decision is not acceptable. Why, in the interests of patient health and life, would we not want to give the father of a young family the best chance at life? The family has done its homework. The surgeons that he is dealing with here have told him that if they had his type of cancer, they would want to be treated in the Memorial Sloan–Kettering Cancer Center. The patient's best chance of life is not to be treated in France.
I ask the Minister to guide me. Where should I go from here? The family is leaving for New York in the morning - their decision is made. The €40,000 is approved. We made a commitment - my party and the Minister of State's party - that money should follow the patient and the treatment offered should be in the best interests of the patient, but now we are saying we are constrained.
I acknowledge the case made by the Senator. Unfortunately, as matters stand, TAS is confined to certain countries in certain regions. Referrals are not made outside Europe. I do not know whether the regulations can be amended. Incidentally, I compliment TAS on its rapid response to the initial application to have the treatment provided in France - it did that in just one day. I do not know whether there are any international regulations or protocols that would prevent the transfer of the €40,000 towards treatment at Sloan-Kettering. All I can do is forward the matter to the Department to see what are the possibilities.
I am confined to the current rules. I am personally not in position to change them, even though I know this family and the trauma they are going through. As I have said, the treatment abroad scheme only covers the countries that are stipulated in the regulations.
I would appreciate it if the Minister of State could look at amending the rules as he suggested. We are not talking about more money. If the Minister of State could make a representation on that basis, I can given him the case-----
I do not know whether the Minister for Health is familiar with the case. I am not sure about that because I am just standing in for him because he had to attend another engagement. I will ensure the Minister gets the details of the case if he does not already have them.