Matthew Xuereb
Ruling opens door wider to free treatment abroad
‘Far-reaching’ implications for health service
Patients requiring treatment which is unavailable in Malta or which cannot be provided within a “medically acceptable” timeframe may now expect the government to foot the bill of operations performed abroad, following a judgment handed down by the Appeals Court.
The landmark ruling could potentially lead to a huge demand for the resources allocated by the health authorities to patients seeking medical treatment abroad, according to lawyers involved in the case.
The appeal court confirmed a judgment handed down in November 2008 which ruled that the authorities’ refusal to cover a diabetic patient’s treatment abroad was in violation of EU laws.
The case was instituted in 2004 by Daniel James Cassar against the Chief Government Medical Officer and the Director of Social Services.
Mr Cassar suffered from Type 1 Diabetes and his health had progressively deteriorated to the extent that he urgently required surgery consisting of a simultaneous pancreatic and living donor kidney transplantation.
Since this operation was not performed in Malta he had applied to the Director of Institutional Health for free treatment abroad. The request was turned down because this treatment did not form part of the publicly funded health care services package offered to persons living in Malta and covered by Maltese social security.
Mr Cassar had argued that this denial was in violation of European law which provided for free circulation of services – the law specific-ally provides for medical care in member states other than that in which the applicant resides.
Following this refusal, Mr Cassar underwent surgery in Pisa at his own expense after his mother donated one of her kidneys. The costs of the surgery amounted to €74,241.91 and Mr Cassar had incurred further expenses for travel and living while in Italy.
The first court, presided over by Mr Justice Ray Pace, said there was no doubt that the provision of medical treatment fell within the definition of services as stipulated by EU law.
This law also laid down that governments could not place restrictions on freedom to provide services within the EU states. European case law also determined that even where the health service was free, as was the case in Malta, medical treatment was still to be deemed a provision of services.
Consequently, as a person entitled to free medical treatment in Malta, Mr Cassar was entitled to the treatment he sought. Had such surgery been possible in Malta, then he would have had the same operation performed free of charge. The fact that the surgery could not be performed in Malta did not mean Mr Cassar was not entitled to receive it.
The first court also ruled that the same applied if “the waiting time imposed on the person concerned exceeds the medically acceptable period in the particular case”.
Mr Justice Pace said the Travel Abroad Advisory Committee within the Health Department did not apply objective criteria when discussing applications for overseas treatment but decided each case on its own merits. As a result, the criteria adopted by the committee were discretionary.
The Appeals Court, presided over by Chief Justice Silvio Camilleri, Mr Justice Albert Magri and Mr Justice Tonio Mallia, agreed with the first court.
It also noted that the public did not know what was contained in the publicly funded health care services package offered by the government.
Commenting on the outcome of this “landmark case”, Mr Cassar’s lawyers, Paul Micallef Grimaud and Jotham Scerri Diacono, said the judgment’s implications for Malta’s healthcare benefit system were far-reaching.
“As the position currently stands, any resident in Malta who pays social security contributions is entitled to receive medical treatment in any EU member state at the expense of the Maltese government if the treatment he or she requires is not currently available or available within a reasonable time.
“Unless a list of treatments that is available under the health benefit scheme is published, the system will pose a huge demand on the resources Malta allocates for patients seeking treatment abroad,” they said.
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Mr John Azzopoardi
Jun 28th 2011, 23:53
Mr. Micallef, we all need to be reasonable. If the treatment serves a purpose, then I am all for it, but if it's not, then why prolong a life of pain and misery. I know of people who know the end is near, but they force authorities to do what cannot really cure someone. IF it's your money and you want to spend it that way, that' is your perogative, but not at taxpayers expense.
Mr Joe Micallef
Jun 28th 2011, 13:26
Re Mr. John Azzopoardi comment>
What you would have done if it was your son or daughter you would have sit next to him and watch him die?????? and all this because the Tax Payer have to foot the bill so what and we should foot the bill for the sick.
Mr carlos ellul
Jun 28th 2011, 12:24
Tax payers money has been spent on MPs salary increase, on forcing immigrants to remain here to appease our EU masters and on theaters without a roof and city gates without a gate, I guess we can afford spending a euro or two on who needs it.
Ms Rose Cilia
Jun 28th 2011, 15:42
Whilst I agree with you that money was squandered I cannot agree about the euro or two.We are already paying high taxes, imagine how much more taxes would be imposed on us if a large number of sick persons decide to to go to other european countries for treatment and then ask the maltese taxpayer to foot the bill !
Odette Longo
Jun 28th 2011, 11:35
if there's a case that merits all the help we can give, it's this case ! Yes, we , the tax payer foots the bill .
So what do we do... we let him die? He's just 19 and has his whole life ahead of him... and this operation would let him live a reasonably good life .
'There are ways to cut down on certain bills in healthcare. we must cut down on the abuse. i.e. where more than one person is paid for to accompany the patient abroad.
Also, The UK have adopted a number of health initiatives that have helped cut down cost. One small example for instance is that one will not be given free treatment for infertility if one is obese or too thin. They are asked to reach an acceptable weight (bearing in mind age and height) and then they will be granted free help.
Odette Longo
Jun 28th 2011, 12:19
ooops.... apologies.... typo re the age... but the rest still stands.
Ray Mifsud
Jun 28th 2011, 11:31
It hurts to read some coments when health is involved.
I have serious doubts if anybody with an average take home wage of €1000 to €1200 a month can afford to pay for his operations.
The patient paid over €74000 plus other expences. I am sure that not many people can do what he did. Whether it is justified or not I would not like to go into that. But if a person is fighting for his life, he will do what ever he can to servive.
I wish that people realise the importance of how we do not waste what it is given to us free. (paid out of taxes)
Mr Pat Hobson
Jun 28th 2011, 10:57
To all commenters below. Why all this blah blah? What would you do if you or one of the family needs the treatment but cannot be treated locally? What would you do if for you and your immediate family if such an intervention would be financially impossible for you to handle? Yes, the taxpayer is footing the bill, and yes I'm glad that I form part of the system and happily contribute.
Maria C Sceberras
Jun 28th 2011, 11:37
Well said - how many would be able to afford such a hefty amount? So much of the taxpayer's money goes down the drain so why not to save someone's life!!
Mr John Azzopoardi
Jun 28th 2011, 10:41
For all of you who are happy about this, this will come at the expense of all of us. You know who will end up footing the bill right. The taxpayer and also it will definitely impact our health free coverage. As I always say, you get for what you ask for, but it won't be free for long.
Franco Abela
Jun 28th 2011, 11:01
OR they could save money from other projects like building a new parliament and use the money on the most important thing.... human life!
Mr Joseph N. Attard
Jun 28th 2011, 10:14
Notwithstanding our excellent cardiac specialists and excellent hospital facilities, some extremly complicated interventions cannot be done in Malta. So far, the health authorities seem adverse to allow these interventions to take place in the best specialized hospitals in Europe, insisting that patients go only to one particular EU country. Why, if the chances for survival are greater elsewhere?
Edward Zammit
Jun 28th 2011, 10:56
May I add that that not only the cardiac specialists are excellent. Many of the specialities in Malta, including Family Practice, are made of excellent doctors.
Mr ALBERT LEONE GANADO
Jun 28th 2011, 10:57
Try to live in America to understand the crippling medical costs if you fall ill without being insured or the astronomic cost and necessity of insurance to stave off financial disaster. A constant worry in many countries is what happens if I or a member of my family falls ill . I am one of those who have been a high taxpayer all my life and still contrary to many whiners and moaners I am still highly appreciative of the excellent medical state service. My only gripe is that many abuse of the free service provided and that is why I believe that the patient should pay part of the treatment in line with what socially more advanced richer countries like Canada and Sweden demand. Try to take out a private insurance to realise that medical benefits provided are a fraction of what the state provides. One of the areas where this government has done us proud is our hospital services and let us hope that future governments will continue along this path of constant improvement in our health services.
Mr Joseph N. Attard
Jun 28th 2011, 11:34
Mr Zammit, agree with you 100%. Mr Leone Ganado, agree with most of what you say, too. My point is that once Govt. is supplying a free service in one EU country, why not also in another, where costs are probably the same? There are many of us who have been high tax payers, and in the normal course of events, we'll never get our money back!
Mr ALBERT LEONE GANADO
Jun 28th 2011, 09:41
We are indeed privileged as Maltese citizens to have a good free medical service in our hospitals. However we do not sufficiently appreciate it as a major life enhancing value and keep expecting more without appreciating the astronomic cost of such a medical social services and without being willing to put more into the social kitty or co-share the burden.. Whilst I fully agree that this unfortunate patient had probably the right to seek treatment unavailable locally I find it strange for anyone of his own bat to decide to go abroad, select his own hospital and then present the bill to the taxpayer.Not even if you are privately insured are you allowed such freedom because you have to seek prior sanction for your treatment.
The core problem lies in lack of transparency and clear guidelines on which extraordinary medical interventions qualify for overseas treatment and a doubt of an assurance of equality of assessment for all citizens.
Mr Joseph Micallef
Jun 28th 2011, 09:56
Who do you think foots the bill already for our "free" medical services here in Malta???!!!
Mr Paul Caruana
Jun 28th 2011, 08:50
What this will do, is to once again bring up the "taboo" subject in the Maltese political landscape. Should all and any type of healthcare to the Maltese be 100% funded through public funds?
This is the so called "free" healthcare which our politicians are so fond of! For several years, our political leaders have been kicking this particularly nasty can of worms down the road, rather than tackling the problem head on - then again why would they, considering this to be a guaranteed vote loser?
So instead our courts decide to open this particular can for the benefit of the Maltese taxpayer! Basically the courts are saying that if a medical treatment is not available locally to a Maltese citizen, he/she can go any ware in Europe for said treatment without prior authorization while, incredibly, the rest of us get to foot the bill!
John Spiteri
Jun 28th 2011, 09:40
You want it to if it was you!