Reid v Health Service Executive
| Jurisdiction | Ireland |
| Judge | Mr Justice Charleton |
| Judgment Date | 03 March 2016 |
| Neutral Citation | [2016] IESC 8 |
| Date | 03 March 2016 |
| Court | Supreme Court |
| Docket Number | Record number 2010/4478P Appeal number 275/2011 [2016] IESC |
[2016] IESC 8
An Chuirt Uachtarach
The Supreme Court
Charleton J.
Record number 2010/4478P
Appeal number 275/2011
[2016] IESC
Hardiman J
MacMenamin J
Dunne J
Charleton J
O'Malley J
and
Health – Dentistry – Contract with Health Service Executive – Self–employed dentists – Alleged failure to reimburse
Facts: The appellants were self–employed dentists who had a contract with the respondent. They contended that the respondent had failed to reimburse them for treatment provided to medical card holders. The High Court had found for the respondent on the basis that the Irish Dentist Association had agreed to revised procedures with the respondent which were binding on the appellants. They now sought to challenge the judgment below.
Held by Mr. Justice Charleton, the other Justices concurring, that the appeal would be dismissed. The circular by which dentists were notified of the agreed procedures was clear, and provided for the circumstances which the respondent relied upon. The wording of the circular was clear and binding. On that basis, the Court was satisfied that the decision of the High Court was correct.
Martin Reid and James Turner are self-employed dentists. They claim a breach of their contract with the Health Service Executive to pay for the provision of dental treatment to medical card holders. Prior to a circular of 26th April 2010, dentists were entitled to reimbursement for all routine treatments provided to medical card holders; thereafter only emergency treatment qualified. The Health Service Executive administers the medical card scheme. Those qualified are able to obtain certain forms of medical and dental treatment. Qualification for holding a medical card changes from time to time, depending on social and political considerations. Dentists participate in the medical card scheme by offering their services at an agreed rate. Decisions as to who is qualified to receive treatment, how dentists are to be remunerated and as to what forms of treatment are covered, are administered by the Health Service Executive. The money for that ultimately comes from central funds through allocation to the Health Service Executive. Given the numbers of dentists in the scheme, the entitlements of the respective parties are settled through collective negotiation. This results in a standard contract in writing which must be signed by each dentist. Here, the relevant contract dates from 1994. It was revised in 1999. Under the terms of the 1999 revision, the Health Service Executive claim to be entitled to have made the unilateral change in 2010. Thereby all routine treatments, apart from emergency cases, were disallowed. The appellant dentists counter that nothing in the wording permitted such a major unilateral change by the Health Service Executive.
As with the provision of other State services by self-employed professionals, disputes will arise from time to time. Initially, dentists' contracts were with the various health boards set up under the Health Act 1970. The Health Service Executive is the successor. This particular scheme was introduced in 1994 through collective bargaining. After lengthy negotiations with the Irish Dental Association, a revision came about in 1999 and the contract was altered accordingly. According to the evidence given in the High Court by Dónal Atkins, the former secretary general of the Irish Dental Association, the 1999 revision settled issues between the dentists and the health boards as to fees, access by patient medical card holders and approvals for certain more complex treatments. All participating dentists worked under that scheme for the next decade. This dispute then arose in the wake of the economic crisis that became manifest from September 2008. By 2009, the national cost of this scheme had risen to ?80 million. A decision was taken to limit the expenditure for 2010, and for all subsequent years, to ?63 million. The decision limiting funding for dental treatments took the form of a letter dated 26 th April 2010 to each participating dentist from the Health Service Executive, under the title ?Circular No. 008/10?. Certain treatments were disallowed. Essentially, the Health Service Executive told the dentists that only emergency treatments were to be funded after April 2010. This was not a negotiated position. It was a decision made solely by the Health Service Executive. As a result, many treatments were cancelled or did not proceed. This affected the income of the dentists. Martin Reid and James Turner contend that the alterations unilaterally made by the Health Service Executive were not authorised by the terms of the 1994/1999 contract. They also claim not to have been party to the 1999 contract revision and thus not bound by it but only by the 1994 form of the contract.
Martin Reid and James Turner had applied to the High Court for an interlocutory injunction to restrain the Health Service Executive from implementing the change to their contracts. By decision of Laffoy J, dated 16 th June 2010, the High Court ordered ?that pending the trial of this action or until further order the [Health Service Executive] its servants or agents or any of them acting howsoever be restrained from giving effect to or purporting to give effect to Circular No 008/2010 on April 26 th 2010?. The Health Service Executive appealed that judgment and order by notice of appeal dated 18 th June 2010, on the grounds: that the injunction sought was mandatory and not prohibitory, as Laffoy J had held; that Laffoy J had erred in holding the test to be applied was whether there was a fair issue to be tried; and that the balance of convenience did not favour the grant of the order. A motion was then brought before this Court to stay the order of Laffoy J. In case 194/2010, on 9 th July 2010, this Court ordered that ?the motion be refused and that the defendant do pay to the plaintiffs the costs of this motion when taxed and ascertained.? The outcome of this appeal will govern the result of any subsisting appeal as to any interlocutory matter.
At the substantive trial in the High Court, only very limited testimony was allowed by the trial judge, Murphy J. He ruled that the parol evidence rule permitted him to consider only the text of the 1994/1999 contract set within the relevant factual matrix which, in this instance, included a statutory provision as to the budgeting responsibility of the Health Service Executive. The trial judge included in the background against which the contract was to be analysed, two letters from September 1999; one dated 17 th September from the Irish Dental Association to the Health Services Employers Agency and the other was the reply from that source dated 21 st September. In the High Court, Martin Reid and James Turner disputed that they had been bound by the negotiations conducted in 1999 by the Irish Dental Association. While Murphy J ruled on that issue, it was pursued on this appeal only as a minor point. Nonetheless, it must be decided. In any event, by the time this dispute had arisen, both parties had apparently interacted with each other over a decade by reference to the provisions of the 1999 revision of the 1994 contract. By written judgment, (High Court, unreported, 28 February 2011) Murphy J ruled against the dentists as follows:
The court is of the view that the [revised] procedures had been negotiated on behalf of all dentists, including the plaintiffs herein, by their association. The Irish Dental Association is necessarily a contracting party in relation to the resolution of disputes between dentists and the HSE acting through the Health Services Employers Agency.
The court is satisfied that the emphasis in Circular 008/10 is, despite the limitation, patient oriented. Not alone is the HSE to provide emergency dental care to eligible patients with the focus on relief of pain and sepsis but also additional care would be considered in exceptional or high risk cases. It is the practising dentist who must satisfy herself or himself as to the clinical emergency. The dentist must provide the necessary urgent treatment in accordance with the detailed 11 point schedule.
The court is also of the view that the acknowledgement by the Irish Dental Association of the Health Board's right to take whatever measures are necessary to live within budget and statutory obligations is, as in the previous clause, a term of the revised procedures. These measures were affected through the circular which implemented what was agreed between the parties.
In the circumstances the court, having regard to the statutory background to the scheme, is of the view that the circular is contractually binding upon the plaintiffs.
The defendant, by virtue of the circular of 26th April, 2010 limits expenditure to what the court understands was the previous budget of [?63 million]. Using the 2009 uptake levels the defendant notified to dentists, including the plaintiffs that it would provide emergency dental care to eligible persons with a certain focus and, indeed, would consider additional care in exceptional or high risk cases. It is the individual dentist who must satisfy him or herself as to the clinical emergency and provide the necessary urgent treatment.
It seems to the court that the circular is within the scope of s. 2 of the Health (Amendment) No 3 Act of 1996.
Accordingly, there is no breach of contract.
Though the circular was dated to have effect on the 28 th April, 2010, the plaintiffs had been granted an injunction restraining the defendant from giving effect or purporting to give effect to the circular until the trial of the action. It would follow from...
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