How does the operation of PHARMAC's 'Community Exceptional ...

Walsh’s Evidence
The plaintiff, Chris Walsh, submitted to the Court that she contested the policies
and processes of the panel considering her application. Walsh presented
evidence that her application under the Exceptional Circumstances policy was
made by her solicitor not by her treating physician. This was because her
oncologist, Dr. Isaacs, who was also the treating physician of the eight plaintiffs,
felt that he was unable to complete their applications for the obvious reason that
it did not appear to him that the applicants were eligible under the criteria. He
felt that a twelve month therapy was the optimal therapy for them. This he
regarded as consistent with the current international standards of care. In his
view, the plaintiffs had no access to the course of treatment because they fell
outside the proposed nine week Herceptin treatment option. More importantly
he agreed that the women were not at the end stage of cancer treatment.
These were the reasons he believed he could not support the plaintiffs
application.
This placed Dr. Isaacs in the invidious position of not being able to support the
application for the treatment that he believed his patients needed. Whilst the
nine week and twelve month argument was also part of Walsh’s application to
the court, this argument did not make part of her Exceptional Circumstances
claim. A further difficulty for Walsh arose when a specialist oncologist practicing
in Auckland, provided expert opinion that when funding access for an effective
treatment is denied, this naturally causes him distress. However, there is no
evidence demonstrating that any one treatment duration of Herceptin is better
than another. He stated that in his opinion PHARMAC’s decision was a direct
result of its need to consider the cost of funding and the potential impact funding
twelve months Herceptin. This would also have created a negative impact on
the ability of the health care system to fund other health service treatments.
The constraint on the spending in health care, including pharmaceuticals, was
politically determined through the size of the New Zealand health budget. He
contended that this is not a matter for PHARMAC to determine but one for the
government to determine (Paragraph 152 Walsh v. PHARMAC BC 200860616).
The court received evidence that the Exceptional Circumstances claim on
behalf of the claimants was not simply about the exceptional circumstance of
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