High Court: Minor granted leave in weight loss injection dispute

About this case:

• Citation:
  [2026] IEHC 651
• Judgment:
  External link
• Court:
  High Court
• Judge:
  Ms Justice Mary Rose Gearty

Delivering judgment for the High Court, Ms Justice Mary Rose Gearty confirmed that the HSE’s decision refusing to reimburse the minor who suffers with a rare syndrome for weight loss injections was reviewable and that he had an arguable case in respect of the rationality of the decision.

Background

The minor, a 7 foot tall teenager suffering from a rare syndrome, was, until recently, severely overweight. 

The minor’s weight caused numerous health difficulties, including orthopaedic complications and exacerbation of a cardiovascular defect. His past aggressive behaviour complicated his care.

In July 2025, the minor was prescribed with the weight loss injection “Wegovy” or “Ozempic”, resulting in a four-stone weight loss and positive effects on his independence, exercise and aggression.

Although the minor held a medical card, the minor’s mother had been paying for the drug herself at a cost of €150 per month as it is not generally reimbursable under any general medical or community drug schemes.

As a single parent and full-time carer, the minor’s mother could not afford to continue to pay for the drug herself and sought to be reimbursed under the respondent’s discretionary hardship scheme pursuant to s.23 of the Health (Pricing and Supply of Medical Goods) Act 2013. 

On 19 May 2026, the respondent refused reimbursement on the basis that the minor suffered from three medical conditions, that an alternative drug was available and on the basis that its decision could affect numerous others. The respondent did not appear to consider the minor’s rare syndrome in its decision.

The minor’s mother sought leave to bring judicial review proceedings on his behalf, seeking certiorari of the respondent’s decision and declaratory relief. 

The High Court

Ms Justice Gearty set out the relevant legislative provisions, noting that pursuant to s.17 of the 2013 Act the respondent was obliged to establish a “reimbursement list” of items in respect of which payment would be made to those requiring the listed medication.

The court further highlighted that s.23 of the 2013 Act permits the respondent to, at its discretion and subject to whatever conditions it deems appropriate, arrange to supply a non-listed item to a patient if satisfied that the patient requires it for clinical reasons and there is no listed item which is a suitable alternative insofar as that patient is concerned.

The respondent argued that a grant of leave would not be appropriate, emphasising inter alia how closely a decision as to reimbursement resembles a policy decision, rather than a quasi-judicial decision, and that the court could only interfere if its decision was arbitrary or capricious.

In this regard, the respondent relied upon Garda Representative Association v Minister for Finance [2010] IEHC 78 in support of its argument that the more closely a decision apparently aligns with a political choice, the more care the court should exercise in interfering with a discretion.  

Ms Justice Gearty noted that while it was not appropriate for the court to substitute its own decision for that of the respondent, “if a decision was made having ignored or irrationally discounted a relevant consideration thus leading to a conclusion that was, arguably, irrational, a judge may take the view that it should be quashed and remitted to the decision makers for a decision based on accurate facts”.

Turning to the case before her, the judge considered the respondent’s resistance to review of the rationality of its decision, highlighting that this position was despite the decision-makers’ express concern that the respondent must view the issue as one potentially affecting many patients and which could not be considered on the circumstances of the minor alone. 

In that regard, the court pointed out that “It is simply not clear if this consideration would apply at all if the rare syndrome identified in the evidence here had been a factor in the decision.”

Ms Justice Gearty found that two potential scenarios arose from the facts – either a report dated March 2022 from a Consultant Clinical Geneticist which confirmed that the minor suffered with the rare syndrome was before the decision-makers, in which case there was a failure to consider or to address a potentially material factor, or the report was not submitted by the applicant mother to the decision-makers in her most recent application.

Confirming that the court would not resolve these issues of fact at this stage of the proceedings, the judge outlined that a consideration of the case would involve examination of the medical issues arising and what was available to the decision makers.

Finding the respondent’s decision to be reviewable, the court was satisfied that the minor had an arguable case in respect of his application to quash the decision refusing to supply him with Wegovy under s.23 of the 2013 Act.

Conclusion

Accordingly, the High Court leave to apply to quash the decision, but refused leave in respect of the declarations sought on the basis that they were not necessary reliefs.  

T.O. (A minor suing by his mother and next friend, R.O.) v The Health Service Executive [2026] IEHC 651