Kenneth Fisher, 33, who was diagnosed with MS in 1987, was assessed as suitable for treatment with beta-interferon, used to extend periods of remission from the disease, in January 1996.
He never received the drug, which costs pounds 10,000 a year, because North Derbyshire health authority operated what was in effect a blanket ban despite explicit instructions from ministers that the drug should be made available on the basis of clinical need.
Mr Justice Dyson accused the authority of using "creative constraints" and being "disingenuous" in its attempts to avoid implementing national policy and hold the line on an "unsustainable" position.
The judge said Mr Fisher's condition had since deteriorated and there was now a question of whether he would still benefit from the drug.
Giving the health authority 14 days to reconsider its decision not to fund his treatment, he said: "This is a matter on the conscience of the individuals in question."
Outside court, Mr Fisher's parents said they would take legal advice with a view to suing the health authority. His mother, Margaret, 60, said: "I am just upset that it has taken so long. It has been heartbreaking."
Peter Cardy, chief executive of the Multiple Sclerosis Society, said it was an "extraordinary judgment delivered in extraordinary terms" which attacked the authority for repeatedly finding new reasons not to prescribe the drug.
Most health authorities in England followed the national guidelines but some, such as Cambridge, Lambeth, Southwark and Lewisham, did not. "I am sure they will want to look at their policies again," he said. Health authorities in Northern Ireland followed the guidelines but most in Scotland did not, he added. Beta-interferon was licensed in 1995.
Normally health authorities are left to decide whether to fund expensive new treatments but, because of the interest in beta-interferon, the NHS Executive exceptionally issued guidelines saying it should be made available to those capable of benefiting from it as judged by consultant neurologists. The drug is only suitable for the 40 per cent of MS sufferers with the relapsing/remitting form of the disease, of whom about 10 per cent are thought likely to benefit.
North Derbyshire health authority yesterday denied it had operated a blanket ban on the drug but admitted it had not set aside a specific sum to pay for it. "We did not feel able to give it additional priority because of the limited evidence of its effectiveness available at the time," a spokeswoman said.
The British Medical Association said arbitrary rationing of treatments based on where patients happened to live was unacceptable and called on the Government to take the lead in creating a national framework.Reuse content