Cardinal George Pell has been excused from giving evidence in person to the Royal Commission into Institutional Responses to Child Sexual Abuse.

Key points: Commission found travel could risk heart failure

Commission found travel could risk heart failure Counsel for abuse survivors pushes for medical report to be made public

Counsel for abuse survivors pushes for medical report to be made public Commission rules ailing Bishop Ronald Mulkearns should give evidence

Cardinal Pell will appear before the inquiry by video link from Rome to give evidence on church abuse in Ballarat.

Commission chair Justice Peter McClellan said he accepted medical evidence that the 74-year-old would be at risk of heart failure if forced to fly to Australia to give evidence.

"Although people with the conditions that Cardinal Pell has may fly long distances, it is apparent from the medical report that in the case of Cardinal Pell there is a risk to his health if he undertook such travel at the present time," Justice McClellan said.

"Having regard to the nature of his aliments it could not be expected that his health is likely to improve and remove those risks."

"Although it remains preferable that he gives evidence in Australia, when the alternative that he give evidence by video link is available the Commissioners are satisfied that course should be adopted."

In announcing the decision, Justice McClellan said the commission decided the Cardinal's medical report would not be made public.

Cardinal Pell, a former Catholic archbishop in Sydney and Melbourne, did not attend a hearing in Ballarat in December, angering victims.

Cardinal Pell's office in Rome issued a statement at the time saying his heart condition had worsened, making it unsafe for him to travel.

Justice McClellan previously denied a request for Cardinal Pell to give his testimony via video link.

Abuse survivors angry over Cardinal Pell being excused

Survivors of abuse have reacted angrily to the ruling with advocate Nicky Davis calling on the Cardinal to front the inquiry in person, despite the royal commission's decision.

"For survivors we're very clear about this," Ms Davis said.

"Those who have been doing this must man up, come to Australia, get out of the nursing home that they're hiding and come and face the music."

Another survivor, David Ridsdale, said he felt let down by the decision and that it was difficult not to feel cynical.

"The problem for the royal commission is it's become an institution in itself, it's such a big event, such a broad-reaching program," Mr Ridsdale said.

"We're not privy to the political goings-on behind the scenes, so we have to do what's really hard for us, and that's have faith in an institution.

"This is something that's really difficult for all us survivors."

Leonie Sheedy from the abuse survivors' advocacy group, CLAN, has also renewed the group's call for Cardinal Pell to appear before the inquiry in person.

"I think that Cardinal Pell's integrity and reputation is zero, it's in tatters — but he has a chance to redeem himself by getting on a plane and coming back to Australia," Ms Sheedy said.

Push for Cardinal Pell's medical report to be released

Paul O'Dwyer SC, a counsel for abuse survivors, renewed his application for the Cardinal's medical records to be made public.

"If the Cardinal relies upon a medical report, the contents of that medical report — even given what your honour has revealed — are not open to public scrutiny. In our respectful submissions, they should be," he said.

However, Justice McClellan turned down the request.

"I have sought to balance everyone's interest, but I repeat to you again, what I have given you in my reasons is the critical elements in that report," he said.

The medical report said Cardinal Pell was suffering from hypertension, ischemic heart disease complicated by a previous myocardial infarction and cardiac dysfunction related to the hypertension and ischemia.

The commission has also decided that Bishop Mulkearns should give evidence.

The Bishop, who was in charge of the Ballarat diocese from 1971 to 1997, has bowel cancer and is receiving palliative care.

He will give evidence by video link from the aged care facility where he lives or the court house at Ballarat where hearings will be held later this month.