Dáil Éireann - Volume 508 - 30 September, 1999

Adjournment Debate. - Hospital Charges.

Mr. Gilmore: I thank the Chair for permitting me to raise this matter on the Adjournment. This case concerns a 68 year old pensioner and medical cardholder who underwent emergency open–

heart surgery in the Blackrock Clinic in mid-1998. The Minister for Health and Children is refusing to reimburse the cost of the operation.

The man concerned had been suffering from recurring chest pains and went to see his general practitioner in May 1998. The general practitioner referred him to a cardiologist at the Blackrock Clinic. He was examined by the cardiologist on 21 May and it was decided that he should undergo a stress test which was carried out on 22 May. The patient failed the test. The cardiologist informed him that something was wrong and that he should arrange for an angiogram.

The patient accepted that he had to pay the cardiologist for his professional attendance and for the stress test. These cost £80 and £97, respectively. He further understood that he would have to pay about £1,000 for the angiogram. Because he was by now very concerned about his condition he paid this sum from personal savings and had the angiogram at the Blackrock Clinic on 29 May. About 20 minutes after completion of the angiogram he was informed by the cardiologist that he needed immediate heart surgery and that his condition was so serious that he should be kept in the hospital in intensive care and that it might even be necessary for him to undergo the operation that night.

The problem now was that the surgery would cost about £10,000 and he did not have the money. He discussed the matter with his wife and they decided that they had no choice but to authorise the hospital to go ahead with the operation. The patient was kept in intensive care at the Blackrock Clinic and successfully underwent the operation on 2 June. He has since made a full recovery.

In due course he received a bill from the Blackrock Clinic which was eventually reduced to £10,000. The patient borrowed this sum from his family and paid the bill. He applied to the Eastern Health Board and the Minister for Health and Children for financial assistance towards the cost of the surgery but both refused relying on the distinction which was made in the 1991 Health (Amendment) Act between public and private health care. I have pursued the matter over the past year with the Minister for Health and Children, Deputy Cowen, and there is a sizeable file of correspondence between us. The Minister's argument is that because this patient opted for “treatment in a private hospital he is liable for the costs and that neither the Department nor the health boards are in a position to provide financial assistance towards the costs”.

In normal circumstances this response would [708] be acceptable. However, in this case it is harsh and uncaring. This man did not voluntarily opt for treatment in a private hospital – he had no choice. He was lying on a trolley being told that he had an urgent, life threatening heart condition and that he needed immediate surgery. Who in their right mind would leave the hospital to shop and wait around in the public health system for an admission?

This man needs financial assistance towards his medical costs. The daughter from whom he borrowed the money, and who is living abroad with her own family responsibilities, needs the money back. Had this patient not gone ahead with the operation he might not have survived. Had he survived and eventually been seen through the public hospital system, the State would have had to pay the cost of his care anyway. Indeed, as sometimes happens in urgent cardiac cases, he might have ended up back in the Blackrock Clinic with the State paying the bill.

The distinction between financing the public and private health systems is not absolute as the Minister well knows. Indeed his recent decision to make £50 million available to the VHI is evidence of considerable State assistance to private medical care. This is an individual case and, while I appreciate that there may be departmental worries about creating a precedent, I believe this case is exceptional and one-off. I invite the Minister to investigate this case and to contact the Blackrock Clinic and the cardiologist directly to establish the facts and the bona fides of the case, and to find some way of providing financial assistance to this very exceptional human need.

Minister of State at the Department of Health and Children (Dr. Moffatt): I thank the Deputy for raising this issue on the Adjournment. The hospital involved in this case is a private hospital and receives no funding from the Department of Health and Children. The Minister has no function in the provision of services by that hospital or on the level of charges set by it or its consultants.

Entitlement to health services is primarily based on means rather than payment of income tax or PRSI. Any person, regardless of nationality, who is accepted by the health boards as being ordinarily resident in Ireland is entitled to either full eligibility, category 1, or limited eligibility, category 2, for health services. Persons in category 1 are medical cardholders and are entitled to a full range of services free of charge. Services provided include: general practitioner services, prescribed drugs and medicines, all in-patient public hospital services in public wards, including non-consultant services, and out-patient public hospital services, including consultant services, dental, ophthalmic and aural services and appliances and a maternity and infant care service.

Anyone ordinarily resident in Ireland who does not have category 1 cover automatically has category 2 cover. These non-medical cardholders are [709] entitled, subject to certain charges, to all in-patient public hospital services in public wards, including consultant services, and out-patient public hospital services including consultant services. The current public hospital statutory in–

patient charge is £25 per night, up to a maximum of £250 in any 12 consecutive months. Attendance at accident and emergency departments is subject to a charge of £20 where the patient does not have a referral note from his or her doctor. This charge applies only to the first visit in any episode of care.

Prior to 1991, it was possible for a patient to be treated as a private patient of a consultant and as a public patient of a public hospital. The Health (Amendment) Act, 1991, removed the entitlement to combine public and private elements of in-patient care at the same time. The position now is that every patient is entitled to full public hospital services, including public accommodation and public consultant care. Alternatively, one can opt to be a private patient of both the consultant and the hospital. Any patient, whether a medical card holder or not, who opts for treatment in a private hospital or as a private patient in a public hospital is normally liable for the costs relating to such treatment.

A refund of tax in respect of medical expenses incurred by any individual, his or her spouse, or children, may be claimed by making an application to one's local tax office. Relief is payable on un-reimbursed medical expenses over £100 per person or £200 per family. There are certain expenses which are excluded from the relief. These include costs relating to normal pregnancy, sight testing and advice on routine dental treatment.

However, in view of the circumstances of this case I will ask the chief executive officer of the Eastern Health Board to examine the case on clinical and compassionate grounds as a matter of urgency. That is all I can promise the Deputy but he has made a genuine case and I will look at it again on his behalf.