Terry Leyden (Fianna Fail)
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I have tabled a motion on the Adjournment regarding the situation of a constituent in County Roscommon who is the holder of a full medical card. She was referred by her general practitioner to Portiuncula Hospital in Ballinasloe for a DEXA bone scan on 14 January 2005.

The hospital was purchased by the Western Health Board with the approval of the Department of Health and Children in autumn 2001. As chairman of the board, I had the honour of signing the contract for the purchase of the hospital, which cost approximately €14 million. It was an excellent decision, and it worked very well within the framework of the Western Health Board. It has given the staff of the hospital security they would not have had but for the fact that it was purchased by the Fianna Fáil Administration on the basis that there would be a full public hospital.

I was very surprised, to say the least, when my constituent brought me the bill from something called the consultant radiology group within the hospital for carrying out the DEXA scan on 14 January 2005. That account came to €71. Any public hospital such as Portiuncula is fully funded by the State via the western region of the HSE. All the staff are employed by the State, and all the equipment has been purchased by it. All the electricity and power to run the scanner is supplied by the State. Nursing and ancillary staff are paid by it. However, we hear of the consultant radiology group.

There are serious questions to be asked about this issue, and I seek an answer from the Department, although I know it currently has some other issues with which to deal. This is probably another indication of issues that will arise in future regarding the carrying out of private consultancies in a public hospital, the use of public equipment for private medicine, and the charging of a public patient, who in this case finds it very difficult to find €71. It is a great deal of money to someone on a full medical card, who does not have readily available funds. She was referred by her general practitioner to the hospital, as far as I am concerned on the basis that the scan would be carried out by the State without charge. That was certainly the impression she was under and she was quite surprised to receive the account later in the month. She was also particularly upset when she received a demand yesterday threatening legal action unless the bill was paid.

I do not normally table motions on the Adjournment, since it imposes a cost on the State in having to supply information. However, I felt that a policy area was involved that was of significance to the Department of Health and Children, in which, like the Minister of State, Deputy Seán Power, I served. I am very concerned at this issue. My advice to my constituent is that I do not believe she is legally or morally liable, and I hope the reply is positive in that regard and will give us some information on this practice by a group in the hospital.

Seán Power (Kildare South, Fianna Fail)
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I thank the Senator for raising the matter and giving me the opportunity to clarify it as best I can.

I would first like to outline the basis of eligibility for services. Entitlement to health services in Ireland is based primarily on residence and means. The determination of eligibility for medical cards is the responsibility of the Health Service Executive. Other than for persons aged 70 years and over, who are automatically entitled to a medical card, such cards are issued to persons who, in the opinion of the HSE, are unable to provide general practitioner medical and surgical services for themselves and their dependants without undue hardship.

It should be noted that the guidelines are not statutorily binding, and even though a person's income exceeds the guidelines, a medical card may still be awarded if the Health Service Executive considers that his or her medical needs or other circumstances would justify it. It is open to all persons to apply to the Health Service Executive for health services if they are unable to provide such services for themselves or their dependants without hardship.

It should be remembered that the Health Service Executive has discretion regarding the issuing of medical cards and also that a range of income sources are excluded by the Health Service Executive when assessing medical card eligibility. Many allowances, such as carer's allowance, child benefit, domiciliary care allowance, family income supplement and foster care allowance are disregarded when determining a person's eligibility. Given those factors and the discretionary powers of the Health Service Executive, having an income that exceeds the guidelines does not mean that a person will not be eligible for a medical card, and a medical card may still be awarded if the Health Service Executive considers that a person's medical needs or other circumstances justify it.

Regarding hospital charges, it is the case that, under arrangements for public hospital services introduced in June 1991, on foot of the Health (Amendment) Act 1991, everyone, regardless of income, is entitled to public hospital and public consultant services subject only to modest statutory charges from which those with full eligibility, that is, medical card holders, are exempt.

Private patients attending public hospitals are liable for consultants' fees, which are a matter between the patient and the consultant. In addition, the patient would be liable for accommodation charges as approved of or directed by the Minister under section 55 of the Health Act 1970 once he or she explicitly exercises the option to be treated as a private patient. The requirement that patients make an explicit choice between public and private health care was recommended by the 1989 Commission on Health Funding.

Having made inquiries with the Health Service Executive regarding the case in question, the executive has advised that the individual concerned attended the radiology department in the hospital for a DEXA scan requested by the patient's GP. Furthermore, the charge in question did not emanate from the hospital itself but from the consultant radiology department. The charge was made in the form of a fee demand from the consultant radiologist. The hospital is unclear if the patient was public or private. The matter is being followed up directly with the consultant radiologist involved.

As soon as the position is clarified I will revert to the Senator directly on the matter. As the Senator appears to have all the facts available to him, perhaps he is in a position to clarify the issue I raised.

Terry Leyden (Fianna Fail)
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I thank the Minister for a comprehensive report gathered at very short notice. This patient was a public patient. She was the holder of a medical card who went to her own general practitioner. She had no knowledge that she was being referred for a private consultation. She was quite happy to go to the UCHG or some other public hospital that would provide this particular scan. In the circumstances, I would request the Department to inform the people involved that whatever misunderstanding occurred, it was not the responsibility of my client and it is imposing undue hardship on her. It is also a warning to public patients being referred by their GPs to ensure they are informed that they are being sent for a private consultation in a public hospital. They should clarify that with their GPs. This discussion may be of assistance to other practitioners in the region.

I want to record that the services provided at Portiuncula Hospital are second to none. It is a terrific hospital working as a unit with Roscommon County Hospital and it is better to have this matter clarified publicly in the Seanad. I thank the Minister of State for his reply.