A health board used a debt collection firm to recoup money from people with medical cards who were illegally charged for long-stay care in public health institutions, it has emerged.
The Southern Health Board - now the Health Services Executive (Southern Area) - used Dun & Bradstreet International to collect money from patients in the early 1990s.
The letters threatened court action if the money was not paid within 14 days.
Neither the health board nor the Department of Health could say last night how many people received such letters or if patients were taken to court.
When the matter was raised in the Dáil in February 1991, the minister of state at the Department of Health, Chris Flood, defended the practice.
He said: "The use of debt collecting agencies is a recognised and legitimate means of endeavouring to secure payment of difficult debts.
"Their use by health boards to secure payment of properly due hospital charges, when all other measures of recovery have failed, is justifiable on the grounds that a loss in revenue income from the charges can result in a lowering in the level and quality of the hospital services that can be made available."
Mr Flood said the Southern Health Board used a debt collector for in-patient charges for four Cork city hospitals.
He was surprised to learn that medical card holders were being charged and said these patients and their dependants were exempt from the payment of hospital charges.
Bernard Allen of Fine Gael said at the time that the health board was using debt collection agencies to "intimidate, frighten and harass" medical card holders, many of whom were in their 60s or were psychiatric patients.
In one case he heard of a man in his 60s who received a demand for £228 for psychiatric treatment for his wife, a medical card holder, at St Stephen's Hospital, Cork, several times over a two-year period.
The letter warned of legal action within 14 days if payment was late.
Yesterday Mr Allen said he was "even more shocked" at the health board's actions now given that many health authorities seemed to know then that the charges were illegal.
The Irish Association of Social Workers is aware of many cases where medical card holders who refused to surrender their pension or welfare benefits received demands for payment from health boards.
Patricia Doherty of the association said those threatened paid out of fear that they might not receive treatment if they became ill again.