Thousands of patients undergoing treatment for strokes and fractures have been charged for hospital care despite having medical cards, The Irish Times has learned.
The Health Service Executive (HSE) has confirmed that patients receiving treatment in acute rehabilitation units throughout the State were charged a maintenance fee even though health legislation stipulated that people with medical cards were to receive free treatment.
The error, which the HSE estimates affected up to 6,000 people, occurred because health service managers believed that these patients, most of whom are over 65, were liable for maintenance charges.
A spokeswoman for the HSE said it appeared a decision had been made, following the 1976 Supreme Court judgment, to include patients receiving rehabilitation in acute wards in geriatric homes in the levying of charges after 30 days inpatient care. As a result, people still in receipt of active treatment were charged 80 per cent of their pension in contravention of the 1970 Health Act.
The HSE was unable to say with certainty last night how many patients were overcharged for rehabilitation and how long the overcharging had gone on for. The spokeswoman said the practice had now ceased and that all money would be refunded.
However, a leading geriatrician last night questioned the HSE total of 6,000 people affected by this decision.
The specialist said the problem stretched back to 1987 at least, and in one former health board area alone accounted for 400 patients every year. As the charging only ceased at the end of 2004, the consultant estimated that over 7,000 patients may have been affected in each former health board in the State.
While the total amount improperly charged remained unclear last night, a demand notice sent to a patient in 2003 (for a 16-day period) by the Mid-Western Health Board, which has been seen by The Irish Times, amounted to €270. Sources in the health service said it would not be unusual for a stroke patient to require 60 days rehabilitation, 30 days of which would have been incorrectly charged for.
They estimated that a typical patient may have been billed for up to €600.
Commenting on this practice, Dr Ken Mulpeter, chairman of the Irish Society of Physicians in Geriatric Medicine, said: "if patients are not admitted for long-term residential care then the rules regarding billing should be the same as applies in acute hospitals.
"We have grave concerns that patients admitted to community facilities with illnesses such as stroke requiring prolonged rehabilitation will be charged after 30 days, whereas such charges would not be raised if they were admitted to a general hospital," Dr Mulpeter said.
A spokesman for the Minister for Health said that Section 4 (b) of the 2005 Health Amendment Bill, which is making its way through the Oireachtas, exempts "a person in a hospital for the care and treatment of patients with acute ailments" from hospital charges.
Dr Christine O'Malley, consultant in geriatric medicine at Nenagh General Hospital, said the legislation must specify that necessary hospital treatment is free to all, regardless of age or the type of hospital the treatment is given in.
Case history: one patient's story
Susan ( not her real name) is 81 years old and lives at home in Co Tipperary. On Christmas Eve, 2002, she fell and was admitted to Limerick Regional Hospital with a fractured hip.
After two weeks she was transferred to the Hospital of the Assumption in Thurles for intensive rehabilitation. She was admitted there under the care of Dr Christine O'Malley, consultant geriatrician.
Susan improved with treatment from a team of occupational therapists and physiotherapists. She was then briefly admitted to Nenagh general for an unrelated acute medical condition before returning to Thurles hospital to complete her rehabilitation. Having relearned how to walk and care for herself she was discharged home three weeks later.
On May 7th, 2003, Susan received a bill from Thurles hospital requesting €270.56 for maintenance charges for the period February 4th to February 20th.
Her daughter queried the bill with the Mid-Western Health Board pointing out that her mother had not been resident in a long-stay bed but had been receiving treatment in the hospital's acute rehabilitation unit.
In the meantime, Susan received a final demand for payment on May 23rd advising her that non-payment in seven days would result in legal proceedings. Her daughter received a reply to her query on June 6th, 2003. It explained the charge was based on Susan's weekly pension less €32 a week "comfort money".
Susan did not pay the bill and received no further correspondence.
Dr O'Malley told The Irish Times that charging a patient for rehabilitation is worse than charging for long-term care. "If you are in long-term care you no longer have to maintain a house. Rehabilitation is part of medical treatment in hospital and hospital care is supposed to be free."