asked the Minister for Health on what authority and under what circumstances a local authority hospital is empowered to make a weekly deduction from the pension of an old age pensioner in respect of hospital treatment where the person concerned is the holder of a medical card under the Health Acts.
Ceisteanna—Questions. Oral Answers. - Hospital Treatment of Old Age Pensioner: Pension Deduction.
5.
A person holding a medical card is entitled to receive hospital treatment free of charge from a local authority. This is the position whether the person is an old age pensioner or not; it follows that no deduction may be made by the local authority from the old age pension in respect of the hospital treatment. The relevant statutory authority in this case is subsection (3) of Section 15 of the Health Act, 1953.
Any person, including an old age pensioner, holding a medical card, is eligible, under Section 54 of the Health Act, 1953, to receive institutional assistance, which the Section defines as shelter and maintenance, in a county home or similar institution. Local authorities may require persons receiving such assistance to contribute out of so much of their income as exceeds 10/- a week, such sum as they consider appropriate towards the cost of providing that assistance. The statutory authority for this is contained in Article 12 of the Institutional Assistance Regulations, 1954.
May I take it from what the Minister has said that an old age pensioner holding a medical card, who goes into hospital as an acute case purely for medical treatment and not for shelter or maintenance, will be dealt with in no way differently from any other holder of a medical card and get free hospitalisation?
That is so long as he stays there for treatment.
Does that apply to a mental institution?
I should require notice of that question.
6.
asked the Minister for Health if he will state in respect of a person (particulars supplied) who is an old age pensioner and a holder of a medical card under the Health Acts (a) the total amount of deductions made from her old age pension for treatment in St. Finbarr's Hospital, Cork, (b) the statute or regulation under which the deductions were made, (c) the amount subsequently refunded as a result of representations made, (d) why a full refund was not made, and (e) whether he will now instruct the local authority to adjust the matter.
I have ascertained from the local authority that the pensioner mentioned spent 22 weeks in St. Finbarr's, Cork, which serves as both a County Hospital and a County Home. The answers to the Deputy's queries are as follows:—
(a) The local authority initially required the lady concerned to contribute a total of £16. 10s. 0d., i.e. 22 weeks at 15/- a week, from her income towards the cost of providing her with institutional assistance.
(b) This action was taken pursuant to Article 12 of the Institutional Assistance Regulations, 1954.
(c) A refund of £3 was later made by the local authority on the grounds that for 4 of her 22 weeks' stay the person concerned had received hospital treatment, as distinct from institutional assistance, which means shelter and maintenance. As she was the holder of a medical card, she was entitled to receive such treatment completely free.
(d) A full refund was not made because the local authority regarded the pensioner as being in receipt of shelter and maintenance, and not hospital treatment, during the remaining 18 weeks of her stay. This was provided under Section 54 of the Health Act, 1953. I have already quoted the statutory instrument under which the local authority had power to require the lady in question to contribute to the cost of sheltering and maintaining her.
(e) It is a matter for the local authority to administer the statutory provisions mentioned on the facts as they find them and I have no power to direct a particular course of action in any individual case.
Is the Minister aware that there was no question of providing shelter or maintenance for this person? That was available to her in her own home. Is the Minister not aware that the person concerned met with an accident and suffered a fractured femur and was taken to St. Finbarr's Hospital, Cork, where she received the necessary treatment; that her relations were only too anxious to bring her home when she was cured and that they did in fact bring her home when she was certified as suitable for discharge; that at no time was she in the county infirmary section of the institution; that during her whole stay in hospital of 20 weeks or so, she was in the same bed in the same ward; and that there can be no differentiation between the first four weeks and the remaining period she was in hospital? If the Minister is aware of this, does he not think, in view of his reply to my previous question, that she was entitled to free hospitalisation during her whole stay there? The full facts may not be available to the Minister and, in the light of what I have said, I should like if he would look further into the matter.
The Deputy must realise that the Minister for Health has no function in this matter beyond making the regulations which would cover the provision of shelter and maintenance to persons under Section 54 of the 1953 Act. I think the best thing I could do would be to read an extract from a letter I have received in response to inquiries from the South Cork Board of Public Assistance in which, having recited the circumstances, which are roughly in accordance with what the Deputy says, the letter goes on to state:
As a result of representations made, a refund of £3 was subsequently made in respect of the four weeks ended 20th October, 1958 as the patient was regarded as being at the "acute stage" for this period. A full refund was not made because an old age pensioner who holds a medical card is not eligible for accommodation in a county home free of charge. (He is however eligible for hospital treatment free of charge.) In St. Finbarr's Hospitals there is no hard and fast line between the hospital and county home accommodation. Each case is therefore decided by reference to the condition of the patient rather than the particular bed in which he or she is accommodated. If a patient is admitted for hospital treatment the full amount of his or her pension is refunded to him or her each week for the first four weeks. If he or she continues in hospital for more than four weeks, ten shillings only of his or her old age pension is refunded to him or her for the subsequent weeks. If however it is clear that he or she is receiving hospital treatment for a longer period than four weeks, the application of the general rule is reviewed according to the circumstances of the case and is dealt with on its own merits.
Does the Minister consider it reasonable for the hospital authorities to deem that adequate attention was given in four weeks to such a serious injury to an old age pensioner? Surely it is not suggested that an old person with a fractured femur could have been cured in four weeks and that after four weeks, she was simply getting shelter and maintenance? Surely the doctors handling the case will be able to certify that it would require the full 20 odd weeks to cure that person, that her relatives were most anxious at all times that she should get better as quickly as possible so that they could take her home, which they have now done, thank God. I should like the Minister to look further into this matter because there is an important principle involved in it.
I have no function in the matter beyond what I have already said. The matter rests with the local authority to whom the Deputy's question might be more properly addressed. Indeed, neither he nor I could pass judgment as we are not qualified to do so in a surgical case.
Is the medical card holder to have little or no redress if the local authority fails to implement the Act? Many county managers with impunity disregard the Act passed by this House and the individual person concerned has no redress at all.