On the Motion for the Adjournment, Deputy James Tully gave notice that he would raise the subject matter of Question No. 10 on today's Order Paper.
Adjournment Debate. - Teeth Extraction Fee.
First of all, let me say that I regret the inconvenience which has been caused to a number of people, including the Minister and myself, by asking the House to sit late in order to discuss this Question on the Adjournment but I did so because of the unsatisfactory nature of the reply which I received today from the Minister to Question No. 10.
The Question was:
To ask the Minister for Social Welfare, if he is aware that an insured person under the Social Welfare Acts (name supplied) has been charged a fee for teeth extraction by a dentist (name supplied) on the 8th March, 1965; and if he will take the necessary steps to prevent a reoccurrence of this practice.
The Minister's reply was:
In the case referred to by the Deputy the insured person required emergency dental treatment. Normally an insured person who wants dental treatment completes an application form which can be obtained from any dentist on the Department's panel. Such application form on which the particulars of the treatment required are entered by the dentist is referred to the Department. If the necessary contribution conditions are satisfied and the treatment is deemed necessary for dental fitness the application is approved and the dentist and insured person are so informed. In the case of emergency treatment such a procedure may not be possible and the dentist is at liberty to give the required treatment without reference to the Department. However as the insured person at this stage has not been formally qualified for dental treatment and as no liability would rest on the Department if it should transpire that he was not so qualified, it would not be feasible to compel the dentist to give the treatment under the dental benefit scheme. It is, in fact, the type of case in which the good will of the participating dentist must be relied upon. As the number of cases giving rise to complaint is extremely small I do not consider that any special action affecting all participating dentists is called for; I shall, however, have the matter further examined.
This position has arisen because of the fact that a workman, on 8th March, got a violent toothache while at work and received permission from his employers to go to a local dentist who was on the approved list of the Department. He went to the dentist, was met by a receptionist whom he told that he required treatment. She took him in to the dentist. He had two teeth extracted. On his way out he was asked by the receptionist if he was an insured person. He said he was. She then gave him a form, told him to fill up the form and gave him an appointment for further treatment approximately a month later. She then asked for 35/-. He said he was under the impression that being an insured person, he did not have to pay the 35/- and she said the 35/-must be paid. Any of us in the same circumstances, if we had the 35/-, would probably do what that man did. He paid the 35/- for the treatment and he went home, filled the form and sent it to the Department. The form is Form D. 2 Rev. and on it it is stated for the information of the dentist that if the person presenting this form is qualified for dental benefit under the Dental Benefit Scheme, treatment may be undertaken without prior approval, provided that it is not major dentistry that has to be carried out.
The Department notified him, and the dentist, I presume, that he was entitled to free dental treatment and, despite that, the dentist refused to repay the 35/-. The man concerned wrote to the Department and gave the details which I have just recounted to the House. He wrote on 22nd April and on 6th May he got an acknowledgment and on 27th May he got this gem of a letter:
With further reference to your letter of the 22nd ultimo I am directed by the Minister for Social Welfare to state that the question of your treatment as a person insured under the Social Welfare Acts appears to have arisen only following the completion of the extraction of your teeth. In these circumstances the Department is not in a position to be of assistance to you in the manner requested.
What the Department suggested in this letter was that because the man who was suffering from a raging toothache did not point out to the receptionist that he was an insured person before he had the teeth extracted the Department were not going to force the dentist to refund the money which he had got.
Why did the dentist not refund the money? The answer is quite obvious. The charge for extracting two teeth was 35/-. I understand the Department pays for the same operation 14/-. So, in fact, the dentist got 21/- more than he would have got if he carried out the system under the Department's scheme.
The reason I have asked the Minister to come in here tonight to discuss this matter with your permission, a Cheann Comhairle, is that I believe there is a nasty little racket being built up, not by all the dentists, as the Minister says in his reply, but by a small group of dentists who are, in fact, taking advantage of human suffering for the purpose of earning a few paltry shillings.
The State lays down the amount of money which it is prepared to pay to a dentist for this work and we have this person who apparently has agreed to accept that and wants to get something more out of the insured person's pocket. The Minister says it is only an isolated case and there are not so many people involved in it and therefore it is not a matter which the dentists should be notified about. The trouble about it is that if the answer which the Minister gave here today passed unchallenged it is quite possible that people in the position of that dentist would get the impression that there was nothing at all wrong with it and it would be there as a precedent that in this House the Minister had stated that it was not a matter of very great importance.
I know that the Minister will probably say it was only a matter of two teeth and the extra cost for two teeth but I am sure he will agree with me that an extra 21/- to an insured person who is already paying insurance for this type of benefit is far too much to pay. Those of us who have from time to time suffered from toothache would be prepared to pay anything to get rid of the pain and the tooth but that should not be taken advantage of by the dentist who wants to get a few extra shillings.
I am informed that this is not an isolated case with this particular person and that, in fact, others have complained of similar treatment. The Minister may ask why did not they complain to him. Here is a case where the full details have been given to him and a representative of the person concerned called on the dentist, explained the position, explained what the requirements were and asked for a refund of the money and in that case he was refused.
I suggest to the Minister that this is a matter which could become serious and his solution to it, and the only solution to it in a case like this, is that the dentist should be removed from the list of approved dentists. There is no reason why somebody who does something like this should be allowed to remain on the list of approved dentists. If the Minister does that, it will be an example to those who might be tempted to do the same thing. This is just a case of an extra 21/-. I am quite sure that if the man happened to be unfortunate enough to have required treatment for more than two teeth, the amount would have been very much greater.
There is no reason why the Minister should not stamp out this once and for all. The documents which were sent out by the Department of Social Welfare, the explanatory leaflet which I am sure the dentist knows all about, SW 17, the various booklets, S.W. 4 which are issued by the Department every year and kept up to date—all these things must be well known to the person concerned and I suggest to the Minister that there was a deliberate attempt to outwit his Department by an individual who wanted to get some extra money. The way to prevent a recurrence is to ensure that this particular case is dealt with in the proper way, that the dentist is forced to refund the money which he got from this insured person. If he is not prepared to do that he should be informed that he is no longer a person who may carry out dental treatment under the Act.
It is all right for the Minister to come into the House at Question Time, give a rather lengthy answer to a question and conclude by saying: "I shall, however, have this matter further examined." When I asked a supplementary question of the Minister, he said I did not know the facts, that the information I had was entirely incorrect. However, he himself admitted in his reply that it was this morning that he looked at the reply to the question; in other words, all he knew about it was the information supplied to him in a brief which he did not read until today. I have the whole file here and I am prepared, as I told the Minister at Question Time, to make this available to him so that he can have this matter fully investigated. The Minister apparently was not prepared to adopt that line. That being so, I had no option but to ask him to give a further explanation here tonight after the matter had been fully explained by me.
Again, I make the offer to the Minister. I have all the particulars here, including letters from the Dental Association, which the Minister can have if he wants to further his examination. I shall not be satisfied until I am assured that this sort of thing will be stopped once and for all. I do not want the comment that it is not a serious matter, that it is only a matter of two teeth and 35/-. It is a matter of principle. If the dentist concerned is allowed to get away with this, it will be repeated not alone by this person but by others. This man stated, I think to the Minister and most definitely to the Dental Association: "I may mention that from conversations with my friends I have since discovered that they also have been treated by the same dentist in the same way and have had to pay him sums for dental treatment where the Department of Social Welfare would have accepted liability." The reason the liability of the Department of Social Welfare is not accepted is, obviously, that the Department's scale is not as high as that being charged by the dentist to the individual.
The Minister should see to it that this racket—and there is no other description for it—is stopped. I do not want to detain the House. If the Minister wants any further information about this case, I shall be only too glad to have that information made available to him.
I should, perhaps, first correct one misapprehension under which Deputy Tully apparently is labouring. He stated that insured persons pay insurance in respect of this benefit. That is not correct. This is a benefit which is given free and there is no element in the insurance stamp covering it.
They must qualify with the number of stamps.
But they do not pay anything in respect of this benefit.
That is only a quibble.
It is of no practicable importance so far as this case is concerned. There is no doubt that the person about whom this question was asked was an insured person and that he was qualified according to the regulations for this dental benefit. However, it is only possible to operate a scheme like this on the basis that the dentist is entitled to know beforehand that the patient who claims this dental treatment under the scheme is qualified for it. That is fairly obvious. It is surely unreasonable to expect a dentist to treat everyone who claims to be qualified for dental treatment without payment in the hope that his claim will turn out to be correct. The Department can pay only in respect of those people who are qualified in accordance with the regulations and if dentists treated indiscriminately people who claimed to be qualified they would obviously be at the loss of the fees in respect of patients who proved not to be qualified.
The dentist in this case claims that these extractions were performed on a private patient basis and that there was no question of insurance until after the event, that in fact, the only context in which the question of insurance was raised was when it was raised by his receptionist who inquired from the patient as to whether he was insured in connection with further dental work which was deemed to be necessary. Contrary to what Deputy Tully implied in his supplementary questions here today, this is confirmed in the insured person's letter to my Department which states:
With reference to my recent application for Dental Benefit I wish to inform your Department that on the 8th March, 1965, I obtained time off from my employment and called, without appointment, at the surgery of——
This particular dentist
—as my teeth were giving me trouble. I had two teeth extracted during my visit, after which a Receptionist inquired if I was a Social Welfare case, and I stated that I was.
That confirms, as I said, what the dentist claims, that the question of insurance was not raised until after the extractions were made. It must be obvious that in cases where emergency dental treatment like this is required we must, of necessity, depend on the goodwill and co-operation of the dentist and, as I said, it is only very seldom that trouble arises in this regard. In this case, since the patient proved later to be qualified I had hoped, as I indicated in the last sentence of my reply to Deputy Tully here today, to obtain the co-operation of the dentist involved in having these extractions dealt with under the dental benefit scheme. I do not think that Deputy Tully's handling of the matter will be helpful in this.
Would the Minister answer two questions? If, as he says, it is not possible to give treatment to people unless there is prior notice of the fact that they are insured, why is this form D.2 Rev. issued by his Department? Secondly, is there a different type of treatment given to private patients from that given to those who come under the Department's scheme?
I am not a dentist. Question Time was at 3 o'clock today.
The Dáil adjourned at 10.50 p.m. until 10.30 a.m. on Thursday, 24th June, 1965.