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Dáil Éireann debate -
Wednesday, 18 Jul 1973

Vol. 267 No. 8

Adjournment Debate: Medical Card Patient.

I have a motion on the Adjournment which we would be taking normally at 10.30 p.m. If the appropriate Minister and Deputy O'Connell are ready we will take it now. We will await some order in the Chamber. The Chair is anxious that order would be restored as quickly as possible so that we can get on with the motion on the Adjournment.

I am raising this subject on the Adjournment because I consider it to be an important matter of principle. I think I will await a little order.

The Chair is anxious to secure good order.

This is a matter of principle which I brought to the attention of the Minister, the right of a doctor to prescribe what he considers is in the patient's interest. This medical card holder was an old lady living alone and suffering from cancer of the gullet. She was not able to swallow solid foods. I felt obliged to prescribe a food or nutritional substance which is a medicinal product and which I thought should be prescribed to keep this patient alive. I was told by the health board that this could not be done. I challenge the right of an official of the Department to question my right to prescribe that product, when I feel it is in particular circumstances a drug or medicinal product and not a food. I explained to the Minister on a number of occasions the reasons why I have the right to prescribe this product.

I have heard over and over again exhortations to doctors to keep patients out of hospital. Where possible patients should not be admitted to hospital if they can be treated at home. Had I admitted this patient to a hospital for treatment with this product it would have cost the State from £56 to £112 per week. I asked the Minister, the Department, and the health board, if I could prescribe the same product and keep the patient at home at a cost of 75p and I was told I could not. That is ludicrous in the extreme. It shows the way the system works in the Department. They cannot see the logic of it. It makes fools of us and will discourage me from doing anything to help reduce the cost of hospitalisation for patients. As I said, the cost of this food would be 75p per week. This would not be an abnormal burden on the Exchequer but it would have meant a lot to this particular patient.

The question in the mind of the Department and, indeed, in the mind of the Minister is whether this is a food or a medicine. To me that is a very relative point. In certain circumstances a food is a medicine. This particular food is a mineral and nutritional supplement. I cannot accept the argument that this is a food when foods are allowed for certain other medical conditions, one of which is PKU or phenylketonuria, where a special food diet is allowed under the medical health services. The Minister cannot say that there is no precedent for this because there is this specific condition to which I referred, phenylketonuria, the food is used to keep the patient alive, and this is permitted under the Health Act.

In this case it was necessary to keep the patient alive and I felt justified in prescribing it and I am annoyed that I was not allowed to do so. The Minister is upholding this stupid regulation. What makes this more ludicrous is that there are two other products of equal caloric value, of almost equal nutritional value, and of equal value as a protein, which I could have prescribed but for the fact that they nauseated the patient and she could not tolerate them.

The Minister said that there is a danger of abuse. To me that is an insult. I accept absolute responsibility when writing prescriptions. If the Minister checks with the health boards he will see that I could never be accused of over-visiting, or of having too many consultations or making any charges on the health boards for anything I prescribe or dispense for medical card patients. He could never make that charge. Because of this I feel doubly annoyed—because the Minister said that there is a danger of it being abused.

The people to whom this product could be given are people in a bad state of malnutrition. It was given to supplement their food, it was given to people who suffered from a bad lack of protein which in itself is a deficiency and a disease, per se. It is a specific condition requiring specific treatment. This is the condition for which I attempted to prescribe this product. The Minister has said it is a matter for home assistance. I bow to no one in regard to my prescribing rights, my evaluation and assessment of a patient's needs and I do not think I should be forced to bring this to a home assistance officer to get him to make a decision. I consider it very wrong and I will never abide by that stupid, ludicrous ruling. I do not think I should have to bring this case to a home assistance officer to know whether he would decide if this product should be used for the patient.

Hear, hear.

It makes the whole thing ludicrous and, as I have said, it is an insult to my intelligence; it is an insult to my experience and qualifications that I should have to do this. I will not delay the House on this matter. I reluctantly brought it up because of the unsatisfactory nature of the reply and the unwillingness to have the matter investigated as a matter of urgency. As I have said, that patient of mine will never need it again, no matter what decision the Minister makes in this case.

However, unfortunately it arises often in cases of old people and I think we are being small-minded if we think people might abuse it. This product would give old age pensioners a protein supplement. It is for the benefit of old age pensioners who are medical card holders. It costs between £56 and £112 per week to keep such a patient in hospital for treatment of the same condition. It makes a laughing stock of the regulations and of the Minister's decision and I should like to know now what the Minister and his officials will do in the light of this. I would ask the Minister whether I should bother to keep patients out of hospital when I meet situations like this, or should I just disregard the whole thing and admit them to hospital at £112 per week?

I will be very brief. Years ago I remember reading one of those intellectual articles by the present Minister for Posts and Telegraphs in which he stated that one of the characteristics of this country which would probably die a sudden death was our sympathy for people—that sympathy would probably die with increasing provision for under-priviledged people, people in bad health, people in bad social and economic circumstances. When I read that I was perturbed because if there was one aspect of life in this country which I had hoped would live and survive it was that of sympathy with the sick, with people in difficulties of one kind or another, whether through their own fault or outside their fault, whether for reasons for which they could be exculpated or for reasons in which they were culpable.

When Deputy O'Connell made his case about a person who was suffering from what he called terminal cancer, "terminal" being a shocking word as far as we who are concerned with the living are concerned, I thought this was the case of "Bumbledom" at its worst, officialdom applying rules and regulations to the detriment of persons who will not be long in this life. A person with a medical card apparently cannot take solid food. A certain substitute for solid food was prescribed by a qualified medical practitioner who happens also to be a Member of this House. I am sure he is not taking this case up other than as something between himself and his patient. This was not allowed under the regulations. I think there is enough humanity in the Minister and his Parliamentary Secretary to waive the rules and to accede to the request by Deputy O'Connell.

I want to make it clear from the start that I did not mention the word "abuse", that I was not the first to use the word "abuse" in the supplementary replies which I gave today.

The Minister mentioned it to me privately——

If we are going to report all our private conversations I think we had better do all our business in the House.

Maybe we had better.

In a supplementary question today Deputy O'Connell said that certainly a doctor would not abuse this power to write such a prescription for an old age pensioner with a medical card and I said:

I am not saying that any doctor would abuse. I am merely saying that under the Health Act, 1970, section 59....

I do not say it would be abused by any doctor because I do not think any doctor would behave in that way. Neither do I deny any doctor the right to prescribe. Deputy O'Connell has the qualifications, he knows the law as far as medicines are concerned and he and other doctors, in my view, should be allowed to prescribe in accordance with the laws.

I want to——

Order. The Deputy had his opportunity to make his case and he will please allow the Minister to reply without interruption.

As far as I am concerned I would not deny to any medical card holder a drug, a medicine or anything else that might alleviate suffering to keep him or her alive, and I resent any suggestion or any innuendo or any inference to the effect that because of any inaction of mine somebody suffered or somebody died.

There is no disagreement on this matter with Deputies O'Connell and Wilson. I am not one to quote the law and stick to it rigidly, but under the 1970 Health Act, section 59, only drugs and medicines can be prescribed. It is not possible for me to have a product like that referred to by the Deputy prescribed as a drug or a medicine because all the evidence I have is to the effect that it is not a drug or a medicine. It is a food. The practice up to this, as far as I know, has been that if a doctor recommends this particular product it can be made available through the health boards, through home assistance officers or through public health nurses.

I know people regard it as a stigma to have to go to home assistance officers, although we must appreciate the importance in the community of home assistance officers. I said this is a food and I made some inquiries. I sent some of my officials to make investigations in order to make it abundantly clear to me that the reply which I was giving to Deputy O'Connell, in private and in public, would be in accordance with the information that was given. This product is described on the packet as a milk-based balanced food. In the advertisements it is described as a meal in a cup. No matter what it is, it is available through the health boards and recently the Eastern Health Board made a special financial allocation to ensure that this product would be made available to people such as those described by Deputy O'Connell.

In the Eastern Health Board public health nurses visit such persons as have been mentioned and if it is decided by the doctor or if it is the opinion of the public health nurse that this product should be given and it is the only one that could be consumed and digested then it is freely given. Many cases which might heretofore be referred to assistance officers will be covered now without reference to head office.

I understand the concern of Deputy Dr. O'Connell and the concern of Deputy Wilson. I also have a deep concern for people like this but I do not want to be, and I will not be, put in a position where it is inferred that I have been responsible for suffering or anything else as far as any person is concerned.

So, therefore, where the doctor is of opinion that this product or similar products are absolutely necessary to a patient I give this guarantee as far as all the health boards are concerned because I will see the CEOs next week about it to give them strict instructions that where this is recommended by a doctor it will be made freely and quickly available. That is as much as I can do within the law, but if I think there is occasion to change the Act of 1970 to provide for what is suggested here I will have no hesitation in doing that.

The Dáil adjourned at 9.12 p.m. until 10.30 a.m. on Thursday, 19th July, 1973.