Medical profession

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What a very curious statement made under privilege in the Senate by independent senator John Crown (See full statement below).

The senator makes extremely serious allegations not just against staff at St. Vincent’s hospital where he works as a consultant oncologist but also against staff in other organisations.

The senator’s statement is curious because of its timing.

Eleven years ago in 2002 Crown discovered that staff of the hospital had been deliberately and fraudulently charging private health insurers in respect of cancer drugs which had been provided to that institution for free.

He notified the relevant authorities, the Irish Medicines Board at the time. An investigation began but was inexplicably stopped and reformatted several days later.

And there, it appears, the matter was laid to rest.

Now, eleven years on, the senator suddenly feels the need to have the matter further investigated.

He claims that new documents that have recently come into his possession and the increased scrutiny of the Public Accounts Committee are the reasons for his new enthusiasm for an investigation.

But there’s something not right about this sudden enthusiasm for further investigation.

For example; senator Crown tells us that he has long been troubled, on many fronts, about how his hospital and other hospitals do their business.

That’s a wide-ranging allegation apparently covering many matters in many hospitals. We need chapter and verse from the senator on exactly what matters and what hospitals he’s referring to.

The senator also needs to answer some other questions; for example.

Why didn’t he pursue the very serious allegations of fraud in 2002?

Why, when the Irish Medicines Board effectively stopped investigating the matter, didn’t he report the matter to other authorities like the Gardai?

Was he the one that suffered substantial intimidation at the time? If he was, did he tell anybody about it, did he make a complaint?

If not him, then who and what action, if any, was taken by him or other relevant authorities?

Why, given that the senator is not exactly shy about speaking his mind on a whole range of matters, has he remained silent on this matter for so many years?

We need a much fuller account from the senator otherwise it may look like he’s a rat abandoning a sinking ship as the allegations of corruption and scandal continue to spew from the health/charity sector.

The senator’s statement:

It is a matter of record that I have long been troubled on many fronts by the way in which the boards of my hospital in particular and of other hospitals do their business.

I would like to personally disassociate myself and any research organisations that I have the privilege of running from any connection with St. Vincent’s hospital group or the St. Vincent’s hospital foundation.

It will become apparent that the board of St. Vincent’s hospital does not enjoy my confidence.

This began in 2002 when I discovered that members of the staff of the hospital had been deliberately and fraudulently charging private health insurers in respect of cancer drugs which had been provided to that institution for free.

I notified the relevant authorities, the Irish Medicines Board at the time, an investigation began and inexplicably stopped and was reformatted several days later.

Documents have recently come into my possession which I’m quite happy to discuss and share with the minister for Health because they refer to money that was fraudulently taken from the VHI of which he is the sole shareholder and of other private insurers.

Documents that show conclusively that there is a cover up conducted by the management and board of St. Vincent’s hospital in respect of this.

Substantial intimidation was brought to bear at the time the whistle was blown on this ten years ago but I believe in light of these new documents coming my way and in light of the increased scrutiny of the Public Affairs Committee it is now time for this matter to be further investigated.

And I’m asking the leader to bring this to the attention of the minister.

Thank you.

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Liveline (Friday) had some interesting calls last week regarding the fees charged by medical consultants. Here’s an example.

Margaret noticed some lumps on her arm. Her GP had no idea what they were but charged €55 before referring her to a consultant. The consultant had no idea what the lumps were but charged her €230 before referring her to a surgeon who would be charging €150 just to have a chat. So, €435 and Margaret is none the wiser about the lumps on her arm.

It reminds me of the old strip club scam (I, er, read about this someplace).

The customer arrives at the club and is charged, say, €20 before being led into a small bar where he is encouraged to buy some very expensive drinks. Where’s the action he pipes up? Oh, that’s in the club proper, it’s just an extra €50.

He’s then led into an even bigger bar where the expensive drinks become very, very expensive. By this time the customer is drunk and becoming impatient and very angry. The bouncers arrive, give him a good thrashing, rob his wallet and throw him out the back door.

Yes, I think that’s a pretty accurate description of how certain parts of the Irish health system operates.

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Letter in yesterday’s Irish Times.

Madam,

The National Treatment Purchase Fund (NTPF) has a budget of of €100 million in taxpayers’ money for 2008.

According to the NTPF’s latest report, some 20,000 “in-patients” were treated in 2007 at a cost of €92 million. The report does not provide precise details of the procedures performed or of their individual cost, but at least two-thirds of the procedures listed, such as endoscopy, tonsillectomy and dental extraction, would normally be carried out as day-case procedures, which are relatively inexpensive.

Some 10,000 out-patient consultations and some 2,000 MRI scans were also provided. Excluding the out-patients, the cost per in-patient treated was therefore €4,600. Four private hospitals shared €49 million of the fund.

The Mid-Western Regional Hospital complex in Limerick, which includes three hospitals – the Regional Hospital, the Regional Maternity Hospital and Croom Orthopaedic Hospital – has a budget of €195 million. In 2007, it treated 33,000 genuine in-patients, about 75 per cent of which were emergency cases, of all levels of complexity, and 19,000 day-case “in-patients”; 29,000 new out-patients were seen along with 109,000 review out-patients. Again excluding this massive out-patient activity, the cost per-inpatient treated was €3,750.

There is something radically wrong here. On the basis of these numbers and the case mix, the NTPF figures suggest a waste of, at the very minimum, €20 million.

Those who are committed to eroding our public hospital system in favour of creeping privatisation might take note.

Yours, etc,

Dr GERRY BURKE, Riverside Clinic, Steamboat Quay, Limerick.

The figures quoted in this letter are astonishing and outrageous. The NTPF was originally set up to treat seriously ill patients languishing on long waiting lists. The idea was to treat these patients outside the jurisdiction in order to relieve pressure on a creaking and inefficient health service.

But as always in Ireland the scheme has been corrupted. Here’s how it now works.

A consultant in a public hospital treating a public patient will be paid X amount for his work. If that patient is put on the NTPF list the consultant’s fee is considerably increased.

So, we can have a situation where a consultant, working in a public hospital paid for by the taxpayer, treats a patient in the morning and decides to put him on the NTPF list. The same consultant returns in the afternoon and because the patient is now on the NTPF list and therefore judged to be a private patient the consultant’s fee is multiplied.

As the above letter reveals many of the treatments are not of a serious nature and therefore should not qualify for NTPF. I suspect that the €20 million wastage mentioned is a fraction of the total cost to the long suffering taxpayer.

See here for more on this scandal.

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Fine Gael health spokesman Dr. James Reilly just couldn’t bring himself to admit the reality of his situation on the Marian Finucane Show on Sunday.

It was Dr. Reilly who negotiated the grotesquely greedy deal that saw doctors receive €640 for every patient over the age of 70. Now he’s trying to condemn the Government for attacking the elderly while at the same time defending his part in the deal.

When asked did he think the fee was a valid one he replied:

“I do because it works out at €55 per patient per visit and that is not excessive in my view.”

This was a cynical attempt to suggest that the fee is dependant on patient visits. In fact the €640 is paid whether or not a patient visits. I assume the €55 fee Reilly mentions is an additional fee for every visit making the deal even more objectionable.

On Liveline during the week another doctor moaned about overheads in an attempt to justify the greed. A doctor’s receptionist told me recently that her pay is so low she qualifies for a doctor only card.

Reilly would be better advised to come out straight and admit that doctors, like most other professions in Ireland, have lowered their moral standards in exchange money.

Copy to:
Dr. Reilly

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