ROTUNDA MATERNITY HOSPITAL consultants in multiple departments who were employed on public-only contracts billed private health insurers for treatments provided to patients.
This included doctors who were appointed directly onto the new public-only consultant contract, and therefore did not have a ‘transition period’ to phase out private care.
These billings related to one-off clinical services provided to women giving birth at the hospital and to newborn babies. The practice has now ceased following the row over payments to obstetric consultants.
Anaesthesiologists who administered epidurals and assisted in caesarean sections, and paediatricians who examined newborn babies of private patients, were among those permitted by the hospital to invoice insurers individually for their work.
A spokesperson for the Rotunda Hospital said it disclosed the practice of such payments following a request for information from the HSE on 8 June.
A Department of Health spokesperson, however, told The Journal that is not “aware of” and “would not condone” any arrangements whereby “one-off billings to private insurance firms were being made by consultants on Public Only Consultant Contracts (POCCs)”.
They added that the Minister for Health, Jennifer Carroll MacNeill has made it “very clear” both publicly and “directly to the Rotunda Hospital” that public-only consultants “are not permitted to engage in private practice within public hospitals”.
Spokespeople for both The Coombe Hospital and the National Maternity Hospital told The Journal that no consultants on public-only contracts billed the private insurers of patients in this manner for these services.
Public-only consultants in the Rotunda who engaged in this practice were told the billing arrangement was permissible by the hospital.
The hospital confirmed to The Journal that payments from insurers were made directly to consultants and that it did not receive any share of the fees.
It said the arrangement reflected its interpretation of the public-only contract and has since been terminated for all doctors.
The Rotunda also told The Journal that details of the practice had been provided to the Department of Health following the HSE request.
The previous dispute between the hospital, the Department of Health and the HSE centred on obstetric consultants on POCCs continuing to provide private maternity care to patients.
A breakdown of private fees on the Rotunda website shows a €539 fee for a caesarean section, an anaesthetic fee of between €350 and €400 and a pathology fee of €100. Each are marked as “if insured, payable by insurance”.
Women are also asked to add their baby to their insurance policy if choosing ‘private’ care “as babies take the status of the mother unless requested to be treated publicly”.
Row over care provided by obstetric consultants
The hospital became embroiled in a row with the Department of MacNeill after the Master of the Rotunda, Professor Seán Daly, told the Oireachtas Health Committee in late May that consultants on POCCs were still providing pregnancy-related private care.
He argued that this was being allowed as there is no private option otherwise for maternity care in the Irish state, and said that women “should have choice”.
Jennifer Carroll MacNeill ended up warning the hospital that it may have its funding cut if it didn’t comply with the terms of POCCs, which restrain doctors signed up from carrying out private practice on the hospital’s premises.
The HSE also warned Daly that if the practice continued, it would be a “manifest breach” of the service level agreement between the Rotunda and the Health Service, which provides the majority of its funding to the tune of over €70 Million each year.
The hospital backed down last Tuesday and agreed to fully revoke permissions.
Yesterday the Dáil heard that a number of public-only consultants in multiple maternity hospitals have been given “gifts” from their colleagues providing private care, for providing services to their patients on the weekends.
A spokesperson for the Department of Health told The Journal: “It is the Minister’s expectation that all hospitals and all consultants are fully compliant with the terms of the contract. Where practices have arisen that are not consistent with the contract, these must cease immediately, and steps must be taken locally to ensure full compliance without delay.”
They added that the HSE is now undertaking a comprehensive review across all public hospitals to ensure adherence to the POCC.
“The HSE will take any actions necessary to address issues identified and to ensure consistent implementation nationwide. The focus is on ensuring full compliance across the system,” the spokesperson further said.