Consultants hint at retaliation over HSE 'hounding'
War of words over treatment of private patients
CONSULTANTS could withdraw "goodwill" and hold up payments to hospitals from private health insurers in the row over treating private patients in public hospitals, according to correspondence from their professional body.
In an indignant exchange of letters with the Health Service Executive, the Irish Hospital Consultants Association (IHCA) claimed that its members were being "harassed" and "hounded" by the HSE.
It claimed that one consultant's health had suffered a "deleterious effect" after receiving a warning letter from the HSE for treating too many private patients.
The association warned the HSE: "Should you persist in hounding consultants on the basis of a flawed system, which flaws have been pointed out to the HSE on many occasion, then this letter may be used in any action the consultant would wish to take."
The correspondence, exchanged last November, reveals the depth of antipathy between the consultants' body and the HSE over restrictions on treating private patients in public hospitals.
Consultants working in public hospitals agreed to restrict the number of private patients to 20 or 30 per cent of their workload when their contracts were renegotiated two years ago.
The HSE has said consultants are exceeding this limit and it is pursuing the worst offenders. Sixty have so far been sent warning letters demanding that they pay "a financial penalty" into a special training fund. One consultant was reportedly told to pay more than €100,000.
However, the IHCA claims that the system used to measure its members' workload is flawed and it has told members not to pay until an accurate system is agreed with the HSE. The HSE does not accept that the system is inaccurate.
Donal Duffy, the IHCA's assistant secretary-general, intervened last November after learning that the HSE Mid-West was to issue warning letters to consultants who were in breach of the public/private patient ratio.
His letters give the clear impression that consultants could make life difficult for the HSE if it persisted in pursuing doctors.
He wrote: "I cannot assure you of the continued goodwill of consultants in the Mid-West with regard to the reconfiguration project or their ongoing dedication to clinical services in excess of their scheduled commitment."
"I cannot assure you that insurance forms will be signed by consultants if that were to render them in excess of their quota, with a consequent taxation liability without matching income.
"That may have significant implications for the budgetary position in which you currently find yourself."
John Hennessy, the HSE's regional director, accused the IHCA of going against the spirit of the Croke Park agreement.
"Your comments with regard to co-operation with the reconfiguration programme, clinical services and the income-collection initiative would appear to be in conflict with (Croke Park) ... " he wrote.
Mr Duffy said this weekend that the letters were "observational" rather than a threat. He said that many procedures carried out by consultants were not captured by the measurement system and the results were therefore flawed.
He added that the IHCA was still awaiting a response to an offer it made to engage with the HSE.
A HSE spokesperson said: "There is ongoing engagement in relation to private practice but the HSE can confirm that consultants have not withdrawn their 'goodwill' towards reconfiguration."