Medical Card treatments on hold ?

fionab2010

Hi,

I went to see my dentist yesterday, i have a medical card and am recieving jobseekers allowance.
I arrived for my appointment, at 9am, and i was seen and given two injections to start my treatment.

During this the nurse came in and spoke to the dentist in private. The dentist came back and told me she was very sorry, but the hse dental office/dental surgeons office, were on strike, and they were told on the phone that dental treatment on medical cards was being abolished. So she had to stop work on me,until she had official confirmation because if the medical card is being pulled whe would not be paid by the hse for my treatment.

She aplogised for already giving me the injections, and told me we could carry on and continue my treatment, and then she could find out after lunch when the strike was done, if it was true and if i would have to pay her. I need 4 fillings at a cost of €80 each, i recieve 196 euro per week??? Also i have a medical card which means i can't pay.

I had to go home with no treatment. I watched the 9 o clock news last night, but i saw nothing about what i experienced and was told, all that was on was a story about medical card applications being centralised and that talks were being held today.

The dentist explained why it was such a big deal. She said if she treats a medical card patient, she gets paid 4 months later and she also said that sometimes the hse do not pay them.

Can anyone shed any light on this ? I am in limbo at the moment and i don't know what's going on. All i can do is keep in touch with my dentist, read the paper and watch the news.

fionab2010

I just found this artical on dentist.ie, so i gues it has all started.:(:(

This chaos is also of great concern for dentists who wish to offer the highest standard of dental care to patients who currently have the greatest need for such care and treatment.

The HSE has made no effort to communicate changes associated with the centralisation of medical cards to this Association or to individual dentists. No explanation of the separate local and national databases was offered to dentists nor was guidance offered on ways to deal with situations where these databases are not reconciled.

To compound matters, dentists have reported that they are finding it impossible to make telephone contact with PCRS staff members when they make calls on behalf of their patients. We regret to say this is entirely consistent with the experience dentists have encountered for many years in regard to the administration of the medical card scheme for dental patients.

It should also be stated that dentists are being left in an invidious situation where they are being denied payment for services offered in good faith where both the dentist and the patient understand the patient to be entitled to such treatment but where the HSE then disputes this entitlement and denies payment to the dentist and effectively terminates before completion the free dental treatment available to the patient as a medical card holder.

We should also warn that we believe the existing scheme of free dental care for medical card holders is set to be terminated as a result of the decision in the most recent Budget to restrict spending on this scheme to 2008 levels. We believe this will effectively amount to a 30% cut in funding required to meet the needs of medical card holders and we would hope to address the Committee on this matter separately and at your earliest convenience.

Fintan Hourihan
Chief Executive

opinion guy

Regardless of the money issue I'm quite shocked that the dentist wold stop in mid treatment because of a money thing. If they didn't know this before they touched needle to skin then they should have just done it anyhow and taken the hit themselves if thats what happened.

georgieporgy

I think the OP said that the dentist intended to proceed with the treatment provided the patient was willing to pay in the event that the med card would not. The OP was not willing to do that ( it was a money thing to him/her) and elected not to have the work done till the situation was clarified. Nothing wrong with that but it's clear it was the patient's choice.

opinion guy

georgieporgy wrote: »

I think the OP said that the dentist intended to proceed with the treatment provided the patient was willing to pay in the event that the med card would not. The OP was not willing to do that ( it was a money thing to him/her) and elected not to have the work done till the situation was clarified. Nothing wrong with that but it's clear it was the patient's choice.

No its not right to give them that choice after you've already started. They have already gotten injected and incurred whatever slight risk is involved in that (bleeding, infection, nerve damage). Its ethically dubious to stop and make them repeat that risk, however small is it, as you've just found out to HSE are on strike.

georgieporgy

The Dental Council, which is sort of the last word on ethics in Ireland, say that the patient must be fully informed in advance and must then give their assent to having a procedure done. If something happens midway during treatment which may change the original understanding the patient should be informed and their wishes adhered to.

I take it the gist of your argument is the dentist should provide the treatment for free and also foot the costs associated with that. Thats more like the old Soviet Union style ethics which have fallen into disrepute.

opinion guy

georgieporgy wrote: »

The Dental Council, which is sort of the last word on ethics in Ireland, say that the patient must be fully informed in advance and must then give their assent to having a procedure done. If something happens midway during treatment which may change the original understanding the patient should be informed and their wishes adhered to.

I take it the gist of your argument is the dentist should provide the treatment for free and also foot the costs associated with that. Thats more like the old Soviet Union style ethics which have fallen into disrepute.

Fully informed in advance. This wasn't in advance this was after the procedure had already started. It also wans't a treatment issue it was a payment issue. Yes the dentist should have continued with the treatment and dealth with the money issue after - no question about it. And if the dentists had to pay for it. Well so what. It was one patient on one day and she would have known for the next patient

Edit: Ok to take a more moderate approach. The dentist should have at least done something - say one filling, the worst one. That way the patient gets some benefit from their injections and the dentist would not be too far out of pocket. Likely 4 fillings would be done at different times anyhow would it not?

digzy

Why on earth are dentists being targeted. I assume the state pays a lot more to GP's for medical card patients and to solicitors under free legal aid.

Surfing_Xboxer

this is an utter disgrace...post injection then not completing work ??

I am in shock !

Big_G

I am reluctant to weigh in on this one because it might be opening a can of worms but...
I also think it unethical to give an injection and not complete the treatment just because something was misheard on the radio. Even if payments were being stopped I think this a bit unethical.

Medical card payments are, as of yet, not stopping. The money will run out sometime in the middle of the year though. What was heard on the radio was a press conference held by the IDA regarding the current state of the medical card finances. It was an attempt to publicise the potential future problems with the medical card scheme.

This is an extraordinary story.

I must stress that the above statement about the unethical nature of the alleged behaviour of the dentist in the anecdote by the OP is my opinion only. Everyone is entitled to their views on this.

I will be watching this thread very closely.

davo10

Surfing, it's my understanding from OP that information was recieved which potentially changed the agreement between patient/dentist/HSE post anaesthetic. The dentist was obliged legally and ethically to advise the patient of this and to discuss his/her wishes to complete treatment under the new circumstances. OP was offerred treatment with the understanding that if HSE refused to pay, the patient was then liable for remunerating the dentist. What is your issue with this?, if the dentist had continued without discussing the situation with the patient then billed him/her for full amount if HSE did not pay, you would be posting saying that this is disgraceful. The dentist acted absolutely correctly in discussing the change in circumstances as soon as she became aware of them, she offerred an alternative arrangement though not one acceptable to the patient. You should be directing your ire at the Government for removing more of the benefits from the people who most need them at the time they most need thm.

Big_G

digzy wrote: »

Why on earth are dentists being targeted. I assume the state pays a lot more to GP's for medical card patients and to solicitors under free legal aid.

Because dentists are currently the easy target. We are seen as overearners and are not valued by the current government and indeed, many members of the public. I believe this is a failing of the profession.

We are currently working as a profession to rectify this situation and educate the public about the valuable service we provide in maintaining the oral health of the public.

Also, another point to make is why are medical card patients being targeted? Why is there not reform of the medical card system? I currently see a lot of patients with medical cards who have been away on holiday, who are driving a new or year old car, or who frequently can afford private treatments such as bleaching and white fillings on back teeth or braces. Reform is needed so that only the most deserving get the cards and then the service isn't bankrupted by oversubscription and frivolous false demand.

opinion guy

I had a nice big answer all typed out but then boards seemed to go down and i lost it

digzy wrote: »

Why on earth are dentists being targeted. I assume the state pays a lot more to GP's for medical card patients and to solicitors under free legal aid.

Like BigG said they are easy targets. Alot easier to target dentists than Gp's or nurses say - both those groups having alot of political clout - not sure dentistry have the same swing. Equally last year they picked on junior doctors -another weak group. They simply go for the easy targets and those who don't lose them too many votes - which just goes to show you how politics affects the running of things :mad:

davo10 wrote: »

Surfing, it's my understanding from OP that information was recieved which potentially changed the agreement between patient/dentist/HSE post anaesthetic. The dentist was obliged legally and ethically to advise the patient of this and to discuss his/her wishes to complete treatment under the new circumstances. OP was offerred treatment with the understanding that if HSE refused to pay, the patient was then liable for remunerating the dentist. What is your issue with this?, if the dentist had continued without discussing the situation with the patient then billed him/her for full amount if HSE did not pay, you would be posting saying that this is disgraceful. The dentist acted absolutely correctly in discussing the change in circumstances as soon as she became aware of them, she offerred an alternative arrangement though not one acceptable to the patient. You should be directing your ire at the Government for removing more of the benefits from the people who most need them at the time they most need thm.

I see your point. All of this is in keeping with the Autonomy and Informed Consent tenets of medical ethics. But its not in keeping with the non-maleficience tenet of medical ethics. In other words do no harm. The patient was injected and potentially had risk from that (and probably had some pain or discomfort). They should have gotten a benefit from it. I agree that the dentist had to inform the patient it would cost money, but I would put it to you that a more ethically correct way to proceed would have been to offer to do one of the fillings at that sitting, and if it happened that the hse wouldn't cough up then the dentist would absorb the cost just this one time.

As it happens the dentist is out of pocket either way since she won't be getting paid for the four fillings either by the HSE or the patient. It isn't the patients fault this happened so therefore they should not have been punished and should have gotten some benefit for showing up and getting a presumably painful injection.

And as Big_G pointed out all of this is taking the story we are told at face value.

davo10

Opinion guy, I agree "goodwill" should have kicked in and it would have been a nice thing for the dentist to relieve any pain OP was in at no cost. But the ethical argument is wrong and the patient had consented to injection under original agreement, the terms changed so the treatment plan agreement changed.

I'm not in med card scheme so it took me a while to find out last night what exactly the HSE situation is. It's my understanding that all treatments are still being paid for by HSE but may not be later in the year when reduced budget is exhausted.

ballsymchugh

in fairness to the dentist, she stopped before anything irreversible was done.

http://www.independent.ie/national-news/dentists-told-take-cheaper-option-and-pull-more-teeth-2108840.html

opinion guy

davo10 wrote: »

Opinion guy, I agree "goodwill" should have kicked in and it would have been a nice thing for the dentist to relieve any pain OP was in at no cost. But the ethical argument is wrong and the patient had consented to injection under original agreement, the terms changed so the treatment plan agreement changed.

I'm not in med card scheme so it took me a while to find out last night what exactly the HSE situation is. It's my understanding that all treatments are still being paid for by HSE but may not be later in the year when reduced budget is exhausted.

No the ethical argument is not wrong. There are four tenets to medical ethics:
1. Autonomy
2. Beneificence
3. Non-maleficience
4. Justice

For a decision to be considered ethical it is supposed to agree with all four tenets. This situation breaches number 3.

Big_G

You are correct, it does breach non-maleficence but that is the tenet of medical ethics that is breached millions of times every day. It is the principle first do no harm. If we strictly adhered to that one, we would have no surgical treatments whatsoever, very few dental treatments etc.

Its about judging what is reasonable. In this case, in my opinion, I don't think it was reasonable for the dentist to start a procedure and not finish. It is unfair that the dentist may not have received payment, but that is something that needs to be taken up with the hse. Herein lies one of the many problems encountered in a privately contracted public healthcare system.

This type of a system regularly breaches medical ethics including autonomy, justice and beneficience. This is opening a can of worms, I think.

opinion guy

Big_G wrote: »

It is unfair that the dentist may not have received payment, but that is something that needs to be taken up with the hse.

Completely agree

btkm8unsl0w5r4

ballsymchugh wrote: »

in fairness to the dentist, she stopped before anything irreversible was done.

http://www.independent.ie/national-news/dentists-told-take-cheaper-option-and-pull-more-teeth-2108840.html

Coming in late to this thread, but i shocked at the HSE's attitude to Dentistry. Medical card holders are being denied the most basic restorative dentistry (and when the scheme was in full swing the treatments available were basic enough to start with).

The idea that somebody with a medical card should have extractions rather than saving salvageable teeth is beyond unethical. I am sure the recent names changes of various government departments will cost millions alone.

Two solutions. Sort out who really need a medical card and who does not. There are a lot of dental treatment being done for people well able to pay privately. Secondly use the HSE dentists in the Health board clinic to do more treatment for adults. They are salaried by the HSE and by getting more units of treatment, could help a lot.

Also I think that all dental treatment should be 100% tax deductible. Seeing as the irish dental service is becoming 100% private with these cuts at least make it more affordable by giving proper tax relief.

opinion guy

Jeesh only read that article now. Atrocious stuff. Yet more evidence that Harney has been systematically dismantling our health service to push people to pay for private health care if you ask me. Disgraceful.

fionab2010

Hi I am the OP, wow there is alot of interest in this thread. Thanks, i have been reading over all your replies.

I just want to say, my dentist is lovely, but what happened to me i don't think she was being unethical, we had discussed whether i wished to go ahead, she did apologise for not knowing the situation once she started with injections.I think i was very unlucky that my appointment was at 9am, when the dentist opened up for the day and also the hse dental office.

I don't blame dentists, i blame the hse, politicians. Dentists are another casualty at the moment. Everyone is being hit.

I just want to clarify that she asked me would i be willing to pay if she went ahead, and i told her no, not to go ahead because i just cant pay that kind of money. Or falsely promise it either.

She called me yesterday to see how i was and to tell me that she was keeping up with what was happening with dentists and the medical card.

That was a nice thing for her to do, that many wouldn't.

I am just a bit shocked that all dental treatment is withdrawn, and the money will run out the end of this year, what about emergency's ?? How will someone manage if two of there front teeth get knocked out and they need surgery ??

They take so much away and replace it with nothing!!

fionab2010

Apologies Ballsymchugh, I just clicked the link to article outlining everything in the Independant.

Thanks for posting that, I guess my questions are answered.

Ah well, since losing my job there has been one thing after another, i'll put this one in the "just another thing" box.

fionab2010

A little update here, some good news.

I have been looking to get my treatment done since last July 09, and i got tired of waiting so i sought out another dentist. By the time i had all this done, the hse decided to pull dental treatment on the medical card.

So yesterday to my delight, i got a phonecall from my old dentist, who apologised for the delay in my treatment (9 months to day !!!), she said the hse had held things up. My details were wrong on THEIR system and one treatment needed approval, so my files were wavering between two offices for 9 months. My details are correct to the best of my knowledge and they obviously have not updated their file system. Ridiculous, why they strike i don't know. They should be in doing the work they are paid to do on a normal day, god knows what that is because their data entry section are having a grand old time.

The files hopped because of my name, my birth certificate First-Middle-Surname, I am called, since birth Middle-First-Surname. I always get hassle with Tax forms, Drivers license and passports. But that to me is not a good enough reason every individual has 1 pps number.

But anyway, the point, she says she will give me my treatment for FREE because it has been so long and she is very sorry.

So i called the new dentist and she said that was great news.
There are good people still around thank god and professionals.

I have never been so pleased about the prospect of seeing a dentist, i can't wait.

In other peoples cases, dentists may stop treatment on the medical card from the first of April, but i'm sure there are more who will finish treating patients. Just ask and call up and pursue. Best of luck x

day dreamer

Coming in very late to thread as internet access problems
It is the sort of a problem you used to get in ethics class but never thought it would actually come to pass. I can see that the dentist did no harm and as OP fiona says, the dentist did discuss the options with her and follow things up. At the same time the treatment was started by giving the injection.

The HSE needs to sort out the medical card issue. This cut has been on the cards since the budget and nothing definite has come from it since. The med card scheme has been a demand led service so whoever presented could have their treatment and the dentist would be paid accordingly. The HSE wants to cut the budget for this scheme by 30% to levels paid in 2008 but the numbers with medical cards have increased due to so many unfortunatley losing their jobs.

The Irish Dental Association claim that 460,000 less treatment will be carried out if this goes ahead. It is ridiculous to change this mid stream so that a dentist doesnt know if they will be paid and a patient with a Med card doesnt know if they can attend for treatment or not.

We need to make voices heard about the Med Card and PRSI schemes