Hospitals may impose a "reasonable charge" for services provided to road traffic victims who are entitled to compensation for their injuries from insurance companies, the High Court decided yesterday.
However, such payments must reflect services provided to a victim, Mr Justice Geoghegan said.
He rejected a formula proposed by the Eastern Health Board which would have allowed a hospital to charge a fee based on its total annual expenditure divided by the number of bed days occupied in a year - a "general averaging" charge.
In a reserved judgment on an action arising out of an award of damages to a Co Louth man for serious injuries sustained in a road accident, Mr Justice Geoghegan said the courts, when making payments to hospitals in road accident cases, had used "the Kinlen order".
This was a formula decided by another member of the High Court, Mr Justice Kinlen, in a Galway case six years ago. In this case, he fixed the amount to be paid to a hospital at £100 (currently £150) a day.
The issue before him essentially related to the interpretation and implementation of Section 2(1) of the Health (Amendment) Act 1986, which provided that a hospital could "make a charge" for services given to a person receiving compensation for injuries in a road accident.
The issue was whether the formula put forward by the EHB was reasonable and did not contravene the 1986 legislation. If the EHB was correct, then the charge by Dublin's Beaumont hospital to a particular patient would have been about £525 a day.
The particular patient to whom Mr Justice Geoghegan referred was Mr Derek Crilly, of Carns town, Ballymackenny, Drogheda, Co Louth, who was awarded £1.56 million damages arising out of serious injuries he received in a road accident in 1989 when struck by a car at Moyaddy, Co Meath. FBD was the insurer.
Between October 1989 and November 1989 (58 days) and between September 1990 and September 1991 (88 days), Mr Crilly was provided with hospital services by Beaumont.
The hospital board claimed the cost of care and services to Mr Crilly was £34,773 but, under the current High Court rules (the Kinlen Order), the hospital had received only £6,642.
The outstanding balance was paid by FBD, but the EHB and FBD asked that the issue of what was "reasonable" be decided by the court.
Mr Justice Geoghegan said that in Mr Crilly's case, the charge which the EHB was obliged to make was for the actual in-patient services or out-patient services provided to him.
This did not mean there could be no element of averaging because some averaging might be necessary in order to assess a reasonable price. On any reading of Section 2(1) of the 1986 Act, it was difficult to see how a health board would be entitled to charge a patient in Beaumont with a broken toe a daily charge identical to a patient who had to undergo expensive brain surgery.
In his view, the charge under Section 2(1) of the 1986 Act must be a reasonable charge for work done and services rendered.
Insofar as a road accident victim would have received treatment within a particular speciality, some averaging within that speciality would be acceptable.
However, the general averaging contended for by the EHB could not be contemplated as a reasonable basis for a charge unless there was a special provision in the legislation.