ACCIDENT AND EMERGENCY TREATMENT (Payment of fees)

Mr J.B. Jeyaretnam asked the Minister for Health (a) whether the Accident and Emergency department of the hospitals turn away persons if they do not happen to have on them the fee payable for the treatment; and (b) whether the same fee is again levied for repeat attendance at the department for follow-up treatment.

The Minister of State for Health (Mr Yeo Cheow Tong) (for the Minister for Health): Mr Speaker, Sir, I will answer on behalf of my Minister.

Persons requiring emergency treatment are not turned away at the Accident and Emergency Department of Government hospitals if they do not happen to have the fee payable for the treatment. They are given medical attention as soon as possible and a bill is presented to the patient for settlement at a later date.

The Accident and Emergency Departments do not, as a rule, undertake follow-up treatment. Patients requiring follow-up treatment are referred to the Specialist Outpatient Clinics or the Primary Health Care Clinics for attention. However, should the patient return within 12 hours because of a recurrence or persistence of his symptoms, he will not be charged for the repeat attendance.

Mr Jeyaretnam: Sir, supplementary questions for the Minister of State. First of all, he says in emergency cases people who do not have the money are not turned away. Would he say what are these emergency cases where they are not turned away? Will he then concede that there were several cases of people turned away because they did not have the $12 on them? And does this also extend to people coming in with cuts or wounds on their bodies?

Secondly, about the repeat attendance, would he confirm that a similar fee of $12 is again levied for dressings on surgical wounds when they are asked to come back again the next day or the day after, simply for the wound to be dressed? And the question following that is, why is that necessary?

Mr Yeo Cheow Tong: Mr Speaker, Sir, the Member for Anson has asked, what constitutes an emergency? Under the guidelines given to the public, an emergency is an illness or an injury which could end in death or serious complication if it is not treated immediately. Examples of emergencies would include major injuries such as fractures and dislocation of the skeleton, head injuries, deep cuts or large wounds on the body, severe bleeding and severe burns or scalding.

Minor injuries such as bee and insect stings are also emergencies as they require immediate treatment. Non-traumatic emergencies such as heart attack, acute appendicitis, abdominal colic, renal colic, vomitting blood, etc, including high fever, are also considered as emergencies.

What are non-emergencies? Non-emergencies are conditions that do not require immediate treatment, such as minor coughs and colds, mild fever, aches and pains which have been present for a long time. So those are the guidelines as to what are emergencies and what are non-emergencies.

As to whether several people have been turned away because they do not have the $12, the answer is no. But recently we have been turning away people from the A & E departments because those were non-emergency cases. So they are turned away not because they do not have the money but because they are not considered as legitimate emergency cases.

As to whether cuts and wounds on bodies are considered as emergency cases, it depends on the degree of the cuts and wounds. If they are minor cuts, no. If they are major cuts and wounds, definitely.

As to repeat attendances in terms of surgical dressings, if they are asked to come back for surgical dressings immediately, ie, the next day, they could be considered. But if they are asked to come back to the Specialist Outpatient Clinics, which is normally the case, then it is considered to be another consultation in which case a fee of $10, or $12 if it is at SGH, would be imposed.

Dr Toh Chin Chye (Rochore): Mr Speaker, Sir, may I ask the Minister of State a question so that we can find what the nature of the problem is? Who decides which patient is an emergency case or not?

Mr Yeo Cheow Tong: Recently the public has been educated very thoroughly on what constitutes an emergency condition. Of course, for the individual, most people would tend to err on the side of safety and treat their own ailment as an emergency. At the A & E departments, the decision as to whether or not it is an emergency is made by the nurse who will triage the case. If there are any objections, then the case is referred to a doctor who will then make the final judgment.

Mr Jeyaretnam: Sir, is the Minister or Ministry aware that some of the doctors are very unhappy about this state of affairs, turning away patients when they should be treated?

Mr Yeo Cheow Tong: If the Member for Anson has any information of that nature, I will be very happy to get the facts from him. As far as we are concerned, we have discussed with the doctors and they are all in agreement with the scheme.

Mr S. Vasoo (Bo Wen): Mr Speaker, Sir, before we jump to discuss on Aids, we might as well move on to Question 9.