Section 48

Fees chargeable by dental surgeon. SCHEDULE 14 Medical Service and Institutions CHAPTER 39 Ch. 79. Ch. 30. 41 of 1964. 31 of 1967. 40 of 1967. 21 of 1973. 29 of 1973. 6 of 1975. 2 of 1977. CAP. 39. R.E. 2020. MEDICAL SERVICE AND INSTITUTIONS REGULATIONS (Section 66) Short title. 1. These Regulations may be cited as theMEDICAL SERVICE AND INSTITUTIONS REGULATIONS. General Control of service and institutions. 2. The Director of Health Services shall be responsible for the proper working and efficiency of the Government Medical Service and institutions. Directives. 3. All departmental directives in connection with the work of the Government Medical Service shall be made either through or by the Director of Health Services. Reports and returns etc. 4. All reports, returns and requisitions required to be submitted by medical officers, either departmentally or for the purpose of being ultimately forwarded to the Governor-General, shall be forwarded in the first instance to the Director of Health Services. Letters and communications. 5. All letters and communications whatsoever made by members of the Government Medical Service relative to their duties, rights and privileges, or to the institutions of which they may have charge shall pass through the hands of the Director of Health Services. Medical Service and Institutions [CAP. 39 15 Duties. CAP. 39. 6. Subject to the provisions of the Medical Service and Institutions Act, the duties of medical officers, medical subordinates and hospital servants shall be such as may from time to time be laid down in writing by the Director of Health Services, and it shall be the duty of all such officers, subordinates and servants to obey all lawful orders and directions issued by the Director of Health Services in relation to their duties to the administration and management of medical institutions. Private practitioners. 7.–(1) The Director of Health Services may, at his discretion and subject to such conditions as he may deem fit, permit any registered medical practitioner, not in the employ of the Government, to continue to attend any private patient after the admission of such patient to a medical institution. (2) The Director of Health Services may at any time without notice withdraw any permission granted by him in accordance with the provisions of paragraph (1) of this regulation. In-Patients Admission of patients. 8. Patients shall normally be admitted to a hospital between the hours of 10.00 a.m. and 4.00 p.m. upon presentation of the prescribed guarantees. Urgent cases shall be taken in at any hour. Allocation of beds and staff. 9.–(1) Every patient admitted to a medical institution shall occupy the bed in the ward which has been allocated to the patient by the medical officer in charge of the institution. (2) Any patient may after admission be moved to any other bed or ward on the instructions of the medical officer in charge of the medical institution. (3) Subject to the provisions of regulation 7 of these Regulations the allocation of patients (whether in-patients or out-patients) to the care of any member of the medical or nursing 16 Medical Service and Institutions staff of a medical institution shall be an administrative matter for decision by the medical officer in charge of the institution. No patient shall be entitled to demand that he be placed under the care of any particular member of the institution’s medical or nursing staff. Patients’ money and jewellery. 10.–(1) Patients on admission to a medical institution are required to hand over for safe keeping to the medical officer in charge of such institution any money, jewellery or other valuable property brought by the patient into the institution. Unless such property is so handed over for safe keeping, no responsibility shall lie with the institution for its loss during the patient’s stay in such institution. (2) Medical officers in charge of medical institutions shall see that suitable arrangements are made for the safe keeping in a locked room, cupboard, safe, strong box or other repository of all property received from patients in accordance with the provisions of paragraph (1) of this regulation. (3) The medical officer in charge of any medical institution shall take such steps as may be necessary to ensure that– (a) a register is kept in which shall be entered separately under the name of each patient details of all property received from him; (b) a detailed receipt is issued to each patient for all such property received from him, a carbon duplicate of such receipt being retained by the officer issuing it; (c) a patient, on being discharged from the institution, shall have all property handed over by him for safe keeping returned to him on his surrendering and countersigning the receipt issued in respect of such property. Medical Service and Institutions [CAP. 39 17 Safe keeping by relative or friend. 11. Notwithstanding anything contained in regulation 10 of these Regulations if the officer in charge of any medical institution is of the opinion that no adequate facilities exist for the safe keeping of a patient’s property, he may require that it be given by the patient into the safe keeping of a relative or friend outside of the institution. Patients confined to wards. 12. No patient in a medical institution shall enter any part of that institution other than the ward assigned to him without the express permission of the officer in charge of the institution. Visits between patients. 13. No patient in any ward of a medical institution may visit a patient in any other ward, except at such times and under such conditions as the officer in charge of the institution may approve. Diet. 14. The diet of a patient in a medical institution shall be in accordance with the scales laid down by the Director of Health Services. 15. Any patient in a medical institution who behaves in a disorderly manner, or who refuses treatment offered to him, or who disobeys or fails to comply with the provisions of these Regulations, or who disobeys or fails to comply with any lawful instructions or orders given to him by a member of the medical or nursing staff may be summarily discharged from the institution by the medical officer in charge thereof. Disorderly behaviour by patient. Out-patients Out-patients. 16. Out-patients seeking attention at a hospital, dispensary or health centre will normally be seen only on the days and during the hours specified by the Director of Health Services by notice published in the Gazette and on a notice board prominently displayed outside the institution. Urgent cases will be attended to at the hospital at any time. 18 Medical Service and Institutions Visitors 17. Visitors shall be admitted to see patients in any medical institution at such times as the Director of Health Services may determine by notice published in the Gazette and on a notice- board prominently displayed outside the institution. Visiting hours. 18. The officer in charge of any medical institution may at his discretion, where in his opinion special circumstances exist, permit a visitor to see a patient at a time other than the official visiting hours for such period of time and subject to such conditions as such officer in charge may deem fit. Discretional visiting hours. 19. Any visitor or visitors may at any time by reason of any special circumstances be prohibited by the officer in charge of any medical institution from entering any ward or visiting any patient therein. Prohibition of visitors. Tobacco, food and drink brought into the ward. 20. No visitor or other person shall take into any ward, or give or send to any patient any tobacco, or any food or drink of any kind, without the express permission of the nurse in charge of the ward; and the nurse in charge of such ward may order the removal from any ward of any such article brought to a patient without her permission. Public excluded from kitchen. 21. No person, other than an authorised member of the staff, shall enter the kitchen, dispensary, storerooms or any other part of any medical institution not normally open to the general public without the prior permission of the officer in charge of the institution. Visits by ministers of religion. 22. Every medical institution shall be open between the hours of 10:00 a.m. and 6:00 p.m. to ministers of religion or persons duly accredited by them to visit the sick. In special cases of illness, or for special purposes, there will be no restriction as to the visits of ministers of religion. Medical Service and Institutions [CAP. 39 19 Singing and services in wards. 23. The holding of services or singing in the wards of a medical institution are strictly forbidden, except by special permission of the officer in charge of the institution. Rates of Payment in Institutions 24. Subject to the other provisions of these Regulations, the charges set out in the Schedule hereto shall be made in respect of the matters therein set out. All such charges shall be payable into general revenue. Schedule of fees. Mode of fixing charges. CAP. 39. 25.–(1) Subject to the provisions of sections 23, 24 and 26 of the Medical Service and Institutions Act, the medical officer in charge of a patient shall exercise his professional discretion to ensure that the charges are fair and reasonable. (2) Charges payable by in-patients for accommodation, maintenance, operations, medicines, or services shall accrue from day to day. (3) Without prejudice to the right to make earlier demand for any charges due, the medical officer in charge of the institution shall, on the discharge of any in-patient, prepare or cause to be prepared a detailed account of all charges owing by such patient and shall see that such account is handed to the patient before he leaves the medical institution. (4) The classification of an operation and the determination of the fee payable therefor is within the discretion of the medical officer performing the operation. Out-patient charges. 26. All out-patient charges, whether for consultation, treatment, medicines or for any other hospital laboratory or other services, shall be paid by the person responsible for such payment at the time of each attendance of the patient or at the time such charges are incurred. 20 Medical Service and Institutions Work done for private medical practitioner. 27. The responsibility for the payment of any laboratory, X-ray examination or operation fees in respect of a patient referred to a medical institution by a private medical practitioner, shall lie with the private medical practitioner concerned. Specialist consultation charges. 28. Where any person requests and is granted a consultation at or in a medical institution or at any other place with a specialist medical officer a specialist consultation fee in accordance with the rates set out in the Schedule hereto shall in addition to any other charges be payable. Specialist medical officers. 29. A specialist medical officer is a medical officer whose qualifications either by diploma or by experience is recognized by the Director of Health Services to be a specialist medical officer. Free treatment of certain diseases. 30. All employees of a medical institution shall be entitled to free medical treatment, and if admitted to a medical institution shall not be charged any fees. Free treatment of certain other officers and employees. 41 of 1964. 31.–(1) Any officer or employee of the Government and their families shall be exempt from the payment of any charge or part thereof to the extent and in the circumstances laid down by law or in any Regulations applying to such officer or employee or in any agreement or contract made by the Government applying to such officer or employee. (2) Any teacher in a Government primary school or in a Government grant-aided primary school shall be exempt from the payment of any charge or part thereof to the extent and in the circumstances laid down by law or in any Regulations applying to officers of the Government. (3) Any employee of the Belize City Council or of a District Town Council who falls ill during his employment shall receive free medical treatment at government hospitals and clinics and, if admitted to hospital, shall not be charged for maintenance. Medical Service and Institutions [CAP. 39 21 Free treatment of certain diseases. 32. Notwithstanding the other provisions of these Regulations no charge shall be made in respect of the maintenance or treatment at any medical institution of any person suffering from tuberculosis, venereal disease or malaria or who– (a) was born in Belize, or (b) is ordinarily resident in Belize. Vaccination and inoculation. 33. No charge shall be made for any protective vaccination or inoculation where such vaccination or inoculation is according to the Director of Health Services necessary in the interests of general public health. X-ray examination. 34. No charge shall be made for any X-ray or laboratory examination where such examination is according to the Director of Health Services necessary in the interests of general public health. 35.–(1) A Medical officer in the full time employment of the Government shall not engage in private practice except with the consent in writing of the Minister. Where such consent has been given private practice shall only be carried on outside of normal working hours and shall not be carried on in a Government Hospital or clinic and shall not interfere with such Medical Officer’s official duties. Private practice by medical officers. 31 of 1967 (2) Notwithstanding anything contained in sub-regulation (1) of this regulation a Medical Officer may at any time in an emergency give treatment to any person whether such person has previously been his private patient or not. 40 of 1967. (3) A Medical Officer who gives treatment in an emergency to a private patient during normal working hours shall keep a written record of all such treatment and such record shall be open to inspection by the Director of Health Services. 40 of 1967. Consultation fee. 31 of 1967. 2 of 1977. 22 Medical Service and Institutions 36.–(1) The consultation fees, exclusive of medicines supplied, payable to a Medical Officer exercising his private practice shall be as follows– (a) for a first visit for treatment or examination at the Medical Officer’s place of private practice (b) for each subsequent visit for treatment or examination in respect of the same ailment (c) for each visit by the Medical Officer to the patient’s home (d) for each certificate issued $2.00 40 of 1967. (2) Where any visit is made, whether to the Medical Officer’s place of private practice or to a patient’s home between the hours of nine p.m. and seven a.m. the following morning the fees payable under the provisions of subregulation (1) of this regulation may be increased by fifty percent. 31 of 1967. (3) Notice of such charges printed in bold capitals at least half an inch high, shall be prominently displayed in the premises used for private practice. Permission for private practice. 2 of 1977. 37. No Specialist Medical Officer in the employment of the Government shall engage in private practice except with the permission in writing of the Minister. Determination of applications. 2 of 1977. 38. In deciding upon any application, the Minister may have regard to the need for any more private practitioners in that area and may in his absolute discretion refuse any application or whilst granting permission, attach any condition he may deem appropriateprovided always, that the Minister may at any time and without stating reasons therefor, revoke the permission granted by him. Hours for private practice. 39. Where such permission is granted private consultative practice shall be carried on outside the normal working hours of Medical Service and Institutions [CAP. 39 23 that officer, and, except in the case of dental surgeons, outside Government Medical Institutions– Provided that a Specialist Medical Officer may at any time in an emergency give treatment to any person whether that person has previously been his private patient or not. A Specialist Medical Officer who gives treatment in an emergency to a private patient during normal working hours shall keep a written record of all such treatment and such record shall be open to inspection by the Director of Health Services. Accommodation for private practice. 40. A Specialist Medical officer shall make his own arrangements for accommodation for private consultation, and where a Specialist Medical Officer uses his Government quarters for private practice, he shall be liable to pay rent at the rate of ten per cent of his salary. 41.–(1) A surgeon may be permitted to undertake private surgical treatment during normal working hours and to use Government facilities therefor, so long as suitable facilities are not available elsewhere for such treatment. He shall make arrangements for his own anaesthetist. Government facilities for private practice. 2 of 1977. (2) Anaesthetists may be permitted to assist in operations undertaken by surgeons in the course of their private surgical treatment during normal working hours. 42. An operating theatre fee of twenty-five dollars for a major operation and fifteen dollars for a minor operation shall be payable to the Government by a surgical private patient, in addition to fees for accommodation, drugs, x-ray, laboratory tests and the other dues owing to the institution. The surgeon performing the operation shall be responsible for all dues payable to the institution. Fees. 2 of 1977. 43. The following provisions shall apply in the case of the dental surgeonPrivate practice by dental surgeon. 2 of 1977. 24 Medical Service and Institutions (a) private practice shall be permitted only outside normal working hours; (b) he shall pay the Government an annual rent of one thousand two hundred dollars if he is in Belize City and seven hundred and twenty dollars if he is in any other city or town for the use of government facilities; (c) expendable materials used in private practice shall be purchased by the dental surgeon and shall be kept entirely separate from similar Government materials. Display of fees. 2 of 1977. 44. The fees payable by patients shall be displayed prominently at the place of private practice by such Specialist Medical Officer. Maximum fees. 2 of 1977. 45.–(1) The maximum fees chargeable by a Specialist Medical Officer carrying on private practice are as follows– (a) on a first visit for consultation at the Specialist Medical Officer’s place of private practice (b) for each subsequent visit in respect of the same illness (c) for each visit by a Specialist Medical Officer to the patient’s home (d) for each certificate issued $2.00 (2) Where any visit is made, whether to the Specialist Medical Officer’s place of private practice or to a patient’s home between the hours of nine o’clock in the night and seven o’clock in the morning the fees payable under the provisions of paragraph (1) of this regulation may be increased by fifty per cent. Fees chargeable by surgeon. 2 of 1977. 46. The fees chargeable by a surgeon are as followsMedical Service and Institutions [CAP. 39 25 Major operation$75.00$225.00 Minor operation$15.00$60.00 These fees shall include all fees payable to the anaesthetist. Definition. 2 of 1977. 47. For the purposes of Regulations 41, 42 and 46 the term “surgeon” includes an “Obstetrician/ Gynaecologist”. Fees chargeable by dental surgeon. 2 of 1977. 48. The fees chargeable by the dental surgeon are as followsFilling $12.00– $45.00 Cleaning Teeth $10.00– $20.00 Dentures $25.00– $85.00 Extractions $3.00 Multiple Extractions (Children under G.A.) $25.00 X-ray $3.00 Surgery of fractured mandible $75.00 Impacted tooth $20.00– $25.00 26 Medical Service and Institutions SCHEDULE OF CHARGES (Regulation 24) The scale of charges at medical institutions, and for out- patient services thereat, shall be in accordance with this schedule– (1) Patients in medical institutions shall be divided into five classes on the basis of income as follows– (i) Category I, being persons, whose income is over $4,800 per annum, or whose hospital expenses are paid directly or indirectly by their employers under their contract of employment; or who hold a policy of insurance entitling them to payment by the insurer of hospitalization benefits; (ii) Category II, being persons, whose income is not less than $2,400 and not more than $4,800 per annum; (iii) Category III, being persons, whose income is not less than $1,200 but under $2,400 per annum; (iv) Category IV, being persons, whose income is less than $1,200 but no more than $600 per annum; (v) Category V, being persons, whose income is under $600 per annum. (2) The following charges shall be payable by each class of patientsMedical Service and Institutions [CAP. 39 27 Item Category Category Category Category Category V $ $ $ $ $ I II III IV Accommodation, Maintenance, Nursing and medical attendance per day (non-private accommodation) 5.00 2.00 1.00 .05 Free Medicine supplied at cost 2.50 Price Flat Rate Free Free Free Maternity 40.00 25.00 15.00 5.00 Free Surgical Operations (a) Major 50-150 25-65 10-40 5.00 Free (b) Minor 10-40 5-25 5.00 Free Free Special Consultation Fee 10.00 5.00 2.00 1.00 Free Medicine Supplied at cost 1.00 0.25 Free Free Domiciliary Deliveries 25.00 15.00 7.50 Free Free Dental out-patient for each extraction 3.00 2.00 1.00 Free Free X-ray Examination (a) Patients under 100% of Charges 31 1/3% of Charges 1.75 flat rate Free Free Treatment in the institution listed listed 28 Medical Service and Institutions (b) Patients under 100% of charges 33 1/3% of charges 33 1/3% of charges 33 1/3% of charges treatment of private practitioners listed listed listed listed Laboratory Examinations 50.per unit for each test 25.per unit for each test subject to 50. flat rate Free Free a minimum of 50 Vaccinations for each international certificate issued 0.50 0.50 0.50 0.50 Free Food handlers – for each examination 1.00 1.00 1.00 Free Free Electrocardiogram 3.00 1.50 1.00 Free Free Basal Metabolic rate 7.50 2.50 1.50 Free Free (3) In addition to the above charges, patients desiring private accommodation at a hospital shall pay charges as follows for accommodation– (a) Private Room– $7.50 per day– single accommodationfront room; (b) Private Room– $5.00 per day– single accommodationback room; (a) Semi-private– Room of 2 beds– $4.00 per bed per day. (4) The cost of medicines supplied to patients shall be deemed to be the landed cost plus handling charge of 15% Medical Service and Institutions [CAP. 39 29 (5) The Charge for each X-ray shall be$ Abdomen 7.50 Ankle Joint 4.50 Barium Enema 18.00 Barium Meal 15.00 Barium swallow 9.50 Bronchography 11.00 Calcancum 4.00 Cervical Vertebrae 7.00 Chest 6.00 Cholangiography (T. tube) 10.00 Cholecystangiography (Intravenous) 18.00 Cholecystography (Oral) 10.00 Coccyx 7.00 Cystography 10.00 Drip Infusion Pyelogram 18.00 Elbow Joint 4.50 Facial Bones 7.00 Femur 7.50 Finger 3.00 Foot 4.50 Forearm 5.50 Hand 4.50 Hip Joint 7.00 Humerus 7.50 Hysterosalpingography 10.00 Intravenous Pyelogram 16.00 Knee Joint 6.00 Leg 6.50 Lumbar Vertebrae 9.00 Lumbosacral Vertebrae 9.00 Mandible 7.00 Mastoids 8.00 Maxilla 7.00 30 Medical Service and Institutions Myelography 21.00 Pelvis 8.00 Retrograde Pyelogram 16.00 Ribs 8.00 Sacro-Iliac Joints 8.00 Shoulder Girdle 6.00 Sinuses (Nasal) 7.00 Skull 8.00 Sternum 6.00 Teeth (Dental Films) 1.00 Thoracic Inlet 7.00 Thoracic Vertebrae 9.00 Toes 3.00 Wrist Joint 4.00