The Department of Health has ruled that consultants in emergency medicine should not carry out private practice in accident and emergency (A&E) units in public hospitals.
The move has prompted anger among doctors in the speciality and could lead to legal action.
The Department of Health policy statement, which was sent out by the Health Service Executive to hospitals in recent weeks, maintains that hospital consultants can only charge fees from the time a private patient is formally admitted.
The department has said specifically that this does not cover the time spent in an A&E department.
The department's move follows queries from health insurance company Bupa Ireland, which was billed for a surgical outpatient procedure by a consultant who had removed an object from the eye of one of its subscribers in a public hospital A&E department.
The patient had already paid the Government's statutory €55 A&E charge.
The consultant concerned told the company that emergency department work was considered as outpatient work.
He said that "for obvious reasons" patients frequently asked for procedures to be performed privately by a consultant, which was their right.
The consultant said that the €55 fee paid to the hospital by the patient was "a Government charge that is of no concern to me".
In a policy statement on the issue, drawn up on August 23rd, the Department of Health stated that accident and emergency departments dealt with the initial reception and treatment of patients with acute serious injuries and sudden and unexpected critical illness, as well as the treatment of minor injuries and illness.
"This department has a clear and firm view that equitable access to accident and emergency services for all patients is a core principle and can see no reason for deviating from this position.
"The nature of accident and emergency services demands treatment without discrimination.
"In the accident and emergency department there should, therefore, be no distinction between public and private patients.
"The payment of private fees to emergency medicine consultants for duties undertaken in A&E departments would, in our view, totally undermine this principle."
The department letter said that if the patient opted to be treated privately, the admitting consultant may charge private fees from the time of admission.
"The time of admission refers to formal admission as an inpatient to hospital, ie it does not cover the period spent in the accident and emergency department.
"The department does not accept that it is possible for the emergency medicine consultant to also claim fees for the care of the same patient while in the accident and emergency department."
The secretary of the Irish Association of Emergency Medicine, Dr Aidan Gleeson of Beaumont Hospital, said last night that, under the terms of the consultants' contract, doctors had a right to carry out private practice.
Dr Gleeson added that consultants in emergency medicine in public hospitals had treated private patients for many years.
He said that everyone presenting in an accident and emergency department was treated on the basis of clinical priority and added that there was no question of private patients being "fast-tracked" ahead of public patients who had a greater need for treatment.
Any breach of the contract by the Department of Health would be referred to the consultant representative bodies and their legal advisers.
Deputy secretary general of the Irish Hospital Consultants' Association Donal Duffy said last night that consultants had drawn the attention of the Health Service Executive to their private practice rights and had sought assurances that these would not be infringed.
