Medical Services Act

	Home \| Databases \| WorldLII \| Search \| Feedback Tonga Consolidated Legislation

1. Short title.
2. Interpretation.
3. Appointment of Medical Officers.
4. Degrees required.
5. Unqualified person may be appointed.
6. Director of Health.
7. Appointment, etc., of clerks, etc
8. Existing officers, etc.
9. Object.
10. Foreigners.
11. Privy Council may make rules and regulations.
12. Director of Health may make rules.
13. Fees to be paid to revenue.
14. Penalty for disposing of medicines, etc.
15. Attendants.
16. Investigation of offences.
17. Conviction.
18. Offence against discipline.
19. Attendant to pay for wilful damage to property, etc.
20. Pay may be stopped.
21. Medical districts.

AN ACT TO PROVIDE FOR THE REGULATION AND MANAGEMENT OF GOVERNMENT HOSPITALS, DISPENSARIES AND PUBLIC MEDICAL SERVICE.

1. This Act may be cited as The Medical Services Act and shall apply to all hospitals, dispensaries and medical services under the control of the Government.

"medical officer" includes the officers appointed under sections 3 and 5 of this Act;

"dispensary" means any dispensary to which this Act applies and includes any dispensary forming part of or attached to a hospital;

"nurse" shall mean a nurse holding a certificate as such from any association duly authorized to issue such certificate;

"attendant" shall include every officer (not being the Director of Health, a medical officer or a nurse) and every Tongan medical practitioner, clerk, dispenser, probationer, student or servant attached to or employed at a hospital or dispensary:

(a) in reference to a nurse, student, dispenser or Tongan medical practitioner, the Director of Health or a medical officer; and

(c) in reference to any other attendant, the Director of Health, a medical officer, nurse, a Tongan medical practitioner or a dispenser.

3. The Prime Minister with the consent of the Cabinet may from time to time appoint a Director of Health who shall subject to the general directions of the Cabinet have the general control of all the hospitals and dispensaries in the Kingdom and also one or more medical officers who shall be liable to be attached to such hospitals and dispensaries as the Director of Health shall select in that behalf.

4. No person shall be appointed a medical officer who does not hold a medical and surgical diploma or degree of some university or institution in a British or foreign country which is authorized by the law of such country to grant medical degrees or diplomas and which the Privy Council may decide to recognize:

Provided that preference shall-other things being equal-be given to a candidate holding a certificate of adequate knowledge of tropical pathology from one of the British Schools of Tropical Medicine:

Provided also that any person not of British or Tongan nationality shall only be appointed as a medical officer where a suitable British or Tongan subject is not available at the time of appointment.

5. Any person registered under the Medical Registration Act as an unqualified registered practitioner may be appointed a medical superintendent by the Prime Minister with the consent of the Cabinet.

6. The Director of Health shall be the principal medical officer of the Kingdom and shall in addition to any duties imposed upon him by the regulations made under section 11 of this Act and by any other Act be medical officer in charge of the Tongatapu district and shall also be charged with the following duties:

(a) to advise the Government in all matters relating to the conservation of public health and to supervise generally the other medical officers and the medical service and institutions of the Kingdom and when practicable and necessary visit such other medical districts;

(b) to convey instructions from the Government to the other medical officers and to receive from them and forward to the Prime Minister all reports relating to the duties of their offices. (Amended by Act 9 of 1958.)

7. (1) The Prime Minister with the consent of the Cabinet may from time to time appoint and, subject to subsection (3) of this section, suspend and dismiss, such other officers and also such clerks, probationers and servants as he may deem necessary for the efficient working of the hospitals and dispensaries of the Kingdom.

(2) A person appointed under subsection (1) shall receive such salary and wages as shall be provided for in the Estimates of Expenditure.

(3) The Prime Minister with the consent of Cabinet may delegate to the Minister of Health the power to suspend and dismiss any person appointed on probation under subsection (1) of this section and, upon such delegation, the Minister of Health may exercise that power until it is revoked. (Substituted by Act 7 of 1965.)

8. All officers, clerks, probationers and servants holding office or employed in connection with any Government hospital or dispensary at the time of the coming into operation of this Act shall be deemed to have been appointed under this Act and it shall not be necessary for any of them to be reappointed after the commencement of this Act by reason of such tenure of office or employment.

9. The primary object of the public medical service and of every object hospital and dispensary is to provide accommodation and medical and surgical aid for all Tongan subjects without individual payment:

Provided that nothing in this section shall prevent or render illegal the provision of any services or benefits by any hospital or dispensary to any patient or group of patients upon payment, of such fees and subject to such conditions as may be prescribed. (Added by Act 3 of 1956.)

10. So far as may be feasible medical and surgical aid and hospital accommodation shall be provided by the public medical service to all British subjects and foreigners at such fees as may from time to time be fixed by His Majesty in Council.

11. His Majesty in Council may from time to time make rules and may make rules and regulations with regard to all or any of the following matters that is to say:

(a) the powers and duties of the Director of Health in relation to hospitals and dispensaries and of medical officers and generally of officers, clerks, probationers and servants holding any office or appointment or employed in connection with hospitals or dispensaries;

(b) the admission, treatment and discharge of patients to, in and from hospitals;

(c) the conditions upon which paying patients may obtain medicines and surgical appliances at dispensaries;

(d) the fees and charges to be paid by paying patients received into hospitals and for medicines and surgical appliances furnished to patients at dispensaries and for professional attendance upon patients at their residences; and this provision shall include power to make different rates of fees and charges payable by different classes of paying patients;

(e) the accommodation to be provided in hospitals for different classes of patients;

(f) the conditions under which any services or benefits may be provided by any hospital or dispensary to any patient or class of patients (Added by Act 3 of 1956.);

(g) the general management and discipline of hospitals and dispensaries and all matters incidental thereto or connected therewith; and

(h) for the further and better carrying out of any of the purposes of this Act.

12. Subject to any rules and regulations made by the Privy Council under section 11 hereof the Director of Health may subject to the approval of the Privy Council make rules and regulations with regard to the following matters; that is to say the powers and duties of all officers below the rank of medical officers and of all attendants and other persons holding office or appointment or employed in connection with hospitals or dispensaries and generally as to the management and discipline of hospitals and dispensaries. (Amended by Act 9 of 1958.)

13. All sums payable by way of fee or charge under or by virtue of this Act shall be paid to the general revenue of the Kingdom.

14. Every Tongan subject who shall for valuable consideration or otherwise dispose of any medicine or surgical appliance obtained at any hospital or dispensary shall without prejudice to any right that may exist to enforce against him any greater or other penalty be liable to a fine not exceeding $20 recoverable before a magistrate or in default of payment to imprisonment not exceeding 2 months.

(i) contravene or be a party to the contravention of any rule or regulation for the time being in force under section 11 or section 12 of this Act or under any enactment amending it; or

(iii) be grossly or habitually impertinent or disrespectful to his superior officer; or

(vi) in general conduct himself or act in a manner calculated to prejudice the efficient working, good order or discipline of any hospital or dispensary, or

(b) (i) deal improperly with or fail to take proper care of or to do his duty with regard to any Government property; or

16. Any charge of an offence against discipline may be investigated tried and determined by the Director of Health.

17. The Director of Health may convict any attendant charged with an offence against discipline upon such evidence not given on oath or affirmation as he may think fit.

18. The Director of Health may in his discretion reprimand or fine to any amount not exceeding $2 any attendant whom he shall convict against of an offence against discipline.

19. Where any attendant shall have wilfully destroyed or injured or have otherwise dealt improperly with any Government property the Director of Health may in addition to the penalty mentioned in section 18 proceed to appraise the damage caused by such act or default and thereupon order the offender to pay to the Government the amount of such appraisement. (Amended by Act 9 of 1958.)

20. Every sentence to a fine passed under section 18 and every order for payment made under section 19 may be enforced by stopping the offender's pay: (Amended by Act 9 of 1958.)

Provided that no sentence or order shall be carried into effect without the previous sanction in writing of the Prime Minister in any case where the attendant shall within 7 days from the date of the sentence or order have appealed to the Prime Minister therefrom or in the case of an order where the damage shall have been assessed at a higher amount than $2.

21. (1) For all the purposes of this Act the Kingdom shall be divided into three medical districts as follows -

(2) His Majesty in Council may from time to time alter the area of any of the said districts or reduce or increase the number of the districts.

(a) to afford free medical and surgical aid to all Tongan subjects in his district and to afford medical and surgical aid to all persons other than Tongans who may require his services for such remuneration as may be prescribed by the Privy Council;

(b) to have the immediate administrative and medical control and management of the hospital in his district subject to such rules and instructions as may from time to time be prescribed by the Cabinet;

(c) to visit daily or oftener if necessary the hospital in his district and to afford medical or surgical aid to all persons who from time to time may be under treatment therein and to discharge such duties in connection with the said hospital as may be prescribed by rules made by the Privy Council;

(d) to attend daily at the public dispensary of the hospital in his district for the purpose of rendering medical and surgical aid to such persons not being inmates of the hospital as may attend there for medicines and medical or surgical treatment;

(e) to visit wherever practicable any Tongan subject in his district who is too seriously ill to be removed to the hospital for treatment;

(f) to afford medical and surgical aid to the officers and constables of the police force and to all prisoners confined in any prison in his district;

(g) to vaccinate under the provisions of the Vaccination Act and to appoint the places and hours for vaccination;

(h) to perform the duties of health or visiting officer for his district under the Quarantine Act;

(i) if so required to act as medical witness and adviser on coroner's inquests held in his district and to make post mortem examinations;

(j) to give evidence in criminal cases before any of the Courts of the Kingdom;

(k) to report annually ending on the thirty-first day of December in each year on the public health and sanitary condition of his district and on the condition and work of any hospitals and other medical institutions therein;

(l) to enter into and inspect any slaughter house, store, building, staff or place kept or used for the preparation or sale of butcher's meat, poultry, fish or any other article of human food or any fermented or spirituous liquors and to examine any animal, meat, carcase, poultry, fish or any other article of human food or any fermented or spirituous liquors which may be therein and in case any of the articles or things so examined shall appear to him to be intended but unfit for human consumption to order the same to be destroyed;

(m) to enter and inspect any premises or any house or building the sanitary condition of which he has reason to believe is not satisfactory and to inquire into such sanitary condition and forthwith to take such proceedings to remedy any nuisance he may find therein as are authorized by law;

(n) in conjunction with the other medical officers to examine and test hospital students who have completed 3 years' service and if satisfied of their proficiency to certify accordingly;

(o) to examine and certify persons desirous of practising as apothecaries or midwives as prescribed by The Medical Registration Act or by any other Act in force or hereafter to be in force in the Kingdom;

(p) to examine and report on the physical condition and fitness of any person as required by the Government;

(q) to perform such other duties as medical officer within or without his district for such time as the Privy Council may require and at such remuneration if any in addition to his salary as the Privy Council may assign.

(b) to attend daily (except Sundays on which the attendance will be for one hour only) at the dispensary under his charge and to provide medical and surgical aid to all such persons as attend there for medicines and medical or surgical treatment;

(c) to visit wherever practicable and afford medical and surgical aid to any person in his district who is too seriously ill to attend for treatment at the dispensary;

(d) to forward to the medical officer for his district for transmission to the Director of Health a return in such form as may be prescribed by the Director of Health;

(e) if so directed by the medical officer of his district to vaccinate under the provisions of any Act relating to vaccination and to appoint a place and hours for vaccination;

(f) to carry out the lawful orders of the medical officer of his district and to obey such regulations regarding his duties and the performance thereof as may from time to time be made by the Director of Health.

1. These Regulations may be cited as the Medical Services (Fees and Charges) Regulations.

2. The fees and charges set out in the Schedule hereto shall be the authorized fees and charges for services rendered by or on behalf of the Medical and Dental officers of the Government.

A		Certificates								$
		(1)		Health certificate required to fulfil Tongan Passport and Immigration requirements						1.00
		(2)		Health Certificate required to fulfil Passport and Immigration requirements of countries other than Tonga						1.50
		(3)		Health Certificate required to obtain a job						.75
		(4)		Health Certificate, other than for Passport and employment requirements						1.50

B.		X-Ray Examination for Passport and Immigration Requirements
		Film Size			17" x 14"					7.00
					15" x 12"					5.50
					14" x 14					5.50
					12" x 10"					3.75
					10" x 8"					3.00
					6½" x. 8½"					2.25
					17" x 7"					3.50

C.		Laboratory Examination for Passport and Immigration Requirements.
		Blood Test								1.00
		Urine Test								1.00
		V.D.R.L. or Kahn Test								1.00
		Other Tests								1.00

D.		Vaccination/Inoculation for Passport and Immigration Requirements.
		Smallpox								1.00
		Typhoid								1.00
		Cholera								1.00
		Others								1.00

E.		In- Patient -
		Food and Domestic Services				-(Single Ward)				2.00 per day
						-(2-bed Ward)				Free
						-(4-bed Ward) or more				Free
						-Intensive care Ward				Free
These fees are not payable by:
(a)		Children up to the age of 12 years;
(b)		Patients in the Infections Decease Ward;
(c)		Patients in a Psychiatric Ward.
X-Rays, laboratory tests, operations and other similar services rendered to an in-patient of the hospital shall be free.
F.	Eye Clinic
	Eye Testing						1.00
	Refraction						1.50
	Supply of spectacles and part thereof						Land cost
	Repairs to spectacles						Such reasonable charge as the Director of Health may determine.

G.	Dental.
	Manufacture and fitting of complete set of dentures							40.00
	Partial denture - for first tooth and progressively less for each additional tooth							4.50
This scale will operate only when there is no private dental practitioner available and the work is done by a Government dentist without the right to private practise.

H.	Mortality Charges.
	(1)		Embalming- for adult						15.00
			- for child under 12 years						10.00
	(2)		Use of mortuary cooler per day						1.50
	(3)		Disinfestations of private homes on request						3.00

I.	Physiotherapy.
	Where physiotherapy equipment is loaned to patients a deposit of $1.00 is payable and is refundable on return of equipment. Payment of deposit may be waived by the Director of Health in case of extreme financial difficulty.

Certificates.

(1)

Health Certificate required to fulfil Tongan Passport and Immigration requirement

1.00

(2)

Health Certificate required to fulfil Passport and Immigration requirements of countries other than Tonga

1.50

(3)

Health Certificate required to obtain a job

.75

(4)

Health Certificate, other than for Passport and employment requirements

1.50

These charges shall be in addition to any fee for consultations.

X-Rays

(1)

Film Size

17"x 14"

7.00

15" x 12"

5.50

14" x 14"

5.50

12" x 10"

3.75

10" x 8"

3.00

6 ½" x 8 ½"

2.25

17" x 7"

3.50

(2)

Special Investigations.

(1)

Barium Swallow

10.00

(2)

Barium Meal

12.00

(3)

Barium Enema

15.00

(4)

Bronochography

15.00

(5)

I.V.P

18.00

(6)

Cholecystography

12.00

(7)

Hystero- Slapingography

10.00

(8)

Retrograde

15.00

(9)

Others

8.00

Laboratory.

Blood Test

1.00

Urine Test

1.00

V.D.R.L. or Kahn Test

1.00

Pregnancy Test

4.00

Other Tests

1.00

Vaccinations/Inoculations.

Smallpox

1.00

Typhoid

1.00

Cholera

1.00

Others

1.00

In Patient.

Single Bed Ward

Two Bed Ward

Four Bed Ward

Food and Domestic Services

3.00 per day

Accommodation

3.00 " "

1.50 " "

.75 " "

Charge at the discretion of Matron for special nursing

1.00 " "

All supplies such as drugs, dressing etc. will be charged for at landed cost, and X- Rays/Laboratory tests in accordance with the scale of charges.
No fees are payable where the patient is accommodated in the Infectious Diseases Wards.

Midwifery
(include ante-natal care, delivery and post-partum care)

30.00

Operations.
(1) Minor Operations

(2) Major Operations

5.00 to 30.00 according to the severity of the operation.
31.000 to 180.000 according to the severity of the operation.

The following shall be deemed Major Operations:

(a) Major operations on eye, ear or nose;

(b) Operations on the lung, kidney, spleen, liver, gall bladder, intestines, stomach, pancreas and the genitourinary system;

(c) Operations or amputations involving large bones or joints;

(d) Operations on the skull or brain;

(e) Operations in cases of empyema, cleft palate, fistula; and

(f) Herimiotomy, radical cure of hydrocele, traceotomy, reduction of fractures and dislocations, ligaturing blood vessels.

(3) Administration of Anaesthetics

3.00 to 50.00 according to technique use.

Consultation/Medical Attendance.
Consultation at hospital/dispensary

(2) Consultation at place other than hospital/dispensary

(a) during normal office hours

(b) outside normal hours
(3)Visit to any ships or vessels

(a) Alongside wharf

(b) At anchorage

2.00

3.00
4.00

5.00
5.00 and costs at launch hire.

Eye Clinic.
Eye Testing
Refraction
Supply of spectacles and parts thereof
Repairs of spectacles

2.00
5.00
Landed cost
Such reasonable charge as the Director of Health may determine.

Dental.
(1) Adults

Manufacture and fitting of complete set of dentures

Partial dentures-for first tooth and progressively less for each additional tooth

Extraction per tooth

Extraction complete

Prophylaxis

Filling (amalgum and composite)

Treatment of Gingivits

Treatment of Nerve Canal
(2) Children

Extraction per tooth

Fillings each

80.00

10.00
4.00
30.00 to 50.00
5.00
2.00 to 10.00
5.00
5.00 to 10.00

0.50
0.75

School children will receive free dental treatment, fillings extractions and cleaning when this is carried out at schools.

(3) Examination/Consultation
(4) X-Ray
(5) Orthodontic -

Removable appliance (Basic Unit)
(6) Relining (Dentures)
(7) Repair (Dentures)
(8) Rebase (Dentures)

2.00
1.00

4.00
8.00
4.00
12.00

This scale will only operate when there is no private dental practitioner available and the work is done by a Government dentist without the right to private practice.

Morality Charges.

(1) Embalming - persons 12 years and over

- persons under 12 years
(2) Use of mortuary cooler per day
(3) Disinfestation of private homes on request

15.00
10.00
1.50
3.00

Physiotherapy

1. (a) Electrical treatment (course of 5 attendances)
(b) Muscle stimulator (course of 5 attendances)
(c) Infra-red (course of 5 attendances)
(d) Wax bath (course of 5 attendances)

3.00
3.00
1.50
1.50

2. Exercises
(a) Programme exercises
(b) Sling and Pulleys
(c) Pre and Post operation
(d) Breathing and Postural Drainage
(e) Any other form of Drainage

1.00
1.00
1.00
1.00
1.00

3. Massage

1.00

4. DP Splints and strapping

1.00

5. Equipment on loan. Deposit of

2.00

Deposit refundable on return of equipment.

Fees payable by Government Servants.

An officer, his wife and children entitled to free medical treatment under the officer's term of service will be charged for tests, examinations, X-Rays, vaccinations/inoculations and certificates where these are required for overseas travel.

Further, treatment does not cover any domestic services for in-patients, the supply of dentures and spectacles.

1. These regulation may be cited as the Medical Services (Detained Patients) Regulations.

2. Special services or benefits may be provided by the Government for one or more persons detained in the district hospital pursuant to section 12 of the Public Health Act.

3. The Minister of Health may from time to time with the consent of the Privy Council order the services or benefits to be provided and the fees to be paid therefor shall be fixed by such order.

Tonga Consolidated Legislation

Medical Services Act