Doctors' 'ash cash' perks to be axed
Hospital doctors around New Zealand are charging grieving families for cremation certificates and spending the proceeds on parties and Sky TV.
In some areas they charge up to $90 in what doctors call "ash cash", for just a few minutes' work.
Tens of thousands of dollars are collected annually, on top of their salaries, and the bonus revenue is often used to fund junior doctors' social club events. It is considered a perk of the job.
But after an investigation by The Dominion Post, DHBs are now scrambling to scrap the archaic practice.
In an email obtained by the newspaper, Deborah Powell, national secretary of the Resident Doctors' Association, advised regional representatives that ash cash perks may soon cease.
"We have been approached by the DHBs who . . . have received an [Official Information Act] request from the media concerning the payment of what is colloquially termed ash cash. All the DHBs now wish to stop payment," she wrote.
The association represents those doctors who charge ash cash fees. She said members in DHBs where the fees paid for, "as an example, Sky in the [doctors'] lounge", would need to contact their local DHB advocates to sort out their finances.
She refused to return calls or comment yesterday.
The cremation certificates, filled out by doctors to verify a body is suitable for cremation and does not contain a potentially explosive pacemaker, take about 10 minutes to fill. Done during doctors' regular work hours, they are a prescribed part of their job.
The fee is invoiced to funeral directors, who in turn pass it on to families of the dead person. It was historically necessary because home visits to confirm deaths were time-consuming. Now, however, 65 per cent of deaths occur in care, and doctors rarely leave hospitals to check bodies.
As a result, the ash cash process has been deemed improper by several DHBs, and several of the larger ones - Capital & Coast, Auckland, Counties Manukau, and Waikato - refuse to charge it.
Waikato DHB, until it ceased charging a month ago, accumulated about $20,000 a year through its $50 cremation certificates.
It stopped applying the charge after it became "inappropriate", acting chief operating officer Maureen Chrystall said.
"The decision . . . was made in September 2011 and, due to an administrative error, it was enacted from September 2012."
Many DHBs, though, continue to charge - and the system can be bountiful.
Hutt Valley DHB's $1600 average annual income from the fee goes into an orderlies' kitty. In Taranaki last year, more than $6600 was taken into a "house surgeons' fund".
Nelson Marlborough DHB charges the most, $90 a time, $60 of which is kept by the DHB. And in both the Southern and Lakes DHBs, the signing doctors personally pocket the fee.
MidCentral DHB charges $70, which pays for "social events".
Peter Beauchamp, owner of Beauchamp Funeral Home, with mortuaries in Palmerston North, Feilding and Marton, was disappointed to learn where the cash was going.
"You probably would question where that [fee] is put. It should really go into the hospital coffers," he said.
"I suppose we knew in the back of our minds it was going into a fund for the doctors, but I thought it would've been an educational fund. I guess it's a little bit of a perk . . ."
Health Ministry deputy director-general of corporate services Barbara Phillips said the ministry's role in cremation certification did not cover what fees could be charged.
Wayne Mapp, the law commissioner responsible for a review of death and cremation certification, said it would be better to have only one certificate, and for any charge to be uniform across all DHBs.
Some charge might be acceptable, but it would have to be reasonable.
DEATH AND CREMATION CERTIFICATES
It is illegal to bury or dispose of a body until a doctor or coroner has established why that person died.
A doctor must decide whether a person died of a natural cause, or whether the manner of death requires further investigation. The required document is known as a cause of death certificate, for which there is no charge.
However, doctors may also fill out a cremation certificate, for which there can be a charge.
Cremation certificates confirm the deceased is suitable for cremation, including ensuring they do not have a pacemaker, which could explode.
The Cremation Regulations 1973 require bodies to be examined before cremation.
Source: Law Commission
ASH CASH - WHAT DHBS CHARGE:
Canterbury: Christchurch Hospital charges $5.75, with 50-70 cases a month generating $3450-$4830 a year to "support administrative costs". Ashburton Hospital charges $17.50, raising about $340 a year.
Nelson-Marlborough: $90, of which $60 is retained by the DHB. The other $30 funds an annual junior doctors' variety show, the proceeds of which go to charity.
Southern: Amount unavailable, but "paid to the practitioner directly".
Taranaki: $20.44 a certificate. Collected $6677.64 last financial year, which goes to a house surgeons' fund.
Waikato: $50. Junior doctors received about $20,000 a year. Practice now ceased.
MidCentral: $70. Goes to junior doctors' fund "for social events".
Hutt Valley: $13, with $8190 collected in past five years. Goes into an orderlies' kitty.
Counties Manukau: Stopped charging for cremation certificates more than five years ago.
Tairawhiti: $50. The practice ceased last month after Dominion Post inquiries.
Lakes DHB: Amount not made available, but the fee "is payable directly to the doctor who completes the certificate".
Auckland: No fee "for a number of years".
Capital & Coast: No fees collected for about 10 years.
The Dominion Post