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Dáil Éireann debate -
Wednesday, 23 Nov 1977

Vol. 301 No. 10

Medical Practitioners Bill, 1977:Report Stage.

Amendments Nos. 1, 2 and 3 are ruled out of order. Therefore, we go on to No. 4 in the name of the Minister. Recommittal is necessary in respect of this amendment since it involves a new matter of substance which does not effectively arise out of Committee proceedings and since it involves an amendment to the Long Title of the Bill.

Bill recommitted in respect of amendment No. 4.
TITLE

I move amendment No. 4:

In page 4, line 12, after "PRACTICE" to insert:

"AND TO PROVIDE FOR THE SETTING UP OF A BOARD TO BE KNOWN AS AN BORD MIOCHAINE AGUS DEIDLIACHTA IARCHEIME OR THE POST-GRADUATE MEDICAL AND DENTAL BOARD WHICH SHALL PROMOTE AND CO-ORDINATE POST-GRADUATE EDUCATION AND TRAINING FOR PERSONS ENGAGED IN THE PRACTICE OF MEDICINE AND DENTISTRY".

Is the amendment agreed?

There is need for this. I shall be most co-operative. I am very pleased that the Minister has done this. The Post-graduate Medical and Dental Council is a separate body and should undertake this work. I am delighted the Minister has included it.

Is amendment No. 4 agreed?

(Cavan-Monaghan): In reference to this, Deputy Boland is on his way. There was some misunderstanding about this item being on the Order Paper at all today. I think Deputy Boland was under the impression that the next item was being taken first; in other words that the order would be reversed. He is at present on his way here.

Might I ask the Minister in the meantime——

We are on Report Stage now.

Will this council have separate powers as distinct from the work of the Medical Council?

Yes, completely separate.

Amendment agreed to.
Amendment reported.

I move amendment No. 5:

In page 4, between lines 21 and 22, to insert the following:

"`the Board' means an Bord Míochaine agus Déidliachta Iarchéime or the Postgraduate Medical and Dental Board established by this Act;"

The position here, as Deputies who were involved in the Committee Stage discussion are aware, was that I indicated during the course of that discussion that I proposed to look again at section 37 as it was in the Bill, as amended in Committee, and the original section 36. Section 36, as originally drafted in the Bill, proposed to give me powers to allocate to the Medical Council which we are now establishing functions in regard to post-graduate training and education. On reflection it became quite clear that that would not be a very good way of proceeding because we already had a post-graduate council, a council for post-graduate education. Therefore, there would be a conflict or overlap between the two bodies. I undertook to look again at the situation. Having looked at the situation again I decided—and I am sure the House will agree with me—that the right way to proceed is as follows. We will leave the Medical Council all the functions which they already have in the legislation, that is, the functions in regard to education, training, discipline, ethics and so on. But, side by side with that, we would give the existing Council for Post-Graduate Education and Training statutory status, give them, by statute all the duties and obligations which they now have as an informal council.

Therefore the purpose of the number of amendments I am bringing forward here on Report Stage will be to bring about a situation in which we will now have two bodies of statutory status: (1) the Medical Council, which will have its functions as set out in this Bill, and (2) the Council for Post-Graduate Education and Training, which will have the specific function of initiating and promoting action in regard to post-graduate education and training in the future. In so far as this amendment is concerned all we are concerned with here is defining the board.

This new board will be an Bord Míochaine agus Déidliachta Iarchéime or, in English, the Post-Graduate Medical and Dental Board established by this Bill. This is just to amend the definition section to indicate that where the words "the board" appear in the Act they will refer to this new statutory body.

Is the amendment agreed?

Amendment agreed to.

On No. 4 did we not discuss Nos. 5, 6, 8, 13 and others?

No, we did not.

All right, then we shall have to take them as we go along. In case there is any misunderstanding, we are now on Report Stage. Therefore, the mover will move and reply and any other speaker will speak only once.

Surely with a whole new chapter——

It will be recommitted, I understand, and where there is a recommital we can go back to Committee Stage on that amendment. But the others are on Report; the mover moves the amendment, every other speaker only speaks once on the amendment and the mover has the right to reply.

These amendments are in reference to the new chapter.

I understand that the new chapter is recommitted.

These amendments are consequential on the new chapter being included——

Actually these amendments should have been discussed with amendment No. 4. They were not at that stage so we will take them briefly as we go along. However, they are not recommitted; it is the new chapter that is recommitted. Amendment No. 6 in the name of the Minister.

I move amendment No. 6:

In page 4, between lines 25 and 26, to insert the following definition:

"`the Dental Board' means the Dental Board constituted under the Dentists Act, 1928;".

This is simply a definitions section amendment. Its purpose is to indicate that where the words "the Dental Board" appear in the Bill the reference will be to the Dental Board constituted under the Dentists Act, 1928.

Is amendment No. 6 agreed?

I want to take the opportunity when speaking on this amendment to register protest at the idea that this set of amendments, involving another discipline in the field of medicine, should have been circulated to some Members here only this morning. I do not think it fair to anyone involved in the discussion, anyone studying the Bill, to be asked to consider new amendments and an entire new chapter of the Bill when the amendments are circulated only on the morning of the Report Stage being taken. It is additionally unfair that some hours later we are asked to discuss those amendments as Report amendments rather than discuss them on Committee. It is clearly quite ridiculous to amend the Long Title of the Bill and insist that it be a Report Stage discussion, that there be no opportunity afforded to have a Committee Stage discussion on a major amendment of a Long Title of the Bill.

I am sorry to interrupt the Deputy—I was not here when it was taken—but all those amendments were to be taken with No. 4 and discussed fully in Committee. Apparently amendment No. 4 was accepted and agreed by the House. I can do nothing about that. The major amendments later will be taken in Committee. These amendments arise out of No. 4. Amendment No. 4 was recommitted. There was a full Committee Stage debate on it. I do not know how long it lasted—it would seem for a very short period—but we have now gone past it. I am sorry about that but there is nothing I can do about it.

I wish to apologise to the House. I was not aware that this Bill was being taken at 3.30 p.m. Therefore, if amendment No. 4 was taken in Committee it was taken in very brief Committee. The Minister was somewhat lucky, shall we say, in that the recommital of the Long Title would have allowed me to discuss the other amendments to the Long Title which were ruled out of order. However, I do want to register a protest. I do not think it fair to the House that major amendments should be circulated, amendments constituting a major change in the Bill, on the morning of Report Stage.

We are discussing them now. There is nothing the Chair can do about it. Is the amendment agreed?

By way of reply to the debate on amendment No. 6, I think the Deputy is exaggerating the position. The amendments which I am bringing forward may appear to be major and certainly they are of some length but I indicated clearly on Committee Stage what I was going to do. To some extent my initiative now arose out of promptings from the House on Committee Stage.

What I am doing here is simply meeting to a large extent the wishes of the House as they emerged in our discussion on Committee Stage. While Deputy Boland may say he had the amendments only this morning he should, and did, know what was coming. While the amendment may be lengthy in actual wording it is a very simple concept and one that I am quite certain will meet with the full agreement of the House. I did not anticipate there would be any objection from the House on the matter.

If I had tabled the amendments at the same time they would have been ruled out of order.

We must now decide on amendment No. 6. Is it agreed?

The Minister said——

The position is that the Minister has replied.

I thought he spoke on a point of explanation.

That is possibly so. If the Deputy wishes to come in on the amendment now he may do so.

The Minister very wisely brought forward this amendment because otherwise there would be duplication of the work of the Medical Council and the post-graduate medical and dental board. The amendment was brought forward to stop any duplication, so that each body would know its own functions. It was a wise decision and it is in the best interests of the public and general medicine. On Committee Stage the Minister indicated he was going to do this with our approval.

Amendment agreed to.

Amendment No. 7 is in the name of Deputy Boland and it arises out of Committee. Amendments Nos. 32, 33, 34, 35, 36, 39, 42, 43, 44, 45, 46, 47, 48, 49, 51, 63, 71, 79 and 83 are consequential. If amendment No. 7 is accepted all the others will be made; if amendment No. 7 is not, the other amendments will not be moved.

I am glad the Chair read out that litany of amendments because it saves me having to do it.

They are all being taken together.

The Deputy had the nerve to complain about me.

I had them in time, even though it was a bad morning.

At 5 p.m. on Monday evening?

I wish to repeat that we are now on Report Stage. The Deputy may speak on his amendment now and he can reply when other speakers, including the Minister, have concluded.

I presume that applies to both sides of the House?

It applies to every Deputy in the House. There are no sides in this matter as far as the Chair is concerned.

I move amendment No. 7:

In page 4, line 30, to delete "Practise" and substitute "be registered".

This large number of amendments would not be necessary if the principle behind some later amendments is accepted. From that point of view I find myself a little constrained in discussing this amendment without knowing the Minister's attitude towards some later amendments.

On Second Stage and repeatedly on Committee Stage I expressed my belief that we should endeavour so far as possible not only to allow the medical profession to regulate itself but that we should introduce as many statutory safeguards for the general public as we could. I said I believed the Long Title of the Bill which speaks about a Bill that will provide for the control and registration of persons engaged in the practice of medicine would lead the general public to believe when the legislation becomes law that all those engaged in the practice of medicine will be controlled and registered on foot of this measure, that if disciplinary action is taken against them by the Medical Council and if their name is erased from the register they will no longer be allowed in law to practise.

However, as we went through the Bill we discovered that in law a person whose name is removed from the register will still be allowed to practise. I believe that concept is undesirable. When we are updating legislation that is 50 years old we should take the basic precaution of ensuring so far as possible that if a person's name is removed from the register by his medical colleagues because they believe he is guilty of gross professional misconduct he should not in law be allowed to practise or to hold himself as being in a position to practise.

From that point of view I considered that if the Bill did not achieve those measures, to have a Fitness to Practise Committee set up under the Bill was as misleading as the Long Title. A Fitness to Practise Committee would lead the general public to believe that if the committee made a recommendation that a doctor was not fit to practise and if the recommendation was confirmed by the Medical Council and the High Court, the general public could reasonably be expected to believe that in law the doctor was no longer entitled to practise. That is not the case.

From that point of view I did two things. I introduced some later amendments that would have the effect of giving High Court authentication to the Medical Council's decision that a doctor should not practise and, as an alternative if the amendments were not accepted, I considered it would be right that the Fitness to Practise Committee should be called "a Fitness to be Registered Committee". That is what the committee would be doing. If it was sitting in judgment on a doctor who was believed to be guilty of gross professional misconduct and if it advised that the doctor's name should be removed from the register, that is all that would happen. While the committee might consider the doctor should not practise and should not be allowed to practise, it does not have the power on its own or in the Bill as constituted to say that in law the doctor cannot continue to practise so long as his name is not on the register.

From that point of view I considered the title of the committee—the Fitness to Practise Committee—could be misleading as far as the public are concerned. If the later amendments that would make it illegal as a matter of law for a doctor to continue to practise after his name was removed from the register and after the decision was confirmed by the High Court are not accepted, I consider the references to the Fitness to Practise Committee should be changed to "Fitness to be Registered Committee". It is rather difficult to make the point in relation to the amendments without discussing the later amendments but I am sure the Minister and the House will appreciate the significance of the point I am trying to make.

I see what the Deputy is getting at but what is meant here is the fitness to practise orthodox medicine. It does not mean fitness to be registered. To solve this problem we would have to have an overall general medical council that would regulate orthodox medicine as we know it and then we would have to consider osteopathic and homoeopathic medicine. I do not think the Minister can control all of that at present although in time he may get around to it. What is being discussed is fitness to practise orthodox medicine as we know it here and I think Deputy O'Hanlon will agree with me on this.

I can understand Deputy Boland's point. The person concerned will not be allowed to practise orthodox medicine as such. He can practise and give advice. Deputy Boland can give advice to me about my health. He can say "You are not looking well. I suggest you have a rest". He is practising medicine when he says that.

Take an Aspro.

We are going into semantics if we talk about changing that. It would be making the whole thing inoperable if we went into all those aspects of it. We have to accept that we are discussing fitness to practise orthodox medicine. I appreciate the Deputy's point but I do not think we could cover it by this. The Minister has gone more than half way in meeting most of the points we raised on Committee. I want to pay tribute to him for doing this because he has done a tremendous job with these amendments.

Deputy O'Connell made my arguments for me and I am very grateful to him. I see exactly what Deputy Boland is at, but if he thinks about it carefully he would realise that he is more concerned here with words than with the reality of the situation. Fitness to practice is a well known expression; it is in common and medical parlance. It has its own standing as an expression. Everybody knows what exactly it means. In this context it means, as Deputy O'Connell pointed out, fitness to practise orthodox medicine on the basis of being a registered medical practitioner with certain minimum qualifications in formal medical education. It is a handy phrase to incorporate all that.

While we could all agree with Deputy Boland that the general situation in regard to the practice of medicine as such could be spelled out and dealt with at great length, it is not really necessary in practical terms for the purposes of this Bill which is dealing with a certain section of the community who have a certain formal education, certain professional qualifications, who, as such, are entitled to be registered and who the general public are entitled to know are registered, have these qualifications and therefore, have a certain standing and fitness in this area. I do not think it is necessary for me to elaborate on what Deputy O'Connell has said in that regard.

In one sense everybody practises medicine every day. My hope, on which I shall elaborate at greater length very shortly, will be that everybody will be his own medical practitioner.

Hear, hear.

I will try to get across a philosophy of medicine that one's health is one's own personal responsibility basically and that I, the Department, the hospitals, the doctors and all the rest, only exist to help a person discharge his own personal responsibility to himself for his own health.

Excellent.

Every mother practises medicine every day. She looks at the children when they come down to breakfast and runs an expert medical eye over them, indeed, in many respects a more expert medical eye than any doctor could run over them.

Quite right.

She practises medicine when she decides whether to let them go to school, to send them to bed, to give them an Aspro, a hot drink or whatever. Let us be absolutely clear about that. We all know that the practice of medicine has a very wide context which is not incorporated in the Bill. What we are dealing with here is a restricted group of professional people who have certain formal basic medical training, who will be registered as such, and as far as the general public are concerned, the only thing that will matter is that these people will be registered; that will indicate that they have the minimum qualifications at least, and that this body will exist to ensure that in the practice of their profession they maintain certain standards, abide by certain codes of behaviour and so on.

While I have a certain sympathy with what Deputy Boland has in mind, that the whole corpus of people who would set up to practise medicine in any way so far as the general public are concerned would be controlled, it is certainly not on at the moment and is not contemplated in this legislation.

The Minister in his last sentence made the point I have been trying to make repeatedly during the debate on this Bill, and that is, that it is not envisaged in this legislation that effective control from the point of view of the general public should be brought about. I am saying it should be and that this is the legislation in which it should be done. In later amendments I have outlined in a very simple way how it can be done by the High Court confirming and making an order similar to the Medical Council's decision which would make it illegal and a statutory offence for a practitioner to continue to practise after the Medical Council had struck him off and had in effect, said: "We do not think this man should be allowed to practise in public" and after the High Court had confirmed that decision. I feel it is undesirable that the man still in law, admittedly with some difficulties, is entitled to practice because he holds a primary qualification. We should not allow that to happen. If it is allowed to continue in this legislation, the reference to the Fitness to Practise Committee is to some extent a charade and misleading the public.

We are all concerned and do our best to ensure that the general public are as well informed as possible about the operation of the medical profession and that the medical profession are safeguarded to the greatest extent possible. In my view we should not be ignoring the opportunity to make it a statutory offence for a doctor to practise orthodox medicine if the Medical Council have said he is not fit to have his name entered on their register. That was the thinking behind this amendment. If the other amendments which would regulate that are not accepted. I do not believe the Fitness to Practise Committees really deserve that title.

Since we last met I have come to the conclusion that virtually every part of this Bill is based on the Merrison Report, the report of the Committee of Inquiry into the Regulation of the Medical Profession, published by H.M. Stationery Office and submitted to the British Government in 1975. They outlined in great detail the situation that obtains in England. There, a doctor being removed from the medical register is still strictly speaking entitled to practise but because of the widespread national health system operating there, he cannot operate within that system if his name is not on the register. There are controlling committees in different areas in that scheme who co-ordinate with the Medical Council to ensure that any doctor who had his name removed from the medical register is removed from the national health service which effectively debars him from practising in Britain.

There is no equivalent system here and for that reason we should make it a statutory offence under this Bill or face up to the fact that this Bill will not completely govern who may practise orthodox medicine even if he is struck off the medical register. If that is a fact, unpalatable as it may be, do not call this a Fitness To Practise Committee or say that this is a Bill to provide for the registration and control of persons engaging in the practise of medicine, when it is only a Bill to control some of the persons engaged in the practice of medicine. That was the thinking behind this and my other amendments. There is no point in delaying the House so I will withdraw the amendment.

Amendment, by leave, withdrawn.

I move amendment No. 8:

In page 5, between lines 12 and 13, to insert the following:

"`registered dentist' means a person whose name is entered in the Register of Dentists maintained under the Dentists Act, 1928;".

This is a further definition.

Amendment agreed to.

Recommittal is necessary in respect of amendment No. 9 in the name of the Minister. since it involves new matter of substance which does not effectively arise out of Committee proceedings.

Bill recommitted in respect of amendment No. 9.

I move amendment No. 9:

In page 5, between lines 42 and 43, to insert the following:

"(3) The Council may, subject to the provisions of this Act, regulate its own procedure.".

I accept your ruling, a An Leas-Cheann Comhairle, that it does not arise out of Committee procedure but I thought it did. I thought this was a point we adverted to. We certainly had it before in a very general way during the Committee Stage debate. It is just to make it absolutely clear that the new council we are establishing will be able to regulate its own procedures.

Amendment agreed to.
Amendment reported.

Recommittal is necessary also in respect of amendment No. 10 on the same grounds.

Bill recommitted in respect of amendment No. 10.

I move amendment No. 10:

In page 7, line 41, to delete "engaged in the practice of medicine in the State".

I accept your ruling fully that this is a new matter. It arose out of discussions which I had with representatives of the medical profession since Committee Stage. The purpose of the amendment is to give a vote to every fully registered medical practitioner in the election of members to the council irrespective of whether or not he is actually practicising medicine or resident in the State. If a doctor pays his retention fee and his registration continues he will be entitled to vote. It will be seen from the wording of this section, as amended in Committee, that that is not what is in the Bill at present. Paragraph (f) reads:

ten fully registered medical practitioners engaged in the practice of medicine in the State....

It goes on to state:

appointed by election by fully registered medical practitioners engaged in the practice of medicine in the State;

These are the words which we propose to delete. If Deputies will study amendment No. 10 it is on page 7, line 41 that it is proposed to delete the words, "engaged in the practice of medicine in the State". We will then have the situation where the persons who can be elected will still have to be in practice but the electorate need not be in practice.

The point the Minister is making is a fair enough one. I take it that it is to some extent designed to allow doctors who have retired and are not in active practice to participate in the election to the Medical Council and also doctors who are involved in the universities in some teaching function.

We were given a lot of things this morning including the Minister's amendment but there is also a newspaper report suggesting that the Irish Medical Association are now unhappy with the composition of the Medical Council. The Irish Independent of today's date states:

The IMA is now seeking direct representation on the Medical Council in view of the fact that its responsibilities had been "widened to embrace all aspects of competence, continuing education and medical ethics."

As we are back on Committee Stage could the Minister explain if the IMA made this point and if in relation to this amendment he has considered the idea that the IMA might have a member appointed or elected? The point I am making could also be discussed on amendment No. 11. The newspaper report goes on to say:

One clause which would give Mr. Haughey power to alter the Medical Council's composition, after the enactment of the Bill, is being opposed by the IMA as this could be done without prior consultation.

I am a little taken aback at that suggestion because I did not see in the Bill that the Minister could alter the composition of the Medical Council except in so far as he might make regulations to various provisions of subsection (1) but only with the consent of the Medical Council.

I would point out to Deputy Boland that it is only amendment No. 10 which is back in Committee. There is nothing else except amendment No. 10.

Amendment No. 10 sets out to vary the college of electors for part of the Medical Council. The subsection I have referred to gives the Minister power to make regulations varying this and the other provisions of subsection (1). It would be as well if it were made clear that, as I understand it, the composition of the Medical Council after the passing of this Bill as amended by this amendment might only be varied by the Minister with the consent of the Medical Council. I am merely giving the Minister an opportunity to make that point clear. The amendment is a good one and one which we should have noted on Committee Stage.

I accept the logic of this because all members of the medical profession who are in active practice will be required to pay a retention fee so they must have a say in it. With regard to the point made by Deputy Boland, the Irish Medical Association have stated that they felt rather annoyed that they were not consulted. They have to realise that we are the legislators not them and that we are the people who may amend any Bill going through the House. We have a right to do this in the interests of the public. We are legislating for the public so it is our duty to amend Bills. I feel that this point should be made clear.

As I indicated, all we are dealing with in this amendment is a tidying up of the process whereby the practising profession will be represented on the new council. I want to make it absolutely clear what we are doing. We are ensuring that whereas the representatives referred to in paragraph (f) will be elected to the council the people to be elected must be in practice in the country. The electorate will be all the people who are on the register, whether they are in general practice or not. That is the very specific purpose of amendment No. 10.

In reply to the point made by Deputy Boland I, first of all, fully agree in principle with what Deputy O'Connell said, that we are the legislators and we must legislate and we cannot hand our duty to legislate over to others no matter how reputable or important those people may be. The position here is quite straightforward. The Irish Medical Association were on the working party which did preparatory work for this Bill and at no stage did they suggest that they wished to claim representation on the Medical Council. They are putting this point forward now. I am not too sure how concerned they are about it, whether they just put it forward for consideration. I do not think they would make a very serious issue of it. We are not really changing the basis of the council and to that extent the situation has not changed.

The number in the council has been increased for very specific and good reasons but the balance has been maintained. Even though the increase has been made from 21 to 25 the balance and the mix on the council has been maintained at the increased level. I do not think the IMA would make an issue of this matter. It would be entirely inappropriate that the IMA as such should be represented on this council. Their function and their responsibility are completely different.

Undoubtedly a very large number of members would be on the council anyway but they will be on the council under a different guise, in a different role, wearing a different hat, and that is only as it should be. They have also put forward a number of other points which we are meeting and, when Report Stage is over, I will write very fully to the IMA—I have not had time to do so in the interval— indicating my view as to why I do not think at this stage we could change and give them representation as such on the council. I am also meeting them on a number of other points they put forward.

Amendment agreed to.
Amendment reported.

Amendment No. 11 in the name of the Minister arises out of Committee Stage and it meets amendment No. 12 in the name of Deputy Boland so amendments Nos. 11 and 12 can be discussed together.

Bill recommitted in respect of amendment No. 11.

I move amendment No. 11:

In page 7, to delete lines 43 and 44, and to substitute the following:

"(g) four persons appointed by the Minister, at least three of whom—

(i) shall not be registered medical practitioners, and

(ii) shall, in the opinion of the Minister, represent the interests of the general public.".

I do not think I need dwell too long in explaining this amendment. It is quite straightforward and self-explanatory. Deputy Boland and Deputy O'Connell like what I am doing here because we discussed this very fully on Committee Stage and what I am proposing now meets with their full agreement. The effect of this amendment will be that the Minister will appoint four members of the board and at least three of these will have to be non-medical people and, in the Minister's opinion, they will have to represent the interests of the general public.

I think my amendment is nicer. It is not as nice as it was on the Bill as initiated and the Minister has changed the wording to such an extent that is has now become cumbersome. However, it meets the point. There is an interesting point in the Merrison Report. On comparative terms there will be four ministerial appointees out of 25 members on this new council, three of whom will not be medical practitioners. The Merrison Report recommended in the British equivalent that there should be 54 elected members, 34 nominated and ten lay members so that, from their point of view, the lay representation of ten as against 88 on that proposed British council would not be as high as the lay representation on the proposed Irish council brought about, as the Minister says, as a result of the amendments of Deputy O'Connell and myself.

I congratulate the Minister on introducing this amendment. We are all here to try to help. It does not matter how the amendment is phrased. It is the intention that matters and the intention was to protect the public and let it be seen that we are doing this in the interests of the public. The Minister has very graciously accepted this and I now pay tribute to him for that.

Amendment agreed to.
Amendment reported.
Amendment No. 12 not moved.

Amendments Nos. 13 and 14 are a composite proposal and, if the House agrees, they may be discussed together.

I move amendment No. 13:

In page 8, line 11, after "Minister" to insert "and any such regulations may, in particular, specify, in relation to any class of persons specified in the regulations, the qualifications to be held by candidates for election to the Council".

Again, this arises out of our Committee Stage discussion. It is also in accordance with the suggestion made to me by the IMA. The effect of the amendment is to drop the proposal that the chief examiners of the health boards would be the local returning officers. As I pointed out on Committee Stage, since the electorate consists of only 3,000 people approximately, a national returning officer is considered adequate. Section 9 (1) (f) is being amended to give all registered medical practitioners a vote in the election of members of the council so that local knowledge to determine who is engaged in the practice of medicine will not be necessary.

The amendment is seconded by a CEO.

Amendment agreed to.

I move amendment No. 14:

In page 8, to delete lines 16 to 25.

Amendment agreed to.

Amendment No. 15 must be recommitted for the usual reasons.

Bill recommitted in respect of amendment No. 15.

I move amendment No. 15:

In page 8, between lines 48 and 49, to insert the following:

"(5) The committee established under subsection (2) (a) of this section shall include in its membership each person appointed to the Council pursuant to section 9 (1) (a) of this Act.".

It is now proposed that the education and training committee which the Council is obliged to establish under section 13 (2) (a) should include among its members representatives of UCC, UCD, UCG, Trinity College and the College of Surgeons appointed under the provisions of section 9 (1) (a)—that is, a representative of each medical school. I am sure the House will agree this is an improvement. The council includes, as Deputies know, the five teaching medical schools. We want to ensure that in the education and training committee these five representatives of the medical schools will be automatically members of the education and training committee.

It would be fair to say this is a suggestion that has come about because of the apprehension in the training schools that an education committee might be set up on which they might not necessarily be represented. There is probably still some degree of uncertainty as to the position between UCD and the RCSI in the event of any future closer co-ordination between these two bodies but if that comes about, I presume it can be dealt with. It is, of course, desirable that teaching bodies should be represented on the education and training committee. This was in my mind when I was framing my amendments. I found some little difficulty in finding a neat way of doing it and, in fact, I did not include it amongst my amendments and so I am very glad the Minister has decided to include it. The Minister might tell us why he did not consider actually naming the education and training committee as the education and training committee and would he tell us if there is any special reason why it is not named specifically?

It is just drafting.

Amendment agreed to.
Amendment reported.

Amendment No. 16 arises out of Committee.

Bill recommitted in respect of amendment No. 16.

I move amendment No. 16:

In page 10, to delete lines 38 to 40.

The House will recall that on Committee Stage I said I thought it was somewhat unfair to suggest that, probably in the very unlikely event that an employee of the medical council becomes a Member of either House of the Oireachtas, he should not in whole or in part of his secondment period enjoy the benefit of any superannuation fund. I understand—I did not take the opportunity of checking—that some professions, on their members being elected to either House, allow them to be seconded. They continue to make their superannuation payments and in the event of their departing from here for whatever reason their superannuation payments have not been broken because of their spell here. It is only right that this should be embodied in new legislation. I think the House is inclined to be too severe from time to time on possible Members and I believe a member of the medical council serving as a Deputy or a Senator should still be allowed to pay into whatever superannuation fund exists and that is the reason why I tabled this amendment. I do not think this clause in relation to superannuation benefit is in some similar sections in recent legislation.

I appreciate the generous motives which impelled Deputy Boland to put down this amendment but I am sure he will agree on reflection that it is not necessary. One job, one superannuation contribution and one benefit is a reasonable proposition and it would be establishing a very serious precedent if we were to break away from it. It is not incorporated in any similar legislation. On Committee Stage. Deputy Boland referred to teachers. They are in a peculiarly different situation. On election to the Oireachtas, a teacher retains his appointment but employs a substitute. When a person is elected to the Oireachtas he comes under a new pension scheme—thanks to my enactment, Deputies have a pension scheme of their own.

If they live long enough.

It is important that the public should know we contribute. There is a widespread misunderstanding about it: people think we get everything for nothing. We do not, not even the bar service. A person who was an employee of the Medical Council and became elected would benefit by the Oireachtas scheme for the period of his membership and he would not be paid by the Medical Council or be expected to make superannuation contributions.

Amendment, by leave, withdrawn.

I move amendment No. 17:

In page 12, between lines 4 and 5, to insert the following:

"(3) Every person whose name is entered in the register shall, as soon as may be after his registration has been completed, be sent by the Council a certificate stating that his name has been entered in the register.

(4) Every person whose name is entered in the register shall, as soon as may be after he has received the certificate specified in subsection (3) of this section, cause the said certificate to be displayed at the place where he conducts the practice of medicine at all times during which his registration continues and at no other time."

This arises out of Committee.

It certainly does. I have done everything within my human capacity to meet the wishes of the House. We are providing here that any medical practitioner who is on the register will receive a certificate to that effect, and he will be expected to display that in his place of practice.

I thank the Minister for meeting us, as he undertook on Committee Stage. I suggested that the certificate should be sent out by the Medical Council. We were endeavouring to control bogus doctors and Deputy O'Connell suggested that we consider the idea of having the certificate issued by the Medical Council and that the onus would be on a doctor to display it in his office. Deputy O'Connell went on to create some difficulties for his own recommendation by saying that if a doctor were practising in more than one place, as a great many doctors do, there would be a problem as to whether he should display a certificate in each of his places of practice. I do not think that point has been dealt with in the Minister's amendment.

The Minister has met us more than half way. I think it should be left to the Medical Council to decide whether they should provide copies of the certificate on request, when necessary. I am happy with the Minister's amendment.

Will the Medical Council be entitled to issue copies of certificates?

Amendment agreed to.

Amendments Nos. 18, 20, 26, 54, 59, 60, 64, 69, 72 and 77 are cognates and may be discussed together.

Amendment No. 87 involves the insertion of a new section providing for the service of notices of decisions of the Medical Council or the High Court, particularly in regard to fitness to practise. I am wondering whether we should discuss it with the others.

If the House agrees, it can be done.

I move amendment No. 18:

In page 12, line 46 to insert "and registered" before "post".

The amendment merely suggests that the documents could be sent by registered post as well as by prepaid post. We are dealing with very important documents, not with simple ones. These documents would be informing doctors that the Medical Council were initiating inquiries into allegations of malpractice against them. There could be other documents informing doctors that matters were being referred to the High Court. All these would have a bearing not only on the happiness of the practitioner but on his future and that of his family.

I suggested that the section should provide for the issuing of these documents by registered post, and at Committee Stage the Minister said there would be some difficulty in that regard because a person might refuse to accept delivery and could later claim he was unaware of the fact that a committee of inquiry was to sit in judgment on him. The Minister said that parts of this Bill were similar to that of the Solicitors Act, 1960. I looked at that Act to see how it dealt with solicitors who were having disciplinary proceedings taken against them and I found a section containing a provision very similar to that in my proposed amendment. It provides that any document could be served in two ways, either by hand or being sent by registered post at the person's last known address. They went on to provide that where a person was absent from the State or where the issuing body were not able to ascertain where he was residing and were not able to serve a notice on him, the Medical Council could apply to the High Court which would make an order. It also provided that the High Court could direct that the notice could be deemed to have been served by public advertisement.

In relation to the notice issuing to a doctor telling him that the Fitness to Practise Committee proposed to hold an inquiry into allegations against him and in relation to a notice that the Medical Council had confirmed a recommendation of the Fitness to Practise Committee that his name be erased or suspended from the register, opening up the appeals period to him, these are documents of such consequence that it is not good enough to suggest that they merely be sent by prepaid post. I was afraid that a situation could develop at some future date where some smart legal person retained by a doctor could argue very cogently a case that his client was completely unaware that disciplinary procedure had been initiated against him. I felt it was likely that such a case could be argued if the doctor could prove that he was out of the country at the time of the issuing of this document by prepaid post and was not aware of the start of this procedure and if he consequently gave no evidence to the Fitness to Practise Committee and had no opportunity of defending himself. If the documents were issued by registered post the doctor could not argue that he was out of the country because a registered letter will be returned to the sender if it has not been accepted and signed for by somebody at the address to which it was sent. Obviously that address would be the last known address of the doctor in the register. For that reason I suggested that registered letters should issue.

I went on to steal the similar section from the Solicitors (Amendment) Act, 1960 in relation to amendment No. 87 by suggesting that if the registered letter was returned to the council they should have the option of endeavouring to deliver that important notice by hand. If they failed in that they might find themselves in a quandary. I suggested in amendment No. 87 that the council could then go to the High Court and say that they had tried to serve notice on the doctor but that he was unavailable and they could ask the court to issue an order as to how they should endeavour to notify the doctor that proceedings had been initiated against him. If the Medical Council should decide to erase his name they should notify him of the decision and inform him that he has two months in which to appeal to the High Court.

I felt that this long list of amendments ought to be introduced so as to provide some safeguard for the council. Alternatively amendment No. 87 could be accepted. This would provide a section which would cover completely all aspects of the serving of notices of such an important nature to doctors, to the aggrieved parties and to the Medical Council. If amendment No. 87 were accepted I would be very happy to withdraw the other amendments.

I agree with what Deputy Boland has said. I also looked through previous Acts and there is mention in several Acts of registered prepaid post. The registered post is not a foolproof method but it does ensure a safer passage for the communication. There is a much greater chance of the communication reaching the person, and the Minister might consider accepting this. Letters can get lost and this is such a serious matter that I hope the Minister will consider accepting the amendment. Deputy Boland's suggestion is reasonable and I hope the Minister will see the merit in it.

Of course there is merit in it. It is a question of deciding the most practical thing to do. There is a fairly considerable difference between doctors and solicitors in this context. Solicitors are officers of the court and as such they are much more part of the court procedure. The court is really a disciplinary body where solicitors are concerned and there is that difference of status. I admit it is not a very compelling reason for a different approach.

Subsequent to the Committee Stage we had a long and serious discussion with the Attorney General on this point and he is quite firm that this is the better way to do it and that prepaid post should be used. He did advert to the practical difficulty that a person could avoid the proper procedures by refusing to accept the registered letter. While Deputy O'Connell was speaking I could not help thinking that Deputies have a certain experience in this respect because if a constituent wants to really make sure that a Deputy receives his representation he will send it by registered letter to his home. There is that precedent which we could follow. Against that, the Attorney General very much favours the procedures laid down in the Bill and the council must accept that the address on the register is the address to which the communication should be sent.

There is one further safeguard to which Deputy Boland and Deputy O'Connell have not adverted. The court must be involved in this. This is in answer to a specific point made by Deputy Boland. When the case would come before the court it would be open to the practitioner to point out that he had not received the communication. This procedure cannot be finalised without the court being involved. At that stage it is almost certain that the court itself of its own initiative would inquire into this aspect, and if they did not it would be a matter for the practitioner's solicitor to point out that notice had not been received.

With some regret I must maintain the position which is in the Bill and which is strongly advocated by the Attorney General, whose advice we must accept in this area.

Whilst I might have been inclined to accept the suggestion to merely enter the amendments to provide for prepaid and registered post, I find it incomprehensible that we should be asked to accept that suggestion in relation to amendment No. 87. It deals with the very difficulty which the Minister presented to us. A person might refuse to accept delivery of a registered letter and the amendment provides that the document can be served by hand. It then provides that if neither of these methods is satisfactory the Medical Council may go to the High Court and ask for a ruling as to how the documents should be served. This Bill was delayed for some time because of difficulties regarding constitutionality.

Those aspects were introduced for constitutional reasons in order that the High Court could put their seal of approval on the decision of the Medical Council. If the Minister's advisers found it necessary to go to such lengths to allow a professional body to have access to the High Court to have its decisions confirmed, there should be no doubt that the notices issued had been received and understood by the person concerned. I am not impressed by the Minister's suggestion that if a decision was made by the Medical Council to remove a person's name from the register he has a two-month period in which he can appeal to the High Court and make the defence that he was unaware of the activities of the Fitness to Practise Committee or of the Medical Council because he had not received the notice by prepaid post. Surely the way to get around that is to accept amendment No. 87.

In 1960 when the Minister was steering the Solicitors Bill through the House he probably gave detailed reasons for the necessity of this section. If it is right for the Solicitors Act, why is it not right to include it in this Bill? During last week's debate the Minister became involved in a discussion with either Deputy Dr. Browne or Deputy Dr. O'Connell on the merits of solicitors and doctors. The Minister pointed out that a solicitor might do away with your money but that a doctor has a much more precious thing in his hand—the ability to save life. If we are talking about taking away his rights to use that ability we should ensure that this Bill contains as many safeguards as the Solicitors Act.

A doctor who is anticipating a disciplinary move could decide to leave the country and stay away until the period within which he could appeal had expired, by which time the High Court may have confirmed the decision of the Medical Council. He could then return and ask the High Court to set aside their order and everything that had gone before it because he had not received the documents notifying him of his different status.

It is very difficult to prove a negative.

I am trying to set down a procedure that would not allow such difficult proof to be submitted. A doctor could make a good case by telling the court that he knew nothing about the decision of the council and that he was not aware of his right to appeal.

A registered letter would not improve the situation.

It is not just a registered letter, but a registered letter or service by hand, or in the event of a registered letter or service by hand failing, the council may ask the High Court to order a substitute service by advertisement or otherwise. Such an event would put a constitutional stamp on that aspect of the procedure. With respect, I believe that the Attorney General's advice in relation to amendment No. 87 is questionable. I withdraw the other amendments but I will not withdraw amendment No. 87.

I move amendment No. 19:

In page 13, to delete lines 45 to 48.

This section is obnoxious because it discriminates against coloured doctors who come here to take up temporary duty while studying for post-graduate degrees. I am not accusing the Minister of being a racist. He is a reasonable person and is broadminded. But unfortunately the Bill reads:

For the purpose of this section, the Council may require any person seeking temporary registration to undergo such tests as may be necessary to determine that he has the necessary linguistic ability for the practice of medicine in the State.

We all know that doctors from other EEC countries may practise here without restriction since the 1st January, 1977. We know that doctors without a knowledge of English from other developed countries do not come here to study for post-graduate degrees. Therefore, we can only conclude that doctors coming here to study for post-graduate degrees are from India, Pakistan and the African states. Ireland is renowned for its post-graduate education. We may not have contributed to the Third World in financial terms but we have made a significant contribution by training many of their doctors. Because they know that we provide excellent post-graduate training a lot of doctors from India, Pakistan and African countries seek to come here to obtain post-graduate degrees. It is a great tribute to our country that they do so. However, in this section we are saying that those who want to undertake post-graduate work—post-graduate work leading to higher degrees involves taking up appointments in our hospitals—will not be given provisional registration. The words "provisional registration" are important. These people are not seeking to settle here or set up in practice; they are merely coming for "provisional registration" while they obtain higher degrees. But we are debarring them at the port of entry. We are making it impossible for them to come here.

The Minister may say that we do not want people coming to work in our hospitals, even for the purpose of obtaining post-graduate degrees, who do not know English. According to this section if they do not know English they will not be accepted. In my view that is blatant discrimination. We are only applying it to such people but not to Germans, Italians, French or those from other member states. They need not know a word of English and they can come here. They can have permanent registration here and can set up in practice. Any German, without a knowledge of English, can set up in practice here tomorrow. Nobody can say anything to him. He has a full right to do so. But a doctor from the Third World, the undeveloped countries, who applies to do a post-graduate degree but whose knowledge of English is not perfect, as determined by a body set up by the Medical Council, is not allowed into the country. If that is not blatant discrimination I do not know what is.

Is it not obvious that the authorities interviewing foreign doctors will know by his qualifications and his ability to converse with them during the course of the interview whether he is a suitable person for appointment to a hospital? I can see no purpose in this section. It is an iniquitous piece of legislation. It is dangerous and holds us up to ridicule. It damages the good name of this country. It holds us up as a racist country, something I am trying to stop. I appeal to the Minister to delete this section. All reasonable people agree that it is not necessary. We are asking that people without a knowledge of English be allowed take up provisional registration. The fact that they are not allowed such provisional registration is what is so damning about this legislation. In the interests of the good name of this country I plead with the Minister to accept my amendment and leave it to the discretion of the interviewing board in the hospital as to whether a doctor seeking provisional registration and a post in a hospital for the purpose of obtaining a post-graduate degree is a person who could, in the course of his duties in the hospital, understand and make himself understood by patients.

I find it difficult to refuse that very impassioned plea by Deputy O'Connell. The only thing I can say by way of reply is that I believe he is overstating the case and magnifying into a point of principle something which is really only a very simple practical matter. What is involved is the getting over of a practical difficulty: that a doctor seeking temporary registration here from wherever he may come—not necessarily the Third World only—would have to undergo some test of linguistic ability. I would have thought that Deputy O'Connell would agree that that is important. In the medical world it is important that a doctor be able to communicate with a patient and a patient communicate with a doctor. Perhaps it is equally important that a doctor should be able to communicate with his colleagues in his profession.

This matter is still under discussion in the EEC context. It is not necessarily a black and white or an open and shut case as far as the Third World is concerned. A doctor coming here from an EEC country with no knowledge of English or Irish might in theory be entitled to the same status as an Irish doctor, but the point is that he would not get a job in the hospital world, with a health board or in an institution if he was not competent to carry out his duties. The only thing he would be left with would be to establish himself in private practice. As far as this is concerned the only possible suggestion would be of discrimination as far as private practice is concerned, and I cannot imagine the type of person Deputy O'Connell is concerned about being worried about establishing himself temporarily in private practice. I do not think it would arise. As Deputy O'Connell feels so strongly about this I would like to scrub this provision, but I am strongly advised and urged not to do so because it is a practical necessity. I hope the council will interpret this in the most liberal, humane and understanding way and that they will never attempt to use it to place difficulties in front of students or practitioners from the Third World or any part of the world.

Deputy O'Connell has adverted to our tradition in this regard. It is a good tradition, a high and noble one. Not alone have we sent priests, doctors, nurses and a great variety of people in the welfare world to the Third World but we have also received here sympathetically students from the Third World. We have been doing that long before it became popular to do so. A lot of countries and a lot of groups now are getting agitated and excited about the Third World and it is only right to point out that Ireland was involved in helping those countries for centuries in the practical way Deputy O'Connell has outlined. I hope our traditions in that regard will be maintained and strengthened. Indeed, I foresee in the near future a considerable growth in the number of students, in medicine and in the paramedical world, who will come here for training and education. That is something we can do to our own advantage and also as a contribution to the development of the Third World. Nothing would be further from my mind and I think that would also be true of the medical world in general.

There is very great activity in the medical world now to establish contacts with the Third World, to try and promote two-way co-operation, co-operation at all levels. The people in the medical institutions are very active in this field. I would think we could leave it to their good judgment and discretion that this would not be used in any discriminatory way, or that the fears of Deputy O'Connell has expressed could be realised. I want to assure Deputy O'Connell that if I thought this could be genuinely and realistically looked at as being discriminatory I would not hesitate to remove it. It has been put in, suggested to me and put forward to deal with a very practical difficulty. I suggest that it is a common-sense sort of provision and that the traditions of our medical world—the people in the different colleges and institutions—are such that there is no danger that it would be used in the way Deputy O'Connell was worried about.

Deputy O'Connell made a very eloquent plea for its removal and it is very difficult for me to resist that. When a Deputy of this House feels strongly about something of this nature it is not just enough for the Minister in charge of the legislation to say "No" in a dogmatic fashion. I do not want to do that. I merely want to assure Deputy O'Connell that in my view it will not be used in a discriminatory way. It is simply a common-sense, practical proposal, of general application and for the present I feel I must leave it there.

I believe the Minister is genuine in his remarks. But he has actually strengthened my argument by the points he has raised. He said that a doctor from the EEC without a knowledge of English might in theory have equal status with an Irish doctor but he would not get a job in a hospital. That is what would happen the coloured doctor if we abolish this. He would only have provisional registration: he would not have the rights of an EEC doctor. He could come here. He might have equal status as long as he was here studying for a higher degree, but he would not get a job in a hospital. The interviewing boards in the hospitals will decide whether or not he is competent to take up a post for as long as he is here only. We are not treating him the same as an EEC member. He has only provisional registration to study for a higher degree.

The Minister has put my argument in saying that the hospital must decide. The Minister said a doctor from the EEC without a knowledge of English might in theory have equal status with an Irish doctor but he would not get a job in a hospital. That is correct in regard to a coloured doctor but we are incorporating it in this Bill. We are making it impossible for coloured doctors, doctors from the Third World, to come in here. We are making it impossible for them. We are laying down unreasonable and unnecessary regulations that they can come here to study, not to stay here.

The Minister may not have alluded to the fact that the British Medical Council may be afraid, may be putting pressure on us to stop coloured doctors coming here for fear it will be a back door entry to Britain for them and, in consequence, we may be bypassing their test of linguistic ability. I have a sneaking suspicion that this is pressure being put on us by the British Council, in which case it would be a dangerous thing for us to fall in line with them. The Minister said that he was strongly advised and urged not to do so. I have always considered the Minister to be his own man and one who listened to reasoned arguments.

I honestly believe I have put forward reasoned arguments why we should not become racist in this. We will not get doctors from Sweden coming here for post-graduate degrees; they are far in advance of us. Neither do we get doctors coming from North America to undertake our post-graduate degrees because they are also far in advance of us. The same applies to any of the other developed countries. The provision was incorporated in the British Medical Council law to stop an influx of coloured doctors into Britain. That is why it is done. We do not have that problem. We do not have a colour problem and I do not think we should resort to the same measures employed in Britain. We occupy a leading place in the world in regard to medical post-graduate education. We offer them an opportunity to come here. We should not forego this great opportunity; it is an indirect contribution to the Third World that we invite these people over here. We have been doing it for over a century. The great names of Irish medicine are well known to them. We have given the names of Irish doctors and professors to diseases, different conditions, and they are household words in the Third World. I remember one man saying that where the name of Christ was never heard he heard the name of Dr. Tom Garry and collis fracture.

Might I interrupt on a point of information? I am afraid I misled the House to some extent. It is always dangerous to think one knows everything in this context. I was going on my recollection of the EEC Directive from my chairmanship of the EEC Legislation Committee. I have looked it up and in the EEC Directive there is the following:

Member States shall see to it that where appropriate the persons concerned acquire in their interest and in that of their patients the linguistic knowledge necessary to the exercise of their profession in the host country.

That would go a long way to removing the discriminatory problem Deputy Dr. O'Connell has in that regard. It is easily applicable in the EEC.

It proves the point that this qualification should be in relation to people coming from the other EEC member states to practise here.

It is in the directive.

But we do not say those coming here for permanent registration; it is provisional only. If the word "provisional" was taken out of that, then I would be glad to accept it. But the word "provisional" does not apply to any doctor of the EEC countries, because doctors coming from those countries get permanent registration under the free movement of doctors provided by the statutory regulations introduced on the 1st January, 1977. They also say that they shall see to it that they acquire linguistic knowledge; but they do not stop them coming in. Therefore doctors could have a broken knowledge of English and improve it while here. Frankly I have heard people from south Kerry speaking and I do not understand a word they say. It is no reflection on them but I never understand a word they are saying. What happens if I am on a committee deciding on the linguistic issue?

The last doctor from those benches who made that sort of comment got into very serious trouble.

I do not care what trouble I get into; I am always in trouble any way. The Minister's argument would be very logical except that it is provisional registration. Were he to agree to omit the words "provisional registration" we would not be discriminating against coloured doctors; we would be treating them all as one. But the EEC regulation says that doctors can come here; they just see to it that they acquire a linguistic knowledge. Of course, they could be here for five years and acquire it in their interests. Of course, a doctor can practise here, and he can acquire it, but it does not say he must undergo a test of linguistic ability. That is a completely different thing.

That is why it is so important that we do not allow this to go through. I was never more serious about any legislation before the House in recent times. We would hold ourselves up to public odium and the odium of the rest of the world if this provision were allowed to go through. I know the Minister is under a lot of pressure but this is where he can be his own man. He can listen to advice but he knows it is not right.

I am not convinced.

It is provisional registration.

It is temporary registration.

That means the doctor is here for only a short length of time. Before he can work in a hospital, before he can do the necessary study to obtain a post-graduate degree, he must obtain temporary registration. He can never practise under the general medical services and there is no danger. What I am objecting to is that we are stopping him at the port of entry and that is open discrimination.

My way is that we should leave it to the hospital authorities when he applies for a job to do post-graduate work. I suggest we should leave it to the interview board to decide if he has sufficient knowledge of English to continue to work in the hospital so that he may obtain a higher degree. It is not possible to obtain a higher degree without gaining a certain amount of experience in a hospital.

In hospitals in the Third World they do not have post-graduate degrees. We are enabling doctors from those countries to come here for a short length of time to get those degrees so that they may return as surgeons, physicians, gynaecologists, psychiatrists and so on. We are helping them in that way but they are also making their contribution.

I am saying we should not stop them at the port of entry and that is what we are doing when we say they must undertake a special test of linguistic ability. I say they should be allowed to come in and apply for the jobs. If the interview board consider that someone has not got enough English to study he should be told he can stay here until his knowledge of the language improves and then come back to the hospital. That is the reasonable approach that should be adopted.

By adopting the method suggested by the Minister we are not giving them a chance. It is blatant discrimination and I should not like the Minister to yield to pressures from other sources that do not see the logic of what I am saying. We will hold ourselves up to public odium if we adopt the course as suggested towards people who come to this country to do post-graduate degrees. I earnestly appeal to the Minister, as I have never appealed before, to reconsider this matter and to accept my amendment. It will be in the interest of the country, the medical schools and our post-graduate medical facilities which are trying to consolidate at the moment. We need it badly. We have had a golden era in medicine but we are now on the decline. This would give us an opportunity again. I am appealing to the Minister not to destroy it.

Is the amendment withdrawn?

No. Will the Minister accept it?

I am thinking about it but I cannot speak on it now.

The Minister cannot come in again. The debate on the amendment is finished. The Minister could indicate if he wished to do something in regard to the amendment in the Seanad.

Yes. I can give the Deputy an assurance that I will almost certainly do something about it.

I should like to thank the Minister very much.

Amendment, by leave, withdrawn.
Amendment No. 20 not moved.

Amendment No. 21 in the name of the Minister. Amendment No. 27 is cognate and they will be taken together by agreement.

I move amendment No. 21:

In page 14, line 43, to delete "28 days" and substitute "two months".

It is obvious the amendments are consequential on my accepting an amendment from Deputy O'Connell on Committee Stage extending the 28 days originally in the Bill to two months. I want to make that extension to two months of general application.

The newspapers have commented that the IMA were suggesting that the period should be three months. I wonder if the Minister has received a submission from them in that regard and why they suggested that period?

They are reasonable people and I am sure they will accept the period of two months. It is a compromise in this case.

Amendment agreed to.

I move amendment No. 22:

In page 15, between lines 5 and 6, to insert the following:

"(3) Whenever, on an application by any registered medical practitioner, the Council decides to enter in the register, pursuant to this section, any additional qualification in respect of that medical practitioner, the Council shall, as soon as may be after the registration has been completed, send to that medical practitioner a certificate stating that such additional qualification has been entered in the register.".

This is just applying the certificate provisions to special qualifications as well as to the original registration.

Amendment agreed to.

Amendments Nos. 23 and 24 are related and they may be discussed together by agreement.

I move amendment No. 23:

In page 15, line 12, to delete "registered medical practitioner" and to substitute "person".

These are drafting amendments. If a doctor's name has been removed from the register he is no longer a registered medical practitioner and he cannot be referred to as such. He is just called a person from then on.

Amendment agreed to.

I move amendment No. 24:

In page 15, line 17, to delete "the registered medical practitioner" and to substitute "that person".

Amendment agreed to.

I move amendment No. 25:

In page 15, between lines 18 and 19, to insert the following:

"(3) In any case where a registered medical practitioner applies to the Council pursuant to this section to have his name removed from any register maintained by the Council and—

(a) an application has been made pursuant to section 40 of this Act for an inquiry into the conduct of that registered medical practitioner, or

(b) that registered medical practitioner has been convicted in the State of an offence triable on indictment or has been convicted outside the State of an offence consisting of acts or omissions which would constitute an offence triable on indictment if done or made in the State,

the Council shall not consider the application by that registered medical practitioner to have his name so removed until such time as the Council has decided whether or not the name of such registered medical practitioner should be created from any such register pursuant to the provisions of this Act.".

Section 33 was introduced on Committee Stage to permit the voluntary removal from the register of a registered medical practitioner who applies to have his name removed from the register. The purpose of the section is to meet the situation where an Irish doctor wants to go to France, for instance, to practise medicine but who cannot get on the French register while he is still on the Irish register.

Without this section there is only provision for erasure from the register as a disciplinary measure. With the introduction of a retention fee it will also enable a doctor to have himself removed from the register for a period during which he does not wish to practise medicine and does not want to have to pay the retention fee for that period.

Subsection (3) provides for a situation where a doctor gets into trouble during the period he is off the register and the council can refuse to put his name back on the register. The person concerned has the right of appeal to the High Court against the council's refusal to restore his name to the register in such a situation.

During Committee Stage Deputy O'Connell mentioned that if a doctor realised he was in trouble and that his name might be erased from the register he could apply to have his name removed instead of facing disciplinary action. The amendment is to deal with such a situation. It provides that if any disciplinary action is contemplated or is being taken in regard to a doctor, these proceedings must be completed before the council can consider an application from the doctor to have his name removed. It is a sensible precaution.

Amendment agreed to.
Amendment No. 26 not moved.

I move amendment No. 27:

In page 15, line 28, to delete "28 days" and to substitute "two months".

Amendment agreed to.

I move amendment No. 28:

In page 15, between lines 43 and 44, to insert the following:

(2) Whenever the Council takes any action pursuant to subsection (1) of this section for the purposes of keeping any register correct, the Council shall forthwith notify the person concerned, or his next of kin, as the case may be, of the action taken and of the reasons therefor.

This amendment, like amendment No. 17, arises from Deputy Boland's proposed amendment on Committee Stage that the council should notify a doctor of any change it makes in the register relating to the doctor in question. The Deputy will recall that I undertook on Committee Stage to consider that matter.

Amendment agreed to.

I move amendment No. 29:

In page 15, to delete lines 48 to 50, and to substitute the following:

(a) as to the suitability of the medical education and training provided by any body in the State recognised by the Council for such purpose,".

This amendment I also referred to on Committee Stage. It is to clear up the position of the council in regard to the powers of supervision. At the moment the Bill provides that the council from time to time shall satisfy itself as to the suitability of the curriculum of training provided. The word "curriculum" is not very satisfactory there because it could be just a sheet of paper. I propose instead to substitute "as to the suitability of the medical education and training provided by any body in the State recognised by the Council for such purpose".

Amendment agreed to.
Bill recommitted in respect of amendment No. 30.

I move amendment No. 30:

In page 16, to delete lines 15 to 22.

Amendment agreed to.
Section deleted.
Amendment reported.

Amendment No. 31 has already been discussed with amendment No. 4. The Minister to move.

Bill recommitted in respect of amendment No. 31.

I move amendment No. 31:

In page 16, after line 48, to insert the following:

"CHAPTER 2

The Postgraduate Medical and Dental Board

39.—(1) There shall by virtue of this section be established a body to be known as the Bord Míochaine agus Déidliachta Iarchéime, or in the English language as the Post-graduate Medical and Dental Board (in this Act referred to as the Board) to fulfil the functions assigned to it by this Act.

(2) The following provisions shall have effect in relation to the Board—

(a) the Board shall be a body corporate with perpetual succession and power to sue and be sued in its corporate name and to acquire, hold and dispose of land;

(b) the Board shall not dispose of land or property save with the consent of the Minister;

(c) the Board shall as soon as may be after its establishment provide itself with a seal;

(d) the Minister may, out of moneys provided by the Oireachtas, make grants towards the expenses of the Board;

(e) (i) the Board may appoint such committees as it thinks fit and may define the functions and procedure of any such committee and may delegate specific functions to any such committee;

(ii) the Board may appoint as members of a committee established under this paragraph persons who are not members of the Board;

(f) the Board may, subject to the provisions of this Act, regulate its own procedure;

(g) the Third Schedule to this Act shall apply to the Board

40.—The functions of the Board shall be:—

(a) to promote the development of postgraduate medical and dental education and training and to co-ordinate such developments;

(b) to advise the Minister, after consultation with other bodies as the Board may consider appropriate, on all matters, including financial matters, relating to the development and co-ordination of postgraduate medical and dental training;

(c) whenever appropriate, to organise postgraduate education and training for registered medical practitioners and registered dentists;

(d) to provide career guidance for registered medical practitioners and registered dentists.

41.—The Board shall carry out such functions, other than functions assigned to it by this Act, as may be assigned to it from time to time by the Minister in relation to post-graduate medical and dental education and training.

42.—(1) The Board shall consist of twenty-five members appointed by the Minister.

(2) Before making appointments to the Board, the Minister shall consult with—

(a) the Council,

(b) the Dental Board,

(c) the appropriate bodies, and

(d) any organisation which, in the opinion of the Minister, represents, in the State, registered medical practitioners or registered dentists.

(3) In this section `the appropriate bodies' means any body or organisation specified in sections 9 (1) (a), 9 (1) (b), 9 (1) (c), 9 (1) (d) or 9 (1) (e) of this Act or any body or organisation recognised by the Council pursuant to section 39 (3) of this Act.

43.—(1) The Board shall appoint such and so many persons to be officers and servants of the Board as the Board from time to time thinks proper.

(2) An officer or servant of the Board shall hold his office or employment on such terms and conditions and shall perform such duties as the Board from time to time determines.

(3) There shall be paid by the Board to its officers and servants out of funds at its disposal such remuneration and allowances as the Board, with the consent of the Minister, from time to time determines.

(4) The Minister may, whenever and as often as he thinks fit, declare that any power conferred on the Board by this section shall be exercisable only with the consent of the Minister and whenever any such declaration is in force, the said power may, in relation to any office or unemployment to which the declaration applies, be exercisable only with such consent.

44.—Sections 8 (2), 8 (3), 12, 14, 18, 19, 20, 21, 22, 23 and 24 of, and Rules 8, 10, 11, 12, 13, 14, 15, 16, 18 and 19 or the Second Schedule to, this Act shall apply to the Board and for this purpose any reference in these sections to the Council shall be construed as a reference to the Board and any reference therein to the President or Vice-President of the Council shall be construed as a reference to the Chairman or Vice-Chairman of the Board, as the case may be.".

Was amendment No. 31 discussed with amendment No. 4?

Amendment No. 31 was discussed with amendment No. 4 at the beginning of the afternoon in Committee, and we cannot go back on that now.

May I make a report?

No, it was reported straightaway. I do not know what happened on amendment No. 4 but it was recommitted, discussed, passed and reported by the House and there it stands.

When I came in late I was told that amendment No. 4 was recommitted and discussed in Committee.

And reported immediately.

If there is some way within the rules of order whereby Deputy Boland would be allowed to say something about this section, I think he should be allowed because this is a change of some substance and Deputy Boland was not here.

I would be creating a precedent if I did that and I would be in trouble. I am afraid not; it has already been disposed of.

Can I say something?

No, you just moved the amendment. There cannot be any discussion on it.

Surely if the Minister moved the amendment, one is entitled to speak?

No. Amendment No. 4 has already been moved. The House fully discussed all these amendments with amendment No. 4. The procedure here is that when you reach the amendment, later the Minister moves it, but there can be no discussion on it.

That is a cod. A whole new chapter has gone into this Bill. The amendments were not submitted until yesterday, which is outside the legal time for amendments. These were submitted yesterday by the Department, circulated this morning and rushed through at 3.30 p.m.

I am not responsible——

I am suggesting that this amendment is out of order because it was not tabled in time for discussion on Report.

It cannot, because it has been discussed and accepted by the House.

It has not been accepted.

This amendment was not tabled two days before it was discussed and I do not believe the amendment is in order.

It has already been accepted by the House.

I am not against the principle of it but I am against the principle of not being allowed to speak on it. It is bad enough that it was sent out at the last minute but it is ridiculous that we cannot speak on it.

That is not my fault. That is the rule of the House. The Deputy was not here when it was being discussed and that is not my fault either.

This Bill was supposed to be taken after the IDA Bill. That was not finished but this Bill was pushed in at 3.30 p.m. and I got no notification of it. I was three minutes late and a whole new chapter has been brought into the Bill which I am not allowed discuss.

On the Order of Business this morning this business was ordered for 3.30 p.m. It was decided that, if they had not been already reached, business was to be interrupted at 3.30 p.m. to take Nos. 7 and 3. The Deputy has my sympathy, but there is nothing I can do about it. It has already been discussed fully.

I appreciate the Chair's position.

Amendment agreed to.
Amendment reported and agreed to.
Amendments Nos. 32 to 36, inclusive, not moved.

I move amendment No. 37:

In page 17, lines 45 and 46, to delete "informed by the Registrar" and to substitute "given notice in writing by the Registrar sent by prepaid post to the address of that person as stated in the register".

The House will recall that on Committee Stage I undertook to consider a suggestion by Deputy O'Hanlon that when it is proposed to hold an inquiry into a doctor's conduct then the doctor concerned should be notified in writing of the proposed hearing, the nature of the offence and so on. This amendment is to meet that point.

Amendment agreed to.

I move amendment No. 38:

In page 17, after line 49, to insert the following:

"(5) The findings of the Fitness to Practise Committee on any matter referred to it and the decision of the Council on any report made to it by the Fitness to Practise Committee shall not be made public without the consent of the person who has been the subject of the inquiry before the Fitness to Practise Committee unless such person has been found, as a result of such inquiry, to be—

(a) guilty of professional misconduct, or

(b) unfit to engage in the practice of medicine because of physical or mental disability,

as the case may be.".

I am making this amendment to meet a point raised by Deputy O'Connell on Committee Stage. He withdrew his amendment on the basis that I would favourably consider an amendment along the lines of his amendment. He was concerned about the findings of the Fitness to Practise Committee. My Report Stage amendment includes also the council's decision on the report of the Fitness to Practise Committee. It is absolute privilege.

Amendment agreed to.
Amendment No. 39 not moved.

Amendment No. 40. Amendment No. 41 is related.

I move amendment No. 40:

In page 18, line 3, to delete "duly authorised", and to substitute "authorised by the Committee for that purpose".

I did not explain fully what amendment No. 38 was about, but I think the House understands it and there is no need for me to go back on it.

It has already been agreed.

It was to meet Deputy O'Connell's point on Committee Stage about the person who was found innocent having the right not to have the findings published.

We are on amendment No. 40.

This is really a drafting amendment. The point was made by Deputy Boland on Committee Stage and this is to make clear what exactly was meant. The original section as drafted only used the words "duly authorised". We are proposing now to substitute "authorised by the Committee for that purpose".

My amendment is similar except that it suggests that it should be authorised by the council. When I first drafted my amendment I discovered I had written "duly authorised by the Committee". When I read the debate on the Committee Stage, at column 330 of the 3rd November, I discovered that when I had made the point to the Minister, I asked "duly authorised by whom?" and the Minister replied "by the council". Consequently, I changed my amendment to "authorisation by the Council".

I am sorry I misled the Deputy.

I am sure the Minister is and so am I, but is he satisfied that authorisation by the committee is the appropriate way of doing it rather than by the council?

Presumably the chairman of the committee is appointed by the council.

Ought an authorised person not have to be appointed by the council rather than by the committee?

No, we have gone into this very carefully. I am sorry I misled the Deputy.

Amendment agreed to.
Amendments Nos. 41 to 49, inclusive, not moved.

I move amendment No. 50:

In page 18, after line 27, to insert the following:

"(8) If the Fitness to Practise Committee require the medical records of a patient of any registered medical practitioner to be produced for the purposes of any inquiry conducted by that Committee, such records shall not be made available to the Committee, without the consent of the patient concerned, unless the Committee specifically direct the registered medical practitioner concerned to produce such records.".

Again, the House will recall the discussion we had about this matter on Committee Stage. We are concerned here with the question of the production of a patient's records. We all recognised that no matter what we did here there would be difficulties. What I am proposing should go a long way towards meeting the situation. My amendment reads as follows:

(8) If the Fitness to Practise Committee require the medical records of a patient of any registered medical practitioner to be produced for the purposes of any inquiry conducted by that Committee, such records shall not be made available to the Committee, without the consent of the patient concerned, unless the Committee specifically direct the registered medical practitioner concerned to produce such records.

This places a very serious onus on the committee. The committee will now have to consider the matter very seriously and only if they consider it necessary will they then direct that the records be produced.

I believe this meets what we all have in mind. I raised the point and I believe I was stating what we all felt about it. It ensures that because the proceedings of the Fitness to Practise Committee are private the records are also private. I believe this is the best that can be produced.

I would like to suggest to the Minister, as I will not have an opportunity of doing it later on, that this is a correct area where a person's medical record should not be bandied about and gone into in the course of investigation into a doctor's fitness for practice or otherwise. There is a further aspect in relation to medical records. In the case of a doctor who has had his name removed from the register and had that decision confirmed by the court, should power not be given to the Medical Council to recover the medical records of that doctor's patients? Those patients could then be asked what they wanted done with the records, if they wanted them sent to another doctor or destroyed.

There is a similar provision in the Solicitors Act which I accept is in relation to legal documents and documents which might be vital for people. A patient's medical record, if he is being treated for a number of years or if he is being treated for a serious illness by a doctor who has had his name removed from the register, might be very useful to the doctor the patient is then attending. I thought it would be a good idea if the Medical Council were allowed, on application to the High Court, to recover the medical records of the patients of a doctor no longer in practice and dispose of the records as the patients directed.

I am quite sure that the council would have no problem going on their own volition to the High Court in those circumstances for an appropriate order from the court.

Amendment agreed to.
Amendment No. 51 not moved.

Amendment Nos. 52 and 53 are related and may be discussed together.

I move amendment No. 52:

In page 18, line 38, after "person," to insert "and not less than one month previously by notice of reminder in writing sent by prepaid and registered post to the person.".

I believe we were all in agreement on Committee Stage that it would be very harsh to suggest that the Medical Council might remove a doctor or go to the courts seeking authorisation to remove a doctor's name from the register because he had not paid a retention fee about which they had sent him a notice not less than two months previously. The Minister suggested he would try to build in some sort of reminder procedure. I am not very happy with the wording of my amendment but I am not very happy either with the wording of the Minister's amendment. It certainly appears to leave the subsection rather cumbersome.

My amendment would have provided that not less than two months before the council decided to remove a doctor's name they should send him a notice in writing telling him they were requesting payment of his retention fee. My amendment would then have gone on to say that not less than one month previously a notice of reminder in writing be sent to him by pre-paid and registered post. At a month's notice the Medical Council might then proceed to send this reminder to that person. It is a harsh provision to suggest that a doctor's name should come off the register because he has failed to pay the retention fee when there may be extenuating circumstances or it may merely mean that it is a sin of omission.

Some of us are very forgetful about paying bills. We ought to ensure that as near as possible to the date of removal from the register the doctor is reminded that he has not paid the retention fee and he stands in danger of having his name removed from the register. That is why I put in the words "not less than one month". The Minister's amendment just says: "on more than one occasion". That leaves the two months provision there. The doctor may be sent two or more notices and then a two-month period would elapse and his name would be removed from the register. I was anxious to have a notice sent to the doctor at a time nearer to the date when his name would be removed from the register.

I do not want to reopen the whole question of whether or not a doctor's name should be removed from the register for non-payment of retention fee as this was fully discussed on Committee Stage. I undertook to try to ensure that a practitioner's name could not be removed from the register by the court for non-payment of the retention fee on the basis of receiving only one notification to that effect. I am suggesting in my amendment that there must be at least two notifications sent, one presumably the demand and one the reminder before the council can go to the court.

I believe that is reasonable. We have, in this and so many other areas, to rely on the common sense and the reasonableness of the council in operation. The council, after all, will be medical men sitting in judgment on their profession and I think we can expect them to be reasonable, sensible and fair-minded. I believe I have done what I promised. I have met the House in response to the arguments put forward on Committee Stage. I am now proposing in my amendment that at least one reminder must be given.

The wording is no credit to whoever drafted the amendment. I am not particularly happy. As the Minister's amendment will stand the notice and the reminders will be issued more than two months before the council set out to take the doctor's name from the register. I am suggesting that at a time nearer than the two months the doctor should be reminded that if he does not pay by a certain date the council will take steps to remove his name from the register. It could be argued that it is a good thing leaving it at two months but I believe it would be better to remind the doctor nearer to the time and make a final effort to try to get the payment from him.

That is what will happen in practice.

I might suggest that in line 37, after the word "previously", if a comma was inserted it might help the subsection to read better. As the matter stands with the Minister's amendment tied on to the end of the section a person will have to read it two or three times to understand what it means.

Amendment, by leave, withdrawn.

I move amendment No. 53:

In page 18, line 39, after "fee" to insert "on more than one occasion".

Amendment agreed to.
Amendment No. 54 not moved.

Amendments Nos. 55, 58, 62, 65, 68, 70, 73, 76, 78, 80, 85 and 93 are related and may be discussed together.

I move amendment No. 55:

In page 19, after line 21, to insert the following:

"(d) the High Court may by order, if it declares that it was proper for the Council to make a decision under this section in relation to such person (other than a decision on account of a person having failed to pay a retention fee), suspend the person from engaging in the practice of medicine for such period as the Court may fix.".

While those are similar amendments there is an amendment to section 46, which although it is similar, relates to a different sort of situation. I suggest it might be better if it were taken separately.

Which amendment?

It is similar amendment but it is in relation to section 46 where the council at short notice may go to the High Court seeking power to remove a person's name from the register, obviously, as we have suggested, only in very extreme circumstances.

That was No. 87.

It is No. 81—if it could be taken separately.

Amendment No. 81 is related but, if the House agrees it may be taken separately.

It relates to a different situation.

We will take amendment No. 81 then out of this list.

These amendments are all designed to try to meet a situation about which I have spoken on a number of occasions in the course of the debate. While the medical council will have the power through its Fitness to Practise Committee to investigate allegations of misconduct against a doctor or themselves to investigate if they are not happy about the suitability of a doctor to practise, where the Fitness to Practise Committee recommend that either his name be erased from the register, that he be suspended from the register or conditions be attached to his entry on the register, the council may adopt these decisions, go to the High Court and ask the court to put the constitutional stamp of approval on the council's decision but, nonetheless, in law the person is still entitled to practise. As I said earlier, I believe the general public will feel that that man is not entitled to practise if his name is being removed from the register but, in fact, he is entitled to practise to whatever limited degree.

The Minister agreed he would be entitled to practise as a surgeon once he had the educational qualifications and to prescribe any drugs not enumerated under the Misuse of Drugs Act. While he certainly would not get employment in a public authority I do not see that there is any statutory disbarment to his operating in the private sector, in a private nursing home or even in general practice if people are silly enough or ill-informed enough to attend him. He is a doctor with qualifications. His name is not on the register but he is still legally entitled to practise. The amendment envisages a situation where the council would go to the High Court and ask the court to confirm their decision that his name should be removed from the register and the High Court would confirm that and only when the High Court confirmed that the Medical Council had acted properly would this amendment then give to the High Court the power to make an order suspending the doctor from engaging in the practice of medicine. Subsequent amendments provide that anyone standing in breach of the High Court order would be guilty of an offence. I am not sure if we are taking amendment No. 93 at the moment.

Amendment No. 93 is being discussed with amendment No. 55.

Are we taking the amendment to remove the permissive right of the council to go to the High Court and making it mandatory?

Which number is that?

It is amendment No. 74.

Amendment No. 74 is not included in this list.

Is amendment No. 66?

It is not included either.

The council at present are permitted to go to the High Court. They are not obliged. I believe it would be better if they were obliged. We are not taking these amendments now so I shall leave the discussion of them until later. I thought we would take them all together.

We are taking amendment No. 66 with amendment No. 56, the next amendment.

Under that second amendment the council would be obliged to go to the High Court to have their decision ratified and the court would then be given the right where a doctor was suspended from practising to prevent him by court order from engaging in the practice of medicine and a subsequent amendment would make it an offence for him to disobey that order. That would be the legal constitutional stand on the decision taken by the Fitness to Practise Committee confirmed by the Medical Council and by the High Court. As far as I could make out wandering through the legal jungle of the Solicitors Act, 1960, with respect to the introducer of it, the High Court appears to have power to suspend a solicitor from practice. The Minister may make the point that solicitors are officers of the court. That point entertained my mind but nevertheless the Act deals with the same sort of situation we are trying to deal with here, a disciplinary committee of members of the profession reporting to the High Court that a solicitor was guilty of misconduct and certain things should happen to him. The court seems to have power to suspend him and to direct that other people do not employ him in any legal capacity. Now there is a very real principle involved in this. This amendment would give the High Court the right to put a legal disbarment on a doctor to prevent him from practising medicine for whatever period of time his name is suspended from the register.

Would the Deputy say a doctor or anybody? Only a doctor? The High Court can only prevent a doctor from practising medicine. Is that the Deputy's concept?

Would he go further and say the High Court can prevent anybody from practising medicine?

Is that not a bit ridiculous? I am not very clear what the Deputy's argument is?

If the Minister will look at amendment No. 55, it is paragraph (a).

I am not so much concerned with the Deputy's amendment as I am with his argument. Is it his argument that the High Court should have power in certain circumstances to stop a doctor from practising medicine?

A doctor whose name has been suspended from the register.

But the Deputy is not saying the High Court should have power to stop anybody from practising medicine.

The Minister is very adept at trying to divert the House into different channels when the main stream is not to his liking. We went through all this on Committee Stage. This is delaying the House. There are two different sorts who need to be controlled—the bogus doctor who has no qualifications at all and who masquerades as a medical practitioner and the other is the person who holds a primary degree, or even better qualifications, whose colleagues on the Medical Council decide that his name should be removed from the register because he is not a fit person to practise medicine. The council go to the High Court and the High Court confirms their decision. As well as confirming that decision the High Court should have power to make an order forbidding him to engage in the practice of medicine. It is here the whole element of protecting the public is built in and that is why I believe the amendment is so important. If the Minister wants to make any sense out of the Long Title of the Bill then he needs some additional safeguards other than the mere removal of a name from the register because the Long Title reads:

AN ACT TO PROVIDE FOR THE SETTING UP OF A COUNCIL TO BE KNOWN AS COMHAIRLE NA nDOCHTUIRI LEIGHIS OR THE MEDICAL COUNCIL WHICH SHALL PROVIDE FOR THE REGISTRATION AND CONTROL OF PERSONS ENGAGED IN THE PRACTICE OF MEDICINE AND TO PROVIDE FOR OTHER MATTERS RELATING TO THE PRACTICE OF MEDICINE AND THE PERSONS ENGAGED IN SUCH PRACTICE AND TO PROVIDE FOR THE REPEAL OF THE MEDICAL PRACTITIONERS ACTS, 1927 TO 1961, AND TO PROVIDE FOR OTHER MATTERS CONNECTED WITH THE MATTERS AFORESAID.

The Bill will not be capable of controlling people who engage in the practice of medicine even if the Medical Council, having investigated something, have come to the conclusion that one of their colleagues should not be on the register and that he should not practise medicine. and have gone to the High Court which confirms it for them.

Is it not ridiculous that the High Court will not be in a position to say to the man: "The Medical Council feel you should not practise and we are making an order, regrettably, forbidding you to practise". The same applies in regard to suspensions or the attachment of conditions. There might be two situations in which the Medical Council would attach conditions. One would be where a doctor was either very young or inexperienced or very old and had not kept up to date. The second situation would be where a doctor might be less cautious than others in the dispensing of drugs to addicts. I recall reading of such a case in Britain. The Medical Council might decide that they would leave him on the register but that he would not be allowed to dispense dangerous drugs or to have drug addicts as patients because he had been less than cautious.

Take a doctor who is not cautious in the dispensing of dangerous drugs. The Medical Council would enter that condition in their register but that doctor, under the Misuse of Drugs Act, could still dispense drugs because that Act provides that drugs could be dispensed by a registered medical practitioner, which he still would be. The Medical Council would have said: "Do not dispense drugs", or "You may not have drug addicts as patients". However, under the Misuse of Drugs Act that doctor may dispense drugs and the decision of the Medical Council, even if confirmed by the High Court, would not be legally enforceable.

I do not understand that. If a doctor is struck off he can no longer dispense drugs.

The Misuse of Drugs Act provides that dangerous drugs may be prescribed only by a registered medical practitioner. In 1973 when the Bill was passed it was not envisaged that medical practitioners could be registered with conditions attaching to their registration. If a doctor had conditions attached to his registration stating that he was not to prescribe drugs for addicts or that he was not to have addicts as patients, and the High Court confirmed that, the doctor could go on dispensing drugs. Is it not ridiculous that though the High Court and the Medical Council had decided that a man should not be allowed to prescribe drugs, the law still would allow him to do so because the law would have allowed him to engage in the practice of medicine? Is it not ridiculous that a man could be suspended for a period from practising but he may engage in public practice and there is no statutory disbarment?

Amendment No. 93 would include two further offences. Its acceptance would mean that a person struck off by his colleagues on the Medical Council and by the High Court would be stopped by law from practising. The amendment is designed in the interests of the general public, and when the Minister was on this side he regularly made points on the basis of the public interest. These amendments are in the public interest and it will not be good enough for the Minister to say that the profession should be allowed to govern themselves. If the Bill is allowed to be passed as it stands we will have a situation where the Medical Council's decisions will not be legally enforceable.

I am unable to accept the amendments or the Deputy's contentions. First of all, let me deal with the technical side of what he is proposing—I will not dwell on any one amendment but on the amalgam, the general effect of all of them put together. It is a nebulous concept to say that the High Court cannot stop people from doing something, as Deputy Boland suggested, that the way to do it is to put something into the Bill providing that persons other than registered medical practitioners should not be entitled to do X, Y, Z. If a person does it he is brought before the court and fined or put in jail. The only other way the High Court can make people do something or stop them from doing something is by way of injunction, frequently of limited duration.

Would the Minister consider accepting amendment No. 93?

It is not the purpose of the Bill to attempt to stop people practising medicine. I think we will all agree that that is not possible.

I do not agree.

That would be too far-reaching and vague to be put into a statute. The Bill is to regulate people of certain competence and ability in the practice of medicine so that the public will know who they are. Deputy Boland has brought up a complicated argument about drugs. The simple fact is that by the combined effects of the Misuse of Drugs Act and this Bill only registered medical practitioners will be able to prescribe or to give certificates for drugs, and if a doctor is struck off the register he will not be able to prescribe not only dangerous drugs but any drugs.

There are conditions attached to the register.

I could not imagine any sensible council in the sort of circumstances outlined by Deputy Boland putting an obscure set of conditions on the register in the case of the doctor concerned and not ensuring that they were followed up. In the type of case Deputy Boland is talking about, I do not think any council would hesitate for a moment to strike off that doctor. If they were foolish enough to allow him to stay on the register with some sort of conditions attached, they would have to see that those conditions were brought to the attention of everybody in the area, particularly chemists who would be expected to honour the conditions. This is not a very realistic situation.

I am trying to outline the approach of this Bill to the practice of medicine. It is as far as we can go. A register will be maintained and kept up to date, certificates will be issued for display in consulting rooms and as far as possible we will ensure that the general public know what the registration of medical people is all about. We hope by education and otherwise to ensure that members of the public in need of medical attention will go to registered medical practitioners. They would be very foolish to do otherwise.

Regarding medical appointments, a very important part of the medical world, nobody will get an appointment to practise medicine in an institution or hospital unless he is registered. We are going as far as we can and as far are common sense, realism and practicality permit. I reject Deputy Boland's attempt to go that much further and to bring the High Court in some sort of omnibus way into this situation and ask it to execute a role which it is not fitted to execute. Basically, the High Court is there to administer the law as we pass it. It is not there to arrogate to itself para-administrative functions in the way that Deputy Boland is seeking.

It is there to confirm that the Medical Council were right to suspend somebody.

Deputy Boland will have the right to reply.

We have discussed this question before. Deputy O'Connell and I do not accept Deputy Boland's approach and we understand what he is driving at. In the best of all possible worlds it might be desirable to attempt what he is trying to do but even then we could not do it completely. In the meantime we must stay with the sensible, rational approach of this Bill. The Medical Council will register practitioners who have certain competence, certain degrees and formal training and try to ensure that only such persons will give medical attention in the normal way to members of the public. We are ensuring that only those people on the register will get medical appointments.

There are several issues that arise. I do not accept the Minister's suggestion that the High Court is not competent in this area because in the Minister's own Bill he provides the right of the Medical Council to go to the High Court for confirmation of their decisions. In that regard I hope that at some stage later on in the debate the Minister will explain something to me; it will arise on the next amendment.

The Medical Council may make a decision to erase a doctor's name from the register. They do not appear to have the power to actually carry out that erasure unless they go to the High Court for confirmation. It seems to me ridiculous that they may say that a man's name should be erased from the register if they are merely given the permitted power to go to the High Court and this is not obligatory upon them. I wonder what would happen if for some reason the council did not go to the High Court. The Minister said that the council always would go. Ministerial undertakings are not good in law and perhaps the council should be obliged to go to the High Court or they should have the power to remove the name from the register without going to court if they think it is the right thing to do.

Section 42 (3) (a) states:

the High Court, on hearing of the application, may either—

(i) cancel the decision, or,

(ii) declare that it was proper for the Council to make a decision under this section in relation to such person and either (as the Court may consider proper) direct the Council to erase his name from the register concerned or direct that during a specified period (beginning not earlier than 7 days after the decision of the Court) registration of his name in that register shall not have effect,

Is the Minister seriously telling the House that the High Court has not got competence in this area? My amendment merely provided that where the High Court declared that it was proper for the council to make a decision under this section, the High Court should make an order saying that the person should not engage in the practice of medicine.

An order could not be made except under legislation.

It would be in legislation if the amendment were accepted.

If the High Court made such an order, it would be taking legislative power. It cannot do things like that.

If my amendment were accepted the law would be there. In section 46 specific powers are given to the High Court to make interlocutory orders. That power is given under the section. Do not let us try to fool anybody that this is a power the High Court could not have. It would have the power if the amendment were accepted. The Minister says the High Court is not competent. If the High Court is not competent to say that a man should not by law practise medicine, then the High Court is not competent to say that the decision of the Medical Council was right and that they should remove him from the register.

They are two different things.

My amendment merely suggests that when the Medical Council decide that a man is not fit to practise medicine and that his name should be removed from the register the High Court should confirm that and make an order to the effect that the man is not to practise medicine until such time as the Medical Council restore his name to the register. If the Medical Council want to suspend a man for a period the High Court, on confirming that the decision was fair and reasonable, could make an order suspending him for the same period.

Amendment No. 93 specifies:

In page 23, after line 49, to add the following:

"(c) Engage in the practice of medicine during a period when an order of the High Court suspending him from so engaging is in force.

(d) Engage in the practice of medicine contrary to the conditions laid down during a period when an order of the High Court attaching such conditions to his so engaging is in force.".

I do not see how that is not an offence; I do not see how the High Court is not competent to make those orders if the amendments are accepted. If the Minister is questioning the competence of the High Court he is questioning the provisions of his own Bill which purport to give to the High Court the power to confirm or cancel decisions of the Medical Council.

In the Solicitors (Amendment) Act, 1960, the Minister saw fit to give to the courts power to prevent a solicitor who had been struck off from practising as a solicitor and power to prevent any other solicitor from employing that man in any other legal capacity. Solicitors deal only with money and documents and doctors deal with lives. The Minister saw fit in 1960 to give to the High Court the power to agree with the decision of the disciplinary committee that a man is guilty of gross professional misconduct and that he should not be allowed to practise law. Why are we in a different position when we say that the High Court should be able to agree with the decision of the Medical Council that a man is guilty of gross professional misconduct and should not be allowed practise medicine?

Because the practice of medicine is a much broader and completely different concept. The practice of law is a very restricted, narrow sort of operation.

I do not accept the Minister's point of view. When the Minister was on this side of the House he often spoke of the necessity for protecting the interests of the public. The simple way to protect the interests of the public would be to give the High Court power to suspend a doctor from engaging in the practice of medicine. The Medical Council can suspend a doctor from their register but they cannot stop him practising, even when the High Court has confirmed their suspension.

It is a ridiculous situation in 1977, when the Minister is being reported in the newspapers every day on the importance of educating the public and that he envisages that every mother will become a doctor to her little flock. These are pious platitudes. If every mother is going to be a doctor to her little flock why is the Minister not ensuring that when she brings her little flock to a doctor with formal qualifications that that doctor is properly registered? If he is not properly registered he should not be allowed to practise.

The Minister and Deputy O'Connell suggested that I would be giving medical advice to Deputy O'Connell if I told him he was not looking well. The Minister suggested that I would be giving medical advice to Deputy O'Connell if I told him to take an Aspro. I want to assure Deputy O'Connell that I would never advise him to take an Aspro because he is well able to take care of his own health. If Deputy O'Connell was struck off the register he would still be entitled to carry out certain practices. If the Minister knew this and was stupid enough to ask Deputy O'Connell for medical advice, Deputy O'Connell would be entitled to cut off the Minister's leg.

I trust he would give me an anaesthetic first.

I am not sure whether he would be entitled to give the Minister an anaesthetic but he would be entitled to take a knife to him.

The law will not confer an entitlement on him.

The law would not prevent him from doing that. The amendments are enforceable and the High Court has the competence to enforce them. The Minister is not prepared to accept the amendments because their provisions are not included in the Merrison Report, and this Bill is a copy of the Merrison Report. Most doctors in Britain are involved in the national health service. If a doctor's name is struck off the register of the British Medical Council, the Council's liaison body ensures that his name is erased from the national health panel.

It will be the same here.

Does the Minister intend to establish a national health service?

He will be struck off the register of the general medical service.

Many doctors would be happy to be struck off the general medical register because they would still be able to make a living. The Merrison Report suggests that there is no necessity for such control in Britain because the national health service is comprehensive. A doctor would lose his livelihood if his name was struck off the national health register in Britain. The Medical Council will regret that the High Court has not the power to legally suspend a person who has been struck off the register. I believe the Medical Association would be in favour of legally preventing a suspended doctor from practising. The higher the standards the better the reputation of the profession.

The Minister has closed his mind to the argument. All I am achieving is putting my view on record. Time will show that those involved in implementing the Act will be sorry that these provisions are not contained in it.

Amendment, by leave, withdrawn.

Amendments Nos. 56 and 57 form a composite proposal. Amendments Nos. 66, 67, 74 and 75 are related and may be discussed together.

I move amendment No. 56:

In page 19, line 25, to delete "may" and substitute "shall".

These amendments were designed to change the situation in which the council are permitted to go to the High Court for confirmation of their decisions but are not obliged to do so. I am not sure that they ought to be permitted to do so.

It appears to be strange that the Medical Council can not erase the name of a doctor from the register without going to the court. For some reason or other they are not obliged to go to the court. It would be a silly situation if the Medical Council, having made their decision, decided not to go to the High Court.

I will not say I am exactly grateful to the Deputy but it is as well to clear up this point. It is clear what exactly the situation is legally and constitutionally. It is a composite process. The council must, if it wants to see the erasure finally effective, go to the court to do so. It cannot complete the process of erasure, whatever it may be, without going to the courts and having that done. That is my clear cut confirmed legal advice on the matter. When one is satisfied about that then the word "may" is the word that is wanted. It is always possible, as Deputy Boland recognises, that at the last minute something might arise which would persuade the council that this process should not be finally gone through and the person should not be removed from the register. That is why we are putting in "may" instead of "shall".

The only reason I was concerned was that if the council came to the decision and then decided not to go to the High Court—the reason for going to the High Court is to make sure that it is constitutional——

The erasure is to complete the procedure. One cannot go off the register without the court coming into the picture.

It is to keep the Medical Council in the clear. For example, if after making a decision they had second thoughts and did not go to the High Court that decision would be public knowledge. Although he was not erased it would be public knowledge that they had gone to that stage.

He would still be on the register.

The Deputy should remember that this is Report Stage.

The reason for bringing the court into the matter is a constitutional one. It is well established by now, since the famous solicitor's case, that a vocational body cannot take a man's livelihood away without a court coming into it. The court is brought into it for that constitutional reason. It is only common sense that one leaves a last minute opportunity with the council—there may be some last minute evidence or some new factor may arise in the situation—not to proceed to erase the man's name off the register. Unless they go to the courts his name stays on the register. It is a composite process. That is why I am leaving the word "may" in.

I should like to make another point by way of further explanation. The basic disciplinary body is the council. It is the council that decides if a person is unfit to practise or should be removed off the register. It is a professional medical decision. The court only comes into the case to decide whether the council followed the procedures correctly, if it followed natural justice. The court has no function in deciding about a person's medical capacity or anything of that nature. The basic medical professional decision belongs to the council.

That is accepted. All I suggested was that the court confirm that legally.

Amendment, by leave, withdrawn.
Amendments Nos. 57 to 60, inclusive, not moved.

I move amendment No. 61:

In page 19, line 57, after "section" to insert "for a period of specified duration".

This is a drafting amendment. As Deputies will see section 41 (1) speaks about a situation where the council may decide that the name of such person should be erased from the register or from the register of medical specialists, as the case may be, or during a period of specified duration. The removal is for a period of specified duration as set out in that subsection and, therefore, when we come to subsection (8) of that section we must use the same wording.

Amendment agreed to.
Amendments Nos. 62 to 79, inclusive, not moved.

I move amendment No. 80:

In page 22, line 20, after "an" to insert "interim or interlocutory".

It was not clear to me on Committee Stage whether the High Court, in pursuance of subsection (1) of this section would have the power to make a permanent order. I understood it would and I understood the Minister to indicate that it would, but when I read the section later I was inclined to think that subsection (1) was regulated by subsection (3) which only gives the High Court the power to make interim or interlocutory orders. My reason for tabling this amendment was to establish clearly that the orders could only be of an interim nature. The powers given in this section to the High Court are the same as the Minister described a short time ago as the High Court taking on to itself legislative authority. It is no such thing. The High Court gets its authority from the Acts and if an amendment is accepted here that is where the court gets its authority from. It is ridiculous to suggest that the High Court has taken something on to itself on foot of section 46 or any other section that gives it the power to make an order. I want it confirmed that these orders are not of a permanent nature. We all agree that this section will only be used in most unusual circumstances. I am anticipating that the Fitness to Practise Committee's activities and the activities of the Medical Council would take place subsequently but in the interim, because of the serious and urgent nature of the case, the council could go directly to the court. I do not think it should be allowed to the court and seek a permanent order.

Of course the High Court can make orders under statutes. I was speaking of a concept which Deputy Boland, in the course of an earlier debate, was asking us to accept, where the High Court could make orders of general application about the practice of medicine.

I thought that was what the Deputy was proposing. The High Court cannot make any such orders. The High Court can only make orders under statutes or, in certain committed circumstances, under the non-statute law. Generally speaking, we lay down the legislation and the court gives effect to our legislation either by penal provisions or by orders of one sort or another.

Had the amendment been accepted it would be legislation.

In my view the sort of order the Deputy asked us to give the High Court power to make could not be made under the approach which this Bill enshrines in it.

I hope some solicitor who is being struck off does not hear that and interprets it in relation to the Solicitors Act, if the wording is taken from that.

This section deals with an emergency situation where the council wants to cut through the normal process because of the urgency and the danger inherent in the situation to get to the High Court and get something done about a difficult and dangerous situation. The procedure is interlocutory or interim injunctions.

Subsection (1) is governed by subsection (3).

Amendment, by leave, withdrawn.

I move amendment No. 81:

In page 22, after line 28, to add the following:

"(4) The High Court may by order, if it considers appropriate, suspend the person from engaging in the practice of medicine for such period as the High Court may fix.".

In view of the Minister's intransigence in his reply earlier there is not much point in labouring this. I asked that this amendment be taken separately because it is a separate situation.

I am sure the Deputy will agree that it was related to the other amendment.

In this section, rather than going back over all the procedure normally gone through before getting to the High Court, the Medical Council would be going to the High Court and saying: "Please make an immediate order to allow us to erase somebody's name from the register", obviously because the person had been found suddenly in a rather public and undeniable way guilty of some flagrant professional misconduct. I wondered if such a case was so urgent, self-apparent or, if it was not felt possible to wait for the Fitness to Practise Committee to make their report, the Medical Council would go straight to the High Court. In those unusual set of circumstances I wondered if the High Court should not just give the council power to suspend the man's name from the register but that the High Court might not also be given the power to suspend him from the practice of medicine until such time as the Fitness to Practise Committee and the Medical Council had carried out their investigations and made their full recommendation. Of course, the Minister does not accept the principle.

Amendment, by leave, withdrawn.

I move amendment No. 82:

In page 22, line 29, after "Act," to insert "proceedings of or communications to or by the Council pursuant to sections 41, 42, 43 or 44 of this Act,"

The House will see clearly what I am at here. It arises out of our Committee Stage discussion. It is merely to extend the privilege provisions to sections 41. 42, 43 and 44 and also to 40.

Amendment agreed to.
Amendment No. 83 not moved.

I move amendment No. 84:

In page 22, lines 37 and 38, to delete ",as the case may be, therefrom as soon as may be." and to insert "therefrom, as the case may be."

This is a drafting amendment. Here I must agree with Deputy Boland that the language in the original draft was particularly—I can only use the Irish word "casta". Therefore, we are just smoothing it out a little by this amendment.

Amendment agreed to.
Amendment No. 85 not moved.

I move amendment No. 86:

In page 23, after line 4, to add the following:

"(2) On the occasion of the occurrence of any of the matters set out in paragraphs (a) to (f) of subsection (1) of this section the Council shall forthwith cause a notice of that occurrence to be published in the national daily newspapers published within the State and shall also cause such notice to be published in such other manner as it may decide.".

The purpose of this amendment would be to ensure that when disciplinary measures have been not only proposed by the Fitness to Practise Committee and agreed by the council——

Should this not fall with amendment No. 85?

No, the second line of this amendment makes reference to paragraphs (a) to (f). Amendment No. 85 would have introduced a paragraph (f). This amendment would now refer to paragraphs (a) to (e). The suggestion is that in any case where the court has confirmed the council's proposal to erase, restore, suspend, or attach conditions to an entry in the register the section obliges the council to notify the Minister. My amendment would put an onus on the council also to publish in the national press, again in the interests of the public, the fact that a doctor's name had been removed from the register, equally importantly the fact that a doctor's name had been restored to the register and also to cause notice to be published in such other manner as it may decide. The reason for that was that I felt it might be necessary in relation to our agreements within the European Community for the Medical Council to publish notices of the removal from or restoration of a doctor to the register in some of the EEC countries as well. The thought is not original. It belongs to the Minister and the 1960 Solicitor's Act except that there the onus is on the registrar to publish a notice in Iris Oifigiúil, and in such other manner as it may decide which allows the Incorporated Law Society to advertise the fact that a solicitor's name may have been removed or restored. I believe this amendment is in the interests of the general public. If it is thought important that the Minister should be notified of any change like this in the register then surely a step should be taken to ensure that the general public are notified also.

My approach here is slightly different from that of Deputy Boland. I regard the council as having done its duty when it amends or alters its register, then notifies the Minister and the onus is on the Minister to take whatever consequential action is necessary—to notify health boards, perhaps even publish advertisements in the paper or do whatever he deems appropriate. But the notification to the Minister will place on him, as the person responsible for the administration of the health services, the responsibility of taking any consequential action.

Would the Minister amend that section to place the onus on the Minister?

The purpose of notification is to place the responsibility on him. He must then, in the normal course of events, take whatever action is appropriate.

On Committee Stage the Minister suggested that it would be a good idea that he and his officials would know——

And that everybody else in the Administration would know.

Is amendment No. 86 withdrawn?

Does the Deputy want me to put it?

Yes. I am putting the question: "That the amendment be made".

Amendment declared lost.
Amendment No. 87 not moved.

No. 87 was the amendment consequential on amendment No. 18.

Yes, but amendment No. 18 fell and therefore No. 87 cannot be moved.

I think we gave the Deputy a separate decision on No. 87.

Does the Deputy want me to put the amendment?

Yes, I want you to put it.

I am putting the question: "That the amendment be made".

Amendment declared lost.

Amendments Nos. 88 and 89 have been ruled out of order. Amendment No. 90 is to be recommitted for the usual reasons.

Bill recommitted in respect of amendment No. 90.

I move amendment No. 90:

In page 23, line 17, after "Council" to insert "or any of its committees".

This is a matter which did not come up on Committee Stage but it has been included at the suggestion of the Attorney General to meet the situation such as providing medical advice to the Fitness to Practise Committee. At present we are only providing that for the council but one of the committees might have to get legal aid.

I notice that in Britain a similar committee has a legal officer of at least ten years standing assigned to it who must attend all its proceedings. Would it be envisaged that a similar measure be taken here? It is obligatory that their legal officer be present at all hearings of their equivalent of the Fitness to Practise Committee. Is it envisaged that something like that might happen here? Is that the reason for the amendment?

No, the reason for the amendment is that they be able to have access to legal advice and employ counsel and solicitors if they see fit.

Amendment agreed to.
Amendment reported.

I move amendment No. 91:

In page 23, line 21, to delete "other year" and to substitute "year in which any register is not printed and published".

The House will see that this is in fulfilment of my Committee Stage promise. There was some doubt about the wording of this question of publishing the register. We want to make it clear that the supplement to the register will come out in every year in which the full register is not published.

Amendment agreed to.

I move amendment No. 92:

In page 23, between lines 22 and 23, to insert the following:

"(2) The most recently published copy of each register maintained by the Council and any supplements thereto shall, at all times, be made available for inspection by any person, during office hours, by the Council at its office and by the chief executive officer of the health board at the headquarters of any health board established under the Health Act, 1970.".

This also follows our discussion on Committee Stage when we were all anxious that the register should be made as widely available as possible. The principal provision here is that each health authority will have to provide a copy of the register at its principal office.

Amendment agreed to.
Amendment No. 93 not moved.
Bill recommitted in respect of amendment No. 94.

I move amendment No. 94:

In page 24, between lines 8 and 9, to insert the following:

"58.—The Council shall carry out such functions, other than functions assigned to it by this Act, as may be assigned to it from time to time by the Minister in relation to medical education and training or other matters relating to the practice of medicine and the persons engaged in such practice.".

This is consequential really because I deleted the section—I think it was 57 —which gave me power to allocate post-graduates to educational training functions of the council. That is gone but I still wanted to have power if it appeared necessary at some time to allocate additional functions to the council.

Amendment agreed to.
Amendment reported.

I move amendment No. 95:

In page 24, line 10, after "any" where it first occurs to insert "other".

This is a drafting amendment.

Amendment agreed to.

I move amendment No. 96:

In page 24, line 14, after "regulation" to insert ",other than a regulation made under section 9 (2) of this Act,".

It is really only a drafting amendment. Deputies will see that the original wording could have a kind of "chasing your tail" situation so far as regulations were concerned.

I am glad I brought that to the attention of the Minister on Committee Stage.

I am sorry. I should have said that Deputy Boland drew my attention to the matter.

Amendment agreed to.

I move amendment No. 97:

In page 24, after line 48, to insert the following:

"(3) It shall be a function of the Council to inform the public on all matters of general interest relating to the functions of the Council.".

Again, I am putting this forward to meet the wishes expressed on Committee Stage. Deputies were anxious that the council should give as much guidance as possible to the public in addition to giving guidance to the profession.

I am very pleased the Minister has included this amendment. From now on the council will have to keep the public informed, something that was not done for 50 years. The council held its meetings in obscurity and the public and the media did not have access to it for information. Requests for information fell on deaf ears. This is a most important amendment and it will serve a good purpose. It is definitely in the interests of the public and the profession. I welcome it and I congratulate the Minister on introducing the amendment.

Amendment agreed to.
Bill recommitted in respect of amendment No. 98.

I move amendment No. 98:

In page 25, between lines 41 and 42, to insert the following:

"(b) Whenever a casual vacancy occurs among the members of the Council appointed by election, the Council, after consultation with the Minister, shall co-opt a person who would, pursuant to the provisions of this Act, be eligible for election to fill such vacancy and any person so coopted shall serve as a member of the Council for such period as is unexpired of the term of office of the person whom he replaces.".

This amendment is to deal with a situation regarding casual vacancies. Rule 6 of the Second Schedule provides for the filling of casual vacancies among the members of the council other than those appointed by election. It had been intended to deal with casual vacancies among the elected members in the regulations dealing with the election as provided in section 11. However, it is now considered more appropriate that the filling of casual vacancies among the elected members should be provided for here as in the Second Schedule.

Amendment agreed to.
Amendment reported.

I move amendment No. 99:

In page 25, line 43, after "seven" to insert "; provided that, in the case of a meeting of the Council where the matter of the erasure of the name of a registered medical practitioner from any register maintained by the Council, or the matter of the suspension of a registered medical practitioner from any such register, or the matter of the attachment of conditions to the continued registration of a registered medical practitioner, is on the agenda, the quorum shall be ten."

Again, this is in loyal and dutiful fulfilment of a promise which I gave on Committee Stage. It is an important point. Members were concerned about the quorum provisions on the council. It was pointed out that if the quorum was seven a person could be struck from the register by four people. The quorum will still be seven in the normal course of events but the amendment provides that it shall be ten in the matter of erasure of a name from the register, the suspension of a registered medical practitioner or the attachment of conditions to the continued registration of a registered medical practitioner. When these matters are on the agenda the quorum shall be ten.

This amendment does not meet my wishes but I respect the Minister's desire to do everything possible to be fair. A Fitness to Practise Committee will make a recommendation to the council about the erasure of a name from the register and the council will make a decision. There are many other functions of the council that are not related to a doctor's conduct; for instance, there are matters relating to medical education and training and so on. I can understand a quorum of seven making a decision on such matters but the question of erasing a doctor's name from the register is a serious matter.

On the previous occasion I pointed out that four people could decide a doctor's future. In this amendment we are just increasing it to six people, that is, less than one-quarter of the total members of the council. I know that the Minister has gone more than halfway to meet me. Perhaps he could reconsider the matter in the Seanad. I should like something on the lines that the decision on such an important matter would be the decision of the majority of the members of the council In discussing such a serious matter I think the majority of members of the council should be present to ensure that not alone is justice done but that it is seen to be done. Six people might be vindictive. It can happen at meetings. I am sure Deputy Boland, as a member of councils and committees, has seen this happen. Often decisions are taken that are not good decisions.

It may happen in councils the Deputy attends but not in mine. However, I agree with him.

I do not mind a small quorum on minor matters but the erasure of a doctor's name from the register is very important.

Important matters are often decided by a single vote.

I agree. Perhaps the Minister could look at this again.

We will see what the Seanad have to say.

The Minister's amendment goes a long way to meet the slight reservation I had regarding the original quorum of seven when considering the erasure of a doctor's name from the register. In the original quorum it is possible that four of the members could have been appointed by the Minister. The increase in the quorum is a significant difference and I should like to compliment the Minister.

The point raised by Deputy O'Hanlon is interesting. In Britain the recommendation was that the Professional Conduct Committee should consist of a chairman and 18 members, to include 12 members reaching the GMC by direct election, four by a nominating body and two lay members. They went on to say that the quorum for the Professional Conduct Committee dealing with disciplinary cases should be a chairman and nine members, that is, ten out of 18 members. The Minister is suggesting ten out of 25. The British recommendations went into some detail to deal with the matter. They said it was right in relation to decisions of the Professional Conduct Committee——

The Deputy can be assured I will look at the matter.

I wanted to make another point——

Is the Deputy suggesting that we should slavishly follow the British?

That is correct.

I was trying to make Deputy O'Connell's point if he would allow me.

Is he suggesting that we should slavishly follow Britain?

The Deputy had us slavishly following the Americans last week with all the American phrases. There should be some provision about a quorum with regard to the Fitness to Practise Committee. It will be on foot of their recommendations that the council will make a decision. It could turn out to be a small committee. That ought to be amended in the Seanad.

I will look at both matters in the Seanad.

It was also suggested that from the point of view of impartiality, the chairman of the council should not be a member or the chairman of the Fitness to Practise Committee so that if a report comes from the committee to the council, the chairman will look at it from an unbiased point of view.

Amendment agreed to.

Amendments Nos. 100 and 101 are out of order.

I move amendment No. 102:

In page 26, line 15, to delete "whose proposal" and to substitute "the intention to propose which".

This is purely a drafting amendment.

Amendment agreed to.

Amendments Nos. 103 and 104 are out of order.

I move amendment No. 105:

In page 27, line 14, after "purpose" to insert "by the Registrar".

The House will recall that we discussed this matter for a few minutes at the end of Committee Stage. It was suggested that, as the minutes of the council would be recording very important decisions from time to time in relation to removing a doctor's name from the register, Rule 15 should include the phrase that the minutes of the proceedings of all meetings of the council shall be drawn up and entered in a book kept for that purpose but we should specify the person to keep the book. With the approval of the Chair I will deal also with amendment No. 106 as it is related.

Amendments Nos. 105 and 106 will be discussed together.

The Bill goes on to say "and such minutes shall be signed by the chairman of the next ensuing meeting". Because important decisions which might be queried in court afterwards could be involved, I thought we should add "after they have been adopted by the Council, or the Committee as the case may be, as a true and accurate record of the proceedings".

I assume the situation which both these amendments propose to deal with would be taken care of in the normal way by usual practice and procedure. In amendment No. 105 Deputy Boland wishes to make it clear that the minutes are kept by the registrar. They would normally be kept by him but there might be circumstances when he would not be available. Registrars presumably will be human and will be subject to the vagaries to which all of us are subject and might not be available. It would be unduly restrictive to confine the function of keeping of the minutes to the registrar.

In amendment No. 106 Deputy Boland wishes to insert the words "after they have been adopted by the Council, or the Committee as the case may be, as a true and accurate record of the proceedings". That is not necessary. That matter could be safely left to normal practice and procedure by a body of this significance and importance.

Amendment, by leave, withdrawn.

I move amendment No. 106:

In page 27, line 15, after "meeting" to add "after they have been adopted by the Council, or the Committee as the case may be, as a true and accurate record of the proceedings.".

Amendment, by leave, withdrawn.

I move amendment No. 107:

In page 27, between lines 29 and 30, to insert the following:

"THIRD SCHEDULE

Rules in relation to An Bord Míochaine agus Déidliachta Iarchéime (The Postgraduate Medical and Dental Board).

Tenure of Office

1. Subject to the provisions of this Schedule in relation to the filling of casual vacancies, every member of the board shall hold office, unless he sooner dies, resigns or becomes disqualified, for a period of five years.

Resignations and Termination of Membership

2. The Minister may at any time terminate the appointment of a member of the Board.

3. A member of the Board may resign his membership by giving notice in writing signed by him to the Minister, but the resignation shall not become effective until the meeting of the Board next held after receipt of the notice of resignation.

Casual Vacancies

4. Whenever a casual vacancy occurs among the members of the Board, the Board shall, with the consent of the Minister, as soon as is convenient, appoint a person to fill such vacancy and any person so appointed shall serve as a member of the Board for such period as is unexpired of the term of office of the person whom he replaces.

Quorum.

5. The quorum for a meeting of the Board shall be seven.

Chairman and Vice-Chairman.

6. (1) The Minister shall, from time to time, appoint one of the members of the Board to be Chairman of the Board and another of its members to be Vice-Chairman of the Board.

(2) A Chairman and Vice-Chairman of the Board, as the case may be, shall each hold office as such for such term as may be specified by the Minister at the time of his appointment unless——

(a) he ceases to be a member of the Board,

(b) he resigns the office of Chairman or Vice-Chairman, as the case may be, and his resignation becomes effective under this paragraph.

(3) A Chairman or Vice-Chairman of the Board may at any time resign his office as such by giving notice in writing signed by him to the Minister, but the resignation shall not become effective until the meeting of the Board next held after the receipt by the Minister of the notice of resignation.

Proceedings at Meetings.

7. Subject to Article 5 of this Schedule, all acts of the Board and all questions coming or arising before the Board may be done and decided by a majority of such members of the Board as are present and vote in relation to the act or matter at a meeting of the Board duly convened according to law.".

May I ask a question? Would the Minister consider in the Seanad a reference in the Third Schedule to Bachelor of Obstetrics because it has been omitted here?

I did not leave it out inadvertently.

The Minister knows there is such a primary qualification?

I do. I am well aware of the fact that the profession of obstetrics finally achieved recognition and respectability in 1927.

What is the Minister doing for it now?

Amendment agreed to.
Agreed to take Fifth Stage today.
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