Ivan Yates
Question:10 Mr. Yates asked the Minister for Health if he intends reforming the present medical liability area; and if he will make a statement on the matter.
Ceisteanna — Questions. Oral Answers. - Medical Indemnity.
An inter-departmental working group is examining the whole area of medical indemnity at present. The group has completed the first part of its remit and has submitted its interim report to me.
A revised medical indemnity scheme has been introduced for non-consultant hospital doctors, dentists and community doctors, as a consequence of the first phase of the group's work. The group is now proceeding with the second part of its remit and will be examining other aspects of medical indemnity. I will await the outcome of the group's deliberations before deciding whether any further reform of the present system of providing indemnity is required.
Having regard to the new wave of medical negligence of a type we have not seen in the past in the medical field, I put it to the Minister that this is a matter of extreme urgency. Over the past five years we seem to have learnt many of the bad habits of American consumerism so far as medical negligence is concerned. Having regard to the amount of buck passing within the general practice, the consequences of this for the medical profession are grave. This may be adding considerably to the log-jam within our hospitals. General practitioners are afraid to treat patients in the manner in which they would like and in many instances patients are being unnecessarily referred to hospitals. May I ask the Minister the exact approach he intends adopting to tackle the issue of the huge fees for cover being extracted from many hospital consultants? Is he aware that obstetricians' defence rates are now approximately £19,900 a huge sum of money in any language? Will the Minister endeavour to ensure that the group's proposals are put before him at the earliest possible opportunity?
Obviously, I am concerned at the growth in the practice described as defence medicine. Doctors and consultants who are afraid of litigation refer clients and patients for tests which in their heart of hearts they do not really believe are necessary — they are safety measures for themselves. This is unfortunate and is also a waste of the scarce resources for the health services. As I have indicated to the Deputy, an interim report has been made available to me and has been acted upon. A revised medical indemnity scheme was introduced as a result of the interim report. The scheme provides non-consultant hospital doctors, dentists, community doctors, directors of community care, senior area medical officers and area medical officers with indemnity for their work in the public service on a group basis. Previously this was done on an individual basis. This group contract is for three years and it is estimated — it is very expensive, at more than £3.5 million per annum — to have resulted in a saving of approximately £1 million to the Exchequer. I am also aware of the expense for consultants. That is the next phase of the group's work, and I hope to have that report shortly. I will then consider how this issue can be addressed.
In regard to the point the Minister made about consultants, I wish to ask him a particular question which I will illustrate with an example. Where does the liability lie in a case where a consultant believes his patient requires a drug which is not readily available because of cost and the patient subsequently has a serious illness due to a lack of this drug? My example relates to my earlier question regarding Prolastin. One of my constituents has been told by his consultant that Prolastin would be a major boost to his life. This man suffers from emphysema arising from a genetic defect. Two or three people in Ireland suffer from this condition, one of whom, I understand is being treated. The Mater Hospital is not in a position to provide this drug because of the cost, which is approximately £500 per week. Where does the liability lie in that case? Will the Minister undertake to investigate the case relating to Mr. Brendan Richmond of Finglas who is in a life and death situation?
The Deputy is raising a very specific matter.
It relates to liability.
It is a specific case.
I do not intend to determine liability in any case put to me; that would be impossible. However, I will undertake to investigate the details of any case the Deputy wishes to make to me. I would be obliged if the Deputy would give me the details of the case in writing so that I can look at it as a matter of urgency.
The Minister referred to the cost of premiums for consultants and doctors working in public hospitals. Would the Minister agree that much litigation occurs because the initial complaint is badly handled and the initial consultation process between the aggrieved patient and doctor, consultant or hospital is not properly managed? Much could be done to improve the initial consultation process, which would cut down on the need for this indemnity cover. Much litigation could be nipped in the bud if there was good initial consultation between the consultant or doctor and the patient.
I am sure there is some truth in what the Deputy says. I do not have a breakdown of the various cases. In fact, it is very hard to get a clear grip of the growth in cases because the medical defence organisations are, by their nature, in competition and they regard much of the information as commercially sensitive. Many cases are resolved in advance of going to court — they are not resolved publicly. It is difficult to be accurate about the number and scale of claims, but I am sure there is some truth in what the Deputy says.
Does the Minister accept that it is in both his and the Department's interest to find out this information since the Department of Health picks up the tab for the insurance premia of doctors working in public hospitals?
Certainly, if we could. Obviously we have a commercial relationship with the companies that provide a service to us and we give the contract to the company which provides the best service, bearing in mind the nature and the cost of the cover provided. I had expected that we would have more accurate information than is available and I hope we can get more information in the future so that we will know the extent of claims. We can then see what action we need to take to minimise claims, more than simply increasing premia.
Does the Minister intend — or perhaps he has done so already — to engage in discussions with his colleague, the Minister of State at the Department of Enterprise and Employment, Deputy Brennan, who is anxious to put a cap on insurance claims? Perhaps the Minister has views on that?
I have not had any discussions on this matter with my colleague, Deputy Brennan. For the information of the House, let me give some ideas that may be considered in the context — I do not want to pre-empt the report before I get it — but the ideas in circulation that might be feasible are: State indemnity schemes, a selective nofault compensation scheme on a defined basis——
That is outrageously expensive.
——the establishment of some form of expert panel or tribunal so that there is no need for recourse to the courts, or a combination of all these. There are a range of options other than exponentially increasing premia that can provide a package that will hopefully address a real problem.
There are other systems for dealing with this problem. Will the Minister pursue this matter with his colleague, the Minister for Justice, because to look at the cost of medical liability on its own is not the way to tackle the difficulties. There is no doubt that the difficulties will increase, as the one thing we know is that the number of cases will continue to grow. Does he agree that by providing financial inducements to doctors in the general medical service to reduce their drug costs he is putting them at risk of an increasing number of claims from patients? He has criticised the drug companies for providing inducements to doctors but he is directing such an inducement at them. Doctors who have chosen cheaper drugs may be putting themselves in a vulnerable position when it comes to claims.
I have already stated a range of options other than simply addressing the issue of the premia. I think that answers the question satisfactorily. On the question of "financial inducements", I have absolute confidence in the clinical independence of every doctor contracted to the GMS system to do what is right and proper for his patients. I thought the idea of improved drugs efficiency would be shared by every Member of the House. There are the same chemical compounds under a number of branded names——
They have different side effects.
——available to doctors to prescribe. What I am trying to encourage, and what my predecessor in reaching an agreement with the IMO tried to achieve, is the best practice. I have not for a minute any doubt that there is a question of the a doctor making a decision that would impact adversely on his patient in order to save money.