The Minister of State is very good to deal with this matter, but the Medical Council is not a public enterprise, it is a private body. I would be very grateful if he would bring this to the attention of the Minister for Health and Children.
The Medical Council.
By all means.
The Medical Council has, over the last 15 years, approached various Ministers for Health regarding changes which it was felt were needed in the Medical Practitioners Act, 1978, which governs the practice of medicine in Ireland. The council is composed of medical practitioners and lay members. About nine months ago the council asked the Minister to increase the number of lay members on the council by ministerial order. This was not agreed. The council has not received any communication in writing regarding this matter, though it did receive a telephone call about eight months later which informed it that the change could not be made in time for the next election, which is in spring.
The council is very disappointed by this. Although the profession is self-regulating, it is important that there are enough lay members to give the public confidence. The decision made was regrettable because it is essential that the public has confidence in medical practitioners and the suggestions the council made that if felt could help should have been listened to. No one regrets this more than members of the medical profession. The profession is seriously hampered in separating ill doctors from incompetent doctors because, under the Medical Practitioners Act, 1978, there is but one method of dealing with both. A single set of procedures is used by the fitness to practice committee of the council. This is an adversarial inquiry which may be suitable for misconduct cases but is quite unsuitable for health related issues.
Doctors affected by health problems should not be accused of misconduct and should not be dealt with in a fashion that implies they may be guilty of misconduct. The present system leads to doctors concealing their problems until either the doctor or one of his or her patients comes to a terrible end. It is not just drink or drugs that are involved in these cases. It can often be a mental or physical illness.
The council has proposed that a non-adversarial system be set up in parallel to the fitness to practice committee which would deal with health related issues. The health committee proposed according to the recent discussion paper on health procedures for 1998 published by the council will be established with the following remit:
1. To deal with complaints which have a health component, where no allegations of patient harm are included. [This may be in cases where there is a mental or physical illness although there might be an involvement of substance abuse.]
2. To carry out an appropriate investigation into suggestions of ill-health by gathering information, obtaining expert reports and meeting with the doctor concerned and others if necessary.
This could be in quite an informal setting initially. For example, I heard of a case involving a person who was a severe diabetic and he was struggling manfully to deal with hypoglycaemic attacks but was not in a position to keep going. The council should have been in a position to ask him to discuss the matter and advise him to take six months off to sort out the problem. At present it would have to have a full scale inquiry.
The proposal continues:
3. To make recommendations to the doctor on the management of his professional responsibilities, compliance with medical advice and monitoring of progress.
4. To operate in a non-adversarial fashion, inviting the co-operation of a doctor with relevant inquiries and recommendations. [Once again the emphasis would be on the doctor's health or ill health and helping him or her regain good health.]
5. To monitor compliance with its recommendations.
6. To report to the fitness to practice committee on doctors who do not comply with its recommendations or who are initially dealt with in relation to a health complaint but who later raise concerns in relation to misconduct.
It is anticipated that the committee would have some teeth.
The proposal indicates that the health committee's interventions would be carried out as follows:
All inquiries and recommendations should be carried out with the co-operation of the doctor and without the need for legal procedures. If a doctor fails to co-operate, produces false information or does not comply with recommendations, then a complaint can be made to the fitness to practice committee.
A screening committee, made up of the president of the council and a small number of council members will review complaints or referrals which have not been clearly directed to either health or disciplinary procedures.
If a complaint includes both health and disciplinary elements, the doctor involved should have the option to bring the health matters to the attention of the health committee.
The council's document continues:
The separation of health and disciplinary functions will have a number of effects:
1. Health matters will be dealt with more quickly and cost-effectively.
2. More doctors may be encouraged to bring health problems to the council's attention.
3. Doctors with health problems will receive fair and appropriate advice about their professional responsibilities in a context which respects their needs as patients.
Urgent action is needed. Inquiries into cases are being set up by health boards and by other professional bodies rather than referring the cases to the Medical Council. This is not desirable. Cases will not be treated in a uniform way and the possibility of inquiries in which the public have little confidence will result. I ask for the council's concerns to be taken seriously before another medical tragedy is a headline in the newspapers.
I compliment Senator Henry for raising this important matter. I am taking this Adjournment matter on behalf of the Minister for Health and Children, Deputy Cowen, and I will relay to him the points made by the Senator.
The Minister has only recently received a copy of the Medical Council's discussion paper on health procedures which outlines the council's proposals for separating inquiries into the conduct of doctors who have health problems from the more general inquiries into allegations of misconduct or unfitness. He has not really had an opportunity to study them in detail or to consult the council or other interested parties but will do so in the new year.
However, he agrees with the council's general approach that the procedures for dealing with sick doctors should be separated from those used to deal with allegations of misconduct or incompetence. The latter procedures, of necessity, are long and complex. They are also adversarial in nature which renders them unsuitable to deal with doctors who, although ill, may not have caused harm to their patients or been the subject of any complaint.
As medical practitioners, doctors should have the best insight into their own clinical condition. Occasionally the nature of their illness may result in a loss of such insight and a family member, friend or patient may have to bring the matter to wider attention. Procedures for dealing with sick doctors should have the confidence of the profession and so encourage doctors who may be experiencing health problems to come forward and seek help at an early stage. It goes without saying that doctors have an ethical obligation to ensure that their own state of health does not endanger or compromise the health of their patients.
The proposals made by the council are constructive and should be the subject of debate among doctors. The Minister hopes the procedures proposed or something similar can be put in place pending an amendment to the Medical
Practitioners Act, 1978. He hopes to be able to bring forward the heads of a Bill to amend the 1978 Act early next year.
The Minister would also like to take this opportunity to thank and pay tribute to Dr. Aidan Meade and his colleagues on the ad hoc sick doctors committee who have handled these sensitive issues on a voluntary basis for many years.
I thank the Minister of State and am glad he thanked those who are involved in the ad hoc sick doctors committee. I was one of the first members of that committee and in the first week it was set up I had five people calling about sick doctors. It is a serious issue and I hope it is dealt with rapidly.
The Seanad adjourned at 6.30 p.m. until 10.30 a.m. on Friday, 18 December 1998.