I welcome the Minister of State at the Department of Health and Children, Deputy Brian Lenihan, to the House. I declare an interest in this issue. The Medical Defence Union and the Medical Protection Society always have a few members of long standing on what are called their Irish advisory committees. I am currently on the Irish advisory committee of the Medical Defence Union.
It is said the benches of this House and the Dáil are very sparsely populated. The last time we debated the role of the Seanad I pointed out that many of us are in our offices watching events unfold in the Houses, which is how the matter I am raising came to my attention. Naturally, I keep a close eye on the Minister for Health and Children, Deputy Martin. Last week, I watched him reply to questions tabled by Deputy Coveney and Deputy Olivia Mitchell concerning the main indemnity bodies operating here. These are the Medical Defence Union and the Medical Protection Society, St. Paul having recently pulled out of medical indemnity worldwide and Medisec, of which Deputy Glennon is a founder and, I believe, chief executive, mainly providing cover for general practitioners.
The huge awards made here against obstetricians have led to a significant increase in subscriptions for medical indemnity. Between 1985 and 2000 annual increases averaged 26%. Early this year an award of €4 million was made in a case of medical indemnity taken against an obstetrician and even in a case which was won the cost in legal fees amounted to some €350,000. This is a very expensive business, particularly for the Department of Health and Children, which pays between 80% and 90% of the fees incurred by obstetricians who are public employees. Private obstetricians must pay their own fees.
The Department has been trying to introduce enterprise liability, whereby the State will cover all the indemnity of the hospitals, including that of junior doctors and consultants. However, consultation is still ongoing, particularly with regard to hospital consultants. Last year a deal was done with the Medical Protection Society to hold the subscription for obstetricians at a certain level, amounting to about a sixth of the level the Medical Defence Union proposed to charge. A request under the Freedom of Information Act found that the Department was subsidising the Medical Protection Society, a practice which has been queried by the Medical Defence Union before the European Commission on the grounds that it breaches competition laws.
While this is not a major concern of mine, I was concerned by the Minister's reply to Deputy Olivia Mitchell in which he stated that one of the main reasons the Department ended negotiations with the Medical Defence Union was that the organisation concentrated on the issue of historic liabilities. The Department should have concentrated more on the issue of historic liabilities because, as the Minister admitted, these are considerable. It is important to note that only about 20% of general medical claims occur after six years, whereas about 40% of obstetrics claims occur after six years. Frequently, these claims are made by young adults. The costs of such claims are currently paid by the Department through the reimbursement of subscriptions to the various medical protection societies.
The Minister gave us to understand that he hopes enterprise liability will be introduced by the end of the year. He still has not settled the question of what will happen with regard to historic liabilities. He established a fund with the Medical Protection Society which will be reimbursed to the Exchequer if there are no claims by public patients by the end of a given year. No decision has been taken regarding the fund he established for private obstetricians, a generous move on his part as it avoided about 30 people being left without cover and the need for private hospitals, such as Mount Carmel and the Bon Secours, to stop undertaking obstetric work. Has the Minister not left the taxpayer in a very serious, open-ended position regarding historic liabilities, which, as he stated, can be considerable?
The current position is that neither protection society will have to take account of these historic liabilities once enterprise liability becomes effective because no agreement has been made between the Minister and either society. It, therefore, will be at their discretion to take up the historic liabilities. Given that they are funded from subscriptions from doctors, it is impossible that other doctors would be able to cover from their much smaller fees the very large obstetric claims which arise. I am at a loss to understand how the Minister proposes to cover these liabilities without resorting to Exchequer funds and why the Department of Finance has not been informed of this surprise.
I am very disappointed the Minister has not addressed a problem associated with obstetrics, namely, the recurrence of cerebral palsy. I am glad the Minister of State at the Department of Health and Children, Deputy Brian Lenihan, is here because the area of children is his responsibility. Difficulties are raised by the fact that a small number of people here can show that obstetric liability is the cause of cerebral palsy in their cases and thereby receive funds to try to improve the life of their children, whereas many families are unable to do so and are, therefore, not in a position to receive financial help. We should promote the idea that the State should provide sufficient assistance to these people. It does not have to be a massive amount, merely sufficient to meet their ongoing needs. While some people receive huge claims, such as in the case to which I referred earlier, others receive nothing.
As the Minister of State will not be in a position to address this important issue now, I ask that he places it at the top of his agenda. We know that those in lower socio-economic groups have lower birth rates and are much more likely to have children with cerebral palsy. This means that those most in need are frequently those who receive nothing.