I move amendment No. 32:
In page 7, subsection (1), line 8, to delete " qualified person " and substitute " practitioner or pharmacist ".
SECTION 6.
Amendment No. 32 is consequential on amendment No. 16.
Amendment agreed to.
On behalf of Deputy Haughey I move amendment No. 33:
In page 7, line 13 to delete " may " and substitute " shall ".
He wished to stress that " may " is much more positive than " shall ", that the Minister should——
" Shall " is much more positive than " may ".
No—yes " shall " is much more positive than " may "—and that he feels that it is more incumbent on the Minister to be seen to be making the law as it were, implementing it.
Generally that would be acceptable. However, if there was some minor offence, some offence of a technical nature, for example a prescribed document not filled in properly, it is conceivable that such a person might be convicted just for this technical misdemeanour if you like, a fault which could be committed by accident. I think I should still retain the discretion of deciding whether or not that would be an offence that would warrant a direction. The Deputy will concede that there can be minor errors made, but there may be a conviction. In that case a pharmacist or any other practitioner should not be pilloried by reason of the fact that he or she had committed a minor technical offence. But in respect of any serious transgression I certainly would be bound to make a direction. I do not think I should make a direction for some trivial incident.
I do not think this would be the intention of the amendment in so far as——
——but it would put the obligation on to me to give a direction.
The Minister would have to give a direction.
Yes, I would have to give a direction.
The Minister does not feel that this is something which a Minister should have to do, that this is something which his officials——?
No, because a direction would be a serious matter. We will come on to this latter on in another context. I presume the offence would have to published in Iris Oifigiúil and it could do damage to a man’s profession, even though what he did was in innocence or in error.
I agree with the Minister's sentiments on this. It could be a technicality or a form filling mistake. I can see Deputy Haughey's point of view also that, if convicted, one should not be allowed to continue. I think the Minister's attitude in this is liberal, and liberal in the correct way.
That was a thought that occurred to me.
I will not press that. I accept what the Minister has said. I think the Minister is aware that this is fully amended because it has been previously discussed with other amendments.
Not necessarily this. The " may " and " shall " were in a different context.
I think the principle behind it was " shall " rather than " may ".
The Deputy will agree that it could be a customs offence where a man might have a drug in his possession. Even though he might be a practitioner or a pharmacist, a person like that should have a special arrangement in respect of him and it says here " given publicity ". The man would be suspected immediately because he did not read the small print and realise the alleged offence.
Amendment, by leave, withdrawn.
I move amendment No. 34:
In page 7, subsection (2), lines 16 and 17, to delete " qualified person is a registered medical practitioner, a registered dentist or a registered veterinary surgeon " and substitute " direction relates to a practitioner ".
Amendments Nos. 34 and 35 are consequential on amendment No. 16.
Amendment agreed to.
I move amendment No. 35:
In page 7, subsection (2), lines 23 and 24, to delete " any other case, be a direction prohibiting the qualified person " and substitute " case the direction relates to a pharmacist, be a direction prohibiting him ".
Amendment agreed to.
Amendment No. 36 and 37 are related and may be discussed together.
I move amendment No. 36 on behalf of Deputy Haughey.
In page 7, subsection (4), line 35, to add " and in at least two recognised medical journals ".
I spoke to Deputy Haughey about this and he is very keen that we would accept this amendment, that at least two recognised medical journals should also publish.
What I had in mind was that, when the Minister publishes in Iris Oifigiúil, this would be circulated to each qualified person and this would then obviate the necessity to print the direction in two recognised medical journals. I realise this would entail the Minister in expense but he might care to look at it. Would the two best recognised medical journals have to be Irish medical journals, international medical journals or British medical journals or what? When you remember that we are now involved in the European context the free movement of doctors is upon us and I would prefer each qualified person to get a copy of the direction when, under this section, it became necessary for the Minister to publish the directive.
I am sure publication in Iris Oifigiúil is sufficient. It is argued it may not get sufficient circulation but in Iris Oifigiúil there are information notices and so on published from time to time and there is no provision in any other legislation I know of providing for the further publication of such information—in this case it is a direction—in respect of any other notice, misdemeanour, bankruptcy, and so on. I think we have to be fair to the practitioner here and the pharmacist in respect of whom there is mention of his name. The direction may be in respect of one or maybe two drugs, and to have that publicised extensively again might damage the professional status of any of the practitioners or pharmacists. I do not follow Iris Oifigiúil very well, I must confess, but there is nothing to prevent the publication of any such direction being taken from any newspaper or journal or whatever the publication might be. They can pick up this information as, indeed, bankruptcies and various other things have been picked from Iris Oifigiúil. On the suggestion by Deputy Haughey that such directives should be published in at least two recognised medical journals, as far as I am aware the two journals we have are The Medical Times and the IMA Journal.
There is another one.
I did not know of it.
The Irish Journal of Medical Science.
Does the Deputy want to declare his interest here?
It is not the Deputy's amendment to begin with.
I do not know how important or how attractive this other journal is. It is broad in the type of article and news it publishes from time to time. " At least two recognised medical journals " could include The Lancet as well.
I assume he means medical journals published in this country.
That is not stated.
I am sure that every doctor in the country gets The Lancet as well.
No. It would not have a 5 per cent circulation in Ireland.
This does not specify Irish journals.
We must address ourselves to the amendments now.
It can be taken by any newspaper or periodical from Iris Oifigiúil. That has been done in the past. As far as amendment No. 37 is concerned relating to the inclusion of a new subsection:
The Minister shall cause a copy of any direction under this section to be circulated to each qualified person, each health board and to the National Advisory Committee on the Misuse of Drugs and to each sub-committee of that Committee.
It may not be the best argument, but this would involve about 3,000 people plus some of the bodies Deputy Byrne mentions here like the National Advisory Council. I would not anticipate that many directions would be given, because the professions are pretty responsible, in the main anyhow, so I do not think it would be worth the trouble or serve any useful purpose by having it circulated. I suppose the public are concerned in this also. I do not think there is a great circulation or readership of Iris Oifigiúil. If any sort of direction is given and it is published in Iris Oifigiúil those who would be concerned in the journal business would readily pick it up, and the same would apply to newspapers.
The Minister is obviously not going to take a decision under this section very lightly—it would be a very serious decision for him to take—as regards the publication and the directive here, but what I would like to see is that each health board would be made aware of it so that a doctor, employed in the Western Health Board area who might be employed in a hospital there would not be employed in the Eastern Health Board area without the employer, the Eastern Health Board, being aware of this, because there can be a breakdown and maybe not every official in the Eastern Health Board would have read it.
What would the official in the health board want to read it for anyway? Could the Deputy elaborate on what he has in mind?
What I have in mind is that the Minister issues a directive under this section prohibiting the doctor from prescribing a particular drug or drugs, and this doctor is practising in one health board area and he moves from the hospital in that health board area to another health board area, the only authority of collusion or co-operation between the two is the Department and I feel that each health board area should be aware that the doctor is moving. This can happen so easily and it is not just moving from a health board area but moving from here to New Zealand.
Surely this is a relatively new Bill on drugs and any health board or any official of a health board, particularly the county medical officers, would know now that any direction given in respect of uncontrolled drugs would be published in Iris Oifigiúil and steps would be taken to ensure that they would have a copy of that every time it was published.
Take the employment of a doctor as a locum, in that capacity would the employing doctor be made aware officially by the Department or could he say: " Well, I have not read the magazine. I do not get that magazine. How was I to know?"
I do not know the drill but I assume that, if I went forward for an appointment in the Western Health Board, having been employed by the Eastern Health Board, they would soon check up on me to know whether or not any direction had been given.
We must keep a balance.
I am not finished. It is very easy to conceive the possibility of a doctor employing a locum who has been convicted under this section. A directive has been issued but it would be quite easy for him to employ a doctor in the capacity of holiday locum and he to be paid by the appropriate health board, and recommend him to the health board without his being aware of the directive. This is in the practical as distinct from the theoretical sense. I agree with the Minister completely that it should be the responsibility of every health board to guard against this when the Bill comes into operation. As regards the actual practicality of it, I think it might just nail it down a little bit more if—and I know it would involve the Minister in some expense—a copy of the directive were to be sent to each qualified person. The same applies to a chemist. If a chemist is guilty of a misdemeanour he can move from Dublin to Galway and practise there without there being any line of continuity. Even though the line of continuity might not necessarily work, the line of continuity would be there and the chemist at some stage would have been informed by the Department that this directive had been issued and an implied onus can then be placed on the employer since he should have known because he had been informed.
Could one not use the same example in respect of bankruptcy which is published officially in Iris Oifigiúil?
What about drunken driving? Should we have to notify every insurance company every time a fellow is convicted of drunken driving?
One does not have to because his licence is endorsed.
There is no obligation on the State to notify every insurance company of a drunken driving offence.
That is private enterprise.
The question is, if a doctor continues to prescribe, how is a chemist to know? Remember, Iris Oifigiúil is not even available to Deputies. Let us be honest about this.
I can get it. If you are dealing with the Land Commission in your constituency you will get it.
I am not dealing with the Land Commission. If I am banned, if there is a directive issued in respect of me—what happens if I continue to prescribe? A chemist will honour the prescription because he will have no way of knowing. We do not want this doctor's name publicised in every newspaper but there may be some way in which a chemist may be informed or it may be impossible. Everyone cannot be told. How will we know if he continues to prescribe? It is an offence. It may not be possible to have any built-in safeguards, but what happens? Will the chemist be notified? A chemist would never question the doctor's right to prescribe. If we had a special narcotic number and a doctor contravened this then his narcotic number could be withdrawn, without stating the reason for its withdrawal. You do not specify that the doctor is guilty of something. You just state narcotic No. such-and-such has been withdrawn.
But the Minister gave consideration at a previous meeting to that point.
If there was a narcotic number that would provide an adequate safeguard.
In the event of the practitioner violating this direction what sanctions would apply to him?
It is an offence under the Act and you withdraw his ability to prescribe certain drugs.
Assuming that is done, and he goes ahead and writes more prescriptions what happens? The only way to deal with this is to apply some sanction.
Any person contravening a direction given under this section shall be guilty of an offence.
And what happens?
He might be fined £20 if he is caught.
If you want to stop contraventions you must make it tough for the person who contravenes rather than publicising it in journals all over the place. If the Minister makes an order against an individual and he contravenes that order he is guilty of an offence but what I want to know is, when he is found guilty of the offence, what happens to him? Could the Medical Registration Council be informed?
Section 27, subsection (2) of the Bill provides:
Every person guilty of an offence under section 6 or section 7 of this Act——
We are talking about section 6
——(a) in the case of the relevant controlled drug
that would not make any difference because they are all in the same category now
shall be liable . . .
(i) on summary conviction, to a fine not exceeding two hundred and fifty pounds or, at the discretion of the court, to imprisonment for a term not exceeding twelve months, or to both the fine and the imprisonment.
To me that is a sufficient sentence to prevent people. A person can take the chance in prescribing drugs all right, but after all it is notified in an official journal, and that can be picked up by the various health boards and others. Therefore, he can be convicted of doing this.
Yes, but—it is a written prescription and it is easy to prove against.
What I am asking the Minister is to consent. We are not at great variance on this. The Minister has gone very far in the Bill. What I want is that if a doctor employs a locum he is not going to ring up the registration council. He would probably be very lucky to find a locum but if the locum happens to have a directive issued against him under section 6 (6) of the Bill the doctor will probably not be aware, the chemist in the area will not be aware, but the locum is the responsibility of the employing doctor.
(Interruptions.)
With respect——
May I finish?
Where do you bring in the health board? The doctor may be working independently of the health board. You are asking——
Let me finish. That is only one instance of it. A health board might employ a doctor and you can have continuity—and the Minister is not being very harsh in this section of the Bill and he will be very responsible before he imposes it. I would like to see each qualified person notified, and leave it at that.
If I may come in at this stage I think we have got to look at it with a sense of proportion. Otherwise we would have a situation where we would have a democratic big brother going mad under this section. We will have to have some concern for doctors, dentists, vets, chemists and manufacturers who must operate this Act. It is by no manner of means easy. Therefore, any person who is charged with or convicted of an offence will already have appeared before the courts. He will be known to the profession because this is a small country and the profession is relatively small even in the context of the totality of professions involved. His name will undoubtedly appear with the usual horrific sub-editing in relation to the offence itself. Even in Ireland it may appear on television or be heard on radio if he has been convicted of an offence of the profession.
This is idle supposition.
I would suggest that to have to subsequently turn around and send out to another 3,000 people his name once again may be subjecting somebody to a second public trial. This is something which would be entirely improper. For example, there have been many thousands of people in this country over the years who were declared bankrupt, or who were convicted of drunken driving, and their names have not been subsequently circulated to every employer, manufacturer or agent in the country if declared bankrupt, no more than was the name of every drunken driver sent to every insurance company.
If the professions are confident and if the editors of the medical journals are confident about publications in Iris Oifigiúil—I have no reason to believe that they are not—they would keep a close watch on that relevant section of Iris Oifigiúil. Just for example, if I may give an analogy, we have had reprints every month, when Business and Finance was in operation, of the extracted judgments taken straight from Iris Oifigiúil. I do not believe that it is a function of the State to provide free lucrative advertising of other people’s wrong-doings in private enterprise medical journals.
That is silly talk.
(Interruptions.)
One wonders if it is a good idea to even publicise it in Iris Oifigiúil. No. 1—I am just asking, 1 may be allowed to ask——
Apologies, apologies.
I will start off on a proper footing if I may be allowed to speak. I do not see the purpose of notifying the rest of the profession unless, No. 1, the profession is going to take specific disciplinary action against a doctor or, No. 2, unless the profession would want to warn off their members not to employ him if he is a local. Those are two reasons. It seems to me that the rest of the profession would want to be warned. Whether or not the medical profession could take disciplinary action against him is a matter which will come up very shortly in this new medical registration council. We do not know that yet. Under the present powers of the medical registration council I do not think they would have powers to deal with it.
No, they would not.
It is debatable if they would or not. So one wonders if they should be informed. I would see as much more important——
What about the chemists?
——would be the chemists. The chemist could refuse to accept the prescription by a doctor who has been convicted.
Not necessarily a prescription, but a prescription in respect of maybe only one drug.
Yes, of course, only one drug—not just any prescription. The doctor can continue to practice in his——
A direction has been given in respect of one drug, not necessarily——
It is publicised so much that people often take the wrong meaning out of it. They might say that this person is a criminal. That person might have no criminal intent in doing it but he is found guilty of that offence. It is a very narrow matter. It is not his duty to prescribe, it is not infringing on his ability to prescribe and treat in respect of other conditions. I am wondering how you might stop at source the continued prescribing of this. There was a situation in Britain where a doctor was warned and he continued to prescribe, and he ended up by getting himself into more difficulties by virtue of the fact that there was no effective action taken against him in time and they were not able to stop his prescriptions as he issued them. He then got himself into more and more trouble, and finally erasure took place a couple of months ago. I wonder if there is some way of protecting the doctor against himself with regard to the particular drug without publicity, without having his name bandied about all over the newspapers and so on. My idea was that with a narcotic licence it could be withdrawn and then he is automatically deprived of his licence in respect of controlled drugs. It could be cumbersome and difficult and pose numerous problems for the Department. Iris Oifigiúil may not be the answer to it.
If we go back to amendment No. 23 there was another amendment which we discussed with the Minister—it was on the day the Deputy was absent—whereby it might be possible and the Minister undertook to give it consideration whereby some form of stamp would be issued to each doctor for use on specified prescriptions for controlled drugs. The Minister said he would give this detailed consideration. Along those lines I am quite happy that the Minister and his Department will be giving it as detailed consideration as possible. Prior to withdrawing this amendment, I can see that the Minister is quite happy and he is leaning over on behalf of the secrecy in favour of the qualified person. It is not just the doctors he is talking about, it is also chemists and veterinary surgeons.
In relation to this section could I ask the Minister if he is satisfied that there is sufficient international co-operation, if alone between the UK and ourselves, where a doctor is convicted under a very similar section of the British Misuse of Drugs Act, 1970, whereby we could be informed so that a doctor might not be able to come across here and take up practice and prescribe the drugs here. The Acts are very similar, but could the Minister give consideration say between now and the Report Stage to investigating the possibility whereby the British Department of Health might perhaps get a copy of Iris Oifigiúil and we might get a copy of their equivalent gazette?
I am informed that that can be done and I can see the force of the argument of Deputy Byrne in this. We are thinking in terms of Irish doctors doing a lot of toing-and-froing between the two countries. They have their equivalent to Iris Oifigiúil—whatever it is I do not know—but certainly arrangements could be made to have it published in that particular publication or the British Ministry of Health could be notified of the directive. We are all in a little difficulty about this because some people think it is too confined if it is just in Iris Oifigiúil. I think it is necessary to have it in respect of a small offence, a relatively harmless offence, without doing damage to the man; the direction will only say he cannot handle one or two controlled drugs. But if there is some chancer going around the country and there is no control over him, people do not know whether or not directions have been given, in a case like that there should be a sort of general alert in the country, an alert that would not come from Iris Oifigiúil if it were just published in that. In all those circumstances—and I am prepared certainly to have suggestions from the Committee—we could notify the registration councils here.
They would automatically notify the GMC in Britain.
If I changed " the Minister shall propose " to " the Minister may propose "?
I would not see that there is any difficulty, if you like, although again may I say that when this Bill is passed it surely will be incumbent on the authorities in the health boards to buy the relevant publications.
We are talking only about health boards but it has already been pointed out that not every doctor works under a health board.
I subscribe to the Irish Medical Journal or to the union magazine and this is information I would expect they should carry so as to inform me of those things. I would agree with the Minister that there is an obligation on them to read Iris Oifigiúil and publish this information. Chemists also have their magazines for the same purpose. It would be the ideal situation to circularise everybody concerned, but the objections to it are reasonable.
I would have thought that, because the Minister insisted that he would use " may " instead of " shall " in order to give him a certain amount of leeway, it would only be on a very serious offence that anyone would be indicted under this section. I would have thought on amendment No. 36 that it would be in a very serious case. I have approximate figures of the medical journals that are available. The Irish Medical Times, without wishing to embarrass Dr. O’Connell in any way, has 99 per cent approximately readership.
Circulation—not readership.
The Irish Medical Journal has somewhere in the region of 44 per cent and The Lancet is 5 per cent approximately. I would have thought that in any serious offence, where there was a renegade doctor going around the country working in a private capacity, the medical profession and people who would be concerned should be made aware of this man.
He would not be a renegade. He might just have committed an offence in respect of one drug.
Before being indicted it would have been adequately shown that——
We want to be sure we do not do damage. These directions will, I hope, be few and far between. If a direction is given in respect of some small offence, no matter what it might be, under this it will have to be put into the two medical journals and, according to Dr. Byrne's proposals, circulated to about 3,000 people, you would possibly do the man damage because people would just see the direction.
Would he be indicted under what might be called a misdemeanour in the sense of a small technicality? Surely he would be warned initially.
That would be up to the court. I could not anticipate what the court might do.
Is there any onus on an employing doctor or a doctor employing a locum who has this direction issued against him? Would the doctor be liable to committing an offence under this Act, or a chemist who employs a locum chemist who has had a directive issued under this? Would they be liable to committing an offence?
Unless it was proved in law——
The employing of a professional or qualified person by the person to whom a directive issued would not be his responsibility. There should be somebody or some way——
In law, the master is responsible for the actions of his servant.
Could we leave it at that? Perhaps at Report Stage the Minister will consider something about this.
We have plenty of time. I just want to ask the Minister if a health board were to employ a person against whom a directive had been issued to prescribe, say, two or three drugs would that health board not be held responsible in some way or other? Should they not be held responsible?
No. The doctor himself would be. I am sure the health board would be aware of the direction and would be aware that he could not have in his possession or use certain controlled drugs.
What I am trying to avoid is that if you issue a directive and if the health board then employs this person with carte blanche——
They can employ him with the restriction that he cannot in accordance with the directive do certain things.
Agreed, but supposing they employ him without restriction?
They cannot do that. If he carries on as if there was no direction at all, he can be reported. He will commit a further offence.
Can I put it this way? Could I ask the Minister to consider providing that a copy of the directive be served on each CEO?
I would not mind doing that as there is a limited number of them but there are private doctors involved as well. The only people you could communicate the direction to then are the registration councils.
I think the obvious thing here is to await the opportunity of considering this on Report Stage. I suggest the best thing is notification to the medical registration council.
And the other bodies regulating. If the Minister does this he will also detect situations such as Dr. Byrne has raised about doctors going to England and coming from Britain. There is automatic notification from one to the other.
Could we agree on this? Iris Oifigiúil—I do not think that is contested; No. 2, the health boards; No. 3 the registration council——
And the other comparable registration bodies.
And the pharmacists as well, and the international corporation——
You will have this poor man completely strung up.
As somebody pointed out, the sooner we have to distribute it around the country——
The Minister was emphasising that he might be only using this power in relation to one activity of the doctor; what exactly would that activity be defined as?
Just the prescribing of a particular drug.
The Minister stated on a few occasions that it was related to very small activities of a doctor or a medical practitioner. I took it that it would be dealt with only in relation to one or two of the drugs in this schedule. This strikes me as strange. If you are responsible in dealing with one or two drugs in this schedule would it not be foolish to leave them the power to continue to be irresponsible with the others?
As the Act stands at present the direction would be given only in respect of a drug or some drugs. There is no provision that would debar them unless you use the whole lot.
If you are happy with that stage.
May I get the Committee's view on this, the Solicitors (Amendment) Act, 1960, which is somewhat similar, but a little more drastic?
Where an order striking the name of a solicitor off the role or suspending a solicitor from practice is made by the High Court under section 8 of this Act or under the said section 8 as applied by section 11 of this Act, the Registrar shall forthwith cause a notice stating the effect of the operative part of the Order to be published in Iris Oifigiúil and shall also cause the notice to be published in such other manner as the disciplinary committee may direct.
I am not concerned about the disciplinary committee, but I ask the Committee to accept that this change could be made:
" And it shall also cause notice to be published in such other manner as the Minister may direct."
bearing in mind what we have said here, because we do not want them to get away with it but we do not want to——
We do not want to destroy it——
On the assumption that the Minister will give further consideration to greater international co-operation——
I think it will be embodied.
I think on Report Stage we shall leave it in the hands of the Minister on that understanding.
With relation to 36 I accept what the Minister stated, that he would take into account any case which would be referred to him and on the basis of the Solicitors (Amendment) Bill that other journals in extreme cases might be——
The Deputy is shaking his head. In an extreme case where some chancer is going round the country, some reputable doctor might be caught, a direction is given and we publish it in Iris Oifigiúil and I will undertake to do what the Committee may direct. I think I would be bound to give the full publicity, if there was a chancer or a blackguard going around.
Good.
Meaning the journals and possibly the newspapers.
Where would you cover that?
Amendment, by leave, withdrawn.
I move amendment No. 37:
In page 7, between lines 35 and 36 to insert the following subsection:
" The Minister shall cause a copy of any direction under this section to be circulated to each qualified person, each health board and to the National Advisory Committee on the Misuse of Drugs and to each sub-committee of that Committee."
Amendment, by leave, withdrawn.
Section 6, as amended, put and agreed to.