Professor Risteárd Ó Laoide:

The Faculty of Radiologists, which I am representing here today, has involved itself in open disclosure since it was launched in 2013 by the HSE. We have engaged proactively with the HSE in this regard because this is a very important issue for us in radiology. It is important in radiology because it is one of the specialties where this is a most difficult and nuanced issue because radiologists work in a profession where mistakes are made all of the time. In other words, for a practising radiologist, international best practice would be an error rate of 3% to 5%. We are working in a profession where we know errors will arise. It is in our interests and in the patients' interests primarily that we have a good open disclosure process to deal with that. Historically, it has not been there and we now need to put it in place.

When the national document was launched in 2013, we engaged with other jurisdictions, such as The Royal College of Radiologists in London and the Royal Australian and New Zealand College of Radiologists, that have similar methodologies to ours. We also engaged with patient representatives and the State Claims Agency and we produced a document on open disclosure relatively quickly in 2015. This document was subsequently updated in 2016 and is available on the faculty website. It sets out our approach to open disclosure.

We are also mindful of the ethical guidelines from the Medical Council on this issue. We do realise this is an evolving process. We heard at an Oireachtas committee meeting last week that the Civil Liability (Amendment) Act 2017 was enacted in November 2017 but that it is still awaiting implementation and regulations through the Department of Health, which is outside my ambit. While we need that legislation implemented, we need more than that. To do open disclosure properly we have to focus on the patient and in this regard, the environment must be such that the patient is counselled and supported through the process. There are a number of doctors in this room. We have all made mistakes. The serious mistakes that I have made in my career are seared into what I do and so I am very conscious of this. We need to have a process where the people who are involved in the incident, the patients primarily, are dealt with in a supportive way through appropriate counselling and appropriate infrastructure. As for the infrastructure required for this process, it has been proven internationally that it has to be provided in a learning environment, a non-judgmental environment and an environment where a single issue does not explode into one of national prominence. Unfortunately, given Ireland is a small country, we suffer a little bit of the fish bowl effect such that a single issue can suddenly explode into one of national prominence. I worked in California for a number of years, which is supposed to be a highly litigious society. The background effect of open disclosure and litigation there was seemingly a lot less because it does not suffer the fish bowl effect that we have in Ireland.

In radiology, when we make an error we are not sure whether that error precisely causes harm. It has to be looked at in the overall clinical context of the patient and we have to do a systems review of it. In summary, as radiologists, we are keen to do this but we do need a framework and we need the help of the Oireachtas in creating that framework. To do this, we need a supportive environment, one where people can learn from their errors without the risk of litigation. We also need to be honest. We want to have an open process but we want the whole process to be open on the table. To be open on the table we need to know the number of errors it is anticipated will happen in our services. For example, we in radiology, can say that in a model 4 hospital might have approximately 10,000 errors per year. How is it proposed to legislate to have open disclosure for all of these cases? If it is proposed to compensate everyone for every error, that then needs to be set out clearly in legislation. We need to move forward together in this regard because at the end of the day it is the patient who will benefit.