Oireachtas Joint and Select Committees
Wednesday, 8 March 2017
Select Committee on Health
Medical Practitioners (Amendment) Bill 2014 [Seanad]: Committee Stage
The meeting has been convened to consider the Medical Practitioners (Amendment) Bill 2014. The purpose of the Bill is to amend the Medical Practitioners Act 2007 to provide for a requirement for registered medical practitioners to have medical indemnity insurance, except in certain circumstances, to give effect to Article 4 2.(d) of Directive 2011/24/eu of the European Parliament and of the Council of 9 March 2011 on the application of patients rights in cross border health care and to provide for related matters.
I ask the Minister of State at the Department of Health, Deputy Marcella Corcoran Kennedy to make her opening statement.
I am very pleased to be here today at the resumption of the Committee Stage of this important Bill. The Bill, which has been passed by the Seanad, will make it mandatory for medical practitioners to provide evidence of minimum levels of indemnity cover to the Medical Council, on registration with the Council and on annual renewal of registration. There is currently no legal obligation on a medical practitioner to have medical indemnity insurance cover. As a result, some patients and the users of medical practitioners' services may find they are unable to seek redress in the event of a medical mishap or negligent care from a medical practitioner. Given the high cost of litigation and the long-term consequences of some adverse events, this legislation is to be welcomed as patient-focused and progressive.
The main purpose of the original Medical Practitioners Act 2007 is to protect the public and to have a proactive system of robust registration and regulation of the medical profession, in order to minimise the risk to the public and safeguard the health and well-being of people accessing health services. Under the Medical Practitioners Act, the Medical Council must register every medical practitioner who practises in Ireland. In anticipation of the enactment of this Bill, the Council already asks medical practitioners on application for registration and on annual retention of registration whether they have indemnity cover.
On the enactment of the legislation medical practitioners will not be registered to practise unless evidence of adequate indemnity cover is provided to the Council. This development can only be to patients' benefit. The Bill requires that the State Claims Agency would specify the minimum levels of indemnity required for medical practitioners in different medical specialties. The State Claims Agency has the relevant competence and expertise in the area of managing clinical claims and it also has close links with medical indemnifiers and so is well placed to specify what the minimum levels of indemnity should be.
This policy change requires that a new function be given to the State Claims Agency under section 8 of the National Treasury Management Agency (Amendment) Act 2000. There are currently 58 medical specialties on the Medical Council's register and practising in some would be higher risk than practising in others. Within different specialties too, there could be a higher risk attached to certain types of practice. It is important to point out that all doctors who work in the public health system are provided with medical indemnity insurance under the State's clinical indemnity scheme. Likewise, private consultants who practise in public hospitals are also covered by this scheme.
However, doctors who are engaged in wholly private practice must purchase private indemnity insurance cover. There is a wide range in the cost of cover for consultants engaged in wholly private practice. For example, a consultant practising dermatology, based on figures from medical indemnifiers, would be considered low risk and the annual premium for this practice would be around €16,000. Nevertheless, a spinal surgeon may have to pay over €100,000 for annual medical indemnity insurance cover, reflecting the much higher risk involved in that practice. The cost of this private cover increased by approximately 42% for private consultants in 2014 and this was mainly due to the high cost of awards for clinical negligence.
We will now examine the Bill, which includes three minor technical Government amendments. The amendments are needed because the original text of sections 45 and 50 of the Medical Practitioners Act 2007 were amended by Regulation 95 of the transposing regulations of the European Union (Recognition of Professional Qualification) Regulations 2017, that is SI 8 of 2017. I will explain the implications of these textual changes on sections 7 and 8 of the Bill as we examine those sections.
I move amendment No. 1.
In page 5, line 4, to delete “subsection (7)” and substitute “subsection (3)”.
Section 7 amendments section 45 of the Principal Act to introduce a new subsection (1A) after subsection (1). Subsection (1A) (a) requires a medical practitioner to provide evidence in the manner in which the Medical Council may specify in rules of the minimum level of indemnity which applies to his or her practice. The Medical Council will provide all relevant information to registrants and prospective registrants on its website to assist them in complying with the legislation.
Subsection (1A)(b) requires a medical practitioners who is not engaged in medical practice and therefore who would not fall into a class of medical practitioners who must have medical indemnity to provide evidence that he or she is not engaged in practice, again in accordance with rules, which may be set out by the Medical Council.
Subsection (1)(b) of the Bill had introduced a new subsection (8) after subsection (7) of section 45 of the Principal Act to specify that the Medical Council cannot register a medical practitioner who falls within a class of medical practitioner, which requires indemnity, unless the medical practitioner has provided evidence of his or her minimum level of indemnity cover as may be set out in rules under section 11(2)(va). However, a minor amendment to that text is required for the following reason, which is that the Medical Practitioners (Amendment) Bill 2014 was passed by the Seanad on 4 November 2015, but section 45 of the Principal Act was amended by regulation 95 of the transposing regulations of the European Union (Recognition of Professional Qualifications) Regulation 2017, SI 8 of 2017 and was signed into law on 17 January 2017 by the Minister for Education and Skills. These regulations transposed EU directive 2013/55/eu of the European Parliament and of the Council of 20 November 2013 on the recognition of professional qualifications. In this transposition subsections (4), (5) and (6) of section 45 were deleted by regulation 95.1(e) and an amendment is therefore required to the text of the current Bill to state that subsection (7) in section 45 of the Principal Act has now become subsection (3).
This is the effect of amendment No. 1 in the name of the Minister. Following on from that the next subsection, that is subsection (8) will become subsection (4). This is the effect of amendment No. 2 in the name of the Minister.
I move amendment No. 8:
In page 5, between lines 13 and 14, to insert the following:
“Amendment of section 50 of Principal Act8. Section 50 of the Principal Act is amended—(a) in subsection (1) by the substitution of “and has provided evidence, in the manner specified by rules (if any) made under section 11(2)(va), that the minimum level of indemnity (if any) applicable to that practitioner is in place, the Council shall”for “the Council shall”, and
(b) in subsection (3) by the substitution of “unless he or she has provided evidence in accordance with this section that the minimum level of indemnity (if any)applicable to that practitioner is in place and unless the practice is” for “otherwise than”.”.
Section 8 amends section 50 of the Principal Act to require that a visiting EEA practitioner may not practise medicine in the State unless he or she furnishes evidence in accordance with Medical Council rules which will be made in accordance with section 11(2)(va) of the Medical Practitioners Act. The original text of section 50 of the Medical Practitioners Act 2007 was amended by regulation 95.1(i) of the transposing regulations of the European Union (Recognition of Professional Qualification) Regulations 2017, SI 8 of 2017. As a consequence the text of section 8 of the current Bill must therefore be amended to take account of the new wording of section 50 of the Principal Act and to ensure that the original purpose of the section is achieved.