Paschal Mooney (Fianna Fail) | Oireachtas source

I compliment the Minister on showing his continued respect for the House by taking this important Bill. I am sure he has a sense of déjà vu listening to the robust proposals put forward by Senator Colm Burke. I will not repeat the arguments made by the Senator, particularly given that the Minister spent many waking hours putting together the original version of this Bill in 2009. I presume the Minister went down the same route as the Senator.

Paragraph 51 of the Medical Council's guide to professional conduct and ethics for registered medical practitioners states that medical practitioners must ensure they have adequate professional indemnity cover for all health care services. Clearly this cannot be equated with a statutory obligation to have in place such cover and, consequently, it could be submitted that patient protection measures are not what they ought to be.

Fianna Fáil would support the objectives of that Bill. In the 2009 debate, the then Minister, Mary Harney, was very sympathetic towards the Bill when it was brought forward by Deputy Reilly, now the Minister. Deputy Reilly raised a number of issues at that time. He said the majority of doctors were responsible and carried appropriate medical negligence insurance. One would assume that would be the case. As a medical practitioner, Deputy Reilly himself would be aware of the need for such insurance because of the highly litigious nature of the business in which GPs operate. We have not quite gone as far as the United States in that regard, but it has been said many times in recent years that we seem to be going down that route. Doctors tend to take a more cautious overview now than heretofore in terms of how they deal with patients and I am sure Professor Crown would have something to say in that regard.

What the then Minister, Mary Harney, said at the time is still relevant. She continually referred to the trust between patient and doctor. I would trust Professor Crown completely if I was under his care and, perhaps, would not be thinking about whether he was covered adequately if I was availing of his expertise. At the same time, in the real world in which we live, I am sure he and his colleagues would be of the view that it is better for them to have the defence of having adequate insurance in place, in the event of something going wrong, which is essentially what we are talking about here. Interestingly, it was stated at the time that the Department of Health and Children and the Medical Council did not know how many practitioners had insurance, what level of cover they held, the type of insurance or who provided it. I wonder whether that remains the case. However, this legislation will address the situation and because insurance will be obligatory the information will be available.

Another aim of the Bill is to close a loophole that could allow an unscrupulous doctor to apply for medical registration and practise without insurance. There are only a small number of such cases. Senator Burke referred to 99.9% of practising doctors having adequate insurance. In the event of mistakes or medical negligence, the State must offer patients the best protection it can. Compulsory indemnity would instil confidence in the system and guarantee patients redress if something went wrong. This is what Deputy Reilly said at the time and we would all agree with that. He also pointed out - I am curious as to whether these figures changed - that it was expected the State would pay out some ¤60 million in medical legal costs in 2009, ¤20 million of which would go to lawyers. Far be it from me to suggest Senator Burke would have a vested interest in that regard, but I better not go down that road.

In her response, the former Minister, Mary Harney, gave the background and context for the debate. The Medical Practitioners Act 2007 was a comprehensive modernisation of legislation dating back 30 years governing the medical profession. She said it was clear from contributions to the 2007 debate that trust was at the heart of the doctor-patient relationship and that oneself or one's family member was a patient, one wanted to have the utmost confidence and trust in one's doctor, not from blind faith or deference but for good reason. However, she said she did not believe people wanted a bevy of lawyers, legislators or insurers metaphorically sitting in on the confidential discussions with their doctors. We would all agree with that. Perhaps, that is what guided her view at the time she deferred the Bill, although she said she fully agreed with the objectives behind it at the time.

She went on to say that given the complexities and sensitivities of medical indemnity insurance, the method deserves detailed reflection from the legal, administrative and practical points of view. She did not elaborate on that, but perhaps the Minister will. Has anything changed since with regard to what she referred to as "complexities and sensitivities of medical indemnity insurance"? Financial intermediaries, solicitors and a range of other professionals are compelled to hold professional indemnity cover and I do not see why it should be any more complex for the medical profession. Was that just the Government's way of saying that it was a fine Bill, but it would not give the Opposition the credit for introducing it so would kick it down the road for a few months and then come back to it? However, the then Minister did not come back to it.

The last reference I can find to what happened to that excellent Bill dates to January 2011. The then Tánaiste and acting Minister for Health and Children, Mary Coughlan, said the heads of a medical practitioners (amendment) Bill to make it mandatory for registration purposes for doctors to have clinical indemnity insurance had yet to be approved by Government. This was approximately 18 months since then Deputy Reilly had introduced his Bill. Was there something going on in the Department of Health and Children we need to know about?