John Crown (Independent) | Oireachtas source

Cuirim fáilte roimh an Aire. I am very supportive of this legislation which has a sort of resonance with some of the issues that have arisen in the context of the abortion debate. We believe the contingency for which we are legislating is extremely rare, thankfully, but that does not mean the necessity for this legislation is invalid. We have an obligation to ensure the bases are covered, just as we are obliged to ensure appropriate guidelines are in place for the rare cases in which the life of a pregnant woman may be compromised. In this case, we must make provision for the extremely rare circumstance where people practise medicine without the appropriate insurance. I compliment Senator Colm Burke on the initiative he has shown in bringing forward this Bill. He is a thoughtful and extremely well informed commentator on health care issues. In the past two years he has brought a great degree of wisdom to various health debates in this House.

The Minister might be familiar with the tombstone imperative, a phrase used in air safety circles. It refers to the manner in which attempts are made to ensure air safety by examining previous disasters, learning from the mistakes made and trying to prevent similar bad things from happening in the future. It is based on things like black box technology and flight recorders. We are familiar with the dramatic scenes when teams of investigators descend on these locations. Having been involved in studying aspects of the health service for the past ten years or so, it seems that a version of the tombstone imperative has been in operation in that period. I accept that this has not been a characteristic of the tenure of the Minister for Health, Deputy James Reilly. It can be argued that the politics of the last health care atrocity, to borrow a phrase, is used in many circumstances to advance the health care reform agenda. Issues to do with breast cancer care in certain areas led to the reform of the health service. Problems with diagnostics in other areas led to further improvements.

We have to understand something. My colleagues have alluded to the fact that Ireland appears to be adopting the US attitude to medical litigation. If I am not mistaken, Ireland has the second highest rate of medical litigation in the world, after the United States. We had the third highest rate, after the United States and New Zealand, which had a quirkily high place in the pecking order, for many years. We are now higher on the league table than New Zealand. Certain similarities between our system and that in place in New Zealand are relevant in this regard. I give a regularly recurring lecture on legal aspects of cancer care as part of a course on the legal aspects of medicine, or the medical aspects of medico-legal care. There is no doubt that it is incredibly important. In the United States breast cancer is the one disease which leads to doctors being sued. The cases refer to misdiagnosis, a failure to refer for mammograms appropriately, inappropriate treatment and a failure to provide proper multidisciplinary care, etc.

There is no doubt that there is a major problem in this country in dealing with cancer and other diseases. For this reason, I have studied the famous book the Medical Protection Society publishes every year. It is an annual reminder of the horrors that can befall us. It goes through various cases that have appeared on the society's case books in the previous year and the various mistakes made. I recommend it to anybody who wants to get a sense of how things can go wrong in medicine. The problem that most frequently recurs in Ireland is the making of inappropriate decisions by non-consultant doctors and trainees. The core reason we have so much medical litigation is we have an abnormally small number of career level legally responsible doctors at general practice level and in hospital specialties. Overall, we have a relatively average number of doctors. However, we have a bizarre demographic. Many of our doctors are involved in various training jobs in which they are asked to make responsible decisions.

I support this legislation and it is likely that I will make some comments on amendments on Committee Stage. I suggest we consider the issue of tailback insurance for people who have passed retirement age. We need to ensure the relevant section of the Bill is worded in a way that would not impose an extra burden on those who may not have much income at the time of retirement. We should remember that in some specialties the annual premium is higher than the public salary.