Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I am pleased to have the opportunity to participate in the debate on Second Stage of the Medical Practitioners (Amendment) Bill 2014. The Bill will make it mandatory for medical practitioners engaged in medical practice to provide evidence to the Medical Council of minimum levels of indemnity cover. It provides that the Medical Council, following consultation with the State Claims Agency, will set the minimum levels of cover. It places a statutory duty on medical practitioners, as they register with the Medical Council, to have indemnity or insurance for liabilities which may be incurred in carrying out work as a registered health care professional. A condition of registration and staying on the register is that a medical practitioner must have the appropriate indemnity cover. He or she must show evidence of this to the Medical Council when he or she first registers and also annually when retaining 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 practitioner services may be unable to seek redress in the event of a medical mishap or negligent care on the part of a medical practitioner. The Medical Council requests all medical practitioners, on registering for the first time and on annual retention of registration, to confirm whether they have medical indemnity cover. The vast majority have indemnity cover. However, the proposed legislation will place a legal obligation on medical practitioners to have cover and provide evidence that it is adequate for the medical practice in which they are engaged.

Article 4.2(d) of EU Directive 2011/24/EU of the European Parliament and the Council of 9 March 2011 deals with the application of patients' rights in cross-border health care. It obliges member states to ensure systems of professional liability insurance, or a guarantee or similar arrangement, are in place for treatment provided by medical practitioners. The legislation will fulfil Ireland's obligations under the directive in relation to medical practitioners. Similar legislation will be drafted as soon as possible which will apply to other registered health professionals.

The Bill places a statutory duty on registrants to have insurance or indemnity cover in respect of liabilities which may be incurred in carrying out work as a registered health care professional. A statutory condition of registration will be that the medical practitioner must show evidence of indemnity cover. The Medical Practitioners (Amendment) Bill 2014 is good news for patients. It will reassure them that they will be able to obtain redress in the event of a medical mishap or negligent care. To comply with the legislation, medical practitioners must ensure the indemnity cover they have is in accordance with the minimum levels appropriate for their practice. The Medical Council is best placed to ascertain whether doctors have indemnity cover as all doctors who practise in the State must, in compliance with the Medical Practitioners Act 2007, register with the council and retain this registration annually.

The Bill should not require medical practitioners to have any more than what would be the normal indemnity cover which is adequate for the medical practice in which they are engaged. If a medical practitioner is not engaged in medical practice and does not pose a risk to another person in his or her medical practice - for example, a medical practitioner who is a full-time lecturer - there is no legal obligation on that medical practitioner to have medical indemnity cover.

The Medical Council will specify which classes of medical practitioners require indemnity.
The Bill is divided into 12 sections. Section 1 notes that the "Principal Act" referred to in the Bill is the Medical Practitioners Act 2007. Section 2 amends section 2 of the Medical Practitioners Act, to include definitions of the terms used in the Bill. In the Bill indemnity is defined as a policy of medical indemnity insurance or other indemnity arrangement against losses arising from claims in respect of civil liability incurred by a medical practitioner for any act or omission of that medical practitioner arising from his or her practice as a medical practitioner.
Section 3 amends section 7(2) of the Act to introduce a new function for the Medical Council, in that it must specify the minimum levels of indemnity which will apply to various classes of medical practitioners.
Section 4 amends section 11(2) of the Medical Practitioners Act and it gives power to the Medical Council to make rules to specify the evidence that a medical practitioner has to give to the Medical Council to prove that he or she has the appropriate minimum level and how this should be displayed.
Section 5 amends section 36(1)(c) of the Act to allow for a fee to be charged by the Medical Council to put a medical practitioner back on the register where the registration has been removed because he or she failed to provide evidence of the minimum level of indemnity cover.
Section 6 is one of the most important sections in the Bill. It inserts a new section - Section 38A into the Act. This section puts the onus on a medical practitioner to have the level of indemnity appropriate for his or her practice in place at all times while he or she is registered, unless he or she is a medical practitioner who does not require indemnity. A medical practitioner who contravenes this must notify the Medical Council within 14 days.
Section 7 amends section 43 of the Act and requires that the medical practitioner displays at all times where he or she works, the evidence of minimum level of indemnity cover, where practicable.
Section 8 inserts a new section 43A after section 43 of the Medical Practitioners Act. Subsection (1) of this new section requires the Medical Council to publish a notice in Iris Oifigiúilsetting out the minimum levels of indemnity which apply to different classes of medical practitioners, following consultation with the State Claims Agency and any other person the Medical Council considers appropriate.
Subsection (2) requires that the notice inIris Oifigiúilwould specify the dates from which the levels of indemnity take effect for different classes of medical practitioners.
Subsection (3) sets out the criteria which the Medical Council must take into account when setting minimum levels of indemnity in respect of certain classes of medical practitioners. This includes the risks identified by providers of indemnity which are particularly associated with the medical specialty practised by various classes of medical practitioners. The criteria also include awards or settlements where the cause of action arose out of an alleged breach of duty involving a member of that class of medical practitioners in his or her capacity as a medical practitioner who falls within that class.
Section 9 amends section 45 of the Act to introduce a new subsection. This section of the Act deals with registration of medical practitioners. The new subsection requires a medical practitioner to provide evidence that he or she has the appropriate level of indemnity. It also provides that a medical practitioner who does not fall into a class of medical practitioners who must have medical indemnity, to provide evidence that he or she is not required to have indemnity. This new subsection also provides that the Medical Council shall not register a medical practitioner who should have indemnity, but does not provide evidence of the indemnity required.
Section 10 amends section 50 of the Act to require that a visiting EEA practitioner may not practise medicine in the State unless he or she furnishes evidence that he or she has the appropriate minimum level of indemnity.
Section 11 inserts a new section, section 80A. into the Act. Subsection (1) enables the Medical Council to remove a medical practitioner from the register if he or she fails to provide evidence of the minimum level of indemnity. Subsection (2) provides, however, that the medical practitioner would not be removed from the register, if the medical practitioner was the subject of a complaint which was ongoing. This power allows the council to proceed with that complaint, whereas if the medical practitioner was no longer registered, the council could not do so.
A further section 80B is added after 80A. This section sets out the steps to be followed by the medical practitioner in order to be restored on the register, for which a fee will be charged by the Medical Council.
Section 12(1) gives the Short Title of the Act - Medical Practitioners (Amendment) Act 2014. Subsection (2) stipulates that the Act will come into operation when the Minister signs a commencement order and different parts of the Bill may be commenced at different times.
The role of the health service is to improve the health and well-being of people in Ireland in a manner that promotes better health for everyone, fair access, responsive and appropriate care delivery, and high performance. The main purpose of the Medical Practitioners Act in 2007 was to protect the public and to have an active system of robust registration and regulation of the medical profession, in order to minimise the risk to the public and safeguard the health and wellbeing of people accessing health services.
The Medical Council is doing an excellent job, in providing an efficient and accountable system for the regulation of the medical profession. The public can be satisfied that registered medical practitioners are both appropriately qualified, and competent to practise in a safe manner. 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.
I commend the Bill to the House.