Colm Burke (Fine Gael) | Oireachtas source

I welcome a debate on this matter as it is important that there is open disclosure of any adverse events occurring in medical practice, whether in a hospital, in a voluntary hospital or any medical facility. It is important to recognise we have come a long way. The problem is that our judicial system is an adversarial system and that is not helpful or conducive to all information being given at an early date.

We need to change the process for when adverse events occur in the course of medical treatment. We need a totally different system from the adversarial one we have. Last year we paid out over €300 million in claims via the State Claims Agency. If all the claims with that agency were settled in the morning, it would cost the State approximately €2 billion so there must be a better way. As much of the cost of that system is absorbed by solicitors and counsel, we need to look at the system and I welcome the Government's decision to carry out a review.

On open disclosure, not all adverse events have answers which are immediately available when they occur and, while information may be available to medical practitioners, the reasons for how such an event occurred may require further investigation. I am aware of cases where it has been decided to bring in an external person to examine the history of how a patient has been managed but, 18 months later, no agreement has been reached as regards who that person should be.I had one case where the nurses and doctors on the front line wanted someone appointed immediately, and 18 months later the HSE had not taken a decision about who should be appointed. Cases such as this contribute to the worry and concern and, obviously the immediate impression that something is being hidden, but the people who work on the front line are not the people who caused the delay.

Where there have been very adverse events where deaths have occurred there have been considerable delays in the holding of inquests. This has also contributed to the concern of the families involved that someone is hiding something. In fact, it is beyond the power of the HSE and beyond the power of the front-line nurses and doctors and support staff to dictate when an inquest should be held. As a result, they are the people who seem to be identified as causing the delay when, in fact, it has to do with the system of holding inquests. For instance, there is no requirement for a coroner to hold an inquest within a particular period of time and this needs to be changed. In cases of infant deaths and maternal deaths I have seen a considerable delay in the holding of inquests. As a result it caused the wrong impression. It is important that the information, as soon as it is known, is made available to the people who suffered as a result of the adverse event. Any delay causes confusion, upset and anxiety, outside of the fact that people are going through a very traumatic period of time anyway. It is important that we make some of the changes in that area. Specific time periods for coroners are not covered by the Bill but it is something that should be looked at. In some areas of the country it is extremely good and efficient and coroners deliver very early, but in other areas it seems to be a problem.

The Minister will outline the Government's position on the Bill. We need to make the change in law. We need to make sure people are satisfied that every relevant piece of information about an adverse outcome is available to them and that nothing is kept from them. This is no criticism of the Minister because it happened before he was in office, but I had one scenario where I spent two and a half years getting an order for discovery against the Department and after getting that discovery I got a letter stating 1,100 hours of staff time had been used in assembling the documents for me to inspect. Of course the next line in that letter from the Department's solicitor was asking whether I would like to settle the case. That was after two and a half years of looking for discovery. It justified my persistence in getting it. I should not have had to do it and no one should have to do it with regard to any adverse event. It was not a medical negligence case but it was a case that involved the Department. We have made a lot of changes in the judicial and legal processes with regard to the disclosure of documents rather than discovery, but we still need to do a lot more with regard to how we can make information available so people do not have to be forced into the court system. It is extremely important that we do this. I welcome the debate and I look forward to listening to the Minister and hearing his response on the matter.