Wednesday, 17 May 2017
Medical Practitioners (Amendment) Bill 2014: [Seanad Bill amended by the Dáil] Report and Final Stages
This is a Seanad Bill which has been amended by the Dáil. In accordance with Standing Order 118, it is deemed to have passed its First, Second and Third Stages in the Seanad and is placed on the Order Paper for Report Stage. On the question, "That the Bill be received for final consideration", the Minister may explain the purpose of the amendments made by the Dáil. This is looked upon as the report of the Dáil amendments to the Seanad. For the convenience of Senators, I have arranged for the printing and circulation of those amendments. I have also circulated the proposed groupings in the House. Senators may contribute once on the grouping. I wish to remind Senators that the only matters that may be discussed are those relating to the subject matter of each of the amendments made by the Dáil and nothing else.
The purpose of the Bill is to make it mandatory that all medical practitioners must provide evidence to the Medical Council of the level of medical indemnity insurance cover they hold. They will do this initially on first registering with the council and each year thereafter on renewal of registration. Medical practitioners will not be placed on the register of the Medical Council, that is, they will not be able to practise as a medical practitioner in Ireland unless this evidence is provided.The legislation gives the State Claims Agency, which has appropriate experience in the area of medical indemnity insurance, the power to specify the minimum levels of indemnity required for different classes of medical practitioner. This policy change requires that a new function be given to the State Claims Agency, under section 8 of the National Treasury Management (Amendment) Act 2000. 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.
The Bill was introduced on Second Stage in the Dáil on 6 December 2016. There were no amendments proposed by members of the Dáil. However, Regulation 95 of SI 8 of 2017, which was made by the Minister for Education and Skills in January this year and which transposed the European Union (Recognition of Professional Qualification) Regulations 2017, amended the original text of sections 45 and 50 of the Medical Practitioners Act 2007. This necessitated three technical amendments to the Bill on Committee Stage. Two amendments were required to section 7 and another amendment to section 8 of the Bill as passed by the Seanad, to take account of the new wording in those sections as a result of the changes made to the text to sections 45 and 50 of the original Act by the regulations.
I now wish to report on the amendments made to the Bill on Committee Stage in the Dáil.
Amendments Nos. 1 and 2 amend section 7 of the Medical Practitioners (Amendment) Bill 2014. This section amends section 45 of the principal Act to introduce a new section 45(1A) after section 45(1). Section 45(1A)(a) requires a medical practitioner to provide evidence, in the manner which the Medical Council may specify in rules, of the minimum of indemnity which applies to his or her practice.
Yes, amendments Nos. 1 and 2. Section 45(1A)(b) requires a medical practitioner who is not engaged in medical practice and who therefore does 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.
Section 45(1B) had introduced a new section 45(8) after section 45(7) of the 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 the proposed section 11(2)(va) of the Act. However, two minor amendments to that text are required for the following reason. Section 45 of the Act was amended by the European Union (Recognition of Professional Qualification) Regulations 2017. These regulations, transposed through SI 8 of 2017, were signed into law on 17 January this year by the Minister for Education and Skills. The regulations transposed Directive 2013/55/EU of the European Union and Parliament on the recognition of professional qualifications. In Regulation 95(1)(e), sections 45(4), 45(5) and 45(6) of the Medical Practitioners Act 2007 were deleted. An amendment is therefore required to the text of the current Bill to state that section 45(7) has now become section 45(3). This is amendment No. 1, which was introduced on Committee Stage in the Dáil by the Minister. Following on from that, the next subsection will become 45(4) rather than section 45(8). This is amendment No. 2, which was proposed by the Minister.
Would the Cathaoirleach like me to proceed to amendment No. 3?
The speaking note which I have is on amendment No. 3. Section 8 of the Bill amends section 50 of the Medical Practitioners Act 2007 to require that a visiting European Economic Area, 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 2007 Act was amended by Regulation 95(1)(i) of the transposing regulations of the European Union (Recognition of Professional Qualification) Regulations 2017, that is, 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 in section 50 of the Medical Practitioners Act and to ensure that the original purpose of this section is achieved.
The amendment is on an extremely important issue. In 2009, Senator Reilly introduced a Private Members' Bill. The then Minister for Health, Mary Harney, at that time in late 2009 or early 2010, undertook to take action on this matter. I subsequently raised the issue in 2012 when I published another Private Members' Bill along similar lines to this Bill. The big concern was about doctors coming into Ireland to do cosmetic surgery. Is the Minister of State satisfied that this amendment ensures that someone coming to the country for a week to perform cosmetic surgery in a private facility would have adequate insurance? That was one of the principal reasons the legislation was brought forward in 2009 and again, by myself, in 2012.
The Act requires that a visiting EEA practitioner may not practice medicine in the State unless he or she furnished evidence in accordance with Medical Council rules, which will be made in accordance with section 11(2)(va) of the Medical Practitioners Act 2007. Such a doctor must provide evidence in accordance with Medical Council rules.
I will be very brief. I welcome this Bill. I am astounded that we did not have this before. It seems neglectful in respect of the trauma patients might be put through. Coming from the perspective of health, in the past there have been people, of whom I would be very aware, who have not been up to scratch and whose practice would not have been the best. Despite that, these people seem to have gone through the rigmarole of An Bord Altranais or whatever. Several years ago it was discovered that these certificates were fraudulent. English authorities contacted An Bord Altranais to say they had found many of these fraudulent certificates. It is a double-whammy of checks and balances if one has to have the insurance and be with the Medical Council. It will make it a lot more difficult to fly below the radar and have extremely poor practice for those who may never have been trained at all. I welcome the Bill and the protection of patients. We need to have redress in respect of what may go wrong.
Fianna Fáil welcomes the Bill. The amendments to it are very practical. Our spokesman for this area, Senator Swanick is a doctor. He briefed me and made it clear that this is good legislation that is badly overdue. We are very happy to support it and delighted to see it passed through the House.
I thank the Minister of State for bringing this Bill through its final Stages. As I said earlier, this matter first came to light in 2008 and 2009 in respect of cosmetic surgery. There was a concern that procedures were being carried out and the medical services here had to pick up the pieces.There were people performing procedures who did not have adequate insurance. Senator James Reilly, when Fine Gael health spokesperson, brought forward a Bill to deal with this area in 2009 and the then Minister, Mary Harney, said she would deal with it in early 2010. It was not dealt with, however. I brought forward my own Bill in 2012, having consulted with the Medical Council and Ciarán Breen in the State Claims Agency. Representatives of the Medical Protection Society, MPS, came in from London to meet up with me and those of us working on the Bill because it was concerned there were several medical practitioners who did not have insurance.
My Bill was debated in the Seanad but it was parked because the Department was dealing with it. The big question was how one judged the level of insurance. The Medical Council would not have the expertise to set out the criteria in that regard. In fairness to Ciarán Breen in the State Claims Agency, he came on board giving help and advice on the insurance issue.
With the Department, the Medical Council and the State Claims Agency working together, we have moved forward with this legislation. I cannot drive a car unless I have insurance. Neither could I practise as a solicitor without insurance. However, there are medical practitioners who are practising without insurance. That situation will prevail until this Bill is signed into law. While 99% of medical practitioners have insurance, some do not. In Cork city, for example, I came across a radiologist providing services but who did not have insurance.
I welcome this long-overdue Bill. I thank the Department’s officials for their help and assistance in 2012. I also thank the State Claims Agency, the MPS and the Medical Council for the assistance they gave. I am delighted the first Private Members’ Bill I introduced, although it is in a different format, will at least be law within the next week.