Seminar highlights concerns over how new doctors legislation will be applied
Last week, IrishMedical News held a seminar explaining the likely impact of the new Medical Practitioners Act for Irish doctors.
Priscilla Lynch reports
On Tuesday May 1, IMN held a seminar explaining the impact of the forthcoming Medical Practitioners Act for doctors as part of its Medico Legal Series. The event, organised in conjunction with Madden Events, took place in the Trinity Centre for Health Sciences, St James's Hospital and was attended by GPs, solicitors and a number of prominent legal and healthcare academics.
Dr Kieran Doran, solicitor and senior Healthcare Ethics Lecturer at University College Cork gave the keynote address. Dr Doran, who has written extensively on the medico legal implications of the new Medical Practitioners Bill, outlined the main points of the Bill and contrasted how the new legislation will differ from the existing Act. He said the new Act will bring greater ministerial interference/input, higher regulation of the medical profession by non medical personnel, and stricter enforcement of professional discipline and monitoring of clinical performance.
He described the amended Medical Practitioners Bill, which has been passed by both houses of the Oireachtas and is due to be signed into law by the President by today, as vague and open to interpretation in many key areas. Dr Doran said there had been no addressing of the more contentious aspects of the Bill during its passage through the Dáil and the Senate, where only a number of minor procedural changes were made, and this was something people had to bear in mind. The Bill's provision for a lay majority on the Medical Council was highlighted by Dr Doran as one of the aspects that was most concerning doctors. Understandably he said there was a lot of concern about whether members of the fitness to practice committee with the requisite clinical expertise and training to adjudicate on claims will be in the minority in the new Council.
Fitness to practise hearings will in future be held in public unless otherwise decided by the Council on application of a request by the involved medical practitioner or a witness/complainant to hold part or all the hearing in private, but the Council will have the final say on the decision. This could raise new problems regarding professional reputation and confidentially, the seminar was informed.
Dr Doran said that while competence assurance will be mandatory under the new Bill, there is no detail on how exactly it will be funded or a clear time frame for its implementation. He said the absence of a legal definition on ministerial directions to the Council was a serious issue as was the apparent connected contradiction between sections 9 and 23 of the Bill in relation to failure to comply with ministerial directions and removal of Council members.
While the Bill does mention a mediation process to help deal with complaints against medical practitioners it does not issue guidelines on such, which is another weakness of the legislation, stated Dr Doran. During the extensive Q&A session at the seminar, which was chaired by the Editor of IMN, Mr Gary Finnegan, questions were asked about when the current Medical Council will be dissolved, how will the additional responsibilities of the Council be funded, and whether the new Act could be changed once it was signed into legislation. Dr Doran said that while people would have "to watch this space" in regards to how some parts of the Act were implemented, it was very difficult to change an Act once it was on the statute books unless there was a serious political will to change it, but amendments could be made.
Introducing the session, Mr Finnegan made reference to the huge amount of medical and main stream media coverage generated by the Bill and highlighted how the Bill was so contentious that it became a key issue during the Medical Council's mid term elections. The aspect of the Bill most focused on during the Medical Council election was the lay majority provision, which Dr Doran told the audience during the Q&A session he believed was "a populist measure".
Speaking to the floor, Ms Ivana Bacik, Reid Professor of Criminal Law, Criminology, and Penology at Trinity College Dublin, said she also suspected the lay majority was a populist measure and said she believed many aspects of the Bill were unworkable.
"I too would have particular concerns about lay majority. Its not a good thing if in practice it turns out to be populism without any evidential basis," she told IMN.
Prof Ray Kinsella, Director of the Centre for Insurance Studies, UCD, speaking during the Q&A session described the Bill as "flawed, problematic and difficult" and said it would generate a sea change in the governance of healthcare in Ireland. "I would certainly be very concerned about it. My information is that there are grounds for a serious legal challenge to it. It may be that the course of the Election will pre-empt that but my information is that people who know more about law than I do have expressed grave reservations about the constitutionality of it. It is a highly politicised Bill,"he commented. Prof Kinsella asked why the representative bodies including the Medical Council itself have been so slow to bring forward an alternative model of governance.
"Why have they not been proactive and put forward amore rigorous and transparent model that is still practitioner driven?" he queried, and added that the Government itself should have to go through a competence assurance process.
"Basically you have a Medical Council that has been emasculated and its governance structures transformed (by the new Bill). I can only attribute it to post-Neary syndrome. The Neary debacle was a tragedy of tremendous proportions but then again if you look at the State, the State is not in any position to lecture a professional body on debacles of that kind. You have to ask the question where should the governance of the medical profession lie. Should it lie with the people who are entrusted with delivering care or should it lie in a very difficult Bill, with the State, where the powers are ill-defined and could be augmented or misinterpretedin future?"
At the end of the seminar respects were paid to Dr Deirdre Murphy, former President of the ICGP, who died recently.
Source & Photos: Irish Medical News
Dr Kieran Doran, keynote speaker at the seminar
Ms Emma Maguire, Madden Events; Dr Kieran Doran, Senior Healthcare Ethics Lecturer in the School of Medicine UCC; and Mr Gary Finnegan, Editor, Irish Medical News
Solicitors Ms Judy O'Kane, Ms Karen Daly, Ms Alice Lanigan, and Ms Caroline Crowley
Ms Miriam O'Connor, VHI Healthcare; Dr Ros Quinlan, North East HSE; and Mr Flor Madden, Madden Events
Mr Gary McCann, Solicitor; Ms Megan Hooper, Solicitor; and Mr David Hickey, Medical Council
Mr M A Aremu, St James's Hospital; and Prof Ivana Bacik, School of Law, TCD and candidate in forthcoming Seanad elections