A consultant in the Republic was refused professional indemnity cover by one of the UK's medical defence agencies this year.
While the issue at the centre of the refusal remains unclear, it is not one which involves the professional competence of the consultant, who practises outside Dublin.
The Irish Times understands that the refusal to renew the annual insurance contract in July resulted in the consultant being unable to work for some time. The Department of Health was involved in talks with insurers to try to resolve the issue.
The Department has published a discussion document which addresses some of the difficulties in medical litigation. It proposes that liability from next July will be dealt with on an "enterprise" basis.
Each health board or hospital will be assigned an enterprise which will insure its consultants as well as insuring its normal potential liabilities.
In future, malpractice claims will be taken against the health board or hospital rather than the consultant.
The Department proposes to establish a clinical claims management agency to handle all negligence claim in the public sector. The new agency will also be responsible for implementing risk management programmes in the State's hospitals and health boards.
A state indemnity pool will also be set up to act as the basis for financing future settlements and to which each individual enterprise will be required to make an annual contribution.
Under the system as it is now, consultants enter into individual indemnity arrangements with one of the UK medical defence agencies. Doctors who hold public appointments have at least 80 per cent of the insurance premium reimbursed by their employers.
The main practical difference in the new proposal, from a claimant's perspective, is that he/ she would institute a single set of proceedings against the "enterprise" rather than multiple proceedings against doctors and the hospital as at present.
From the Department's point of view the new system offers considerable cost savings; the legal and administrative costs of a single defence would be much less that those associated with the current multiplicity of advisers and legal teams.
According to Mr Finbarr Fitzpatrick, secretary general of the Irish Hospital Consultants' Association, his members are disappointed that the private hospital sector had not been included in the Department's indemnity proposals.
"We are especially concerned about private obstetric care. If consultants are forced out of this sector, public hospitals could not possibly manage the overload," he says.
Consultants are also critical of the document for not addressing issues such as the level of medical negligence awards, which represent the single largest cost component.
Mr Fitzpatrick also questioned whether a doctor's clinical independence could be maintained under the risk management proposals.
The total cost of medical indemnity to the Exchequer for the year 2000 is £32.3 million, of which £25 million is paid to reimburse hospital consultants.
The rising costs of medical insurance are illustrated by figures from 1991 which show the State paid £9.7 million to the Medical Defence Union and the Medical Protection Society, the two UK based medical indemnity bodies.
The new enterprise liability proposals are confined to doctors employed by the State. General practitioners, who are independent contractors, are excluded.