The State is heading for a medico-legal crisis unless the spiralling cost of medical negligence claims is curtailed, an insurance expert has warned. The cost of medical litigation settlements jumped by 450 per cent between 1990 and 1998, and the State cannot afford to let current trends continue, according to Dr Christine Tomkins of the doctors' insurance firm, the Medical Defence Union.
The increasing costs ultimately had to be paid for by the taxpayer, she said yesterday. "This is not a situation which, in our view, can go on," Dr Tomkins said, noting that there were also social and medical consequences to such settlements.
Awards totalling £4.6 million were made recently in four obstetrics cases, Dr Tomkins said. While just 2 per cent of its members in the Republic were obstetricians, these cases accounted for 45 per cent of their case reserves.
"A doctor in this country is four times more likely to be sued than his counterpart in England, and the legal costs in Ireland are about four times higher than in England," the Irish Hospital Consultants' Association general secretary, Mr Finbarr Fitzpatrick, said. The Department of Health would pay between £17 million and £18 million this year towards the cost of indemnity insurance for the public work done by doctors, he added.
These payments and the cost of legal awards were from funds which could otherwise be invested in health care, Dr Tomkins said.
In addition, the high costs of litigation were influencing the type of medical care patients were receiving, with doctors practising "defensive" medicine, she said. This involved prescribing medications and undertaking procedures which were arguably unnecessary.
A survey of their members in Britain, Dr Tomkins said, found that 82 per cent of their members employed such defensive approaches to avoid negligence claims.
The threat of litigation also took its toll on doctors, with 99 per cent suffering from moderate or considerable stress as a result of complaints against them.
Among the legal changes Dr Tomkins believed would help tackle the problem were:
adequate legal pleading so that each party knew what the problem was, thereby shortening hearings and reducing legal costs;
early access to records to enable facts to be established at an early stage;
the exchange of expert reports to end "trial by ambush";
a requirement that claimants quantify and explain the damages they are seeking;
guidelines for damages for each category of personal injury.
Dr Tomkins believed some cases could be prevented if doctors provided patients with a proper explanation when things went wrong, along with assurances that it would not happen again and, if necessary, an apology.
Mr Fitzpatrick said the Irish Hospital Consultants' Association had tirelessly campaigned for reform of the legal system. The association will hold a special conference in Dublin on Saturday to consider the costs of litigation.