Industrial action by doctors over their insurance cover would damage their cause and hurt patients, writes Mary Harney.
Hospital consultants are considering industrial action as a response to an insurance grievance they have with a British-based organisation that has let them down badly.
I don't believe this is the right course of action for consultants or for patients and I hope consultants will agree.
The issue is complex, but the basics are clear.
When we put ourselves in the care of a doctor, we place huge trust in one person. We know there is always risk involved. Medical mistakes happen. Some are unavoidable mishaps, others are due to negligence.
Because the consequences for patients can be so grave, it is vital that doctors have medical insurance to cover both compensation payments to patients and to ensure that doctors do not practise medicine in fear of financial ruin from damages against them. Much of the same reasoning is behind motor insurance being compulsory for all drivers.
From February 1st, 2004, the State has insured consultants in public hospitals under the Clinical Indemnity Scheme. This covers claims, and compensation that arises, from that date. But there are still cases that happened before February 1st, 2004, and these are supposed to be covered by insurance arrangements then in place.
The Medical Defence Union was one provider of this cover for consultants over many years. Premiums were paid in good faith. Up to 90 per cent of the premium was subsidised by the State.
Unfortunately, since last August, the MDU has withdrawn cover from many consultants, particularly obstetricians who face high claims. It maintains it has the discretion to do this. Naturally consultants are outraged. And I agree with them. I believe the actions by the Medical Defence Union are unreasonable and unfair. I made this clear to them when we met in December.
Hospital consultants, the Government and patients are all on the same side on this insurance issue.
I am obliged to do all I can to ensure that the Medical Defence Union meets its responsibilities to Irish consultants and to Irish patients. There are two ways this can happen: by the State agreeing with the MDU on what the latter will definitely cover, and what the MDU would do for the State for it to take over some claims.
The alternative is for the State to join in litigation with consultants against the MDU.
I told the Medical Defence Union that I would prefer to resolve this matter without litigation. Work is well under way on the technicalities of an agreement. We have no intention of letting this drag on and I am working with my Department officials to ensure brisk progress now. Litigation remains a real option, however.
In the meantime, consultants are living with some uncertainty: those from whom cover has been withdrawn do not know what cases may arise against them. Others don't know if the MDU is about to withdraw cover.
To help consultants through this difficult time, I gave an assurance in writing within a month of becoming Minister for Health and Children that "no Irish person who has suffered from a medical mishap would be left without compensation and no consultant would be left without cover in all reasonable circumstances and in accordance with law".
I have met consultants' organisations on three occasions to discuss what this means in practice.
In particular, when a case arose in November where the MDU refused to provide even a legal defence to a consultant heart surgeon, I put in place arrangements for the State to assist in his court defence. This is now available to all consultants left without a legal defence team by the MDU.
I am interested therefore in solutions that underline that the Government, consultants and patients are on the same side in relation to this insurance issue.
What I cannot do, and will not do, is allow the Medical Defence Union to walk away from its obligations. It would be grossly irresponsible and indeed amount to professional misconduct on my part. I hope that everyone understands and respects this position. We are not yet in a position to bring the matter to legal finality. We cannot do anything to jeopardise our legal position.
But while we are still in this phase, I am not aware that any consultant who ought to be covered by insurance faces an imminent judgment of damages against him or her. Where legal proceedings begin, we are helping with a legal defence, as I mentioned above.
In the meantime, if industrial action were to proceed now, no consultant would positively benefit, but patients would certainly suffer from delays and cancellations. The Medical Defence Union, whose actions have caused so much distress to consultants, would be entirely unaffected. The action would miss its target.
This could hardly be what most consultants want on behalf of their colleagues who have been let down.
Any such industrial action would be very regrettable.
I have met many consultants individually and in groups since September. My approach is always that of a solution-seeker and I see the potential for progress. We should not let a dispute with the Medical Defence Union result in delayed treatment for patients. With common purpose and shared understanding, we can and will find solutions.
Mary Harney TD is Tánaiste and Minister for Health