State facing €160m medical negligence bill

The State is facing a bill of more than €160 million to settle the 1,300 claims for alleged medical negligence lodged with the State Claims Agency (SCA).

Ciaran Breen, deputy director and head of claims at the SCA, said obstetrics and gynaecology cases are by far the most expensive category. The 340 obstetrics and gynaecology cases were just 25 per cent of all claims but are expected to require 60 per cent of the €160 million reserve.

In comparison, settling the 284 surgery negligence claims would require just 14 per cent of the reserve, he said.

Mr Breen said 85 per cent of legal cases were settled, with 10 per cent either being discontinued or having liability taken over by a third party. The remainder end up in court.

The SCA said fees and other expenses account for up to 65 per cent of the cost of settling a medico-legal claim.

The SCA deals with medical negligence claims under the Clinical Indemnity Scheme (CIS), which was established in 2002. The scheme now covers over 68,000 front-line medical staff at 87 hospitals, community care services and facilities offering services for intellectual or physical impairment.

In February 2004, the CIS was extended to include consultants in public hospitals.

The CIS expects about 500 claims each year at a cost of €65 million to the State.

"Medical negligence claims are not rising significantly and it would be wrong to say that they are," said Mr Breen.

The CIS provides clinical indemnity on the basis of enterprise liability, meaning the hospital or care centre where the alleged negligence took place takes vicarious liability for all employees.

According to Mr Breen, the benefit of this system is that there is only one defence team, reducing both the cost involved and the time required to settle a case, where there is proof of negligence.

"Our claims approach is that if we recognise that the enterprise has a liability, then we would seek to settle the claim at the earliest possible time for the lowest possible cost," he said.

The average time required to settle a case under the CIS is three to five years, although the SCA hopes to reduce that.

The CIS remit is broader than just settling claims. It is also mandated with a risk management and risk advice function and the development of a National Clinical Risk Management Strategy.

As part of this strategy, the CIS is building a national database (STARSweb) of adverse clinical incidents and near misses.

Since the rollout out in 2004, this database had logged more than 52,000 incidents and near misses.

Head of the CIS, Dr Ailis Quinlan, is responsible for managing the database, which allows the CIS to identify and analyse trends.

"One of our goals is to try and prevent serious adverse events from occurring," she said.

Dr Quinlan is critical of the poor utilisation of data in the Irish healthcare system: "We have a great tradition in Ireland of collecting data and it going into a black hole with no feedback."

The CIS will disseminate its anonymised data on adverse events through seminars, newsletters and the agency's website.