In a move that may have a negative impact on patients, the Minister for Health, Mr Martin, has said he will terminate the existing medical insurance arrangement for hospital consultants from January 1st.
And in a separate move the main UK-based medical insurance firm has warned that it cannot guarantee continuing cover for obstetricians in relation to past years, even for consultants who have paid regular premiums to it. The Department of Health and Children has already indicated that it will not cover this "historical liability", making it more difficult for parents seeking to raise legal claims.
The Minister's decision to end the existing malpractice insurance scheme and to proceed solely on the basis of its own "clinical indemnity scheme" from January 1st could have a significant impact on patients in two ways.
It is likely to precipitate industrial action by consultants, and it creates uncertainty as to who will pay for successful malpractice claims initiated prior to the beginning of next year.
The Government's clinical indemnity scheme is based on the concept of "enterprise liability", an approach that sees both consultants and hospitals indemnified by the State as a single entity and not as individuals. However, doctors are concerned the new system covers only public practice and not private practice and that it deprives them of clinical independence.
In a letter sent yesterday to both the Irish Medical Organisation (IMO) and the Irish Hospital Consultants Association (IHCA), Mr Martin has asked both organisations to agree to their members being covered by the enterprise liability scheme.
The Minister warned, however, that: "If you are unable to return to me with a positive response, I regret that I will have no option but to direct health boards and hospitals to terminate the existing arrangements for providing consultants with indemnity cover with effect from 1st January, 2004." The IMO and the IHCA last night indicated they would be unable to agree to the Minister's request. An IMO spokesman said: "A meeting of the consultants' committee today sanctioned the organisation to undertake a ballot for industrial action on this issue." He added, however, that this action would not involve patient care. Mr Finbarr Fitzpatrick, Secretary General of the IHCA, told The Irish Times: "It is regrettable that the Minister for Health's peremptory decision may leave patients as well as doctors uncovered."
While there has been no movement on the issue of historical liability, the Government has offered a concession on indemnity for consultants in private practice. This would involve the State bearing the cost of personal injury claims when the level of claim passed above a threshold of €1 million. It is estimated that this could cost €15 million a year.
In a separate development, one of the UK-based medical insurance companies, the Medical Defence Union, has stated it cannot guarantee continuing cover for the speciality of obstetrics. The Department of Health has refused to take on this "historical liability", leading to a situation where a woman who has proved medical negligence in a case where a baby suffered permanent brain damage during childbirth may be unable to secure damages from the consultant who took care of her.