The new chief executive of the Medical Council has expressed concern over a significant rise in disciplinary cases involving doctors who have failed to undertake on-the-job training.
Bill Prasifka says doctors have a legal obligation to maintain their competence by engaging in continuing professional development (CPD) but the procedures for regulating these rules are cumbersome.
Prasifka says there is “no future” for the council in bringing to a fitness-to-practise hearing every doctor who fails to maintain CPD and “there has to be a better way of dealing with this”.
Since 2011, doctors are required to undertake 50 hours of CPD a year, in the form of training, evaluation and personal learning, as well as one clinical audit.
As an alternative to disciplinary hearings, doctors should not be allowed to renew their professional indemnity unless they can prove they are in compliance with this regulation, he suggests.
The new broom at the Medical Council is an American lawyer who has lived in Ireland almost 30 years. Prasifka has held a number of regulatory roles, most recently as Financial Ombudsman. He also served as chairman of the Competition Authority and Commissioner of Aviation Regulation.
In his first interview since taking up the post of chief executive in October, he says the council is hopeful the rules governing fitness-to-practise hearings will be changed early next year to make the system more streamlined.
The council has made submissions to Government seeking changes to the current system which would see only the most serious allegations against doctors go to public hearing and would give greater scope for witnesses to be given anonymity in proceedings.
Prasifka says the current system is “overly formalistic” and prevents the council from dealing with simpler cases more promptly, at an earlier stage.
The process has been criticised by both doctors and patients but he points to internal surveys that appear to show it enjoys high levels of support generally.
“At the end of the day, we have a formalistic legal process and complaints must be proven to criminal standards of proof. Our procedures are appropriate to that, and they are not complainant-friendly in that sense.”
He says there is “extreme interest” in some disciplinary cases against doctors, in contrast to the UK where most cases attract little press attention, and suggests this must be “a cultural thing” specific to Ireland.
About one in 10 complaints to the council results in a fitness-to-practise hearing, and two-thirds of these result in a finding against the doctor.
In the past year, 39 fitness-to-practise hearings were held; 22 were heard in public and the rest were in private. The council says a rise in the number of private hearings was due to the “specific nature” of the complaints involved.
While HSE director general Tony O'Brien has criticised "medical show trials" and the presence of television cameras at cases involving doctors, Prasifka says it isn't clear whether he was talking about council disciplinary hearings or litigation at the courts.
“Our hearings are in public because the Act requires that. There’s nothing we can do about that.”
Referring to recent cases of doctors acting as “whistleblowers” on behalf of their patients, Prasifka says the council believes doctor advocacy was an important part of patient safety and this would be highlighted in a new ethics guide to be published shortly. “We are very strong on this, and on how it is an important part of the role of a doctor.”
He says the reported prevalence of bullying in the medical profession is of concern and needs to be addressed through mentoring, further training and assistance hotlines. “All we can do is highlight the problem but it’s up to stakeholders to address it. We have our own role to play but we are not the HSE or the medical schools.”
Prasifka says he does not accept there is any dichotomy between the interests of patients and practitioners when it comes to the work of the council. As a former ombudsman, he has a keen awareness of the possibilities and limitations of his past and present roles.
“It’s important that the ombudsman has a complementary role to that of the regulator. The ombudsman is there to provide a remedy for an aggrieved person. As a regulator, that’s not something we can do. The ombudsman is designed to act informally and decisions are not legally binding. We have to prove a case to a criminal standard of proof.”