DISPUTE: In a major escalation of the row over medical insurance cover for doctors, one of the main medical defence organisations has accused its counterpart of "holding a gun to the head of both the Department of Health and the medical profession", writes Dr Muiris Houston, Medical CorrespondentDispute
Dr John Hickey, chief executive of the Medical Protection Society (MPS), told The Irish Times that the Medical Defence Union's (MDU) recent threat to refuse to indemnify consultant obstetricians in the Republic was morally wrong.
"We believe that the reason this occurs relates to the MDU's financial position rather than any other reason.
"The financial position of the MDU appears, from its published accounts, to be very weak," he added.
However, the MDU says it "entirely refutes the suggestion that we are holding a gun to the profession's head and that what we are doing is morally wrong".
Dr Christine Tompkins, head of international affairs at the MDU, said its non-obstetrician members had been severely disadvantaged "by the refusal of the Department of Health to accept its rightful responsibility for obstetrics claims".
"The MDU's financial position is sound. To suggest that the MDU stance on behalf of its members is due to financial weakness is misconceived," she said.
The Irish Times understands the public statement by the MPS, which is not directly involved in the current stand-off between the MDU and the Department of Health over the issue of the past liabilities of consultant obstetricians, was prompted by a fear that the concept of "discretionary medical cover" was being damaged by the impasse.
The MPS continues to offer discretionary insurance, in which the provider may exercise its right not to provide insurance cover in a particular case.
The MDU has moved away from this traditional approach to doctors' professional indemnity and while it remains a "discretionary mutual", most of its Irish members are indemnified by means of a traditional insurance policy with Eagle Star.
Dr Hickey also questioned why the MDU had not exercised its right to "make a call" on its obstetrics members for extra funds before the State-backed enterprise liability was introduced on February 1st this year.
When this point was put to Dr Tompkins, she said, "we did not think it would be fair to make a call on other members when the problem has arisen because the Department of Health has failed to address the problem... Even if we had made a call, we could not have raised enough money to fund the estimated historic liabilities of €130 million."
While the MPS says it favours discretionary cover "which is best for doctors and patients", the MDU warns "discretion does not provide certainty in a volatile medico-legal climate".
"Because it is not an insurance company, the MPS may not say it will assist with a claim in advance and they must consider each new request for assistance as the incident arises," Dr Tompkins said.
Confirming that a number of Irish consultants had recently moved to the MPS because of recent uncertainties, Dr Hickey said: "I would like the issue to be settled for the piece of minds of obstetricians, other consultants and for Irish patients."
Problems surrounding enterprise liability and medical indemnity led to limited, industrial action by the Irish Hospital Consultants' Association earlier this year.
An "all-out" strike was narrowly averted when the Department of Health and the MDU entered negotiations to try to resolve the issue of historic obstetric liabilities.
However, these talks have stalled on a number of occasions amid continuing actuarial difficulties.