Hospital consultants are refusing to sign up for a plan intended to cut the cost to the State of medical negligence claims. The consultants are objecting to a Government plan to give the National Treasury Management Agency responsibility for handling medical negligence claims in the public healthcare system.
The initiative will replace the current system where each of the parties to a medical negligence claim, such as consultants, junior doctors, health boards, hospitals and nursing staff, have separate insurance arrangements paid for completely, or in part, by the State.
Under the proposed Clinical Indemnity Scheme (CIS), the Government will assume liability for the acts and omissions of health board, hospital and other health agency employees in respect of personal injury arising as a result of clinical negligence or malpractice.
The claims will then be handled by the State Claims Agency (SCA), part of the NTMA which manages the national debt.
Centralising the handling of claims should lead to significant savings, according to Mr Adrian Kearns, the director of the SCA. Instead of having several sets of defendants in each case, paid for by the State in the form of insurance premiums, there will now be only one defendant and one legal team.
The decision by the Government to go ahead with the plan has outraged the consultants' representative body.
Consultants currently pay insurance premiums to either the Medical Defence Union or the Medical Protection Society. However, up to 90 per cent of the premium is reimbursed by the State in respect of work in the public health system. Premiums vary according to speciality - most obstetricians, for example, pay €78,622 annually.
Under the new scheme, the State will no longer have to contribute towards consultants' insurance premiums. Consultants engaged in private practice would have to make their own insurance arrangements in respect of this work. Many consultants with public appointments carry out some private practice in addition to their public duties.
The general secretary of the Irish Hospital Consultants' Association, Mr Finbarr Fitzpatrick, said yesterday that the plan, if implemented without agreement, would cause "an absolute rebellion by consultants. All hell will break loose," he said.
Mr Kearns said he expected the delegation order, which will legally enable the SCA to manage the scheme, to be made by Government in the next couple of weeks. Already about 100 claims have been lodged under the scheme.
"Efforts are being made to persuade them [consultants] that it would be better if all clinicians were part of the CIS," he said.
Mr Fitzpatrick said there had been "on and off" consultations between both sides . He stressed that the plan, as currently proposed, posed major difficulties for the State's 1,600 hospital consultants. It would mean the direct contract between consultants and their insurer would end and their work in private hospitals would not be covered, which would result, in practice, in them becoming unaffordable. "The public hospital system would crash under the pressure if the private sector closed down," he added. There are 2,500 hospital beds in the private sector.
He said the issue would be raised at an extraordinary general meeting of the IHCA, which represents more than 85 per cent of all consultants, on February 23rd.
The SCA has been in operation since December 2001, managing personal injury and property damage claims taken against the State and providing risk management advice.
It currently employs 14 people, but this is expected to rise to 20 by the end of March as the medical negligence claims are taken on board.