The Department of Health has told hospital consultants it is prepared to pick up the bill for any portion of a compensation payout above €1.5 million made in respect of malpractice by consultants exclusively in private practice.
The concession, which would ultimately hit the taxpayer, is on offer in a bid to get consultants to sign up to a proposed new system of insurance cover for medical malpractice.
However, consultants have grave misgivings about the changes. At least two delegates attending the annual conference of the Irish Hospital Consultants' Association (IHCA) in Limerick at the weekend suggested members should engage in industrial action if the plan was forced on them without agreement.
However, IHCA secretary general Mr Finbar Fitzpatrick cautioned against such a course of action. The IHCA has a no-strike clause as one of its founding principles.
He suggested instead that, if the deal as it currently stands was imposed, consultants could take action by refusing to co-operate with the implementation of health-service reform, particularly the reforms proposed in the soon-to-be-published Hanly report, which envisages a major reorganisation of hospital services. Delegates voted unanimously in support of this course of action.
The chairman of the IHCA's enterprise liability committee, Mr Michael O'Keefe, told the meeting the public system would not be able to cope if all the patients now in the private system had to be dealt with in public hospitals. But there was a danger that private practice, which is not to be covered under the new insurance scheme, would become unaffordable by virtue of huge rises in insurance premiums for doctors in this sector if they were left outside the scheme, he said.
He said the Government now accepted there should be some sort of protection in this regard and had offered last Thursday to pick up the bill for the excess on compensation awards over €1.5 million which might be made against consultants exclusively in private practice. Private practice in public hospitals is covered.
Traditionally, doctors have indemnified themselves with either of two UK-based bodies: the Medical Defence Union and the Medical Protection Society. The State, however, reimbursed a large portion of their insurance premiums, while also separately insuring health boards and hospitals. It wants to change to what it believes will be a cheaper system if the whole health service is insured as a single enterprise.
Meanwhile, the question of who will foot the bill for claims arising from malpractice - before the new system is introduced - still has to be ironed-out.
The Medical Defence Union (MDU) was condemned by delegates for saying it may default on payouts for historic liabilities if doctors sign up to enterprise liability.
The Government is willing to back doctors who go to court to try to force the MDU to honour their historic liabilities, the meeting heard.