FRCPI, FRCP (Lond),
Madam, - The enterprise liability indemnity scheme introduced by the Government last week, without agreement of the medical consultants, is an incomplete, poorly-thought-out and half-baked piece of legislation. Most importantly, it will result in no improvement in the health service or the care of patients for the following reasons.
Consultants will cease to be insured for "good Samaritan" work, coroner's court work, inquests, administration negligence, needle-stick injuries, Irish Medical Council complaints, defamation or any disciplinary action by a health board. Thus the hard-working consultant will have to trim back his or her service to patients so as to practise cautious, defensive medicine. The waiting-list and waiting times will increase in an already overstretched, under-funded hospital service, as has already happened with a similar scheme in the United Kingdom.
Enterprise liability threatens the clinical independence of the consultant. Thus patient care decisions will be influenced by, or made by, administrators with no prior training, knowledge, education or interest in clinical care. For example, the NHS in the United Kingdom did not provide known effective treatments for multiple sclerosis because of the cost involved. These types of callous decisions can, and will, happen in Ireland under enterprise liability.
Moreover, it is likely that health boards or the Department of Health and Children will discipline or suspend outspoken consultants under the scheme. It will silence consultants from being advocates for their patients. It will silence consultants from exposing wasteful bureaucratic administration within the health boards and the Department of Health and Children. Top-heavy administration robs sparse funds from the coal-face of patient care. It is vital for our future health service that consultants continue to speak out for their patients and fight for resources. This will be impossible under the enterprise liability scheme.
It is likely that consultants will have to arrange their own insurance for "good Samaritan" work, coroner's court work, Irish Medical Council complaints, etc. Thus enterprise liability will increase the number of lawyers involved in medical litigation and probably increase the number of claims against hospital institutions and consultants. Enterprise liability breaks the consultants' common contract agreed and signed by the Minister for Health and Children. It will introduce further layers of bureaucracy and increase administrative costs at a time when the health service is in desperate need of limiting its bureaucracy. Therefore it will result in no cost-saving.
The Department and the Minister naturally have little first-hand knowledge of patient care. They should seek advice from those who have this knowledge rather than controlling and silencing them. - Yours, etc.,
Dr TIMOTHY LYNCH
FRCPI, FRCP (Lond),
Consultant Neurologist,
Director, Mater Stroke Unit,
Mater Misericordiae
and Beaumont Hospitals,
Dublin.