Health service staff should be legally required to inform patients when mistakes or errors occur, according to a new report.
The introduction of an open disclosure policy in public hospitals, which is currently being piloted in a small number of sites, should be accelerated as part of the reform of medical negligence, the report by the Oireachtas Health Committee also states.
Patient safety should be made a key priority for the health service and a duty of candour should be regarded as “absolute” for Irish health professionals.
The report proposes a number of reforms which enjoy broad support among the medical profession and medical negligence lawyers, such as the introduction of periodic payment orders instead of lump sum payment to victims of mishaps, and the application of pre-action protocols to all cases.
More controversially, it suggests lawyers should be sanctioned in cases where there is evidence of inappropriate joining of parties to medical negligence cases.
However, the report shies away from recommending a cap on awards to patients, as advocated by some medical groups.
The total cost of medical legal claims has risen by 221 per cent since 2008 and the value of awards paid out by the State has grown by 304 per cent. The average payout has also increased, from €37,000 to €90,000. As a result, the cost of indemnity cover for consultants has almost doubled.
The report says the Department of Health should consider reducing existing medical indemnity caps to €250,000 and €500,000 to alleviate pressure on private consultants. This would mean the State picking up more of the cost of settlements.
The committee says it is concerned about the rising cost of medical indemnity for consultants, which may render private practice in some areas unviable.
Because of the increased indemnity costs, it is likely consultants required to retire from the public system at age 65 will not continue in private practice. Meanwhile, younger consultants may not find it financially tenable to practice privately.
“The long-term implications of this trend would be significant difficulties in replacing medical expertise in certain private hospitals, with a consequent transfer of workload to public hospitals.”
The report says there is a strong element of cross-subsidisation of premiums between consultants, regardless of their risk profile or track record.
It says premiums should be designed to incentivize learning and eliminate medical errors, and the Minister for Health and medical groups should link premiums to consultant performance.
