The masters of the three Dublin maternity hospitals - Holles Street, the Coombe and the Rotunda - have warned of a threat to the private obstetric unit at Mount Carmel hospital that could result in a maternity crisis at their own hospitals.
Doctors Séan Daly, Declan Keane and Michael Geary have said they are concerned that changes to medical insurance arrangements due to take effect on February 1st will result in Mount Carmel "quickly scaling down its capacity".
They say the likely cost of malpractice insurance for obstetricians in full-time private practice - at €300,000 per annum - is unsustainable. Medical malpractice insurance for individual consultants is due to be amalgamated with hospital public liability insurance in order to create a single insurable entity.
This concept is known as enterprise liability.
"The Dublin maternity hospitals are currently overstretched and could not cope in the short term with the 1,500 deliveries which now take place in Mount Carmel. The masters believe that they have a duty to ensure that the Minister and his Department are fully aware of the crisis that could begin to arise in the latter part of this year should indemnity for private obstetricians become unaffordable," they said in a statement issued by the Irish Hospital Consultants' Association (IHCA) last night.
In response to the suggestion that pregnant women with private health insurance may have difficulty accessing maternity services at Mount Carmel, a spokeswoman for the Minister for Health said: "This is unnecessary scare-mongering. Enterprise liability has been Government policy since 1999 and we would reject any claim that insurance premiums will increase by the amount claimed."
Some consultants who hold public appointments at the three maternity hospitals also engage in private practice at Mount Carmel. They will be unaffected by medical indemnity changes proposed by the Minister.
However, approximately six consultants in Dublin who work only in private obstetric practice could face increased premiums for malpractice insurance as they are not covered by the Government's proposed enterprise liability scheme.
On Friday, the IHCA claimed there could also be difficulties for public patients if the enterprise liability scheme was introduced without the agreement of consultants. "Public patients may not be indemnified for obstetric claims from the past because of the announcement by the Medical Defence Union (one of two UK-based medical insurers) that it may not provide cover for public obstetric cases following the introduction of the State insurance scheme," it said.
IHCA secretary general Mr Finbarr Fitzpatrick said the Minister seemed determined to introduce the scheme "irrespective of its consequences".
The Department of Health plans to sue the Medical Defence Union (MDU) should it fail to provide cover for past claims by public patients. A spokeswoman said the State could not be exposed to that kind of liability "particularly in view of the fact that the MDU accepted premia over a long period of time, 80 per cent of the value of which was subsidised by the State".
Mr Fitzpatrick called for a negotiated settlement that would provide certainty for public patients and consultants.