Dr Rachel Birch, Medico-Legal Consultant at Medical Protection, illustrates the importance of having the right professional protection through a case study
HSE doctors who rely on their State indemnity – otherwise known as the clinical indemnity scheme (CIS) – may be unaware of its limitations. The CIS only protects against clinical negligence claims in the public sector; if you receive a complaint from the Medical Council, are investigated by the gardaí or are subject to a disciplinary hearing, you are on your own. The CIS will not cover you for claims for any private work.
According to the most recently published Medical Council Annual Report, there were 279 new complaints in 2020, involving in total 311 doctors. Despite the challenges presented by the Covid-19 pandemic, the Medical Council concluded 27 fitness to practise inquiries in 2020.
Having representation at fitness to practise inquiries can cost a considerable amount of money. It may be difficult for you to self-fund your defence where you do not have adequate indemnity arrangements in place.
What to look out for
A key consideration should be whether your indemnity or insurance provider is an organisation that is focused on your interests. At Medical Protection, with our philosophy of supporting safe practice in medicine by helping to avert problems in the first place, we try to help reduce risks for our members with a wide range of learning resources.
With more choice in professional protection than ever before, it may be tempting to consider new insurance entrants, which offer low pricing. Unfortunately, in the last decade, Ireland has seen such entrants exiting the market or limiting the service they provide and thereby leaving practitioners unprotected.
Members of Medical Protection are part of an organisation, run for and owned by members; our focus is on protecting members’ careers and reputations, not generating profits. Members who are HSE doctors pay subscriptions and if they face a complaint, regulatory investigation or any other matter listed in the previous table, members have a right to request assistance.
Besides, we actively campaign for regulatory and legal reforms that benefit members and the wider healthcare professions.
AS A MEMBER OF MEDICAL PROTECTION, YOU CAN REQUEST ASSISTANCE WITH:
*where not supported by CIS
Reputation management – a case study
Dr K was working in the emergency department of a busy hospital on a demanding Saturday night when a patient, Mr O, arrived in a semi-conscious state. His medical notes revealed a history of alcohol abuse. History-taking was difficult as Mr O seemed very sleepy and incoherent, but the smell of alcohol was enough for Dr K to dismiss the patient’s symptoms as simply the effects of excessive alcohol consumption.
Bloods were taken and sent to the laboratory, and an entry was made in the notes to follow up later. Dr K then took Mr O to a quiet corner to sleep it off and continued to attend to other patients. The next morning, Mr O was found dead. When Dr K had assumed Mr O was drunk, he had actually been ketoacidotic, meaning his death that night had been very likely preventable.
Outcome 1: If Dr K had CIS indemnity only
Dr K spoke to his employer, but they were not able to provide him with the support that he needed. By the time the hospital’s internal review commenced six months later, Mr O’s medical notes had gone missing. This left Dr K feeling extremely vulnerable, as he had no access to his contemporaneous notes to back up his actions. Given the timeframe, his recollection of events was unclear.
As expected, the patient’s family brought a claim against the hospital. The hospital solicitors acting on behalf of the HSE requested a statement from Dr K, but, without the medical notes, he found it difficult to defend his actions.
The family also made a complaint about Dr K to the Medical Council, who commenced an investigation. Dr K was not entitled to advice or support with this process through the CIS.
The story attracted some media interest and once Dr K’s local community found out that he was being investigated by the Medical Council, he lost the trust of many of his patients. The damage to his reputation – and, potentially, his livelihood – was difficult to repair.
Outcome 2: If Dr K had been a Medical Protection member
When Dr K was told that Mr O had died, he immediately phoned Medical Protection’s 24-hour helpline for advice:
For more information, visit Medical Protection at medicalprotection.org/Ireland
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