Month: September 2018

A medical law expert and a patient safety advocate have both urged a rethink of provisions in the Patient Safety Bill that would criminalise medical practitioners for failure to disclose information in relation to serious mistakes.

Simon Mills, a barrister and former doctor, and Bernie O’Reilly of the Patients for Patient Safety initiative — who lost her husband to medical misadventure — said the aim should be to foster a culture of willing open disclosure instead of threatening medics with jail.

Mr Mills said the open disclosure provisions of the Civil Liability Amendment Act 2017, which come into effect today, should be given time to bed in. Instead there was a “rush to criminalise”.

The 2017 Act was designed to encourage open disclosure by enabling an apology to be made without it invalidating a practitioner’s insurance or being taken as an admission of liability in court.

It was also intended to give the medical regulatory bodies stronger grounds on which to commence fitness to practice proceedings and/or sanction a practitioner.

The proposed Patient Safety Bill goes a step further by making open disclosure a legal duty under threat of criminal prosecution, fines of up to €7,000 and/or six months in prison.

Mr Mills said there may be an argument for institutions to be made criminally liable but targetting individuals was a rushed response to the CervicalCheck scandal.

“Politicians need to be seen to do something,” he said.
“We have two parallel systems in train. One is creating space for open disclosure to take place and the other is, without waiting to see whether that fixes the problem, raising the idea of criminalising individuals or systems and it seems to me for the two of those to be proceeding in parallel rather than sequentially may well turn out to be a mistake.”

Ms O’Reilly spent years trying to get the truth behind her husband Tony’s death after bowel surgery in 2006 and still has unanswered questions which she said might have been answered if there had been automatic preservation of all materials relating to his case and timely disclosure of the events that went wrong.

However, she added: “I don’t think anybody should be criminalised. I think when something awful like that happens, you should learn from it and involve the family in that learning.”

Mr Mills and Ms O’Reilly were addressing a conference hosted by the State Claims Agency which heard the agency was currently handling 3,342 medical negligence claims and 7,579 general personal injury claims with a total estimated liability of €3.2bn, of which the medical negligence claims made up €2.32bn.

Former doctor Adam Kay, now comedian and author of This Is Going To Hurt, his diaries from his time as a physician, said health services also needed to review the way they treated staff involved in serious incidents.

Mr Kay said it was not until he was published that those close to him realised he had left the profession in devastation over a tragic case which he only attended when it had already become an emergency but which still had a profound effect on him.

“I didn’t tell anyone,” he said. “There’s a stiff upper lip approach.”

He said he asked if he could work part-time for a while but the response was akin to: “Why? “Are you pregnant?”

“We don’t like to think of our doctors as human because when someone is looking at an MRI of your brain, you want them to be God or Google or something equally infallible,” said Mr Kay.

“Medical schools are not honest about what the job is. If you are going to be a train driver, they will do a psychological test on you.

“If you’re going on Big Brother they will check you’re not going to crack. But if you want to be a doctor all they will check is whether you have enough As in your grade.”

Author: Caroline O’Doherty
Source: The Irish Examiner

The government has been urged to improve its draft legislation on abortion to stop doctors interpreting the new laws too conservatively.

A position paper by experts from Dublin City University, the University of Birmingham and Queen Mary University of London said that the government should consider asking doctors who have a conscientious objection to providing abortion care to declare it before the law comes into effect. Clinical guidelines that are due to be introduced alongside the legislation should clarify when and how a doctor who holds a conscientious objection should disclose it, it says.

“Hospitals and general practitioners should be required to publish information making patients aware of the fact that personnel hold a conscientious objection, for example, on websites, in practice leaflets and on posters in public areas,” the paper says.

The Times revealed last month that a new “code of ethics” drafted by the Irish Catholic Bishops suggested that Catholic hospitals could break the law and refuse to offer abortions in all circumstances.

“Clinical guidelines should address the intersection of the general scheme with Catholic medical ethics, to ensure equality of abortion access for all pregnant people. Additional research, or public hearings, may be required to identify likely areas of conflict,” the paper says.

The state should take steps to ensure all pregnant women can access the care they need equitably in the event that a mass conscientious objection makes abortion inaccessible in a particular area or hospital, they say.

The experts found that women in Ireland could still be denied abortions because doctors fear lengthy jail terms or refuse to terminate pregnancies because they object on principle. The authors say that the proposed bill does not make a strong enough break with abortion being a crime that carries the risk of up to 14 years’ imprisonment.

“It remains a serious offence for a doctor to carry out an abortion and much of the draft legislation’s language frames abortion in criminal terms, suggesting that termination remains an unusual and stigmatised procedure under Irish law,” said Máiréad Enright, a co-author from the University of Birmingham. “Residual criminalisation may see some doctors interpret the law more conservatively than the Oireachtas intends, for fear of prosecution. It also raises the prospect of ‘stings’ by anti-abortion activists, which may make service providers feel vulnerable to prosecution.”

The paper was co-written by Ms Enright, Professor Fiona de Londras, of the University of Birmingham, Dr Ruth Fletcher of Queen Mary and Dr Vicky Conway of Dublin City University.

The authors also say that exclusion zones are needed to protect healthcare providers and pregnant women from protest or interference with services.

The legislation proposes a three-day waiting period between a woman being granted access to an abortion pill and being prescribed it. The authors say that this should be removed. “Waiting periods do not necessarily function as periods for reflection, but exacerbate stress in abortion decision-making,” they say.

More than 66 per cent of voters backed repeal of the Eighth Amendment in the referendum in May.

Author: Jennifer Bray, Ireland Deputy Political Editor
Source: The Times