The regulatory body for the 18,000 strong medical profession in Ireland is the Medical Council and this week it published its annual report for 2012. There is lot of interesting information in the report, not least of which is that number I just mentioned – to be precise in 2012 it was 18,184 doctors in Ireland. That means we have approximately 4 doctors for every 1,000 people based on the most recent census results. That puts us in the 10 ten countries of the world for doctor/patient ratio with only Greece and Italy a little ahead of us in the EU. It also puts us streets ahead of the Scandinavian countries, France and Germany, all places that we aspire to in terms of the quality of our health service. So, on the face of it, whatever else is causing poor access to healthcare in Ireland, it isn’t a shortage of qualified doctors.
Of those doctors, 40% are female and 60% male. It is reasonable to assume that the profession is approaching an equality of the sexes as the older, more male dominated cohort moves towards retirement.
The report also shows that our medical profession is a very international one. 7,014 of our doctors did their primary medical training abroad – that is 38% of the entire medical profession here. The largest grouping comes from India and Pakistan which combined taught over 1,500 (8.3%) of our doctors although a significant proportion of doctors who trained in Ireland would also originate from abroad because our medical schools have for many years encouraged international students - and particularly non-EU students who pay much higher fees - to study in Ireland.
It is perhaps a surprise then that when we turn to the main purpose of this article, the disciplinary aspects of the Medical Council’s work, we see that out of 413 complaints considered in 2012, only 91 cases or 22% related to doctors trained outside Ireland despite them making up 38% of the profession. Clearly therefore, Irish trained doctors are attracting a disproportionate level of complaints of poor professional practice or misconduct. The statistics do not give us an explanation for this or offer guidance on how the problem might be addressed but it would be interesting to see this investigated on as there may be improvements that can be made to improve both patient service and patient safety.
But what of this complaints process offered by the Medical Council? Many patients may not be aware of the process of making such a complaint. While there are several categories of possible complaint, the main three of interest to patients would appear to be:
(a) Professional misconduct
(b) Poor professional performance
(c) Relevant disability.
When such a complaint about a registered doctor is received the Medical Council’s Preliminary Proceedings Committee (PPC) considers the information received as well as any information from the doctor. The PPC may look for additional information relating to the complaint. The PPC will decide whether the case should go forward for an inquiry by the Medical Council’s Fitness to Practise Committee (FtPC).
In any other case the PPC forms the opinion that the following is required:
(a) no further action
(b) referral to another body/ authority/competence scheme
The Council makes a decision based on the PPC opinions or can direct the complaint to be referred to the FtPC for inquiry.
In the event of an inquiry, the FtPC will usually be made up or three people: two without a medical background and one doctor. The FtPC is chaired by a member of the Medical Council. An inquiry may be held in public or if the FtPC believes it is appropriate, all or part of an inquiry may be heard in private.
The person who made the complaint, the doctor, who is the subject of the complaint or any other witness, can apply to have all or part of inquiry held in private. After hearing an inquiry, the FtPC reports its findings to the Medical Council. If the FtPC finds that the allegations against the doctor have been proven, the Council may impose sanctions on the doctor including advice, admonishment, censure or removing the doctor from the Register so that he or she cannot practice for a specific length of time.
My legal practice, although specializing in medical negligence cases, does not get involved in such disciplinary proceedings very often. Even in the most awful cases of medical negligence, ones involving fatal misdiagnosis or clearly avoidable serious harm, patients rarely even consider making a complaint to the Medical Council. There are rare occasions however when I do find myself dealing with the Medical Council such as in one case where a state body made a complaint against a doctor for poor professional performance and I was already acting for the client in related medical negligence proceedings. At present I am acting in a case that involves appalling misconduct with assault and insult in almost equal measure. This current case unfortunately is one where I think the Medical Council is not living up to its promise of independence in policing the profession. In this case, the complaint was made one full year ago and because the doctor has failed to give a reply to the Medical Council, no further action has been taken. Even the most generous reading of the legislation would not offer support for the view that a doctor who fails or refuses to give his response to a complaint can hold up proceedings like this. Certainly if it were a Law Society complaint by a client against a solicitor, the solicitor would be given a brief and defined period within which to give his or her side of the matter and after that, the case would proceed, and rightly so.
This recent experience of mine feeds into the general sense among the public that the Medical Council is more protective than policing of the medical profession. It is for the Council to act quickly and decisively to show that it is an effective and reasonable alternative to a completely independent, non-medical regulator such as the legal profession is currently developing.