Dáil Éireann - Volume 602 - 11 May, 2005

Other Questions. - Registration of Medical Practitioners.

  63. Mr. Kenny asked the Tánaiste and Minister for Health and Children the protection and safeguards that exist for patients from discredited doctors; and if she will make a statement on the matter. [15427/05]

  Ms Harney: Under the Medical Practitioners Act 1978, the Medical Council was established as the body with responsibility for the registration of [411] medical practitioners and the regulation of their activities. The function of the Medical Council is to protect the public through implementing appropriate controls on the medical profession.

Doctors practising within this State should be registered with the Medical Council. It is an offence under the Medical Practitioners Act for a doctor to represent himself or herself falsely as a registered medical practitioner when he or she is not registered. Registration is required to sign medical certificates and to issue prescriptions for certain categories of drugs. In addition, doctors are not entitled to recover in legal proceedings fees charged for the provision of medical or surgical advice or treatment given when they were not registered.

Where a concern arises about the professional activity of a registered medical practitioner, the Medical Council has the power to investigate the circumstances of the complaint and, if a prima facie case exists, to conduct an inquiry. Where a finding of professional misconduct or unfitness to practise is made against a doctor, the council has the authority to suspend, limit or revoke the registration of that individual.

The parliamentary counsel is drafting a new Medical Practitioners Act to update substantially the provisions of the 1978 legislation. Among the many changes I propose to introduce are a clear compulsory requirement for registration for all medical practitioners, changes to the fitness to practice process, the introduction of a mandatory scheme of competence assurance for all doctors practising independently and a much increased public profile for the council. I also intend to increase significantly the non-medical representation on the council to best ensure that public safety and protection is given the highest possible priority by the council as it develops in the future.

  Dr. Twomey: There is no point in rejigging the council unless it is backed up by a proper legislative position. The 1978 Act is totally inadequate today. In this House we have discussed the case of a medical practitioner who abused his position and the case of an alternative practitioner who in effect cost a person’s life. Doctors and the Medical Council have called for a change to the Medical Practitioners Act because it does not work in today’s world. For example, in regard to the distinction between doctors and alternative practitioners, no doctor can wilfully prescribe a placebo to a patient.

Under the Act, the Medical Council could strike off a doctor for prescribing a sugar pill. However, much of what alternative practitioners distribute is no more than a placebo. There is no regulation of the alternative health industry. The Tánaiste must introduce the necessary legislation not only for medical practitioners who are trained doctors and who, usually for financial reasons, prescribe dubious treatments, but also to regulate alternative practitioners.

[412] The latter want to be regulated. Many of those who practise reiki or other alternative therapies such as acupuncture want regulation because they want to keep the cowboys out of their industry too. This is one area of society in which people call for greater regulation.

  Ms Harney: I agree with the Deputy. Until I took up this position I did not know that one could practise as a doctor without being registered. One cannot prescribe but it is possible to practise, which is incredible. I am not sure if I sent the heads of the Bill to the Deputies’ offices.

  Ms McManus: No, the Tánaiste did not send them.

  Ms Harney: I apologise for that. The idea is to work with the Medical Council and others on legislation that will give the council the strongest possible powers. Its powers will allow it to be proactive rather than reactive when a complaint is received. Confidence assurance will be a great guarantee to the public and to patients because it means ongoing training and education. This is important in any profession but especially in the practice of medicine. The procedure of fitness to practise, which requires one to be a member of the council to sit on the inquiry, of which there are 40 to 50 per year, is a huge demand on the complement of people that makes up the council. This includes people in other professions and people who are very busy, so we need to provide more flexibility in this area.

It is not an either-or situation. We must strengthen the legislation governing medical practitioners and provide for the registration and regulation of alternatives. That can be done under the Health and Social Care Professionals Bill 2004 which is going through the Oireachtas. This will provide for the registration of several different health care professionals, but we need to go further to reassure the public that someone is competent and safe to give them assistance.

  Dr. Twomey: There should be a statutory registration for all people who consider themselves either acupuncturists, general practitioners or physiotherapists. Every GP must register with the Medical Council. If one does not do so, one cannot prescribe in this country. GPs pay more than €5,000 per year for insurance purposes in case they make a mistake. The alternative practitioner to whom Deputy Cowley referred does not have to pay anything. She does not have to pay a registration fee or indemnity insurance. This is not a nice situation in which to leave patients when so many use alternative practitioners. There should be regulations covering that. We would find that cowboys would disappear quickly if they had to have insurance and had to register.

  Dr. Cowley: On 26 May 2004 the former Minister for Health and Children, Deputy Micheál [413] Martin stated that: “While the proposed amendments to the Medical Practitioners Act will relate to conventional medical practitioners, it must be acknowledged that the public will continue to use the services of alternative and complementary practitioners and alternative and complementary remedies.” That suggests the legislation will not include these alternative practitioners who do not purport to be doctors but are natural healers, such as the lady to whom I referred earlier.

There is a need to regulate the treatments people use. Anyone can give out a placebo except a doctor. Doctor Paschal Carmody, with his dubious cancer treatment, was struck off the register but can still continue as an alternative practitioner and give placebos that doctors cannot give. There must be some measure to ensure that someone prescribing tablets is giving something that is evidence-based, that is, that it works, as opposed to tablets that purport to be something but which amount to nothing, such as in the case of homoeopaths. I have nothing against complementary practitioners but I have a problem with alternative practitioners who set themselves up as the alternative to traditional medicine and who endanger people’s lives. The Medical Practitioners Act refers to mainstream medical practitioners. My concern is the alternative medical practitioners. Will the Tánaiste re-examine this situation?

  Ms Harney: The Medical Practitioners Act deals with the medical profession and will greatly strengthen and enhance the powers of the council. We want to maintain self-regulation in this and other areas of health care because it is more appropriate and does not involve the State carrying the cost of the regulatory regime. The Health and Social Care Professionals Bill will provide for a host of people to be brought under regulation but practitioners of alternative therapies might not easily be classified under a professional title.

There is a role for the Garda Síochána. We have strong laws regarding fraud. If people are told they will be cured of cancer on payment of €17,000 per treatment, as happened in some cases I came across last week, it is worthy of investigation from a criminal perspective. Many people are fooling very vulnerable citizens who have illnesses into paying large sums of money. Desperate people will do desperate things and these people are extraordinarily convincing. Very smart people can be fooled by them and the criminal law needs to take effect in this area.