Medicine

1
Medicine a ProfessionGuidelines and
Regulations

• Prof Orla Sheils
• Department of Histopathology
• TCD

2
Medicine a profession

• Major attributes of a profession
• Acquisition of learning prior to practice
• Requirement for continued learning after
  qualification
• Separate sense of identity
• Ethical code of conduct

3
Statutory and non-statutory professions

• Statutory
• Profession is backed by law
• Law creates a regulatory body
• Supervisory and disciplinary powers
• Self-regulating with deference to the laws of the
  state
• Non-statutory
• More loosely affiliated
• Representing body without regulatory or
  disciplinary powers

4
Examples

• Statutory
• Doctors(Medical Practitioners Act 1978)
• Dentists (Dentists Act 1985)
• Nurses (Nurses Act 1985)
• Pharmacists (Pharmacy Act (Ireland) 1875,
  Pharmacy Act 1962)
• Opticians (Opticians Act 1956)

• Non-Statutory
• Physiotherapists
• Radiographers
• Occupational Therapists
• Speech Therapists
• Social Worker
• Dietician

5
Statutory Regulatory Bodies are responsible for

• Defining ethical guidelines
• Overseeing disciplinary issues and fitness to
  practice of members
• Generally suspension or removal from register is
  conducted under supervision fo the High Court
• Maintaining a register of practitioners

6
Statutory Regulatory Bodies

• Created by a specific law which empowers them to
  oversee and regulate aspects of the profession.
• Medicine
• Medical Council
• Medical Practitioners Act 1978

7

• The Medical Council protects the interests of the
  public when dealing with registered medical
  practitioners.
• The Council was established by the Medical
  Practitioners Act 1978 and commenced operation in
  April 1979.
• It shall be a function of the Council to give
  guidance to the medical profession generally on
  all matters relating to ethical conduct and
  behaviour

8

• The Medical Council is funded exclusively by the
  annual payments of registered doctors no funds
  are received from government or other sources. 
• The annual retention fee for a fully registered
  doctor has been set at  475 from 1st July 2008.
• On 1st January 2008 there were, in total 18,316
  doctors, of the various registration categories,
  registered with the Medical Council.

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Medical Council

• Elections held every 5 years
• 25 members - representatives
• Irish Medical Schools
• RCS (surgery and anaesthetics/radiology)
• RCPI (Medicine and Pathology and Obs and Gynae)
• Psychiatry, General Practitioners
• Medical Practitioners elected from the profession
• Ministerial Appointees

10
Medical Council- Breakdown

• 25 members
• 5 appointed by authorities of medical schools in
  the State.
• 6 appointed to represent medical and surgical
  specialities, psychiatry and general practice.
• 10 registered practitioners elected by the
  profession
• 4 people appointed by Minister for Health (at
  least 3 of whom must come from outside the
  medical profession).

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Current Members of Medical Council

• Professor Kieran Murphy (President) Medical
  PractitionerNominated by Irish Psychiatric
  Training Committee
• Mr Jon Billings Non-medical memberNominated by
  the Health Quality Authority
• Dr John O'Mullane Non-medical memberHealth
  Social Care Professionals Council
•      
• Ms Anne Carrigy Non-medical MemberNominated by
  An Bord Altranais
• Professor Anthony Cunningham AnaesthesiaElected
  member
• Dr Regina Connolly Non-medical
  memberMinisterial Nominee  
•  
• Dr Deirdre Madden Non-medical memberMinisterial
  Nominee
• Dr Richard Brennan Medical PractitionerNominated
  - Irish College of General Practitioners
• Dr Éamann Breatnach Elected memberRadiology
• Professor Damien McLoughlin Non-medical
  memberMinisterial Nominee
• Professor Paul Finucane Medical
  PractitionerNominated by the University of
  Limerick  

• Mr Frank McManus Medical PractitionerNominated
  by Royal College of Surgeons in Ireland      
• Dr Anna Clarke (Vice-President) Public Health
  MedicineElected member
• Dr Daniel O'Hare Non-medical memberNominated-
  Independent Hospitals Assoc. of Ireland
• Ms Margaret Murphy Non-medical member
• Ministerial Nominee  
•    
• Dr John Monaghan Obstetrics GynaecologyElected
  member
• Dr Pauline Kane Non-Consultant Hospital
  DoctorElected member
• Ms Mary Culliton Non-medical memberNominated by
  the Health Service Executive
•    
• Ms Katharine Bulbulia Non-medical
  memberMinisterial Nominee
• Mr Brendan Broderick Non-medical
  memberNominated by the Health Service Executive
  
• Professor Diarmuid O'Donoghue Medical
  PractitionerNominated - Royal College of
  Physicians of Ireland
• Professor William Powderly Medical
  PractitionerNominated by University College
  Dublin

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The principal roles of the Medical Council
include

• assuring the quality of undergraduate education
  of doctors
• assuring the quality of postgraduate training of
  specialists
• registration of doctors
• disciplinary procedures
• guidance on professional standards / ethical
  conduct

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Medical Council

• Maintains register of practitioners
• Full, provisional or temporary
• Full registration is available to any doctor who
  has a recognised medical qualification together
  with recognised and verifiable experience, either
  prescribed by law or acceptable to the Medical
  Council, as a practitioner.
• Doctors from Ireland and EU entitled to full
  registration

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Registration

• Full registration
• This permits a doctor to work as an independent
  practitioner.
• Internship Registration
• This permits a doctor to carryout internship
  training in approved hospitals.  Internship
  training normally begins immediately after
  graduation from medical school and lasts for one
  year. Only graduates of Irish and EU medical
  schools may do their internship in Ireland.
• Temporary Registration
• This form of registration allows non EU doctors
  to practise medicine in approved hospitals under
  consultant supervision in a specialty recognised
  by the Medical Council. 

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Registration

• Register of Medical Specialists
• contains the names of registered specialists. 
• Register of Medical Specialists is a voluntary
  register.  Only doctors who currently hold full
  registration in the General Register of Medical
  Practitioners may apply to have their names
  entered in the Register of Medical Specialists. 
• If a doctor removes his/her name from the General
  Register they are automatically removed from the
  Specialist Register.

16
It is an offence under the Medical Practitioners
Act for a doctor to falsely represent
himself/herself to be a registered medical
practitioner when they are not registered.
17
Medical Council Register

• Register of Medical Practitioners
• Medical insurance companies require registration
  before insurance cover is given. 
• Registration is required to sign medical
  certificates and to issue prescriptions for
  certain categories of drugs. 
• 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.
• Register of Medical Specialists
• Expected to enrol once training is complete
• Public Document
• May be inspected by any member of the public 

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Medical Council - Education

• Assess Training and Education of training centres
• Input into curricula and level of experience
  deemed necessary
• Postgraduate Medical Board
• specific responsibility for postgraduate training.

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• The Medical Practitioners Act, 1978, states that
  it shall be the duty of the Council from time to
  time to satisfy itself
• (a) as to the suitability of the medical
  education and training provided by any body in
  the State recognised by the Council for such
  purpose,
• (b) as to the standards of theoretical and
  practical knowledge required for primary
  qualifications,
• (c) as to the clinical training and experience
  required for the granting of a certificate of
  experience, and
• (d) as to the adequacy and suitability of
  postgraduate education and training provided by
  bodies recognised by the Council for the purposes
  of medical specialist training.

20
Medical Council-Disciplinary Function

• Area which has occasioned much interest
• Combination of proactive and reactive/punitive
  approaches

21
Medical Council-Disciplinary Function

• Proactive
• Publication of guidelines
• Benchmark for medical practice
• Competence Assurance
• Ongoing confirmation of clinical standards
• Continuing education
• Clinical audit

22
Medical Council-Disciplinary Function

• Punitive/Reactive measures regarding misconduct
  or fitness to practice
• Censure or admonishment
• Attachment of conditions to continuing practice
• Suspension from the register
• Erasure from the register

23
Medical Council-Disciplinary Function

• Disciplinary decisions regarding suspension or
  erasure from register MUST be approved by the
  High Court.
• Council can request an immediate order of the
  Court, enforcing suspension if it is deemed to be
  in the public interest.

24
Professional Misconduct

• conduct which doctors of experience, competence
  and good repute, upholding the fundamental aims
  of the profession, consider disgraceful and
  dishonourable.
• Must have an element of moral failure or
  persistent recklessness/negligence

25
Fair procedure and disciplinary matters

• Irish Constitution declares the administration of
  justice is reserved to judges.
• Court requires to know that any decision was
  based on reasonable and if fair procedures were
  followed in making the decision.

26
Fitness to practice

• The Fitness to Practice Committee consists
  of members of the Medical Council, of which, the
  majority must be elected and include at least one
  lay member.
• At present the three lay members appointed by the
  Minister for Health to represent the public
  interest sit on the Fitness to Practice Committee.

27
Fitness to practice

• The Fitness to Practice Committee of the Medical
  Council  has a statutory duty under Part V of
  Medical Practitioners Act, 1978 to consider
  complaints made by the Council or any person into
  the conduct of a registered medical practitioner
  on the grounds of
•     his/her alleged professional misconduct
  and/or,
•     his/her fitness to engage in the practice of
  medicine by reason of physical or mental
  disability.

28
Fair procedure and disciplinary matters

• Delay
• Timely investigation, as delay can hinder a
  persons ability to defend themselves.
• Notice
• Requirement for due notice so a person can
  prepare a defence
• Hearing
• Generally presented by barristers
• Cross-examination
• Reasons
• Full reasons regarding any decision must be
  provided to facilitate appeal if appropriate
• Prejudice and Bias
• Unfair if a person has already made up their mind
• Bias- more subtle, financial interest, personal
  or political position
• Proportionate nature of censure
• Punishment should fit the crime

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Irish Healthcare system

• Mix of public and private funding.
• Everyone is entitled to free public inpatient and
  outpatient care in public hospitals should they
  wish to avail of them.

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Irish Healthcare system

• Administration and delivery of services
• Legislature
• Minister
• Department of Health and Children
• Health Service Executive and regional health
  authorities
• Others e.g.
• Irish Medicines Board
• Health Research Board
• Comhairle ns nOispidéal
• IBTS

31
HSE

• Up until January 2005, public health and personal
  social services in Ireland were delivered by a
  network of ten health boards, located throughout
  the country.
• Health and personal social services in Ireland
  are now delivered by the Health Service
  Executive, through a network of Local Health
  Offices, health centres and clinics.

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HSE

• Each Health Service Executive Administrative Area
  is responsible for the provision of health and
  social services in its area.
• They provide many of the services directly and
  they arrange for the provision of other services
  by health professionals, private health service
  providers, voluntary hospitals and
  voluntary/community organisations.

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Duty of HSE to provide services

• The HSE Area is obliged to provide certain
  services, e.g., family doctor (GP) and public
  hospital services.
• There are other services that they may provide,
  e.g., home helps and other community care
  services.
• A significant part of the HSE Area's overall
  budget is allocated to those services that are
  obligatory.

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Suggested Reading

• Clinical Practice and the Law
• Simon Mills
• Law and Medical Ethics
• Mason, McCall Smith, Laurie
• Medicine Ethics and the Law
• Deirdre Madden
• http//www.medicalcouncil.ie