8th International Conference on Medical Regulation

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8th International Conference on Medical Regulation

• Fitness to Practice Investigations
• A Building Block Towards Professionalism

John Lamont Chief Executive Officer
(Registrar) Medical Council of Ireland
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Outline

• Overview
• Brief review of Professionalism
• A short history
• Fitness to Practise
• The regulatory framework
• Achieving the right outcome
• Options

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A Profession

• The development of formal qualifications based
  upon education and examinations, the emergence of
  regulatory bodies with powers to admit and
  discipline members, and some degree of monopoly
  rights
• Bullock Trombley 1999

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A Little History

• Medical Act 1858
• General Council of Medical Education and
  Registration
• Section XXIX if any registered medical
  practitioner shall be convicted in England or
  Ireland of any felony or misdemeanour or in
  Scotland of any crime or offence or shall after
  due inquiry be judged by the General Council to
  have been guilty of infamous conduct in any
  professional respect, the General Council may, if
  they see fit, direct the Registrar to erase the
  name of such medical practitioner from the
  Register.

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What has changed?

• 1874A woman died from an overdose of morphia
  administered by her husband, a surgeon, to help
  her to sleep. He allegedly administered 17 grains
  (778 mg) of morphia over a 3-hour period. He was
  charged with manslaughter but acquitted.
• 1999A general practitioner administered 30 mg of
  diamorphine to a 55-year-old man suffering from
  lower back pain. The patient died from
  respiratory failure. The maximum recommended
  initial dose of diamorphine is 10 mg. The GP was
  charged with manslaughter and convicted.
• 1969
• First reference to professional misconduct

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A Topical Issue

• Doctors performance and fitness to practise are
  attracting increased attention.
• Occupational Medicine Vol 58 - August 2008

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Professional Regulation 2008

• Medical education and training
• Setting and monitoring standards of at basic and
  post-graduate levels
• Registration
• Establishing appropriate criteria and registering
  medical practitioners in accordance with those
  criteria
• Medical practise, ethics and behaviour
• Setting standards and investigating alleged
  breaches of these standards
• Complaints and disciplinary action
• Investigating allegations of misconduct or
  unfitness to practise, and taking appropriate
  disciplinary action where such allegations have
  been upheld (more serious sanctions being
  subject to confirmation by the courts)
• Professional competence
• Setting standards, assessing compliance with
  those standards

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Professional Misconduct

• Professional misconduct is
• (a) Conduct which doctors of experience,
  competence and good repute consider disgraceful
  or dishonourable and / or
• (b) Conduct connected with his or her profession
  in which the doctor concerned has seriously
  fallen short by omission or commission of the
  standards of conduct expected among doctors.

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Handling Complaints Process Medical Council of
Ireland

• Receive complaint
• Considered by a Committee
• MPA 1978 two options
• A Prima Facie case ? FTP Inquiry
• No Prima Facie ? no further action
• MPA 2007 many options
• A Prima Facie case ? FTP Inquiry
• OR

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Options Regarding Complaints

• Treat the complaint as trivial, vexatious,
  without substance or made in bad faith
• Refer the matter to a more appropriate authority
• Seek further information before making a decision
• Refer the matter to mediation or other informal
  means
• Refer the complaint to a professional competence
  scheme
• Complaint may be withdrawn

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Fitness to Practise Inquiry

• Formal (and adversarial) process
• More options as to the outcome
• Undertaking by the registrant to
• not repeat the conduct
• Undergo a competence assessment
• Undergo medical treatment
• Consent to censure
• Or recommend erasure, suspension, conditions,
  advice, admonishment or censure

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FTP Inquiry

• Formal
• Legalistic
• Adversarial
• Rigid

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Alternatives Mediation?

• The MPA 2007 provides for mediation as a form of
  alternative dispute resolution
• - untried in respect of professional regulation
• - what if it breaks down?

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A Profession is

• The development of formal qualifications based
  upon education and examinations, the emergence of
  regulatory bodies with powers to admit and
  discipline members, and some degree of monopoly
  rights
• Bullock Trombley 1999

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Conclusion

• Fitness to Practise procedures are a necessary
  part of the regulatory process
• The process ensures that patients are protected
  from both poorly performing doctors, doctors who
  are unwell, and from doctors whose practise is
  dangerous
• The processes must be reasonable and fair
• There should be a range of outcomes available at
  every stage

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In Summary

• A consideration of professionalism
• A brief history of fitness to practise
• The handling of complaints in Ireland
• The options available to the Council
• Some conclusions outlining the role of fitness
  to practise investigations

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Contact Details

• jlamont_at_mcirl.ie
• or
• Medical Council
• Lynn House
• Lower Rathmines Road
• Dublin 6
• 353-1-498-3151