Irish medical claims system ‘propagating a cycle of harm’ for patients and society, says NHM doctor

The claims system in Irish medicine is “propagating a cycle of harm” which hurts patients, healthcare practitioners and wider society, former master of the National Maternity Hospital Dr Rhona Mahony has said.
Dr Mahony and Minister for Health Stephen Donnelly have released a new report which examines the rising cost to the taxpayer of medical negligence cases taken against the State. Speaking at the launch of the report on Thursday, Dr Mahony said the current liability to the State from such claims stands at around €5 billion.
She said the current system is unnecessarily adversarial, while financial costs are rising at an average rate of 13 per cent a year. According to her report, the current estimated outstanding liability of almost €5 billion “could rise by multiples over the next two decades if unchecked”.
“Over half the total annual costs of healthcare litigation in Ireland are associated with claims for catastrophic injuries that account for only 2 per cent of claims annually. It is the rising cost of damages paid in these cases to provide for care for affected individuals that is the standout driver of rising costs,” the report says.
It includes a research study of 15 patients and families who have litigated. They talked of “a very negative experience of seeking justice through the civil litigation system in Ireland”.
“They variously described it as triggering, re-traumatising, jarring, insulting, shocking, horrible, not fit for purpose, and a battle. Several participants identified the system as particularly unsuited to those who have already experienced a significant trauma.”
The report states that the rising cost of clinical claims is predominantly driven by the rising costs of individual claims rather than by increasing numbers of new claims.
Mass action claims accounted for 8 per cent of all new claims in recent years, and 10 per cent of the total costs.
The estimated outstanding liability for healthcare claims in Ireland has risen by 64 per cent between 2018 and 2022, or from €2.8 billion to €4.6 billion, representing an average rise of approximately 13 per cent per year.
The report says it is “impossible to address strategies to minimise harm if shortages of staff and resources combine to create potential risk for the very harm the system is trying to reduce”. While her group acknowledged progress made in the increased recruitment of clinical staff in recent years, it warned that “serious problems still exist in relation to recruitment and retention of frontline clinical staff”.
Dr Mahony’s report recommends that every healthcare setting providing clinical care should have the capability to undertake a “swift and comprehensive analysis of, and response to, serious adverse events that occur within its own setting”.
The report also recommends that guidelines and training for meaningful debriefing with the patient and family following an adverse event should be put in place in each hospital. It also recommends that any necessary supports should be available immediately, within existing resource allocation, to assist parents with the additional care needs of children with catastrophic birth injuries.
Dr Mahony’s working group also recommended the development of a vaccine damage scheme. Speaking at the report launch, Mr Donnelly said that money that can be saved “through keeping people safe is money we can invest in our hospitals, invest in our community care. The group, along with examining the financial costs, also placed a strong emphasis on the human cost of litigation.
“We really want to find less difficult processes, and the report sets out a lot of recommendations and measures aimed at improving civil litigation, preventing clinical harm, obviously, which is the first priority, and then providing enhanced care for those who were affected by harm.”