Professor Martin Corbally speaks frankly about the pain and hurt that still endures from the 2012 Irish Medical Council’s findings against him, while also issuing ‘admonishment or censure’ against him. When the High Court quashed the decision of the IMC, it appealed to the Supreme Court which found that the Council had failed to follow fair procedures and had acted disproportionately in relation to the complaint made against the distinguished professor of medicine and consultant paediatric surgeon. The complaint was initially made to the IMC by the parents of a child who was due to have a frenulum release procedure carried out in Our Lady’s Hospital, Crumlin on April 30, 2010.
Would you ever have left Ireland do you think if the Medical Council had not pursued you all the way to the Supreme Court with the subsequent fall out in negative publicity until you cleared your name?
I had fully hoped and expected to continue my professional career in Ireland and had enjoyed the challenge of working in a busy unit with well-qualified and experienced colleagues. I think that it was, at that time, most graduates’ ambition to return to work in Ireland and I had always considered myself fortunate to have done so. I am no longer convinced it is so and many, like me, have become disillusioned with over-regulation, mounting negative public attitude to doctors and ineffectual hospital administrations which appear eager to blame others. Following my experience with the IMC I felt betrayed by hospital management at OLCHC and felt unsupported and unsafe working there. Against this backdrop leaving would always be possible but it was the decision of the IMC to pursue me for outcomes beyond my control and the malice of the media that made my final decision easy. That said, I am very happy to have a full and rewarding position here in Bahrain where I can devote my time to education, hospital management and treating sick children.
How do you now view the Irish Medical Council? Should non-medical members be allowed to make up the council? (There are currently 13/25 over half). Are there too many people?
I remain deeply disappointed with the Irish Medical Council and feel that it has behaved in an arrogant and callous manner with little or no regard for the consequences of its decisions. I am not sure if the IMC truly accepts or understands the rulings of the High and Supreme Courts in my case and it is likely that it has lost significant credibility amongst doctors and the public. The IMC has, at times, acted without common sense in an overly legalistic manner. It still conducts some hearings where doctors attempt to defend themselves without legal representation. This is unethical, in my view, throwing these, often doctors in training, into an adversarial public FTPC with little chance to present an adequate defence. I believe the State has a moral and, perhaps, a legal duty to provide legal aid for those doctors who find themselves in this situation.
Up to this point they have had an overly legalistic view of complaints and have rarely used mediation, despite it being available, as a means to resolve complaints. One has to ask: “Who or what has fuelled this crusade”?
It does not engage in proper peer review. In my case a professor of general practice chaired an FTPC and passed a very flawed judgment on me. This is unacceptable as it is quite unrealistic to expect that a general practitioner could have the required insight or experience into the demands of a busy surgical consultant who was on call nearly every second night for paediatric and neonatal emergencies and was the responsible doctor for the delivery of two national surgical services. Surgeons should be judged by surgeons and general practitioners by general practitioners.
The IMC, like any regulatory body, has a duty not only to protect patients but very importantly to support doctors. Despite encouraging doctors to apologise to patients it, itself, cannot apologise to me for the wrong it did me. I hope that the Minister will include the need for an apology (when the IMC gets it wrong) in his much-awaited amendment.
It is not clear what experience or training its members have in risk management and it seems unrealistic to expect its lay composition to have any significant experience on risk in clinical practice. In my opinion every member of the IMC (and also hospital managers) should have training in risk management to ensure they are fit for the job.
There should always be a lay presence on the IMC but the lay representation on a FTPC (currently 2 lay members and one doctor) is unbalanced and should be either 2 doctors and one layperson or two doctors and 2 lay representatives. This will restore order and transparency.
The IMC spends a great deal on legal fees and in my experience not always on the most appropriate opinion. It places too great an emphasis on one single opinion which may not be balanced, “expert” or indeed accurate (as in my case) and also relies on medical opinion from outside the jurisdiction. In countering any single opinion obtained by the IMC, doctors should obtain as many separate opinions as possible at the PPC stage.
A cause of great concern to me, and I am sure to many practitioners, is Section 10 of the 2007 Act which provides immunity to members of the IMC when they are acting for the IMC. The only exception to this immunity is if a member or members fail to act ‘in good faith’. It is extremely difficult, if not impossible, to prove absence of ‘ good faith’ even if a doctor feels that the IMC or some of its members has or have acted against the evidence in a particular case. In my case the IMC was aware of a lack of causation to the matter complained of, yet it decided to proceed to a FTPC hearing and onwards to the Irish Supreme Court. The High Court and Supreme Court were extremely critical of the IMC’s behaviour, yet I was left with no legal remedy against the IMC. The IMC has also failed to apologise.
How would you reform it so that it could do its job more sympathetically and with more understanding to the modern demands of the Irish medical profession?
Change the mantra to “Supporting Doctors to Protect Patients!” Great harm is done to doctors, their families and society when sensationalist reporting is allowed to influence the outcomes of an FTPC hearing. Although this is impossible to prove, I believe that the level of malicious reportage from some elements of the “media” can and does influence the outcome of some FTPC hearings. The chairman of each FTPC has the authority to instruct the media to refrain from reporting anything but the facts and I still find it difficult to understand why he did not do this in my case.
More hearings should be heard in private or if in public the media should not be allowed to report the case until the findings are made public. It is not always in the public interest to name and shame the doctor and satisfy the public appetite to blame. The vast majority of doctors are hardworking, committed and caring members of society and do not deserve to be treated the way the IMC have treated me and many others.
The decisions of the FTPC and IMC must be overseen by another body as currently exists in the UK. All decisions of the IMC, like any organisation, are potentially flawed and must therefore be subject to scrutiny. Recourse to legal instruments such as an appeal or judicial review is costly and time consuming. It is surely not appropriate for the IMC to act as judge, jury and executioner!
How many years did its ruling affect you or has it gone away yet? Is there a better way than the ‘trial by media’ people such as you have had to face.
The entire process has and continues to affect me and my family. It will never truly go away. The media interest was intense, unbalanced and unjust but I do hope that the judgment will make it more difficult for the media to act in such an unprofessional and biased way especially considering the service that I had provided to over 20,000 Irish children over 17 years. Trial by media is never acceptable and it was extremely painful to be at the wrong end of this especially when I had devoted my life to providing this service. I believe that the judiciary and hopefully society now know that there is much to lose when doctors are unjustly treated in this way.
Are there cases you know of where doctors were unable to cope with the pressure of such negative publicity?
I just about made it through the entire process but found resilience in the support of my family and friends. It was not easy to hear yourself being labelled a “butcher” to witness calls to the IMC to ensure I did not get a mere “slap on the wrist”, to have certain “newspapers” attempt to have me fired from my current position and to witness the effects the entire matter had on my family, while knowing I was not to blame.
I do know of doctors who died prematurely after an FTPC hearing. Suicidal ideology is common and as many as 4-10 per cent of doctors end up taking their own life. The PPC should only refer cases to a FTPC when the matter is very serious and only with good cause. I do not believe they had good cause in my case and the judgments of the High and Supreme Courts confirm this.
The new Medical Advocates service is reporting substantial interest from the profession in its MA Guarantee that provides expert legal representation in the event of a complaint to the Medical Council. Do you think it’s a good idea?
I think it’s a great idea and I wish it every success. There is a real need for doctors who are not members of the MPS or MDU to have legal advice and representation, at least until the State provides this. I understand Medical Advocates is going a step further by guaranteeing legal representation to its members in the event of a complaint to the IMC, and this is a very welcome development.
Hospital consultants, in particular, are joining Medical Advocates in large numbers because the Clinical Indemnity Scheme does not provide any cover at all for complaints to the Medical Council. Do you think this will help to reduce the ‘fear factor’ for doctors dealing with such complaints?
Provision of legal aid and advice will go a long way to protect doctors against malicious complaints and scapegoating administrations and that will provide some level of comfort. However doctors and the public need to be reassured that the IMC will always act in a professional manner, in the interests of society and within the terms of the Constitution.
When a body like the IMC appears to deviate from common sense and act from a different agenda then doctors and the public should be afraid. My experience of the IMC is that it made poor decisions, accepted very irrational opinion and appeared to have another agenda both in its decision to proceed to an FTPC and in the erroneous and mistaken conclusion. I was motivated to correct that wrong and also to highlight the bizarre process that led to such an erroneous and damaging outcome.
Judge Adrian Hardiman said your case was a slip of the pen, he noted you had an “intimidatingly great” workload at the time. Is that still the case with consultants and doctors in the Irish Health service? Do they take unrealistic workloads/ poor infrastructure into account? Should they?
Doctors in the Irish Health system often work in challenging environments, governed by administrators who are ignorant or uncaring of the problems faced by clinical staff on a daily basis and sadly only too ready to blame the same staff when the system fails. The lack of accountability from hospital managers is no longer acceptable and managers should be held directly accountable when systems fail. I had a very significant workload at the time and was responsible for the delivery of the surgical aspect of a National Oncology Service and Paediatric Hepatobiliary Service. There were only two full time Paediatric surgeons in Crumlin at that time and a hopelessly inadequate filing system with as many as 18,000 letters and reports unfiled at various times. I understand that the filing system is now more robust and that more surgeons have been appointed. However some children are now referred to London and surgeons from outside brought to Crumlin to deliver oncology and hepatobiliary surgical care. No surgeon should be responsible for intimidating workloads, as I had, and parallel lists should not be allowed in any hospital especially as the surgeon would appear to be held responsible, as I was, for the events in another theatre. I am surprised that parallel lists still run in some theatres, especially after my case.
Does practising ‘defensive medicine’ mean that the surgeon/ doctor in question is moving backwards/ delaying the medical process? Could it be argued that the doctor is prioritizing him/herself over the patient because of this pressure?
I think that defensive medicine is bad for patients and wasteful of resources. However I understand how the IMC has influenced the development of this practice over the recent years. It is not that the doctor is prioritising him/herself just trying to protect themselves against irrational decisions.
How does the system in your current location differ?
Well different enough to write a second article! Very different, very practical approach, less redundancy, greater appreciation for expertise and a value based system. There is no perfect health service but the better ones are rooted in common sense and demonstrate appreciation and support for their staff.
Looking at the Irish health service, do you think it has improved or worsened since you went to live in Bahrain?
Health services in Ireland face many challenges such as recruitment, funding and retention of staff. Many new appointments to the HSE have not undergone formal training in Ireland. We read daily of the large numbers of patients who have to wait on trollies, so called bed blocking and the consequences of a defensive culture fuelled in part by over regulation. The Minister has, like all his predecessors, a difficult task but providing for a separate and properly funded emergency service might go some way to easing the burden.