Medical Council investigations

For doctors in the Republic of Ireland, finding yourself subject to a Medical Council investigation is an upsetting and stressful experience. Here's what you need to know.

  • Medical Council investigations, even those that conclude at an early stage, can take many months - and sometimes years.
  • It's important to ensure you have in place as much support as you can from the outset.
  • While this will include support from friends, family and colleagues, remember that the MDU is expert in assisting and supporting members throughout a Medical Council Investigation.

The Medical Council

The Medical Council (Comhairle na nDochtúirí Leighis) is the regulator of the medical profession in Ireland. It derives its powers from the Medical Practitioners Act 2007 (as amended).

Its purpose is to "protect the public by promoting and better ensuring high standards of professional conduct and professional education, training and competence among doctors". Its key responsibilities include:

  • maintaining the Register of Medical Practitioners
  • ensuring the highest standards of medical training and education in the Republic of Ireland
  • promoting good medical practice and overseeing doctors' continuing professional development
  • investigating complaints against medical doctors.

There are over 21,000 doctors registered in one of several divisions with the Medical Council. Of these, only a very small number each year have adverse findings against them which are referred on to the High Court for confirmation.

However, being told that a patient has complained to the Medical Council, and finding yourself subject to an investigation, is an upsetting and stressful experience for any doctor.

Complaints

Complaints don't only come directly from a patient to you, or to your hospital, through local processes - the first you may learn of a complaint is when you receive notification from the Medical Council.

As well as patients and other members of the public, the Medical Council receives complaints from other doctors or healthcare professionals, from the police, from the HSE and from other employers. The Medical Council can also make a complaint to itself about a registered doctor - for example, if it learns of concerns through the press, which have not otherwise been drawn to its attention.

Complaints can be made about a doctor's professional performance or clinical competence, but can also be about their conduct in both clinical and non-clinical contexts.

The Medical Council's Guide to Professional Conduct and Ethics for Registered Medical Practitioners provides guidance for doctors on the standards it expects, and lists examples of the grounds on which a complaint may be made to the Council.

  • Professional misconduct. This includes conduct considered to be disgraceful or dishonourable, including criminal activity or sexual misconduct unconnected to a doctor's professional role, or fraudulent behaviour. It may also include conduct which falls seriously short of the standard expected among the profession.
  • Poor professional performance, meaning a failure to meet the standards of competence that can reasonably be expected of the doctor.
  • Contraventions of the Medical Practitioners Act 2007 (for example, practising as a doctor while not on the register maintained by the Medical Council, or practising without professional indemnity insurance).
  • A failure to comply with a condition or undertaking imposed by or agreed with the Council (for example if there has been a previous Medical Council investigation).
  • A conviction for an offence triable on indictment in Ireland, or conviction for an offence elsewhere where, if the acts or omissions were carried out in Ireland, they would constitute an offence triable on indictment.

Most complaints fall under the first three categories.

The Preliminary Proceedings Committee

The Preliminary Proceedings Committee (PPC) will consider all complaints made about doctors registered with the Medical Council, but only those falling within the Medical Council's remit will be investigated.

If a case does fall within the Medical Council's remit, the legislation giving the Medical Council its powers allows it very little discretion as to how it can then proceed. In most cases, the PPC will appoint a case officer to assist in the investigation of the case.

The first a doctor will know about a complaint is likely to be a letter from the case officer. This generally explains that the Medical Council has received a complaint, and will enclose the correspondence from the complainant. It will explain the complaints process and the Medical Council's role, including that the PPC will be considering the complaint, usually at its next meeting (these are generally held monthly). It will also invite the doctor to provide any information they believe the PPC should consider.

There is no obligation to provide the PPC with any information on receiving this letter, and we would generally advise a doctor not to comment when it arrives. There are several reasons for this.

  • There may be a tight deadline by which to provide comments or information before the PPC meets. This may lead to you trying to provide comments in haste, perhaps without access to all the relevant information. Anything you do say at this point (or later) may become part of the formal investigation, so it's important it is entirely correct.
  • Anything you say may be sent back to the complainant, and may in turn prompt further comment or complaints.
  • There will be further opportunities to provide comments at a later stage.

If you do receive a letter from the Medical Council, we would advise you to contact the MDU instead of responding directly at this stage.

What happens next, and what we will advise, will depend on the nature of the case and concerns. However, it is helpful to have your comments on the case along with copies of the correspondence from the Medical Council and, if you have access to them, the relevant medical records.

The PPC will write to you again after their meeting and may invite you to comment, but again, there is no obligation to respond. They may, however, require you to comment, and in those circumstances you must do so. Providing the MDU with all the relevant information you have, including the relevant records, will mean we can help you prepare a response.

The PPC will consider any comments a doctor makes, and will gather information from other sources, such as the complainant and the medical records. They may also seek an independent expert opinion - if there is a clinical element to the case, for example. This can be a protracted process and can run to many months.

At the end of its investigation, the PPC will either refer the complaint to the Medical Council's Fitness to Practice Committee (see below) or will give one of the following opinions to the Council:

  • no further action is necessary
  • the complaint needs to be referred to another body or authority
  • the doctor should be referred to the performance assessment scheme
  • mediation, if deemed appropriate, could resolve the complaint and restore the doctor/patient relationship.

Fitness to Practise Committee

  • Fitness to Practise Committee hearings generally take place in public, unless the inquiry concerns a doctor's health.
  • They are adversarial hearings - the Medical Council acts as prosecutor with the doctor as the defendant.
  • The criminal standard of proof applies (unlike, for example the UK's General Medical Council where a much lower standard - the balance of probabilities - is all that is needed to make a finding against a doctor).
  • It can take many months, or even years, for a case to come to a hearing.

A number of sanctions are available if an allegation is proved, ranging from advice to cancellation of the doctor's registration. Most sanctions will need to be confirmed and ratified by the High Court. The choice of sanction will be influenced not only by the seriousness of any allegation, but also (and importantly) by any mitigating factors. This may include any remediation a doctor can show, such as insight by the doctor, further relevant training or continuing professional development.

For this reason we advise that from the earliest stages, doctors reflect on the concerns raised and take what steps they can to address any possible criticism, even if they do not necessarily agree with it.

Evidence of early reflection and remediation may reduce the severity of a sanction if the case is proved, and could also reduce the chances of the matter being referred on by the PPC.

Immediate suspension

Because cases can run for months or years before they conclude, if it believes it is necessary to protect the public while an investigation continues, the Medical Council can make an application to the High Court for an order to suspend a doctor's registration, under section 60 of the Medical Practitioners Act 2007. It can do this whether or not the doctor is the subject of a complaint at the time.

These applications are legally known as 'ex-parte', meaning they can be made without notifying a doctor. In practice, the Medical Council does notify doctors of these applications so they have the opportunity to provide more information, explanation or clarification to the Council, in order to stop an application being made to the High Court.

This can happen at short notice. If you learn the Medical Council is making such an application, contact the MDU without delay.

Summary

Medical Council investigations and hearings are stressful. Finding yourself subject to an investigation can take an enormous toll on your professional and personal life - even if the outcome is in your favour.

If you are notified that the Medical Council has received a complaint about you, you can seek our support by calling 1800 535 935 or emailing advisory@themducom

This page was correct at publication on 15/01/2021. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.