Introduction
What is the Clinical Indemnity Scheme?
The Clinical Indemnity Scheme (CIS) was established in 2002, in order to rationalise pre-existing medical indemnity arrangements by transferring to the State, via the Health Service Executive (HSE), hospitals and other health agencies, responsibility for managing clinical negligence claims and associated risks. Under the scheme, which is managed by the State Claims Agency (SCA), the name used by the NTMA when carrying out its claims' and risk management functions, the State assumes full responsibility for the indemnification and management of all clinical negligence claims, including those which are birth-related.
Why the CIS?
The commercial insurance market had reached a point whereby
it was no longer willing to provide insurance cover to obstetricians/gynaecologists
or to hospitals with obstetric units due to the escalation in the size
of court awards and costs in cases of birth-related cerebral dysfunction.
Up to July 2002, diverse insurance and indemnity arrangements had meant
that each defendant to a claim - hospital, health board, consultant, hospital
doctor or nurse - was represented by a separate legal team. This led to
an unnecessarily adversarial approach to the resolution of claims, to
duplication of effort, considerably lengthened the time taken to process
a claim and added significantly to claims' costs.
When did the CIS come into operation?
The CIS has been in operation since 1st July 2002 and, following execution of the appropriate Delegation Order in February 2003, the SCA formally took responsibility for its two functions, namely, claims management and risk management. Cover was formally extended to hospital consultants from February 1st. 2004.
How is the CIS funded?
The CIS is funded on a 'pay-as-you-go' basis payments in respect of compensation and costs made by the SCA are reimbursed to it by the Department of Health & Children.
Who is covered under CIS?
- All Health Service Executive facilities, public hospitals and other agencies providing clinical services;
- Non-consultant hospital doctors, nurses and other clinical staff employed by health agencies whether permanent, locum or temporary;
- Consultant hospital doctors are covered with effect from February 1st. 2004 in respect of alleged clinical negligence incidents on or after that date.
- Clinical support staff in pathology and radiology services;
- The clinical activities of public health doctors, nurses and other community-based clinical staff;
- Dentists providing public practice;
- Certain other ancillary healthcare providers. Participating enterprises are specified in Schedule 1, Part 1 of the National Treasury Management Agency (Delegation of Functions) Order 2003 [S.I. No. 63 of 2003].
Does the Scheme cover all claims?
No. The Scheme covers only claims alleging medical malpractice or clinical negligence and the associated risk management issues. The Scheme does not cover Employer's Liability or Public Liability claims against health agencies. These are already covered under policies of insurance with commercial insurers.
What is covered by CIS?
All clinical claims arising from the diagnosis, treatment and care of patients. This includes all services of a diagnostic or palliative nature.
Coroner's Inquests
The Scheme provides representation at Coroner's Inquests for agencies and individual practitioners where this is requested.
Good Samaritan Acts on the island of Ireland i.e. North and South
The CIS covers personal injury claims against staff employed by agencies covered by the scheme, who provide emergency treatment on the island of Ireland.
Clinical Drug Trials/Research
The CIS will cover claims from patients whose treatment was part of a clinical trial or other approved research project subject to certain criteria;
- The trial has received approval from the relevant Ethics Committee.
- The trial is designed by an enterprise or any of its employees, covered by the scheme.
- Where a trial is sponsored by external organisations such as pharmaceutical companies, the CIS cover extends to treatment only and does not cover product liability or claims arising from trial design or protocol.
What is not covered by CIS?
Disciplinary hearings or statutory or other inquiries
The Scheme does not provide representation at disciplinary proceedings or before professional regulatory bodies. Nor does it provide representation for agencies or individual practitioners at inquiries.
Good Samaritan Acts outside the jurisdiction of the island of Ireland
The CIS does not provide cover in these circumstances.
Are private hospitals covered?
The CIS does not cover private hospitals with the exception of obstetric practices in Mount Carmel Hospital, Dublin and the Bons Secours Hospital, Cork. A special, more elaborate, indemnity arrangement applies in respect of these institutions.
Features of the CIS
The CIS Team
The team, at the State Claims Agency, is headed by Ciarán Breen, Director, State Claims Agency. Ailis Quinlan, Head of the Clinical Indemnity Scheme (CIS) has responsibility for the clinical risk management function. The Clinical Claims Managers have legal or insurance qualifications and the Clinical Risk Advisers have nursing, para-medical or medical backgrounds. The CIS team work closely together to;
- Provide clinical indemnity on the basis of "enterprise liability", (i.e. the enterprise assumes liability for all its employees' alleged clinical negligence.),
- Manage claims made against the enterprises in a timely and cost-effective manner,
- Assist the enterprises to reduce the numbers of clinical claims through risk management initiatives,
- Drive and support safe patient care,
- Guide and support clinical risk management in all the enterprises.
An integrated approach to Clinical Risk Management and Claims Management is adopted at the CIS, as suggested by international best practice. Clinical Risk Advisers notify their Claims colleagues of serious adverse events that may give rise to litigation while also ensuring that an appropriate risk management exercise is carried out at enterprise level. Likewise, if a Claims Manager, during investigation of a claim, becomes aware of an issue that would benefit from review at enterprise level, s/he will refer it to the relevant Clinical Risk Adviser.
Claims Management
The Clinical Claims Managers at the State Claims Agency are responsible for the formulation of claims management strategies in relation to the entire range of clinical negligence claims. In formulating these strategies, the team is particularly attentive to issues of practitioner reputation which lie at the core of clinical practice. Following rigorous examination of medical records and detailed consultation with practitioners, decisions are made on the basis of relevant case law, expert peer review and the opinion of counsel.
In addition, the clinical claims managers manage hospital inquests on behalf of participating hospitals and practitioners ensuring legal representation for hospitals/practitioners at such inquests. The claims management team also operate an emergency medico-legal helpline.
Risk Management
In addition to the management of clinical claims, the
Agency also has responsibility for advising and assisting enterprises
in the adoption of effective clinical risk management.
Clinical risk management is based on three principles, i.e. Risk identification,
risk analysis and risk control. International research and experience
suggests that this approach will be successful only in the context of
a "Blame-Free" systems model. This requires review of the entire process
leading to the occurrence of an adverse event, rather than focusing on
the individual healthcare worker involved in the actual event.
- The CIS will advise and assist participating enterprises in the development of effective risk management policies and will oversee the development of policies, procedures and guidelines to promote good clinical practice.
- The CIS will promote and publicise best practice in patient care and safety by means of newsletters, seminars and other initiatives.
The team of Clinical Risk Advisers at the Clinical Indemnity Scheme has responsibility for providing advice and support to healthcare facilities within designated geographical areas, DHGRMF (Dublin Hospitals Group Risk Management Forum) hospitals and in certain specialist areas, reflecting their individual experience and clinical backgrounds. They provide advice and assistance to all clinical facilities covered by the CIS and work with risk management and relevant personnel at enterprise level, to support patient safety. This includes encouraging the early notification of incidents and "near-misses" and identifying local and national trends in relation to incidents and claims.
Role of Enterprises
Each enterprise is required to develop and promote a culture that supports clinical risk management. All enterprises covered by the CIS have a statutory duty to;
- Report all adverse incidents to the SCA.
- Preserve relevant documentation.
- Permit and facilitate SCA investigation when requested to do so by the SCA.
Clinical Incident Reporting System-STARSWeb
A key feature of the CIS is electronic incident reporting
to a national database. The CIS has established and maintains a national
database for adverse clinical incidents and "near-misses". A confidential,
highly secure web-based IT system (known as STARSWeb) links hospitals
and other healthcare enterprises to the CIS core database. Each enterprise
has access only to its own data but the SCA has access all data in order
to identify emerging trends.
National rollout of the STARSWeb system commenced in November 2003, and
the majority of all acute sector health enterprises and former Health Boards
are now live on the system. Although the system has a primary Claims Management
functionality, the clinical incident reporting feature is designed to
support sharing of learning from "near misses" and in the aftermath of
serious adverse clinical events, at local and national levels.
Based on this data, the CIS, in conjunction with the enterprises, is
equipped to identify and analyse adverse trends and clusters. Data
can be manipulated to provide a wide range of report options. Any enterprise
may use the system to benchmark itself against the overall national data or
as an aid for Quality improvement initiatives within the enterprise.
The system is subject to ongoing revision and review. Users
also have the option of submitting requests for amendments electronically.
Training in use of system
Once the infrastructure to support the system has been installed, each enterprise is invited to identify staff who will be inputting data on to the system. SCA personnel deliver training at local venues as identified by the enterprises. To ensure sustainability, a "Train the Trainers" approach is being developed in conjunction with HSE.
Contact details
General queries
General queries to include queries in relation to the scope of cover of the Scheme should be referred to 01 664 0900.
Emergency queries
Emergency queries in relation to medico-legal matters should be referred to the CIS Helpline at 01 664 0909.
| Address: | Clinical Indemnity Scheme, |
|---|---|
| State Claims Agency, | |
| Treasury Building | |
| Grand Canal Street | |
| Dublin 2 | |
| Ireland | |
 01 6640900 |
|
 01 6618250 |
|
 info@stateclaims.ie |
