The system for adjudicating on professional complaints against doctors is in disarray following the Supreme Court's dismissal of a case brought by the Medical Council.
At issue is how to strike the right balance when considering such complaints, between the understandable grievances of patients when something goes wrong and the right of doctors to a fair hearing.
It is hard not to feel sympathy for the doctor at the centre of this case.
Prof Martin Corbally is, in the words of the court, "not merely a competent doctor, but a very distinguished one".
Mr Justice Adrian Hardiman devoted a whole page of his judgment to Prof Corbally's many qualifications.
His workload at Crumlin children's hospital was "intimidatingly" large: 1,200 patients; 100 appointments a week; up to 12 nights on call each month.
In 2010, a mistake was made during an operation. A tongue-tie operation on a two-year-old girl was performed incorrectly, although it was later corrected.
Prof Corbally ended up before the Medical Council, whose fitness-to-practise committee found him guilty of poor professional performance.
Although the High Court quashed this decision, and the Supreme Court has confirmed this, the episode has had life-changing consequences.
Prof Corbally took sabbatical leave and is currently working in Bahrain.
Fitness-to-practise hearings used to be held in private until an Act passed in 2007 made public hearings the default position.
In recognition of this, a new, lesser finding of poor professional performance was introduced in addition to the existing standard of professional misconduct. From then up to the High Court decision, most hearings were held in public.
Once-off mistake The position now is that where a once-off mistake occurs, it must be serious for a finding of poor professional performance to be made.
In effect, then, there is no longer much difference between this finding and one of professional misconduct.
An adverse finding can also be based on a fair sample of a doctor’s work, if this is found to be low. It is hard to see how such a composite picture could be developed when individual patients only know of their experience with a doctor.
The effect of the original High Court decision in this case was to put a stop to most public fitness-to-practise hearings; just one has been heard in the past year.
Yes, the council now has a lay majority, but the suspicion arises, whether justified or not, that we may be returning to the old days, where business was done behind closed doors - to the detriment of patients.