Dr Margaret Perrott
The medical defence insurance debacle continues to claim victims, even though the federal government pretends that a solution has been reached.
The January 24 Illawarra Mercury reported that "the crisis [in medical indemnity insurance] hit surgeons on Thursday after their insurance company, UMP [United Medical Protection], refused to cover them for public patients at the region's only urology clinic...
"Urologists [specialists in bladder and prostate surgery] have treated about 25 public patients a week at the Illawarra Private Hospital for the past 15 years because the public hospitals do not have the necessary equipment."
According to the January 28 Mercury, "One of the urologists, Dr Paul Kovac, arranged interim cover with the second medical insurer, MDA National, and was preparing to do the more urgent of the cancelled procedures, but late yesterday he was informed that MDA National would no longer cover him or his anaesthetist".
Because of the failure of the medical indemnity system, all urological surgery has ceased in the Illawarra for public patients. Public patients requiring urgent operations for prostate and bladder cancer are now at risk. In my experience, these urgent cases have always been prioritised by urologists regardless of whether they are public or private patients.
Doctors, whose main concern is the welfare of their patients, are being prevented from carrying out the work they are trained to do.
There is an amicable agreement between the private hospital and the Illawarra Area Health Service (IAHS) that ensures that public patients are treated at the private facility. The urologists bulk-bill health-care cardholders for consultations and examinations, and necessary operations are carried out on the basis of urgency. Waiting lists for non-urgent public patients for urological surgery in the Illawarra are no worse than elsewhere in NSW.
The reason why medical defence insurance companies won't insure these doctors to perform surgery on public patients is economic, not because there is an increased risk of medical negligence claims. The companies are happy to provide insurance for the same doctors, operating on private patients, in the same facility. If these procedures were carried out in a public hospital, by the same surgeons and anaesthetists, the state government's Treasury Managed Fund, which insures public hospitals, would bear a large part of the cost of any negligence claim, even though doctors are still required to have personal coverage.
"Meanwhile, the Illawarra's surgeons have been left to ponder why the state government's Treasury Managed Fund covered doctors working on public patients in Port Macquarie's private hospital, but was not prepared to cover Illawarra doctors performing identical procedures", reports the Mercury.
Doctors using their own private facilities, equipment and staff to treat public patients in Wollongong have saved the public health system a great deal of money in the past 15 years. The current situation is causing increased suffering to public patients, and placing an enormous burden on doctors.
I have no doubt that Kovac would much rather be in surgery removing a bladder cancer from a public patient, than negotiating with the medical defence insurance companies and the IAHS, and dealing with the media.
A short-term solution to the urological crisis in the Illawarra would be for the government to fund medical indemnity insurance for public patients treated in private facilities.
In the longer term, the solution is to restore decent public facilities and to pay doctors a salary for their services, based on hours worked, rather than the number of patients seen. Doctors should have access to all the necessary equipment and training required to provide the best possible care.
Rather than medical indemnity insurance, an adequate system of compensation and care should be provided for all patients who require further treatment or remedial treatment due to "medical negligence", which is, in reality, just another failure of the system.
[Margaret Perrott is a GP at the People's Medical Centre, Warilla, and the Socialist Alliance candidate for the federal seat of Throsby.]
From Green Left Weekly, February 18, 2004.
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