Do I Really Need an MDO?
By Dr Julian Walter
As a doctor, I’m astounded to hear there are practitioners out there who don’t have medical indemnity insurance. Particularly junior doctors, where the cost of the insurance (if there is one at all) is less than two movie tickets and a takeaway meal.
As a solicitor, I shudder to think of the legal costs that would be personally incurred by these uninsured doctors, if a matter did arise. The gnawing fear, not able to pick up the phone for advice through fear of costs – at a moment which may be one of the most harrowing points of their professional career.
As a medico-legal adviser, I’m distressed by calls we receive from uninsured doctors involved in a matter and with nowhere to turn. So let’s depart on a journey to see why medical indemnity insurance really does matter. It starts with a patient, a doctor who cared, and a healthcare roulette that sometimes doesn’t spin your way.
So what could go wrong?
Our patient, septic with pneumonia and pleurisy, had a central line placed earlier today. For the third time this afternoon the nurses seek review of the patient’s recurrent chest pain, reassuringly noting “obs are ok”. They missed that elusive respiratory rate, now 35, suggesting all is not well. It has been a long day. Losing your cool down the phone seems oddly cathartic. “I’m busy, I’ll be there when I can”. After all, pleurisy is why the patient is here.
The staff go quiet. So when the MET call comes, it’s a surprise. Resuscitation doesn’t go so well, taking longer than it should to diagnose the tension pneumothorax in the face of a new arrhythmia. Possibly the amiodarone you gave contributed to the death. Before you know it, you’re completing the coronial referral, the family are threatening to sue, and the nurses are busy completing a risk notification about your delay in attending and unprofessional tone. A really long day…
What kind of insurance is required?
AHPRA registered health practitioners require professional indemnity insurance. A breach of this legal requirement1 can result in action by AHPRA against the practitioner.
The Medical Board of Australia Registration Standard2 importantly tells us that compulsory insurance only refers to cover for claims – insurance against civil liability incurred by, or loss arising from, a claim that is made as a result of a negligent act, error or omission in the conduct of the practitioner. What we doctors would term “being sued”.
Generally, hospital employed doctors will have this simple level of cover provided by their employer – making them “employer indemnified”. If sued, their employer would pay the costs of legal representation and any damages payable to the plaintiff resulting from the claim.
Importantly, such doctors need to ensure they’re still covered by their employer outside of their place of employment, e.g. rotation to a private hospital, GP practice or locum work. If not, they may foot the bill for a claim and breach their registration indemnity requirements.
So why do I need a medical defence organisation?
While being sued might be the most expensive medico-legal matter you could face as a doctor, it’s certainly not the only risk.
The death of a patient can be related to something you did as a doctor. Employees might receive assistance under the hospital’s legal representation at an inquest. Yet your interests may not coincide with the hospital, and legal costs for a typical four-day inquest reach many tens of thousands of dollars. And what if you need separate legal representation?
You’re providing a statement to the coroner now for an inquest years down the track – when lawyers will debate the meaning of words in your statement and examine issues you had no idea would arise. So details do matter. As both doctor and solicitor, I cannot emphasise enough the importance of getting this statement right.
MDA National assists in the preparation of statements, identifying and addressing potential issues. Where needed, we also arrange your legal representation at inquests.
AHPRA health complaint investigations and disciplinary matters
Many hospitals don’t assist or have much expertise with health complaints. A poor quality response provided on your behalf can cause the complaint to escalate, bringing it closer to an adverse finding against you. It is critical that you obtain early advice and experienced assistance from MDA National, as this may save you months to years of worry.
With an employment dispute, you find yourself at odds with colleagues and the hospital itself. Your income provider becomes judge and executioner. Where do you turn? Who should be your support person? Employment matters can have an irreparable impact on your career. Seek advice early from MDA National. We work hand in hand with organisations such as the AMA.
Not every call we receive reflects a disaster. Help with preparing a police statement? Patient wants to write their will? Can you date that patient you met in the ED 12 months ago?
No matter how simple or challenging the query, with MDA National you have at your fingertips a team of medico-legal experts ready to give you timely advice, so you can achieve the best possible outcomes in medico-legal matters.
We are relentless. We love what we do. We hope you will too. Give us a call on 1800 011 255.
Medical systems are complex. The beat of fate’s butterfly wings can fan a seemingly minor task into a subsequent vortex of disaster and shame, causing irreparable damage to your future career and reputation.
- Health Practitioner Regulation National Law s129 as in force in each state/territory.
- Medical Board of Australia. Registration Standard: Professional Indemnity Insurance Arrangements. 2016. Available at: gov.au/documents/default.aspx?record=WD15%2f19047&dbid=AP&chksum=2gcq1vxK9JB2LtCq7YNdWQ%3d%3d
This article is provided by MDA National. They recommend that you contact your indemnity provider if you need specific advice in relation to your insurance policy.