Obstetricians are quitting

published: Monday July 27, 2015 MYT 12:00:00 AM
Updated: Monday July 27, 2015 MYT 7:09:57 AM

Obstetricians are quitting

PETALING JAYA: Senior obstetricians in private practice in the country are opting out of delivering babies as a result of changes in their professional indemnity coverage.

The shortfall of these specialists is expected to create a rise in the workload in government hospitals, increasing the possibility of sub-standards or delays in maternity care.

The Medical Protection Society (MPS), the world’s leading indemnifier of health professionals, changed its policy for obstetricians and gynaecologists this year – from occurrence-based protection to claims-based coverage, under which these doctors have to pay annual premiums for 25 years.

This means if a doctor retires at 60 after delivering a baby, he or she must continue to pay for the coverage until the age of 85.

According to the MPS, the changes were made because of global challenges and risks associated with obstetric claims and litigation.

In Malaysia, the highest protection coverage is taken up by obstetricians, who used to pay more than RM70,000 a year for unlimited indemnity.

Under the claims-based coverage, the amount to be paid annually is lower but the time frame is longer.

More than 500 obstetricians and gynaecologists are covered under MPS, which has over 4,000 members in Malaysia.

MPS has more than 300,000 doctors, dentists and medical students as members worldwide.

Dr Tang Boon Nee of Subang Jaya Medical Centre said many of her colleagues had decided to stop delivering babies as a result of the change in policy.

“As we are liable for up to 25 years after delivering a child, many of us who are older obstetricians will have to pay for coverage well after retirement,” she said.

Dr Tang, who has been an obstetrician for 20 years, said “phenomenally high” damages had been paid out in obstetric claims.

“There was a case last year in which the amount awarded was RM6.9mil. To protect ourselves, we will have to continue paying MPS well into our retirement because of the claims-based system.

“It is not fair as many of us will not be making that much money,” she said.

KPJ Damansara Specialist Hospital’s Dr Gunasegaran Rajan said the occurrence-based indemnity had no ceiling on coverage, but claims-based was capped at RM10mil.

“Recent payouts have already touched RM7mil, and this can only increase. I would have to pay out my of own pocket if the damages awarded are above RM10mil.”

He said that his best option was to stop practicing obstetrics as the future left him vulnerable.

“It is a great shame that the skills and knowledge many obstetricians have acquired over the past 25 years cannot be used to help Malaysian women’s maternal health due to this policy,” he said.

Another obstetrician and gynaecologist, Dr S. Shankar, said doctors could not run the risk of not being covered.

“We don’t have much choice. Our legislation should come up with a better system, like New Zealand which has a no-fault compensation scheme. Personally I will get out of obstetrics as fast as I can.”

In a statement to The Star, MPS defended its policy change, saying that claims-made protection was the more common form of coverage for obstetricians in many countries.

“Claims-made protection requires members to be in continuous membership both at the time an adverse incident takes place and when it is reported to MPS to make a claim.

“It was introduced to price subscriptions for obstetric risks more accurately and fairly as it can be difficult to predict long-term risks.

“This is because obstetric claims can often arise many years or even decades later,” it said.

MPS assured members that even with the new system they would continue to receive high-quality service and support.

Tinasha’s parents accuse hospital of malpractice

Tinasha’s parents accuse hospital of malpractice

Mikha Chan

http://www.freemalaysiatoday.com/category/nation/2015/03/05/tinashas-parents-accuse-hospital-of-malpractice/

| March 5, 2015

The family of the deceased teenager questions the documents released by the insurance company and Assunta Hospital.

PETALING JAYA: The family of Tinasha Ganesan Rao who died suddenly at Assunta Hospital last November, is suspicious that the hospital had intentionally delayed concluding their daughter’s death in order to hike up the medical insurance fees.

Tinasha was 14 when she passed away at Assunta Hospital on November 21 with her family by her side, after being declared brain dead for four days at the hospital. She was brain dead within eight hours of admission after suffering fits.

In a press conference today, the family presented the media several documents to corroborate their suspicions that the hospital had overcharged on the procedures and products used to supposedly test Tinasha’s condition.

“Why did they delay in confirming that she was brain dead?” asked Ramesh Inthirarasa, Tinasha’s uncle. “They only reassured us that she would be fine. ‘We will try our level best.’ Those were their words,” he said.

“Instead, they kept her body alive unnecessarily, and prolonged our agony. A person certified to be brain dead is dead. No two ways about it. But they delayed pronouncing her death.”

The documents presented included the insurance papers, the police report, the medical report and records released to the family by Assunta Hospital on the orders of CKAPS (Private Medical Practice Control Section under the Health Ministry), and the Malaysian Medical Council guidelines on brain death.

Ramesh referred to the Malaysian Medical Council guidelines regarding brain death, and pointed out that “non-recognition (of brain death) either through ignorance or choice can be construed as unethical”.

Ramesh presented copies of the itemised hospital bill that the family had managed to obtain from their insurance company, saying that they found many of the items in it to be suggestive of overcharging.

Cross-referencing that with a copy of the medical report by hospital chief executive officer Peter Leong, he cited a CT scan they had performed on Tinasha, questioning the need for it as the MMC guidelines were clear that brain death diagnosis is a clinical one and no confirmatory test was necessary.

“They performed three tests. We didn’t even know that they had done the third test until we saw the medical report.”

He also pointed out that the hospital had claimed insurance for the administering of medicine that was already her own, i.e. not originally prescribed by the hospital.

“They charged RM52.56 just to give her own Keppra medicine.

“They also charged a whole RM2,640 to give her injections of norepinephrine. How many injections did they give her to be able to charge that much?”

He again questioned whether an independent monitoring body existed to probe the standard operating procedures of such cases.

“We don’t want to prolong this case any longer than we should. But we feel that such things should be brought to light. Who knows if this has happened to anybody else?” said Ramesh.

According to an earlier report, Peter Leong had maintained that all hospital procedures were followed and that Tinasha’s nausea was treated with the usual medication for such cases.

Leong also said that the hospital was eagerly awaiting the results of the post-mortem so that everyone could know for certain what caused the girl’s sudden death.

Since her death three months ago in November, the post-mortem is yet to be released by Assunta Hospital.