Your views Medical Indemnity Scheme or Shame?

‘A good newspaper is a nation talking to itself’

Following the recent Lautoka High Court decision ordering the Permanent Secretary for Health to pay $171,260, including costs, to the family of an infant who died as a result of negligence in their duty of care, recent articles in the Fiji Sun have questioned who should pay for such medical negligence.

The article states that for those in private practice, the answer is clear. But is the answer really so clear?

In a nutshell, medical indemnity covers a medical practitioner against breach of his/ her professional duties. If someone believes that there has been a breach of duty of care or omissions, or professional negligence whilst carrying out medical work, there is a possibility that a person will make a claim hence medical indemnity will cover the legal cost and claims for the damages associated with the perceived negligence.

Private medical practitioners who opt for local coverage are indemnified under the Fiji College of General Practitioners (FCGP) Indemnity Scheme, or Scheme for short. Truly, a Scheme in every negative sense of the word as payments into the Scheme seem to benefit only the coffers of the Board of Trustees while leaving both private medical practitioners and patients out in the cold.

Annual coverage under the Scheme is capped at $40,000 for any one claim and a combined coverage cap for all members is set at $100,000. This means that if the damages in the recent High Court decision were awarded to the family against a private practitioner then the Scheme’s shockingly low annual caps, which would be exceeded in this single claim, would prevent it from paying the full amount of damages.

In reality, however, it is unlikely that the Scheme would pay anything at all. Why? Because the Scheme is highly discretionary.

In fact, the Scheme operates under the absolute discretion of the FCGP Executive Council who have complete control over how claims are processed, reviewed and ultimately decided upon. There are no procedures on how claims are processed and reviewed, and with no appeal process all decisions under this arbitrary process are final.

To further complicate matters, terms such as ‘clinical negligence’ and ‘carelessness’ which trigger coverage are not defined, and medical practitioners with specialties who participate in the Scheme are not covered.

To date, the Scheme has neither processed a single claim nor paid a single penny so who knows if it even works at all or what it actually covers.

Calls on the Board of Trustees by members to reform the Scheme have fallen on deaf ears.

In denying reform, their dismissive response to members has been that claims will be handled in a “how can we help you” approach which is of little comfort when the terms of the Scheme are the ones binding in a court of law. It is even questionable as to whether the Scheme is compliant with section 52(1) of the Medical and Dental Practitioner Decree of 2010 which governs such indemnities.

Hiding behind its deed and charter documents, the Board says it is simply operating within its parametres but the Trustees are granted with wide latitude to make any such amendments.

Further, there is little to no accountability to members of the Trust’s investment activities.

Recent calls to wind up or discontinue the trust by its members have been denied by Trustees who justify the Scheme’s existence under the guise for the need of a local insurer yet ironically, it is the Trustees stance which has led to many practitioners to opt for an overseas insurance provider.

So, with absolute discretion and zero accountability by the Trustees, who then is ultimately on the hook for damages awarded against a private medical practitioner? Is it the Scheme which is intended to protect these very patients, unlikely.

The medical practitioner, unclear. More than likely, it is the out-of-pocket victim who will suffer the greatest.

In a world where living under pandemic conditions are the new normal and medical professionals are at the greatest risk, isn’t it time this tone-deaf Board of Trustees had their hearing checked?