The Operating Theatre Journal - Journal - Page 10
MIND THE (INSURANCE) GAP
Four out of Five Surgeons Unknowingly Practicing Without Adequate Insurance Cover
Up to 80% of surgeons are unknowingly
not adequately covered by their insurance,
leaving patients in limbo and prompting
the UK’s sole trade union for surgeons and
anaesthetists to call for an overhaul of the
system.
The GMC requires all doctors and surgeons
to have adequate protection in place to
allow them to practise in the UK, which
theoretically covers both the patient and the
practitioner. However, providers are largely
unregulated with no external accountability
or scrutiny, leaving it to their discretion as to
whether they pay out or not. And although
practitioners are covered by NHS indemnity,
many aren’t aware that this cover does not
extend to locum work, ‘Good Samaritan’
acts, or private practice. This means that
in the event of a claim, patients will have
to resort to suing the surgeon directly and
if they do not have the means to pay the
compensation out of their own pocket, the
patient will be left with nothing.
With 80% of surgeons relying on medical
defence organisations (MDO) to provide their
insurance, the potential impact on patients is
vast. The UK’s sole trade union for surgeons
and the surgical team; the Confederation of
British Surgery (CBS www.cbsgb.co.uk); is
calling for an end to discretionary cover and
a shift to contractual cover, which is closely
monitored by 昀椀nancial authorities, ensuring
it operates with transparency within the
parameters of the contract. This type of
indemnity cover offers clear guidelines as
to how and when payouts will be made, and
will make payments within the terms of the
contract, holding both parties accountable
to its terms. Conversely, discretionary
protection is a gamble, leaving payouts to a
seemingly random system of chance.
Consultant plastic surgeon and President of
the Confederation of British Surgery Mark
Henley, says:
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“It is a disconcerting truth that the vast
majority of surgeons 昀椀nd themselves without
adequate indemnity insurance coverage,
with many oblivious to its limitations. This
not only jeopardises the practitioners but
patients in the event of a claim, resulting
in arduous legal battles that drain both
昀椀nances and psychological wellbeing. Urgent
and sweeping change is imperative to
dismantle the current landscape plagued by
unscrupulous insurance providers.”
The growing complexities and costs
associated with private practice have led
many surgeons to reconsider how they work.
The lack of proportional increases in fees
for private operations, combined with the
costs of insurance products that may or may
not pay out when needed, contributes to the
challenges surgeons face in maintaining viable
private practices, whilst failing to protect
patients.
CASE STUDY
General surgeon Peter Sedman used to
operate a private practice, until a failed
claim left him with an unaffordable insurance
bill.
Peter had been paying £40K a year to an
MDO, which appeared as though it would
cover him adequately in the event of a claim.
With the cost of private operations having
remained the same for some years, Peter
was worried his practise was no longer viable
and so he set about looking for cheaper
insurance. He found a company who would
insure him for 16K and set up a new policy.
When a grieving wife whose husband had
failed to attend follow-up appointments
with Peter and who had later tragically died,
attempted - unsuccessfully - to sue Peter,
he contacted the original MDO insurance
company who had covered him at the time of
the incident.
THE OPERATING THEATRE JOURNAL
The MDO refused to help with the 9K cost of
a letter to the claimant and Peter was left
to pay the bill out of his own pocket. The
claim was not viable and the action taken no
further as Peter was not at fault.
When Peter’s insurance renewal came up, he
was told that, despite the untenable claim,
he was high-risk. Peter was shocked to see
that his premiums had risen to £130K a year.
Peter says:
“When I purchased insurance, I believed I was
securing a safety net that would safeguard
both myself and my patients in case anything
should go wrong. The notion that this
coverage was discretionary never crossed
my mind. This situation, which appears to
be the norm for many of the biggest medical
insurance companies, not only puts doctors
and surgeons in a position in which they could
potentially lose their livelihood and homes,
but also fundamentally does very little to
protect patients.
“A surgeon who is essentially unwittingly
working without adequate insurance is very
unlikely to be able to pay litigation fees out
of their own pocket, leaving patients with
no compensation. In the instance of Ian
Paterson, the MDU refused to pay out as his
actions were criminal rather than negligent.
Had it not been for the intervention of other
insurers, those he harmed or who tragically
died at is hands would have been left without
a payout.
Crucially, these organisations are not subject
to 昀椀nancial conduct regulation. Something
needs to change, and it is imperative that it
changes soon.”
CBS President Mr Henley concludes;
“Our trade union offers all its members
peace of mind through access to bespoke,
contractual medical indemnity insurance.”
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