The Health Minister plans to change laws to control malpractice rates for obstetricians, which have risen so high that business is threatened.
The focus of the proposed new legislation involves putting a cap on the amount of money a court can award to a family in maternity cases involving negligence. This includes looking at what other Western jurisdictions are doing, explained Health Minister Mark Scotland.
‘We are hoping to bring in [the new] legislation by the end of year,’ said Mr. Scotland.
Medical and Dental Society President Dr. Ruth Pomares, said she is pleased Mr. Scotland plans to deal with the issue.
‘But we are still looking at alternatives, because we are afraid government won’t come through for us,’ says Ms Pomares.
Obstetricians must have malpractice cover to deliver babies in the Cayman Islands. But over four years, malpractice rates have quadrupled, rising from nearly $40,000 in 2006 to $167,550 this year.
By comparison, rates for neurosurgeons, spinal surgery and other super high risk categories for doctors have had a modest increase to $26,570 this year.
Ms Pomares, negotiated a reduced rate with the UK-based Medical Protection Society, the primary insurer for physicians for one year. The one year reprieve was to give them time to lobby the new government for tort reform. But at $126,000 for $10 million, the reduced rate is still about five times higher than for doctors considered to be in the super high risk category.
While an obstetrician can choose to pay a lower rate for $2 million of malpractice cover, it is not recommended, said obstetrician Dr. Barry Richter. If there is a problem during a delivery, $2 million may not be sufficient, he added.
The problem of rising rates for obstetricians is not unique to the Cayman Islands, said MPS Operations Director Dr. Tim Hegan.
‘[We] recognise the difficulties our members and governments face in many Caribbean countries,’ said Mr. Hegan.
If government does not bring in new legislation or some other avenue that keeps malpractice rates down for obstetricians, the rates will be increased again next year, said Ms Pomares. Most likely that increase will be at least $167,550 or even higher, she added.
About 650 babies are delivered in Cayman annually. About half are delivered by private obstetricians with the other half by midwives at the Cayman Islands Hospital with the government-employed obstetricians supervising them.
If malpractice cover continues to increase, it could drive all obstetricians out of private practice, said Mr. Richter.
While the midwives at Cayman Islands Hospital are top notch in delivering babies, many expecting mothers prefer to have their own obstetrician, said Mr. Richter.
‘Women want choices,’ said Mr. Richter.
The lack of private obstetricians could drive more women go to Miami to deliver where malpractice insurance is not legally required. Fewer private obstetricians may also make Cayman less attractive to families still expecting to have children.
Furthermore, Caymanian doctors practicing obstetrics may not return to the country to work, because malpractice insurance is too expensive.
The Caymanian Compass had previously reported the driving factor behind the escalating rates are three cases involving negligence in childbirth by obstetricians with the potential for awarding millions in legal settlements, according the Health Practice Commission chair.
For years, the medical community had lobbied the previous administration’s Health Minister, but legal reforms had never materialised.
Another alternative is to set up a captive insurance company, which is effectively self-insurance. However, getting the upfront capital to set up captive insurance could prove to be prohibitively expensive for the five or six obstetricians still practicing in the Cayman Islands.
‘If government doesn’t come through, what then?’ stated Ms Pomares.