A huge hike in malpractice
insurance rates for obstetricians in Cayman could mean fewer doctors in the
private sector will deliver babies locally.
Obstetricians say a $40,000 hike in
their insurance rates this month puts not only their practices at risk, but
could also mean patients face greater risks as the workload for doctors would
increase if some of the six private OB-GYNs stop delivering babies.
With effect from 1 March, the
latest increase in the rates mean that obstetricians are now paying $162,360 a
year for their insurance. Six years ago, the rates were $14,000.
UK-based insurance company Medical
Protection Society insures Cayman’s obstetricians.
Dr. Tim Hegan, director of international
operations for the insurance company, said Medical Protection Society had
delayed introducing increases in obstetric rates over the last two years
“hoping that intervention from government would prevent the necessity to do
However, over time this became unfeasible, given the risks associated
with indemnifying obstetricians and gynaecologists and we had to increase our
Chairman of the Health Practice
Commission, Dr. Steve Tomlinson, said a sub-committee to look into the
escalating rates and the issue of medical malpractice submitted a report to
government in 2008.
However, the issue was only recently addressed by the
Cayman Islands government, which has drafted a Medical Negligence (Non-economic
That bill is expected to be tabled
in the Legislative Assembly in its next sitting, which begins on Thursday, 17
It sets a cap of $500,000 for non-economic payouts – settlements for
pain and suffering and loss of amenities in personal injury cases, rather than
loss of earnings or medical expenses.
The Law Reform Commission opposed
the cap in a report it submitted to government last year.
The proposed establishment of a new
medical tourism hospital by Indian cardiologist Dr. Devi Shetty has been the
impetus for the introduction of the bill as a cap on non-economic damages was
one of the criteria set down by the doctor before he would move ahead with building
Mr. Hegan said it was too soon to
know whether the insurance company would review its subscription rates as a
result the proposed bill and the $500,000 cap, which he described as
“interesting”, adding “however, it only makes up a small part of the overall
He said his company had been in
discussions with the Department of Health and medical professionals in Cayman
for several years to “bring to the attention of the government the issues
relating to the high level of damages and the impact this has had on the cost
and affordability of indemnity”.
Mr. Hegan said the insurance
company had increased its rates for obstetricians and gynaecologists “due to an
increase in settlement values, particularly those involving catastrophic
injury” – a situation he said was not unique to the Cayman Islands.
Cayman has six obstetricians
working in the private sectors, all of whom face the hike in rates.
Obstetrician Dr. Howard Deosaran
said he feared the latest increase would put pressure on some obstetricians to
stop delivering babies because they could no longer afford to do so and those
who continue to practise will have to take on more patients.
“What this will serve to do is
increase the risk. If we have fewer OB-GYNs in the private sector, the number
of complications will increase because those physicians will have to work
harder, they’ll have more patients, and they’re going to be tireder,” he said.
The expensive rates would also mean
that new obstetricians would be reluctant to start a new business here, he said.
“When I started in 2005, I was
paying $14,000 in rates. Now it’s more than $162,000. It cannot go on like
this,” Dr. Deosaran said.
Another OB-GYN, Dr. Barry Richter
said if the increases in rates continued, it was likely some obstetricians in
the private sector would choose to no longer practise because it would not be
This in turn would mean that the
overall amount of money the insurance company needed to collect from the
remaining obstetricians in Cayman would remain the same but the bill would be
split between fewer doctors, meaning the obstetricians who continue to practise
would end up paying even more.
“Say two or three obstetricians
stop practising, everyone else has to pay more,” he said.
Dr. Tomlinson agreed that the
increasing rates were worrying and could lead to fewer obstetricians practising
in Cayman. “Something needs to be done,” he said, adding that he believed other
medical fields would likely also face hikes in the future, such as anaesthesiologists and other professionals.