A cap of $500,000 on non-economic damages in medical negligence cases will not lead to a reduction in skyrocketing insurance rates for local obstetricians when rates are reviewed this year.
A month before members of the Legislative Assembly passed a cap on pain and suffering compensation in cases involving medical negligence last year, the Medical Protection Society, or MPS, the United Kingdom-based organisation that insures Cayman’s obstetricians, increased doctors’ malpractice premium by $40,000, bringing it to a record high of $162,360.
There is no relief in sight this year for the Cayman Islands’ obstetricians, according to MPS, whose director of international operations Dr. Tim Hegan said the rates will probably increase even further from March.
“Unfortunately, the new cap will not mean a reduction in subscription rates and because we are seeing an increase in the overall cost of claims, particularly those involving catastrophic injury, it is very likely that rates will rise for this speciality,” Dr. Hegan said.
He said non-economic damages were just one part of the overall cost of damages when an award is made, adding there have been no cases in which MPS has been involved that awarded so-called pain and suffering damages exceeding the new $500,000 limit.
“The major part of the award for damages is for the cost of future care, which is not capped and can still run into the millions,” he said.
The government introduced the $500,000 cap, despite opposition from the Law Reform Commission, last April. The awards limit applies only to compensation for pain, suffering and loss of amenities, and not on economic damages for long-term care, loss of income and other expenses arising from an injury due to medical malpractice.
Health minister Mark Scotldand said he was aware a reduction in the insurance rates were unlikely.
“I am aware of this situation – and I recently met with the OB/GYNs to discuss this and review other options available. I am waiting for them to get back to me with some additional information, so we can consider other available options,” he said.
“I would like to note that in tabling the legislation – I did say that this was not the only solution; I am not surprised that the rates are not going down,” the minister added.
During a debate to introduce the Medical Negligence (Non-economic Damages) Bill, 2011, last year, Mr. Scotland said MPS had written to the government in 2006 to outline potential actions that would help mitigate its risk and manage the increases in the medical malpractice insurance premiums.
“They highlighted a cap on non-economic damages as one of those factors that should contribute to containing or even reducing medical malpractice premiums,” said Mr. Scotland at the time.
Minister Scotland said MPS had also recommended that the Cayman Islands government cover medical malpractice insurance premiums for obstetricians, which he said was not “reasonable” for government to do. The Society also called on the government to implement decreased limitation periods for minors making injury claims; for legislation requiring attorneys to only take on cases with reasonable grounds of success, thus limiting frivolous cases and controlling costs; and take steps to keep medical negligence claims out of the courts by pursuing mediated resolutions.
The government was obliged to take action on non-economic damages last year because a $500,000 cap on such damages was one of the conditions included in a Memorandum of Understanding with Dr. Devi Shetty, who plans to build a medical tourism hospital in Grand Cayman. Mr. Scotland told legislators last March that the Shetty Hospital project was just one of the reasons why the issue had been tackled.
An average of 600 babies a year are born in Cayman, approximately half of whom are delivered by the Islands’ six obstetricians in private practice and the other half by four obstetricians at the public hospital in George Town.
Until recent years, there were seven private obstetricians, but one stopped practising due to the rising insurance rates.
Local obstetrician Dr. Barry Richter said if a private doctor delivered, for example, 50 babies a year, patients would have to be charged $3,000 just to cover the doctor’s insurance premium from MPS, without taking any other expenses into account.
He said the escalating insurance premiums will force some obstetricians out of business, eventually leaving just two or three private practitioners to deliver babies. A reduction in the number of private obstetricians would mean that the overall amount MPS charges the Cayman Islands’ obstetricians, which is currently just under $1 million, would be split between the remaining doctors, so their premiums would be much higher.
“Everybody is hanging on and hoping something is going to happen. If it doesn’t, those costs are going to skyrocket,” Dr. Richter said.
He said it was likely more pregnant women would go overseas in their third trimester because it would be cheaper for them to have their babies abroad.
Already many patients were transferring to the public hospital’s obstetricians as their due date came nearer because the costs were lower, Dr. Richter said. “They stick with the private doctors until the last trimester and then go to the hospital,” he said.
Bermuda’s obstetricians faced similar problems in the past, with huge hikes in malpractice insurance making it untenable for them to practice or leading to exorbitant fees for patients. In response to this, in 2009 the Bermuda Hospitals Board employed the local obstetricians to deliver obstetric care from the 24th week of gestation onwards, thus encompassing them in the board’s insurance policy.
Related Videos
