Saturday, February 13, 2010

Private Practice Midwives and Insurance

Private practice midwives / Independent Midwives, both mean the same and are used interchangeably. Just to put some issues in perspective this is a global problem and it comes down to money. Why is it we need insurance? ... this is because we live an over-litigious society.

The current situation in the UK....there is no professional indemnity insurance available to Independent Midwives, the bottom line is that they are liable for any negligence claim made against them as is the case in Australia.
The systems are similar between Australia and the UK. Hospital midwives, and Community Midwifery Pogram are covered by the hospital and in the UK by the Trusts therefore covered by vicarious liability through the employer.

Like Australia the Royal College of Midwives (RCM) provided insurance to independent midwives until Australia 2002 and UK 1994. The RCM decided to exclude those members who practised independently from the Private Indemnity Insurance cover, in order to keep RCM premiums at an affordable level. The insurance cover was half a million much to cover... However the UK did still have some insurers that would cover Independent midwives, despite having good outcomes the price still increase to 20,000 pounds per year for a midwife (A$45,000 per year). In 2002 the last commercial insurer withdrew from the market because it was not commercially viable due to the small numbers of independent midwives in the UK.
The UK is considering.... Independent Midwives and Contracting to NHS Trusts....its worth a thought....

Midwives have not had access to professional indemnity (PI) insurance since 2002/03, when Australia faced a medical indemnity crisis that resulted in large premium increases.

Just to add reality to the equation here is a case of negligence that resulted in a payment of $11 million dollars.....
In November 2001 the NSW Supreme Court awarded Calandre Simpson, an infant born at St Margaret's Private Hospital with cerebral palsy, fourteen million dollars (the award was reduced on appeal to eleven million dollars) for the overdose of syntocinon, which caused her birth defects. At that time the award was twice that of the next highest payout. This payout assisted in the collapse of Australia’s largest medical indemnity organisation, United Medical Protection (UMP, now Avant) and brought with it what we know as the ‘medical indemnity crisis’.

From this crisis came the key reforms was the introduction of the Policy Support Scheme (PSS), available to obstetricians, neurosurgeons and rural procedural GP’s.
and off course midwives were not included.... I think we missed the boat here.
Now this is an interesting concept that came out of this....
‘Under the PSS, if a doctor's gross medical indemnity costs exceed 7.5 percent of his or her gross private medical income, he or she will only pay 20c in the dollar for the cost of the premium beyond that threshold limit. In other words, the PSS meets 80 percent of the premium above the 7.5 percent threshold of an eligible doctor’s gross private medical income.

Justine Caines stated....Interestingly the rights of Australian women choosing private midwifery don’t have the same value as those women choosing the services of a specialist obstetrician or a procedural G.P. When I challenged the legal branch of NSW Health with this comment I was greeted with silence.

The Australian College of Midwives continues to lobby and negotiate for possible solutions to this current problem...... so watch this space....

The picture: Laura is my friend we did our Midwifery together at Hertfordshire University.. she is now an Independent Midwife......" midwives have babies too, and I can really empathise with the women I care for now"

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