Doctors performing high-risk procedures need to pay higher premiums

PETALING JAYA: Specialists who perform complicated and high-risk procedures are paying more for their medical indemnity insurance premiums, which are increasing due to a rise in malpractice lawsuits, says the Malaysian Medical Association (MMA).

MMA president Datuk Dr Kalwinder Singh Khaira said these lawsuits and the huge court awards are deterring doctors at private hospitals from carrying out complex procedures.

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As a result, he said public hospitals, which are already grappling with a high volume of patients, end up having to accept such patients.

He said specialists involved in advanced healthcare would pay premiums of up to RM100,000 yearly.

“While medical indemnity insurance premiums have generally remained static over the past seven years, doctors who conduct high-risk medical procedures – such as those in the field of neurosurgery, obstetrics and gynaecology – are seeing an increase in premiums, which can largely be attributed to rising medical compensations awarded in lawsuits.

“This also contributes to medical inflation and higher costs to patients,” he said when contacted.

Dr Kalwinder said the Medical Act stipulates the need for doctors in private practice to obtain medical indemnity coverage for the application and renewal of their annual practising certificate.

The MMA, he said, would facilitate the application and renewal of medical indemnity insurance for its members under two insurers – Medefend and the Medical Protection Society.

He added that the MMA also regularly evaluates the terms and conditions of these policies and makes recommendations for improvement.

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Asked if the MMA is taking steps to address the rise in insurance premiums for doctors amid concerns over escalating court awards in medical negligence lawsuits, he said MMA had discussed this with stakeholders such as the Bar Council, the Attorney General’s Chambers, Bank Negara Malaysia and the Health Ministry.

“The MMA and other like-minded groups have agreed to form a working group to raise proposals and solutions that will be submitted to the government,” he said.

Federation of Private Medical Practitioners’ Associations of Malaysia president Dr Shanmuganathan Ganesan also shared the view that multimillion-ringgit court awards have led to certain doctors refraining from performing high-risk procedures.

“Certain disciplines have become too risky. A good example is obstetrics. Cases are not complex, but anything can go wrong either with the mother or the baby.

“Many private obstetricians- cum-gynaecologists are dropping the practice of the former and just focusing on gynaecology,” he added.

Dr Shanmuganathan said he believes that in the coming years, the quantum paid out can become a serious concern even for the government.

“Every time the government loses a medical lawsuit, the payout comes from taxpayers,” he said.

However, he said that when a medical practitioner takes on a complex case, he will see it to the end and the question of “abandoning” a patient does not arise.

“On the other hand, if a doctor feels that a case is too risky, he can or would inform the patient or next of kin that he would rather refer the patient to a public or academic institution.

“This would be done before any admission.

“Complex cases where risk is very high, like neurosurgical interventions, are generally rare. The neurosurgeons would make it known that they handle such cases and would accept referrals,” he said.

Dr Shanmuganathan said the medical indemnity insurance for general practitioners (GPs) costs between RM2,000 and RM10,000 annually depending on the medical services they offer, while doctors in high-risk disciplines like obstetrics, neonatology, neurosurgery and orthopaedics fork out higher premiums of between RM3,000 and RM8,000 monthly.

Association of Private Hospitals of Malaysia president Datuk Dr Kuljit Singh said medical indemnity insurance has increased across all specialities, particularly those in high-risk areas such as obstetrics and certain fields of neurology and orthopaedics.

“The surge in costs directly impacts physicians whose fees are regulated and cannot be passed on to patients.

“As a result, there is a possibility many doctors may resort to defensive medicine, opting to take up cases with lower risks with lower chances of a medicolegal battle with the current climate of medical lawsuit cases and increasing premiums of medical insurance,” he said.

Insurance agent Kumaran Sinnappan said the purpose of such coverage was to deal with compensation in the event of medical negligence lawsuits.

He said GPs who do not conduct surgical procedures in their clinics usually take up policies with a coverage of about RM1mil.

“The coverage can be as low as RM250,000 but a majority of my clients opt for RM1mil. The annual premium is about RM1,000.

“The insurance company offers coverage of up to RM1mil and any amount awarded beyond that will have to be borne by the doctor involved,” he added.

Kumaran said the company he works for has not increased its medical indemnity insurance premiums in recent years.

Consumer groups are urging doctors to adhere to their fiduciary obligations and not turn away patients over concerns about malpractice lawsuits.

Malaysia Consumers Movement secretary-general Herby Dhillon said doctors or hospitals must ensure their patients receive adequate treatment on being admitted.

He said the choice to discharge themselves and seek treatment elsewhere should be up to the patient.

“Under no circumstances should a doctor or hospital decline to treat or force patients to discharge and be treated at another facility,” Herby said.

Consumers Association of Penang president Mohideen Abdul Kader said private hospitals would be shirking their responsibilities as healthcare providers if they turned away patients over concerns of facing legal action.

“In case of lawsuits, private doctors and hospitals are covered by medical indemnity insurance. Government hospitals should not be further burdened with referrals from private hospitals,” he said.Galen Centre for Health and Social Policy chief executive officer Azrul Mohd Khalib said private hospitals are healthcare providers, but they are also business entities and their concerns on the outcome of recent court judgments in cases of malpractices was understandable.

He agreed that patients who seek treatment at private facilities should not be turned away and referred elsewhere.

“In ensuring the well-being of patients, there should be a standard code of conduct or a patient’s Bill of rights that private hospitals should prescribe to, so that when a patient is admitted, there is an obligation on the part of the healthcare facility.

“Currently, each private healthcare centre has its own Bill of rights,” he said.