Doctors’ disquiet over lawsuits

Dar es Salaam. Doctors are advocating incorporating professional indemnity insurance in policy and regulatory frameworks. This comes as a result of increasing public awareness regarding patients’ rights – and, thus, avoiding possible litigation against medical malpractice.

Thanks to the Information Communication Technology (ICT) revolution, people are getting more conscious, experts say, citing the relentlessly increasing numbers of patients seeking compensation, compared to twenty years ago.

In trying to cope with the changes, doctors believe that it’s time for them to be shielded from risks emanating from negligence – the shield being in the form of professional indemnity insurance cover.

Such a scheme essentially provides professionals with insurance cover in respect of charges or allegations which may be made against them for professional negligence when practising their profession.

Why now?

During their meeting in Kenya on April 24 this year, the Coalition of African Medical Associations (CANMA) consisting of 14 African member countries including Tanzania joined hands to raise concerns that all medical professionals and healthcare practitioners must obtain indemnity insurance cover.

Other countries supporting the motive as members of the Coalition were the Democratic Republic of Congo, Ethiopia, Gambia, Ghana, Kenya, Mozambique, Nigeria, Rwanda, Senegal, Somalia, South Africa, Uganda and Zambia.

Representing Tanzania at the meeting, MAT President Elisha Osati told The Citizen that one of the recommendations by the member countries was for doctors to obtain professional indemnity insurance cover to protect doctors from claims of negligence, errors or omissions in the performance of their professional tasks.

Dr Osati said: “In Tanzania, we have developed initiatives to raise awareness among doctors on how important the indemnity insurance is to their profession. (This is) because the number of cases of people demanding compensation has increased over the years.”

The MAT president admits that information technology has contributed to that.

“Currently, we have the so-called ‘Google Doctor’ on the internet where people can ‘screen’ themselves and think they have known it all. When they come to the hospital, they want the doctor to do what they have seen on the internet!”

Noting that most doctors don’t have professional indemnity cover, Dr Osati said MAT (Medical Association of Tanzania) is working on ensuring that more doctors obtain insurance cover.

“Now, when a doctor faces litigation, there is the danger that the employer will not be involved. Therefore he (the doctor) will have to meet the claim(s) on his own,” he stated.

At the same time, however, it is important to know that not all complications or bad outcomes are necessarily due to negligence by the healthcare provider, be it an individual or an institution.

“In most cases all over the world, only a small percentage of doctors are ever found guilty of negligence,” Dr Osati said.

What insurance authority say

When asked by The Citizen about the availability and accessibility of professional indemnity insurance cover, the Insurance commissioner at the Tanzania Insurance Regularity Authority (Tira), Dr. Baghayo Saqware, said there is an indemnity insurance cover in Tanzania for professions such as doctors, accountants, engineers, etc. to help them in case of litigation. But, the only issue is the fact that the insurance is voluntary – and, so, not all of them have it.

Dr Saqware further noted that “our society has never had the tradition to hold doctors accountable. But, due to the continuous globalization and related developments, the public has now awoken to it. (The world) has become a society that wants compensations.

“People nowadays know that they can have a (successful) medical negligence claim if something goes wrong during a procedure, or when you’ve had a ‘bad outcome,’” he added.

Challenges

Speaking to The Citizen, Dr Saqware explained that the absence of professional indemnity cover makes doctors to constantly worry about litigation. This somehow adversely affects their decision-making.

“I encourage medical practitioners to obtain an indemnity cover because, without it, some doctors developed a defensive attitude, an overcautious behaviour when providing medical services,” he said.

Dr Osati also explained that medical practitioners constantly worry about what might happen if they do a certain procedure, or recommend different medication or treatment because they know they might be subjected to adverse consequences.

He narrated a scenario where a cancer patient who was diagnosed by doctors in a certain hospital at Dar es Salaam to the effect that leg amputation was he only answer.

Three years later, the patient returned to claim compensation from the hospital on the grounds that the doctors who treated him should have known that the amputation procedure was unnecessary.

“That is why we emphasize insurance, as it will increase confidence in the services provided by healthcare practitioners. Indeed, some medical practitioners second-guess their decisions, asking themselves ‘what would happen to me if I suggest this – and it doesn’t work out that well?’ Or: ‘what if he dies?’

Way forward

According to the insurance commissioner, Dr Saqware, Tira as the country’s authoritative insurance organ has submitted to the government through the ministry of Finance and Planning a request to make indemnity insurance mandatory for professionals.

Dr Saqware explained that the aim is to make sure that every professional doctor is obliged by law to have insurance cover.

“Like how you can’t operate a vehicle without an insurance cover; this is what it is supposed to be: that a doctor cannot start practising the profession without first obtaining the indemnity insurance cover,” he said.

He insisted that this will actually improve performance of the medical sector in Tanzania, as the confidence of medical practitioners will be boosted.

Supporting that notation, Dr Osati stated that MAT also supports the move, and called upon the government to make insurance cover mandatory under the law.

“We need it to be in our Medical, Dental and Allied Health Professionals legislation and policy,” he said.

However, Dr Osati noted that they prefer the indemnity cover to be under the jurisdiction and obligations of the employer. This is especially considering that some doctors will not be able to afford the insurance due to low salaries.

“Paying for professional indemnity cover would be an additional expense on medical workers’ salaries, which would be an extra burden on some of them,” he explained.