Litigation forces doctors to take Rs 1 crore-plus insurance
A cardiovascular surgeon in Mumbai has sought an indemnity cover of a staggering Rs 20 crore, highlighting a trend of doctors buying bigger-than-before insurance policies to safeguard against litigation. Health activists and even a section of doctors have called it an unhealthy trend, “a reflection of growing commercialization of healthcare”.

Most medical associations now advise doctors to go for minimum insurance of Rs 1 crore per annum, which is four times what they would opt for just a couple of years ago. The period has seen a 30-40% annual rise in the number of doctors enrolling for indemnity schemes to cover legal costs if sued, as well as to shore up against possible payouts to aggrieved patients.

“When courts now grant compensation in crores, what choice do doctors have but to go for higher insurance covers?” said Dr Sudhir Naik, who heads the medico-legal cell of the Association of Medical Consultants (AMC). His reference is to a Supreme Court judgment of 2013, awarding an eye-popping Rs 11.4 crore to an NRI, Dr Kunal Saha, for his wife’s death at a Kolkata hospital, which marked a precedent for the award of large payouts after litigation.

The costs of all ranges of covers have gone up in recent years. While Rs 50 lakh to Rs 2 crore (and far above that) is what gynaecologists, neurosurgeons, heart surgeons, intensivists and anaesthetists choose (as they are the most susceptible to litigation), Rs 50 lakh-Rs 1 crore is what orthopaedics, general surgeons, radiologists, and pathologists opt for. Even general physicians, paediatricians, and psychiatrists, who traditionally have been at the lowest risk of litigation, have upgraded to a minimum of Rs 20 lakh versus 5 lakh earlier.

The need for protection from medico-legal liabilities, doctors say, has mainly been brought on by increasing litigation and the decisions of “consumer-friendly” courts. One of the first bodies in the country to offer an indemnity scheme to its members in 2000, AMC today has insured nearly 7,500, or 65%, of its 11,500 members (the body pays an annual premium of Rs 4.5 crore to the Oriental Insurance Company).

AMC said there are 11 ongoing cases against its members at the National Consumer Disputes Redressal Commission and 58 at state commissions. Cases in the states nearly doubled from 15 in 2017-18 to 27 in 2018-19. “The SC order changed a lot of things,” said Dr Anand Kate of the Indian Medical Association (IMA), which has since 2013 added nearly 300 members in its indemnity scheme every year. “A payout of that scale can wipe out a doctor’s entire practice and push him into financial distress.”

The Association of Surgeons of India (ASI), a body of 22,000 specialists, rolled out an indemnity scheme three years ago following strong demand from members. “Associations can bargain better with insurance firms than individual doctors,” said Dr Arvind Kumar, head of surgery at AIIMS and president of ASI.

Some doctors say it’s one-sided to blame litigators or the courts. They say that the situation has come about in the first place because of the increased commercialization of healthcare. ‘If you charge more, treating medicine as a service and not a human right, you will get sued if the patient isn’t satisfied with that “service”,’ goes the refrain.

“What’s happening is a direct product of commercialisation of healthcare, and a sign of a deeper problem, which is the breakdown of the patient-doctor relationship,” said Dr Abhay Shukla, convenor, Jan Swasthya Abhiyan.

“Like in the US, we are witnessing a shift from a trust-based relationship to a conflicting one. Unfortunately, neither the patient nor the doctor gains much in such an arrangement. It’s the insurance company that laughs its way to the bank.”

Saurav Datta of ICICI Lombard said there is a near-10% increase in doctors opting for indemnity cover annually. “It’s true that covers have started moving into crores as patients demand more accountability and no longer want to look at treatment outcomes as God’s work,” he said. Doctors, and also activists, also fear a rise in healthcare costs in the near future owing to the insurance trend.

“In many hospitals, it’s a prerequisite. A doctor has to submit indemnity policy papers to get on board as a consultant,” said noted gynaecologist Dr Kiran Coelho, who consults at Lilavati and Hinduja hospitals. “Most doctors I know have a cover of Rs 1-3 crore,” she said.

Medico-legal experts feel the Consumer Protection Act, 2019 could fuel the trend. “Under this new Act, people can demand higher compensation of up to a crore right in the district forums (the cap used to be Rs 25 lakh) without having to go to the national commission.

“Though India is not close to the situation prevailing in the US, one in 14 doctors is sued every year,” said Dr Shivkumar Utture, a general surgeon, “ in the west-like trend, no doctor is encouraged to practice without insurance, will give rise to defensive practice.” The net loser is likely to be the patient.

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Dr. V●●●●●●j D●●●i
Dr. V●●●●●●j D●●●i Legal Medicine
Taking insurance is a good option, if you think that it is not a burden to pay the monthly or yearly premium. However, there is no substitute to the following things : (1)keep close contacts with a medicolegal specialist like me, who is highly experienced in law as well, (2)keep your documents complete & intact, (3)communicate accurately & completely with the patient & influential-well wishers of the patient, (4)take SPECIFIC written consent (not a blanket all encompassing 1 sentence) in the language which the patient & relative understands, and preferably take one of your staff member' s sign as witness for the explanation & consent, and (5)MOST IMPORTANT: remain away from all forms of negligence. CARE SHOULD NOT ONLY BE GIVEN; IT SHOULD BE SEEN TO BE GIVEN ALSO.... Read more
Sep 28, 2019Like