Articles and Case Studies

The Cases Committees: A Hospital Grand Round

02 Apr 2012

Claims Manager, Candice Danby, takes a behind-the-scenes look at MDA National’s Cases Committees.
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At MDA National we understand that when a patient sees a solicitor about making a claim regarding your treatment or care, or when a patient issues proceedings through the court system the process may impact on you emotionally, mentally and physically, as well as having an effect on your work and home life.

Our Cases Committees operate in the Western and Eastern regions of Australia.

Similar to a hospital “Grand Round”, our Cases Committees – comprising medical practitioners – provide medical input and advice to MDA National’s internal Claims and Advisory Services team and are an integral element of our claims process.

Who sits on the Cases Committees?

The committees comprise a chairman and a mix of practising or recently retired medical practitioners – between the committees representing:

  • anaesthetics
  • general practice
  • general surgery
  • obstetrics/gynaecology
  • oncology
  • ophthalmology
  • orthopaedics
  • physician
  • plastic surgery
  • radiology
  • sports medicine.

What do the Cases Committees do?

Claims Managers present claims to the Cases Committee by introducing the facts, expert evidence obtained and their view of the legal issues involved, including liability and causation.

Before each case is presented internal checks are conducted to ensure that no Cases Committee member has a real or perceived conflict of interest with either the doctor or the patient involved in a case. If a conflict does arise, the member has a duty to declare that interest and must not receive any information regarding the case and absent themselves from the committee during the discussion of that matter.

On presentation of the case, the Claims Manager refers back to the chairman who opens the case up to the Cases Committee for discussion. Such discussion involves in depth analysis and interesting commentary. Opinion can at times be divided and discussion robust, including dissecting the medical records, expert evidence, the patient’s account of events and any other useful information and documentation in order to drill down to the real medical issues of each individual file.

The Cases Committee achieves its purpose in relation to cases presented to it by:

  • reviewing all medical issues
  • providing a recommendation regarding the standard of care provided by the Member, consistent with the field(s) of expertise of the particular committee member
  • commenting on causation issues
  • commenting on apportionment of causation between Members and other parties where applicable
  • providing other professional input linked to the medical aspects of a case
  • where appropriate, providing opinions to management on perceived trends in incident reports
  • providing the Claims and Advisory Services team with other advice as requested by the Claims Manager.

At the end of the process the Cases Committee makes:

  • a recommendation regarding standard of care
  • suggestions regarding the medical management of a case, such as obtaining further expert evidence or information.

All Cases Committee members are bound by MDA National’s obligations under the Privacy Act 1998 (Cth) and have a duty to maintain the confidentiality of information received by them or to which they have access in the course of their role as a Cases Committee member.

Conclusion

Our Cases Committees provide a valuable resource for the benefit of our Members and ensure we achieve the best possible outcome for each of our Members on an individual basis. While you may not necessarily meet or speak with the Cases Committee members, rest assured that they are there to get to the real medical issues through the process of a claim.

By Candice Danby
Claims Manager (Solicitor)

Anaesthesia, Dermatology, Emergency Medicine, General Practice, Intensive Care Medicine, Obstetrics and Gynaecology, Ophthalmology, Pathology, Practice Manager Or Owner, Psychiatry, Radiology, Sports Medicine, Surgery
 

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