Do I Really Need an MDO?

The beat of fate’s butterfly wings can fan a seemingly minor task into a subsequent vortex of disaster and shame, causing irreparable damage to your future career and reputation.

As a doctor, I’m astounded to hear there are practitioners out there who don’t have medical indemnity insurance. Particularly junior doctors, where the cost of the insurance (if there is one at all) is less than two movie tickets and a takeaway meal.

As a solicitor, I shudder to think of the legal costs that would be personally incurred by these uninsured doctors, if a matter did arise. The gnawing fear, not able to pick up the phone for advice through fear of costs – at a moment which may be one of the most harrowing points of their professional career.

As a medico-legal adviser, I’m distressed by calls we receive from uninsured doctors involved in a matter and with nowhere to turn. So let’s depart on a journey to see why medical indemnity insurance really does matter. It starts with a patient, a doctor who cared, and a healthcare roulette that sometimes doesn’t spin your way.

So what could go wrong?

Our patient, septic with pneumonia and pleurisy, had a central line placed earlier today. For the third time this afternoon the nurses seek review of the patient’s recurrent chest pain, reassuringly noting “obs are ok”. They missed that elusive respiratory rate, now 35, suggesting all is not well. It has been a long day. Losing your cool down the phone seems oddly cathartic. “I’m busy, I’ll be there when I can”. After all, pleurisy is why the patient is here.

The staff go quiet. So when the MET call comes, it’s a surprise. Resuscitation doesn’t go so well, taking longer than it should to diagnose the tension pneumothorax in the face of a new arrhythmia. Possibly the amiodarone you gave contributed to the death. Before you know it, you’re completing the coronial referral, the family are threatening to sue, and the nurses are busy completing a risk notification about your delay in attending and unprofessional tone. A really long day…

What kind of insurance is required?

AHPRA registered health practitioners require professional indemnity insurance. A breach of this legal requirement¹ can result in action by AHPRA against the practitioner.

The Medical Board of Australia Registration Standard² importantly tells us that compulsory insurance only refers to cover for claims – insurance against civil liability incurred by, or loss arising from, a claim that is made as a result of a negligent act, error or omission in the conduct of the practitioner. What we doctors would term “being sued”.

Generally, hospital employed doctors will have this simple level of cover provided by their employer – making them “employer indemnified”. If sued, their employer would pay the costs of legal representation and any damages payable to the plaintiff resulting from the claim.

Importantly, such doctors need to ensure they’re still covered by their employer outside of their place of employment, e.g. rotation to a private hospital, GP practice or locum work. If not, they may foot the bill for a claim and breach their registration indemnity requirements.

So why do I need a medical defence organisation?

While being sued might be the most expensive medico-legal matter you could face as a doctor, it’s certainly not the only risk.