Medical indemnity letters
Letter from the Health Minister (5 May, 2003)
Dr Bernard Pearn-Rowe
President
Australian Medical Association
14 Stirling highway
NEDLANDS WA 6009
Dear Dr Pearn-Rowe,
I noted your comments on the issue of Medical Indemnity as reported
on 720 ABC Perth News this weekend:
"The State President of the AMA, Bernard Pearn-Rowe, says hundreds
of visiting doctors will walk off the job if the Government doesn't
provide a concrete solution."
In the context of the report, it is implied that you were referring
entirely to the State Government without any reference to the Commonwealth.
I also read your comments on this issue on the President's Page
in the April edition of Medicus wherein you say:
"The solution to these problems is complex and lies partly
with the Commonwealth Government, and partly with our State Government.
Although the AMA is far from content with the extent of the Federal
initiatives, it can at least be said that Canberra has made some
decisive and positive moves. There has been a productive dialogue
at regular meetings between the AMA and the highest level of
Commonwealth Government. There has been a sense that things are
being progressed and the Prime Minister has taken personal control
of the matter. Our disappointments must not detract from the
fact that a lot has been achieved by the Federal Medical Indemnity
task force working with the Prime Minister and his department."
Further to this in a bulletin to your members dated 24 April 2003
you said:
"The State Government has agreed to legislative reform and
policy changes to address medical indemnity issues."
Given these public statements, I am somewhat confused about your
approach, particulars in light of a nation-wide advertisement placed
by the Federal Branch of your association in The Australian on
Saturday 3 May 2003. In that advertisement (copy attached) your
Federal colleagues appear to be vehemently disapproving of what
you have labelled as "decisive and positive moves" of the
Commonwealth and the introduction of its legislation-clearly evidenced
by a call to doctors to retire, cease practice of high risk procedures
or cease private practice altogether in favour of public work only.
It is misrepresentation to your membership in this State to infer
that the added difficulties surrounding medical indemnity that
they will encounter from 1 July this year is the result of any
action of the State Government. Unless of course it is actually
the case that AMA WA Branch has a completely different understanding
of the Commonwealth legislation than its Federal Branch. In which
case I would be very interested to hear your view.
Your association has been repeatedly assured that the State Government
will provide indemnity cover to VMPs for their public work, effective
1 July 2003. This commitment remains unchanged and in this regard
you will be provided with the details of the intended cover this
week.
It would be a terrible disservice to your membership if the administration
of the AMA WA Branch were deliberately muddying the waters on this
issue in an ill-conceived attempt to redirect criticism away from
the Commonwealth government onto the State Government. I look forward
to come clarity from you on this issue as soon as it is convenient.
Bernard, I have noticed in the past that in the interests of your
members you have taken the liberty to public my correspondence
to the AMA. I would be more than happy for you to repeat that practice
on this issue.
Yours sincerely,
Bob Kucera APM MLA
MINISTER FOR HEALTH
Response from Dr Pearn-Rowe (6 May, 2003)
The Hon R Kucera
Minister for Health
10th Floor Dumas House
2 Havelock Street
WEST PERTH WA 6005
Dear Minister
Thank you for your letter of 5 May 2003 advising
me of your confusion following some of my recent media comments.
Your response is indicative of the chasm of misunderstanding
that exists between us and I am deeply concerned that our State
Minister for Health, who is also Chair of the Australian Health
Ministers Conference, should be so poorly briefed in these matters.
There are two principle reasons why hundreds of my
colleagues may opt to retire prematurely or restrict the services
they provide. The first is the uncertainty of indemnity in respect
to services provided to public patients in State Government hospitals.
The second involves the question of "run-off" cover to indemnify
a doctor against claims that may be made after retirement.
You will recall, Minister, that at a meeting I had
with you and the State Attorney-General in early October last year,
I advised you both of the decision by WA's major MDO not to offer
insurance contracts to VMPs after 30 June 2003. I explained to
you then, as I have on several occasions since, the far-reaching
implications of this decision and the impact it would have upon
health service delivery to Western Australians especially in rural
and regional areas.
On many occasions I have stressed to you the need
for leadership and prompt action to preserve the integrity of medical
services. I have explained that, in the face of this uncertainty,
my colleagues have already been forced to make decisions about
their future practice. Obstetric and surgical bookings are made
months in advance. Other professional decisions have had to be
made already. Yet seven months after you were first alerted to
this, and seven weeks before the deadline, the profession has yet
to be advised of any detail or receive anything more than reassurances
that "she'll be right" and broad brush policy directions.
Minister, my profession is weary of your Government's
promises and your bland reassurances offer no comfort at all. We
needed your support earlier in the year, when these decisions were
being made. Even your indemnity reform package announced today
will be too late for many doctors to wind back arrangements they
have made as a result of your 'policy vacuum'. In your indemnity
reform package released today, you had the opportunity to "stem
the tide" of uncertainty, show leadership and bring a new stability
to the provision of health care to Western Australians in State
Government hospitals. Instead of seizing the opportunity, you have
provided what you yourself describe as a "interim" solution.
The Government's failure to make a concrete commitment will create
more uncertainty rather than less.
As I write this letter, executives of MDA WA are
in Europe negotiating the next round of reinsurance contracts.
When considering the so-called "run-off" or death, disablement
and retirement cover, a critical consideration is the Statute of
Limitations that will apply in respect to allegations of medical
negligence and that Statute currently allows claims to be made
up to 24 years after an alleged event. As you well know, the Association
has long advocated a reduction of the limitation period to three
years with a modest extension for special cases, such as those
involving some minors and the intellectually disabled. It is not
possible to arrange reinsurance for an extended period of time
like 24 years and consequently MDA WA cannot give members any certainty
of cover while this law stands. This State Government has not yet
legislated and followed the lead of other jurisdictions in the
country and revised the Statute and made other necessary changes.
As a result Western Australian doctors will suffer for your Government's
delays.
Minister, these are the major drivers of the uncertainty
and dissatisfaction that currently exist here in the West. This
is not a 'buck' that you can pass to Canberra as you have done
so often in the past. These are not Commonwealth issues, they are
State issues. They are issues that you and Dr Gallop's Government
have been aware of for over a year and which you have spectacularly
failed to resolve.
Rather than address the problem - even at this late
hour - you have accused me of "muddying the waters on this issue
in an ill-conceived attempt to redirect criticism away from the
Commonwealth onto the State Government". You may wish to play Commonwealth/State
politics, readers of this correspondence will judge for themselves
that these are State matters and no amount of mud can obscure that.
I am interested in results. Your responses compared to other States,
such as New South Wales and Queensland, are belated and have caused
unnecessary stress and instability which the AMA (WA) has tried
to assuage with, for example, my recent bulletin. The proposal
to cover VMP's for only 12 months, does not engender security.
It is insufficient to assist in facilitating services in rural
Western Australia or maintaining some services in metropolitan
Perth.
It is as sad as it is frustrating to note that almost
every issue that has arisen between you and my profession since
you became Minister has been characterized with this kind of "us
and them" mentality. Your letter under reply is typical of our
face to face discussions - always aimed at a political imperative
rather than actually working through a problem and advancing the
promotion of health services to Western Australians.
You have concluded by asking that I publish your
letter in Medicus. I was appalled that in my presence, you
distributed your letter to me to selected members of the press.
Therefore, I have no alternative but to send this response to the
media. I will also mail this correspondence to every member of
my profession in the State and to every State Politician. When
people ask 'why is health in such a bad way?' the answer will be
abundantly clear.
Yours sincerely,
BERNARD PEARN-ROWE
PRESIDENT
c.c. State Members of Parliament
Federal Cabinet
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