Cedric E. Stephens, Contributor

Question: I don't see much information about medical malpractice or medical malpractice insurance. Can doctors get insurance to cover alleged cases of malpractice? If yes, which insurers provide coverage? How expensive is it? Can institutions, like hospitals, buy insurance to cover the alleged liability of their employees?

- carol_v2002@yahoo.com.

Answer: Who pays for the mistakes of doctors? This is the sub-text to your questions. Sabrina Gordon and Gareth Manning, two reporters of this newspaper, wrote an article this year about the availability of malpractice liability insurance in Jamaica. It was published on June 15. The answer to your first question was partly captured in the article's five-word headline: 'No insurance for medical malpractice'.

Unlike the typical piece of writing found in most local papers about insurance, it was very rich in details. I will lean heavily on their work.

The incidence of medical malpractice in Jamaica is worrying. This is what local insurers say. Four out every 100 patients seen in a hospital will be victims of a medical error. Other than naming the source, the article did not give any details about the origin of those figures. Citing The Journal of (the) American Medical Association, Ms Gordon and Mr Manning said that in the US, one person out of every 10,000 patients who are admitted to hospital would have lived for three months or more "had optimal care been provided". What was meant by "optimal care" was not clear. The reporters also quoted a Harvard University study. It estimated that "at least 44,000 persons (in the US) died each year as a result of medical errors and over one million (are) injured".

The reporters did not give any details about the number of patients that were treated locally each year.

The Planning Institute of Jamaica, for example, provides information about the bed occupancy, number of out-patient visits, casualty attendance, death rate per 100 discharges, etc, in the public-health system.

Frequency of malpractice

These are some of the data which I believe would be used to estimate the frequency of malpractice claims in public hospitals. Information obtained by Ms Gordon and Mr Manning under the Access to Information Act about the number of claims filed against medical practitioners employed by the Government made interesting reading:

Seventeen cases were filed in court between 1993 and 2006.

Nearly 50 per cent of these cases were filed in 2004.

Insurers in Jamaica have generally turned their backs on professional (or, in the case members of the medical fraternity, malpractice) liability insurance.

This is a very specialised, high-risk area. These types of coverages are often sourced directly overseas or by way of membership of professional groups. American Home Assurance Company, the local branch of a subsidiary of the AIG group - the big American entity that was rescued recently from disaster by a big bailout - did not follow the trend.

It wrote the coverage for the University Hospital of the West Indies between 1997 and the year 2000. There were 38 cases reported during the period. The company paid out an estimated $29.2 million in claims.

No information was disclosed about the premiums which were paid. In 2001, the company stopped writing this class of business.

Malpractice liability insurance for doctors is very expensive. In Florida, for example, obstetricians can pay as much as US$250,000 to get coverage.

Some members of this specialty have reportedly left the profession because they cannot afford the premium. In Jamaica, local doctors are very secretive about the issue of the incidence of malpractice liability claims and the nature of their coverage.

The Government of Jamaica pays for the mistakes of doctors who are employed in the public-health system. The costs associated with the settlement of or the defence claims are charged to the budget. In the case of the private hospitals, I would expect that the funds to defend or settle claims of professional negligence would come from a variety of sources: private insurance companies, self-insurance schemes and/or doctor-owned insurance vehicles.

Cedric E. Stephens provides free, independent information and advice about risk and insurance. Email: aegis@cwjamaica.com.