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Managing Director’s ReportIt is that time of the year again!

National Disability and National Injury Insurance Schemes

There are a number of uncertainties for MIPS and members associated with the National Disability Insurance Scheme and in particular the National Injury Insurance Scheme.

Recently the National Disability Insurance Scheme Bill (NDIS) was introduced to parliament. A particular area of (unexpected) uncertainty for MIPS and members relates to the ability of the NDIS CEO to require scheme participants or prospective participants to take action to claim or obtain compensation (or risk sanctions) and the ability of the NDIS CEO to approach compensation payers or insurers directly to offset the costs of the scheme.

MIPS is keen to avoid any possibility that members might be exposed to higher levels

The end of 2012 finds MIPS in a very sound position with ongoing improvements in the service, benefits and security offered to members. In general terms, an analysis of the 30 June 2012 accounts for the sector shows the efficiency of MIPS use of members’ funds in achieving the very high levels of financial security and stability that MIPS members enjoy.

of uncertainty in respect of; number of claims; when claims or potential claims can be finalised and to minimise the adverse impact on the mental and physical health of members associated with late opening or re-opening of matters.

Members are already exposed to the potential for multiple claims and complaints from a single incident (hospital/practice complaints, State health complaints body, AHPRA, coroner’s court, civil litigation etc) and adding further uncertainty must be avoided.

MIPS is also involved in National Injury Insurance Scheme (NIIS) discussions. MIPS remains concerned that the financial impact on medical practitioners from the NIIS passed on through medical indemnity premiums may be significantly greater than otherwise and significantly greater than expected. The most

important of the current NIIS unknowns include the number and value of;

* current ‘negligent’ catastrophic injuries that are intended to be covered by the scheme. This is mainly because of current lack of clarity in respect of;

• entrythresholddefinition

• theoperationsofthedecisionmaking body that will determine eligibility

• theuncertaintyastowhetherthe High Cost Claims Scheme can and/or will operate to help fund the scheme and

• decisionsregardinginclusionor transfer to the NDIS of Cerebral Palsy matters; and

* non-negligent catastrophic injuries that are intended to be covered by the ‘no-fault’ scheme (such data is not readily available)

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Dr Troy BrowningManaging Director, MIPS

Managing Director’s report page 2

ArticlesDollars, Defence and Dentistry - Dr Gerry Clausen page 8

Psychiatric training linking Australian physicians with Fiji - Prof Philip Morris pages 9 & 10

Risk Education

Member risk education - Why participate? pages 6 & 7

‘Conversations at the end of life’ online module page 7

Other News

GP12 eHealth Hypothetical page 4

Breath test for bowel cancer page 11

The NIIS is intended to cover medical injuries from all sources. Currently however only State (public hospital insurers) and specialist Medical Indemnity insurers have been put forward as ‘insurer’ funding sources. Health is a team sport with many

different craft groups. MIPS is keen to ensure that members and the medical profession generally are not called upon to fund the claims of health service providers who do not contribute to funding of the NIIS.

Take care!

I take this opportunity to wish members a happy, safe and enjoyable holiday season and I look forward to sharing with you the challenges of the new year.

Mifepristone Receives TGA approval

Only medical practitioners recognised by MS Health (a not-for-profit pharmaceutical arm of Marie Stopes International Australia) as having completed appropriate training will be able to prescribe the medicines.

There is a requirement that MIPS members have the appropriate recognised qualifications, training and experience for the health services they provide. That means members are required to complete the above training as well as meeting medical college requirements.

Members considering such practice should provide such documentation to support that these requirements have been met.

Any further queries may be directed to the

Membership Assessment, Acceptance

and Advisory Committee.

Practice StaffConcerns have emerged within MIPS that the staff of members’ practices may be seeking advice and/or making a notification on a member’s behalf without the member’s express knowledge or consent.

Ultimately, the benefits provided by MIPS are solely for members and whilst we are happy to provide access – on your behalf – to practice staff acting with your express authority, we must protect your interests and seek confirmation of this arrangement.

With immediate effect, MIPS staff taking Clinico-Legal Support calls from member’s practice staff will ask practice staff to provide an authority signed by the member they are representing. That will authorise your staff member to engage with MIPS on your behalf, assures us that you are aware of the matter and helps MIPS protect your confidentiality.

We apologise if this adds some minimal additional administration, but MIPS is determined to act in your best interests.

In August 2012, the Therapeutic Goods Administration (TGA) registered mifepristone and misoprostol for wider use by Australian women. Previously, the medication was only available through the TGA Authorised Prescriber Scheme.

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The highlight of the RACGP national GP12 conference held at the Gold Coast Convention Centre, 24–27 October was the final plenary session: an eHealth hypothetical.

GP12 eHealth Hypothetical

MIPS provided sponsorship of the conference which was attended by over 1,000 GPs, hospital employed doctors and medical students.

The final plenary session was facilitated by medical and health expert and media personality, Dr Norman Swan and consisted of a panel of various industry stakeholders including Ashley Jones of Norton Rose Brisbane firm on MIPS’ legal panel.

This session was attended by 200 GPs and created a huge amount of interest. MIPS clinico-legal advisers: Dr Rob Walters (role-playing as the elderly widower Max) and Dr Nichola Davis (role-playing as Sharon, the dedicated daughter and carer of Max) helped create the hypothetical scenarios that generated robust panel discussion with probing questioning from Dr Swan.

Aspects covered included the PCEHR registration process, practical barriers to its rollout, issues surrounding privacy, the likelihood that the general practitioner population will be the drivers of this process, the lack of software readiness, roadblocks at the hospital emergency department not interfacing with the personally

controlled electronic health records (PCEHR) and how patients will control the detail. Clearly, form the perspective of the panel, eHealth and the PCEHR will be a long term process and require a huge change in professional practice across the board.

The discussion focused on the clinico-legal challenges and potential risks that eHealth may bring however, it ended on a positive note with a successful PCEHR consultation and the benefit of an improved healthcare experience – apart from one embarrassing aspect of Max’s previously unknown past medical history which he requested be removed!

As previously stated MIPS is supportive of the objectives of the PCEHR. The potential for better outcomes for patients and therefore members and better use of health dollars are objectives worth supporting.

The session was filmed and MIPS is currently developing the material into a suitable member risk education activity.

continued …

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The session moderated by Dr Norman Swan

PCEHR plenary session

Key points on the PCEHR are explored by the panel

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L-R Dr Christa Bell, Mr Ashley Jones, Mr Mark Tucker-Evans, Mrs Patrice McCafferky, Dr John Bennett, Dr Ross Maxwell

Member Risk Education – Why Participate?

• MIPSiskeentohelpmembers better manage risk in their day-to-day working life, to help avoid adverse outcomes to patients or, in the event they occur, help mitigate those outcomes. Attending tailored risk education to manage your medico legal risk so as to avoid adverse or unexpected outcomes means better outcomes for your patient, a more rewarding practice for you, is in the interests of all MIPS membership and the health system. MIPS tailored risk education extends to include your professional risk where your reputation and ability to practice may be investigated and challenged by the various regulatory authorities.

• ItisamandatoryRegistrationStandard of the Medical and Dental Board of Australia that you “are required to participate regularly in continuing professional development (CPD) that is relevant to their scope of practice in order to maintain, develop, update and enhance their knowledge, skills and performance to ensure that they deliver appropriate and safe care”.

• TheMedicalBoardGoodMedical Practice: A Code of Conduct for Doctors in Australia and the Dental Boards Code of Conduct for Registered Health Practitioners at 7.2 Continuing professional development , both reinforce the aforementioned Boards’ Registration standards and that CPD is a core aspect of medical and dental practice.

• Generally,membersorfellowsof medical colleges need to meet the CPD standard set by their college. The RACGP standard is 120 hours in the triennium 2011-13. MIPS is an accredited education provider of the RACGP for the 2011-13 triennium.

• Ingeneraltermsdentalpractitioners must complete a minimum of 60 hours CPD over 3 years of which 80% must be clinically or scientifically based.

• Atrenewalofyourregistrationyou need to declare you have met your CPD obligation and your CPD could be subject to audit by your Board. Failure to comply with this CPD standard is a breach of the legal requirements for registration.

MIPS provides risk education as a membership benefit at no additional cost. There are many reasons why members should participate in MIPS risk education. The most important of these are:

• MIPSriskeducationworkshops and online modules are accredited for CPD. For example, attendance at a workshop can earn a RACGP member up to 6 Category 2 CPD points and completion of an online module 2 Category 2 CPD points.

• Allparticipantsinriskeducation will receive a certificate of completion confirming all the education details and also have their membership record reflect that participation.

• AllMIPSriskeducationisprovided by your expert peers who are practising health and dental practitioners, often file managers, with a specific interest in risk education.

• Forthosemedicalmembersparticipating in the Federal Government Premium Support Scheme it is a mandatory requirement to complete risk management that MIPS deems appropriate in the financial year you receive the subsidy. Attendance at a MIPS risk education workshop or completion of any one of the five online modules will meet that requirement.

MIPS provides extensive risk education workshops in Autumn and Spring programs. Members will receive full details of the Autumn 2013 program in February.

continued …

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New online risk education module Conversations at the end of lifeDr Ranjana Srivastava

MIPS is pleased to announce the launch of a further online risk education module to members

The module has RACGP approval for two Category 2 QI & CPD points (Activity 763828).

MIPS online education can be found at mipseducation.com.au. Members can sign up for online education using their MIPS member number (as the username) and a password (at

MIPS online modules are available for you to complete at any time at mipseducation.com.au

There are 5 modules to choose from:

• Conversationsattheendoflife

• Dealingwithdifficultpatients

least six characters long and include one number).

Premium Support Scheme (PSS)

Members completing any online module shall meet the PSS mandatory risk management requirement for the membership year in which the module is completed.

• Healthrecords

• Opendisclosure

• RisksforIMGs

Members should consider the following:

CPD Registration Standard (medical)

Code of Practice (medical)

To add to the array of online risk management modules, MIPS has further developed a ‘Conversations at the end of life’ module. It is an interactive online learning module outlining some of the strategies to assist members dealing with patients with a terminal illness. Managing patients and the consultations in such a scenario can be challenging and the Medical Indemnity Protection Society (MIPS) has developed this module with the assistance of MIPS member Dr Ranjana Srivastava, Oncologist at Monash Medical Centre in Melbourne.

Dr Ranjana Srivastava – for article on page 6. No hi-res available. Please add in a shield

element for better presentation 

 

 

 

 

Prof Philip Morris – for article on page 9 – no hi-res version of this avaialable. Please add in

a shield element.

 

There are now five online modules available:

• HealthRecords

• DealingwithdifficultPatients

• Opendisclosure

• RisksforIMGs

• Conversationsattheend of life

Registration standards (Dental)

Policies and guidelines (dental)

For more information contact Doug Gallagher, Manager, Member Risk Education on dgallagher@mips.com.au

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Dollars, Defence and DentistryDr Gerry Clausen

matter could be resolved for the sum of $84,000 plus a modest allowance for the legal and other costs incurred to that time.

However the claimant went on to claim that he had not been able to work since 2008, “due to anxiety and panic disorder causally linked to the issues he was having with his teeth”.

The evidence regarding pre-existing psychiatric issues is interesting; since 1994 the claimant had been treated voluntarily and involuntarily at a hospital mental health facility, with a significant treatment history in the thirteen years prior to the dental treatment. In addition, despite not working between December 2008 and April 2009, this failure to work was unexplained.

Finally, Commissioner Gething indicated that “the Plaintiff is prone to “delusions and not telling

the truth, such that his reliability is open to serious question”.

You may surmise, after reading the preceding paragraphs that the matter resolved for little more than the costs of remedial treatment. The final summary of damages awarded is at the very least, interesting.

Again, it is significant to note that in the final amount awarded, the figure associated purely with the dental treatment is only approximately 20% of the total sum.

Members need to be acutely aware that the dental area is becoming more litigious and increasingly costly. Unfortunately dental matters are no longer viewed as the ‘poor cousin’ to medical indemnity matters. The importance to all dentists of active risk management strategies has never been greater.

For many years, high profile medical claims have been viewed as the ‘Big Ticket’ matters in the professional indemnity sphere, whilst dental cases have had significantly lower financial implications.

However, recent judgements have seen a increase in the amounts awarded in dental cases, not due to the costs of remedial treatment, but related to associated factors such as loss of income (past and future) and psychiatric damage.

A recent case in the district court of Western Australia is worthy of review, as it indicates how a matter with a defined cost for remedial treatment can escalate.

In this instance the MIPS member, the treating practitioner undertook removal of the claimant’s remaining periodontally involuted teeth, placed implants and constructed implant supported fixed bridges in both arches. Subsequently there were issues with mechanical and biological failures and the further opinions obtained were critical of the MIPS member’s management.

A figure of $84,000 was proposed and agreed upon as the cost of remedial treatment (noting that such treatment was to be performed by specialist practitioners, despite the Plaintiff having initially elected to have treatment with a general dentist).

The MIPS member admitted negligence and one may be forgiven for thinking that the

DrGerryClausen

General damages $80,000

Past economic Loss $148,112

Loss of superannuation – past $13,996

Future economic Loss $70,524

Loss of superannuation – future $4,826

Other head (agreed) $84,000

TOTAL $401,458

Dr Ranjana Srivastava – for article on page 6. No hi-res available. Please add in a shield

element for better presentation 

 

 

 

 

Prof Philip Morris – for article on page 9 – no hi-res version of this avaialable. Please add in

a shield element.

 

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Psychiatric training linking Australian physicians with FijiProf Philip Morris

My visit to Fiji highlighted the ongoing opportunity of regular visits from Australian physicians to assist with the provision of specialist services and mentoring of Fijian medical officers and nurses.

I saw psychiatric outpatients at the Hope Clinic in Lautoka with Dr Susana Pene and staff nurse Misau. I met with the medical director, Dr Susana Maikalevu, of the Western Division Health

Service and the manager of Lautoka Hospital. I also met with the consultant physician supervising Dr Susana Pene.

The nursing and medical staff at Lautoka Hospital and the regional health district was very appreciative of my in-service training sessions on assessment and management of psychiatric and dementia conditions in older patients. More training is needed in this area because of

the ageing population in Fiji.

My discussions with the dean of the University of Fiji medical school point the way forward to stronger links between visiting Australian physicians and medical education and training in the Western Division.

I visited the dean, Professor Altaisaikhan Khasag, of the medical school of the University of Fiji in Lautoka. We discussed the medical course curriculum and the place of psychiatric education and training in the course. We discussed the University of Fiji inviting Australian psychiatrists and other physicians to contribute to the teaching program of the medical school when they visit the Western Division of Fiji. The dean was extremely supportive of the medical school being involved in various psychiatric meetings or conferences organised in Fiji for training of health professionals.

Prof Philip Morris volunteered his time to train Fijian medical officers and nurses in the Western DivisionofFijiforaweekinNovember2012.Heconducted psychiatric clinics and training for doctors and nurses from the Lautoka Hospital and local health district.

continued …

Prof Morris is qualified in psychiatry and addiction medicine in Australia and has a private psychiatric, psychogeriatric and medico-legal practice on the Gold Coast.

He has expertise in the psychiatric care of older adult patients, medical and surgical patients (consultation–liaison psychiatry), neuropsychiatry/psychogeriatrics, post-trauma syndromes, clinical drug trials, and co morbid drug and alcohol and psychiatric conditions.

He is visiting Professor at the Faculty of Health Sciences and Medicine, Bond University, and visiting Professorial Fellow at the Centre for Forensic Excellence, Faculty of Law, Bond University. Prof Morris has held professor positions in psychiatry at the University of Melbourne and the University of Queensland, and at the School of Health Sciences at Bond University. More information is available at drphilipmorris.com

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I enjoyed this visit immensely and believe I made a small contribution to the provision of psychiatric services in the Western Division. A wide range of adult psychiatric patients was seen with the local medical and nursing staff in both outpatient and inpatient settings. I was able to assess the clinical work of Dr Pene and staff nurse Misau. Both are keen, hardworking and knowledgeable clinicians. In order to be even more effective in her role as chief nurse at the Hope Clinic in Lautoka, staff nurse Misau needs to be supported by an additional nurse or occupational therapist. I hope she can put forward a submission about additional support that meets with approval from her local managers.

During my stay I saw elderly patients at the Golden Age residential aged care facility with Dr Pene and staff nurse Misau and I provided an in-service training session for nurses on psychiatric and cognitive assessment in older patients. I reviewed all the inpatients at the Lautoka Hospital Stress Unit with Dr Susana Pene and the psychiatric nursing staff. I conducted an in-service training session for the unit nurses on assessment of common psycho-geriatric problems and I ran an in-service

training session for Lautoka Hospital medical officers on the assessment, diagnosis, and management of common dementia syndromes.

Towards the end of my trip I visited a community health clinic in Ba where I was invited to be guest speaker at the Mental Health Celebration Day as part of the Non-Communicable Diseases Week activities. I spoke about advances being made in Fiji to reduce stigma about psychiatric illness, to educate the public, to establish postgraduate training courses in mental health to improve the quality of psychiatric treatment, and to decentralise mental health services to make them more accessible so as to allow faster and more effective treatment for patients.

I would like to thank Dr Peni Biukoto and St Giles Hospital

for offering to pay for my accommodation at the Gateway and Waterfront Hotels and for offering a living allowance payment for the period of my visit. I also extend my thanks to Mr Kishore Kapadia, a local businessman who paid for my accommodation at the Northern Club. His support is much appreciated.

I wish to thank the Minister of Health, Dr Neil Sharma, and the Fiji Medical Council for facilitating the administrative aspects of my visit. Dr Shunil Sharma was most helpful in arranging the visit from the Australian end.

Finally, I would like to offer my sincere appreciation to Dr Susana Pene and staff nurse Misau for their help and hospitality during my visit.

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Breath test for bowel cancer

Delays in diagnosis present a serious claims risk to health practitioners. In 2007 MIPS published an article in the MIPS Review that detailed a case where the failure to conduct adequate testing for colorectal cancer resulted in a $60,000 settlement. The following provides a good example of how a breath test screening could be used to potentially diagnose a patient and avoid an adverse outcome.

A 59 year old male patient presented to his General Practitioner with positive blood on faecal screening. The patient was referred to a specialist insured by MIPS – he arranged a Barium Meal and Barium Enema, which were both normal and planned for a colonoscopy.

The patient elected to wait and have the procedure done in a Public Hospital. The colonoscopy was only performed 15 months later. It showed an advanced rectal carcinoma with metastases. The patient made a claim against the specialist for his failure to diagnose the

carcinoma.

MIPS’ experts were critical of the specialist for his failure to perform a sigmoidoscopy in his rooms, relying instead on the negative radiological investigations. In this case, colorectal cancer was a distinct possibility and the specialist had the responsibility to ensure that the test was done in a reasonable time. The delay of 15 months, plus the failure to do the sigmoidoscopy, meant that MIPS would lose in court. MIPS settled the case for approximately $60,000.

Unfortunately, a breath test device isn’t available just yet. There’s still a lot of development work to do before one is available for health practitioners and the potential benefits over current diagnostic or screening approaches is settled. In the meantime, ensure you take complaints seriously and follow recommended screening and treatment policies and procedures. In the event you need a ‘second opinion’, do not hesitate to contact MIPS on 1800 061 113.

Gerontologists may be able to easily detect colon cancer with a breath

test according to a study by the British Journal of Surgery (BJS).

The studied showed that a simple breath analysis could be used to detect colorectal cancer with an accuracy of 75%.

It works by analysing the volatile organic compounds (VOCs) linked to cancer. Cancer tissue has a different metabolism compared to healthy cells and produces some substances which can be detected in a person’s breath.

Led by Dr Donato F. Altomare at the University Aldo Moro of Bari in Italy, researchers collected exhaled breath from 37 people with colorectal cancer and breaths from 41 healthy people, which were processed to evaluate the VOCs.

“The technique of breath sampling is very easy and non-invasive, although the method is still in the early phase of development,” said Dr Altomare.

“Our study’s findings provide further support for the value of breath testing as a screening tool.”

MIPS DL Xams Card_1111.indd 1 9/11/11 10:34 AM

Medical Indemnity Protection Society Ltd

po box 25 carlton south vic 3053 | info@mips.com.au | www.mips.com.aumember services

| p. 1800 061 113 | f. 1800 061 116 | abn 64 007 067 281

MIPS DL Xams Card_1111.indd 49/11/11 10:34 AM

MIPS DL Xams Card_1111.indd 1 9/11/11 10:34 AM

Seasons Greetings from all at MIPS

In August this year, MIPS was approached by Medical Observer to participate in a series of special medico-legal panel discussions surrounding a number of topics. Resident medico-legal adviser, Dr Robert Walters lent his expertise and knowledge to the project, the result of which can be found on the MIPS website at mips.com.au/videos.

In the series that ran over a period of 4 weeks, Dr Walters provided expert analysis on topics such as mandatory reporting, doctor shopping, eHealth records and the PCEHR and writing medical reports.

Medical Observer video series

Contact MIPS on info@mips.com.au to make comment on any of the articles in this edition or to contribute to the next edition of your

quarterly newsletter, the MIPS review.

Do you have an interesting story to share?

PB201211115