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News and opinion

Under the influence

MPS Medical Director Dr Rob Hendry reminds doctors of their unique opportunities to influence and inspire those working around them

Doctors are often surprised how influential they are within their teams and organisations. The things they do and say and the way they conduct themselves is increasingly being recognised as central to effective healthcare.

Most medical care is now delivered by teams rather than by individual healthcare professionals working in isolation. When teams work well the results can be spectacular, but when teams are dysfunctional, patient care can suffer. Stories in the press about “failing hospitals” are, in fact, often actually about failing teams.

Sadly at MPS we frequently see members getting into difficulties with their employers and their regulators, not because of their lack of specialist knowledge or poor technical skills, but because of the way they interact with their colleagues.

When relationships break down in healthcare teams not only do things go wrong more often, but when they do the impact on everyone involved is usually much greater.

One of the characteristics of being a professional is taking responsibility for one’s actions. Often, choosing to turn a blind eye to problems within a team can lead to problems becoming magnified and intractable.

Product liability and MPS

Issues with product liability have made the headlines in a number of countries around the world recently – notably the DePuy metal on metal hips in South Africa and Ireland, and the PiP breast implants in the UK. These issues arose from faulty products, where normally responsibility lies with the manufacturer or supplier of the product.

However, in both cases, attempts were made by claimants to include surgeons in the claims – in the DePuy hips case, the justification given was that the surgeons had failed to properly fit the prostheses; with the PiP implants, the insolvency of the manufacturer was the motivation for involving the surgeons in the claims.

In both situations, whilst MPS is not providing an indemnity for product liability, MPS is supporting members with these cases by doing whatever is possible to prevent the development of litigation targeting clinicians, when other more appropriate sources of compensation (the manufacturer or supplier) are no longer available.

In the meantime, members can take steps to protect themselves in the event of a claim for product liability, by retaining documentation relating to:

  • Evidence of purchase.
  • Where possible, the serial number of the item in question – it can be used as evidence of the batch of goods obtained.
  • Terms and conditions.
  • Express warranties and guarantees.
  • Instructions and packaging.
  • Correspondence regarding product specification and any alteration.
  • Where whole goods are transported by an external logistics company, relevant contracts/terms/correspondence.
  • Complaints history relating to product and similar products (if relevant).
  • Order forms, emails, faxes.

Clinicians should also take care regarding any verbal statements made to patients regarding a product. Statements that erroneously imply a lifetime guarantee, for example, can make a clinician liable in the event of a related allegation or claim.

IMPORTANT: MPS to introduce indemnity limits

MPS has recently written to members to explain a change that we are making to how one element of the benefits of membership is being offered.

We are experiencing an increase in high value claims being brought against members. In particular we have seen more cases where special damages are being paid to fund the treatment of patients in a country other than the one where the incident occurred, often at a much higher cost. Legal costs in these claims are also increasing as they take much longer to be resolved and require a greater degree of case management.

Rather than make substantial increases to subscription rates to reflect these extra costs, MPS’s elected Council has indicated that, whilst it always retains absolute discretion, it will limit the maximum amount the organisation will indemnify per claim.

This limit, which has been very carefully considered and assessed, is set at a level that reflects MPS’s experience in each country.

This change will come into effect when members renew with MPS on or after 1 October 2013. If members’ annual renewal date falls before this date, the limit will come into effect upon renewal in 2014. Only claims arising from an incident that occurs after the renewal date will be affected.

This is not the first time that MPS has introduced an indemnity limit; they have been in place in several countries throughout the Caribbean for a number of years. Our experience suggests that introducing this limit is unlikely to affect the vast majority of members. We have deliberately set the threshold at a higher level than almost all cases in which MPS has been involved. For further information, please contactnancy.boodhoo@mps.org.uk

Dates for your diary

A number of healthcare events are taking place across the region during the next few months

7-10 October
Current Anesthesia Practice
Paradise Island, Bahamas
www.nwas.com

16-20 October
83rd Annual Meeting of the American Thyroid Association (ATA)
San Juan, Puerto Rico
www.thyroid.org

16-17 October 
World Congress of Surgery, Obstetrics, Trauma and Anesthesia
Port of Spain, Trinidad and Tobago
www.hopkinscme.edu

20-25 October 
Giant Strides in Anesthesia
Kralendijk, Bonaire
www.nwas.com

23-26 October 
29th Annual Fall Conference on Pediatric Emergencies
Paradise Island, Bahamas
http://symposiamedicus.org

29 October-2 November
20th Cuban Congress of Urology
Havana, Cuba
www.eventospalco.com

30 October-2 November
21st Annual Fall Conference on Issues in Women’s Health
Guanacaste, Costa Rica
http://symposiamedicus.org

7-10 November
Internal Medicine for Primary Care: Endo/Pulm/Derm/Neuro
Atlantis Resort, Bahamas
www.mer.org

13-16 November 
14th Annual Fall Conference on Emergency Medicine
Paradise Island, Bahamas
http://symposiamedicus.org

16-23 November 
24th MDtravel Fall Conference
Montego Bay, Jamaica
www.mdtravel.ca

17-22 November 
Reviews in Anesthesia Practice
Port Maria, Jamaica
www.nwas.com

2-6 December
Convención Internacional de Psicología: Hóminis 2013
Havana, Cuba
http://hominis2013.sld.cu/

5-8 December 
Neurology/Psychiatry for Primary Care
Atlantis Resort, Bahamas
www.mer.org

8-13 December
Current Topics in Anesthesia
Palm Beach, Florida
www.nwas.com

8-13 December
Imaging Warm-up in the Caribbean
St John, US Virgin Islands
www.cme.ucsf.edu

Suriname: Surgery error makes headlines

A claim has been made against a surgeon and Lachmipersad Mungra Hospital of District Nickerie, following a high-profile case in which a bandage was left inside the abdomen of a patient.

An investigation was due to be launched, announced Health Minister Michel Blokland, following the incident – which made local headlines after the patient’s husband appeared on the Indian language TV show Apna Apna Ghayaal.

A claim has been made against a surgeon and Lachmipersad Mungra Hospital of District Nickerie, following a high-profile case in which a bandage was left inside the abdomen of a patient

The wife of Sanjay Jairam, who has not been named, had an ovary removed in January and returned to the hospital on numerous occasions with pain and discomfort.

Mr Jairam said: “I knew right away that something went wrong. My wife was feeling a hellish pain in her stomach area and I could feel a strange, hard object there.”

When the pain wouldn’t subside, the doctor agreed to operate again to see if maybe he had ‘forgotten’ something inside, but nothing was found during five further explanatory operations. Meanwhile Mrs Jairam’s health deteriorated and she was having difficulty walking. Finally, on 21 June, the seventh time the surgeon operated on Mrs Jairam, he found a 30 x 32 x 1cm bandage in her abdomen.

Mr Jairam said: “I had insisted that they would show me whatever they found in my wife’s body. I was furious when I saw the bandage, but happy that finally my wife was relieved from the pain.”

He added that as well as making a claim against the hospital, Mr Jairam had filed a complaint against the surgeon.

Jamaica: Fight against HIV – reflecting on progress

Joint cross-Caribbean efforts to tackle HIV were reflected on at a major meeting in Jamaica in July, featuring representatives from eight countries.

The health and finance ministries of Barbados, Belize, Cuba, the Dominican Republic, Guyana, Haiti, Jamaica and Trinidad and Tobago met for a two-day deliberation on improvements to efficiencies surrounding their HIV programmes.

The meeting was hosted by the Joint United Nations Programme on HIV/AIDS Caribbean Regional Support Team and the US President’s Emergency Plan for AIDS Relief.

During the opening ceremony, UNAIDS Caribbean Regional Support Team Director, Dr Ernest Massiah, noted that since 2000 the region has received US$1.3 billion in external financing for HIV.

Dr Massiah stressed that many Caribbean countries’ economic classifications by the World Bank as Upper Middle Income and the global economic slowdown mean that there is now a very different funding context.

Dr Fenton Ferguson, the Jamaican Health Minister, emphasised that while national and regional leaders aim for country ownership of their programmes “there has to be a reasonable transition period”.

He said: “We are willing to take country ownership but we are not there yet. It is my hope that Jamaica will continue to share best practices that would allow for the people of the region to be better prepared in dealing with their health issues and quality care.”

British Virgin Islands: National Health Insurance: debate goes on

A fresh public consultation over the implementation of a National Health Insurance (NHI) system in the British Virgin Islands was due to go ahead again in July.

Premier Dr D Orlando Smith said the public were generally in favour of NHI, but they still had many unanswered questions and concerns. These concerns mainly revolved around making the system mandatory for all legal residents.

Premier Smith said: “A careful review of the actuarial data has confirmed that a single-payer system is the best available option for ensuring the viability and long-term sustainability of a National Health Insurance System in the Virgin Islands.

“The single-paying National Health System will provide the same excellent care from all your providers in the country, greatly improve hospital care and the same referral process for tertiary care that other insurers provide.”

Barbados: Warning over non-communicable diseases

Continued rises in incidences of non-communicable diseases will have a significant impact on the cost of healthcare, according to Minster of Health John Boyce.

Mr Boyce issued his warning to House of Assembly as he reiterated the plans of the National Chronic Non-Communicable Diseases Commission, which he said was set up to lead the fight against those diseases.

Continued rises in incidences of non-communicable diseases will have a significant impact on the cost of healthcare, according to Minster of Health John Boyce

“It’s no point waiting until one has contracted these diseases to say let us now deal with it, because as I said that it is a cost which we cannot contemplate for our country. And as we continue to move in a world where the view is that healthcare should be available to all persons, the reality is that this has become even more urgent and therefore the work in terms of looking at the entire diet, as to what we eat; the question of smoking because there is no question that it has been clearly demonstrated that smoking of tobacco has increased the onset of lung cancer; alcohol abuse, the whole question of alcohol abuse again and the repercussions of hypertension, diabetes in our older years is something which we must be fully aware of,” he said.

Mr Boyce added: “We already have an expansive debate taking place in terms of the cost of providing healthcare in Barbados, and the Ministry of Finance is constantly having to grapple with the demand of the Queen Elizabeth Hospital and the other institutions which I have mentioned. So that one of the strategies that we have employed in this regard, is to try to emphasise the benefit of prevention, and indeed the benefit of treatment of our population at the primary stages of the onset of any of these diseases and I speak specifically to our polyclinic institutions.”
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