Midwives Indemnity Insurance

Extract from Hansard

Legislative Council
24th July 2001

Sandra Kanck
Deputy Leader Australian Democrats
Member of the Legislative Council

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The Hon. SANDRA KANCK: I seek leave to make an explanation before asking the Minister for Transport, representing Minister for Human Services, questions regarding indemnity insurance for midwives.

The Hon. SANDRA KANCK: The recent decision by Guild Insurance to stop providing professional indemnity cover for midwives has serious implications for the profession as well as for South Australian women and babies. A South Australian independent midwife has told us that 13 pregnant women and two postnatal women will be affected when her insurance cover expires as of 1 August.

These women and their babies will all have their services, birthing options and postnatal care withdrawn. A couple of these women, who are due to give birth by the end of this month, have been under the care of their independent midwife for nearly nine months but are faced with the prospect of losing this care at the last minute and having their birthing plans seriously changed.

The inability of midwives to access professional indemnity insurance will mean that South Australian women will have their birthing choices severely restricted and place greater pressure on mainstream hospital services. This will fly in the face of World Health Organisation recommendations, which state:

The midwife is the most appropriate and cost-effective type of health care provider to be assigned to the care of normal pregnancy and normal birth, including risk assessment and the recognition of complications.

It will also contradict years of state and national reports such as the Senate report Rocking the Cradle, which advocates increased birthing choices for women and support for community midwifery models. The Rocking the Cradle report states:

High intervention rates in pregnancy and child birth are influenced by the threat of litigation.

The extent of the threat is a matter of dispute, but there is no doubt that fear of litigation is having a powerful influence on obstetrical practice. It also states:

At present far too many practices in maternal and child health are based on custom and fashion rather than evidence and evaluation.

The Human Services Minister has advocated a community midwifery model as a substitute for care at the Queen Elizabeth Hospital. There is also the highly successful Northern Suburbs Community Midwives Program, which is underwritten by the state government and which exemplifies the best practice model of continuity of care.

The increasing lack of doctors prepared to offer obstetric services in rural and regional South Australia can, for the most part, be blamed on the prohibitive costs of indemnity insurance. Significantly, the state government has provided an insurance scheme to help maintain obstetric cover for doctors in these areas. My questions are:

1. Will the minister provide immediate assistance to independent midwives in South Australia in accessing professional indemnity insurance?

2. Will the minister match the current arrangements of subsidised insurance for general practitioners providing obstetric care for midwives?

3. Will the minister consider the capping of medical malpractice payouts as a solution to the crisis in health and medical services across the state?

4. How will the minister continue to advocate community midwifery models with the absence of private indemnity insurance for midwives?

The Hon. DIANA LAIDLAW (Minister for Transport and Urban Planning): Certainly, the fear of litigation is having an effect not only on the obstetricians and clearly the midwives but also across the whole medical field and well beyond. Therefore, the questions that the honourable member asked are probably well founded but the precedence that would be set is something that any government would have to take into account, I suspect, in addition to the issues of quality service delivery and access to service. The honourable member has raised important questions; I will refer them to the minister and bring back a reply.

The Hon. DIANA LAIDLAW: The Minister for Human Services has provided the following information:

1. Independent midwives provide a service to private patients and are not considered to be any different in that sense to obstetricians who provide services to private patients. Independent midwives are able to access commercial professional indemnity cover. While it is acknowledged that the cost may be significant, the responsibility of the government is to insuring its own employees who provide services to public patients, not in relation to independent midwives.

2. The government does not provide a subsidy to general practitioners for professional indemnity related to services to private patients. The government, in 1996, introduced a Fee For Service professional indemnity scheme for rural resident medical practitioners, which had as one of the options payment of a subsidy to medical practitioners who chose to arrange their own indemnity insurance cover. This option is no longer available.

The government, as part of the Fee For Service professional indemnity scheme for rural resident medical practitioners, insures medical practitioners who are resident in rural areas for services they provide to public patients in public hospitals. The scheme also provides a brokerage service with a medical defence organisation for insurance cover related to services to private patients, for those medical practitioners who wish to avail themselves of this service. Unfortunately, medical defence organisations are not prepared to provide professional indemnity insurance to midwives.

3. The Australian Health Ministers' Advisory Council has established a Jurisdictional Working Party, supported by a Medical Indemnity Consultative Committee, which has as one of its Terms of Reference "Sustainable solutions for addressing long term care costs in health care litigation". The report of the Jurisdictional Working Party will provide the basis for dealing with this issue at a National level. At the Australian Health Ministers' Conference held in Adelaide on 1 August 2001, it was agreed to refer the medical indemnity issues raised by independent midwives to the Jurisdictional Working Party.

4. As mentioned above, independent midwives are able to purchase commercial professional indemnity cover. Although the government will continue to support community midwifery models, the cost of indemnity insurance for services to private patients must be borne by the provider of the service.