How Medical Negligence and Insurance in Relation to Indemnity - Coursework Example

Running Head: Medical Negligence Currently Poses an Explosive Situation for Insurance in Relation to Indemnity of Professional Persons Customer’s Name: Customer’s Course: Tutor’s Name: 3rd, November, 2011. Abstract Medical practitioners have a duty of care to patients when there are treating them. However, cases of medical negligence usually occur with patients suing medical practitioners for adverse outcomes after they are treated. Medical practitioners on the other take medical indemnity from insurers so that their jobs are not jeopardized in the event that an outcome in a patient is not as was expected and the patient has sued the medical practitioner in question. Insurers are pushed to a situation that seems explosive due to the many malpractice cases in medicine. This paper therefore, seeks to comment on how medical negligence currently poses an explosive situation for insurance in relation to indemnity of professional persons. Introduction High medical costs impacts on availability of health care services resulting to a crisis that is commonly referred to as “medical malpractice crises1” which translates to an increase in litigations triggered by the probability that large sums of money are to be rewarded for damages. The many lawsuits which are filled by patients claiming to have suffered adverse outcomes out of medical negligence, has increased the liability of health care providers and at the same time shaking insurance players in the medical arena. This results to high costs in insurance policies by players in the insurance industry not forgetting that service delivery in health care ultimately decreases. With these facts in mind, states like Australia and the United States of America have been forced to come up with reforms that regulate the amount the plaintiff can get as compensation. Australia’s model of reform in curbing the rising costs of policies for medical malpractice is considered a good move that tries to help medical professions to stay in the medical field. In as much as medical malpractice is posing an explosive situation for insurance to indemnity of professional persons, medical negligence among medical practitioners also continues to increase. According to AIWH releases statistics on medical indemnity claims in Australia, indemnity claims for both private and public sector in 2007 – 2008, accounted to 8555 in which there was an increase of new indemnity claims of 22552. Notably too, mostly associated with the indemnity claims were the GPs and Obstetrics among other professional in what are considered the risky areas for medical practitioners3. Should the problem be because of many cases of medical malpractice or so many litigation cases in the courts? Many reports are indicating that having many litigation cases in court is not the real reason as to why indemnity premiums are increasing. Then what could be the causes behind the rising costs of indemnity premiums? In a more recent case, a patient aged 8 died while being attend to at Westmead Children’s Hospital in Australia4. The case was as a result of failure to diagnose that the patients suffered from appendicitis. The patient’s GP had initially diagnosed him with appendicitis and thus referred the patient to Liverpool Hospital where the patient was misdiagnosed despite his GP following up his case to the referral hospital5. This is among the many and most recent cases that are casting doubts as to whether medical negligence is vibrant among doctors and thus pushing insurance companies to increase the costs of premiums of medical indemnity. Such a case will no doubt find its way to the courts for compensation. In as much as insurance companies are being blamed for the rising costs of medical indemnity, it is also wise to have to take a keen look and reflect whether medical practitioners are fully doing their part or they are neglecting their duty of care and then raising their arms in protests as to the increase in costs of indemnity insurance. The fear of increased law suits for medical negligence is also creating a dynamic shift in the way doctors are practicing medicine. Doctors now avoid patients who need risky procedures and this is altogether impacting on the way services are delivered in health cares with most doctors practicing defensive medicine. In addition, medical practitioners feel vulnerable because of increased medical negligence lawsuits that patients file. Lawyers and patients also are more than willing to sue medical practitioners at the drop of a hat in speculation of hefty awards for damages. It is with these concerns that states like Australia have enacted policy reforms that are meant to reduce litigations for medical malpractice and at the same time save professionals operating in risky areas. The explosive situation in Australia especially the New South Wales is of particular interest in this paper. NSW has had increased claims for liability of personal injuries and statistics suggests that costs of premiums in medical indemnity in Australia continue to raise a lot of questions. Medical negligence as causing an explosive situation for insurance in relation to indemnity of professional persons is more than a two way lane. On one hand, insurers are raising the costs of indemnity premiums so that they can tap into the market, while on the other hand, some insurers are existing the professional insurance market for instance in medical indemnity due to the increased payout in personal liability insurance. The health care sector is also not spared as doctors fear the increased lawsuits in medical negligence and resort to practicing defensive medicine, quit the practice or practice in areas that are not risky. The governments on the other hand is concerned with the provision of health care services to its citizens and thus moves towards enactment of legislations in a bid to curb the rising costs of premiums. Medical negligence victims and local citizens seeking medical services are not to be spared either. Increase in insurance premiums for medical professions especially the ones in private practice passes down to the citizens making health services unaffordable to many6. In-depth Analysis of Medical Negligence, the Duty of the Claimant and the Position of the Defendant in Medical Negligence Medical negligence occurs when medical practitioners in their duty to attend to patients depart from the generally accepted standards that they are supposed to adhere to when dealing with patients leading to adverse outcomes7 on the patients. In law, negligence takes a stricter definition to mean failure to do an act that a man under reasonable circumstances would do or doing an act that a man under reasonable circumstances would not do8. The law of tort under negligence specifies that the medical practitioner’s duty is to handle patients with care in such a way that in the process of treating them, the medical practitioner may not cause harm to patients. Doctor’s when being admitted to medical profession swears under Hippocratic Oath that they will use standards that are only acceptable in the medical profession to care for patients. However, the law does not require doctors to act like gods but only to take care when they are treating patients. The risks, perils and uncertainties never predetermined by neither the patient nor the doctor. Some adverse outcomes are as a result of mistakes which are honest while others are as a result of professional negligence in the medical filed. Medical negligence is ascertained through investigations done to the allegedly medical practitioner by a medical practitioner in the same area of practice. The latter makes a conclusion whether the alleged medical practitioner has been involved in medical negligence. In some states in Australia and where common law exists, the decision of whether a medical practitioner is competent is the decision of the judge and not the decision of other professionals in the same field for this can lead to biasness. The court therefore is believed to hold an objective view when ruling such cases. When a medical practitioner breaches the contents of the oath, he/she is said to be negligent9. However, negligence of a medical practitioner by the court is done by comparing the performance of the medical practitioner against the blueprints of the acceptable standards of care in medical profession. Examples of medical negligence include, misdiagnosing a patient, errors which are made when operating on a patient, inappropriate diagnosis and following up treatment to a patient, when drugs are prescribed inappropriately to patients and surgical errors among others. Medical practitioners are also not negligent if they happen to have a different opinion from their counterparts in medical profession. In the case of Bolam v Friern Hospital Management Committee [1957]10, the defendant (the doctor) was not negligent despite the claimant evidence that the defendant followed a practice that many other practitioners in the same circumstances would not have followed. Court of Appeal thus ruled in favor of the defendant. This case shows that the Court of Appeal in the case of medical negligence does not rely on the condition of the patient to the extent that the patients would expect sympathy rather than it rules on the facts of the case and that it is the duty of the Court to determine whether a doctor was negligent or not in states like Australia11. Medical negligence may not always imply that injury will be caused to the patient; however, it does not cease to be medical negligence in the absence of injury to the patient. Patients in some cases may have a stake in medical negligence. Patients participate in medical negligence when they do not heed to the doctor’s advice upon treatment. For instance, a doctor may instruct a patient to take two weeks to rest and the patient upon being discharged from hospital after a surgery ignores the doctor’s advice and goes back to his/her normal activities. The patient may ignore the doctor’s advice and thus contribute to medical negligence. While this mistakes that lead to adverse outcomes occur, many patients will often tend to sue for compensation12. In the event that a patient suffered an adverse outcome as a result of honest complications, the practitioner is not to compensate the patient. This implies that not all patients who suffer from a bad outcome after treatment, is necessarily a result of negligence and may not be liable to seek compensation. On the other hand, an adverse outcome that occurs as a result of professional negligence puts the practitioner in the position of compensating the patient. In proving that medical negligence actually did occur, it is the obligation of the patient to prove in court that there was a violation of medical standards of patient’s treatment by the doctor that resulted to adverse outcomes and that the doctor in question was the one responsible for the adverse outcome in the patient. The court places the responsibility of proving that there was medical negligence on the patient despite that in most cases, the patient may not be in a position to prove it due to his/her illness and their medical conditions may not allow them to be in a position to give proof to the court. A patient is also supposed to give convincing evidence that the outcome of a treatment would have been better if the doctor had not violated his/her duty or if the medical practitioner (the defendant) would have taken precaution to lessen the injuries that the plaintiff had suffered. Thus, in most cases, the patient is not able to certify the conditions that are required by the court whilst insurers tend to claim that the patient’s had pre – existing conditions like disabilities before the doctor treated them. Insurers always support that patients had pre – existing conditions that were not out of negligence so that they avoid compensating the patient. If a patient can satisfy the court that indeed there was negligent on the defendant’s side, then the court rules in the favor of the patient and the patient is indemnified. However, indemnity only places the patient in the financial position he/she was before the occurrence of the adverse outcome that lead to loss. Compensation cannot be used as a substitute for the patient’s health nor is it meant to benefit the patient financially. Professional Indemnity Insurance and MDOs Professional indemnity insurance is a cover that is offered by the insurer to the insured in the event that a loss occurring arising from a breach of professional duty especially professional slackness occurs. Professional indemnity insurance tries to indemnify the insured against risks, perils and uncertainties that may or have risen when there was a violation of professional duty. Actuaries while calculating professional indemnity insurance always takes into consideration factors like the cost of defending claims in relation to medical negligence in court, the current level of compensation that the courts are offering for each particular type of negligence, and the incurred but not reported cases (IBNRs)13. In addition, the area of practice for each medical practitioner relative to the risks which are typical to such areas is also assessed in calculating premiums. For instance, plastic surgeons and neurosurgeons pay high premiums for professional indemnity cover than general practitioners (GPs) who are believed to be in areas with lower risks. There are two categories of medical insurer’s providers that are the ones operating on commercial basis and the MDOs which are not in actual sense regulated by the Insurance Act of 197314. In Australia, most doctors operate with non profit organizations called MDOs and which are not taken as insurance companies by the regulator of insurance companies in Australia, APRA (Australian Prudential Authority)15. Examples of MDOs in Australia are, Medical Indemnity Protection Society (MIPS) and Medical Defense Association of Victoria (MDAV). The MDOs belong to the members and offer open and unrestricted medical indemnity covers to their members. The lack of regulation of MDOs is among the contributing factors that are making the costs of professional indemnity policies to continue to rise. MDOs continue to make call – ups which is done to shield MDOs profit margins but since they are regarded as open organizations, this is seen or excused to members as additional payments so that the MDOs continues to exist. It is reported that MDOs rarely fail to compensate their clients. In addition, there are many MDOs in the country and this gives medical practitioners the freedom to select the ones that they believe are the best. Thus different MDOs compete to get clients to insure with them. For instance, though United was considered to be the dominant MDO in Australia, it was omitting the IBNRs figures in its balance sheet and thus was in a position to offer competitively low indemnity premiums to its members. However, this did not last long as the government needed to bail it out to rescue it from collapsing. It is evident that many lawsuits in medical malpractice including the ones that are not reported and claimed after a practitioner is no longer practicing are driving insurers to limits of collapsing. Professional Indemnity Insurance Crisis (Australia) and How Medical Negligence Poses an Explosive Situation for Insurance in Relation to Indemnity of Professional Persons Patients who suffer adverse outcomes may decide to take action against the medical practitioner in question or also take action against the health institution that he/she attended. Health provider’s institutions are sued on the basis of being negligent for instance poor conditions or on the basis that it is the responsible body for the actions of its employees. However, whether to sue a practitioner or a health care provider institution depends on factors like who actually caused the negligence. Indemnity arrangements with the insurance under medical negligence falls under three main categories namely; insurance which cover health providers institutions (commercial or self insurance), arrangements covering professional in health cares and arrangements which are commercial and are between professionals of health cares and commercial providers of insurance16. In most cases, medical professions rarely take insurance covers with commercial insurers and they therefore prefer the indemnity arrangements with MDOs which are mutual. United Medical Protection simply referred to as United is the giant MDO (Medical Defense Organizations) in Australia. In a call – up in 2000, united increased costs of the insurance policies. This was seen as the onset of escalating premiums for indemnity insurance. Increase in premiums means that many practitioners in medicine feels that there is a viability of medical practice due to high indemnity insurance. To further illustrate that medical negligence is causing an explosive situation for insurance in relation to indemnity of professional persons, MDOs initially offered the “claims incurred cover” but nowadays they offer the claims made cover which is costlier than the “claims incurred cover”. MDOs are offering the “Claims made cover” to cater for claims which fall within the year. On this note also, MDOs results to numerous calls – ups to raise the costs of premiums in “claims incurred cover”. Introduction of commercial insurers also plays a contributory role towards insurer’s crisis in Australia. The evidence provides a glimpse picture of the explosive situation posed to insurance by the practitioner’s negligence. While there is a notable difference between government sponsored health care providers with the private institutions providing health care for instance in Australia, government sponsored health care providers are compensated by the government in most cases while private institutions have to cater for their own indemnity insurance pact. While doctors and other medical practitioners still continue to be absorbed in the private sector and others setting up their own private firms, the demand for professional indemnity insurance continue to knock on the insurers door and this also collectively contributes to the explosive situation for insurance in relation to indemnity of professional persons. In Australia, private health cares puts it a prerequisite for doctors to have their own professional indemnity cover. Thus, the more medical practitioners that are in the private sector, the higher the demand for professional indemnity cover and this makes the insurance industry increase the costs of the premiums especially where litigations will be many. Insurance companies are not willing to cover some areas in medicine and if the insurance companies have to cover such areas which are regarded as risky areas for instance plastic surgery and neurosurgeons17, then the insured will have to cope with high premiums associated with covering areas that are more risky than others. The rising liabilities in insurance due to medical negligence is causing insurance companies to shy away from such areas or are finding it easy to exit the medical practice market. This is because the predictability and probable occurrence of litigations in medical negligence continues to increase. Insurers also have to cope with the rising costs of defending the claims made on malpractice basis and also the costs of covering he litigation processes is becoming expensive for insurance companies. Insurance companies are thus not able to tap their profits from the predictability of liability and this eventually contributes to the rising costs of premiums. Insurers are taking advantage of the situation of rising claims in medical malpractice together with fewer insurers in the market to hike the costs of premiums which is serving as a good marketing strategy. With increased law suits due to medical negligence lawsuits increasing, coupled with other factors that are making insurance companies to have high operating costs like high salaries paid to insurance employees and value reduction of returns from company’s investments, insurers either have to offer high cost indemnity policies or exit the market in regard to covering medical negligence. Another major contributor of the rising costs of indemnity premiums is that insurers just like any other businesses, invests money that is paid as premiums in the stock markets. When prices of the shares in the stock market do not appreciate as expected, the insurers are not in a position to pay the claims; they are left with the only option of increasing indemnity premiums to cover for any short falls in the stock market. They therefore play the speculative role in the stock markets and thus when returns on shares fall, they tend to capture the profit margins through increasing indemnity insurance premiums so that they afloat. Society has changed and people are fully aware that they can be compensated for adverse outcomes caused by medical professionals. The general public due to access to media and improved education has known how to go about in recovering damages caused by medical practitioners who fail in their duty of care. Communities now believe that people to whom adverse outcomes are caused should automatically be compensated and this willingness of the community to sue for adverse outcomes has become a driving force for professionals to take policy covers. The increase in medical claims by patients and worse still if the system relies on the jury to award the claims as in the case of the USA is also a contributing factor as to the rise of premiums in medical indemnity. The high awards by juries in form of damages works towards motivating the patients to claim for injuries caused on them by negligent medical practitioners. It also serves as a motivating factor for lawyers who are paid a commission after winning a lawsuit. The belief that a crisis exist in Australian’s medical negligence and insurance companies in relation to indemnity of professional persons is one of the tactics that insurance companies are using in marketing their policies and trying to justify why the prices of medical indemnity premiums have increased. Most researches which have been conducted in Australia indicate that the situation is not as reported and that there is no crisis in essence18. In addition, malpractice on the side of the insurers is also seen to cause the increase in costs of indemnity premiums for medical practitioners in that when there are few insurers offering indemnity cover to medical practitioners, it means that the few insurers which are there can charge more than is fairly reasonable due to absence of competition in the industry. The existence of MDOs in insurance industry that is not regulated leaves other commercial players unwilling to venture in a field where MDOs are not even regulated. Commercial insurers would play the role of injecting competition in the insurance for indemnity for professional persons only if they are operating on the same regulation standards with the MDOs. Such aspects of the nature of the players in insurance for professionals, together with fewer areas to cover, leaves few insurers who remain in the insurance market resort to setting higher rates of premiums in a bid to cover the uncertainties in medical malpractice. Increase in the number of lawyers for personal injury is directly related to the demand for such lawyers. Though, we may argue that society is more aware that people can be compensated when there are adverse outcomes, questions range as to whether doctors are also engaging more in malpractice. Advertising for lawyer’s services is also contributing to patient’s awareness with the patient oblivious of the procedures that are involved in the litigation process. The “no win no fee” offer by lawyers gives patients confidence of taking a step to sue for medical malpractice. Lawyers therefore aim for those cases where the reward for damage or compensation is promising a lucrative incentive. This leaves patients whose adverse outcomes are not that serious having no attorneys to represent them in court. When lawyers aim for big cases with their no win no fee offers, insurers always find themselves on the wrong side for they are likely to incur high costs of litigations in representing their members. If the plaintiff is able to satisfy the court that adverse outcome were as a result of the doctor’s breach of duty of care, compensation is made inform of services (professional) which were incurred by the patient and also future expenses which the patient may incur, loss either future or past that the patient may incur due to negligence, the interest and the legal costs that are involved in litigation. With these facts in mind, it is no doubt that lawyers not only in Australia but in many other states are likely to bring in cases in court with the hope that they are going to win. The more medical practitioners breach the duty of care, the more insurance companies continues to pay for compensation. When compensation covers even the legal costs, patients become even bolder to try their chances in court coupled with the numerous advertising by lawyers in Australia. Even if the lawsuits are not successful, insurers still suffer through catering for the cost of defending the lawsuit, thus the high costs of medical negligence premium costs. In practicing defensive medicine, doctors subject patients through rigorous tests in order to eliminate the possibility of errors. Each test that patients undergo is consistent with an increase in the cost of health care services. With states like Australia interpreting negligence based on the premise of reasonable care, it is not clear to medical practitioners as to what may cause negligence and which unreasonable actions may make a medical practitioner not liable. This uncertainty in medicine in regard to malpractice is what is also contributing in medical indemnity premiums escalating and medical negligence as posing an explosive situation for insurance of professional indemnity. Insurers are not sure of what constitutes negligence owing to Australia’s explanation of duty of care from the practitioner’s side to insurers charging higher premiums to cover for these uncertainties. Medical negligence still possesses an explosive situation to insurance in relation to indemnity of professional persons in that even if the medical practitioner is covered as in the case of doctors operating in private institutions and which offer a indemnity insurance at a time when the medical practitioner is working in the private health care institution, when the contract of the medical practitioner to work with the private health care institution ends and a claim happen to be made after the medical practitioner is no longer an employee of the private institution, then the medical practitioner ought to have a private cover with an insurer to cover for the claims which might arise when the doctor is no longer in practice. This is possible due to the time duration that victims of negligence are required to make a claim to the court with some states in Australia giving a time allowance of 3 years to 6 years for a patient to claim for medical malpractice. The incurred but not reported claims (IBNRs) are reflected in the insurer’s balance sheet. Therefore, as long as doctors still continue to practice and be covered by insurance companies, there is no breaking point for insurers where they will feel that they can only cover for claims which are being made by the doctors in practice and that if they had covered a medical practitioner who was never involved in a lawsuit when he/she was practicing, that the insurers can bank the premiums as profits. The unpredictability of liabilities in medical negligence claims is what insurers avoid through offering high indemnity premiums. Before a plaintiff can satisfy the court that there was negligence on the side of the defendant, insurers have to cater for the litigation costs which are involved. These costs are collectively impacting on insurance profits and when there are many in numbers, insurance companies for instance the UMP became bankrupt in 2002 to the extent that government had to save (bail) it, in order to ensure that the medical practitioners who were covered by the MDOs continue to be covered. If MDOs in Australia are crying foul, what about commercial insurers who offer medical indemnity insurance. To say that the costs of medical indemnity insurance will reduce would be like telling the commercial insurers to operate their organizations by only making losses. However, if commercial insurers and MDOs were to operate on the same level, then it would be one way through which premium costs would be lowered. Effects of increase in premiums for insurance of medical indemnity can be explained through the hawk eyes of the competition existing between the MDOs and commercial insurance providers. The two categories of insurance providers always want to attract client and they do this through compensating their clients. Various reports which have been done in Australia shows that in most cases, MDOs rarely fail to compensate their clients and thus medical practitioners will always opt for MDOs or commercial insurance providers who are known to be reliable in compensation. Thus, doctors are not keen on their duty of care for they are aware that there are going to be compensated by their insurance providers. This conclusion is made on the basis that some studies discredit the fact that there is no litigation upsurge in Australia and that it is simply a media misrepresentation. The changed system where medical practitioners competence is not judged in regard to accepted standards of his/her profession but on the basis of whether the medical practitioner has conformed or adhered to his/her duty of care which is reasonably demanded by the Australian law. Thus, such questions arising as to the competence of a medical practitioner are best left in the hands of the court as other professionals in the field cannot be relied on by the courts. Concentration is on the increase in premiums in medical indemnity and what is causing to the insurance industry with little attention paid to how to improve the quality of health cares in countries and how medical negligence can be avoided by medical practitioners. This shift of focus from the root of why insurance industry is facing an explosive situation in regard to insurance in indemnity of professional persons is doing little to alleviate the problem. Therefore, as long as the focus is on the rise of medical indemnity insurance, the explosive situation for insurance will still continue to loom. Australian legislation reforms on the amount of compensation that plaintiffs can get for non economic damages19. Tort reforms are meant to reduce monetary awards which are to be given to patients seeking compensation for instance the damage caps. This restricts the amount that juries are to award to plaintiffs with critics arguing that non economic damages for instance pain should be scrapped off20. Conclusion Critics debates as to whether it is malpractice that is pervasive or whether it is litigation that is on the rise. Nonetheless, whether it is litigation or malpractice, insurance industry is looking up to a future of unknown. The lack of competition in insurance companies as a result of many insurers leaving the market and also MDOs that are not regulated by the insurance Act places the insurers at a loosing end. One thing that we cannot fail to ask is whether the rise in litigation cases in medical malpractice will reduce and thus relieve the insurance industry from having to compensate medical practitioners and having to cater for the litigation costs. Of importance to note is that in most cases, the defendant is able to pass the burden of compensating the patient to the insurer. With these said who actually bears the costs of compensation especially in government run health cares where the government is the one that compensates its employees when they are sued? Is it the government or the citizens? Citizens bears the burden through the numerous tests that they have to undergo when seeking treatment when doctors make it a necessity to have all the tests done even if some are not necessary. Thus the cost of health care services also escalates proportionately with the increase in lawsuits for medical negligence because doctors are now practicing defensive medicine. If so who is really benefitting when there are so many litigations for medical malpractice? It is without a doubt to say that there is a new twist that is involving lawyers and attorneys when it comes to litigation for malpractice not only in Australia but all over the world. In as much as medical negligence cannot be excused, my subjective judgment is that the triggers for explosive situation in insurance for indemnity for professional points in the direction of lawyers. References 1. Malpractice Crisis: A term that is commonly used to refer to the increases in premiums for health care providers 2. AIHW 2011. Public and private sector medical indemnity claims in Australia 2007-08. Safety and quality of health care no. 7. Cat. No. HSE 90. Canberra: AIHW. Viewed 2nd November, 2011. 3. aihw.gov.au, "Public and private sector medical indemnity claims in Australia 2007-08," and "Australia's public sector medical indemnity claims 2007-08," dated 11.03.11. 4. The Daily Telegraph, 16.08.11. 5. Ibid (4) 6. Michelle M. et al. (2004). “Caring for Patients in a Malpractice Crisis: Physician Satisfaction and Quality of Care,” Health Affairs, Vol. 23, pages 42-53 7. During medical treatment, the outcome of procedure performed on a patient may not always be as expected and the injuries sustained are termed as adverse outcomes 8. Ibid (2). 9. Patricia M. (1985). Medical Malpractice: Theory, Evidence and Public Policy. Cambridge, Mass.: Harvard University Press, page 214. 10. Bolam v Friern Hospital Management Committee [1957], in this case, it is clear that the existence of contrary view from the ones help by professions in the same fields does not necessarily mean that the doctor is negligent. 11. See; District Court Act 1973 (NSW), section 44 12. ‘Doctors and Indemnity’, The Sydney Morning Herald, 20/01/01, p 40. 13. Insurers have now adopted the system where they include the IBNRs in their balance and show their members due to the unpredictability in insurance of medical practitioners. 14. See Insurance Act of 1973 15. See the web site at www.apra.gov.au for information about APRA 16. New South Wales Department of Health Professional Indemnity Insurance for Medical 17. Practitioners, A Discussion Paper, August 1988 18. Victorian Parliamentary Law Reform Commission (1997). Inquiry into the Legal Liability of Service Providers, Chairman’s Foreword. 19. Non - Economic Damages refers to awards for example pain, mental anguish and suffering by the plaintiff as a result of medical negligence 20. Paul H. (1996). Tort Reform by Contract. Washington, D.C.: American Enterprise Institute. Read More