Covid-19 or the Coronavirus 2019 is rapidly becoming one of the most severe global pandemics ever with 2,409,826 open cases, 165,109 deaths and 629,235 recovered patients as at 20 April 2020.
The pandemic has caused significant economic depreciation locally and internationally, closure of academic and schooling institutions in many countries, a sharp decline in oil prices and suspension of business activities in some sectors, but one of the biggest impacts is its continuing severe effect on healthcare provision across all nations. Whilst its effect on individuals is important, its effect on health care professionals is even more critical.
Health workers
By the 4th of March 2020, China reported 3400 health workers infected by Covid-19 and the deaths of 13 healthcare workers. These deaths included highly specialised medical professionals in the fields of ophthalmology, neurosurgery and the most humbling of all a 29 year old plastic surgeon who postponed his wedding to help fight the virus and later succumbed to it.
By the 18th of March 2020, 2629 health workers in Italy were reported to have contracted the virus. These medical professionals include but are not limited to doctors, nurses, and other healthcare professionals who may not be in the direct line of fighting this virus. Importantly, this number could be higher as medical professionals are not regularly tested and hospitals displayed weak protocols in preventing contagion, which Dr Google defines as the communication of disease from one individual to another by close contact. The socially acceptable distance is 2 metres. In the context of healthcare professionals that is next to impossible.
As at the 4th of April 2020, the number of healthcare workers that have died from the virus include but are not limited to 66 doctors and nurses in Italy, five doctors and nurses in the United Kingdom, five doctors and nurses in Spain and at least one physician in the United States of America.
In South Africa, the Department of Health (DOH) has confirmed that close to 100 medical professionals have tested positive for the virus to date. These health workers are all in good health despite the infection and are only presenting mild to no symptoms.
With a dilapidated public health system and out of pocket payments on the private sector, South Africa cannot afford to play coy at a time like this. According to Statistics South Africa, less than 17% of South Africans have medical aid which leaves the remaining 83% at the mercy of the public health system.
South African public hospitals are characterized as overcrowded and understaffed with long queues. As the infection rate increases, people with mild to severe symptoms who are not under any medical scheme will flock to public hospitals for treatment. As the number of patients in public hospitals increase, any delay in treatment could lead to the death of patients with severe symptoms as a result overcrowding, shortage of medical supplies and overloaded health workers.
Medical Malpractice claims
Historically, South African doctors have worked ridiculously long hours with reports suggesting that some medical professionals working non-stop for 24 and even up to 36 hours non-stop. This statistic becomes even more prevalent when taking into account the rate at which individuals contract the virus in the country. The ripple effect of this is that more cases are reported, medical professionals are likely to work longer hours, fatigue will set in, fear of contraction is significant, emotional distress is real and overall decision making by the average medical professional is compromised.
Authors Simon Folkard and David Lombardi in a 2006 paper titled Modelling the impact of the components of long work hours on injuries and accidents found that some work scheduling patterns are related to higher risks for errors and incidents. When compared to 8-hour shifts, 10-hours shifts and 12-hour shifts increased the risk of medical professionals making errors in judgment by 13% and 28% respectively.
Paramedics as first respondents, general practitioners as initial screens for Covid-19 and Accident and Emergency units receiving patients from ambulances, are likely to be most affected by the virus. As the number of patients increase and the number of medical professionals stays the same or decreases (considering illness or death of professionals) the impact on the overall health system could be catastrophic. It has been noted that in some countries retired healthcare professionals and final year medical students have been called upon to assist, however, there is no evidence regarding whether the former or the latter have Medical Malpractice insurance.
Furthermore, in times of chaos there is no time to supervise a student which could result in an increase in Medical Malpractice claims.
Under normal circumstances, recently qualified medical interns work under the supervision of a resident or experienced physician in a hospital. This period of training is critical in the development of these medical interns into astute medical healthcare workers. In addition, this supervision happens simultaneously with the resident physician treating his or her own patients. Whilst it is normal for medical interns to make errors in judgment such as misdiagnosis of a patient under the supervision of a resident physician, in the event of a large number of patients flocking to hospitals for treatment with varying symptoms of the Coronavirus, the likelihood will be severely reduced supervision from qualified staff and increased errors from inexperienced medical interns.
Underwriting
Medical Malpractice insurers in response to the pandemic need to exercise some flexibility in their offering to medical professionals. To assist with this, the Health Professionals Council of South Africa (HPCSA), has set out telemedicine guidelines to continue ongoing medical health during the outbreak. Importantly, this only relates to those services that can be offered remotely; there is still exposure for those practitioners that have to have direct contact with patients.
- The term “Telemedicine” is replaced with “Telehealth” which comprises of Telemedicine, Telepsychology, Telepsychiatry, Telerehabilitation, etc. and involves remote consultation only allowed in circumstances with patients using telephonic or virtual platforms on consultation
- Telehealth should preferably be practiced in circumstances where there is an already established practitioner-patient relationship. Where such a relationship does not exist, practitioners may still consult using Telehealth provided that such consultations are done in the best clinical interest patients.
- Although practitioners may charge fees for consultations undertaken through Telehealth platforms, the Council strongly cautions against practices that may amount to over-servicing perverse incentives and supersession.
- Where practitioners are in doubt whether a telehealth consultation will be in the best interest of the patient, they are encouraged to advise patients to present themselves for a face-to-face consultation to seek assistance at a health care facility closest to them.
Whilst this move from the HPCSA is progressive, there are risks that are related to telemedicine. Medical practitioners and Medical Malpractice insurers alike need to be mindful of the platforms that will be used to conduct any of these sessions i.e. a therapy session with a psychologist or a fitness session between a gym instructor and a client.
Not only are these platforms susceptible to cyber related risks, miscommunication and misinterpretation could become a common feature as network services are not perfect in nature and if not controlled could lead to claims.
Example of a claim that may arise is an incorrect diagnosis as the practitioner may not have the full clinical history of the patient which may lead to further deterioration of a condition of a patient or an underlying condition being missed.
It is evident that medical practitioners in South Africa and all over the world continue to risk their lives in order to curb the spread of the Covid-19 virus. Efforts have been made by the Department of Health, the NICD, HPCSA and other various institutions to protect patients and health professionals. Medical Malpractice insurer’s alike need to play a role in ensuring that medical professionals need not worry about liability at a time like this but be fully focused on the job at hand.
iTOO through our Medical Malpractice offering in compliance with the guidelines from the AHPCSA and HPCSA has adapted our Medical Malpractice policy to ensure that we enable the practitioner to continue providing a service through “Telehealth” which includes amongst other Telemedicine, Telepsychology, Telepsychiatry and Telerehabilitation as per the provisions of the AHPCSA and AHPCSA. All our policyholders, who meet the requirements of the guidelines will enjoy cover in accordance with the guidelines. This effort is to ensure that we play a role in supporting and assisting in so that this virus does not cripple the South African health care system. It also ensures that our medical practitioners enjoy the benefits of cover as they do their utmost to contribute in curbing the spread of Covid-19.
iTOO will continue to adapt its coverage where possible to ensure that its Medical Malpractice policy holders will receive support and exceptional service during and post Covid-19.
Together, let’s hit the Coronavirus for a six!
Author:
Specialist Underwriter – Medical Malpractice
Thebe Matlhaku
