Dr Kerryn Phelps, AMA President, at the Launch of Family Doctor Week 2002, Sydney

PHELPS: Does anyone have any questions of James or of Dr Frankowicz?

QUESTION: What were you doing to lose weight?

WELCH: A lot of exercise and basically changed the way I was eating. I was eating a lot of junk food. That is pretty much all I ate. I did a real lot of exercise.

QUESTION: Adopting a healthier lifestyle?

WELCH: Yes.

QUESTION: How are you going now?

WELCH: I feel great.

QUESTION: Do you feel like a new person?

WELCH: Yes. People don't recognise me. Most of the guys I used to work with, I hadn't seen them for a couple of months. They do not recognise who I am and stuff like that.

QUESTION: What have been the advantages of losing weight, apart from the loss of the weight?

WELCH: Everything is easier. Buying clothes and driving and going to a restaurant and stuff like that is a real lot easier. I do not have to worry about whether a chair has arms on it and whether I can fit into it.

FRANKOWICZ: I met James one year ago. He came to the surgery already grossly overweight. The first motivation was that he could check his weight. As such we checked out what we could do about it. James said he was already very motivated. Follow-up with him was encouraging him to do that. I helped him with little relapses, which of course will happen. For one year, he lost 100 kilograms and cut his size in half. So I am really grateful to him. And I think he has done a great job. I helped him as much as I could. He was very regular coming to the surgery, once a month. He was very good at communication.

PHELPS: Does everyone have any questions of Dr Frankowicz?

QUESTION: Losing weight is obviously something you can't do overnight.

FRANKOWICZ: We always established short-term goals and long-term goals. The short-term goals were always about lifestyle changing, such as diet and exercise and balancing that. It was very individual, of course. The long-term goal is losing weight. Of course, that can't come first. We have to have a starting point and we have to know as well how to go with that. So everyone has an individual path.

PHELPS: Does anyone have any further questions of James or of me? I am happy to take questions on any other subject.

QUESTION: We know that the AMA met with the task force for the first time this week. What was the outcome of that meeting regarding the medical indemnity insurance?

PHELPS: The AMA appreciates that there is a lot of work going on within government at federal and state level towards a solution to the medical indemnity crisis. But we are not entirely happy with progress with the way that things are going. Particularly, we need to see a national standardised approach to the statute of limitations. It's all over the place. Some states don't have a statute of limitations. In other states, it varies grossly. We need to see a standardised, three years for adults and six years for minors so that we have some predictability about future liabilities.

Some of the states have really been dragging the chain on tort law reform. I single out Victoria, particularly here, as dragging the chain on tort law reform. Queensland has made some progress with the need for further modifications. New South Wales has made significant progress but still needs to introduce the statute of limitations legislation. We also need to see an urgent establishment of a care and rehabilitation scheme for the people who are severely disabled by medical accident, whether that is cerebral palsy from an injury or brain damage from some other form of medical accident. These people need care. They need it without having to go through the trauma of adversarial litigation. Unless we get those two things in place, I do not think doctors will be prepared to contribute towards this levy that the Prime Minister is talking about. It would be throwing money into a black hole. Any other questions?

QUESTION: Are the States holding up the process or is the Federal Government?

PHELPS: I think the Federal Government needs to move more quickly than it is moving. I understand that it is a difficult and complex matter. But they seem to have backed away, and indeed stalled on the process of this long-term care and rehabilitation scheme. If this stalls, it will really have major implications for the solution for medical indemnity. We only have a few months left up our sleeves before we hit another brick wall. That is coming up at a great pace. Unless we get these reforms and we get them all in place - it is not a matter of an either or - we have to get all of these reforms in place to have any kind of long-term solution. We also need to be starting the debate on how we best take care of people injured by medical accident.

We also need to urgently redefine medical negligence. The Prime Minister's Eminent Persons Group is going to be looking at this redefinition of medical negligence as part of their review of public liability and medical indemnity. We would like to see that process certainly fast-tracked to make sure that we can get those changes in place in each of the State jurisdictions.

QUESTION: How are doctors feeling at the moment?

PHELPS: Doctors are feeling very frustrated and very anxious about the future of their profession. We are in Family Doctor Week. There is no question that medical indemnity is one of the straws that is severely straining the camel's back at the moment. Unless we get a solution to medical indemnity within the next couple of months and one that is long-term and really does put in place solutions that will reduce premiums. There is no use putting in place a number of different types of changes without them reducing premiums to affordable levels. At the moment, talking about a levy on top of unaffordable premiums is like a slap in the face to doctors who are already, particularly in rural areas, doing it tough. There are many GPs who are having to give up procedural work in rural areas because of the unaffordability of medical indemnity insurance.

QUESTION: Dr Phelps, what do the reforms look like in their entirety?

PHELPS: We are looking at tort law reform in every state. There are a whole range of reforms, including capping and thresholds. There would be thresholds for minimum levels of disability before somebody has access to the tort law system. We need to look at capping of general damages. We need to look at issues like having expert judges - judges who are very experienced in medical negligence cases - so that they can tell what is negligence and what is not. We need to see a redefinition, going back to what we call the Bollen principle, where the test is whether a doctor actually behaves in a manner that was along the lines of what any other doctor in those circumstances would reasonably be expected to do, before it is called negligence. We need to look at a statute of limitations, which is a national standard. We have to look at a way of looking after people in a timely and efficient manner who are injured in medical accidents for the costs of that long-term care need to be taken out of the common law damages.

QUESTION: What will happen if these reforms are not put in place?

PHELPS: If we do not get all the reforms in place - it has to be by December this year, because that is when the next round of premiums will come up - I think we will see chaos in our health system. We already have major problems recruiting people into obstetrics and neurosurgery. We are having people who are deciding to retire early, to leave particular specialties. We are seeing GPs dropping procedural work, particularly in rural areas. This will have a long-term chaotic effect because it takes more than a generation to be able to encourage people back into a specialty when they have decided to leave it. It takes 10 years to graduate a medical student and train them for a specialty, be it general practice, obstetrics, neurosurgery, orthopaedics or any of the other specialties. If we do not get people training or staying in those specialties, then we are not going to be able to keep up the numbers that are required by a growing ageing population unless we get urgent change and we get it now.

QUESTION: Are you confident that these reforms are going to be put in place?

PHELPS: I am not confident at the moment. I think we have seen a stalling of the process, particularly with the long-term care costs. We need to see the State Governments making a uniform commitment and preferably to have some kind of standardisation of their tort law reforms. New South Wales has led the way. Queensland has baulked at the harder issues, like capping and thresholds. Victoria is dragging the chain. South Australia has baulked at the hard issues. We are really seeing a bit of a piecemeal approach around the States. Where we had agreement that they would all move forward on certain principles, we are now seeing the politics of the whole thing coming into play and a lack of commitment from some of the governments. Some governments are a little more captive of the plaintiff lawyers than other governments, too. They may not be able to see the bigger, long-term picture beyond the next electoral cycle. That is a matter of concern.

QUESTION: Bob Carr has indicated that there will be an increase in Medicare levies for spinal injuries.

PHELPS: The long-term care and rehabilitation of people who are severely injured, be it by accident in the community or medical accident, is something that I think, as a community, we have to get a grip on. To suggest an increase in the Medicare levy, I think a lot of people would find that acceptable. It is a cost to the community. We have the universal health insurance scheme under Medicare. At the moment, only the people who can afford the emotional trauma and the financial cost of going through the adversarial legal system are getting any form of compensation or rehabilitation costs, unless their families are very wealthy. This means that a lot of people are missing out. The bottom line here should be care and rehabilitation. It shouldn't be compensation.

QUESTION: What is the bottom line? Should people have to sue to get compensation.

PHELPS: The bottom line is that people should not have to sue their doctor or their local council or their school or their authority in order to get sole justice and in order to get the care and rehabilitation they need. That is where the system is sick.

QUESTION: Anthony Mundine put up a challenge to you today to be ringside at his next stoush. Will you be there?

PHELPS: I have no intention of witnessing a fight. I remind Mr Mundine that he is not 'The man', he is a man. As a man, he is just as vulnerable as any other man. He should remember that from his last fight, when he was knocked out because he copped a hit to the head. Unfortunately, we are hearing a lot of rhetoric. A lot of it is designed to get people to go along to a mismatch on Monday night. I just pray that nobody gets seriously hurt.

Thank you all.

Ends