Dr Kerryn Phelps, AMA President, Sydney

Secondly, there's been the release today of the AHMAC paper on medical indemnity insurance. We think this is a very welcome addition to the debate on medical indemnity but there are some major issues to be considered. There are some issues that the AMA has issue with.

Firstly, to legislate for open disclosure we feel is not appropriate in an environment of adversarial litigation and that open disclosure would only impede the doctor/patient relationship and would help nobody but the lawyers.

The second concern that we have is that there is not support in the AHMAC paper for the Ipp recommendation which looks to a national statute of limitations so that there is, once again, some certainty over the length of time in which patients can sue their doctor in the case of a negligence action.

There's also a concern with the AHMAC report that it does not support Justice Ipp's recommendations about the review of the law of negligence. The AMA has long supported a return to what we call the Bolam principle, which is where a doctor should be able to behave in a way that is acceptable to the majority of their peers, that a reasonable doctor working in those circumstances would have acted in a certain way rather than having the courts determine how a doctor should behave.

So, as far as medical indemnity is concerned, those certainly are the major issues today. Any questions on any of that?

QUESTION: Is the Federal Government sitting on its hands, still, on this? Is Kay Patterson up to the job as Health Minister?

PHELPS: This is not just about Kay Patterson. This is about Senator Coonan, Senator Patterson, the Prime Minister's Department, the Attorney-General's Department, Treasury and Finance. It crosses a number of different portfolios. It is a complex situation. We understand that, but the Government has had this in hand now for months and months and it is time that the medical profession got some certainty so that we can get on with treating our patients.

QUESTION: Can you tell us more about the disclosure issue?

PHELPS: The disclosure issue is a source of major concern. What it is likely to do is open up a whole new area of litigation for lawyers, and that is that did the doctor disclose, how much did they disclose, was it an appropriate amount and time of disclosure? And, unfortunately, it does nothing to improve the doctor/patient relationship. All it does is open another avenue for lawyers, and the only people who are going to benefit from this, at this stage, are lawyers.

The reason it doesn't work in an adversarial environment is that doctors would be reluctant to tell their patients what went wrong in any detail because they would fear that that would actually lead to litigation, rather than lead to a resolution of a problem with a patient. I would be much better to look at an alternative way of resolving disputes rather than litigation, and then have disclosure so that patients could get an explanation of what went wrong and why, but not with the aim of that leading to litigation.

QUESTION: You seem to be quite scathing about the report. Is there anything good in it or is it all bad?

PHELPS: No. As I said at the beginning, this is a very welcome entry into the debate about the future of medical indemnity. We have three problems with it. The first one is recommending legislation for open disclosure, the second one is about the Bolam principle and about redefining negligence, and the third one is about the statute of limitations. Those are the three problems with it. They don't agree with the Ipp Report.

We are hoping that the Ipp Report will be taken as the document which is more likely to provide those sorts of solutions, but clearly what is needed is a harmonious national, federal and state approach to medical indemnity. The Federal Government, we understand, made a decision during this week that a levy would be part of a solution to the medical indemnity crisis facing Australia at the moment.

We are on the record as saying that doctors will not accept a levy until tort law reform is in place in every state and territory because unless we have medical indemnity reform, then a levy is just throwing money into a black hole, and we're not prepared, as doctors, to do that because it doesn't solve the problem. It would be at best a band-aid and, at worst, a delay to the inevitable crisis that is going to befall the Australian health system unless we get a comprehensive solution.

QUESTION: We seem to be having press conferences like this once a month. Can you believe the way the Government's just stalled and failed to come up with real answers?

PHELPS: It's time we got answers and we do need to have answers and soon, because doctors, thousands and thousands of doctors, will be coming up with their premiums towards the end of this year. Many of them are right now deciding on their futures, whether they're going to continue to work in obstetrics, neurosurgery, plastic surgery, orthopaedic surgery. A survey just last week by the AMA showed that 8.2% of surgeons are going to stop work unless there's a solution to the medical indemnity crisis. Now, this isn't going to happen some time in the future, it's going to happen within the next 12 months unless we get a solution and soon.

QUESTION: What do you think about the report's recommendations to regulate insurance premiums?

PHELPS: I think there does need to be some regulation of the medical indemnity industry but whether it's done in terms of regulating premiums or in some other method, I mean, we haven't had a chance to really analyse that at this stage.

QUESTION: I think something like 10 neurosurgeons are considering retiring. Is that an example of the seriousness of the stage we're getting to?

PHELPS: We have precious few neurosurgeons now. To lose 10 of them would be to lose extremely precious expertise that takes a generation to recover, if ever. We're also losing many obstetricians, we're losing procedural GPs, and this trend, will continue until we get a comprehensive solution. It's a tragedy and it's a tragedy that is not just waiting to happen, it's happening right now.

Any other questions?

QUESTION: Do you have a view about Telstra's arrangement, I understand, with the AMA, about patients who are at high risk and some deal to help them? Can you explain a little bit about that?

PHELPS: The AMA has had concerns about this idea of Telstra's for some time, of having a list of people with life-threatening conditions, because it's just not going to work. What it is is a red herring to deflect from the fact that Telstra is not providing services to regional Australia at a rate that it ought to be. Now, if we had enough technicians installing and repairing phones, you wouldn't need to have this list.

Anybody who has a telephone needs to have it fixed quickly, particularly if they live in a remote part of Australia. Now, if this is what privatisation means then I think that the Government needs to think twice about proceeding any further with its privatisation plans.

What we need is to have people who can get their phones fixed within 48 hours, no matter what their medical condition.

The other concern that we have is that it's very difficult to predict a life-threatening condition and if somebody has a phone that's been out of order for weeks or a month, if they have a chest pain when they've got no history of heart attack, if they have an acute allergic reaction, if it's a child who has a convulsion, I mean, just because they haven't got a Telstra certificate from their doctor saying that they have a medical condition that requires you to have a phone on, doesn't mean they're not going to need the phone in an emergency.

If a tractor tips over, if someone has an accident on their farm, they need to have a phone that works whether they've got a medical condition or not.

QUESTION: If they're type one diabetic as well, if they had a hypo and there was no one there to help them, no one competent. It would be an incredibly long list, hundreds of thousands of people.

PHELPS: The list would run into millions and that's why this whole thing is a complete nonsense and why the AMA have ideological difficulties with it right from the outset. We told Telstra that this wouldn't work, we told them that it was not a solution to the problems of getting telephones fixed. The solution is having enough technicians to fix the phones, not getting doctors to be recruited into rationing telecommunications services. That's not the way to go.

QUESTION: What can doctors do, other than leave the industry and keep on pressuring the Federal Government through the AMA? Will doctors ever consider striking over the indemnity issue? Is that an option?

PHELPS: What's happening now is worse than a strike. What's happening is that doctors are quietly making a decision as individuals to leave the work that they're trained for. They are saying, "I cannot do this any more, I cannot work in obstetrics, I cannot work as a neurosurgeon, I cannot work as a plastic surgeon because I just don't want to face the risk of being sued when I'm going about my work with due diligence. I don't want the risk of having to pay $100,000 dollars or $200,000 dollars a year in premiums." They have to pass that onto their patients. Many of their patients can't afford that and so the doctors have got to a point where they can't absorb it any more.

So, the tragedy is happening inch by inch, day by day. It's not something that's going to be a big strike. It's something that is, in fact, I think, more serious than that.

QUESTION: Is it only still New South Wales and Queensland?

PHELPS: There are doctors all over Australia who are insured with UMP which is where the immediate crisis is but we have doctors working all over Australia who will eventually, sooner or later, be impacted upon by this medical indemnity crisis. It doesn't matter where a doctor is working, sooner or later, the problem will hit them.

If we can get this right, in every state now, then we can prevent the crisis rolling across the country like a tidal wave. But right now it's hitting states like New South Wales and Queensland. It's not far off in Victoria and it will hit the other states. That is for certain.

Thank you all.

Ends