Transcript of Interview, Dr Mukesh Haikerwal, AMA Vice President with Christopher Still, Channel 10, Friday 18 July 2003

CHRISTOPHER STILL: This spate of law suits that have sprung up in regards to failed sterilisation operations or contraceptives and so forth, how is that going to affect your profession?

MUKESH HAIKERWAL: This is going to be a major departure from current practice. We have seen a situation where the law has interpreted the birth of a normal child, thus far, as being a blessing for the parents and the child taking with it, making its own fortune along the way - it's own good luck, if you like. The change that the High Court's ruling has made is that the family has been awarded a sum of money to look after the child until the age of 18. This is going to bring an awful lot more anxiety around the current medical defence situation. Just when we thought it was all over, things have started to get worse again. The States have done an awful lot of work, as have the Federal Government to try and sure up the medical indemnity situation and now we have a ruling challenging all that we have known thus far.

CHRISTOPHER STILL: What do you think the ramifications in terms of this High Court case will be?

MUKESH HAIKERWAL: The ramifications initially were around the sterilisation procedure being something that became high risk for the gynaecologists, and of course obstetricians have since stopped doing obstetrics and delivering babies and gone onto gynaecology. This now becomes a high risk procedure for gynaecologists, sterilisation procedure, because not only are there particular problems from doing the procedure itself, but there results of a failed procedure. The birth of a normal child is now seen to be another, what is called, 'heads of damage' and that is something we find unacceptable. The knock-on effects of this are that other forms of contraception are also under consideration. We have seen today in Victoria, two cases of a failed device which is inserted under the skin to provide contraceptive care, called Implanon. Now every single form of contraception has associated with it, some form of risk of failure. That failure is something that has to be understood at the time of consultation and it is something that is part of a contract between patient and doctor in the new doctor/patient relationship, which is one of the meeting of partners. It is very important for people to understand what is going on and it is also very important that it is explained to them that there is a failure rate and why there is a failure rate.

CHRISTOPHER STILL: What do you think is the possible outcome from legal actions like this one of the High Court and the Implanon failure.

MUKESH HAIKERWAL: The concern here of course is the access to contraception and contraceptive choices may well become limited because people are not willing to take on the responsibility of prescribing because things can go wrong. Somebody may not take a pill, someone may have diarrhoea or be on antibiotics whilst taking the pill, and then try to blame the doctor for that particular action. When this thing comes to court, the usual finding is that the patient only sees you a couple of times a year and you see 200 people a week, so you are not likely to remember what you said, and the patient is. So the ramifications are that people are not going to get access to contraception and contraception choices will be greatly diminished. We are already seeing this with the Implanon device, it is a fantastic method of contraception, it lasts for anything up to 3 years, it provides very good contraception. Unfortunately there have been some cases where it has not worked. The result of that is that premiums have gone up for people putting those implant devices in and there is actually an excess on practitioners who put those devices in for each time there is a problem

CHRISTOPHER STILL: And what about other very common forms of contraception like the pill. Do you think this could spread to that?

MUKESH HAIKERWAL: Absolutely, I think the real concern is that people are seeing yet another change in which laws are interpreted. We believe that law reform needs to be further addressing this situation. We believe that people prescribing the pill, the injectable, and also the under skin devices are all running a risk, if there is a failure, of not only having a problem because of negligence in terms of failure to warn, but also the fact that people will want payment for bringing up the child from the age of 0 - 18 years.

CHRISTOPHER STILL: So it's really a bit of a paradox, a doctor being sued over the delivery of an otherwise healthy baby.

MUKESH HAIKERWAL: The claim for payment for bringing up a healthy child from birth to 18 years of age is a very bad message to society, and it is also something that I think the High Court has had a great deal of difficulty in coming to because it was a 4 - 3 decision and not a unanimous one and this obvious reflects the complexity of the case. I think it is a very bad precident that has been set here and certainly as an association we will be lobbying hard to have the laws around this issued reviewed, and indeed the laws around all of insurance indemnity. At the end of the day, the profession wants to make sure that patients are looked after in the best possible way. If there is an adverse outcome, due to negligent practice, it is properly compensated and that the framework in which this is done is reasonable, affordable, and will work.

CHRISTOPHER STILL: And so at the end of the day you can foresee doctors refusing to hand out contraceptives for this fear?

MUKESH HAIKERWAL: I think there is going to be a great deal more fear about it. In the medical press this week, there are articles about people who do lots of Implanon devices and lots of contraception through family planning clinics, who are feeling very much under pressure and may well decide it is not worth the risk of doing this kind of work, but moreso, the premiums that are going to be charged may well reflect the fact that there is a greater degree of risk with doing this kind of work.

CHRISTOPHER STILL: So it's a financial incentive as much as just outright fear about legal action?

MUKESH HAIKERWAL: It's about fear, it's about restrictions to rights of practice and it's about cost, and ultimately we as patients will bear the brunt of this when we don't have a choice that we otherwise would have. We have got to understand that whatever we do is limited, first of all how well it will work in terms of contraception and the many problems in terms of any other procedure. And we need to be aware of that and that's what a good therapeutic relationship is all about, making sure the patient understands, that the doctor understands the patient's past history and that together they work on what they are going to do about their future health.

CHRISTOPHER STILL: Thanks.

Ends