Transcript of Interview - Dr Mukesh Haikerwal, AMA Vice President, with Grant Goldmand, Radio 2SM, Thursday 17 July 2003

GRANT GOLDMAN: Doctors groups have expressed shock over a High Court decision that a surgeon who bungled a woman's sterilisation is actually liable for the cost of raising her child. Amazing! The court yesterday threw out an appeal against an earlier decision that the cost of raising the boy be covered until he's 18. That's going to be quite an amount.

The AMA says if the decision results in an increase in negligence insurance premiums doctors may refuse procedures, and you would have to agree that that makes sense. Yes. Not going to do it any more if that's the risk.

Mukesh Haikerwal from the AMA joins us on the line right now. Good morning, Mukesh, thanks for taking the time.

MUKESH HAIKERWAL: Good morning. Thank you.

GRANT GOLDMAN: Correct me if I'm wrong, surely it's been shown in the past that there's no 100% guarantee here.

MUKESH HAIKERWAL: Absolutely right and there's no procedure - as I always say you can never say never in medicine and no more so in the area of obstetrics and gynaecology, obviously there's a failure with every procedure, including this one.

GRANT GOLDMAN: Isn't that the information given before the procedure?

MUKESH HAIKERWAL: I would certainly hope that that was in the case, but in this particular case if you look at the specifics the guy didn't tie one tube and, of course, he himself put his hands up and said there is a problem here. But in general there are very few problems across the country in all the millions of procedures that are done and very few things come to litigation, so that's really very reassuring. But when something does come up the numbers become pretty big, especially when it involves the cost of raising the child.

What this case raises is the issue of the law suddenly being interpreted in a different way. Up until now it was always thought that having a child - the negligence side apart - when you have a child it's actually seen as a blessing and brings with it it's own bounty, if you like.

GRANT GOLDMAN: That's right, that's the way I see it. Surely people who say we'd like to try and not have a child for awhile, but if the child comes along everything seems to change. That's been the way it's always been.

MUKESH HAIKERWAL: Sure. But the problems I suppose we're having as a profession is that each day we think it's over it's only just began and something else sort of crops up out of the woodwork from left field and the way things get interpreted takes away the certainty we thought we were getting back into the system and it takes away the finite nature of the liability that we would have in working in the profession, and so we do get statements where people say I'm not going to do that any more, and that's really very worrying because it actually removes the choices that we have as patients and certainly that our ladies have in society in terms of contraception procedures and I think that's a real shame.

We have to accept that whatever we do there is always going to be a down-side, that things may not go well or that things may not work, but they have to be part of the proper information process that we have in terms of consent, and from a procedural point of view we have to make sure we certainly do throughout learning bodies, our colleges that look after our education that not only we train properly, but we continue with that training and do risk management and make sure that the risks are very low.

GRANT GOLDMAN: Yes. We're hearing about doctors pulling out of obstetrics because of the insurance premiums and now with this situation do you think a lot of doctors will refuse the procedure?

MUKESH HAIKERWAL: It's a real shame. I mean when obstetricians and gynaecologist who are trained both in obstetrics and gynae ran into difficulty with their insurance they actually switched to gynae only and this means that this is the same sort of high risk, high cost item in the gynae practice which will make them not want to do that.

We see that in general practice as well at the moment, where there's a very good contraceptive that people can have put in under their skin which works extremely well, but unfortunately in the first few months of use there were some cases where people got pregnant while using this contraceptive device. The down-side is that insurance has become astronomical now on that and there's actually an excess that the insurance companies are putting on for people doing these sorts of procedures. So it's much bigger than one case, it's across the country and it's reducing choice, it's reducing access and I think it's making people more squirmy again about doing different things they otherwise do very well.

GRANT GOLDMAN: I think so. Just one thing, has the sterilisation operation improved in recent times?

MUKESH HAIKERWAL: It's a very good operation. It's very safe because it's done with little keyhole surgery, the tubes are tied off or burnt or clipped and it's very good. But there's always this failure rate of around one in a thousand or so - better than some but worse than others. It's always sold as an irreversible procedure but there is a risk that it may fail.

GRANT GOLDMAN: Once again another question mark in another area for doctors. It's a tough time for them, that's for sure. Thank you, Mukesh, appreciate your time this morning.

MUKESH HAIKERWAL: Thank you, Grant.

GRANT GOLDMAN: That's Mukesh Haikerwal, he's the Vice-President of the AMA.

Well, well, there you go. I suppose my mother could sue the doctor because I wasn't as good looking as she expected, or I was born too early. Sue him.

Ends