Tuesday, August 18, 2009

Indemnity insurance: the great obstacle

In past months, as the momentum in activism to protect private midwifery and homebirth has increased, the general agreement among midwives and consumer groups has been to accept that indemnity insurance is in the public interest. That it is somehow the right of the consumer/woman to sue the practitioner/midwife if something goes wrong.

[Pause for a moment and check the evidence of how many people who have adverse outcomes in health care have even a remote chance of winning such a case. The winners are the insurance companies and the legal representatives.]

The plan for mandatory indemnity insurance for all health professionals has been in government circles for years now – and I have been fighting it for many years. When midwives' indemnity insurance ceased about eight years ago, I was a member of the Nurses Board of Victoria, and mandatory insurance was being introduced into draft legislation. I stated that it was unreasonable for anything to be mandated if it was not accessible, and argued that, if required, the Board should provide it with registration. For my troubles I was declared to have a conflict of interest, and any time the issue of professional indemnity insurance was mentioned in Board minutes, my conflict of interest was noted.

[Yes, it is personal!]

I think we are being na├»ve to just lie down and accept this requirement, when what is being required is inaccessible. There’s no established ‘consumer right’ to anything about indemnity – it’s a market $$$ issue. I find it interesting (from Lisa’s blog) that the UK NMC (Nursing and Midwifery Council) said: "We do not have the legal power to impose indemnity insurance on nurses and midwives. It is extremely difficult to obtain indemnity insurance on the open market. Imposing such a requirement could place an unreasonable expectation on nurses and midwives because they may not be able to find the insurance. For these reasons we have reinforced the need for them to be honest with their clients about this situation."

So we shouldn’t argue that insurance for all health practitioners is a right, and we should not support its introduction unless it is accessible on equitable terms. If there’s no legal power for the UK NMC, there’s probably no legal power for the Australian health practitioners board. But as long as we believe there is, we will never challenge it.

The only real human right in birth and parenting is that basic ‘natural law’ right to do what our bodies were created to do. As it happens, that’s the terrain of homebirth midwifery. If a woman can’t or doesn’t want to act in concert with her own body’s physiological processes, she has to find the best on offer from the medical obstetric system – and that’s not a right, it’s a ‘privilege’ that we have in a wealthy developed society, that our sisters in many other countries do not have.

We midwives really have to think for ourselves in this, what’s ethical and moral. The Health Minister has two choices – either provide indemnity for ALL midwives in a way that is affordable and accessible, or don’t mandate it.

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