Are you covered for your Teleradiology consults?

Before you answer “yes”, take a look at the following statement issued in ‘Casebook’ by the Medical Protection Society (MPS) January 2012;

‘Members are expected to advise MPS if they are participating in teleradiology and restrict the practice to their respective local jurisdiction’ (UK jurisdiction only for most members unless otherwise requested). Further, ‘Members who wish to practise teleradiology in circumstances where the image is taken in another jurisdiction must both be appropriately registered and have professional indemnity cover in the jurisdiction where the image is taken. Members should not assume that their current MPS membership will offer such an indemnity’

So according to the MPS, if you are not appropriately registered in the country that an image has been taken, and have not requested a jurisdictional extension to your indemnity cover for that country, the MPS is under no obligation to indemnify you.

Covered by another insurer such as Medical Defence Union (MDU)? A review of their indemnity policy indicates that cover is similarly restricted to the provision of professional services within the United Kingdom.

It would therefore appear that the following cases may not be covered under the standard terms of cover provided by either the MPS or MDU:

Cases examined outside the UK with images sent by electronic transfer for a primary opinion given by a radiologist working in the UK – no other radiologist involved.
Cases examined outside the UK, images sent by electronic transfer for a second opinion given by a radiologist working in the UK, already reported by a radiologist outside the UK.
Cases as for 1 and 2 but sent by CD or delivered by hand in the UK
Cases as for 1 and 2 but the patient brings the CD to the UK for an opinion as part of a consultation in the UK
Cases as for 1 and 2 sent to decide whether specialist treatment can be offered in the UK
Cases examined in the UK but there is a need to review older images examined outside the UK in order to provide an opinion in the UK
Cases examined outside the UK but being reviewed in the UK as part of UK medico-legal litigation
Cases reviewed as part of an International Panel of experts sent in for specialist advice from a site outside the UK
Cases shown to a radiologist attending an International meeting outside the UK

This potential restriction to the practice of Teleradiology by UK clinicians not only creates huge complexities and problems in routine tertiary referral practice but is also very damaging to specialist services and to patients who seek advice from these centres.

And those who fail to observe their insurers terms risk finding themselves on the end of a claim with no indemnity cover.

Working in Sports Medicine?

Those radiologists providing diagnostic services to elite sports professionals might do well to consider the Court of Appeal judgment in the case of West Bromwich Albion FC vs. El-Safty, which highlighted the importance of ensuring that, when treating individual professional sportspeople, the arrangements you make do not lead to the creation of an additional duty of care (or implied contract) to the club or team as well as to the individual patient receiving treatment.

Examples of common practice that can result in an express or implied contract with, or a duty of care, to the sporting body, club, agent or sponsor, include but are not limited to;

Treatment of professional sportsmen / women
Routine screening, medical reports or assessments for clubs
Pre-signing medicals, reports or assessments for clubs
Agreements or contracts whether implied or actual, to provide services to a club
Reports forming part of a reported image provided to a club by an imaging unit or hospital provider
Reporting on images received from teams touring outside UK
Invoices issued directly to clubs

Following this court’s judgment, the MDU and MPS announced the introduction of the following restrictive guidelines and exclusion of critical aspects of their indemnity cover;

MPS: (with effect from April 2008):

The MPS does not provide indemnity for doctors who are employed by, or contracted to, a Premiership Football Club.

Specialists/consultants should:

not enter into a written or oral contract with an employer to treat employees for reward
only accept referrals from other healthcare professionals not from clubs directly
address any professional fee notes to the patient and not the employer
review any existing relationship with an employer of a patient very carefully

MDU: (with effect from June 2010):

The MDU will not indemnify members for any damages, claimants’ costs and/or defence costs which relate to a claim against them by:

the employer, agent or sponsor of a sports person who is an individual patient;
any club, team or organisation for, with or under which a sports person who is an individual patient plays a sport; or
the organiser or owner of any sporting event in or for which a sports person who is an individual patient plays a sport.

The MDU have also stated that under the above circumstances they will not respond to a subrogated claim from an insurer that has paid a loss under an insurance policy where the cause of that loss relates to medical negligence.

The MDU has also advised that, “The endorsement will apply from a particular date (renewal after June 2010) and so any claim made after that date will be subject to it, regardless of when the treatment is conducted.”

Who is responsible if my policy does not cover my practice?

Your natural instinct might well be to point a finger at your MDO for failing to highlight or notify you of the indemnity requirements for your practice. Consider though the administrative practicality of applying that process to every individual member within every medical discipline, speciality and sub-speciality – it simply isn’t possible. At least, not within the framework of the MPS or the MDU whose indemnity arrangements, by sheer consequence of membership numbers, determine that they be centred on a one size fits all basis. Both will also reasonably argue that there is a mutual responsibility to advise them of your practice and any changes to that practice. Similarly, they may argue that it is incumbent upon you, the member, to understand the terms of your cover and to ensure that your cover matches the full scope of your practice.

Nonetheless, it is reasonable for you to expect your MDO to provide guidance on policy design so that you can be sure that your cover meets the needs of your practice. Doctors cannot be expected to understand the difference between territorial cover and jurisdictional cover, the meaning and threat of subrogation, to distinguish between Tort and Contract law or to understand the implications surrounding claims from third parties, as distinct patients.

Without such guidance, medical practices that increasingly involve collaboration with colleagues across the world, will increasingly find themselves inadequately or inappropriately covered by their policies.

In the end, however, as with car insurance, the onus sits firmly with you, the member, to choose a provider who understands your individual risks and can tailor your policy accordingly.

What are my options?

In addition to the traditional ‘one size fits all’ policies such as MPS and MDU, there is a growing stable of specialist indemnity schemes that have been developed specifically for specific medical risk groups. The objective of these schemes is not to compete for market share but simply to provide speciality specific indemnity tailored to the needs of these groups.

The providers of these schemes have a detailed understanding of the risks associated with a given specialty and the indemnity requirements needed to respond accordingly. With a defined pool of risk and the absence of cross subsidy or risk sharing with other poor or high claiming specialties, the cost is competitive and accurately reflects the true risk and cost of a given practice mix.

SEMPRIS is one example and was introduced in August 2010 in response to the introduction of restrictive guidelines and exclusion of critical aspects of indemnity cover by the MDOs for doctors treating professional and elite sportsmen and women.

In addition to indemnity for clinical negligence claims to cover costs and damages, fees and disbursements arising out of the defence or settlement of a clinical negligence claim, breach of confidentiality, defamation and Good Samaritan, standard cover is provided on a worldwide basis excluding USA/Canada (available subject to individual request).

In addition standard SEMPRIS cover specifically includes Indemnity for damages, claimants’ costs and / or defence costs relating to a claim brought by a sport person’s employer, club, agent, sponsor or event organiser in relation to alleged negligent treatment of a player, or pre-signing medical assessments undertaken directly for clubs, or, treatment provided when travelling overseas with teams.

SEMPRIS is available to all GMC registered members who treat professional sportsmen and women. It has been developed to cover all aspects of practice, not just sports related work, including non-sport related independent practice and professional issues not covered by NHS indemnity Membership has expanded rapidly with support from SEM Physicians radiology, Orthopaedics, cardiology, and rheumatology.

If you think SEMPRIS may be appropriate for your individual or group practice and you would like further information please contact Neil Redman at SEMPRIS on 07775 807561 or e-mail <a href=”mailto:neil.redman@sempris.co.uk”>neil.redman@sempris.co.uk</a>.

SEMPRIS are currently developing a Radiologist specific indemnity scheme for radiologists not involved with sport. Please contact Neil Redman to discuss this development.

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