NEW collaborative care agreements between doctors, nurse practitioners and midwives could increase the cost and length of legal claims against doctors, an expert in medical liability claims has warned.

Ashley Jones, an insurance partner in the Brisbane office of international legal practice Norton Rose, said the legislative framework for collaborative care arrangements for midwives and nurse practitioners was legally complex.

Mr Jones told a medical law forum titled “No doctors in the room”, organised by law firm Slater & Gordon, that the collaborative care agreements had the potential to cause legal action between medical care providers over responsibility for a patient’s care.

“It’s a Brave New World of contracts between health providers”, Mr Jones told the forum.

Legislation regarding collaborative agreements was introduced in 2010 in conjunction with midwives and nurse practitioners being given access to the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme. (1)

A federal government fact sheet describes collaborative agreements as an arrangement between an eligible midwife or nurse practitioner with a medical practitioner that must provide for consultation, referral and transfer of the patient’s care, as clinically relevant, “to ensure safe, high quality health care”.

Mr Jones said in the case of independent practitioners the agreements amounted to contracts, which raised issues of responsibility and liability regarding continuity of care, the separate duties of each practitioner, who ordered tests and saw results, and who was responsible if a patient made a claim.

He said if a patient made a claim against a medical practitioner, the doctor could then take action against the nurse practitioner or midwife involved in the patient’s care as contributing to the claim. This could add to the cost and length of litigation.

Two representatives from medical indemnity organisations who also spoke at the conference agreed there was a chance that the cost of litigation could rise because of the new collaborative agreements.

Cheryl McDonald, medicolegal manager of Medical Indemnity Group Australia (MIGA), said although the cost of claims could rise, it was unlikely to affect members’ premiums as the number of defendants involved in a case did not affect the final amount paid to a patient in a successful claim.

“It is not unusual to have one plaintiff and multiple defendants now, so the concept of working out who is responsible won’t change”, Ms McDonald told the forum.

Harry McCay, Queensland manager of Avant, said there was the potential for increased costs from claims because more health providers were involved in a patient’s care.

“Medical practitioners need good collaborative arrangements with clear guidelines and clear understanding”, Mr McCay said.

He advised doctors to enter collaborative agreements only with midwives or nurses they trusted and who they would willingly refer a patient to because of their experience and competence.

“Aim for a good collaborative agreement but a great collaborative relationship”, Mr McCay said.

The medical law forum was attended by midwives, nurse practitioners and lawyers. Only two attendees indentified themselves as doctors.

– Kath Ryan

1. Department of Health and Ageing: Programs and Initiatives: Collaborative arrangements for participating midwives and nurse practitioners

Posted 23 May 2011