The most important insurance cover that MIPS provides in indemnity insurance. Indemnity insurance for healthcare practitioners is also referred to as:
- Medical indemnity (typical in Australia)
- Professional indemnity (typical in the UK and for other occupations)
- Medical malpractice insurance (typical in the USA)
One of the mandatory registration standards of the Medical Board of Australia relates to professional indemnity.
" All medical practitioners who undertake any form of practice must have professional indemnity insurance or some alternative form of indemnity cover...initial registration and annual renewal of registration will require a declaration that the medical practitioner will be covered for all aspects of practice for the whole period of the registration".
Interns and other public hospital employed doctors are covered by their employing hospital in terms of professional indemnity as the employing hospital is vicariously liable for the omissions or negligence of employees. This meets the AHPRA indemnity requirement. Hospital employed doctors are also frequently members of medical defence organisations (MDOs) or insurers to ensure they have additional back up cover for the provision of any healthcare that may fall outside of their work at the hospital (eg gratuitous work) or professional matters where your employer may decide not to represent you (e.g. Coroner Court appearance). This is generally available at no cost in these early years.
Once commencement of private practice, practitioners need to ensure that they notify their MDO/insurer to ensure indemnity cover is in place and commensurate with their new risk exposure.
I've had a request to provide a patient's records.
This question has a varied response based on your state. Generally speaking patients have a right under Commonwealth or State/Territory legislation to request access to their health records, or can authorise others to receive them on their behalf (for example, lawyers, and insurance companies).
Access to medical record requests should be done in writing, signed and dated by the patient. There are some limited circumstance in which health records can be withheld from patients, if you are unsure about disclosure we recommend contacting MIPS for advice
When should I not disclose information?
You should not disclose health information from a deceased patient’s medical records if you know the patient would have objected to the disclosure when he/she was alive. Such objection should have been noted in the medical records. It may not be that the patient has explicitly stated it but if you form a reasonable belief that the deceased would have objected to the disclosure, this is sufficient to refuse disclosure.
I need to prepare a death certificate
The death certificate is a legal document, and one that you need to ensure you are the appropriate person to sign before doing so eg a Dr responsible for the patient's care immediately prior to death or one who saw the deceased after the death.
Only sign the death certificate if the cause of death is known and the death is not reportable to the Coroner. Whilst it is not legally necessary to view the deceased, it is advised to do so prior to signing the death certificate
When is the death reportable to the Coroner? The legislation on this differs between states, the following are general inclusions:
- If the deceased person was a child or person in care or custody
- Follwing an accident that contributed to the death
- Any violent or unnatural death
- Any sudden death of unknown cause
- A death under suspicious or unusual circumstances
- When the deceased had not been seen by a Doctor recently
- During or following an anaesthetic and / or a medical procedure
If a healthcare practitioner has died, who can provide authority to release medical records?
If a doctor of other healthcare practitioner is deceased, his/her estate may still receive a request from a patient to release medical records. In these situations, the authority rests with the Executor or Administrator of the deceased doctor’s Estate. A power of attorney does not have authority to release the records because a power of attorney is no longer valid after a person dies.
If a patient has died, who can provide authority to release medical records?
If a patient dies you must still maintain their healthcare records. The person authorised to access the deceased patient’s medical records is the executor or administrator of the deceased patient’s estate. A power of attorney does not have the authority to request/release the deceased patient’s records because a power of attorney is no longer valid after a person dies.
You should always sight the will or the grant of probate (if available) and ascertain the identity of the person before releasing the information. Always attach a copy of the relevant documentation to the medical records of the patient.
What if a relative of the deceased patient requests medical records?
It depends on the purpose of the request. Doctors may be able to disclose limited information to immediate family members for compassionate reasons.
It is important to be cautious about releasing information where there may be disputes amongst family members.
How do I destroy patient records?
Having maintained the patient records as defined by the practice state (as general guideline consider maintaining adult records for seven years from last provision of health care and children until the child is 25), records should be destroyed securely. Paper based records may be scanned into a computer based system and destroyed within this timeframe.
I have been asked to provide a report for the coroner or police
A request in writing may come from the Coroner or the police officer acting on behalf of the Coroner requesting a report
MIPS is available to assist with the response to this request, ensure that assistance is sort as early as possible.
The report should be accurate, factual and based on your medical records.
An insurance company or solicitor has requested I provide a report
In your capacity as either a 'treating doctor' or an 'expert' you may be asked to prepare a report, before preparing the report ensure that you have the patient's written consent to provide the information. The consent should be in writing, signed and dated from the patient or authorised representative (eg parent or guardian).
The two reports mentioned have different requirements and require clarification.
You are not legally obliged to provide a report unless ordered to do so by a court or tribunal, but medical practitioners have an ethical obligation to assist patients in providing information which in some cases may require production of a 'treating doctor’s' report.
If you agree to provide an 'expert' report you must be aware of the ramifications of doing so, including your duties to the court as an expert.
Obtain correspondence and copies of the patient's medical records ensuring that the report is accurate and refers to the medical records.
In some cases you may be asked to give evidence in court based on your report or receive a subpoena to give evidence.
I have been asked/received a subpoena to be a witness concerning a patient I was / have treated
Read the subpoena fully and carefully to establish its breadth.
- Understand whether the subpoena is for you to give evidence or for you to provide patient documents to the court.
- The person being served the subpoena is obliged to only produce or include information that is set out in the subpoena.
Once you have worked out that the subpoena is valid and that you need to comply with it call MIPS to clarify the first practical step.
So long as the subpoena is validly provided, you must comply regardless of patient consent. You must also comply regardless of your availability (most times) although you can often take steps to work through these issues with the party who issued the subpoena. Look at when and where you need to do the steps involved in the subpoena.
Henness Wong, Public Relations Officer (Australian Medical Students’ Association)
Henness is a MIPS member in his final year of medicine and has long been an advocate of change among his peers. Here are some of his thoughts as he completes his final year and embarks on a long and illustrious career.
Graduating from medical school is a milestone worth celebrating in any year. Fellow students in this class of 2020 should be incredibly proud of their perseverance; surviving the year is a noteworthy achievement in and of itself. While I reflect on my personal experiences, I would like to pay respects to the Dharawal and Yuin people for hosting this international student from Hong Kong and thanks to MIPS for inviting me to look back on the journey thus far.
COVID-19 has no doubt challenged us in innumerable ways in the final year of training and assessments, especially when there is often very little room for missed steps and missed opportunities. Some of us have become “Zoomers”, some of us had to cancel overseas electives that were prerequisites to an internship in home countries. All of us have had some manner of disruption to medical education. How university faculty and student leadership navigated the challenges have no doubt directly impacted the experiences of all healthcare students, for better or for worse. Granted, the extent of this pandemic was unforeseen by the medical and dental schools and the management and response to COVID-19 varied across the spectrum. Often, the unfortunate circumstances were unintentional outcomes by the faculty. It is at this time that the participation of medical students in providing constructive feedback will be beneficial to the learning process of all parties.
Positively, the novel recruitment of final year students (eg Assistant in Medicine positions in NSW and Sub-Interns in Victoria) represents a unique arrangement that capitalised on the competence of final year medical students to fortify and strengthen the medical workforce in anticipation of a worst-case scenario under COVID-19. This rapid adaptation of student placements to ensure that our cohort could meet the graduating requirements of clinical placement was welcomed and signposted a potential future conversation discussing the possibility of providing financial stipends and industrial protections for final year medical students to contribute their growing expertise to the healthcare workforce, similar to that of New Zealand's Trainee Intern system.
COVID-19 presented as yet another ‘stress test’ to the wellbeing and mental health of medical students, with graduation prospects fluctuating throughout the year. MIPS has been a steadfast advocate for this matter, from providing confidential indemnity advice to sponsoring student-based wellbeing activities.
It needs to be stated that the resilience of medical students in the face of adversity is something of great value. Throughout the year and during the pandemic, there was an underlying, selfless message of hope; the health profession holds great power when it bands together, such as in this time of crisis, to work for the safety and betterment of others.
The mental health of medical students and junior doctors receives national attention and Federal funding with the recent launch of Everymind National Framework for tackling the Mental Health of Doctors and Medical Students. It is a milestone in response to the repeated demand of Australians medical students for systemic and cultural changes on the matter, as reflected in the annual National Student Survey by Australian Medical Students’ Association (AMSA). Other fervent nominations of AMSA’s advocacy efforts in recent years called for action for climate health, action against sexual harassment, bullying and discriminations, and the need for specialty vocational training in regional and rural Australia.
Ancient wisdom from the saged Chinese medical practitioner Sun Simiao (孫思邈) in the Tang Dynasty described three nobilities of doctors：「上醫醫國，中醫醫人，下醫醫病。」
“Superior doctors treat the country. Middle doctors treat the person. Inferior doctors treat the disease.”
Medical students’ participation in advocacy has enabled cultural shifts within the medical profession, as witnessed by the 2020 cohort in a variety of sectors over our training. Climate change has been declared a health emergency, and medical students are standing together with progressive organisations in demanding that all stakeholders collaborate to seek strategies to mitigate the impacts of climate change. The medical student voice has been clear from AMSA, catalysing AMSA’s divestment efforts away from fossil fuels this year.
2020 has also been pivotal in the pursuit of racial justice too. The #BlackLivesMatter movement from America raised global attention, but Australia has been dealing with its own racial inequalities with its treatment of Aboriginal and/or Torres Strait Islander peoples since Invasion Day. Current affairs raised essential conversations not only about the world around us, but also about diversity and inclusion in medicine. Medical students have seen brand new conferences dedicated to improving our competence in recognition of clinical signs from racially diverse populations. This is not a silver bullet, and it will take consistent and dedicated hard work to heal years of inequity. However, these opportunities are crucial for grappling with the representation of patients of racially diverse backgrounds, culturally-safe communication and healthcare, and being aware of medical education’s longstanding Eurocentricity.
Within our medical student community, we have elected increasingly diverse leaderships to reflect the modern composition of our cohorts, embodied by the first Asian AMSA President Jessica Yang in the 60th year of the national organisation’s history. One more example to be proud of, it is a step towards the inclusion of sexual and gender diversity when AMSA invited pronouns for attendees at National Councils in 2019. The rainbow lanyard that replaced the usual black or orange strap beaconed inclusivity to every colour in the rainbow family.
The class of 2020 is about to join the medical profession, carrying the experiences and lessons unique to our training. We are a cohort who has risen despite adverse challenges, with the resilience to recognise opportunities in every crisis. The mission to improve the lives of patients will be our first and foremost vocation and may those willing also enable positive changes towards a safer, more inclusive society for all.
Over the last decade, Australia has successfully achieved control of several vaccine preventable diseases with high routine vaccination coverage.1 There has been significant investment in the provision of cold chain guidelines and patient safety and risk minimisation education for vaccine providers. Breaks in the cold chain, lack of compliance to storage guidelines, exposure of vaccines to unacceptable temperatures and the concomitant loss of potency are all real concerns of which healthcare practitioners should be aware and they must be prepared to manage these adequately. Additionally, it must be considered that failures in technique or inadequate informed consent of the risks can lead to complaints and claims.
Frequently asked questions
What possible clinico-legal risks do I face in providing vaccinations?
In MIPS’ experience, such issues can be rare and may not relate to all members, however they may be associated more with the manufacturer of the vaccine. In the instances where conduct of MIPS members is called into question, it is usually regarding issues such as wrongful administration of a vaccine to an individual, incorrect dosage, inappropriate follow-up of storage, cold chain management guidelines, inadequate dissemination of information about expected and rare side effects, lack of informed consent and disclosure of material risks; as well as family or custody issues arising from one parent’s refusal to vaccinate a child. In these circumstances, there is a risk of a claim, complaint or an investigation (including regulatory) into your provision of healthcare, therefore it is always our advice that you alert MIPS if there is any occurrence of an adverse or unexpected outcome following a vaccination.
How can I reduce my clinico-legal risk when administering vaccinations?
Closely follow government advice from health authorities, the TGA, Medicines Australia, the National Immunisation Program, your College and the vaccine manufacturers. Always provide appropriate and adequate informed consent and good medical practice as defined by AHPRA. You must clearly document your consult advice, discussion and outcome in the patient’s health record.
What should I do about patients who refuse to be vaccinated?
Ultimately the patient or parent/guardian must provide consent for a vaccination. Many individuals may be concerned about the risks or they do not clearly understand the benefits to the individual or the overall public health interests. In some cases, Government benefits or access to childcare may be prevented if certain vaccinations do not proceed. Your time and good communication may be required in assisting hesitant patients and information together with the provision of further government and health sector evidence-based resources may be required. Your discussions and the patient’s ultimate decision needs to clearly documented in the patients record.
What should I do if a patient experiences an adverse event following administration of a vaccine?
Ensure you understand the recommendations stipulated by the Australian Health Department regarding how to manage Adverse Events Following Immunisation (AEFI) including anaphylaxis, and that you have the right equipment available. Document information about the vaccine you administer and report any adverse effects. Advice can be found in the Immunisation Handbook from the Department of Health
If a patient has an adverse result, notify MIPS.
Will MIPS cover me in case of an adverse event related to administering a vaccine?
The MIPS Indemnity Insurance Policy provides cover for civil liability and defence costs for matters arising from healthcare provided by you. Within the policy, healthcare is defined:
“Healthcare means: Any care, treatment, advice, service or goods provided for the physical or mental health of a person…” See Member Handbook for full definition.
The administration of vaccinations would normally fall under the definition of healthcare, therefore MIPS will provide assistance and indemnity to members, subject to the terms and conditions of the policy and Member handbook.
Key advice to mitigate clinico-legal risks
- Keep up to date with advice from the Government Health Department and other authorities
- Ensure correct storage of all vaccines
- Ensure staff are adequately trained in:
- Vaccine storage and vaccine cold chain standards
- Effective responses to patients’ concerns
- Effective disclosure of material risks and formal informed consent is gathered to vaccinate
- Clinical features, management and epidemiology of vaccine allergic responses
- The use of personal protective equipment
- Effectual communication approaches with patients
- Implement a formal monitoring routine to ensure proper equipment operation
- Audit your vaccine storage facilities regularly
- Implement adequate contingency plans to manage cold chain breaches and power breaks in your practice
- Implement open disclosure protocols to manage unexpected adverse events. Always contact MIPS as soon as an adverse event occurs to seek tailored advice to the situation.
Any queries, contact MIPS
Insurance cover is subject to the terms, conditions and exclusions of the policy. The information provided is general advice only and does not take into account your personal circumstances or needs. You should review the Member Handbook Combined PDS and FSG and/or contact MIPS on 1800 061 113, before making a decision. Information is current as at the date published.
- COVID-19 vaccine information for GPs
- COVID-19 vaccination training program
- ACRRM Vaccination Information
- Australian Immunisation Handbook
- Australian National Immunisation Program
- Australian Immunisation Register
- Australian Commission on Safety and Quality in healthcare – Australian Open Disclosure Framework
- National Adverse Events Following Immunisation (AEFI) reporting form
- National Vaccine Storage Guidelines ‘Strive for 5’
- RACGP Cold Chain Management
- RACGP Immunisation errors
- RACGP Standards for general practices (5th edition)
- RACGP - Improving vaccination cold chain in the general practice setting
- RACGP - National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people (immunisation)
- RACGP - Infection prevention and control standards (Section 2.1: Staff immunisation)
- Deaker, R., Birden, H., Earnest, A., Page, S. L., & Clark, C. (2008). Improving vaccination cold chain in the general practice setting. Australian family physician, 37(10), 892.