These areas include MPS' risk-management and education programmes with health professionals to reduce adverse incidents and promote safer practices in health environments.

The MPS is a not-for-profit, mutual organisation, and its income comes from the membership fees paid by its approximately 235,000 health professionals in all parts of the world - except in the United States and Canada.

A highly successful organisation - one that again closed its 31 December 2005 Financial Year with a further strengthening of the enterprise - it sets subscriptions levels based on its non-profit, fully funded requirements.

According to Dr Hickey, "This means that we aim to collect in each year enough money to fund all claims arising from adverse incidents occurring in the year.

"In setting our subscriptions, we are advised by independent consulting actuaries and take account of the investment yield that will accrue over time from those subscriptions. We must make provision for the effects of claims inflation, the rate of which is (unfortunately) often well above retail price inflation."

Despite MPS' prudent investment management, and successful operations, claims sizes in varying jurisdictions are a source of major concern and Dr Hickey's view on the problem is that countries should "ask what the communities (of doctors and patients) are able to afford."

Dr Hickey also said that jurisdictions should "debate what is fair."

Dr Hickey explained that his advice is set against the background that "when doctors cannot afford their malpractice cover fees because awards in the jurisdiction have caused a hike in these fees," then there are problems such as a shortage of professionals, and
others, to deal with.

The importance of the concern can be seen in Dr Hickey's most recent Activity Report, in which he reviewed the Society's operations in MPS regions - the United Kingdom, Ireland, South Africa, New Zealand, Hong Kong, Singapore, Malaysia and, the Caribbean region.
For the UK, Dr Hickey's concern surrounds the size or "severity" of claims - even though the number of claims may be manageable, or even few.

He said, "The problem is not one of frequency but of average value, or, severity of claims. The claims frequency for general practitioners, for example, maintains its downward trend."

He said that frequency is expected to be some 30 per cent lower in 2006 than it was in 1993, however, the average claim size had increased by approximately 10 per cent over the last year alone.

Claim size concerns exist for South Africa and Malaysia as well, but for Hong Kong - after a period of having to implement very substantial subscription rate rises over the last few years - claim sizes and frequencies have "stabilised," Dr Hickey explained.

"Thus the driving force for (doctors') subscriptions remains the severity of claims, and this is in the control of the Government and the courts" in individual territories, he said.

There is good news in the 2006 report relating to the Caribbean region: average claim values and the frequency of claims remain relatively stable. "Plus Cayman does not seem to be particularly litigious," said Dr Hickey.

"While I don't have the details on Cayman's draft Freedom of Information Bill, hospital records and risk-management systems should become even more important as any country looks towards adopting FOI legislation."

Dr Hickey added that in an FOI era, healthcare records and doctors' notes - which were formerly exempt - could become accessible.

"Therefore these would consistently have to be prepared with the knowledge that they could possibly be read out in court one day," he added.

Where residents feel that legislation will allow their negligence, right up to malpractice complaints to win higher awards - and not simply provide correct and appropriate redress to patients that have been harmed by doctors' negligence - then proper reporting and risk-management systems must be even more important to come up strongly against this.

According to Dr Nancy Boodhoo - MPS' Regional Coordinator for the West Indies and Bermuda, who also spoke exclusively with Cayman Net News - MPS' relationship with medical and dental practitioners is not only focussed on providing independent, confidential advice on a range of medico-legal and ethical issues, as often as it may be needed and, providing occurrence-based indemnity for health professionals through a network of lawyers. MPS is especially concerned with implementing risk-management and education programmes.

"Risk management programmes in a hospital can be geared towards the gardener, cook or doctor. We look at systems to see how we can effect change to avoid adverse incidents and it can involve anything, such as the institution of armbands for patients, in order to reliably identify the patient for whom the treatment is intended," said Dr Nancy Boodhoo.

"The theory is that from one bad incident we can help prevent another. Then, the other side of the business is providing a network of lawyers to handle criminal matters that emanates from the doctors' practice. MPS has approximately 40 in-house lawyers. However, with doctors, we provide anything from training with body language to advice to diffuse a possibly problematic situation at an early stage.

"Doctors have access to expert advice from a 24-hour emergency helpline and, where appropriate, legal assistance and compensation for patients who have been harmed through negligent treatment," Dr Boodhoo added.