By comparison, malpractice coverage for specialties considered super high risk such as neurosurgery, reconstructive surgery and spinal surgery is only CI$14,000 per year, 40 percent lower than the cost for obstetrician malpractice.

Obstetrician at Chrissie Tomlinson Memorial Hospital, Dr Sarath De Alwis, said that if malpractice insurance goes up to $120,000 per year, it will drive most of Cayman’s Obstetricians out of business.

“Mothers will have to go to Miami to have their babies,” said Dr De Alwis. “That is not good. The country will suffer if we allow that to happen.”

The long term implications of going off Island for all baby deliveries could have a ripple effect on the financial and tourist sectors, if professionals with young families decide against moving to the Caymans, because of limited Obstetrician services.

The driving factor behind the escalating costs of OB malpractice insurance is the growing risk for high damage awards in the courts, in particular, cerebral palsy and other neurological impairment. Currently there are three negligence claims for damaged babies, one of which could be awarded CI$3 million.

Additionally, with the recent award of CI$6 million to a victim of a road traffic accident, there is a clear trend of Cayman courts awarding high damages for negligence, which are typically paid by insurance companies.

Dr De Alwis explained that a big factor in lowering risk and keeping malpractice insurance low is to make sure that doctors are properly checked out before allowing them to practice medicine here.

“We need to clean our own house and check the validity of doctors’ qualifications, especially if they have court cases in their home countries,” he added.

The Cayman Islands is not alone in grappling with higher malpractice insurance for OBs. Developed countries the world-over are also struggling with higher costs of malpractice insurance.

More than half of France’s obstetricians held a nationwide strike in 2003 in the midst of record birth rates to protest spiralling costs of malpractice insurance. In numerous states in the US, OBs are leaving the practice in droves because of high costs.

Some states are allowing doctors to practice without medical coverage such as Florida. They are only required to hang a sign out that says that the doctor does not carry malpractice insurance. It appears to be a joke among doctors that they don’t own anything of value to take in litigation when they actually put their assets in the names of their spouses and children to avoid paying.

The situation is considered so dire here that the Health Practice Commission has set up a special committee to look at possible solutions to keep malpractice rates to a reasonable level.

The committee Chairman, Dr Steve Tomlinson said one option being investigated is legislative reform that would set a cap on insurance claims with Government being responsible for the remaining award above the cap

Another option is setting a health captive insurance, which may be a viable solution as Cayman is the number one country for registered health captives for the US. The problem is the initial capitalisation for a captive could be cost prohibitive, said Dr Tomlinson.

Another potential solution is to have OB/GYN subscriptions subsidised by other specialties. But doctors from specialties with low premiums such as general practice may not be keen on paying higher rates to subsidise the obstetrician practice.

The committee is also looking at other commercial insurance providers, but good medical malpractice to $6 million is difficult to get and most insurance companies don’t provide the long-term protection that obstetricians need.

One success the Committee has achieved, is the temporary deferment of the $120,000 to give the Health Practice Commission time to find a workable solution that will get the risk management under control.

“We are looking at how other jurisdictions have solved their problems such as New Zealand and Ireland,” added Dr Tomlinson.

“We are also carefully looking at what is happening in the US, because there are vast areas in the US that are out of OBs.

“If no doctors can work in this island - how can you develop the Cayman Islands? What young family will come here without an OB/GYN?”

Complicating the problem is the fees, because fees for delivering a child in Cayman are not keeping up with the rest of the world. Dr De Alwis stated the average delivery fee for the doctors is $1500 to $2000. By comparison a baby born in the US is between US $10,000 to $20,000 and  $15,000 pounds in Hong Kong and Singapore. In addition, there are less than 600 babies born per year.

With half of the babies being born in George Town hospital, the remaining 300 baby deliveries are divided by OBs in private practice, and with costs of keeping an office, nurses and other overhead expenses, the numbers just do not add up.

Dr De Alwis acknowledged the current number of eleven OB/GYNs working here may be too many to support 600 deliveries per year. But even as market forces come in to play and there are fewer doctors, it is unlikely the malpractice insurance premium will be lowered. That means the few remaining OBs who tough it out will still struggle to stay in practice. Some experts say the only OBs who will be able to practice are if they are employed by George Town Hospital, unless of course they move to a full fee-for-service model where OB/GYNs are also paying for their own malpractice coverage.

 shurna@caymannetnews.com