With increasing awareness and use of litigation in healthcare, doctors in India have begun seeking insurance cover as a safeguard against, what is essentially, an occupational hazard. The cover can run up to Rs. 1 crore; almost four times the amount doctors would have opted for just a couple of years ago.

The recent slew of multicrore settlements have unnerved the physician community. According to recent reports, a cardiovascular surgeon from Mumbai has sought an indemnity cover of a whopping Rs. 20 croresthat covers all the legal costs for doctors and the compensation they owe their patients or patients’ kin.

Healthcare vs consumers

Doctors in India have started acting on the need to protect themselves from medico-legal liabilities only recently, especially with courts awarding compensations to patients in crores. In a landmark judgement in 2013, the Supreme Court had ordered three doctors to pay an NRI a compensation of Rs.11.4 crores after his wife’s death at a Kolkata hospital. The demand for indemnity for doctors had spiralled soon after this order.

Reportedly, the number of doctors enrolling for indemnity to cover legal costs (if sued) has seen an annual rise of 30 to 40%. Shockingly, it is being advised and endorsed by medical associations themselves who are telling doctors to go for a minimum of Rs. 1 crore per annum.

Dr. Anita Sadashivaiah, paediatrician and member of Indian Medical Association in Bangalore, says, “Given the present scenario, I would endorse doctors to have an insurance cover to protect themselves. These days, doctors should be ready to deal with patients suing them.” Even at the unfortunate cost of eroding trust between doctors and patients, that is inevitable with the over-commercialisation of healthcare, she feels.

Seeing the demand for covers and following strong requests from members, the Association of Surgeons of India launched an indemnity scheme three years ago. Speaking to the media, Dr Arvind Kumar, Head of Surgery at AIIMS and President of ASI said that, “when associations get involved they can bargain better with insurance firms.”

Insurance against loss of trust

The Consumer Protection Act of 2019 has fueled the so-called ‘compensation culture’ and has become controversial in the medical community. This new act did away with the Rs. 25 lakhs cap on compensations, meaning patients/kin can sue their doctor for heftier sums, sometimes running up to crores.

Senior lawyer Amit Karkhanis, said “Furthermore, the option of appealing to the National Commission has been taken away. This had been a major deterrent against litigation.” Earlier people had to go to the NC in order to initiate litigation but now they can demand high compensations without ever having to involve the commission. This development could potentially open the door to more litigation."

While some doctors justify the need for an insurance cover, others in the medical field feel it is an unhealthy trend.

Dr. Pradeep Gadge, a renowned Diabetologist in Mumbai said, “I think we are fast-moving towards “guard your interests” type of practice. I remember, even a decade back I used to treat patients empirically when the diagnosis could not be established. I have empirically treated patients on tuberculosis medicines and they survived. We need to understand that sometimes diagnosis remains obscure despite all investigations and efforts. So many doctors treat based on their clinical experience.” This is increasingly no longer the case. “A doctor tries to thoroughly investigate and only then take steps in that direction. Because every doctor today is worried about big claims when medico-legal cases happen.”

Dr. Gadge argues that “you can’t do your best with a sword dangling on your neck. In fact, patients who can’t really afford expensive treatments are willing to spend on investigations and rigorous documentation, if only to furnish these as proof should complications arise. So the ‘trust’ in a relationship is replaced by ‘suspicion’; this is harmful.”

The author Sonali Desai is a Mumbai-based freelance writer and a member of 101Reporters.