Justice, Health, and Finance Ministries' recommendations differ.
By JUDY SIEGEL-ITZKOVICHdani naveh 298 AJ(photo credit: Ariel Jerozolimski)
The establishment of a national risk management system to reduce negligence and errors in the health system has been recommended by a Justice Ministry committee that looked into ways to reduce expenditures on medical liability lawsuits.
While Justice, Health and Finance Ministry representatives on the committee agreed on this, they disagreed on whether financial awards to those found harmed by medical negligence should be limited and whether lawyers' fees should be capped.
The Justice Ministry, which officially issued the 80-page report Sunday morning, barred reporters who received it earlier from giving any information before that, and thus it was impossible to obtain reactions to the recommendations from any source, including the Israel Medical Association, hospital directors, medical insurance companies or others who were not give an advance copy.
More than a year ago, the Justice Ministry appointed a committee, headed by Deputy Attorney-General for Civil Matters Tana Shpanitz, that included representatives of the three ministries. The members held 19 sessions, during which they heard from judges and representatives of medical professionals, hospitals, the Israel Bar and others.
A separate committee, headed by deputy Finance Ministry accountant-general Zvi Halamish, was appointed to recommend alternatives for providing medical negligence coverage for all the general state and public hospitals and individual doctors, nurses and other professionals. At present, a government company called Inbal insures state hospitals, while individual medical staffers are covered via collective agreement with the Shuki Madanes insurance agency, representing large overseas insurance companies.
Medical institutions have charged that being a near-monopoly has caused Madanes to increase medical liability premiums by hundreds of percent over the last few years. Jerusalem's Bikur Holim Hospital, which is under temporary receivership, recently had to cut by 10 percent the wages of its higher-earning employees to pay an increased liability insurance bill to Madanes worked out and approved by a court.
If the government decides to set up a not-for-profit state agency to insure all medical personnel and medical institutions against liability, it would publish a tender to choose an insurer that would operate under restrictions and supervision.
The Shpanitz committee studied more than 4,500 court cases that involved medical negligence at all judicial levels between 1993 and 2002. Of these, data was computerized in more than 3,000 and studied by the committee members. They found that 48 percent of the cases reached the magistrate's courts, 45% the district courts and 7% the Supreme Court.
The number of lawsuits has grown moderately by several scores of cases per year, the committee learned. In more than half the cases, the lawsuits were settled in a compromise between the plaintiff and the defendant and approved by the court. Each case took about three years to settle.
The medical specialty with the most lawsuits was pregnancy and obstetrics (33% of all lawsuits), followed by others with much lower numbers - oncology, orthopedics, surgery and internal medicine. The average payment to plaintiffs was NIS 837,000. After 1998, awards granted by the courts were higher than those agreed upon by compromise; before 1998, this trend was reversed.
The Justice Ministry opposed putting any cap on the amount that could be won by patients suing for medical negligence, while the Health and Finance ministries urged that a limit be set. The Justice Ministry also opposed setting a cap on lawyers' fees for representing plaintiffs, while the other two ministries - which ultimately have to pay for medical negligence by state-owned medical institutions - favored restrictions.
The Health Ministry has already appointed an expert on risk management, Prof. Ofer Kaplan, to plan a national unit for preventing medical errors, and several million shekels have been allocated to finance it. Such a unit would aim at finding the causes of medical errors and ways to prevent them by examining near-fatal and fatal cases; blame would not be placed on the doctors or institutional representatives who provide data.
