Insurance Law on Medical Negligence - Essay Example

Heading: Insurance Law on Medical Negligence Your name: Course name: Professors’ name: Date Introduction Today, there is an increase in the number of cases regarding medical negligence. As a result, this has posed a great situation for insures in terms of professionals’ indemnity. Therefore, this paper explores the issue of medical malpractice, causes of medical malpractice, and insurance law on medical negligence. In order to understand the issues of medical negligence, the paper provides a definition of negligence and its elements, and will define the concept of indemnity. Negligence Before embarking on the issue of medical negligence, it is critical to understand the concept of negligence. Negligence, basically, means a breach of duty that results from omission to undertake something that any reasonable individual, led by considerations that normally control human affairs conduct would, or doing something that a reasonable and careful man would not do (Hiltz, 2004, pp. 1-20). In other words, negligence refers to a breach of duty of care on individual that leads to damage, which the defendant does not desire to the plaintiff. Further, Sage and Kersh (2006, pp. 56-67) point out that there are three elements of negligence that include: a legal duty to provide care to a plaintiff by the defendant within the limits of the duty; breach of the aforementioned duty; and resultant damages. Medical negligence This refers to a professional negligence, either by omission or act by medical practitioners, whereby the kind of treatment offered does not meet the acceptable standards of practice within the medical community, and results in death or injury to the patients. In most instances, this is caused by medical errors (Hiltz, 2004, pp. 1-20). Regulation and standards of medical negligence vary from one country to another, and by their jurisdictions. In order to offset the costs and risks involved in medical negligence, medical professionals can get liability insurances based on their profession. Hiltz (2004, pp. 1-20) says that doctors can be held liable for issues that include performance of cosmetic surgery and experimental drugs, depending on the situations. In order to fully understand the issue of medical negligence, consideration of certain cases is highly indispensable. To start with, there is Achutrao Haribbhau Khodwa v state Maharashtra (AIR 1996 SC 2377). Here, the Supreme Court stated that medical practitioners’ skills vary from one doctor to another. Notably, there may be more than one way or course of treating a patient. Therefore, courts would not claim negligence on physicians that have performed their duties to their level best, with reasonable caution and care. Moreover, Iii (2006, pp. 15-20) contends that the court held that medical opinion can vary in relation to the course of action that should be undertaken by doctors attending patients, but if the physician acts in the acceptable manner to the medical profession, and the court has proved to the court that he has diligently and carefully acted, but the patient still suffers a permanent illness or dies, the doctor cannot be held liable for negligence. Secondly, considering the case of Boloman v Friern Hospital Management Committee (1957) 2 ER, Mc Nair J, maintained that: the test of negligence on the use of professional competence or skill lies not on tests regarding on top of Clapham omnibus, since he does not have any special skill. Instead, the measure is the standard of the usual skilled individual that exercises and professes to be highly skilled. Notable, Iii (2006, pp. 15-20) holds that the court held that individuals should not have high competence at the risk of being held negligent. Therefore, law establishes that it is enough if he merely exercises the usual skills as a common man would do on that specific art. According to the court, negligence implies the failure of a physician to act according to the reasonably standards of competence of the medical professionals at that time (Priaulx, 2008, pp. 10-18). Imperatively, a medical professional is not held negligent if he has acted in accordance with the standards provided by a professional body that have competence on the specific art. In other words, a physician is not negligent if he has performed his duties as required by the medical body of the profession. Thirdly, in the case of Laxman v Trimbak AIR 1969 SC 128, the Supreme Court held that doctors’ duties to their patients are very explicit. This implies that anybody that takes responsibility of providing medical treatment and advice undertakes that he has the required knowledge and skills for that particular purpose. Therefore, upon consultations by patients, such practitioners owe patients duties that include a duty of care in the taking up the case; duty of care on the kind of treatment to offer; and a duty of care on the treatment administration. Therefore, a breach of any of the duties justifies a negligence action to the patients. Imperatively, Iii (2006, pp. 15-20) argues that the physician ought to employ considerable degrees of knowledge and skill, and should exercise sensible level of care. However, neither the highest nor lowest degrees of competence and care, on particular circumstances, are required by the law. Principles of medical negligence With reference to the aforementioned cases, it is crucial to understand some of the principles of medical negligence. First, Hiltz (2004, pp. 1-20) holds that negligence refers to the breach of duty, which results from failure to act in a manner that a reasonable man would do with the guidance of some considerations that control human conduct, or undertaking something that a sensible and cautious man would not do. Second, Sage and Kersh (2006, pp. 56-67) say that in medical negligence, there is a distinction between professional and occupational negligence. According to Freckelton (2006, pp. 74-84), an error of an accident or judgment, and simple failure to care, do not necessarily imply negligence on a medical practitioner’s part. Therefore, law cannot hold a doctor liable for negligence if he exercises his duties and responsibilities in a manner that is acceptable to both the profession and the law. Still on this, failure of taking precautions is not always the measure of negligence. Third, Freckelton (2006, pp. 74-84) holds that a medical professional can be charged for negligence if he does not have the requisite skill that he claimed to have, or if he fails to exercise with substantial competence, in a particular competence, the professed skill. In order to judge negligence on the individual is based on a usual person exercising the normal skill in the profession. Fourth, Freckelton (2006, pp. 74-84) maintains that there is a difference between the civil and criminal negligence. This implies that what criminal law may hold as negligence may not necessarily the case in civil law. In order to have negligence amounting to offense, there ought to be a mens rea element (Priaulx, 2008, pp. 10-18). An act becomes a criminal negligence if the level of negligence is higher or gross. Otherwise, it might offer a basis for action, but not for prosecution in civil law. Fifth, with regard to Bolam’s case (1957) 1 W.L.R. 582, 586, the test for establishing negligence holds in its practice in India. Sixth, prosecution of a medical practitioner for negligence in criminal law ought to be demonstrated that he undertook or failed to undertake something, which in his medical usual senses would have performed, or failed to perform. Lastly, Iii (2006, pp. 15-20) points out that Res ipsa loquitur implies evidence rule and works in civil law, especially in torts’ cases, and aids in the determination of onus of proof in negligence in undertakings associated with negligence. Besides, Res ipsa loquitur is restricted to trials of criminal negligence (Freckelton, 2006, pp. 74-84). Causes of medical practice To start with, Byrd (2000, pp. 34-56) argues that medical malpractice can be caused by careless or negligent acts by healthcare providers or institutions. Moreover, Hiltz (2004, pp. 1-20) postulates that it can be caused by failure to provide care in a way that is required by the medical profession standards. In addition, medical practice may result from errors, such as, wrong diagnosis, wrong prescription of medicine, surgery errors, anesthesia mistakes, improper treatment, incompetent healthcare, and disease misdiagnosis. Additionally, Iii (2006, pp. 15-20) says that some of the injuries caused by medical malpractice include mental retardation, cerebral palsy, birth injuries, deafness, blindness, paralysis, quadriplegia, infertility, bone fractures, death, Erb’s palsy, developmental retardation, and limited control and use of limbs. Medical Profession Indemnity This refers to the protection of individuals or institutions from damage and loss claims that are filed by another individual (Bornstein 2008, pp. 175-185). Its fundamental principle entails the financial restoration of the injured party to the level he was in just before the injury or accident or illegal act took place. In most cases, laws related to civil court acts employ indemnity as a standard measurement for damages. Therefore, if the complainant is entitled to compensation for the defendant’s actions, the awarded amount should just restore the plaintiff to the state he was in before the accident or injury (Byrd, 2000, pp. 34-56). This implies that only the actual losses would be compensated, but punitive damages would be treated separately. In relation to the medical profession, Bornstein (2008, pp. 175-185) says that an individual that suffers a serious consequence as a result of negligence can take a legal action against a negligent clinician, or healthcare provider, or an institution. Hiltz (2004, pp. 1-20) says that a healthcare organization or institution can be charged for its negligence or for vicarious acts by its employees. Some of the factors that determine who an injured individual should press charges upon include: whether the damages were caused by a clinician, institution, practitioner’s employment status, and which of the possible defendants can pay the compensation sought (Byrd, 2000, pp. 34-56). Various liability forms that are covered by insurance and indemnity arrangements can be categorized into: First, there are insurance arrangements that are either made through self-insurance or commercial, that cover a healthcare organization. Secondly, there are mutual indemnity plans that cover individual medical professionals. Thirdly, Priaulx (2008, pp. 10-18) maintains that there are commercial insurance plans that are responsible for covering individual health care providers. Insurance arrangements that cover healthcare organizations Notably, Bornstein (2008, pp. 175-185) asserts that healthcare organization can be held liable for own negligence, or vicariously negligent for the employees. A medical professional hired by a healthcare institution is covered by the institution’s insurance, and therefore, need not take private indemnity insurance. Sage and Kersh (2006, pp. 56-67) maintain that Most of the public medical institutions are governed by Territory and State governments, and each government makes certain arrangements for vicarious liability of healthcare institutions. Besides, Byrd (2000, pp. 34-56) notes that some of the Territories and States have self-insurance plans in which government indemnifies its institutions and employees for claims filed. Imperatively, Freckelton (2006, pp. 74-84) maintains that payments are directly made by the government through particular appropriations from consolidated revenue. Nevertheless, some of the governments, particularly New South Wales, have the most sophisticated self-insurance arrangements (Bornstein, 2008, pp. 175-185). Besides, Freckelton (2006, pp. 74-84) contends that the insured individuals pay yearly premiums that are calculate to show the actual risks incurred. These premiums are, in turn, credited to an account under the organization’s name in a central fund. In case of surplus interests, they are paid to the organization. Additionally, Clark and Harris (2005, pp. 20-30) note that the entire premiums are paid into a single fund, which is governed by GIO Australia. However, the fund does not cover Visiting Medical Officers (VMOs). In other Australian Territories and States indemnify the VMOs for their work in public healthcare institutions (Priaulx, 2008, pp. 10-18). On the other hand, private hospitals have the responsibility of getting indemnity insurance of their own. It is noteworthy that private hospitals have a wide range of indemnity arrangements (Byrd, 2000, pp. 34-56). Mutual indemnity arrangements Most of the Australian medical practitioners take out indemnity insurance with the Medical Defense Organizations (MDOs). MDOs are mutual organizations, which are owned by members, operate of non-profit basis, and provide discretionary, instead of contractually defined cover (Clark & Harris, 2005, pp. 20-30). Discretionary cover implies that MDO can determine the indemnification of member on a certain claim. However, it is rare to find a case in which an MDO declines to indemnify its member. Because of the discretionary nature of the MDO cover, they are not within the domain of the Insurance Act 1973, as they do not provide insurance contracts. Impliedly, they are not supervised by the Australian Prudential regulation Authority (APRA), which is the industry controller. In fact, this lack of control is termed as one of the contributors to the rising insurance premiums in Australia. In addition, Clark and Harris (2005, pp. 20-30) maintain that MDOs offer more services to the members that include medical practice advice and legal advice. Besides, since they act as representative organizations, they play a major role of lobbying for the members interests. Therefore, medical practitioners can look for indemnity covers all over the country. Covers offered by MDOs Traditionally, Priaulx (2008, pp. 10-18) postulates that MDOs provided claims incurred cover, under which doctors are indemnified against claims that is associated with incidences that took place when they were MDOs financial members, whether they still have membership at the time the incidents are reported. Hence, claims which are made long after the physicians stopped being members and after the incident, are covered by MDOs (Clark & Harris, 2005, pp. 20-30). Incurred but not reported claims refer to those incidents, which occurred but no claims have been made about them. There are also claims termed as claims made cover. This type requires that health care practitioners must have MDOs membership, both at the occurrence of the incident, or at when the incident became a patient’s claim (Priaulx, 2008, pp. 10-18). In case doctors cease to be MDO members, they are required to take out run-off cover in order to ensure that the incidents occurring after stopping to be members are covered. Nevertheless, this cover is usually expensive, but it is mostly provided freely by some insurers under some situations. Calculation of premiums This is done by in-house actuaries who consider several factors, which include compensation levels that courts award for medical malpractice; legal costs incurred in defense of medical malpractice claims; and IBNRs (Priaulx, 2008, pp. 10-18). Moreover, they consider medical officer’s area of practice, risks of the area. The level of premiums depends on the level of the specialty risks. Medical malpractice crisis This refers to a time of instability in the health professional responsibility insurance market, which decline in insurance carriers’ fiscal ratios are succeeded by a rise in insurance premiums and, or decreased insurance supply (Aidman, 2005, pp. 95-100). In order to evaluate the state of medical negligence crisis, it is vital to consider both total levels of premiums. Besides, it is significant to contrast the costs, and how the providers are repaid in the state, since refunding influences provider’s potential to meet the increasing costs of insurance (Bornstein, 2008, pp. 175-185). Clearly, medical negligence crisis affects states more than other regions in the country because of some reasons. Firstly, Aidman (2005, pp. 95-100) notes that the difference in the socio-demographic across states is responsible for the varied tort settings in terms of average awards size and litigiousness. Secondly, there is a difference in the rules that govern medical negligence across states. Thirdly, Bhat (2001, pp. 95-110) notes that the issue of malpractice insurance is predominantly controlled by states. Fourthly, most of the malpractice insurers operate only in one or few states. Clark and Harris (2005, pp. 20-30) say that recent and present proposals for federal tort restructuring like a nationwide restriction on non-economic damages demonstrate a considerable disappearance from an undistracted past tradition of state governance on this domain of law. One of the indicators of a state’s entry to negligence crisis is the declining insurers’ fiscal performance (Bhat, 2001, pp. 95-110). With time, insurers ought to adjust premiums, or underwrite practices so as to correct profitability problems. If they increase prices adequately, the crisis can be solved for them before it ends for medical officers. Presently, there are indicators that insurers’ monetary ratios are stabilizing, and some of them do not intend to make more increases. Another indication of malpractice crisis is the reduction in the availability of insurance. When insurers realize the business is no longer profitable, is unstable and unpredictable, they tend to exit the market (Aidman, 2005, pp. 95-100). Moreover, they can get stronger with underwriting, and refuse to renew doctors’ policies, fail to write new policies, or write policies for the greatest risks only. Moreover, Bhat (2001, pp. 95-110) asserts that the provider’s inability to transfer the high costs of insurance to the payers indicates malpractice crisis. Additionally, Byrd (2000, pp. 34-56) argues that the huge increases on premiums indicates malpractice crisis of a state. This raises a question of insurance affordability that happens as a result of large increases in comparison to the past increases. Consequently, many insurers exit the market, while those that remain charge more premiums. Evidently, these affordability issues differ across states and territories, with the urban areas having greater increases than the rural areas (Bhat, 2001, pp. 95-110). It also vary according to clinical specialty, for instance, the most influenced ones include neurosurgery, obstetrics-gynecology, general surgery, orthopedics, and radiology. Problems of malpractice system Lately, there have been indications of dissatisfaction in the medical liability organization. These complaints revolve around some of the system’s performance on many measures that include: one of them is that the system undertakes a poor job in the compensation of patients that are injured by medical negligence (Baker, 2005, pp. 6-20). According to the epidemiological researches, it is clear that only two percent of the medical negligence injuries are compensated as claims. In addition, there is a complaint that the system has put high transaction costs. Evidently, for every dollar compensated in medical insurance premiums, only 40 cents are awarded to the injured individuals (Aidman, 2005, pp. 95-105). The rest of the cents is taken by the insurers’ litigation and administrative expenses. In comparison to compensation systems that depend on administrative, instead of legal processes in order to direct refunds to the injured parties, like the Social Security Disability Insurance, or employees’ compensation, the transactions are very high. Additionally, Baker (2005, pp. 6-20) says that there is a complaint that the system is providing inequitable awards for medical negligence. Most of the plaintiffs that have meritorious claims are given nothing by the system, whereas other are awarded compensations that are disproportionate to the degree of the injuries caused. More so, Anderson (2005, pp. 198-205) says that complainants with the same injuries are given extremely different awards, even under a similar jurisdiction. Further, Bhat (2001, pp. 95-110) says that the system is said to focus on individual medical officers’ mistakes, yet medical errors always result from the whole healthcare systems. In spite of the rising awareness of the systems’ role in the safety of their patients, there is unavailability of systems orientation in the liability structure. Therefore, it is cumbersome to hold a healthcare system guilty for medical misdeeds so negligence awards are often charged against individual clinicians. Besides, Aidman (2005, pp. 95-110) says that some people argue that there is actual proof that medical liability system prevents negligent care. There is a tendency of defending the tort system on grounds that it deters malpractice, but the existing evidence that suggest limited deterrence of medical mistakes. Lastly, Baker (2005, pp. 6-20) asserts that the system has vicious effects on the initiatives regarding patients’ security. This implies that instead of deterring mistakes, a heated liability system can obstruct patient’s safety enhancement by discouraging healthcare providers from taking part in initiatives like serious event reporting, which may be beneficial to analysts to know the causes of medical errors (Anderson, 2005, pp. 198-205). Most important, Clark and Harris (2005, pp. 20-30) the patients’ safety advocates argue that the present emphasis on tort reform does not really handle the actual negligence crisis; medical mistakes. They further contend that today’s negligence is different from the last crises in which there was a higher public understanding of medical errors occurrence. According to the 2000 report of Institute of Medicine, “To Err is Human: Building a Safer Health System” created a lot of attention, approximating that 44, 000-98,000 deaths annually are caused by medical errors (Baker 2005, pp. 6-20). Nonetheless, the modern focus on medical mistakes has modified the tone of policy debate on negligence (Anderson, 2005, pp. 198-205). Healthcare providers have a harder time proving that negligence litigation is irrational and there an urgent demand for changes that enhance safety of the patients. The issue of patients’ safety has caused federal regulators and state litigators to enforce disclosure requirements of serious events to patients. Anderson (2005, pp. 198-205) says that this increases the stakes of negligence crisis for physicians, as extensive confession would lead to a greater pools of patients who know of their unpleasant event, and can decide to take legal action. Therefore, patient security movement has influenced both negligence environment, and the types of policy reactions that the public is ready to help. Causes of medical malpractice crisis One of the causal factors of negligence crisis is the high costs of litigation as contended by hospitals, physicians, and insurer institutions. According to them, the past few years have registered a drastic increase in the average amount awarded on claims based on claims severity, and claims frequency (Baker 2005, pp. 6-20). On the contrary, consumer and attorney groups often provide explanations that mainly concern insurers. Further, they assert that the insurance industry naturally goes through fluctuations of its profits; insurance cycle. Moreover, Bornstein (2008, pp. 175-185) notes that they maintain that some factors like the reduced investment returns and insurers’ imprudent pricing are responsible for the hostile market swings. Besides, the belief that increased costs of claims have led to the recent rise in insurer exits and insurance premiums is aided by the many academic studies and 2004 National Association of Insurance Commissioners’ report (Aidman, 2005, pp. 95-110). Nevertheless, these factors do not have explicit connection with the rise in malpractice crisis, as for the crises that existed in the mid 1970s and 1980s were triggered by both claim severity and claims frequency (Marcinko, 2005, p. 253). In addition, National Data Bank gathers fundamental insurer reports of all negligence claims upon which compensation was awarded to clinician defendants (Baker, 2005, pp. 6-20). According to the study, the average severity refunded on claims has risen since 1991; nonetheless, the growth rate did not rise during the negligence crisis period (Anderson 2005, pp. 198-205). Additionally, Bhat (2001, pp. 95-110) postulates that in relation to the claims frequency, there is no proof that the increase in the instances of negligence claims contributes to the present negligence insurance crisis. Moreover, statistical link between negligence premiums and insurers’ claims compensation is weakly positive (Bornstein, 2008, pp. 175-185)). Many insurers assert that their pricing decisions are motivated by their liability costs predictions at the time of the covered policy. Actuaries predict these costs on the basis of the pats data loss and their awareness of pertinent environmental issues in the future date, like tort changes (Marcinko, 2005, pp. 253-260). However, some stakeholders oppose this by claiming that increase in premiums has no relationship with the loss trends. What is more, Baker (2005, pp. 6-20) contends that the insurance cycle is partly responsible for the current negligence crisis. There are many cycles that insurance markets undergo, and insurance cycle has attracted substantial attention from economists, yet there are many arguments on the occurrence of the cycle. The current crisis is based on the reduction of investment returns, but they do not show the magnitude of the increase on premiums or their state differences (Aidman, 2005, pp. 95-110). Moreover, the cycle is influenced by the insurer pricing decisions. Here, many critics assert that insurers are aimed at maximizing their business volume by unreasonably pricing their policies, at around 1980s and 1990s. Therefore, insurance cycle should not be addressed separately from claims costs as a reason for negligence crisis because the two factors are related. Reform proposals Obligatory professional indemnity insurance Among the New South Wales Government reform to enhance the increase in professional indemnity premiums insurance include the introduction of compulsory professional indemnity insurance for medical officers (Clark & Harris, 2005, pp. 20-30). Lately, in the New South Wales, clinicians are not obliged to take out professional indemnity insurance, and there is evidence that suggest that some of the physicians are practicing without any medical indemnity insurance. Nevertheless, there is unavailability of the data of the number of medical practitioners that hold no medical indemnity insurance in the region. There are two existing public policy assertions to make professional indemnity insurance obligatory, yet they have are not associated with the reduction of premiums (Nunes, 2004, pp. 20-32). Firstly, medical indemnity insurance will ensure that a complainant is always in a position to identify a suitable party to seek refund for a medical malpractice claim (Priaulx, 2008, pp. 10-18). A plaintiff that sues a medical officer without any indemnity insurance will only manage to restore money from practitioner’s personal assets, which in most cases is insufficient compensation. Secondly, Clark and Harris (2005, pp. 20-30) postulate that liability for malpractice should be held by the responsible party; the practitioner and the insurer, but not the public purse. This implies that plaintiffs should never resort to the social security system if they fail to recover adequate compensation from the medical practitioners. According to the New South Wales Department of Health’s 1998 review of Medical Practice Act, there are many submissions made in support of the mandatory professional indemnity insurance (Nunes, 2004, pp. 20-32). Further, the department outlined benefits of the proposal that include: it enables the clients to get compensations for injuries that are caused by medical officers. In the implementation of the compulsory professional indemnity insurance, there was need for the amendment of the medical practice 1992 of the New South Wales. This was intended to make the make the indemnity insurance a requirement for the registration as clinician in the region. Moreover, Nunes (2004, pp. 20-32) argues that it would be implemented through the introduction of the State legislation that makes it an offense to offer medical care without any indemnity insurance. The type of indemnity insurance required, there are contractually defines cover and, or discretionary cover. Clark and Harris (2005, pp. 20-30) note that since the MDOs provide discretionary cover, it is not guaranteed that clinicians will be indemnified when claims are made. Although it is rare for MDOs to decline indemnification of their members, the probability that an MDO can object will demoralize the requirement’s obligatory nature. In terms of the claims incurred or claims made cover, a requirement for mandatory indemnity insurance should provide specifications of the type of required cover, and whether they are desirable. According to the PIR, professional indemnity insurance for clinicians must be based on claims made since claims incurred cover offered most certainty of cover (Clark & Harris, 2005, pp. 20-30). Additionally, other issues that ought to be considered are whether there is a requirement of retrospective cover for those that are currently not covered; whether the State Government insurance cover on medical practitioners is adequate; and what proof is necessary in the satisfaction of the Board that clinicians have cover (Nunes, 2004, pp. 20-32). Besides, there another issue of obligatory professional insurance is the level of the required indemnity. This implies the question on whether the indemnity level required is capped or unlimited (Clark & Harris, 2005, pp. 20-30). According to the PIR, imposition of restrictions on cover shifts costs to the injured parties and their families, and the government sector. This is because attempts of getting compensation from individual clinicians or institutions beyond the restriction can be regarded as too expensive or difficult. Notably, Nunes (2004, pp. 20-32) asserts that caps leave clinicians financially susceptible, and transfer costs from the malpractice system. On the contrary, insurers contend that caps are highly indispensable in ensuring sufficient financing of their liabilities. In addition, Clark and Harris (2005, pp. 20-30) claim that there is an issue of who is required in order to have mandatory professional indemnity insurance. This implied the question of whether medical officers that remained registered, but are not presently practicing, should be indemnified or not. This included physicians who are on teaching or study leave. Besides, many doctors who go on leave, but not retiring, are required to keep their registration. With reference to other Australian jurisdictions, Nunes (2004, pp. 20-32) notes that South Australia’s section 69 (1) of Medical Practitioners Act 1983 (SA) holds that: a medical officer can practice medicine unless: there is a consensus that subsists between him and an individual that is approved by the Board; the Board is satisfied, basing on the agreement, that the medical practitioner will be repaid to the Board’s required extent in the event of loss by reason of civil responsibility he incurred in his medical practice. In fact, there is a penalty of $5,000 (Clark & Harris, 2005, pp. 20-30). Conclusion Evidently, the issue of medical malpractice is increasing by the day in the society. As a result, the insurers are facing tough times with regard to the professional indemnity insurance of the medical practitioners. In the compensation of claims, there is a need for a proof that the defendants have breached duty of care to the patients; that whether the breach conduct has direct measurable damages. Besides, there is malpractice crisis that is claimed to be caused by the increase in the costs of premiums, claims frequency and decreased insurance supply. Moreover, it is not guarantee that the aforementioned factors are always the cause of the increased insurance premium costs. Furthermore, the proposed reform addressed issues that include: who is required, level of the required indemnity, whether the State Government insurance cover on medical practitioners is adequate; and what proof is necessary in the satisfaction of the Board that clinicians have been covered. Therefore, the legal system ought to come up with appropriate laws that will effectively address negligence malpractice as well as enhancing patients’ rights and safety. Bibliography Books Aidman, E. (2005). Winning your personal injury claim. Naperville, Ill: Sphinx Pub. Pp. 95-110 Anderson, R.E. (2005). Medical malpractice: a physician's sourcebook. Totowa, N.J: Humana Press. Pp. 198-210 Baker, T. (2005). The medical malpractice myth. Chicago, Ill: University of Chicago Press. Pp. 6-20. Bhat, V. (2001). Medical malpractice: a comprehensive analysis. Westport, Conn: Auburn House. Pp. 95-110. Bornstein, B.H. (2008). Civil juries and civil justice: psychological and legal perspectives. New York, NY: Springer. Pp. 175-185. Byrd, W. (2000). An American health dilemma. New York, NY: Routledge. Pp. 34-56. Freckelton, I.R. (2006). Regulating health practitioners. Annandale, NSW: Federation Press. Pp. 76-84. Hiltz, P. L. (2004). Medical malpractice: issues and law. New York, NY: Novinka. Pp. 1-20. Marcinko, D. E. (2005). Insurance and risk management strategies for physicians and advisors. Boston, AU: Jones and Bartlett Publishers. Pp. 253-260. Sage, W.M. & Kersh, R. (2006). Medical malpractice and the U.S. health care system. Cambridge England New York, NY: Cambridge University Press. Pp. 56-67. Journals Clark, S.S. & Harris, C. (2005).Tort Law Reform in Australia: Fundamental and Potentially Far- reaching Change. Defense Counsel Journal, 72(4), 20-30. http://www.questia.com/PM.qst?a=o&d=5037717901 Iii, A.A.A. (2006). American Diagnostic Radiology Moves Offshore: Is This Field Riding the "Internet Wave" into a Regulatory Abyss? Journal of Law and Health, 20 (2), 15-20. http://www.questia.com/PM.qst?a=o&d=5028521036 Nunes, T. (2004). Charterer's Liabilities under the Ship Time Charter. Houston Journal of International Law, 26 (6), 20-32. http://www.questia.com/PM.qst?a=o&d=5007058033 Priaulx, M.N. (2008). A Letter from the UK: Tort Law and Damages for the Unwanted Child. Journal of Legal Economics, 14 (3), 10-18. http://www.questia.com/PM.qst?a=o&d=5035117485 Cases Achutrao Haribbhau Khodwa v state Maharashtra (1996) 2 SC 2377 Boloman v Friern Hospital Management Committee (1957) 2 ER 118 Laxman v Trimbak (1969) 1 SC 128 Read More