Dr Rosalyn Chaloner, Case Manager at Medical Protection, explains the various ways in which members can seek assistance

When a healthcare professional receives a request for records, or worse an email from the Health Professions Council of South Africa (HPCSA) attaching a letter of complaint, as a member of Medical Protection, the first thought that ought to come to mind is, how do I ask Medical Protection for help?

It seems like a simple enough question, but in times where attorneys may be pressurising the member or the member is getting contacted by a patient constantly, it is understandable that what Medical Protection might need from a member in order to properly assess the member’s request for assistance, is not always carefully considered by the member from the outset. However, getting us the relevant information as soon as possible, and ideally at the outset, can help us to best help you. With that in mind, we set out below a basic guide on what information is required by Medical Protection in order to consider a member’s request for assistance.

How can you contact Medical Protection for assistance?

Medical Protection tries to make the process of members requesting assistance as easy as possible and the methods available to members include:

• The medicolegal advice line on 0800 014 780. General medicolegal advice is available at this number 24 hours a day to assist members in emergency situations.
  • The member may directly call this line. Once their identity is confirmed, with their contact details, date of birth, email address, or case reference/specialty/home address, general advice may be provided. However, given that many requests for assistance are case-specific and not of a general nature, the member is often asked to send their detailed request to Medical Protection’s email address, as listed below, so that it may be carefully considered and discussed among Medical Protection’s experts to the extent necessary, before being deal with accordingly.
  • If a member’s practice manager or receptionist phones in, Medical Protection will request that the member makes contact directly and asks for assistance. This is to ensure that Medical Protection protects the confidentiality of the member regarding any information received or given.
  • Medical Protection’s email address at [email protected] or [email protected]. It is requested that the member emails Medical Protection with their personal email address so that Medical Protection may be sure of the identity of the person who will receive the correspondence Medical Protection sends.

• If a member would like a receptionist or practice manager to receive all correspondence from Medical Protection, a request for the receptionist or practice manager to be the member’s designated contact needs to made by the member personally to the above-mentioned email address.

What will Medical Protection require to consider the request for assistance?

For all queries Medical Protection will require at least three of the below listed identity checks to ensure the correct member is identified, requires assistance and that the confidentiality of any information shared is maintained:

• the member’s Medical Protection membership number
• email address
• phone number
• cell phone number
• address
• specialty
• Medical Protection telephone reference provided when the member calls the Medical Protection medicolegal advice line
• Medical Protection case or claim reference number, provided by Medical Protection when a file has already been opened regarding the member’s request for assistance.

Please note that the information the member provides needs to correspond with the information the member has provided to Medical Protection’s membership department and bearing in mind that some information may have changed as time passes, there is no harm in providing more than three of the above listed items for identification purposes, just to be sure.

If this information is not supplied Medical Protection is required to verify the member’s identity by asking the member to confirm three or more of the above items, before assistance may be considered and before a case may be opened.

What other information is needed

The rest of the information required for assistance to be considered will be divided into sections based on the types of matters Medical Protection assists its members with.

If the member is in a Medical Protection limited membership grade, which requires the member to be involved in private practice for a limited number of hours weekly or to have an income from private practice of a certain limited amount, the case handler assigned to the matter will contact the member to ensure that the member is practising within their grade limitations.

Advice

Advice matters are any requests that Medical Protection receives where the member would like to be given medicolegal guidance about the matter and/or guidance on what the member’s next steps are suggested to be.

Here Medical Protection needs the following information in order to consider providing the member with assistance:

• A summary of the advice the member requires and why the member needs this advice eg, “I need advice regarding how long to store records as I have heard that the HPCSA has recently changed its guidance regarding this.”
• If the matter involves a patient, the dates of first and last contact the member had with the patient together with the patient’s initials and year of birth.

Report

Report matters include:

• Adverse incident reports, where something may have gone wrong with or during the patient’s management, or a patient may have had a complication that the member would like to make Medical Protection aware of in case medicolegal action is pursued.
• Claims-made adverse incident reports, when the member is in a claims-made membership and needs to make Medical Protection aware of any matters where there is a risk that medicolegal assistance may be needed in future, as soon as reasonably possible.
• Requests for records from patients and or attorneys, whether the request is made orally or in writing.
• Requests for a member to attend a hearing or act as a witness in a legal matter.
• Requests for a member to prepare a report regarding their clinical involvement with a patient.

Here Medical Protection needs the following information in order to consider providing the member with assistance:

• The dates of the member’s first and last contact with the patient.
• The patient’s initials and year of birth.
• A brief summary of the member’s involvement with the matter.
• A copy of any correspondence the member has had with the patient and or the patient’s family and or the patient’s or family’s attorneys regarding this matter.
• Any other documents that the member feels may be necessary for Medical Protection to consider assisting the member, such as the member’s draft report for consideration by Medical Protection.

Please note that when assistance is requested, the patient’s medical records should not be sent to Medical Protection – these will be requested if and when they are needed.

Complaint

Complaint matters include any request for assistance involving an expression of dissatisfaction pertaining to a member’s clinical practice. If there is an expression of dissatisfaction regarding the member’s clinical practice, then the matter is classified as a complaint regardless of whether the complaint itself is delivered directly to the member, or via a third party such as the member’s employer or practice. However, if the complaint is addressed to the HPCSA, that will be classified as a regulatory matter, which will be discussed later.

In complaint matters, Medical Protection needs the following information in order to consider providing the member with assistance:

• A copy of the complaint. If the complaint is made orally, a summary of the complaint made to the member will also suffice.
• The dates of the member’s first and last contact with the patient.
• The patient’s initials and year of birth.
• A brief summary of the member’s involvement with the matter.
• A copy of any correspondence the member has had with the patient and or the patient’s family and or the patient’s or family’s attorneys regarding this matter.
• Any other documents that the member feels may be necessary for Medical Protection to consider assisting the member.
• The member may also send in a draft response to the complaint.

  Please note that when assistance is requested, the patient’s medical records should not be sent to Medical Protection – these will be requested if and when they are needed.

  Regulatory

  Any matters that involve correspondence between the member and the HPCSA including complaints, investigations of the member’s practice, investigations into the alleged impairment of a member etc, are classified as regulatory matters.

  Here Medical Protection needs the following information in order to consider providing the member with assistance:

  • A copy of any correspondence the member has received or sent to the HPCSA.
  • If a patient is involved:
    • The dates of the member’s first and last contact with the patient.
    • The patient’s full name and date of birth.
    • A copy of any correspondence the member has had with the patient and or the patient’s family and or the patient’s or family’s attorneys regarding this matter.
  • A brief summary of the member’s involvement with the matter.
  • Any other documents that the member feels may be necessary for Medical Protection to consider assisting the member.
  • If an explanation is required, the member may send in their own draft response to the complaint, for consideration by Medical Protection.
    
    Pre-claim or claim

    A matter where the patient or their authorised representative has demanded reimbursement or a monetary amount for the alleged harm the member has caused by managing or being involved in the management of the patient. This includes matters in which the member has received a letter of demand or a summons.

    This may also involve a matter where it is very likely that this matter will evolve into a claim or where a patient has intimated that they seek compensation or reimbursement from a member, such as a case of dental damage caused by an anaesthetist, where the patient has already notified the anaesthetist that damage has been done to their teeth and they are seeking treatment from a dental practitioner for the dental damage.

    Here Medical Protection needs the following information in order to consider providing the member with assistance:

• The dates of the member’s first and last contact with the patient.
• A brief summary of the member’s involvement with the matter.
• A copy of any correspondence the member has had with the patient and or the patient’s family and or the patient’s or family’s attorneys regarding this matter.
• A copy of the summons, letter of demand and or any legal document which has been issued to the member.
• Any other documents that the member feels may be necessary for Medical Protection to consider assisting the member.

Once an email has been received by Medical Protection from a member, we endeavour to get back to you within two to five working days, unless it is an urgent matter where immediate assistance is required. In essence the most important thing you can do in any medicolegal matter is to involve Medical Protection as soon as possible and respond to all requests for further information timeously so that the matter may be dealt with without delay.  Consequences of members not seeking assistance and or not sending responses promptly to Medical Protection could be a simple complaint matter leading to an HPCSA complaint, an HPCSA fine or a claim where a judgement is made without Medical Protection’s expertise assisting the member in receiving a fair resolution.