If you would like to arrange malpractice insurance for your pilgrimage medical team (doctors and nurses), or would like further information on policies, please contact:
CJ Coleman International Insurance Broker
On this page, the current situation in regard to medical and nursing indemnity for our work in Lourdes will be outlined. It should be noted that a great debt of gratitude is owed to the companies and organisations that have provided this cover to both doctors and nurses in the past on a goodwill basis. It is important however to acknowledge the change in EU legislation in 2014, which now means that medical malpractice cover can no longer be assured with arrangements as they stand.
These are complex issues, which will no doubt cause much discussion at individual pilgrimage group level. Indeed, some pilgrimage groups may already have their own malpractice insurance in place (e.g. the Irish Order of Malta), and so no further action may be necessary at all. Additionally, if all doctors in a pilgrimage group are GPs who are insured with Medisec, then it is also likely that no further action would be needed.
The information is presented here to inform all pilgrimage groups, and to provide a solution that will suit those groups who do not have adequate cover in place based on the legislation changes outlined below. It will be up to individual pilgrimage groups to decide whether or not to arrange medical malpractice insurance, and Seirbhís merely aims to comprehensively summarise information as it currently stands. Individual pilgrimage directors, doctors or nurses may want to make their own enquiries in regard to these issues, but Seirbhís has sought to do as much of the research into these issues as possible in order to find a swift solution in time for this year’s pilgrimages to Lourdes.
The Recent Problem in Regard to Medical Malpractice Insurance
To explain this point, I will use a quote from the Medical Protection Society:
‘Last year (the year 2014) we became aware of various jurisdictions within the EU now enacting the provisions of EU directive 2011/24/EU (the cross-border healthcare directive) insofar as it referred to a requirement for medical practitioners to have indemnity or insurance provision in order to practise.
Each State was free to regulate as to whether or not indemnity in its broadest sense (as indeed membership of a medical defence organisation) or insurance (as a policy issued by a recognised insurance company) was required or, indeed, if either was acceptable. Our understanding is that France requires an insurance policy which, of course, MPS, nor indeed any other MDO, is in a position to supply. You will of course be aware that such compulsory indemnity provision is also coming in the very near future both in the UK and Ireland although both these states have accepted that either indemnity or insurance will be acceptable.
On a literal interpretation of the regulation, we felt this caused us some difficulty in respect of doctors accompanying pilgrimages to France. Given that other carers accompanying the pilgrims would require some form of indemnity provision as well, I believed it might be appropriate for doctors to be included within that insurance provision.’
Because of the French response to EU law, remaining compliant with the French regulations will be necessary to remain in a position of good standing with the General Medical Council/Irish Medical Council. In the event that a malpractice claim would be raised in relation to voluntary work in Lourdes, not only would a doctor not be covered for his/her work if only registered with an indemnity organisation (e.g. MPS or MDU), but he/she would also be breaking the law, which could result in fitness to practice restrictions and possibly criminal prosecution.
To avoid any of these outcomes, medical malpractice cover provided by an insurance company is a simple solution to this complex problem.
The Current Position of the Medical Protection Society (MPS) and Medical Defence Union (MDU)
The MDU and MPS are now both saying that they will still provide assistance to their members, but the MPS now does this with the following restrictions:
- Your indemnity extends only to treatment of members of the organised group that you are accompanying.
- Indemnity is available in relation to matters brought in your home jurisdiction only.
- You act within your competency.
- Different territories may have different legal, regulatory or licensing requirements that need to be met to allow a doctor to practice medicine in that territory. It remains your responsibility to ensure that you meet any such requirements.
The third point here raises an issue for secondary care specialists, or for doctors in a specialty training pathway, who may be acting in a more general role in Lourdes. For example, a surgeon/surgical trainee who deals with a diabetic emergency may be deemed to be working out of their normal scope of practice and cover terms from his/her indemnity provider. The medical malpractice policy that has been developed for our Lourdes pilgrimages takes into account the range of skills that are provided in a medical team in Lourdes, and proposes to provide cover for a medical/nursing team as a unit, as opposed to individual practitioners. This fits much better with the ethos of our work in Lourdes, and will make it easier going forward to convince doctors and nurses to sign up to volunteering in Lourdes, as it will be a safer work environment from a medicolegal point of view.
The fourth exclusion laid out by the MPS is the one that should cause most concern, based on the change in EU legislation and the French government’s position in regard to this. This issue is highlighted in the fourth point, and it is made clear that there will be no cover if a doctor in breach of local legislation. It must be understood that doctors will be in breach of local legislation if an insurance company (specifically) does not cover them for medical malpractice, and not a mutual organisation (e.g. MDU or MPS).
The MDU is also a mutual organisation, and therefore an insurance company does not underwrite its policies. It should be assumed that the same situation applies for this organisation as for the MPS.
In essence, both the MPS and MDU are offering to cover their members for Lourdes work, however the responsibility to comply with the EU law is placed on the individual practitioner. Compliance can only be assured if medical malpractice insurance is in place.
The Different Situation for GPs who are covered by Medisec
Medisec is an Irish company that indemnifies GPs only, and the insurer Allianz underwrites its policies. Individuals who are already covered by Medisec are therefore not in need of any additional cover personally, however if there are other medical team members with other organisations, then it would be advisable to ensure that team malpractice insurance is in place.
The Current Position for Nurses
As outlined at the meeting on 7th March 2015, the Irish Nursing Board/An Bord Altranais does not provide cover for Lourdes work. Those who are members in good standing of the UK Royal College of Nursing in NI/UK or those who are registered with the Irish Nurses and Midwives Organisation will be covered if they are fully paid up members with no fitness to practice restrictions.
Medical Malpractice Insurance Solution
The insurance broker CJ Coleman has been working with WR Berkley (an insurance underwriter) to develop a specific policy for Lourdes, and this is now ready for distribution to pilgrimage groups. This insurance policy will provide malpractice insurance for registered doctors and nurses who volunteer with people domiciled in the UK or Ireland (including the Channel Islands and the Isle of Man) who are on pilgrimage in Lourdes.
The cost of this policy will be €10 per person on the pilgrimage (costings are in Euro, even for pilgrimages from the North of Ireland or other parts of the United Kingdom). All of the people on the pilgrimage must be covered (even those with no pre-existing medical conditions), as those who are perceived to pose the highest medical malpractice risk are those who develop illness, sustain trauma, or suffer from another similar malady having been previously well.
The policy is based on a team structure that is composed of at least two doctors per group, and a ratio of carers (doctors and nurses combined) to registered sick pilgrims of 1:10. If individual groups cannot meet these requirements, then enquiries should be made to CJ Coleman, who may be able to arrange cover with alternative terms.
The exact details of this cover are included with this email, having been finalised by the underwriter just earlier today. I have been making great efforts to ensure that the interests of sick pilgrims and their carers are defended, and I have also negotiated on cost and the terms laid out.
The Issue of Medical Registration in the EU Member State Where Work is to Be Carried Out
The UK Lourdes Medical Association has been actively working to ascertain the legalities around medical registration in France, since the legislation change listed above also stipulated that doctors who come from another EU member state (UK or Ireland in our case) should register with the local authorities. This matter has been brought to the Chair of the Board of Doctors in Hautes Pyrenees, who is currently raising this issue at national level in Paris. We do not have a clear picture on this issue at present, but we are continuing to seek clarification and a solution to this aspect of legislation change.
It is hoped that a straightforward solution will be found to suit the needs of pilgrimage doctors in Lourdes. In the meantime, all medical and nursing professionals are encouraged to register at the medical bureau in Lourdes shortly after arrival, as this will serve for now as our ‘local register.’
Practical Issues that Need to be Addressed to Comply with Various Insurance Policies
- CJ Coleman (if insurance is required by pilgrimage groups for medical malpractice) will need to know in advance of travel:
- Total number of pilgrims on the trip to be insured
- Number of registered sick/disabled pilgrims
- Number of terminally ill pilgrims
- Number of doctors
- Number of doctors and nurses (on live registers) combined
- That all individuals on the trip have EHICs (within expiry date) and travel insurance
- That all pilgrims with pre-existing medical conditions have a fitness to travel certificate from their GP/hospital specialist, and that this has been issued less than 3 months prior to travel. It is the pilgrim’s responsibility to update the pilgrimage group organiser/medical officer of any change in health between the time of issue of this certificate and the date of travel.
- The fitness to travel certificate is also likely to be a requirement for the pilgrimage travel insurance, such as that provided by Blue Insurance. If Blue Insurance insures your group, a standard form is available from their team for use. This ensures that the correct form is completed to meet both the requirements of the travel insurance policy and the medical malpractice policy. Other insurance companies should be able to provide a similar form, or will outline their requirements. The form from Blue is included here: BLUE_PILGRIMAGE_A4_Form
- The public liability insurance from Allianz for the UIPL pilgrimages is conditional on the fact that: ‘all medical doctors have in place medical malpractice insurance in respect of any advice or treatment they provide during/in the course of the pilgrimage.’ This point has been discussed with an insurance expert at Allianz, who agrees that without appropriate medical malpractice insurance (in light of the legislation changes in 2014) the public liability insurance could be invalidated in the event of a claim being raised. Different groups may not be insured with Allianz for public liability cover, so do check your individual situation and the policy wording of the relevant documents.
- It is also important to note that the Allianz public liability cover also requires that ‘the insured has documented procedures in place detailing the roles and responsibilities of all volunteers travelling on the pilgrimage and that such procedures detail specifically the procedures/protocols to be followed in respect of persons who require or may require medical assistance during the course of the pilgrimage.’ Again, this may not apply to those who are not covered by Allianz for public liability, but it will be important to check policy wording again to clarify individual situations.
- Doctors (and ideally nurses) should register with the medical bureau on arrival in Lourdes
I hope that this information, although detailed, is helpful in clarifying what is required of us as doctors, nurses and pilgrimage directors who work with Irish/UK pilgrims in Lourdes. The information lays out options for individual groups to consider and decide on the best way forward. I would suggest that unless there is robust medical malpractice cover in place, this leaves us all in a vulnerable position going forward, with potential financial penalties, fitness to practice proceedings and criminal prosecution to consider.
I would encourage all medical and nursing staff to continue to inform their medical indemnity organisation about their trips to Lourdes, but it will be necessary now to arrange additional cover for those registered with MPS and MDU. The alternative to this will be sending pilgrimages with doctors and nurses unable to work in their professional capacity, and this would really be detrimental to the fantastic voluntary pilgrimage care system that has been built up over the years.
Best wishes for the pilgrimage season ahead,
Dr Michael Moran
Founder and Chairperson of Seirbhís
Chief Medical Officer of the Down and Connor Diocesan Pilgrimage to Lourdes
Member of the Comité Médical International de Lourdes