Malpractice Insurance
by Michael Hussin B. Muin, MD

Doctors are concerned about three legislative proposals on the Senate floor that attempt to protect the rights of patients against errant doctors. One bill even mandates practicing physicians to secure medical malpractice insurance at the risk of losing their license. Various medical organizations, including the Philippine Medical Association, shared their protest through newspaper commentaries and position papers. In the United States, medical malpractice insurance promotes the practice of defensive medicine. This increases the cost of health care because doctors ask for procedures and tests to cover all bases. Legislators insist their bills benefit the Filipino people who they allegedly serve.

It is imperative to put things in proper perspective. The Philippine Health care system is a mess, plagued by one problem after another. In the private sector, big hospitals operate on ballooning debts and are always on the lookout for capital infusion. Provinces and urban outskirts are lined with small private hospitals that are forced to increase prices to cover operational costs. These hospitals work with outdated laboratory equipment and fast employee turnovers. Despite the proliferation of Health Management Organizations (HMOs), overall private health insurance coverage is meager. Important procedures and prolonged hospitalizations are either not covered or beyond prescribed limits.

The public health sector is much worse. The devolution of the early 1990's forced provincial and municipal hospitals to collapse under small budget allocations from their local governments. Many operate on skeletal crews while occupancy rates and average length of stay continue to increase to inefficient levels. Many regional hospitals don't meet secondary or tertiary hospital standards. Primary hospitals are reclassified to infirmaries because they can't keep with costs. Busted and outdated equipments are common. Most laboratory and diagnostic tests are not available and brought outside to private laboratories. Some municipal hospitals can't afford an 80 thousand peso ECG machine, while mayors drive multi-million peso SUVs. PhilHealth has yet to achieve wide insurance coverage, but with the continued exodus of health care professionals, patient coverage is moot.

Health workers in both public and private sectors are overworked and underpaid. Several rural health units don't have nurses and doctors. Local governments are tapping the traditional health workers—hilot, ambularyo, panday—to augment the lack of basic health services. National health programs, e.g. Anti-Tuberculosis and Family Planning, are underfunded or mishandled. Medicines and supplies are either reduced or stored in warehouses to rot. The Department of Health is hard put at funding and finding doctors for the Doctors to the Barrios program. The whole concept of primary health care is hinged on the work of non-government organizations where unbelievably more results are expected than from local government and health units.

Despite these distressing scenarios, our legislators find it compelling to look at protecting patients from a few—as they say so in the proposals—errant doctors rather than creating laws which bring back basic health care services to the people. With so many problems to tackle, it is mind-boggling how Senators find time to look at increasing liabilities for medical personnel. It seems that patients need protection from the government more than they need it from doctors.

The son of a stroke patient called up my wife to ask her to see his mother. This surprised my wife since she thought the patient was in the community hospital under the care of a neurologist. My wife, the dedicated doctor that she is, decided to visit the patient even if it was way past midnight. I can't do anything but drive for her. We woke up our 3-year-old son, dropped him off at my wife's parents and went to the patient's house. My wife went in and I stayed in the car.

After more than an hour, my wife came out with a story. The family brought the patient home against medical advice because they can no longer sustain the hospital costs. While at home, the patient fell off the bed unnoticed until late at night. The family called my wife to make themselves feel better. They vehemently argued against going back to the hospital. They didn't have enough money for prolonged hospitalization especially for an illness with a poor prognosis. My wife couldn't do anything but check the status of the patient, review the prescribed medications and comfort the family.

'That shouldn't have taken two hours', I said. Well, it so happened that when my wife arrived, a faith healer was there with the patient. Apparently, the son called up a faith healer and a doctor. My wife had to wait for over 20 minutes as she witnessed some of the faith healing procedures involving a piece of paper, several leaves, some stones, and a lot of loud murmurings.

'Binayaran ka naman?', I asked.

'Two hundred pesos. Five hundred daw sana kaso three hundred daw singil nung faith healer.'

And that is where our government has driven Philippine health care—where patients and relatives have nothing working for them except loud prayers and cheap science; where the poor are asked to choose between food and medicine; where dedicated doctors compete with patient resources and quackery. The government doesn't seem to realize that the Philippines is a third world country. It is a poor country where doctors frustratingly practice the art of palliative medicine, where most diseases are addressed when it is too late, where preventive medicine is an idea found only in textbooks and government pamphlets. Doctors scream silently as they give their prescriptions and see their patients hold it with a heavy heart. With the continued increase in drug prices, writing prescriptions are exercises in futility as government drives people to deepening levels of poverty.

When patients teeter on the edge of sanity to make ends meet, it is ludicrous for legislators to waste precious time addressing the needs of special interest groups. With the continued loss of health workers to other countries, it is stupid to squeeze small financial gains from doctors who stay. When patients die from lack of primary health care services, it is callous and heartless to spend public funds keeping seats warm in government.

The patient should always be the central benefactors of health care. And I do not deny that medical errors exist. But patients do not yearn for complex laws, they yearn for basic health services. They do not ask for mandatory malpractice insurance, they ask for affordable health insurance. They do not deserve defensive medicine, they need preventive medicine.

With obscene spending and misplaced priorities, government is bent on pushing health care way below humane levels. The continued persecution of physicians is a nail on the patient's coffin. Malpractice is not the problem, malgovernance is.

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Michael Hussin B. Muin, MD is the Founder and Editor-in-Chief of Pinoy.MD | The Website for Filipino Doctors. He is currently doing a Postdoctoral Fellowship in Medical Informatics in the National Institutes of Health, Bethesda, Maryland.