SPEAKER_02 0:00

You're listening to Confidence to Thrive, the podcast for ambitious healthcare practitioners and entrepreneurs, brought to you by Alex Providers. Welcome to Confidence to Thrive, the podcast helping growing practitioners and healthcare entrepreneurs navigate the challenges and risks of regulation while building brands that matter. Every episode we tackle a different issue facing healthcare practitioners or entrepreneurs, or we interview a guest who is working on the leading edge of private healthcare building something that matters in their sector or profession. My name is Jody Rainsford, and on today's episode I'll be discussing with Christopher Cloakbrand and Roger Houston, directors at OLSD, of a recent situation in the real world that reveals the reality of not getting your medical insurance cover right. Now, uh Welcome Roger, welcome Christopher. This is a very interesting case that focuses very much on a real life situation where people who think that they are uh well insured turn out not to be. And it goes into a lot of the consequences of what happens when it goes wrong, when you don't have insurance, when you're facing claims, and even includes third party complaints to the GMC. So why don't we go straight into the case here and uh start unpacking exactly what happened?

SPEAKER_00 1:16

Well, I think Jody isn't even a client of ours, it's a different client of ours, wants to hire a fairly recently arrived from Turkey doctor. She's transferred all her qualifications. She was GMC registered working in this country. It's very high-quality business our client. They must have assessed and liked her hair transplant tricology skills, but phoned up to say, can we get her insurance? Because she's just had a little bit of a problem with the GMC. So maybe Roger, you'd like to give us a little bit of detail.

SPEAKER_01 1:51

Yeah, so that yeah, is a masterpiece of understatement. So the situation is this she works in another clinic that offers tricology amongst a menu of other processes. They have a particular patient that needs to benefit from enhanced wound healing due to ozone treatment. There's another doctor in the same practice that carries out ozone treatment, not the person the doctor I'll call our lady. So that's our so that's the relatively newly arrived doctor who's the gycologist. Conversation internally within the practice to say this person needs to come in for another episode of ozone treatment according to the treatment plan. I can't be here to deal with that in person. I've got to go abroad for family reasons, but I will be able to dial in on the internet and I will be able to support you and guide you in this process via, let's say, Teams, a video call. Our lady says, I'm a tricologist, I know nothing about ozone treatment. It's not what I do. I may have had a passing experience of it as a medical student, but it's not what I do. I'm not competent to do this. The other doctor said, No, that's fine, I'll be able to talk you through it, I'll be on the screen, I'll be with you metaphorically every step of the way. So she ends up agreeing to do this. Consultation booked, patient comes in, ozone treatment begins, and for reasons which we don't need to get into. The upshot of the treatment is that he ends up with an episode of oxygen starvation and he faints. The consequences of the fainting we don't know, other than he's just simply fainted. We do know that he spent three days in hospital, one day in ITU intensive care unit, some treatment unit. He complains to the clinic. The clinic has an obligation to report this whole suboptimal adverse treatment complaint episode to the care quality mission, the CQC. They have an audit function, they investigate this referral of this uh episode with the patient, get into the detail, realize what's gone on with our lady administering this treatment for which she has no qualification or experience, notwithstanding her self-declaration inside the clinic. And it's the CQC that reports her to the GMC. So, again, we said in previous podcasts of the GMC there is this route through third-party complaint, so it's not the patient that complained to the GMC about our lady, it's the CQC. So the upshot of that will be an extremely dim view will be taken of this by the GMC. It is very likely to go to a fast-track disciplinary route known as an interim orders tribunal or an IOT. And for our part, we refer to her to a specialist solicitor who deals with GMC and GDC disciplinary cases, which are particularly problematic, and this is, on any view, particularly problematic. So she's been absolutely the victim of her own good nature or pressure within the clinic to support a colleague who's remote in another country dialing in for a treatment for this patient to keep onto the schedule. Now, whether this is common or not, I imagine it's very common in small multi-private clinic where they want to keep the patient and they want to keep the treatment plan on cost that she ends up being pressured into doing something. The consequences will be severe. She's very likely to lose her license to practice. We'll find out. The other sting in the tale is that this situation was reported to her insurers. You remember Chris said at the beginning of this that she's not a client. And because she was undertaking a procedure for which she wasn't qualified and had not disclosed to the insurers, they have repudiated the contract. They have rejected this claim in anticipation of a negligence claim being made by the injured patient. That has been rejected prospectively because the claim formally hasn't been made yet. So they're covering their bases there. But for immediate purposes, there was disciplinary cover to provide indemnity for legal costs in terms of a representation at the GMC. They rejected that claim as well. So this lady is uninsured in both respects.

SPEAKER_00 6:54

So the disciplinary cover relies on the negligence cover being active, effectively.

SPEAKER_01 7:01

Yeah. So again, on other podcasts, we've said that this is a trap in terms of declaring what you do, and in terms of a specific breach of a condition. This particular claim, because I've seen the correspondence, relied on a general claims condition where the insured, our lady doctor, was obliged to operate within her sphere of medicine for which she's trained. And obviously, the ozone procedures outside of that, she's a tricologist. The idea that this is all theoretical and this happens to other doctors just simply isn't true. There's a real so we're talking on a Tuesday after a bank holiday Monday. This phone call came in Thursday afternoon, and that's where we are. So she will get some extra legal advice on her GMC matter. She'll have to pay for that privately. I hope she can afford to pay for that privately. I don't, we didn't get into that. That's not, but she's going to need some proper representation at what will be a tribe, a full tribunal, an IoT tribunal, and she'll be obliged to go to a hearing in Manchester with the GMC.

SPEAKER_02 8:06

So it's almost like a double whammy, is the fact that because the terms of her insurance only allowed her to cover that the area in which she was originally going to be hired for what she was originally working there for. Yeah. Means that she now does not have that legal cover to then help her representation when she goes to the general medical council with so she is not just facing that, she's also likely to be heavily out of pocket as well.

SPEAKER_00 8:35

Yes, yeah, yes, yeah, correct. And I think Jodie, this is for us, this is an important thing to highlight is you know, whilst we we arrange insurance for doctors, our service is really a phone a friend. What this poor lady needed was somebody to phone up and say, Should I be doing this? If I do it, it will my insurance cover me if it goes wrong. Should she have been with us and done that and phoned us up, she would have got very clear advice and very clear support to say, no, you shouldn't be doing this. As we might have touched upon, it's there is going to be an awful lot of pressure as a young doctor just in abroad in a new clinic and a private clinic, which is money motivated to be honest. She's going to be under enormous pressure. We work with a full range, we work with HR people and all sorts of people. If it came down to HR issues and so on, then we would have got that sort of person involved. For us, it's not just about the insurance. The insurance is there to pay for when it goes horribly wrong, which it won't in this case, but for us it's all about that full support. It's somebody you can trust, it's a friend that you can phone to make sure that you are on track and doing the right thing.

SPEAKER_01 9:47

So the irony of these circumstances is had that happened and she'd spoken to Chris or I, we would have said you're not insured. And had she gone back to the clinic to say, I really can't do this ozone procedure because my insurers have confirmed I'm not insured, would you like to give me an indemnity in case I carry this work out and it goes wrong? Guess what? She wouldn't have been doing the ozone procedure that day. They would have found someone else. Yeah. So it's just tragic from every perspective. And she's a lovely lady who doesn't deserve this. I'm sure she's a wonderful trichologist and a very caring physician that has been the victim of her own good nature. But that will count for precisely zero when she's got when she's going through her tribunal hearing at the GMC. To coin the phrase, they will throw the book at her. Now they could end up having a look at the whole, what's your colleague doing from dialing in from abroad? And they do have the powers to extend their investigation to look at the conducts of that doctor, but that won't help our lady.

SPEAKER_02 10:50

No, no. I imagine the question that most people would have is so what happens to the clinic in terms of what their level of responsibility in this whether that's just thinking about that.

SPEAKER_00 11:01

So that yeah, that's an interesting question. So what's almost guaranteed to happen here is that our lady's insurance will fall over, so any claim for negligence she won't be able to afford to pay. That will become uh fairly obvious to any claimant lawyers very quickly. So claimant lawyers will very quickly switch their attention to the clinic as the target, they will see the clinic for lack of supervision and lack of oversight in allowing this to happen. The clinic might or might not have clinic level insurance for that. Even then, there's a question as to whether the clinic insurance responds. It spends literally, you might have to go through the terms of the clinic insurance because the clinic has ultimately allowed somebody to be bullied into undertaking a procedure for which they weren't qualified. So that would be an interesting question.

SPEAKER_01 11:54

And the other aspect, JD, is that the CQC will take a very keen interest in the whole governance and what on earth is going on at that clinic, and they have very far-reaching powers, much the same way as the GMC do for individual practitioners. So they have the power to close this clinic, and that could be what happens. So overall, this episode is hardly one for their marketing brochure, is it, from any perspective? The GMC will take a close interest in Our Lady, as it were, and the CQC, from their perspective, will take an equally close interest in what goes on going forward with the clinic.

SPEAKER_02 12:32

But none of those additional, none of the additional legal action against the clinic or anything to do with CQC and any action they may take, the clinic is going to do anything at all to stop a potential striking off of that doctor. She's very much very much on her own in that situation. Just like you were saying, when the patient made a complaint to the clinic, you said that the clinic then was obliged to report to the CQC. What are the conditions under which they have to do that? How does that work?

SPEAKER_01 13:00

There's a broad governance framework and it's an ongoing obligation to report to the GMC adverse dangerous patient treatment episodes. And I think we can all agree someone passing out through ozone treatment delivered by someone that's not qualified falls within that criteria. Now, curiously enough, the CQC, as far as I understand, do not investigate every adverse report that they get through this reporting framework. So they will have a way of sifting cases, and they may even have a traffic light system, but this would blink red on any criteria. And they do have the resources and they will investigate in a timely way what they see as the red category of cases. So to say that she was unlucky that they've investigated and then they carry down the action they have will be naive. They do, they're not a watch with resources, nothing in healthcare is, and the oversight the CQC give by way of order is no different. But they will have a strategy of sifting cases and they'll look at the very serious ones. And this, on any view, is a very serious set of circumstances. So the fact that the CQC have acted so quickly doesn't surprise me at all. From one view, for us as wanting to benefit from proper healthcare delivery in the private sector and elsewhere as potential patients, members of the public, all of this is encouraging. This is the system working as it should do in terms of trying to keep people safe. But there's a very different perspective from our dear lady who's about to have a very short career in UK healthcare, would be my fear.

SPEAKER_02 14:36

And is the rapid reporting to the CQC is that looked favourably upon in any subsequent follow-up, the fact that it has been reported quickly and fully, or is that a standard obligation there?

SPEAKER_01 14:49

That's you being optimistic. The fact that it's an absolute train wreck and they get to know it earlier doesn't change the fact it's a train wreck.

SPEAKER_00 14:55

Oh I I think it would be looked upon favorably, but it'll make no difference in how they respond. There's the answer.

SPEAKER_01 15:02

Yeah, so they've got an obligation to report within a time frame and the CQC is doing its job. So yeah, no, that's not a mitigation on any view.

SPEAKER_02 15:11

How do how do we avoid situations like this though? So if we were that that lady or that person put in that position, would the first thing that they would need to do would be to check their insurance, check that they were capable of doing such a procedure, or even rejecting that outright. If they don't have a if they don't have a the kind of insurance provision where they have a level of support where they can, like you say, phone a friend, the the thing for them to do, call whoever is is covering their insurance to that situation.

SPEAKER_00 15:46

The absolute best way of dealing with even from time to time, we've helped doctors to do things that they don't that for which they are qualified, but they didn't want to do. The easiest way of dealing with it is to say it's not I'm not insured to do it, because then the clinic really can't force you to do it. It's a legal requirement to have the insurance, and uh we've talked about the consequences for the clinic. There's there's an awful lot of consequences for the clinic in in having some a practitioner who isn't insured actually undertake the work. So absolutely, and I think that's the thing, it's difficult to see how we can make a make the doctors coming in from abroad aware of us as as as they come over and so on. In many ways, we wish we had, because Roger's spoken to her, not me, but clearly she is a lovely, competent lady, and it's tragic to see. But it's really our encouragement to all doctors is to have somebody that you can phone and you trust uh and will back they've got your back, basically. The consequences of it going wrong, it can unravel horrifically fast. And it's not this is probably the worst situation that we've ever seen. But how many interim order tribunals do you deal with the year what you're doing?

SPEAKER_01 16:56

Yeah, do a couple of quarter. So, yeah, what's that? Six, eight a year.

SPEAKER_00 17:01

So it's not completely uncommon for these kinds of things to happen. And again, that's interim orders tribunal. We've also recently helped another uh upper GI surgeon who had he was with one of the medical defence organizations who are these non-commercial, so they are membership organizations who might come to your assistance rather than having a contract. And one way through his own honesty, to be honest. He their membership fee is based on your reported income. He reported according to his tax returns, and bits of income came in here and there, and his tax returns went up to date. So he went back to them and said, Oh, actually, I think I made a bit more money in the previous couple of years, and then got this claim, and they came back to him and said, Because you didn't report your income correctly, we'll only pay 40% of that claim. And that claim might be between 100 and 150,000. Nobody knows, but that's quite a big bill for the surgeon.

SPEAKER_01 18:01

Yeah, yeah, that's just we said at the time there are many marriages wouldn't survive that. What you're basically saying around the dinner table one evening, I'm never so sorry about you. There's a 90 hundred thousand pound liability that's just landed because my medical defence organization will not give 100% assistance, they'll only give 40% assistance. So we've gone through I say we, I feel like it's we he with me have gone through the appeals procedure, so we'll see what the outcome is.

SPEAKER_02 18:32

But the other thing that you alluded to there was the concern that this uh in a multidisciplinary practice, particularly which is small, that this is probably happening a lot more often than uh than is reported. Most of the time things don't go wrong, uh and possibly the gap between the I think we said beforehand that uh her specialism and the thing that she was doing were in no way related at all. Whereas I think probably in some some practices uh there may be a little bit more, it might be a little bit more closely aligned, yet they still may not be covered in the way that they realise it, and it may not be it may not be as black and white or as obvious yet, but people will still be on the hook for not having the right cover.

SPEAKER_01 19:19

Yeah, I think that's true. Insurers can get really quite granular, the level of detail that's required is not a coincidence. It would be a brave, I think it would be a brave doctor to take the view that I don't need to say this is a treatment that's allied to what to what I do, it's essentially the same thing, and that might be right, of course it isn't, and the point to which it isn't is when they end up with a claim. So this is fine, all of these are pressure situations because this whole repudiation is when she's looking down the barrel of a GMC complaint and a possible civil claim on the basis that something's gone wrong. That's the tragedy for me. A, she's very nice, and B, had we had the opportunity of a five-minute phone call to say to the clinic she's not covered for this, so you either cover or she's not doing it, that would have carried the day because it always does. And yet, here we are, a couple of weeks after the procedure on the Thursday afternoon speaking to someone whose life literally's world's just fallen apart. The saving grace for her is I came off the phone thinking she really doesn't appreciate how serious this is, she needs to get some expert advice. So the next call I made was to our lawyer that deals with these cases. She hasn't got a clue how serious this is. She will have now because he would have told her. But you think, my God, you think what they take to qualify as a doctor anywhere in the world, seven years plus expert training, who knows what sacrifices the families made to put her through med school, and yeah, yeah, all of that goes in a 10-minute treatment that goes wrong. Talk about Russian roulette.

SPEAKER_02 20:53

And all of that could have been potentially prevented by the fact that you having the right advice at the right time when the situations arise.

SPEAKER_00 21:03

It's to me support. I you know, I think our feeling is she knew that it was wrong, but she just felt she didn't have any, she was under pressure and she had no support. So that that's really what we're there to provide is that support. And as I say, it wouldn't just be our CNN if it gets in and say hairy HR situations, we have and not just the disciplinary lawyers, we have HR lawyers and people like that. We we will put the support in that you need in those circumstances to do the right thing.

SPEAKER_02 21:34

Okay, so we're gonna we're gonna cover the see what happens as a result of all the activity, and because of the severity of it, it's been pushed very quickly to quite a later stage as well. So this will be wrapped up relatively quickly as a result of the concerns about patient safety.

SPEAKER_01 21:51

Yeah, I think the only other saving, Grace, I think I'm right in saying that IoTs are not public hearings. Most GMC hearings are, so she could end up in the national press. I don't think she went on this. So we will circle back in the subsequent podcast and tell people what's happened. But we've seen enough of this down the years, because haven't we to know a happy ending when we see it? And this is not one of those.

SPEAKER_02 22:15

And so, in terms of the kind of core message you want people to leave when they see this play out or they see things like this in the national press when it does hit the paper, what should people be doing in order to avoid the situation escalating to this point?

SPEAKER_01 22:32

To me, and I know I'm biased, but I'm going to say it anyway, they need a relationship with whoever arranges their insurance where they can phone up and get sensible advice in a timely way when they need it, preferably before it's all gone horribly wrong. So you take this example, she's not, she's a bright girl, she's medically qualified, she knows she's being pressured to do something that she's not qualified for. So, in what reality did it make any sense for her to say yes, other than the fact that there's an implied or an expressed threat to say you either do this or you find another job. And the irony of that particular case is this whole case came to our attention because a value client, as Chris said, wanted to give this girl a job with them, and she said, I'm really sorry, and we're gonna have to pause the application process because I've now got this GMC cloud on my horizon. That's how we got involved with it. And you think, God, if only she'd phoned almost anybody, her own insurance broker, a friend or family friend backing wherever she comes from, or us, or the insurance director, anyone with half a brain cell would have said, for God's sake, you can't do this.

SPEAKER_02 23:44

Is there, and when I say a cultural thing, I don't mean from a national perspective, but is there a cultural thing around when people think about insurance, they don't think proactively. They don't think, oh, the normal thing is I when a claim comes in or I want to make a claim, that's when I speak to that. Whereas a much healthier attitude to any potential risk that comes up should be getting straight on the phone and and discussing it.

SPEAKER_00 24:09

Yeah, so there is a little bit of that, JD, and it's hard to say in this circumstance and so on, but there is definitely a sort of view with insurance that you hide problems from your insurer because if they know the problems, then they'll just put your premium up. So that's that that didn't really help in this circumstance, but as a general comment, as we always say, the insurers know that there are problems. Um so, in fact, and and in fact, we can we can talk about our own risks actually. So, our own our license is professional indemnity insurance just halved, and it's halved in the face of we actually had a client make a complaint against us. Now, this client had been an absolute pain and not followed advice and been completely evasive in a renewal, had ended up no, I think he'd agreed to renewal at 10 to 5 on a Friday when it renewed, and then literally, as we were saying yes, he'd got a call from somebody else and said, Oh no, I'm going with these other people. So it was all fraught and a mess. And what's very clear is it's due to the new brokers to give him advice on how to cover dovetails because we can't, because we have no idea what the other cover is, and so on and so forth. So we've dealt with it all, we've found the Ombudsman's rulings that say that, we've sent it all, we've shown everybody what's going on. So when our insurance renewal comes up, we've already reported this as a potential circumstance, and then we've gone through to say, but we're comfortable it's not going to go any further because X, Y, Z, and so on. Our experience of doing that is our premiums halved. So that's always our advice to our clients is it matters how you report it, and that's what we help people do, in terms of you tell us everything, we'll filter it, we'll report to the insurer what they need to know when they need to know it, they will get to know everything in time. But what's important to the insurer is things happen, how do you deal with them? And if they're all dealt with effectively, actually that's a big green flag to an insurer.

SPEAKER_02 26:11

Okay, so that's the case for being proactive, being really clear, being upfront and honest, and just having that constant communication around potential risks, how you're dealing with them, and whether you're at risk as well whenever those situations come up. I think that's a good place to leave this example. And like I said, to the listener, that we are going to be following this up when we hear more about this and to look at the consequences of this. But for the time being, thank you very much, Chris and Roger, and we look forward to seeing you on another episode. Thanks very much. Thank you for listening to Confidence to Drive. Before you go, please rate, review, and subscribe to Confidence to Drive on your preferred podcast platform and help us spread our message to others while making a difference in private healthcare. This podcast was brought to you by Our Litity. Learn more about how Ouritity can support you by finding the link in the show notes or visiting our t.co.uk.