Wednesday, June 17, 2009

Questions about indemnity insurance and homebirth

As the time for the new health practitioner legislation in Australia approaches, many in the homebirth community have asked questions about how it will impact on them personally.

The timeline as I understand it at present is:
Early October 2009: women who conceive a child, and who would at present book a midwife to attend them privately for planned homebirth will need to know that, without government intervention, this will not be possible if their labour starts after 30 June 2010.

1 July 2010 - Midwives, who do not have professional indemnity insurance, will no longer be able to be registered, and therefore will no longer be able to provide midwifery services for homebirth. Independent, self employed midwives are the main provider of homebirth services in most of Australia.

1 November 2010 - *Eligible* midwives will be able to purchase indemnity insurance for their private practices, but NOT for homebirth, with government support. The services of these *eligible* midwives will also be rebatable through Medicare for the first time. Criteria for eligibility are not yet available.

Midwives have asked, will I be able to attend homebirths without insurance, if the parents agree?

Probably not. If after 1 July next year a midwife is not registered under the current legislation (Health Practitioners Regulation Bill), it will be illegal for that person to act as a midwife. If a registered midwife (eg someone employed in a hospital) were to attend a homebirth privately (rather than as part of the hospital's services), the note on clause 101 below states that this does not constitute an offence but may constitute behaviour for which disciplinary action may be taken! That's a big stick. How many most midwives will be willing to step out of line to continue to provide homebirth services???

Justine Caines, who is the leading activist and political commentator in Homebirth Australia, has reviewed the exposure bill (draft legislation).
"I read this to say that a registered midwife must not practice midwifery without professional indemnity insurance. Therefore in the case of a registered midwife that was providing hospital based care she would be prevented from providing homebirth unless she had indemnity insurance that covered homebirth."

Clauses from the draft legislation Health Practitioner Regulation Law 2009 below have been identified by Justine as being very problematic to homebirth practice.

69 Eligibility for general registration

(1) An individual is eligible for general registration in a health profession
(a) the individual is qualified for registration in the health profession,
(b) the individual has successfully completed:
(i) any period of supervised practice in the health profession required by the National Board established for the health profession, or
(ii) any examination or assessment required by the Board to assess the individual’s ability to competently and safely practise the profession, and
(c) the individual is a suitable person to be registered in the profession, and
(d) there is, or will be, in force in relation to the individual appropriate professional indemnity insurance arrangements, including a policy held, or arrangements made, by the
individual’s employer that will cover the individual

101 Conditions of registration

(1) If a National Board decides to register a person in the health profession for which the Board is established, the registration is subject to the following conditions:
(a) for a registered health practitioner other than a health practitioner who holds non-practising registration:
(i) that the registered health practitioner must complete the continuing professional development program required by the National Board, and
(ii) that the registered health practitioner must not practise the health profession unless professional indemnity insurance arrangements are in force in relation to the practitioner’s
practice of the profession,
(b) for a registered health practitioner who holds non-practising registration, that the person must not practise the health Profession,

Note. A failure by a registered health practitioner to comply with a condition of
the practitioner’s registration does not constitute an offence but may constitute behaviour for which disciplinary action may be taken.

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