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Professional Indemnity Insurance for Midwives
|From 1 July 2010, when national registration commenced for all states except Western Australia, all midwives with current registration as of that date are deemed to be registered on the national register for midwives. |
There are a number of registration standards which midwives have to meet. For more information on this visit the Nursing and Midwifery Board of Australia’s website and click on registration standards.
One of the requirements relates to holding professional indemnity insurance. Under section 129 (1) of the Health Practitioner Regulation National Law, a health practitioner must not practise the health profession in which the practitioner is registered unless appropriate professional indemnity insurance arrangements are in force.
If a registered midwife contravenes subsection 129(1) - that is, the midwife practises midwifery without appropriate professional indemnity arrangements in place - then subsection 129(4) provides that this is not an offence; however it may "constitute behaviour for which health, conduct or performance action may be taken." The Nursing and Midwifery Board of Australia (NMBA) will be responsible for deciding whether or not any action is taken.
Most midwives meet this registration requirement by virtue of being employed. Employed midwives do not need to purchase insurance for midwifery care they provide as an employee, provided their employer holds a vicarious professional indemnity cover.
However, midwives who are self-employed (in private practice), whether on a full time or part time basis, need to ensure they have professional indemnity insurance for their practice. There is currently only one source of insurance for private midwives. This is available from MIGA, and covers pregnancy and postnatal care in any setting, and labour and birth care in a 'clinical setting'.
You can find out about the MIGA policy by visiting the MIGA website, or ask questions by phoning them on Free call 1800 777 156.
The ACM is NOT AUTHORISED to advise midwives on their professional indemnity insurance needs or arrange any insurance for them, and does not endorse the policy terms. The ACM strongly recommends that members seek their own advice by contacting MIGA directly.
|Suggested questions we would recommend that you ask of an insurer include (but are not limited to) the following:|
• What midwifery practice does your insurance policy cover?
• What exclusions to the policy are there? (all insurance policies have exclusions)
• What is the maximum amount of a claim that the policy will respond to?
• What does the policy provide support for? In the event of a claim arising, what will this insurance do for me?
• Who is eligible to buy your policy?
• What do I have to do to maintain my eligibility for this insurance over time?
• What are my responsibilities for reporting under this policy?
• What price is your policy? Are there any alternative price options or discounts available?
• Does your policy provide for run-off cover? (this is essential if you cease practice and a claim arises from the time when you were practising)
• If run-off cover is provided what does it cost?
The ACM has provided advice to MIGA about some of the information and professional development resources it has developed for its midwife policy holders. ACM is reviewing the Risk Management Continuing Professional Development offered by MIGA to consider endorsing these activities under MidPLUS. MIGA is also considering endorsing the ACM’s Midwifery Practice Review program to award points towards a discount on annual premiums.
Midwives providing labour and birth care at home
Following the Health Ministers' Council decision last September to give an exemption from the requirement for private practice midwives to hold professional indemnity insurance in relation to homebirth for a period of 2 years, the exemption has been written into the national laws for the registration scheme (NRAS).
The NRAS exemption is from the need for privately practising registered midwives to hold professional indemnity insurance for attending a homebirth. However, midwives attending homebirths will still need appropriate insurance for the remaining scope of their practice, i.e. antenatal and postnatal care. This is regardless of the woman's intended place of birth.
The Commonwealth Department of Health and Ageing has advised that you will not need to apply for the exemption. It will automatically extend to a midwife providing labour and birth care at home from 1 July 2010 to 30 June 2012.
The exemption is not a separate category of registration. A midwife who meets the requirements set out in section 284 (including any relevant codes or guidelines developed by the Board) will be covered.
UPDATE 17/4/15: Communique from COAG Health Council
"Ministers agreed to extend the current excemption for Professional Indemnity Insurance for midwives in private practice providing intra-partum care for women who choose to have home birth to December 31 2016 while further work is being undertaken." To view the full communique: http://www.health.gov.au/internet/main/publishing.nsf/Content/mr-yr15-dept-dept005.htm
Who is eligible for the exemption?
|Every registered practising midwife will be eligible (i.e. every midwife on the 'general' part of the midwife register, as opposed to the 'non-practising' part of the midwife register) - But there are a few things you have to do if you want the exemption to apply to your practice.|
Firstly, if you are a midwife working under the exemption you will need to ensure you are legally allowed to provide labour and birth care at home without insurance in your state/territory. ACM wrote to all state and territory governments last year about this, and each has confirmed that this is possible, but you may also want to make your own inquiries about this.
The legal wording of the NRAS law says "the practise occurs in a participating jurisdiction in which, immediately before the participation day for that jurisdiction, a person was not prohibited from attending homebirths in the course of practising midwifery unless professional indemnity insurance arrangements were in place".
Once you're sure you can attend a home birth in your home state or territory without insurance, you'll need to do 3 key things and have proof that you are doing this if you are audited by the NMBA. These things are legislated for in the NRAS laws (s284)
1. Gain the informed consent of the woman to your not having insurance for her labour and birth care
NRAS says "informed consent means written consent given by a woman after she has been given a written statement by a midwife that includes
a. a statement that appropriate professional indemnity insurance arrangements will not be in force in relation to the private midwife's practise of midwifery; and
b. any other information required by the National Board."
2. Submit data about women's care to your relevant state/territory perinatal data agency, and
3. Be able to demonstrate, if audited, that you are working in accordance with any safety and quality requirements as required by the Nursing and Midwifery Board.
What does the Quality and Safety Framework require?
|We don't yet know what the safety and quality requirements for midwives accessing the exemption will be. The Victorian Health Department has had carriage of creating a framework, but it will be the NMBA that will need to adopt it if it is to apply to midwives practising under the exemption. Positive discussions have apparently been held with the Board but the adoption of the framework hasn't happened as yet.|
What we do know, from the latest draft of the Quality and Safety Framework, is that it is likely midwives wanting the exemption will need to maintain usual registration evidence on such things as how you meet the competency standards, that you participate in CPD, and that you reflect on your own practice. You'll need to keep good documentation of each woman's care, submit perinatal statistics for each woman to the relevant state agency, and have documentation showing planning of consultation and referral pathways, all of which private midwives already do.
In the absence of a Quality and Safety framework for labour and birth care at home, the exemption still applies. You will simply need to adhere to any professional codes and guidelines that are in place at the time.
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