Australian Private Midwives Association: Revised Professional Indemnity Insurance Arrangements Registration Standard

Tuesday, January 10, 2012

Revised Professional Indemnity Insurance Arrangements Registration Standard

The Nursing and Midwifery Board of Australia has distributed the following message:

A revised Professional Indemnity Insurance Arrangements Registration Standard for nurses and midwives will be in place from the 10 January 2012. ... The registration standard was approved by the Australian Health Workforce Ministerial Council on 11 November 2011.

The revised registration standard:

• will ensure all nurses and midwives are able to practice in accordance with legislative and professional practice requirements

• will be included in the NMBA Safety and Quality Framework for the regulation of midwives including privately practicing midwives providing planned homebirths, and

• is supported by updated and comprehensive guidelines for midwives.

The registration standard can be accessed at http://www.nursingmidwiferyboard.gov.au/Registration-Standards.aspx

The Guidelines for Professional Indemnity Insurance Arrangements for Midwives can be accessed at: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx

Q&A DISCUSSION added 11 January 2012

Some midwives who have read the new PII Registration Standard have questioned the meaning of the statement:

Requirements: ...

3. Nurses and midwives in different types of practice will require different levels of PII cover, according to their particular level of risk. The following PII cover should be considered:
a). civil liability cover
b). unlimited retroactive cover and
c). run-off cover.

The definition of ‘retroactive cover’ is given: “Retroactive cover means PII arrangements which cover the insured against claims arising out of, or as a consequence of, activities that were undertaken in the course of the practitioner’s professional practice, prior to the date of commencement of the insurance.” (emphasis added)

Q: What does this mean, in reality, for a privately practising midwife?

A: The requirement in the standard says this ‘unlimited retroactive cover’ should be considered. [Note: this statement has not changed since the earlier draft of the document, circulated for comment.]

Q: How would a midwife would come to the conclusion that unlimited retroactive cover is necessary or not in private midwifery practice? How would a midwife weigh up their “particular level of risk” and conclude that retroactive cover is necessary?

A: These questions are theoretical, because there does not seem to be any indemnity insurance product for midwives that offers anything like retroactive cover. When midwives apply for insurance we are required to disclose any incidents that may lead to legal action.

I don’t mean to trivialise the matter. It’s difficult to explore these issues, because they are very emotive.

This standard says

“4. It is the responsibility of nurses and midwives to understand the nature of the cover under which they are practising”

As I see the situation around this revised registration standard, it doesn’t change anything.

Every midwife who is offering private midwifery services is required to have PI insurance that covers all antenatal and postnatal aspects of care
Midwives attending homebirths privately are able to obtain exemption for the attendance at homebirth, if they comply with the requirements set down in the current Board-approved Safety and Quality Framework for Privately Practising Midwives attending homebirths.

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WHO ARE WE?

The Australian Private Midwives Association represents midwives in private practice. The association is focused on the safety of women, the ability of women to access quality midwifery care across Australia and the partnerships between women and midwives. APMA supports women’s choice in maternity options within a framework of quality and safety and believes in women being able to access midwives in all settings. APMA unites all midwives seeking to provide continuity of care for women.

APMA strives to provide midwives in private practice with information relevant to their practice and advocacy in the political process.

Enquiries:
Joy Johnston joy@aitex.com.au
Marie Heath NSW and National 0407 266004
Clare Lane (Vic) 0416 130219

APMA POSITION STATEMENT on PLANNED HOME BIRTHS WITH A MIDWIFE

1. We support home birth with a midwife in attendance for women who have uncomplicated labours. 2. We support and adopt the International Confederation of Midwives’ (ICM) Definition of the Midwife (2011), which is foundational to all midwifery practice, including homebirth. 3. We support the right of every woman to access a midwife as the primary maternity caregiver who works in partnership with the woman throughout the episode of care, who is able to be the responsible professional in attendance at the birth either at home or hospital, and who is able to make appropriate referral and transfer of care when required. 4. We support the right of a midwife to practise privately in a fee-for-service or funded relationship with the client, or to take up employment. 5. We support only those regulatory restrictions that are able to pass the ‘public interest’ test: “How does this promote health and wellbeing in the mother and baby?” 6. We support an expectation of equity, including equal pay for equal work throughout a midwife’s scope of practice. Midwives who provide primary maternity care are entitled to the same public funding, the same opportunity to charge a fee-for-service, the same access to hospital referral, and publicly supported indemnity insurance, as medical practitioners providing the same maternity services. 7. We support processes by which midwives are able to gain experience and mentoring in order to commence and demonstrate competence in homebirth practice. 8. We support seamless and reliable processes by which midwives are able to make hospital bookings for women planning homebirth, and arrange transfer to the hospital in a timely way when needed.