Lessons from the largest ever malpractice claim

The rise of telemedicine and medical tourism mean that medical malpractice insurance restricting cover to Singapore only no longer meets doctors’ needs.

Howden’s malpractice cover for doctors therefore provides worldwide coverage, for both claims arising where our doctor was physically outside Singapore and for claims brought in courts outside Singapore. There are, however, two important exceptions to the worldwide protection, as we do not include the USA or Canada. 

The USA/Canada exclusion is common to many forms of insurance issued in Singapore. For Howden, it is not that our insurer is unable to extend the cover, but because of the high additional cost. Even covering the very remote possibility of a US citizen receiving treatment in Singapore, returning home, and then launching legal action alleging malpractice results in a huge jump in premium. This is because the USA and Canada are home to most of the largest malpractice damages awards the world has seen.
    
In August 2000, Allan Navarro presented at the University Community Hospital in Tampa, Florida, complaining of headache, dizziness, blurred vision, and nausea. He advised the doctors of a family history of stroke but was instead diagnosed with sinusitis and sent home with painkillers. The next day Mr Navarro returned to the hospital with worsening symptoms. He was admitted, a stroke was diagnosed and emergency surgery performed to relieve swelling of the brain. Mr Navarro subsequently spent three months in a coma and was permanently paralyzed, confined to an electric wheelchair and with limited speech abilities.

Mr Navarro sued both his treating doctor and the medical group that managed the emergency section of the hospital. During the trial it emerged that the initial assessment of Mr Navarro had been carried out by a nursing aide, and that the treating doctor did not in fact conduct an examination. From a malpractice perspective this case now appears indefensible, but the doctor’s insurer inexplicably rejected an offer to settle for $2 million, so the case continued. The jury ultimately awarded Mr Navarro $116 million in damages, plus a further $101 million in punitive damages against the doctors involved. At $217 million this was, and remains, the largest malpractice award ever handed down by a court anywhere in the world.

Is there anything that we in Singapore, where the largest ever malpractice award stands at around $5 million, learn from this case? In my view there are two lessons.

1. Disputing a claim can backfire

The first is that where malpractice is evident, disputing a claim can backfire badly. Doctors sometimes feel admitting to an error will damage their professional reputations. In fact, however, the greater damage is caused when a guilty finding is made in court, with the judgment a matter of public record. Settling a case out of court, by contrast, is a confidential process which will not result in any publicly accessible records. Howden’s policy gives our doctors the right to fight, but in some cases, we do advise that this may not be in their interests.

2. No cover ups

The second takeaway from the Navarro case is that attempting to cover up facts is to invite very harsh treatment should the concealment be uncovered. In 2006 Dr Looi Kok Poh, a Singapore hand surgeon, instructed a nurse to alter a patient’s consent form after a procedure had been completed. The amendment was uncovered, and the SMC censured Dr Looi and suspended him from practice for a full year. In the associated civil case, the Singapore courts made a rare award of aggravated damages against Dr Looi. While we do not know if Dr Looi was insured, it is also possible that his malpractice insurer may have rejected his claim on the basis that he had acted dishonestly. 

There seems no prospect that Singapore’s courts will ever hand down malpractice judgments anywhere near the size of those of the USA or Canada. The Navarro judgment may be an outlier, but there is always something to be learned from such cases.