Indemnity questions on abortion prescribing

GPs are encouraged to seek education on MS-2 Step, even now that the requirement has been dropped.

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Red tape around prescribing for medical termination has been slashed, but it’s unclear whether it will mean additional insurance premiums for clinicians who haven’t completed the once-mandatory training.  

On Tuesday, the TGA announced a decision to remove the requirement for doctors to complete an online training course before being permitted to prescribe mifepristone and misoprostol (MS-2 Step, MS Health Pty Ltd), which is used to terminate pregnancies of up to nine weeks. The requirement for repeat recertification has also been dropped.  

The education program itself was facilitated by the drug sponsor, MS Health, a non-profit which is part of MSI Reproductive Choices (formerly Marie Stopes International).  

It’s unclear whether MS Health’s training and education material will remain as a voluntary option for clinicians, but leading women’s health researcher Professor Danielle Mazza assured The Medical Republic that ample educational resources existed at every level.  

“When you prescribe, you have a professional duty of care to educate yourself about the medication that you’re prescribing,” she said. 

“Nobody has to mandate you to do that [for other services provided in general practice].” 

Requirements for pharmacists to register as dispensers were also dropped, and the PBAC elected to allow nurse practitioners to prescribe the medicine.  

Assistant Health Minister Ged Kearney, a former nurse herself, said the changes recognised the importance of health practitioners that women see regularly, which include their GP, nurse practitioner and community pharmacist.  

“Those nurse practitioners who are also prescribing are those who’ve got their background in women’s health, so they’re going to be an important part of this team as well,” RACGP president Dr Nicole Higgins told TMR.  

The changes come into effect from Tuesday 1 August, a scant three weeks after it was first announced.  

“There are different indemnifiers, but I understand a number [of GPs] might need to relook at whether they need a higher level of indemnity cover,” AMA president Professor Steve Robson told TMR. 

Under the current system, GPs who provide medical terminations in line with RANZCOG standards typically do not need to seek additional medical indemnity coverage, given it is generally considered non-procedural.  

It’s unclear how, if at all, this will change now the requirement has been removed. 

While generally safe and effective, around 5% of women will require surgical intervention for issues like a retained clot following a medical termination.  

For what it’s worth, the RANZCOG standards – which are referenced in at least one Medical Defence Organisation’s insurance risk guidelines – don’t make specific mention of the education requirements. 

Instead, the recommendation is that abortion by any method should be in accordance with the regulatory requirements of the specific jurisdiction it occurs within.  

MIGA national underwriting manager Maurie Corsini told TMR that doctors with the MDO do not need to inform it if their prescribing changes, but encouraged clinicians to pursue education on the medicine.  

“Doctors should be mindful that while in this case the TGA have removed the requirement for certification, the requirement to have appropriate qualifications and training remain,” Mr Corsini said.  

“The standard insurance policy terms under which doctors are covered specifically exclude cover ‘in any way related to healthcare treatment, advice or service provided by any person who does not have the requisite training, accreditation and qualifications to do so.’” 

MIGA also warned that, in the event where a patient came to harm following improper use of the medicine – say, using it outside the nine-week window – and the doctor had not undertaken “appropriate training”, an insurer may seek to avoid covering the claim.  

“The underlying premise to the cover provided to doctors is that the treatment they provide is within their scope of practice, is appropriate in the circumstances, and they are trained and qualified to provide the treatment,” Mr Corsini said.  

MIGA has not taken a position on any prescription medicines previously, many of which may be more dangerous than the MTOP drug.  

Both the Australian College of Nurse Practitioners and the Australian College of Nursing welcomed the opportunity for nurse practitioners to be eligible prescribers for medical terminations.  

“Removal of barriers to health care, especially for our most vulnerable, is always welcome news and nurse practitioners are well prepared to provide this care,” ACNP CEO Leanne Boase said.  

“Many nurse practitioners will now be able to access training and professional development, if they haven’t already, to provide this valuable service, in the interests of better healthcare for women.” 

Under the current regulations, around 10% of GPs – just under 3900 – were certified to prescribe MS-2 Step.  

There are only around 2250 nurse practitioners in Australia; even if every nurse practitioner elected to become an MTOP provider, it appears that GPs will still be providing the bulk of the care.