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PARIS — In 2021, the Mutual Insurance Company for French Healthcare Professionals (MACSF) received about 100 claims based on COVID-19. The claims were related to nosocomial infections, delays in treatment, and even diagnostic errors made during e-consultations. This was a change from the previous year, which had seen a significant decrease in medical claims. The MACSF alerted its 162,000 member physicians that experts will review these files, and the decisions they make very likely could result in compensation.
The lull didn’t last. In 2020, COVID led to the closure of doctor’s offices and the cancellation of interventional procedures. Along with this lower level of activity came a 15% drop in claims. But this episode had secondary effects.
The MACSF, which is the largest insurer for healthcare professionals, recently reported at a press briefing that judgments against physicians started to rise again in 2021. And COVID has not stopped disrupting practitioners’ lives. The insurer has noticed that a significant number of proceedings involving its members is associated with the coronavirus epidemic. All this when so many physicians have themselves fallen victim to the disease.
“These are recent claims,” said Thierry Houselstein, MD, the MACSF’s medical director. “They haven’t been reviewed by experts yet. And so, decisions haven’t been made by the Commission for Conciliation and Compensation for Medical Accidents — the CCI — or by any court. Nor, consequently, has there been any compensation.”
Numerous patients have initiated proceedings, blaming their COVID infection, or those of people close to them, on private practitioners working at clinics or other healthcare facilities. There are around 40 such cases, the MACSF revealed to Medscape French Edition outside the press conference.
“Often, the patient was hospitalized for another illness, and COVID made the initial situation worse. This frequently resulted in a poor outcome, including death,” Houselstein explained. As an example, the MACSF mentioned the case of a woman in a nursing home who got COVID and died. A second case involved an 85-year-old woman with hypertension and diabetes who had been hospitalized as a result of cardiac damage. During her stay, she was infected with COVID, which worsened her cardiac status to the point where she also died.
Misdiagnoses in E-consultations
Telemedicine, a solution at the height of the health crisis, has also been a source of problems. Indeed, e-consultations are the basis of about 10 claims filed with the MACSF. “These claims primarily have to do with general practitioners, criticizing them for diagnostic errors related to the lack of a clinical examination,” Houselstein specified. An e-consultation for abdominal pain ended up being diagnosed as gastroenteritis. The patient’s condition worsened until the correct diagnosis — peritonitis secondary to appendicitis — was given. “During e-consultations, members sometimes underestimated the situation at hand,” added Houselstein.
COVID was also at the center of around 15 claims resulting from operations being canceled. These were filed against surgical and interventional specialists as well as gastroenterologists, cardiologists, and ophthalmologists. These cancellations led to delays in diagnosing neoplasms and other acute illnesses. One family asked that a MACSF member be held accountable after a patient died from rectal cancer that had spread to the liver. This individual’s colonoscopy had been postponed for 6 months during COVID. Similarly, a patient with coronary syndrome who should have undergone a bypass had to postpone his interventional procedure in October 2020 because of the health situation. His condition abruptly deteriorated, and he died.
Four claims were about damage related to vaccination. A case of anaphylactic shock — but also a claim for a death that occurred 48 hours after the injection — are the subjects of proceedings. The causal link has yet to be demonstrated. Likewise, two cases of alleged side effects are being debated.
Some patients who contracted COVID have also initiated proceedings for poor management of care. The MACSF spoke about the file of a patient claiming that a test was not done even though there were signs of virus. He was sent home. Within 48 hours, his condition got worse, and he had to be admitted to the ICU. Several patients also found fault with the management of the treatments in the ICU. One of them cited the failure to diagnose decompensated diabetes.
This article was translated from the Medscape French edition.