HAPI is not a traditional insurance company. It is established in the framework of a general partnership where all members share personal liability and all members are at financial risk for the other members. The general guidance regarding telehealth is that there must be a prior established doctor-patient relationship. This must be an in-office, face-to-face visit and not a virtual visit via telecommunication. Even with this established relationship, providers must use their professional judgment and risk assessment regarding the decision to use telehealth as a means to provide services. Telehealth may be used, for example, for follow-up and other consultations, however the provider must review the medical severity, patient condition, etc. to assess whether or not telehealth services are an appropriate and safe means of delivering services to that patient. HAPI operates on a ‘facts and circumstance’ basis, so if an issue should arise, each case will be reviewed individually. HAPI does not have a formalized policy that states telehealth services are or are not covered. The general position, however, is that telehealth services, as any other medical services, should be within the providers medical specialty and for the good of the patient.
MIEC’s June 2014 Newsletter lists its policies on the Place of Practice and Telemedicine. An excerpt of the policy is listed below. To view the Issue in its entirety, please click the link above (pages 5-16).
MIEC’s policy, General Conditions, Paragraph 21,
PLACE OF PRACTICE AND TELEMEDICINE reads:
21. PLACE OF PRACTICE
A. You agree that insurance coverage under this policy is available only if
you maintain your principal place of practice in the location identified
by you in written notification to MIEC within 30 days after establishing
your principal place of practice, and that relocation by you to another
principal place of practice without notification to and agreement by
MIEC as evidenced by MIEC’s issuance of a policy declaration or
endorsement shall constitute an automatic termination of insurance
coverage under this policy.
B. You agree that insurance coverage under this policy is available
only for acts, or the alleged failure to act, occurring or undertaken
within the state wherein your place of practice identified in a policy
declaration or endorsement is located, except for (1) services rendered
in an emergency, without compensation or other consideration, and
on an irregular or infrequent basis, (2) services rendered as part of the
training you receive in the course of a formal program of continuing
medical education or (3) services rendered by you when acting as an
independent forensic psychiatric medical examiner or in the provision
of professional forensic psychiatric advice or consultation at the
request of parties to civil or criminal legal proceedings regarding the
health or condition of a person who is not a patient, only if you have
previously notified MIEC in writing of your intention to provide such
C. You agree that insurance coverage under this policy is available
for acts, or the alleged failure to act, when providing health care
services to patients remotely by information and/or communication
technologies only when such telemedicine or telehealth services are
provided in accordance with the laws of any jurisdiction wherein such
act or failure to act (or any part thereof) is alleged to have occurred,
only you are duly licensed or permitted under such laws to engage
in such practice in such jurisdiction, and only if you have previously
notified MIEC in writing of your intention to engage in such services in
such jurisdiction and MIEC has agreed in writing to provide coverage
for such activities.
The Doctors Company’s standard policy excludes services via the Internet or media, meaning telehealth services are not covered if no prior relationship is established between the doctor and patient. If a prior relationship is established, then the provider needs to contact a TDC underwriter to provide specific information (e.g., patient location, type of services, etc.). TDC will make a determination on a case-by-case basis of whether or not the service is covered under the provider’s plan.
Medical liability is unique in American Samoa. No private medical malpractice insurance is required in American Samoa. Physicians can not be sued individually, only the American Samoa Government.
Medical malpractice insurance is not available for health care providers in the Commonwealth of the Northern Mariana Islands (CNMI). There are only about 40 doctors on Saipan, the major island of the CNMI, and maybe 10-12 midwives. 30 or so of the doctors and all of the midwives work for the government at the Commonwealth Health Center (CHC). With such a small risk pool, no reputable U.S. insurance carrier will sell medical malpractice coverage here. So, the private practitioners simply do without, and the government providers are immune from suit by statute. When a malpractice action is filed naming an individual health care provider who works for the government as a defendant, CMMI Public Law 15-22 requires that the health care provider be dismissed from the lawsuit, and the government substituted as the defendant, upon certification by the Attorney General that the health care provider was acting within the scope of his/her employment at the time of the incident of alleged negligence. This statute was copied from the Federal Torts Claims Act, and is basically the same procedure employed by the Federal government when its employees are sued for negligence. The CNMI Office of Attorney General handles all of the medical malpractice claims and litigation against the government and government employees. As for “tail” coverage, Public Law 15-22 also specifically applies to former employees of the government.
Medical malpractice availability is rare for Guam in the Private Sector. In the Government of Guam, malpractice insurance is essentially self-insured and any claims would fall under the Government Claims Act. The claim limit in the Government Claims Act is $300,000 per incident. Physicians working for the Government of Guam in any capacity, are considered agents of the Government and are therefore covered under the Government Claims Act.