Insurance Ombudsman Dr. Wickrema Weerasooria writes on:

Special Insurance cover for Ambulances needed

Accompanying patients: I wish to bring to public notice through the HealthWatch this caution to persons who travel or are carried as patients in ambulances. Very recently I had to inquire into a sad case where a patient who was being taken in an ambulance from Colombo to Point Pedro.

At Kekirawa at about 6 a.m. early morning, the ambulance met with a serious accident, as a result of which the patient who was inside the ambulance had died. That was not all. Three close relatives of the patient were also inside the ambulance.

They had got into the ambulance in Colombo to assist and keep company with the patient on the long journey. All three of them were also badly hurt by the accident.

Also injured were the medical attendant and the ambulance driver who were in the front. The accident had occurred in January 2005. The Police have yet to file a case relating to this accident to find out how it was caused.

As the Insurance Ombudsman, one of the three relatives of the deceased patient asked me to inquire into the insurer's liability which I did.

On inquiry, I found that the insurance company in this case did not have a special or separate insurance policy for ambulances. (I am not sure whether this is so with all insurance companies).

In this case, the owner of the ambulance had been covered by a policy given for 'Hiring of Motor Lorries. The net result was that such insurance cover only protects and covers:

(1) Damage to the vehicle (ambulance) itself

(ii) Death or bodily injury to the patient and any employee of the ambulance owner, including the driver etc. but not third persons not employed by the ambulance owner. Here the 'patient' is (in my view) covered because under the policy he is "a passenger carried in pursuance of a contract of employment". The medical attendant would also be covered as an employee of the ambulance owner.

The other three persons injured were not motorists or pedestrians on the highway. If so they would have been covered by normal 'Third party' cover. The person injured was travelling inside the ambulance (with two other relations) but not as an employee of the ambulance owner.

Hence, according to the insurer, he was not covered by the insurance policy which clearly excluded such cover in its clauses/conditions.

The person injured was no doubt a 'passenger' and normally would be covered under Third Party liability but in this case the insurance policy clearly stated 'passengers' inside the vehicle other than the patient - would not be covered unless they were being carried in pursuance of a contract of employment with the ambulance owner.

The insurance company also stated that for the policy to cover passengers travelling within the ambulance an additional premium had to be paid by the insured which was not so paid in this case.

The insurer therefore denied any liability on the grounds that the terms of the policy did not cover 'death or injury' to the three passengers in this accident.

As I said earlier, the three persons accompanying the patient and travelling inside the ambulance were undoubtedly passengers but to be covered by the relent policy they had to be passengers "carried in pursuance of a contract of employment".

Did the ambulance owner (the insured) agree to carry the three relations in pursuance of a contract of employment? This is the legal issue that will have to be decided on the evidence, if this matter goes to litigation. As the Ombudsman I was not able to mediate because of this legal issue.

Accordingly in my view, the injured relations if they wish to obtain damages for the serious injuries they suffered will have to file action, if at all, against the insured - who is the ambulance owner and also join the insurance company as a defendant to such action.

This case prompts me to caution members of the public NOT to travel inside an ambulance to accompany or assist patients (whether as a relation or close friend) unless they have been assured by the ambulance owner that they are also covered by the insurance policy given for that ambulance.

If there is no such assurance, they may not be covered for any injuries or bodily harm they may suffer, if the ambulance meets with an accident - as happened in this case.

As the ombudsman I also feel that insurance companies - should in the light of this case - evaluate the type of insurance policy they give for ambulances and discuss with ambulance owners the type of cover given by such policies. As motorists when we hear an ambulance siren, we are always quick to get to a side and give way for it to proceed.

In this particular case, the three relations accompanying their friend never realised the risks they were taking even with such sirens!

As ombudsman I find it difficult to accept that an ambulance engaged on a hire and meant to carry the sick and those attending on them could take to the road without insurance cover for any person travelling inside it. If there is no such cover the ambulance must refuse to take them.

Cell phones and health

Cell phone usage: Earlier this year, a study found that there was no clear association between brain tumours and cell phone usage.

There had been a few studies that found an increased risk of brain tumors with cell phone use, but those studies were criticized for problems with the study design. The recent study which used 427 Danish participants, found no clear association between brain tumours and cell phone use.

However, the researchers recommend further studies on this topic.

What is the newest concern about cell phone use?

Is it safe to use cell phones outside during a thunderstorm? A letter published in BMJ (British Medical Journal) says "maybe not."

The letter comes from Ram Dhillon, FRCS, and two other experts in ear, nose and throat health. They work at Northwick Park Hospital in Middlesex, England.

Dhillon's team tells of a London teen struck by lightning while talking on her cell phone in a park during a storm. The girl survived, and it's not clear what role, if any, her cell phone played in her injuries.

"This rare phenomenon is a public health issue, and education is necessary to highlight the risk of using mobile phones outdoors during stormy weather," write Dhillon and colleagues.

The 15-year-old girl cited in the letter was seen being struck by lightning while using her mobile phone in a large London park during stormy weather.

The girl's heart stopped beating when the lightning struck. She was successfully resuscitated, but one year later she was a wheelchair user with complex physical, cognitive and emotional problems.

The girl also suffered hearing loss from a torn left eardrum. She had been holding her phone on her left ear during the storm.

While the doctors have no way of knowing if the cell phone worsened the girl's injuries, that might be possible, they write.

Do cell phones increase the injury risk?

If someone is struck by lightning the high resistance of human skin results in lightning being conducted over the skin without entering the body; this is known as flashover.

Conductive materials in direct contact with the skin, such as liquids or metallic objects, disrupt the flashover and result in internal injury, with greater morbidity and mortality. 'Morbidity' means illness or injury; 'mortality' means death.

Dhillon and colleagues say they know of no similar cases in medical literature, though they found three fatal cases reported in Asian newspapers from 1999-2004. The doctors didn't confirm those newspaper reports through medical sources.

Get inside

However, it is too early to jump into any sort of conclusion regarding this. The girl's main problem was that she was standing out there, during the storm.

The safest thing to do in a storm is to seek cover, ideally in a large, enclosed building.

Simply being outside during a storm - regardless of cell phone use - made her an easy target, for lightning.

However, some experts feel that the amount of metal in a cell phone is far too small to attract lightning.

The main take home message should be to stay indoors when there is lightning.

It would also be wiser, not to pay attention to your ringing phone, when you are in a thunderstorm, because your life may just be at risk.

Reference:WebMd health

Kelum Pelpola, Final Year Medical Student Faculty of Medicine, Colombo.

It's never too late to start exercise - Heart study

LONDON, July 18 (Reuters)

It's never too late for couch potatoes to start exercising and cut their risk of heart disease, according to research recently.

Neither does it have to be strenuous activity - even just walking can make a difference.

"You don't have to go to the gym. Just get off the couch," said Dr Dietrich Rothenbacher of the University of Heidelberg in Germany. "It is never too late to start exercising," he told Reuters.

The researchers studied the impact of physical activity on patients with coronary heart disease (CHD) and a group of healthy volunteers of the same age and sex.

They found that people who exercised throughout their lives had the lowest risk of the illness, which is one of the biggest killers in industrialised countries.

"But we also found that people who changed their physical activity patterns in late adult life also reduced their risk for coronary heart disease," added Rothenbacher, an epidemiologist at the university.

The scientists re-evaluated data they had previously collected on patients and volunteers ranging in age from 40 to 68 who had been questioned about their habits and exercise patterns.

Smoking, diabetes and high blood pressure, which are risk factors for heart disease, were more common in the patients with the illness than in the healthy volunteers.

People who said they had been active throughout their lives had about a 60 per cent lower risk of being diagnosed with coronary heart disease.

Couch potatoes who changed their ways and began exercising after the age of 40 were about 55 per cent less likely to be diagnosed with the illness than people who had always been inactive.

"Our results suggest that a more active physical activity pattern is clearly associated with a reduced risk of coronary heart disease, and that changing from a sedentary to a more physically active lifestyle even in later adulthood may strongly decrease CHD risk," Rothenbacher said in the study published in the journal Heart.