Essay
Preparing For and Limiting
Potential Liability for Medical
Care Provided During Disaster
Events
Chapter 21
Factors that Affect Standard of
Care
• Loss of resources
• Deteriorating conditions
• Sporadic help
• Fragmented legislative framework of reference
• Lack uniform liability standards
Memorial Medical Center
• Loss of power
• Loss of air conditioning
• Physical damage of hospital structure
• Inability to transport critical patients
• Compromised sanitation system
• Lack of disaster training
• Staff exhaustion
• Lack of contact with outside world
• Efficacy of palliative care
Legal Liability Landscape in
Disaster Events
• War zone analogy
• Gonzalez Act
• Supreme Court position
• American Public Health Association survey
• Volunteer Protection Act
• State statutes
Development of Altered Standards
of Care
• Modification of medical standards
• Modification of legal standards
• IOM definition of crisis standards of care
• IOM “vision” for crisis standards of care
IOM Vision
• Standards are fair to all those affected
• Equitable implementation of standards
• Community input in development of standards
• Appropriate legal framework
IOM Recommendations
• Strong ethical grounding
• Community and provider engagement and communication
• Assurances regarding legal environment and framework
• Clear indicators and triggers
• Evidenced based clinical operations
Proactive Preparation for Disaster
Events
• Effective planning
• Effective training
• Preventative efforts
Lack of Education and Training for
Disaster Events
• Inadequate corporate plans
• Inadequate medical school training
• Inadequate continuing medical education
• Inadequate funding
Planning and Implementing a
Disaster Response Plan • Internal and external communications
• Chain of command and triage
• Acknowledge vulnerabilities of patients and staff
• Clearly communicate plan to all physicians and staff
• Plan should include specific triggers and indicators
• Training
• Mechanisms to limit chaos