Health care risk management assignment week 5

Chapter 10: Strategies to Reduce Liability

Managing Physicians

• Facilities may have liability when a

physician is involved in malpractice

– Respondeat superior

– Ostensible agency

– Corporate negligence

Professional Practice Acts

• Regulatory boards

– Created by State legislation

– Statute defines the scope of professional

practice and specifies:

• Composition of the board

• Duties and powers to create rules for the

professional practice

• Licensure process

• Continuing education requirements

• Investigation and disciplinary actions

Professional Discipline

• Regulatory Board will:

– Investigate suspected misconduct

– Prosecute confirmed misconduct, as

appropriate

– Take appropriate disciplinary action for

confirmed misconduct

• License revocation

• License suspension

• Fines

• Referrals for professional assistance

Examples of Misconduct

• Repeated acts of negligence

• Incompetence

• Aiding or abetting the unlicensed practice of medicine

• Failure to comply with government rules/regulations

• Exploitation of the patient for financial gain

• Evidence of moral unfitness to practice medicine

Examples of Misconduct

• Failure to maintain appropriate medical

records

• Abandoning or neglecting a patient

• Harassing, abusing, or intimidating a

patients

• Ordering excessive tests or treatments

• Unlawful use of controlled substances

Physical impairment of professionals

• Health problems, disease, disability,

psychiatric issues, and alcohol/chemical

abuse

• Symptoms of impairment

– Making rounds late --complaints from staff

– Inappropriate orders -- frequent accidents

– Hostile behavior -- mood swings

– Personal hygiene -- job changes

– Neglected social commitments

Sexual Harassment

• Providers are in the unique position of

power

– Patient is dependent on the provider

Identifying Previous Misconduct

• Licensing boards share information concerning adverse actions against providers across state lines – The Federation of State Medical Boards

– National Practitioner Data Bank

• Risk Managers should ensure that the facility hiring and credentialing policies include a procedure for checking the data banks

National Practitioner Data Bank

• Designed to collect comprehensive data on adverse actions taken against health care practitioners, malpractice payments made and Medicare/Medicaid exclusions.

• Insurance companies and hospitals are required to report to DHHS and state licensing boards any medical malpractice payments resulting from court judgments or settlements

• Facilities are required to check the NPDB for all new medical staff and every two years for re-credentialing

• 4 classes of adverse actions requiring reporting – Those taken against a practitioner’s license by

a state medical board

– Those taken against a practitioner’s clinical privileges at a health care facility

– Those taken against membership by a professional society

– Those taken by Medicare/Medicaid and the DEA

National Practitioner Data Bank

Clinical Practice Guidelines

• Systematically developed statements to assist practitioners and patient decisions about appropriate health care for specific clinical circumstances. – Private Initiatives

– Government Initiatives

– Worker’s Compensation

– Medical Liability Insurers

• Risk managers must not only be aware of clinical practice guidelines, but also the legal implications of ignoring them

• Health professionals reviewing other like

health professionals to assess:

– Quality concerns

– Hospital privileging decisions

– Group practice membership decisions

– Staff conduct

– Professional isolation

– Education

Peer Review

Liability Alternatives

• Limit number of lawsuits

• Control size of awards

• Limit access of plaintiffs to the system

Removal of Malpractice Litigation from Judicial System

• Several tort reform proposals recommend shifting malpractice litigation away from the judicial system

– Administrative Agencies

– Alternative Dispute Resolution

No-Fault Proposals

• Under this type of system, adverse outcomes would be automatically compensated without lawsuits regardless of whether the outcomes resulted from negligence.

– Accelerated Compensation Events

– Enterprise liability

– Other methods

Summary

• Risk Managers must work with the

healthcare professionals in terms of

practice guidelines and peer review.

• Proactive liability reduction can offer

significant protection of the organization’s

financial resources.