• Medical Malpractice Insurance in the Age of the ACA Part II

     

    “Twenty years ago, we would have taken care of this with a phone call” said the young internist as I waited with my 90-year-old  mother-in-law for him to work through the lengthy list of questions required at every visit now, due to healthcare reform.  On the one hand, I could understand his frustration with the process.  I recalled my first visit to my own primary care physician, who we fondly refer to as “Crazy Dr. Larry.”  Crazy-BRILLIANT, that is, following Dr. Larry’s implementation of Electronic Medical Record keeping.   Dr. Larry was very frustrated with the new requirements at that first visit.  “You know computers, right?  Can you answer all these questions?  He gave me the laptop and ran to check another patient whose EKG was irregular.  So, I got to try it for myself, working through the lengthy list of questions, and possible replies via drop down menu.  I noted the prompts and other built in checks.  Hmmm, I thought, this might actually be good for Dr. Larry who is multi-tasking and fielding staff interruptions and calls from the hospital during every patient visit.  Back to the young internist, he is not my mother-in-law’s regular physician, and had never seen her before as a patient–he did know that she is a retired physician herself,  and one of his asociate’s most “VIP” of patients.   As he worked through the lengthy list of questions, I noted that he was learning a lot about by mother-in-law’s history, things he probably would not have known had he been using an old paper chart, and reviewed only the last few visits and recent lab work.  Since my first visit after Dr. Larry implemented the new requirements, he has become much more adept at working through the electronic chart and is seeing his patients more promptly.  Certainly, there are improvements that can be made, and much streamlining that can be done.  Bottom line, though, change is hard, but it is not all bad–in fact much about it is an improvement over our old systems.  From a medical malpractice risk management standpoint, the electronic charting will help physicians improve their chart documentation, which is often key in defending a malpractice case.  Incidents of “if it is not in the chart, it cant be proved it was done” will be reduced to nil for physicians diligently completing every field in their electronic  charts.

  • Medical Malpractice Insurance and Liability in the Age of the ACA

    Affordable Malpractice Insurance

     

     

     

     

    An ongoing question on the minds of medical malpractice insurance professionals is what is the impact of the Affordable Care Act on the medical liability exposure to physicians?  A decade ago, we cautioned physicians who were purchasing their malpractice insurance through hospital sponsored programs that the interests of the hospital, and the interests of the physician, are very different, when it comes to defending both in a medical malpractice claim.  It was commonly held that physicians are more aggressively defended when they have representation independent of the hospital.  To speak more plainly, in a joint defense scenario when the hospital and the physician are covered by the same insurance company (or RRG or Captive), hospital counsel will pressure the insurance company to protect the hospital at the expense of the physician.  Typically, the hospital  counsel will want to settle as soon as, for as little as, possible.  Physicians, on the other hand, want to fight every case aggressively, to protect their reputations.  With  the increase in hospital-employed physicians, how will these divergent interests shake out? Presently there is no real data available to review and come to any conclusion. Risk Managers are focusing on the changing liability landscape presented by the ACA. Hospitals now have a continuum of vicarious liability issues including employer liability, greater duty to train on policy and procedures, and a renewed emphasis on open communication between employed physicians, ancillary staff and hospital administration.  Prior to widespread employment, physicians did not need to be concerned with policing other physicians and hospital staff. As employees of the hospital, they will have the same interests at stake as the hospital.  There will need to be an organization-wide commitment to Risk Management  and Patient Safety Initiatives. So…can the ACA reduce liability exposure?  Maybe.  The ACA emphasis on quality of care, coordination of care,  improved outcomes, prevention of hospital re-admissions, all of these,  if implemented correctly, can reduce liability over the long-run.  On the other hand, plaintiff attorneys will be ready to exploit any deficienceis in comppliance with the ACA to further their medical malpractice allegations.

  • Medical Malpractice and Disaster Preparedness

    Medical Malpractice and Disaster Preparedness–January is not the customary time for healthcare professionals to review their Disaster and Emergency Preparedness Plans–but maybe it should be. Better yet, it might be advisable to review plans and conduct in-service staff training on a quarterly basis. I’m reading Five Days at Memorial by Sheri Fink, a detailed account of the events during and after Hurricane Katrina at Memorial Medical Center in New Orleans, LA. It is a sobering account and a cautionary tale for Medical Professionals. The saying no good deed goes unpunished comes to mind. In no way would we construe allegations of euthanasia as a good deed; however, an overriding desire to mitigate and alleviate horrible pain and suffering is a quality we hope for in all our care givers. Employed physicians, nurses and ancillary healthcare professionals should take note of how events can unfold in a time of crisis and how actions will be viewed down the line, out of the context of the crisis. Heroic caregivers who put their own lives at risk to care for their patients and who dutifully “followed orders” may be thrown under the bus. Most medical malpractice insurance companies have seminars and/or publications to assist and support the efforts of their insureds in the area of emergency preparedness. It would be a best practice to take advantage of these services, and review and update disaster preparedness plans on a regular basis.