Risk Management

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Risk Management Chapter Ten

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OBJECTIVES

• Understand the goals of an effective risk
  management program.
• Be aware of loss prevention strategies used to
  improve patient care and reduce exposure to
  malpractice claims.
• Appreciate the appropriate manner in which to
  explain untoward events to patients and families.
• Understand ways of maintaining good communication
  with patients and families.

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Specialties Having DifficultyObtaining
Affordable Coverage

• Obstetrics
• Emergency medicine
• General surgery
• Surgical subspecialties
• Radiology

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Malpractice Climate
States Currently In Crisis States Currently In Crisis States Currently OK
Washington Oregon Nevada Texas Missouri Arkansas Mississippi Illinois Kentucky Ohio West Virginia North Carolina Georgia Florida Pennsylvania New York New Jersey Connecticut California Colorado New Mexico Louisiana Wisconsin Indiana
The Remaining States Are Showing Problem Signs
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Definition of Malpractice

• Professional misconduct or unreasonable lack of
  skill in the provision of medical care.

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Outcomes Favorable To Plaintiff

• In civil legal actions, attempts to make the
  victim as whole as possible generally manifest
  as awards of money damages sufficient to return
  the victim to the status quo ante (state in
  which they were before the injury).

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Malpractice Payments Are Increasing
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Causes Of Increasing Settlements

• Use of cutting-edge treatments
• Advent of managed care
• Reports in the media

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Effects of the Healthcare System

• Many physicians, faced with increasingly hefty
  insurance premiums or, in some states, an
  inability to obtain coverage, have been driven
  out of practice or have had to limit their
  practices.

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Awards Are Often Excessive
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Definition of Risk Management

• Risk management is defined as identifying,
  evaluating, and minimizing exposure to the risk
  of liability that is inherent in the provisions
  of health care services.

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Goals of Risk Management

• Insure that practitioners are competent and
  patients are safe.
• Minimize the damage to physicians and practices
  from marginal or unwarranted lawsuits.

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Climate for Tort Reform

• Legislated capitation on verdict and settlement
  payouts
• Combining capitation of noneconomic damages, that
  is, pain and suffering, with reforms to eliminate
  joint and several liability and shorten statutes
  of limitation.

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Tort Reform Proposals

• Placing a flat percentage maximum on fees
• Imposing a sliding scale for fee payment.

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MICRA

• The California Medical Injury Compensation Reform
  Act (MICRA) of 1974 serves as a gold standard for
  many proponents of national tort reform in their
  efforts to lobby Congress. Californias reforms
  specifically put caps on noneconomic damages.

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Areas of Risk in ACOs

• Diagnosis and Screening
• Follow-up
• Patient identification
• Over sedation of patients
• Complex technology
• Inadequate training of personnel

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Recommended Risk Strategies in ACOs

Structured organization Risk identification and analysis mechanisms Loss prevention and loss control, Risk financing Careful claims management.
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Patients Likely to Sue

• Patients who have sued before, have a pending
  lawsuit, or simply talk as if they have a
  contentious nature
• People who are unhappy, often for reasons
  unrelated to their health

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Patients Likely to Sue

• People who do not understand their diagnosis,
  treatment, or instructions for self-care
• Family members, acquaintances, friends,
  colleagues, or people who are busy and do not
  want to take the time for consultations or
  detailed instructions

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Patients Unfavorable Ratings of Their Primary
Physician Include

• Communication skills
• Knowledge of their life circumstances
• Knowledge of their whole-person situation
• Knowledge of medical history

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Definition of an Incident

• Any perceived or actual negative event related
  to patient care, or any other medical or
  administrative occurrence that deviates from the
  normal course of patient interaction or
  treatment.

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High Risk Areas to Monitor

Abnormal lab results Patients who fail to keep appointments Telephone Communications Patients on high-risk medications.
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Causes of Poor Documentation

Inadequate time spent creating the record Inadequate attention to details Lack of organized recording of ones thoughts Delay in completing the record.
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Most Frequent Allegations of Wrongdoing

• Errors in diagnosis
• Medical misadventure
• Improper procedures performance
• Failure to supervise or monitor care
• Medication errors
• Procedures performed when not indicated or when
  contraindicated
• Failure or delay in referral or consultation

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Professional Legal Duties

• The duty to disclose the risks of treatment
• The duty of confidentiality regarding information
  about the patient
• The duty of providing reasonable care in the
  supervision of resident physicians

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Areas of Importance

• Explaining untoward events
• Listening
• Providing comprehensive informed consent
• Speaking with patients at a level they can
  understand
• Allowing patients to partner with the practitioner

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Communication

• Keep a steady flow of communication with the
  patient and the patients family.
• Calling just to follow up, with no particular
  agenda, helps inspire a patients trust in a
  provider.
• Identify potentially high-risk patients, but be
  careful to not stereotype patients.
• Be aware of cultural diversity.

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Use of Systems

• Develop fail-safe systems in every area of the
  practice.
• Use more formal tracking systems for patient
  satisfaction.
• Do not review cases outside of your specialty.
• Avoid disagreements among healthcare members.

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Steps in Litigation Management

• Notify the insurance company
• Solicit expert reviews
• Collect depositions
• Decide whether to settle or defend
• Prepare for trial

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Public Law 99-660, the Healthcare Quality
Improvement Act of 1986.

• This legislation called for the creation of the
  National Practitioner Data Bank (NPDB), which
  serves as a central clearinghouse for information
  about the competence and conduct of healthcare
  practitioner.

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Elements a Plaintiff Must Prove

That the professional (defendant) owed the plaintiff a duty to conform to a specific standard of conduct. That the defendant breached his duty to the plaintiff that is, the defendant was negligent. That the plaintiff suffered damages to her person or property. That the plaintiffs damages were caused by the defendants breach of duty.