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Chapter 10: Strategies to Reduce Liability
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Transcript of Chapter 10: Strategies to Reduce Liability
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.