Medical Risk Management

1st South American Congress Risk ManagementSantiago, Chile

August 6 & 7, 2012

By: Geoffrey HaytonClaims Counsel for Adventist Risk Management

Medical Risk Management

Topics Covered:1. Medical Malpractice2. Risk Management Strategies 3. ARM Claims Process

Medical Malpractice Defined

• Medical malpractice occurs when a medical care provider fails to act as a reasonable medical care provider would have acted under the circumstances.

• (Occurs not merely when there is an error, but when the degree of error exceeds the accepted norm.)

Medical Malpractice Components

1. Duty:The physician has a duty to treat the patient

2. Breach:The physician’s interaction with the patient

falls outside the accepted standard of care3. Causation:

The patient is harmed as a result of this interaction: physician’s actions caused the harm

4. Injury/Damages:Actual damages are suffered by the patient

Hospital Liability

• When the negligent act is committed by a hospital employee (doctor, nurse, etc.) case is controlled by the doctrine of respondent superior.

• The doctrine of respondent superior states that an employer may be held liable for the negligent acts or omissions of its employees, if, the employees were acting within the scope of their employment.

Risk Management and Medical Liability

Why have Risk Management Strategies?• Reduces medical liability exposure• Ultimately provides better care for your

patients• Will provide a more organized office, clinic or

hospital operation• Fewer chances of important details to fall

through the cracks

Medical Risk Management: 3-step Process

1.Identifying risk2.Avoiding or minimizing the risk of loss and 3.Reducing the impact of losses when they occur*Medical Risk Management focuses on risk

reduction through improvement of patient care

Key to Medical Risk Management:

Communication and Documentation:“HAND IN HAND”

Key to Medical Risk Management

Communication….• Although you will not find POOR

COMMUNICATION listed anywhere as an official cause of MEDICAL MALPRACTICE CLAIMS, it underlies almost every malpractice action.

Key to Medical Risk Management

Communication….• Good communication with the patient is

fundamental in achieving a strong physician patient relationship. This relationship requires the physician to provide the patient with the acceptable standard of care.

Key to Medical Risk Management

Communication….• When negligence causes the patient injury,

transparency and openness should be implemented instead of distancing and avoidance.• Negligent actions injuring patients are

primarily due to misinformation and lapse of good judgment and rarely due to malicious recklessness.

Key to Medical Risk Management

Communication….• When injuries or other losses are incurred,

the physician should apologize to the patient.• Compassion and sympathy for patient’s

pain and suffering is not an admission of wrong doing.

Key to Medical Risk Management

Documentation….Serves three purposes:

1. Reminds the healthcare professional what he/she has done for and to the patient

2. Alerts other healthcare professionals what has been done for and to the patient

3. It is a LEGAL RECORD

Key to Medical Risk Management

Documentation….Strengthening the medical record:

1. Write a full note. Write the positives and the negatives.

2. Limit abbreviations.3. Do not ALTER the record.

Documentation of Medical Records

PHYSICIANS

“If the nurses around this hospital would read the medication orders, we would not have medical emergencies like this one.”

NURSES

“If the physicians around this hospital would learn to write so we could read it, there would not be medication emergencies like this one.”

Key to Medical Risk Management

Conclusion….•Risk Management encourages and promotes:– open communication between physicians, nurses,

other medical healthcare providers and their patients

– careful documentation– the development of technical and diagnostic skills– eliminating problem areas in a physician’s practice

and in hospital protocol

Hospital Duties in the Event of a Medical Incident, Claim or Suit

• Every hospital should have an “EVENT REPORTING FORM.”

• Hospital administration must require/mandate that this form be completed.

• Form should be completed as soon as possible following medical incident.

• Form should be completed by all medical care providers involved.

Event Reporting Form

Should include:• Name of person completing form• Name of patient and hospital identification

information• Date and time of medical incident• Description of medical event• Actions taken/Effect/Result• Severity of medical event

Penang Adventist HospitalEvent Reporting Form

When to Use an Event Reporting Form

• Using best medical and administrative judgment, determine the seriousness of the medical incident, or a medical incident “which may result in a claim.”

• A copy of the Event Reporting Form should be sent to Jabson Magalhaes da Silva, General Director of Adventist Risk Management in the South American Division as soon as possible.

Medical Incident is not a “Claim”

• A claim is officially recognized by ARM when the injured party notifies the hospital that they are pursuing indemnity from the “medical incident.”

• The notice by the injured party can be verbal or in writing.

• If an Event Reporting Form has not previously been filed with Mr. da Silva the hospital should do so immediately.

ARM and the Event Reporting Form

• When Mr. da Silva receives Event Reporting Form:– he will notify the Riverside, California ARM office.– local legal counsel will be notified.– legal counsel will contact parties to conduct

further investigation to prepare a defense.– everything possible will be done to resolve the

matter as quickly as possible.

THIS POWER POINT PRESENTATION AND ANY MATERIALS DISTRIBUTED ARE FACT BASED GENERAL INFORMATION AND SHOULD NOT, UNDER ANY CIRCUMSTANCES, BE CONSIDERED SPECIFIC LEGAL ADVICE REGARDING A PARTICULAR MATTER OR SUBJECT. PLEASE CONSULT YOUR LOCAL ATTORNEY OR RISK MANAGER IF YOU WOULD LIKE TO DISCUSS HOW A LOCAL JURISDICTION DEALS WITH ANY SPECIFIC CIRCUMSTANCES YOU MAY BE FACING.