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OUR VALUES Service Integrity Collaboration Respect Protection Washington Healthcare Access Alliance September 20, 2013 – Port Angeles, WA Understanding.

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Presentation on theme: "OUR VALUES Service Integrity Collaboration Respect Protection Washington Healthcare Access Alliance September 20, 2013 – Port Angeles, WA Understanding."— Presentation transcript:

1 OUR VALUES Service Integrity Collaboration Respect Protection Washington Healthcare Access Alliance September 20, 2013 – Port Angeles, WA Understanding Professional Liability & Implementing Risk Management Presented by: Maggie Provine, Account Executive Cathy Reunanen, ARM, CPHRM, Sr. Healthcare Risk Management Consultant

2 What we’ll cover today A little bit about Physicians Insurance and why we are here Medical professional liability Risk management essentials Confidentiality of protected health information (PHI) 2

3 Physicians Insurance – who we are & why you might need us History  Since 1982  NW based mutual company Physician owned & directed  More than 6,900 physicians, clinics, and hospitals in Oregon, Washington, and Idaho  Largest insurer of private practice physicians in the Pacific Northwest Practicing physicians are on the Board of Directors & on all committees 3

4 What Physicians Insurance provides Claims Risk management Sales, marketing, customer support Agency 4

5 Volunteer providers & MPL coverage Volunteer Retired Provider Program (VRP) Employed and volunteering  Be sure to verify that outside activities are covered Hospital employed  Hospital may or may not extend coverage 5

6 Professional liability coverage Claims-made coverage Covered services & acts  We will cover you for bodily injury or property damage arising out of direct patient treatment. Limits of liability $1 million/$5 million 6

7 Conditions of coverage VRP Notify us of incidents that may lead to a claim or a notice of a claim or lawsuit. Cooperate in all matters pertaining to this insurance. 7

8 Proposed entity coverage for WHAA What is it? Acts or omissions Vicarious liability of non-treating provider Vetting of the employees Coverage is on a shared-limit basis for all clinics named as additional insureds Covers supervision of non-employees 8

9 Legal elements of malpractice Duty  Provider/patient relationship Negligence  Breach in the standard of care Injury to patient Proximate cause  Relationship between alleged negligence and injury sustained 9

10 Claims and lawsuits Claim: A verbal or written demand for compensation for an injury related to alleged negligence from medical treatment. Lawsuit: A written demand for compensation for an injury related to alleged negligence from medical treatment filed with the courts. 10

11 Reporting a claim or lawsuit Contact your insurer immediately. We have in-take specialists who will obtain all of the pertinent information, walk through the process, and answer all initial questions. 11

12 Common malpractice themes Clinical judgment in diagnosis or treatment Procedure technique Diagnostic delay Failure to follow-up Communication with patient Coordination of care System issues 12

13 What else to report? Bad outcome:  Neurologic injury  Death  Blindness  Amputation/wrong procedure/wrong site  Delayed or missed diagnosis Records request (out of ordinary) It just doesn’t feel right... 13

14 Statute of limitations and repose Effective in 2006, subject to some exceptions, a civil action for injury from health care must be commenced:  Within three years of the act causing injury  Within one year of the time that the patient discovered the injury or should have discovered the injury, whichever is later, but  No more than eight years after the act causing the injury 14

15 What happens when a claim is made? Contact your carrier. If it ‘s Physicians Insurance, we will help you through the process. A claims representative will review the circumstances and manage the claim. Managing the claim may include settlement.  Settlement with insured’s consent The insured must cooperate in the defense of the claim. 15

16 Evaluation of a claim Medical records review Plaintiff Defendant Inflammatory facts Attorneys 16

17 What to expect when a claim is reported Admonitions reviewed (what to do & not do) Claims representative (CR) assigned case Defense counsel assigned case if lawsuit Litigation support arranged if a lawsuit or indicated Acknowledgement letter confirming the above CR and defense counsel will arrange to meet with the insured as soon as possible, generally after related records are received & reviewed. 17

18 Litigation support Lawsuits can be traumatizing for a physician Over 15 years ago, Physicians Insurance created a support program to help The Director of Physician Affairs contacts the defendant at the start of a lawsuit. It is a protected and confidential way a physician defendant can deal with the emotional impact. A supported defendant is a better self-advocate 18

19 Risk Management 19

20 Why patients become plaintiffs 20

21 The reasons patients sue Dissatisfaction with treatment Patient / family anger Lack of communication Health care bills Provider attitude Control or revenge 21

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23 MD to JD - what they want you to know A large percentage of cases are won or lost on the basis (quality) of the medical record Document patient instructions and patient non-compliance Alteration of the medical record WILL be discovered and is ALWAYS fatal to your defense Medical Economics April 4, 2008 Doctors who become lawyers: What they want you to know Mark Crane 23

24 MD to JD - what they want you to know Document patient refusal of recommended care (informed refusal) Labs, consults, x-rays and other studies must be reviewed and marked - have a system Document provider/patient notification of study results and recommended follow-up Medical Economics April 4, 2008 Doctors who become lawyers: What they want you to know Mark Crane 24

25 Medical record documentation 25

26 Importance of documentation Plan for patient care Often the most important evidence allowing successful defense of a malpractice claim or lawsuit Poor records are the most often cited reason for settlement 35 to 40% of lawsuits are compromised by the medical record 26

27 Charting issues in malpractice Illegible handwriting Insufficient information Medication issues Incomplete or missing entries Phone calls not charted 27

28 Charting issues in malpractice Patient instructions not documented Delayed charting Patient noncompliance not charted No documentation of informed consent and patient education 28

29 Rules of charting If it isn’t in the chart, it didn’t happen. 29

30 Clinical charting techniques Entries should be comprehensive enough to demonstrate clinical rationale for treatment Document so that in your absence a colleague could provide immediate, appropriate treatment with only your chart for assistance 30

31 Clinical charting techniques Keep in mind that the medical record is an objective record of facts, impressions, clinical judgment and treatment Avoid pejorative, insulting or overly subjective remarks 31

32 Good example It is better to document that “the patient reports taking 30 Tylenol #3’s per day” rather than “the patient is a drug abuser.” 32

33 Not so good example “Apparently your brother’s accusations are true. You are a malicious liar and a drug addict.” 33

34 Corrections and additions to the chart Never alter the existing record in an attempt to deceive - it will be discovered and it is always fatal to your defense! 34

35 Looks like a normal blood pressure 35

36 Or is it normal ? or high stage 2 170/90 ? 36

37 Good words of advice “A chart with poor documentation is always better than an altered chart. An altered chart is worse than having no chart.” 37

38 Electronic medical records 38

39 Electronic medical records Benefits – Allows for more detailed and complete documentation – Has ability to prompt the provider regarding necessary follow-up – Capacity for preventive medicine screening – Provides audit trail 39

40 Electronic medical records Downsides – Can interfere with provider/patient communication – Templates and preformatted text – Date and time stamp feature 40

41 Electronic discovery The electronic medical record is discoverable Courts generally grant production of the native files for forensic examination of the computer system Metadata – Data about the data – Shows what was viewed, created, changed and when iPhone and Blackberry 41

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43 EMR and the electronic trail From a risk management perspective it is wise to interpret the “E” in EMR as “eternal”. Remember that all access, changes, edits, or modifications to the patient record are recorded. 43

44 Privacy & confidentiality 44

45 Privacy rules Uniform Health Care Information Act – UHCIA (1991) Health Insurance Portability and Accountability Act – HIPAA (2003) Health Information Technology for Economic and Clinical Health Act – HITECH Act (2009) Final Omnibus HIPAA Rule (2013) 45

46 HITECH Act – Final Omnibus HIPAA Rule New provisions – Business associates to comply with HIPAA – Increased monetary penalties – Criminal penalties for individuals – Patients share in fines collected – Breach notification rules – Nondisclosure of self-pay services – Patients can request electronic copy of PHI 46

47 Need to know 47

48 Need to know versus curiosity Headlines in the news – “Everett Clinic fires 13 for looking at patient records” – “3 Fired for Snooping on Electronic Health Records (EHR) of College Football Players” – “It Was Just Me Being Nosy,” Claims Snooping Employee in UCLA Medical Privacy Breach 48

49 Bottom line If you need to know the information to do your job, you can access the information. If you don’t, STAY AWAY FROM IT! 49

50 Minors and disclosure Parents may access those records regarding general medical care. Parents may not access those records dealing with confidential treatment consented to by the minor unless the minor so authorizes. Physicians Insurance A Mutual Company 50

51 Minors and consent Age 18 is age of majority At age 18 full authority to consent to treatment and to control access to PHI Under age 18 limited rights to treatment and confidentiality Physicians Insurance A Mutual Company 51

52 When a minor may consent If married to a person 18 or older Emancipation by court order (16 or older) Emergency services Minor parent may consent for treatment of his/her own child Abortion, birth control, pregnancy care at any age (at provider’s discretion) Sexually transmitted infections/ HIV/AIDS age 14 Outpatient alcohol/drug abuse age 13 Outpatient/inpatient mental health age 13 Physicians Insurance A Mutual Company 52

53 Who may consent for a minor? A guardian or legal custodian appointed by the court A person authorized by the court to consent to medical care for a child in out-of-home placement Parents of the minor patient A person to whom the minor’s parents have given a signed authorization to make health care decisions for the minor Physicians Insurance A Mutual Company 53

54 Who may consent for a minor? A competent adult representing himself or herself to be a relative responsible for the health care of such minor patient or a competent adult who has signed and dated a declaration under penalty of perjury stating that the adult person is a relative who is responsible for the health care of the minor patient. The declaration is valid for no more than six months from the date of declaration. Physicians Insurance A Mutual Company 54

55 Reducing liability exposure An emphasis on quality care, patient rapport, documentation, and attention to administrative detail will reduce your malpractice exposure. 55

56 OUR VALUES Service Integrity Collaboration Respect Protection Thank you! Phone: (206) 343-7300 or (800) 962-1399 E-mail: Visit us:

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