1. © 2016 McGraw-Hill Education. All rights reserved. Ch 6 Defenses to Liability Suits

2. © 2016 McGraw-Hill Education. All rights reserved.. Key Terms affirmative defenses assumption of risk claims-made insurance comparative negligence denial emergency liability insurance occurrence insurance prior acts insurance coverage quality improvement (QI) or quality assurance release of tortfeasor res judicata risk management self-insurance coverage 6-2

3. © 2016 McGraw-Hill Education. All rights reserved.. Key Terms (cont.) statute of limitations tail coverage technical defenses 6-3

4. © 2016 McGraw-Hill Education. All rights reserved. Learning Outcomes 6.1List and define the four Cs of medical malpractice prevention. 6.2Describe the various defenses to professional liability suits. 6.3Explain the purpose of quality improvement and risk management within a health care facility. 6.4 Discuss the five different types of medical liability insurance. 6-4

5. © 2016 McGraw-Hill Education. All rights reserved. Preventing Liability Suits Prevention is preferable to litigating a malpractice suit Health care practitioners who use reasonable care in preventing professional liability claims are least likely to be faced with defending themselves against such claims 6-5

6. © 2016 McGraw-Hill Education. All rights reserved. Four Cs of Medical Malpractice Prevention Caring Communication Competence Charting 6-6

7. © 2016 McGraw-Hill Education. All rights reserved. 7 Common Reasons for Malpractice Error, failure, or delay in cancer diagnosis Birth injury or negligent maternity care Wrong diagnosis or misdiagnosis of negligent fracture or trauma Delay in diagnosis or failure to consult in timely manner 6-7

8. © 2016 McGraw-Hill Education. All rights reserved. 7 Common Reasons for Malpractice (cont.) Medication errors or medication malpractice from negligent drug treatment Malpractice resulting from physician’s negligent procedures or surgical errors Failure to obtain informed consent 6-8

9. © 2016 McGraw-Hill Education. All rights reserved. Actions that Might Prevent Litigation Explanation and apology Correction of the mistake Financial compensation Correct treatment at the time An admission of negligence Listening to the patient 6-9

10. © 2016 McGraw-Hill Education. All rights reserved. Actions that Might Prevent Litigation (cont.) Disciplinary action against medical personnel involved Honesty Investigation by the hospital 6-10

11. © 2016 McGraw-Hill Education. All rights reserved. Communicating with Patients Develop good listening skills. Set aside time of day to call back patients and provide advice Thoroughly explain illnesses and treatment options Make sure informed consent forms are signed Avoid statements admitting fault 6-11

12. © 2016 McGraw-Hill Education. All rights reserved. Communicating with Patients (cont.) Use tact, good judgment, and professionalism with patients Refrain from overly optimistic statements Advise patients when physicians will be gone for long periods of time Reach an understanding about fees 6-12

13. © 2016 McGraw-Hill Education. All rights reserved. Documentation Referrals Missed appointments Dismissals Treatment refusals All other patient contact 6-13

14. © 2016 McGraw-Hill Education. All rights reserved. Types of Defenses Denial of wrongdoing Affirmative defenses –Contributory negligence –Comparative negligence –Assumption of risk –Emergency 6-14

15. © 2016 McGraw-Hill Education. All rights reserved. Conditions for Emergency Defense A true emergency situation existed and was not caused by the defendant The appropriate standard of care was met, given the emergency situation 6-15

16. © 2016 McGraw-Hill Education. All rights reserved. Technical Defenses Release of tortfeaser Res Judicata Statute of limitations 6-16

17. © 2016 McGraw-Hill Education. All rights reserved. Release of Tortfeasor A technical defense that prohibits a lawsuit against the person who caused an injury (the tortfeasor) if he or she was expressly released from further liability in the settlement of a suit –The victim cannot sue the physician unless the right to do so was reserved in the release 6-17

18. © 2016 McGraw-Hill Education. All rights reserved. Res Judicata “The thing has been decided” –A claim cannot be retried between the same parties if it has already been resolved 6-18

19. © 2016 McGraw-Hill Education. All rights reserved. Statute of Limitations Vary from state to state Generally specifies one to six years with two years most common –It specifies when the statute of limitations begins –It may be modified for minors, people who are legally insane, or special circumstances 6-19

20. © 2016 McGraw-Hill Education. All rights reserved. Risk Management Risk management is the taking of steps to minimize danger, hazard, and liability –May reduce possibility of lawsuits –Identify problem practices or behaviors –Problem solve to eliminate problems 6-20

21. © 2016 McGraw-Hill Education. All rights reserved. Quality Improvement/Assurance Programs to uphold the quality of patient care and reduce liability risk Part of methods used to manage risk Includes compliance with federal, state and local laws 6-21

22. © 2016 McGraw-Hill Education. All rights reserved. Professional Liability Insurance Covers costs of defending a medical malpractice lawsuit up to policy limit –Cost of insurance is based on physician’s specialty and dollar amount of the policy –Usually required to obtain hospital privileges or work with an HMO 6-22

23. © 2016 McGraw-Hill Education. All rights reserved. Medical Malpractice Insurance Types Claims-made insurance –Covers the insurer only for claims made (not for injury occurring) while policy is in force Occurrence insurance –Covers the insurer for any claims made that occurred while policy is in force regardless of when claim is made 6-23

24. © 2016 McGraw-Hill Education. All rights reserved. Extended Coverage Insurance Tail coverage Prior acts insurance coverage Self-insurance coverage 6-24