1. James R. Banfield Director, Risk Management Associate General Counsel Trainee Legal Risks The GME ACTION 2014 Annual Education Conference April 24, 2014

2. Topics Trainee selection Warning signs Evaluations Documentation When problems arise Difficulties with the legal case

3. Sample Case

4. Trainee Selection A thorough application, interview and screening process is helpful to identify potential troublesome candidates Filling that last slot with a marginal candidate can come back to haunt

5. Missing or delayed paperwork E*value (or similar system) completion lacking Attendance, punctuality, disappearing Warning Signs

6. Not returning pages or calls Professionalism (behavior and relationships) Not fulfilling other requirements Warning Signs

7. Evaluations Honest Accurate Realistic Complete Timely

8. Documentation What is the training file? Administrative Administrative (applications, credentialing) Acknowledgement of policies and procedures Performance Communications (emails, letters, comment cards) Maintain communications at least until graduation Evaluations It should all be created and maintained to be considered peer review and thus protected by statute and case law

9. Progressive discipline Awareness meetings (documented) Remediation Involve mentors, ombudsman Leave Probation Suspension Termination When Problems Arise

10. Due process must be provided at all stages Err on side of providing more than less, unless patient safety is an issue or criminal behavior Fitness for duty evaluation When Problems Arise

11. Difficulties with the Legal Case Evaluations and documentation don’t support action taken Inherent difficulty in demonstrating behavior is actually sufficient to warrant action taken Issues primarily concern the trainee and one faculty member Demonstrating that professionalism is as important as trainees providing quality patient care