1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 4 Risky Business: Managing Risk and Defenses to Lawsuits

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Quality Improvement Measures an office takes to help guarantee a high quality of care Risk manager or office manager usually responsible Learning Objective 4.1

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Quality Improvement (cont’d) Examples of duties –Monitor continuing education among staff –Monitor lab equipment –Ensure drugs and clinical supplies are not outdated Learning Objective 4.1

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Managing Risk What is risk management? –Following practices designed to reduce risk of injury What does it involve? –Identifying possible dangers –Working to prevent or eliminate them Learning Objective 4.2

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Managing Risk (cont’d) Basic parts of a risk management plan –Written job descriptions –Procedure manual –Policies manual Learning Objective 4.2

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Managing Risk (cont’d) –Policies manual should cover: Patient privacy Clinical treatment Patient communications Documentation Learning Objective 4.2

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Managing Risk (cont’d) Practicing defensive medicine –Order more lab tests, consultations, referrals –Refuse to accept new patients –Refuse to testify against colleagues Learning Objective 4.2

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Managing Risk (cont’d) Premises safety –Pay attention to your work area –Look for waiting room hazards Learning Objective 4.2

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Managing Risk (cont’d) Product risks –Use products correctly –Warn patients of side effects –Instruct patients about proper use Learning Objective 4.2

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Burden of Knowledge Responsibility to speak out if aware of wrongdoing –Malpractice If you don’t speak out, you violate professional ethics and duty of care Learning Objective 4.3

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Malpractice Prevention The four Cs –Caring –Communication –Charting –Competence Learning Objective 4.4

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Caring Show sincere concern for patient Communicate understanding, empathy, and compassion –Understanding Aware of patient’s emotions Recognize patient’s point of view –Empathy Sharing the patient’s feelings Learning Objective 4.4

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Caring (cont’d) –Compassion Desire to help others Ease patient’s “pain” Final step in caring Do not make promises about outcomes! Learning Objective 4.4

14. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Caring (cont’d) Avoid inappropriate behavior in the office –Loud laughing –Horseplay –Displays of secrecy, extreme excitement Don’t criticize another worker or a physician in front of patients Learning Objective 4.4

15. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication Helps you gain patient’s trust and respect Patients less likely to sue if staff viewed as friendly and helpful –Communicate caring attitude Learning Objective 4.4, 4.5

16. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) Talking to patients –Use good listening skills –Don’t make patient feel hurried or “brushed off” –Make eye contact –Use appropriate touch Learning Objective 4.4, 4.5

17. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Charting Medical records often used as evidence in lawsuits –Need to be thorough and accurate Records should clearly show: –Procedures and treatments patient received, when done –All test results –Medication prescriptions Learning Objective 4.4

18. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Charting (cont’d) What to document –Patient contacts –Missed appointments –Referrals –Consent and refusal –Telephone conversations Learning Objective 4.4

19. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Competence Know and follow requirements of good medical practice Provide high standard of care Keep up with changes in office and practice of medicine Learning Objective 4.4, 4.6

20. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Professional Competence Stay up-to-date –Read journals –Interact with medical assistants –Obtain or maintain credentials –Take advantage of staff training Learning Objective 4.4, 4.6

21. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Workplace Competence Have a good knowledge of your field Work within your scope of practice Learning Objective 4.4, 4.6

22. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Why Do People Sue? Medical reasons –Relates directly to treatment Personal reasons –How patient treated by staff and physician Learning Objective 4.5

23. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Why Do People Sue? (cont’d) Other medical factors –Poor outcomes –Unrealistic expectations –Poor quality of care Attitude of staff in all these situations can influence patient’s decision to file complaint Learning Objective 4.5

24. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Poor Outcomes Medicine not an exact science Signs and symptoms could point to several diseases Sometimes results not what expected Do not tell patient everything will be fine – can sue for breach of contract! Learning Objective 4.5

25. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Unrealistic Expectations Advances in technology cause some patients to expect more than is medically possible Do not tell patients they are going to be fine! Learning Objective 4.5

26. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Poor Quality of Care Provider does not meet duty or standard of care Attitudes and behaviors of staff can cause patient to perceive this is the case Learning Objective 4.5

27. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Understanding Patient’s Needs Patients want to be seen as individuals More likely to sue if feel ignored or mistreated Long delays to see a physician add to frustration –Long wait for scheduled appointment –Long wait in waiting room –Overbooking –Waiting too long for a return call from the office Learning Objective 4.5

28. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Have a Responsible Attitude Practice medicine in a way that prevents lawsuits –Behavior of medical staff is crucial –Staff must work to reduce patient anxiety and frustration –Communication is key! Learning Objective 4.5

29. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Behaviors That Reduce Risk Act within scope of practice Keep equipment in safe and working order Keep floors clean and clear Learning Objective 4.5

30. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Behaviors That Reduce Risk (cont’d) Open doors carefully Dispose of biohazardous waste in proper containers Document all patient contact Learning Objective 4.5

31. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Behaviors That Reduce Risk (cont’d) Never promise a recovery or cure Maintain confidentiality of patient information Acknowledge long waits Treat patients with courtesy and respect Learning Objective 4.5

32. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Defenses Against Lawsuits Assertions of innocence –Deny wrongdoing Technical defenses –Depend on legal points and principles, not evidence Affirmative defenses –Rely on evidence that harm not fault of provider Learning Objective 4.7

33. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Technical Defenses Statute of limitations Release of tortfeasor Res judicata Borrowed servant doctrine Learning Objective 4.7

34. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Statute of Limitations States limit length of time plaintiff has to bring charges Time limit depends on 3 factors –State –Civil vs. criminal law –Type of wrongdoing Learning Objective 4.7

35. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Release of Tortfeasor Tortfeasor is someone who commits a tort Legal doctrine –Often applied when more than one tortfeasor Learning Objective 4.7

36. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Res judicata Legal doctrine Claim cannot be retried once lawsuit has been settled Learning Objective 4.7

37. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Borrowed Servant Doctrine Legal principle Employer not liable if employee is working for someone else Learning Objective 4.7

38. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Affirmative Defenses Contributory negligence Comparative negligence Assumption of risk Emergency Learning Objective 4.7

39. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Contributory Negligence Claim patient’s own actions caused or contributed to injury If proved, patient cannot collect damages Learning Objective 4.7

40. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Comparative Negligence Patient partly responsible for injury Patient can still recover partial damages Learning Objective 4.7

41. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Assumption of Risk Claim patient knew risks Provider must prove: –Patient aware of risk of bad outcomes –Bad outcomes caused patient’s injury Learning Objective 4.7

42. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Emergency Provider claims care given in emergency situation Can’t be held to same high standard of care as non- emergency Learning Objective 4.7

43. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Emergency (cont’d) Provider must prove: –True emergency existed –Emergency not caused by provider’s actions –Standard of care was appropriate Learning Objective 4.7

44. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Malpractice Insurance Liability and malpractice insurance helps medical providers manage risk Covers employees Pays damages to patient if provider successfully sued –May pay provider’s attorney fees Learning Objective 4.8

45. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Malpractice Insurance (cont’d) Why carry your own insurance? –Conflicting goals of employer and medical assistant in settling lawsuit Employer may want to settle out of court Insurance cheaper than hiring lawyer and paying damages Learning Objective 4.8