Transcript Key to Medical Risk Management - ARM Sul

Medical Risk Management
1st South American Congress Risk Management
Santiago, Chile
August 6 & 7, 2012
By: Geoffrey Hayton
Claims Counsel for Adventist Risk Management
Medical Risk Management
Topics Covered:
1. Medical Malpractice
2. 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 care
3. 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 risk
2. 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
NURSES
“If the nurses around this
hospital would read the
medication orders, we
would not have medical
emergencies like this one.”
“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 Hospital
Event 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.