What are the 4 C's of medical malpractice
Caring,communication,Competence, Charting
Why do patients sue
unrealistic expectations, poor rapport & poor communication, Greed, lawyers and litigious society, poor quality of care, poor outcome, failure to understand patient's and families' perspectives and devaluing their point of view
What general categories of information should be documented for legal purposes?
what treatment was performed and when
referrals
missed appointments
dismissals
treatment refusals
all other pateint contact
what types of defense may be used in a medical malpractice lawsuit
denial,affirmative(contributory negligence, comparative negligence, assumption of risk, emergency
Technical (release of tortfeasor, res judicata, statue of limitations
what are the common risk management methods?
Quality improvement or quality assurance & credentialing
What types of professional liability insurance are available to medical providers
claims made (tail coverage, prior acts coverage
Occurrence
SelfCoverage
denial
a defense that claims innocence of the charges or that one or more of the four D's of negligence are lacking
4 D's of negligence
Duty, dereliction, direct cause, damages
duty
the person chared with neglience owed a duty of care to the accuser
dereliction
the health care provdier breached the duty of care to the patient
direct cause
the breach of the duty of care to the patient was a direct cause of the patients injury
damages
there is a legally recognizable injury to the patient
Types of defenses
denial, affirmative defenses, technical defenses
affirmative defenses
defenses used by defendants in medical professional liability suits that allow the accused to present factual evidence that the patients's condition was caused by some factor other than the defendant's negligence
technical defenses
defenses used in a lawsuit that are based on legal technicalities
A denial defense
innocence, denial of wrongdoing. The charge could be missing one of the 4 D's of negligence
affirmative defenses
It happened but I was not negligent
contributory negligence
An affirmative defense that alleges the plaintiff through a lack of care, caused or contributed to his or her own injury.
comparative negligence
An affirmative defense claimed by the defendant, alleging that the plaintiff contributed to the injury by a certain degree. May be awarded money based on percentage of negligence
assumption of risk
a legal defense that holds that the defendant is not guilty of a negligent act because the plaintiff knew of and accepted beforehand any risks inolved
emergency
type of affirmative defense in which the person who comes to the aid of a victim in an emergency is not held liable under certain circumstances.
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
res judicata
the thing has been decided. Legal principle that a claim cannot be retried between the same parties if it has already been legally resolved
statute of limitations
vary with states. Time period established by state law during which a lawsuit may be filed
risk management
the taking of steps to minimize danger, hazard, and liability
quality improvement (QI)
program of measures taken by health care providers and practitioners to uphold the quality of patient care
liability insurance
contract coverage for potential damages incurred as a result of a negligent act
claims made insurance
liability insurance that covers the insured only for those claims made (not for any injury occurring) while the policy is in force
occurrence insurance
liability insurance that covers the insured for any claims arising from an incident that occurred or is alleged to have occurred during the time the policy is in force, regardless of when the claim is made
tail coverage
when a claims made policy is discontinued it extends coverage for malpractice claims alleged to have occurred during those dates that claims made coverage was in effect
prior acts insurance ocverage
a supplement to a claims made insurance policy that can be purchased from a new carrier when health care practitioners change carriers
self insurance coverage
insured subscribers contribute to a trust fund to be used in paying potential damage awards
medical record
a collection of data recorded when a patient seeks medical treatment
five c's of charting
1. concise 2. complete and objective, 3. clear and legibly written, 4. correct, 5. chronologically ordered
photographing or recording a patients image without proper consent may be interpreted as:
invasion of privacy
doctrine of professional discretion
patients treated for mental or emotional conditions may be harmed by seeing their own records
HIPAA
patients who ask to see or copy their medical records must be accommodated
retention and storage of records
2 - 7 years or statue of limitations by state
medical information is often released for
insurance claims, transfer to another physician, use in a court of law
confidentiality of alcohol and drug abuse, patient records
a federal statute that protects patients with histories of substance abuse regarding the release of information about treatment
consent
patient gives permission
expressed consent
orally or in writing
implied consent
for a physician to examine, tests to be run, treatment for a medical condition
doctrine of informed consent
the legal basis for informed consent usually outlined in a state's medical practice act
Doctrine of informed consent implies patient understands:
proposed modes of treatment
why the treatment is necessary
risks involved
available alternative modes of treatment
risks of alternative modes of treatment
risks involved if treatment is refused
Informed consents involves the patients:
right to receive all information relative to condition and then to make a decision regarding treatment based on that knowledge.
who can give informed consent:
adults of sound mind, emancipated minors, married minors, mature minors
who cannot give informed consent
minors, persons who are mentally incompetent, persons who speak limited or no english
Good Samaritan
state laws protecting physicians and sometimes other health care practitioners and laypersons from charges of negligence or abandonment if they stop to help the victim of an accident or other emergency. All 50 states have passed acts
when consent is unneccesary
emergencies
Health information technology
application of information processing, involving both computer hardware and software that deals with the storage retrieval sharing and use of health care information data and knowledge for communication and decision
Health Insurance Portability and Accountability Act
HIPAA passed in 1996
executive orders
2004 President George W. Bush signed an executive order establishing the position of National Coordinator for Health Information Technology. Nationwide adoption of health information technology
Adoption of the Health Information Standards Developed by Health and Human Services (HHS)
licensed a comprehensive medical vocabulary and made it avail to everyone in the US at no cost.
Under the Federal Government to Foster the Adoption of Health Information Technology
Fed. Gov can create incentives and opportunities for health care providers to use electronic records.
Electronic health record (EHR)
contains the same information as any medical record
SLIDE
straight line, initial, date, error
Steps to minimize danger hazard and liability
written job descriptions, office procedure manuals, employee handbooks, proper charting
Quality improvement and quality assurance
compliance with federal, state, and other health care regulatory agencies
compliance plan
developed to help ensure that all governmental regulations are followed.
credentialing
process of verifying health care providers credentials
Two types of medical malpractice insurance
claims made, occurrence insurance
fiduciary duty
a physicians obligation to his or her patient, based on trust and confidence
doctrine of informed consent
legal basis for informed consent and is usually outlined in a states medical practice acts.
Informed consent
proposed treatment
why treatment is necessary
risks involved
available alternatives
risks of alternatives
risks involved if refused
Good Samaritan laws protect when:
care is given in good faith
caregivers act within their scope
caregivers use due care
caregivers do not bill
Benefits of Fed. Gov. to Health information technology
improving health care quality
preventing medical errors
reducing health care costs
increasing administrative efficiency
decreasing paperwork
expanding access to affordable care