Transcript Risk Management, Suzette Goucher

HEALTH CARE RISK MANAGEMENT
Suzette Goucher, J.D., R.N.
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Prior to a Notice of Claim / Notice or Intent
Provider Resilience Support
Avoid costs and stresses of litigation
We can facilitate interactions with families
We also work with attorneys if you are ever
subpoenaed or asked for a deposition
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Take care of the patient
Discuss with the patient and family as soon
as possible. Open and honest communication
has been key to the decline in medical
malpractice claims
Document objectively without placing blame
Ensure there is careful documentation in the
medical record about the event and the effect
upon the patient
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Risk Management is notified of and investigates F. G. and H.
events
F. HARM – Temporary Intervention Needed
G. HARM – Permanent
H. DEATH
Unanticipated, negative
outcomes
 Neurological injury
 Medication errors
 Falls
 Maternal/fetal injury or
death
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Implant device
failures
 Serious patient
injury
 Patient or family
threaten to sue
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◦ First, talk to the family. Our experience shows disclosure is best
accomplished by the Attending physician, or the physician with
the best relationship with the patient
 “I am so sorry you or your loved one was harmed.”
 “We weren’t expecting this to happen.”
 “We are going to look into what happened.”
 Avoid speculation and misstatements.
 For instance do not say “It was anesthesia’s fault” or “It was
the wrong drug”.
◦ Second, participate in investigation with Risk Management.
◦ Third, follow up with the patient/family.
Call Risk Management if you need help with the process
Failure to diagnose
 Failure to refer
 Procedure complications
 Failure to obtain informed consent
 Inadequate communication
 Inadequate history and physical
 Patient dissatisfaction with outcome/unrealistic
expectations
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Interns and residents are named in about
30% of the 40-50 Notices of
Intent/Notices of Claim filed against the
University each year.
1) Duty
Doctor had a responsibility for the patient and in specific cases
the duty can extend to a non-patient
2) Breach
Did not meet the standard of care
3) Causation
Breach caused an adverse event
4) Damages
The Patient actually suffered damages
 Notice
of Claim/Notice of Intent
 Pre-litigation Panel
 Complaint
 Discovery
 Trial
In Writing
 Nature and Purpose of the proposed Procedure
 Discussion of Risks, Benefits, potential
Complications & Alternatives
 Who will perform the procedure
 Opportunity to ask & have all questions
answered
 Emergency Exception
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University Health Care Maintains an SIR Trust with
excess liability coverage.
No policy number
$1 million/claim and $3 million aggregate
Tail Coverage is provided
Dates of coverage is for the period of your
residency/fellowship.
NOI/Prelit/Complaint/Status
Claims are settled on behalf of the University and not
you individually.
Utah Malpractice Laws
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Utah Tort Law – State laws govern medical malpractice
◦ Statute of Limitations – 2 years after discovery of legal malpractice
◦ Damage Caps – $450,000 for non-economic (pain and suffering)
damages
◦ Damage Cap - does NOT apply to wrongful death cases
◦ Limits on non-patient cause of action
◦ Periodic Payments – insurance can make payments over extended
time
◦ Attorney Fee Limits – limit on the total amount an attorney can claim
◦ Joint-and-several Liability Rule – defendants are liable for the
proportion in which they contributed to the malpractice
◦ Prelitigation Screening – all cases are prescreened to determine if
case has merit
◦ Certificate of Merit Requirement – medical professional must provide
certificate verifying claim has merit
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Smaller paid claims are down
Percentage of claims above $1 million and
percentage of claims of $5 million have both
increased over time
Litigation costs have remained the same
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Complex care and higher risk
High cost providing medical care over a
child’s lifetime
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Communication
Problems
◦ Informed Consent
◦ Care Transitions
◦ Discharge
Instructions
◦ Provider Discord
Open and honest
communication
has been key to
the decline in
medical
malpractice
claims
When asked if anything could have been done to
avert legal action, 37% said an explanation and
apology would have made a difference.
In another study, 24% said they filed when “they
realized the physician had failed to be
completely honest with them about what
happened, allowed them to believe things that
were not true, or intentionally misled them.”
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Inaccurate or inconsistent documentation creates
questions of fact the jury will decide
Sloppy notes = sloppy care
Assume records will be read by a jury or family
Just state facts about the care without editorializing
Don’t bare soul or admit liability
If you mention a problem in progress notes, make
certain that orders reflect/address concern
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Don’t use the medical record as a battleground to settle
grudges with other staff members.
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The professionalism of the staff should be reflected
throughout the medical record documentation.
Do chart complications objectively without assessing
fault
Do chart awareness & involvement of physician or
other health care provider
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Educate providers
Guide the process
Assist with fact finding
Determine liability
Walk through the process
Provide support to providers
Work with patients and their families
Work to resolve cases before families hire an attorney
Depositions
Subpoenas
RISK MANAGEMENT CONTACT:
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(801) 581-2031
RL6
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