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Malpractice & Risk Management Flashcards

1
Q

Define medical malpractice

A

Negligence on the part of a physician, allied health care professional, or hospital that causes physical or emotional damage to the patient

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2
Q

How do we define standard of care?

A

What most trained providers would do to treat a specific injury or illness
- In theory all providers would have the “same” treatment plan/intervention

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3
Q

If standard of care is not used =

A

Negligence

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4
Q

Who determines whether the standard of care was met/used?

A

Medical expert/witness

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5
Q

Medical expert/witnesses are

A

Objective

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6
Q

What can guide medical expert/witnesses?

A

Published guidelines, protocols

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7
Q

What is negligence?

A

Failure to exercise a degree of care

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8
Q

Res ipsa loquitur means what in Latin?

A

The thing speaks for itself

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9
Q

Res ipsa loquitur is a doctrine of law that one is presumed negligent if…

A

He/she had exclusive control of whatever caused the injury

  • Even if there is no specific evidence of an act of negligence
  • Without negligence, the accident would not have happened
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10
Q

Under res ipsa loquitur, who is liable for negligence?

A

All those connected with the act

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11
Q

What is gross negligence?

A

Conscious and voluntary disregard of the need to use reasonable care, which is likely to cause foreseeable grave injury or harm to persons
- Implies a level of intent or severe carelessness

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12
Q

What is the statue of limitations in WI for malpractice?

A

3 years from the time the malpractice occurred OR within one year of the discovery of the injury so long as no more than 5 years had passed

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13
Q

What is the NAME of the statue of limitations in WI for malpractice?

A

Discovery Rule

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14
Q

What is the $ limit for claims for non-economic damages (i.e.g pain + suffering)

A

$750,000

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15
Q

Life of a law suit

A

Error -> notify risk mgmt -> negligence claimed by pt. (beginning of discovery period) -> lawyer/insurance -> mediation (required!) -> law suit is filed if mediation failed -> data retrieval (both sides review ALL records) -> settle OR litigation within the court

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16
Q

Average time from being “put on notice” to completion is how many years?

A

7

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17
Q

Only __% of cases go to trial

A

7%

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18
Q

What percent of cases that go to trial are won by plaintiffs?

A

21%

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19
Q

Who pays for attorney fees, expert fees, court costs?

A

Insurance company

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20
Q

Who is sued more: physicians OR PAs/PA + physician teams?

A

Physicians (7600 : 199 in 2019)

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21
Q

4 elements of a negligent action

A
  • Duty
  • Breach of duty
  • Breach caused injury
  • Injury resulted in compensable damages
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22
Q

What is duty?

A

Evidence that the health care provider had a duty to provide medical care
- Defined when treatment had begun (when you first see the patient)

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23
Q

What is breach of duty?

A

Evidence that standard of care was not met

- Action or failure to act

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24
Q

Injury/proximate cause (causation)

A

Proof that an injury occurred + breach was the actual cause of the claimant’s injury
- Whether it would or wouldn’t change the outcome is considered (“the pt. would have died anyway”)

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25
A claimant must have sustained _______ or ________ damage to prosecute a medical negligence suit successfull
Economic or emotional
26
Examples of damage
- Increased medical bills - Lost wages - Death-disability-deformity - Pain & suffering - Lost companionship?
27
Two types of malpractice awards
Compensatory & punitive
28
What is a compensatory malpractice award?
Money to restore pt to prior functioning or accommodate disability
29
What are punitive malpractice award?
Deter future wrongful conduct
30
Common malpractice pitfalls
M - missed diagnoses (not broad ddx) A - assessment inadequate (e.g. PE) L - legibility causing medical errors P - proper documentation & privacy rights R - results not followed through on A - alliances with patients - build rapport C - consent not clearly disclosed T - timely care (delayed diagnosis or referral) I - insurance C - communication E - ethical practitioner
31
Reasons PAs are sued
- Lack of adequate supervision (outside of scope) - Untimely referral - Failure to diagnose (missed or delayed) M/C!!! ~50% - Inadequate exam - Lack of documentation - Lack of communication
32
What is negligent supervision?
Employer fails to reasonably monitor and control an employee's actions
33
How negligent supervision is controlled in WI?
- Supervision laws (Ch. Med 8) - PA : Physician ratios - Chart review/co-sign (no longer required)
34
What is vicarious liability?
Allows patient to commence a malpractice action against a PA's supervising physician and may be solely liable for negligent acts performed by the PA
35
What is imputed liability?
Non-negligent party (e.g. hospital) held liable for the actions of another based on their relationship
36
Examples of medical misconduct
- Practicing fraudulently - Practicing with gross incompetence/negligence - Practicing while impaired (alcohol, drugs, physical, mental) - Being convicted of a crime - Filing a false report or false documentation - Guaranteeing a cure - Refusing to provide services based on race, color etc.
37
If you work in an accredited JCAHO facility, reporting adverse outcomes is....
MANDATORY
38
JCAHO
Joint commission on accreditation of healthcare organizations
39
2 AAPA recommendations to adverse outcomes
- Disclosing errors (prompt explanation of outcomes) | - Apologies (acknowledge responsibility and an expression of remorse)
40
Disclosing errors does NOT =
Negligence
41
EMTALA
Emergency medical treatment and labor act (1986)
42
EMTALA ensures...
Access to emergency care regardless of ability to pay (prevents inappropriate transfers to other facilities)
43
Examples of medical misconduct
- Performing services not authorized by the patient - Harassing, abusing, or intimidating a patient - Ordering excessive tests - Abandoning or neglecting a patient in need of immediate care - Altering records
44
What is abandonment?
When the practitioner does not conform to the applicable standard of care when discontinuing the patient relationship
45
What must we do to avoid abandonment?
Give pt. adequate notice of discharge
46
How do we give pt. adequate notice of discharge?
Notice in writing (certified letter)
47
What is considered a reasonable amount of time to give a pt to find another provider?
10-30 days
48
What are we responsible for doing before our pt finds a new provider?
Providing emergency care
49
What else can we do to help pt when we are no longer working/planning to treat them?
- Provide info on obtaining copies of their medical record - Provide resources to obtain new providers - Identify risk of failure to establish care
50
What are PAs responsible for in regards to impairment?
Recognizing their own and that of colleague's
51
If you have an NPI # you are apart of the
National practitioner data bank
52
When was the nationnal practitioner data bank establish? Become operational?
1980's, 1990
53
What is the purpose of the national practitioner data bank
Restrict practitioners who have been found guilty of medical malpractice from practicing in other states
54
Who does the national practitioner data bank cover?
Physician's, allied health, dentists
55
What are the 4 C's of risk management?
- Compassion - Communication - Competence - Charting
56
How does being compassionate help providers avoid malpractice?
Happy patients are less likely to sue
57
How does communicating help providers avoid malpractice?
Communicate with patients and other staff members
58
How does being competent help providers avoid malpractice?
Up to date on current evidence based medicine, seek consultations, employ protocols
59
How does charting help providers avoid malpractice?
Note what is important (be honest, be objective, be legible)
60
Medical records should include
- What you have done to and for the patient - What you were thinking - Communicate to other HCP - Be a legal document
61
What is a SOOOAAP note
Subjective, objective, opinion, options, advice, agreed on plan
62
T/F: The medical record should not be altered
T
63
What does SLIDE stand for?
Single Line through mistake Initial Date note Error
64
How does EHR monitor changes that are made to a patient's records?
It keeps time stamps
65
Purpose of the medical record
- Provides best medical care to pts - Important to person providing care - Payers who reimburse services (How we get paid!!) - Real time documentation tool
66
Successful providers....
- Spend >15min/pt. - Use humor - Explained procedures before completing them - Encourage pt. to talk Pt. more likely to be compliant with recommendations!!!!
67
General limits of malpractice insurance coverage is how much per claim? how much annually?
$1 mill; $3 mill
68
Employer provided malpractice insurance
"umbrella policy" - covers everyone - Riders for all supervised employees - Shared representation - Cost is less - Know the time its effective and type of coverage
69
Individual malpractice insurance
- Separate limits of liability (lower for Ms. Sinitz who doesn't do endoscopy like Drs) - No conflicts of interest with employer - Guaranteed your own single representation - Can be written to cover other employment/moonlighting - Can take it with you when you leave - Cost $1200-5000/yr (may NOT be reimbursed)
70
State laws requires....
Medical malpractice coverage
71
MD's and nurse anesthetist must have what type of coverage?
Individual
72
Federal/state liability coverage exists for those who practice in
- Nat'l health service corps | - Community/free clinics
73
What entity covers over the $1M/$3M limit?
Patient compensation fund
74
What types of providers are guaranteed participation under the patient compensation fund?
Only MDs and nurse anesthetists | - PAs can participate in they're under employer umbrella
75
Who funds the patient compensation fund?
HCW and employees
76
How do all providers contribute to the patient compensation fund?
Annual premium
77
What are the two types of malpractice insurance?
- Claims made policy | - Occurrence policy
78
What is a claims made policy?
Covers you DURING the time the policy is in place (i.e. the term of employment) - New every year - Less costly
79
It is important to add what to a claims made policy?
"Tail coverage" - $$$ - 5 year term (remember statue of limitations)
80
What is an occurrence policy?
Covers ANY claim while the policy was in force (even after employment ends) - Available "forever"
81
How is an occurrence policy different from a claims policy?
- Expensive | - Does NOT require tail coverage

Professionalism/Ethics (4 decks)

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