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Professionalism/Ethics > Malpractice & Risk Management > Flashcards

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
Q

A claimant must have sustained _______ or ________ damage to prosecute a medical negligence suit successfull

A

Economic or emotional

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26
Q

Examples of damage

A
  • Increased medical bills
  • Lost wages
  • Death-disability-deformity
  • Pain & suffering
  • Lost companionship?
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27
Q

Two types of malpractice awards

A

Compensatory & punitive

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28
Q

What is a compensatory malpractice award?

A

Money to restore pt to prior functioning or accommodate disability

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29
Q

What are punitive malpractice award?

A

Deter future wrongful conduct

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30
Q

Common malpractice pitfalls

A

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

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31
Q

Reasons PAs are sued

A
  • 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
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32
Q

What is negligent supervision?

A

Employer fails to reasonably monitor and control an employee’s actions

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33
Q

How negligent supervision is controlled in WI?

A
  • Supervision laws (Ch. Med 8)
  • PA : Physician ratios
  • Chart review/co-sign (no longer required)
34
Q

What is vicarious liability?

A

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
Q

What is imputed liability?

A

Non-negligent party (e.g. hospital) held liable for the actions of another based on their relationship

36
Q

Examples of medical misconduct

A
  • 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
Q

If you work in an accredited JCAHO facility, reporting adverse outcomes is….

A

MANDATORY

38
Q

JCAHO

A

Joint commission on accreditation of healthcare organizations

39
Q

2 AAPA recommendations to adverse outcomes

A
  • Disclosing errors (prompt explanation of outcomes)

- Apologies (acknowledge responsibility and an expression of remorse)

40
Q

Disclosing errors does NOT =

A

Negligence

41
Q

EMTALA

A

Emergency medical treatment and labor act (1986)

42
Q

EMTALA ensures…

A

Access to emergency care regardless of ability to pay (prevents inappropriate transfers to other facilities)

43
Q

Examples of medical misconduct

A
  • 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
Q

What is abandonment?

A

When the practitioner does not conform to the applicable standard of care when discontinuing the patient relationship

45
Q

What must we do to avoid abandonment?

A

Give pt. adequate notice of discharge

46
Q

How do we give pt. adequate notice of discharge?

A

Notice in writing (certified letter)

47
Q

What is considered a reasonable amount of time to give a pt to find another provider?

A

10-30 days

48
Q

What are we responsible for doing before our pt finds a new provider?

A

Providing emergency care

49
Q

What else can we do to help pt when we are no longer working/planning to treat them?

A
  • Provide info on obtaining copies of their medical record
  • Provide resources to obtain new providers
  • Identify risk of failure to establish care
50
Q

What are PAs responsible for in regards to impairment?

A

Recognizing their own and that of colleague’s

51
Q

If you have an NPI # you are apart of the

A

National practitioner data bank

52
Q

When was the nationnal practitioner data bank establish? Become operational?

A

1980’s, 1990

53
Q

What is the purpose of the national practitioner data bank

A

Restrict practitioners who have been found guilty of medical malpractice from practicing in other states

54
Q

Who does the national practitioner data bank cover?

A

Physician’s, allied health, dentists

55
Q

What are the 4 C’s of risk management?

A
  • Compassion
  • Communication
  • Competence
  • Charting
56
Q

How does being compassionate help providers avoid malpractice?

A

Happy patients are less likely to sue

57
Q

How does communicating help providers avoid malpractice?

A

Communicate with patients and other staff members

58
Q

How does being competent help providers avoid malpractice?

A

Up to date on current evidence based medicine, seek consultations, employ protocols

59
Q

How does charting help providers avoid malpractice?

A

Note what is important (be honest, be objective, be legible)

60
Q

Medical records should include

A
  • What you have done to and for the patient
  • What you were thinking
  • Communicate to other HCP
  • Be a legal document
61
Q

What is a SOOOAAP note

A

Subjective, objective, opinion, options, advice, agreed on plan

62
Q

T/F: The medical record should not be altered

A

T

63
Q

What does SLIDE stand for?

A

Single Line through mistake
Initial
Date
note Error

64
Q

How does EHR monitor changes that are made to a patient’s records?

A

It keeps time stamps

65
Q

Purpose of the medical record

A
  • Provides best medical care to pts
  • Important to person providing care
  • Payers who reimburse services (How we get paid!!)
  • Real time documentation tool
66
Q

Successful providers….

A
  • Spend >15min/pt.
  • Use humor
  • Explained procedures before completing them
  • Encourage pt. to talk

Pt. more likely to be compliant with recommendations!!!!

67
Q

General limits of malpractice insurance coverage is how much per claim? how much annually?

A

$1 mill; $3 mill

68
Q

Employer provided malpractice insurance

A

“umbrella policy” - covers everyone

  • Riders for all supervised employees
  • Shared representation
  • Cost is less
  • Know the time its effective and type of coverage
69
Q

Individual malpractice insurance

A
  • 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
Q

State laws requires….

A

Medical malpractice coverage

71
Q

MD’s and nurse anesthetist must have what type of coverage?

A

Individual

72
Q

Federal/state liability coverage exists for those who practice in

A
  • Nat’l health service corps

- Community/free clinics

73
Q

What entity covers over the $1M/$3M limit?

A

Patient compensation fund

74
Q

What types of providers are guaranteed participation under the patient compensation fund?

A

Only MDs and nurse anesthetists

- PAs can participate in they’re under employer umbrella

75
Q

Who funds the patient compensation fund?

A

HCW and employees

76
Q

How do all providers contribute to the patient compensation fund?

A

Annual premium

77
Q

What are the two types of malpractice insurance?

A
  • Claims made policy

- Occurrence policy

78
Q

What is a claims made policy?

A

Covers you DURING the time the policy is in place (i.e. the term of employment)

  • New every year
  • Less costly
79
Q

It is important to add what to a claims made policy?

A

“Tail coverage”

  • $$$
  • 5 year term (remember statue of limitations)
80
Q

What is an occurrence policy?

A

Covers ANY claim while the policy was in force (even after employment ends)
- Available “forever”

81
Q

How is an occurrence policy different from a claims policy?

A
  • Expensive

- Does NOT require tail coverage

Professionalism/Ethics (4 decks)

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