Risk Management in a Time of Crisis

During the past year, thousands of physicians from Nevada, Texas, Pennsylvania, Florida, and other states have marched on their state capitols demanding help in the latest crisis to hit our profession. With the cost of medical malpractice insurance spiraling upward in triple digit percentage increases, physicians are crying foul. While physician salaries have only slightly increased or remained stagnant, the median malpractice jury award increased by 100 percent from 1995 to 2000, with 43 percent occurring from 1999 to 2000. In addition, many authorities believe that the $1 million payments for life lost on Sept. 11, 2001, may further substantiate high jury awards. Clearly, it is becoming increasingly difficult to rationalize the soaring value of jury awards given the current state of reimbursement for professional medical services rendered. As the medical safety net for our country, emergency physicians now face additional challenges in providing access to patients. In addition to rising insurance costs, some unfortunate emergency physicians are being denied malpractice coverage altogether. Consequently, a thorough understanding of the malpractice risks and how to avoid them has never been more essential. Fortunately, the Internet offers several excellent malpractice and risk management resources containing everything from detailed case studies to CME articles. Stress of Litigation The ACEP web site has several pages (www.acep.org/1,743,0.html) devoted to dealing with the stress of litigation. In all cases, you must be active in the defense of your professional practice and your personal well-being. In addition, ACEP's Risk Management publication, Foresight, is now available online to ACEP members at www.acep.org/foresight/index.cfm. The current issue is displayed in a PDF format, and an online test is available to obtain CME credit for the article. Unfortunately, archives of previous Foresight issues are not available online, and must be purchased from the ACEP bookstore. The Sullivan Group, an emergency medicine risk management consulting firm headed by Daniel Sullivan, MD, JD, publishes an excellent and voluminous online resource containing several sections with direct relevance to EPs. The EM Malpractice Reporter at www.thesullivangroup.com/em_malpractice_reprorter/em_malpractice_reporter_main.html is an excellent collection of more than 100 emergency medicine malpractice case reports. Cases can be researched by category or by keyword searches. Each case report provides the key historical points of the patient encounter and a commentary by Dr. Sullivan.Table: Malpractice on the InternetInterestingly, many cases list the actual individuals and hospitals involved. Visitors also are invited to submit a case to the Reporter for publication, with the editor subsequently verifying that the case was, in fact, a true claim. The Sullivan Group's Physician's Law Review section is a fairly comprehensive library of articles written from the perspective of Dr. Sullivan. Topics include do-not-resuscitate orders, consent, the alcohol-impaired patient, deposition and court testimony, against medical advice, child abuse, and pediatric medical legal Issues. While laws may vary from state to state, EPs will find the views of this emergency physician/attorney to be of unique value. Minimizing Risk The Risk Management Foundation of the Harvard Medical Institutions (www.rmf.harvard.edu/publications/forum/index.html) has published the journal Forum since 1979, and maintains its archives online. The archives include articles examining specific medical malpractice claims and issues, and suggest strategies to minimize risk. Articles qualify for category I Risk Management CME credits. Emergency physicians face increasing challenges to their practices, and the Internet offers powerful tools to help them respond There is an in-depth section pertaining to emergency services that, although originally published in 1997, is quite detailed with recommendations that remain valid today. There are articles describing the common causes of ED malpractice claims, approaches to reducing risk in chest pain and head trauma patients, and COBRA/EMTALA issues. Included is an article about Harvard's ED Quality Study, which implemented several quality improvement measures. Other non-EM topic areas cover relevant issues such as suicidal patients, communicating with patients, resident supervision, and non-physician clinicians. Medical Litigation News (www.medlit.net) is a journal for plaintiffs' attorneys in Canada. The site also has content from Medical Malpractice Alerts, Personal Injury News, and Medical Malpractice News. Although plaintiffs have a more difficult time suing physicians in Canada, the system is adversarial, as is the U.S. system. The site contains useful articles selected to demonstrate standard of care and deviations from standard of care. The content depth is uneven, but for several areas, there are multiple article abstracts. For example, the section on headache abstracts nine articles that describe the standard of care for evaluating headaches. Their 24 page “Role of the Medical Expert” reveals their general strategy for building and pursuing cases against physicians. Poor communication and an uncaring attitude by the physician are implicated in the initiation of lawsuits. Evidence-based medicine is frequently referenced as a source for standard of care. In addition to the aforementioned sites, eMedicine offers two review articles (www.emedicine.com/ent/topic185.htm and www.emedicine.com/emerg/topic760.htm), one with advice on how to prevent suits, and the other discussing how to deal with the stresses generated by a malpractice case. While emergency physicians face increasing challenges to their practices, the Internet offers powerful tools to help them respond accordingly. With so much information readily available, the failure to be well educated about the medico-legal aspects of emergency medicine is becoming less defensible. Letters to the Editor Emergency Medicine News encourages an open exchange of ideas, and welcomes your comments. Please address correspondence to: Lisa Hoffman, Editor Emergency Medicine News 345 Hudson St., 16th Fl. New York, NY 10014 (201)358-8596 (fax) [email protected]

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