On Eggshells: Avoiding (Un)Common Liability Mistakes
More often than not on this blog, we discuss the various trials and pitfalls facing independent physicians. There have never been more pathways to potential ruin than there are today. Perhaps the most frustrating thing about them is that most doctors don’t knowingly set out on these paths, or realize they are on them until it is too late. Once on that steep decline, all they can do is prepare for damage control.
Certain situations can defy the better judgement of even the most levelheaded, and careful physicians. In some cases, liabilities present themselves first as opportunities to increase revenue, or productivity. As the head of your practice, you must always examine the pros and cons, and prepare for the worst-case scenarios. Below are a few sticky situations that many doctors either never saw coming, or simply didn’t give the consideration they deserved.
Patient addiction, and safe prescribing
On a very basic level, a doctor is a healer, one who diagnoses and alleviates pain and discomfort. This simplification, of course, is often taken advantage of by drug-addicted patients. While this phenomenon is nothing new, there are certain disturbing facts to consider. One is that many patients were already abusing street drugs before a health crisis brought them to their doctors (and their handy RX pads). Another is that prescriptions for opioid painkillers have skyrocketed in the last decade or more, with the constant pursuit of pain relief supplanting the culture of quality treatment. A third, and this is most frightening for doctors, is that an addict’s abuses can become your abuses. In the eyes of the law, you may have willfully abused your prescription privileges, and even “contributed” to a patient’s addiction, overdose, or death.
Stopping this potential career killer begins with strong communication, as well as overall patient-doctor rapport. You must discuss with your patients the risks inherent in certain prescription drugs and treatments, and be absolutely sure to document this. Thorough documentation, in fact, is the next step. In the event of a malpractice suit, patient records will be examined as evidence, so make sure they work for you rather than against you. Your patient’s condition must be tracked meticulously, and the reasons for a script-refill well warranted. Look for little blips in their records over time, or sudden changes in behavior. In a previous post, we mentioned how an erratic shift in a patient’s temperament could indicate declining mental health. It could also be due to heightening addiction. Do they ignore your orders, or show up late for appointments? Are they focused chiefly on their meds, and is their tone harsh and demanding? These are referred to as drug seeking behaviors, or DSB, and should be looked out for.
Make use of prescription drug monitoring programs at your practice to identify potential drug abusers. Thoroughly screen for prior substance abuse or mental health issues, and avoid prescribing “cocktails” of painkillers and sedatives unless a serious medical condition calls for it. If possible, stick to the lowest effective dose, and only the appropriate quantity of refills.
Revenue increase, or conflict of interest?
In a previous post we covered several practical, above-board ways physicians can increase their practice’s revenue. Selling certain services, or for this argument, products, is legal. Many licensed physicians sell various products at their office, or are somehow involved in the promotion thereof, leveraging their own reputation to enhance the likelihood of a sale. Any arrangement you have with a third party must be disclosed fully. Consider, also, that too invasive of a product presence at your office can put undesired pressure on a patient to buy. Moreover, unless the product’s efficacy can be backed up scientifically—which is to say, the product’s health benefits are legit, and you are not pushing it for the strict sake of lining your pockets—it could land you in hot water, and damage your reputation significantly. You are a physician, and there is a certain level of gravitas awarded you in the eyes of most people. They believe your judgement, and you should never abuse that. All the trust you built up with your patients over the years can crumble in an instant.
Obtaining EPLI insurance
If your first question here is, “what the heck is EPLI insurance,” don’t worry—you’re in the majority. Coverage of this type falls under “property and casualty” umbrella, and is meant to protect you from the risk of employee lawsuits against your practice. It will also cover cases of “intentional acts”, which is often totally missing from most insurance policies. Let’s assume that the way you conduct your day-to-day business has no liable issues. Now, let’s say a single staff member creates a liability for your practice by acting negligently, or blatantly ignoring the rules. In this case, EPLI insurance can really save you. Other actions that are usually covered include certain types of harassment, discrimination, defamation, and emotional distress.
What constitutes a celebrity, exactly? Are we talking about athletes, actors, and musicians? What about politicians, and high-powered Wall Street investors? The answer is anyone with a high degree of social, civic, or economic status. This status brings with it certain challenges for doctors and their staff.
As melodramatic as it may sound at first, physicians must deal people who have a vested interest in discovering the private information of their famous patients. In some cases, media sources may try and vet your employees for information, hire hackers, and even go so far as to use private detectives. There are special protocols needed when dealing with such high profile patients. Beyond normal confidentiality guidelines, a policy must be drafted and memorized by staff. This should include the names and contact information of the patient’s handlers, managers, or anyone who will be coordinating visits and treatments. For certain specialists, the policy should also include security protocols as well, as they pertain to large numbers of people visiting, or large quantities of gifts being sent.
| HCRC Staffing | Brian@hcrcstaffing.com | www.hcrcstaffing.com
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