2003 CAS Annual Meeting
Nursing Home Professional Liability
Insurance Crisis - An Update
BSHSI ‘s Experience
Sherry L. Brunner, CPHRM, NHA
Vice President - Risk and Insurance
Bon Secours Health System, Inc.
November 12, 2003
BSHSI Overview
The Sisters of Bon Secours came to the United States from Paris in
1881 to care for the poor, sick and dying in their homes in Baltimore,
Maryland. In 1919 they opened the first Bon Secours Hospital in the
United States in Baltimore. Over the years, they opened acute and long
term health care facilities in other states, and in 1983 the Sisters of Bon
Secours established the Bon Secours Health System, Inc.
Established
Acute-Care Hospitals
Number of Acute Beds
Nursing Care Centers
Number of NCC Beds
Assisted Living Facilities
Assisted Living Facilities Beds
Employees
System assets total
Total System revenues
Outstanding long-term indebtedness of
1983
24
5,360
9
1,600
8
747
27,000+
$2.49 billion
$2.5 billion
$1.1 billion
BSHSI’s Mission and Vision
» The Mission of Bon Secours Health System is to bring
compassion to health care and to be good help to those
in need, especially the poor and dying.As a System of
caregivers, we commit ourselves to help bring people
and communities to health and wholeness as part of the
healing ministry of Jesus Christ and the Catholic Church.
» Through our Mission, Values and Operating Principles,
by the year 2006, Bon Secours Health System will be a
leader in Catholic Health Ministry compassionately
reaching beyond tradition to model justice and operating
excellence, liberate the potential of people, and improve
community health and well-being.
BSHSI’s Alternative Risk Financing
Vehicle
BSHSI’s Alternative Risk Financing
Vehicle is the Bon Secours Assurance
Company or BSAC.
BSAC was chartered in Grand Cayman,
BWI, in 1994. It originally provided
HPL/GL occurrence coverage solely.
BSAC was coverted to claims made
coverage in 2002 and now covers large
deductibles for D & O and Property
Coverage in addition to HPL/GL.
BSHIS’s Risk and Insurance Department
Structure
Vice President,
Risk and Insurance Services
Executive Secretaries
Director,
Risk Management
Director,
Loss Prevention
Director,
Insurance and Claims
Senior Risk Managers
Senior Claims Manager
Facility or Entity Risk Managers
Claims Managers
Manager, Workers Compensation
Department’s Goals
Develop a systematized proactive approach
to reducing identified loss exposures; and
 Apply the risk management process to
increase patient and resident safety; and
 Demonstrate the link between risk reduction
strategies and the “bottom line.”

Department’s Area of Focus Administrative Risks
Adopted or Implemented:
• Policies and Procedures for:
- Admissions, Discharges and
Transfers
- Communication
- Surrogacy
- Human Resources related
- Marketing and Public Relations
• An Administrator on Duty program
Department’s Area of Focus - Clinical
Risks
Adopted or Implemented:
• “Best practices” including:
- American Medical Directors Association’s
Clinical Practice Guidelines (e.g. Falls,
Pressure Sores)
- AAHSA and AHCA identified “best
practices”
Department’s Area of Focus - Clinical
Risks (Continued)
• Policies and procedures for all at risk
clinical practices including falls,
dehydration, pressure sores, elopement,
abuse, restraint use, etc.
• Clearly defined “Chain of Command”
Department’s Area of Focus - Emergency
Related Risks
Adopted or Implemented:
• A “Disaster Manual” which includes
protocols for all potential disasters
including weather related (e.g.
Hurricane), utility related (e.g. Loss of
Electricity), medical related (e.g. Code
Response), and external (e.g. Bomb).
Department’s Area of Focus - Provider
Related Risks
Adopted or Implemented:
• A process for credentialing physicians
and allied health professionals
including orientation to policies and
procedures
• An Equipment Maintenance Plan
• Contracts for all outside services
including Nursing Agencies,
Consultants (e.g. Pharmacists), etc.
Department’s Area of Focus - Regulatory
Risks
Adopted or Implemented:
• Concurrent quality reviews
• Tracking and trending of incidents
• “Mock Surveys”
• Policies and procedures for areas
impacted by regulation (e.g.
Biohazardous Waste)
Department’s Area of Focus - Regulatory
Risks (Continued)
• Protocol for responding to Resident
Complaints
• Process for “managing survey”.
Conclusion
In addition to those areas of risk
outlined earlier, perhaps the greatest
predictor of litigation is the patient,
resident and family member (s)
customer satisfaction survey results. A
happy patient, resident and family
member makes it easier when the time
comes to disclose a “bad outcome.”