Chapter 4
Risky Business: Managing Risk and
Defenses to Lawsuits
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Quality Improvement
• Measures an office takes to help guarantee a high quality
of care
• Risk manager or office manager usually responsible
Learning Objective 4.1
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Quality Improvement (cont’d)
• Examples of duties
– Monitor continuing education among staff
– Monitor lab equipment
– Ensure drugs and clinical supplies are not outdated
Learning Objective 4.1
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Managing Risk
• What is risk management?
– Following practices designed to reduce risk of injury
• What does it involve?
– Identifying possible dangers
– Working to prevent or eliminate them
Learning Objective 4.2
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Managing Risk (cont’d)
• Basic parts of a risk management plan
– Written job descriptions
– Procedure manual
– Policies manual
Learning Objective 4.2
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Managing Risk (cont’d)
– Policies manual should cover:
• Patient privacy
• Clinical treatment
• Patient communications
• Documentation
Learning Objective 4.2
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Managing Risk (cont’d)
• Practicing defensive medicine
– Order more lab tests, consultations, referrals
– Refuse to accept new patients
– Refuse to testify against colleagues
Learning Objective 4.2
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Managing Risk (cont’d)
• Premises safety
– Pay attention to your work area
– Look for waiting room hazards
Learning Objective 4.2
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Managing Risk (cont’d)
• Product risks
– Use products correctly
– Warn patients of side effects
– Instruct patients about proper use
Learning Objective 4.2
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Burden of Knowledge
• Responsibility to speak out if aware of wrongdoing
– Malpractice
• If you don’t speak out, you violate professional ethics
and duty of care
Learning Objective 4.3
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Malpractice Prevention
• The four Cs
– Caring
– Communication
– Charting
– Competence
Learning Objective 4.4
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Caring
• Show sincere concern for patient
• Communicate understanding, empathy, and compassion
– Understanding
• Aware of patient’s emotions
• Recognize patient’s point of view
– Empathy
• Sharing the patient’s feelings
Learning Objective 4.4
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Caring (cont’d)
– Compassion
• Desire to help others
• Ease patient’s “pain”
• Final step in caring
• Do not make promises about outcomes!
Learning Objective 4.4
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Caring (cont’d)
• Avoid inappropriate behavior in the office
– Loud laughing
– Horseplay
– Displays of secrecy, extreme excitement
• Don’t criticize another worker or a physician in front of
patients
Learning Objective 4.4
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Communication
• Helps you gain patient’s trust and respect
• Patients less likely to sue if staff viewed as friendly and
helpful
– Communicate caring attitude
Learning Objective 4.4, 4.5
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Communication (cont’d)
• Talking to patients
– Use good listening skills
– Don’t make patient feel hurried or “brushed off”
– Make eye contact
– Use appropriate touch
Learning Objective 4.4, 4.5
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Charting
• Medical records often used as evidence in lawsuits
– Need to be thorough and accurate
• Records should clearly show:
– Procedures and treatments patient received, when
done
– All test results
– Medication prescriptions
Learning Objective 4.4
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Charting (cont’d)
• What to document
– Patient contacts
– Missed appointments
– Referrals
– Consent and refusal
– Telephone conversations
Learning Objective 4.4
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Competence
• Know and follow requirements of good medical practice
• Provide high standard of care
• Keep up with changes in office and practice of medicine
Learning Objective 4.4, 4.6
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Professional Competence
• Stay up-to-date
– Read journals
– Interact with medical assistants
– Obtain or maintain credentials
– Take advantage of staff training
Learning Objective 4.4, 4.6
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Workplace Competence
• Have a good knowledge of your field
• Work within your scope of practice
Learning Objective 4.4, 4.6
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Why Do People Sue?
• Medical reasons
– Relates directly to treatment
• Personal reasons
– How patient treated by staff and physician
Learning Objective 4.5
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Why Do People Sue? (cont’d)
• Other medical factors
– Poor outcomes
– Unrealistic expectations
– Poor quality of care
• Attitude of staff in all these situations can influence
patient’s decision to file complaint
Learning Objective 4.5
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Poor Outcomes
• Medicine not an exact science
• Signs and symptoms could point to several diseases
• Sometimes results not what expected
• Do not tell patient everything will be fine – can sue for
breach of contract!
Learning Objective 4.5
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Unrealistic Expectations
• Advances in technology cause some patients to expect
more than is medically possible
• Do not tell patients they are going to be fine!
Learning Objective 4.5
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Poor Quality of Care
• Provider does not meet duty or standard of care
• Attitudes and behaviors of staff can cause patient to
perceive this is the case
Learning Objective 4.5
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Understanding Patient’s Needs
• Patients want to be seen as individuals
• More likely to sue if feel ignored or mistreated
• Long delays to see a physician add to frustration
– Long wait for scheduled appointment
– Long wait in waiting room
– Overbooking
– Waiting too long for a return call from the office
Learning Objective 4.5
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Have a Responsible Attitude
• Practice medicine in a way that prevents lawsuits
– Behavior of medical staff is crucial
– Staff must work to reduce patient anxiety and
frustration
– Communication is key!
Learning Objective 4.5
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Behaviors That Reduce Risk
• Act within scope of practice
• Keep equipment in safe and working order
• Keep floors clean and clear
Learning Objective 4.5
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Behaviors That Reduce Risk (cont’d)
• Open doors carefully
• Dispose of biohazardous waste in proper containers
• Document all patient contact
Learning Objective 4.5
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Behaviors That Reduce Risk (cont’d)
• Never promise a recovery or cure
• Maintain confidentiality of patient information
• Acknowledge long waits
• Treat patients with courtesy and respect
Learning Objective 4.5
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Defenses Against Lawsuits
• Assertions of innocence
– Deny wrongdoing
• Technical defenses
– Depend on legal points and principles, not evidence
• Affirmative defenses
– Rely on evidence that harm not fault of provider
Learning Objective 4.7
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Technical Defenses
• Statute of limitations
• Release of tortfeasor
• Res judicata
• Borrowed servant doctrine
Learning Objective 4.7
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Statute of Limitations
• States limit length of time plaintiff has to bring charges
• Time limit depends on 3 factors
– State
– Civil vs. criminal law
– Type of wrongdoing
Learning Objective 4.7
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Release of Tortfeasor
• Tortfeasor is someone who commits a tort
• Legal doctrine
– Often applied when more than one tortfeasor
Learning Objective 4.7
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Res judicata
• Legal doctrine
• Claim cannot be retried once lawsuit has been settled
Learning Objective 4.7
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Borrowed Servant Doctrine
• Legal principle
• Employer not liable if employee is working for someone
else
Learning Objective 4.7
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Affirmative Defenses
• Contributory negligence
• Comparative negligence
• Assumption of risk
• Emergency
Learning Objective 4.7
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Contributory Negligence
• Claim patient’s own actions caused or contributed to
injury
• If proved, patient cannot collect damages
Learning Objective 4.7
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Comparative Negligence
• Patient partly responsible for injury
• Patient can still recover partial damages
Learning Objective 4.7
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Assumption of Risk
• Claim patient knew risks
• Provider must prove:
– Patient aware of risk of bad outcomes
– Bad outcomes caused patient’s injury
Learning Objective 4.7
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Emergency
• Provider claims care given in emergency situation
• Can’t be held to same high standard of care as nonemergency
Learning Objective 4.7
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Emergency (cont’d)
• Provider must prove:
– True emergency existed
– Emergency not caused by provider’s actions
– Standard of care was appropriate
Learning Objective 4.7
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Malpractice Insurance
• Liability and malpractice insurance helps medical
providers manage risk
• Covers employees
• Pays damages to patient if provider successfully sued
– May pay provider’s attorney fees
Learning Objective 4.8
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Malpractice Insurance (cont’d)
• Why carry your own insurance?
– Conflicting goals of employer and medical assistant
in settling lawsuit
• Employer may want to settle out of court
• Insurance cheaper than hiring lawyer and paying
damages
Learning Objective 4.8
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