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A Malpractice Primer

What Should Hospitalists Do?

If you are an individual hospitalist and your hospital provides your coverage, our experts have some suggestions on how to best protect yourself from surprises later about your liability insurance.

“[Y]ou certainly ought to get a copy of the policy,” says Halpern, and “focus very carefully on several things: 1) what’s covered, 2) what’s excluded, 3) what are the limits, and 4) who’s providing the coverage?”

You need to be able to feel that you can say “yes” to the question, “Is this a company that I can be confident will be there when it’s needed?”

If after a careful review of your policy, you have areas you would like to discuss with the hospital, it’s a matter of negotiation. And when you have the “negotiation muscle” to get what you need for protection, says Halpern, you’re in a better position.

“Frankly, most hospitals are interested in maintaining quality staff, quality relations with physicians—both employed and on the consulting staff,” says Halpern. “[They] are not typically in the business of muscling people and treating them badly. So if the hospitalist finds a legitimate gap in coverage or a concern, by and large hospitals look to be fair in working those things out. If they’re not, there are two basic approaches, and one is to not continue in the relationship.” (In other words, quit). “The second [approach] is to insure over the gap by going to an insurance broker and seeing if you can find coverage.”

Conclusion

Although most hospitalists are covered under their hospital policies, all hospitalists would benefit from understanding the specifics of their malpractice coverage. The dynamics of the hospitalist model will require changes in many areas including malpractice insurance. The trend of insurance carriers to establish a separate classification for hospitalists is likely to provide more precisely written coverage that accounts for the particulars of hospital medicine practice TH

Writer Andrea Sattinger will write about risk management for hospitalists in the Jan. ’06 issue.

References

  1. Wachter RM. The hospitalist movement: ten issues to consider. Hosp Pract. 1999;34(2):104-106.
  2. Entman SS, Glass CA, Hickson GB, et al. The relationship between malpractice claims history and subsequent obstetric care JAMA. 1994;272:1588-1591.
  3. Alpers A. Key legal principles for hospitalists. Am J Med. 2001;111:5-9.
  4. Pham HH, Devers KJ, Kuo S, et al. Health care market trends and the evolution of hospitalist use and roles. J Gen Intern Med. 2005;20:101-107.

How Are You Insured and What Are You Insured For?

One of the hospitalist groups covered by ProMutual is Southern New Hampshire Medical Center, Nashua, where Stewart Fulton, DO, is the head of that group. The hospitalist department is three years old. In fact, the day The Hospitalist talked to Dr. Fulton was the first day hospitalists were providing 24-hour hospital coverage, seven days a week.

Although Dr. Fulton began as the only hospitalist, there are now 10 in the department They are classified as part of a multispecialty group and did not actively participate in choosing their malpractice insurance. He says there have been few legal issues so far.

“I think what is important to us is 1) the reassurance that [the policy is] there and 2) that there is additional coverage … an umbrella policy that will protect us in addition to … our malpractice [policy].”

But does their hospital-provided malpractice insurance address the particulars of a hospitalist’s work such that the hospitalist team feels reassured with the details of their coverage?

“I don’t think I have an answer to that question,” says Dr. Fulton. “I haven’t personally looked through my policy in regard to the coverage and how it relates to my specific practice. Certainly it’s not a traditional internal medicine practice and I don’t know from that perspective what the underwriters would consider [regarding hospitalists] when they weigh their policy for the traditional practice.”

Think on This: Malpractice Recommendations

  1. Determine roles and accountabilities for yourself and the colleagues with whom you will communicate and work. Establish an institutional administrative policy for the hospitalist’s scope of practice. Supply this information to your risk manager to factor in when discussing your insurance coverage with insurance brokers or carriers.

    “I believe that whether it’s a teaching hospital or a community hospital, they have to figure out how to do it best for themselves,” says O’Rourke, referring to how hospitalists and other providers will need to share responsibilities for a patient’s care. “You have to have everyone buy in. For instance, if you have hospitalists working on a surgical floor, you better have the surgeons understand what’s going on. If you work on the medical floor, you’ve got to have your attendings and the admitting physician, … the PCPs—everyone—understand what you have there.” And she adds, “If I were running a hospital, I’d be touting [having hospitalists] as a real benefit.”

  2. Recognize that malpractice insurance, too, is an area affected by the evolving dynamics of hospital medicine. “Concern surrounds the myriad organizational and clinical issues that inevitably appear whenever there is a major change in our extraordinarily dynamic healthcare system,” wrote Dr. Wachter. “As with the initial debate about whether to embrace the hospitalist model, one hopes that many of these issues will be settled on the basis of rigorous analysis informed by relevant data.”1
  3. Read your policy. Discuss concerns with your employer’s risk manager. “This conversation is encouraging me to go investigate what our policy is and what the coverage is and what the reasoning and thoughts were that generated the policy and whether it’s sufficient,” says Dr. Fulton. “Certainly as our area of medicine grows … we need to be considering all of those issues—malpractice [and] sufficient coverage for what we do.” —AS
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