Lessons from Trials and Settlements of 2004

By Arthur W. Allen, MD, and Anne M. Menke, RN, PhD
Dr. Allen is OMIC’s Chairman Emeritus and is currently serving his final year as Chairman of OMIC’s Claims Committee. Anne Menke is OMIC’s Risk Manager

Digest, Winter 2005

OMIC policyholders have indicated on evaluation forms completed after risk management seminars that they would like to know the outcome of trials and settlements. This article will give an overview of last year’s claims experience. Claims and lawsuits are evaluated by the OMIC Claims Department and the Board’s Claims Committee, as well as by plaintiff and defense attorneys and expert witnesses. The insured ophthalmologist is involved in the process and in the decision to settle a case or take it to trial. Money awarded to plaintiffs as a result of settlements or jury verdicts are called indemnity payments and are reported by OMIC to the National Practitioner Data Bank. As required by state law, some are also reported to the physician’s medical board.

In 2004, there were thirteen trials, which resulted in eleven defense verdicts (85%), one plaintiff verdict, and one mistrial due to a hung jury. One case that resulted in a defense verdict required a payment to the plaintiff based on a pre-trial “high/low” agreement. A jury verdict does not always signal the end of a case. Four of the eleven defense verdicts are being appealed, including one that has already been taken to trial three times. OMIC is appealing the one plaintiff verdict of $500,000. The 56 settlements cost OMIC $6,851,155 in indemnity payments.

All three anesthesia cases involved retrobulbar blocks. In one case, the plaintiff alleged inadequate pain relief during cataract surgery; the other two stemmed from globe perforations, a known complication of the procedure that can occur in the absence of negligence. The cause of the poor outcome in one case was excessive anticoagulation from Coumadin combined with inadequate control of intraoperative bleeding. When a patient is on Coumadin, alternative methods of anesthesia should be considered, and the ophthalmologist should consult with the primary care physician to verify  that the PT level has been recently checked and is in the appropriate range prior to surgery.

The secondary issues in cataract cases were: retinal detachments (5), glaucoma (3), “wrong” IOLs (3), corneal edema (2), endophthalmitis (2), and one each involving informed consent, iritis, retinal toxicity, and payment. Retinal detachments and glaucoma are known complications of cataract surgery, and ophthalmologists who disclosed this information during the informed consent discussion were in a better defense position, especially if the patient had preexisting retinal tears or glaucoma. Failure to diagnose was the main factor in settling these and the iritis case, underscoring the need to determine and treat the cause of visual complaints and to refer patients who do not improve.

“Wrong” cases are considered preventable and are quickly settled. Two were due to using the wrong constant in the A scan, and one from not calculating the effect of pterygium removal on the patient’s astigmatism. Physicians must verify these IOL calculations. Corneal edema developed after intraoperative complications; in one case, the nurse did not note that the phaco machine’s irrigation fluid had run dry, and the anterior chamber collapsed.

Delay in diagnosis is the most common problem we see in endophthalmitis cases. In one case, the infection only developed after a second surgery, later deemed unnecessary, was performed without intraocular antibiotics (see this issue’s Closed Claim Study). In the other case of endophthalmitis, while “telephone treatment” may have contributed to a delay in diagnosis, defense experts successfully argued that the outcome was due to Strep pneumonia, known to be virulent in children. Postoperative cataract patients who call with complications should be evaluated in person by the surgeon or immediately referred to another ophthalmologist if the surgeon is unavailable. Another patient felt his eyes had not been properly shielded during use of the microscope, leading to retinal toxicity; at trial, this was appropriately attributed to his preexisting macular degeneration. Failure to perform surgery due to payment issues led to one lawsuit and settlement. Payment issues should be discussed and handled as part of the preoperative evaluation.

Two unexpected complications led to settlements in chalazion cases. In one, the surgeon cut across the lid margin instead of the lid; the suture required to repair this led to a corneal abrasion. Lack of a signed consent form contributed to the decision to settle. In the second case, a 4×4 gauze pad ignited, burning the patient’s cheek; the fact that the ophthalmologist did not disclose the nature of the injury no doubt influenced the patient’s decision to file a claim.

Six different issues in cornea cases led to settlements. In one, when the extended wear contact lenses ordered were not available, a technician substituted daily wear lenses without consulting the physician or warning the patient, who developed corneal edema. One pediatric contact lens wearer was treated with steroids for a corneal abrasion; the drops masked a pseudomonas infection, which was not discovered in a timely fashion due to inadequate follow-up. This poor outcome reinforces the need to carefully follow abrasions in patients with contact lenses until corneal ulcer is ruled out. Another child needed corneal transplants after he was treated for herpes simplex instead of acanthamoeba. The distinguishing features were not recognized, and the patient was not referred to a corneal specialist when he did not heal promptly.

An eye bank was sued for lack of informed consent when it harvested the corneas of a “John Doe” who remained unidentified after his body was found in a park. A patient receiving corneal transplants developed a choroidal hemorrhage postoperatively, which he attributed to inadequate control of his nausea and vomiting. Defense experts refuted his hypothesis for the cause of this known complication, but venue concerns, high wage loss damages, and a persistent plaintiff contributed to the decision to settle for the cost of defense. In the last case, too much cornea was removed during PTK, requiring corneal  transplants.

There were six glaucoma cases. A patient with a history of corneal abrasions and corneal erosion suffered another abrasion during pachymetry; failure to warn of the risk of a recurrence was deemed below the standard of care. Two cases involved inadequate diagnostic work-up in patients at risk of developing glaucoma: one had a strong family history and was on nasal steroids; the other was African American. The AAO’s Preferred Practice Patterns for glaucoma should be consulted. In another case, although defense experts supported the care of a noncompliant patient, altered records forced a settlement. Additions to the medical record should be rare, clearly labeled as such, and closely related in time to the care provided. No additions should ever be made after receiving notice of a claim or lawsuit.

Medications were the primary issue in two settlements and the secondary one in seven more. A patient with systemic lupus was referred to an ophthalmologist who failed to appreciate and test for the toxic ocular side effects of Plaquenil. A second physician provided psychiatric medications without an examination or informed consent and also failed to monitor the patient. As described above, excessive levels of Coumadin led to a retrobulbar hemorrhage. Another patient suffered a stroke after being given Procardia to control bleeding during a blepharoplasty. The prescribing information contained a warning about the increased risk of stroke in hypertensive patients on beta blockers; there were also criticisms of the perioperative monitoring and decision to discharge.

Lack of informed consent and failure to monitor and treat the side effects of ocular steroids contributed to settlements in five cases. As part of the informed consent discussion, patients on medications need to understand the risk/benefit ratio, and be carefully educated about the method of administration, follow-up schedule, and symptoms of side effects that should be reported to the physician.

In the sole neuro-ophthalmology case, the ophthalmologist ordered an MRI to rule out a mass or aneurysm in a patient with blurred, double vision and a 3rd motor palsy. Although the report indicated a torturous internal carotid artery and stated that a formal arteriography or CT was needed to rule out ananeurysm, this was not done, and the aneursym ruptured one month later.  The fact that the physician suspected an aneurysm but did not act on the radiologist’s suggestion to rule out this “worst case scenario” was difficult to defend.

Over 16% of the cases come from oculoplastics. Two resulted in settlements with both the ophthalmologist and the surgery center; the first, involving Procardia, was described above. The second illustrates the importance of team communication: the CRNA did not inform the surgeon when the patient moved his head, and the nurse did not confirm the Bovie  settings with the physician and set them too high. The burn caused a corneal perforation. A second equipment-related injury occurred when a patient slid to the floor after a bed malfunctioned. Diagnostic failures led to three settlements, two in patients at risk for their condition. One developed secondary glaucoma from steroids; the other suffered a recurrence of basal cell carcinoma, which might have been diagnosed earlier if tissue had been sent for a biopsy. A third patient reported a significant decrease in visual acuity to the technician involved in the preoperative work-up for ptosis repair. The technician did not report the problem, and the retinal detachment was not diagnosed until after surgery. In addition, the surgeon did not sign the technician’s notes, nor did he personally do a complete preoperative examination. In other cases, the surgical technique and intraoperative decision-making in patients with ptosis, repair of an orbital fracture, and orbital decompression for Grave’s disease were criticized. It is important in complicated cases, such as those that might require non-ophthalmic expertise (e.g., roof decompression and craniotomy), to confer with and, at times, operate with the consultant.

Five cases involved children. Four, discussed elsewhere, stemmed from a corneal ulcer, endophthalmitis following cataract surgery, surgical repair of an orbital fracture, and a traumatic foreign body. In another case, failure to evaluate for an accommodative component and a decision to strengthen the lateral rectus muscle in response to a tight medial rectus caused a poor outcome in strabismus surgery. Three of the five LASIK settlements resulted from “wrong” data. The two wrong laser setting cases could have been prevented by complying with the new JCAHO protocol that includes a “time out” before beginning a laser procedure, while obtaining two axis measurements would have brought the problem in the third case to the surgeon’s attention. Informed consent for the partial, off-label treatment would have helped prepare the patient for the fact that the laser could not treat the amblyopia resulting from her esotropia. A defense verdict was rendered in a free-flap complication case where the patient experienced halos, and in an RK case with macroperforation in which the patient required penetrating keratoplasty and cataract surgery five months later. The only PRK case involved inadequate monitoring of postoperative steroids in a patient with a history of glaucoma and thin corneas.

Failure to diagnose retinal detachment occurred in two cases. Nonclinical, largely preventable problems led to settlements in the remaining retina cases. An ophthalmologist and a medical group were both involved in settling a case of macular pucker. Although the care was defensible, records were altered and there was no consent form for the surgery. Lack of an operative report and failure to obtain and document informed refusal of fluorescein angiography in a patient with AMD treated with photocoagulation led to a settlement, as did performing an incision on the wrong eye.

In addition to the case involving surgical treatment of an orbital fracture, there were two other traumacases. In both of these, undiagnosed foreign bodies led to endophthalmitis and enucleation. In trauma cases, to rule out foreign bodies, the ophthalmologist must obtain a careful history, perform a dilated examination, and order a CT scan. These patients must be carefully followed until the eye heals.

As this article demonstrates, some poor outcomes can be prevented by keeping current with clinical guidelines, conducting a “time out” before surgery, and obtaining and documenting all care, including informed consent. Sometimes, however, patients sue physicians when they experience known complications. When the outcome is less than the patient or ophthalmologist anticipated, the physician needs to use his or her very best communication skills. OMIC policyholders are encouraged to call our Risk Manager for help in these instances. OMIC treats these calls as confidential; only the policyholder has the right to share the information with Claims or Underwriting. Also, see “Responding to  Unanticipated Outcomes” in the Risk Management Recommendations section of our web site as well as an expanded version of this article, with tables summarizing the cases and illustrating the associated nonclinical issues, in the Digest section of the web site (www.omic.com).

Preop Planning Can Prevent Mix-Ups in the OR

By Oksana Mensheha, MD

Argus, March, 1993

Among a small group of ophthalmologists I talked with, more than half acknowledged that they had either personally operated on the wrong eye or knew someone who had. Their experiences ranged from performing a cataract extraction on the wrong eye and doing an esotropic procedure on an exotropic child to removing the wrong eye for a malignant melanoma. Surgeons who have not actually operated on the wrong eye admit they have come close.

What can we do to prevent such mix-ups from occurring?

When doing cataract surgery, I find it helpful to record the A-scan by itself for the eye to be operated on and to post this on the wall of the OR. I record the results for the right eye on the top half of a sheet of paper:

Kod=

ALod=

Order Lens Power od=

I record the results for the left eye on the bottom half of another sheet of paper. I try to avoid recording both A-scans in the same place because it can be confusing. Of course, both eyes can be scanned at the same time, but it takes little effort to record the results separately.

I also find it helpful to bring my office chart into the OR. My office chart documents the scheduling of the surgery and has multiple indications of which eye is to be operated on. If I have a chance to see the patient preoperatively, I try to make certain the dilated eye is the preop eye noted in my office record. I also try to verbally confirm this with the patient. Another safeguard some surgeons use is to preoperatively mark the eye to be operated on with a marking pen.

Performing the wrong procedure on a strabismic child can also prevent significant problems. Some children’s eyes can appear to be straight under general anesthesia, adding to the confusion. If possible, try to examine the child before the anesthesia. In the case in which the ophthalmologist performed surgery for an esotropia instead of an exotropia, the child was wearing the wrong name tag, and the operating rooms had been switched.

Such a mix-up might be avoided if the parents identify the child prior to surgery, or if preop photographs are available for each child scheduled for surgery that day. Once in the OR, a quick check of the photos together with the office record will confirm that the correct child is in the OR, receiving the proper surgery.

The most serious event I heard about was the removal of a healthy eye instead of an eye with melanoma. The diseased eye subsequently was removed. Again, bringing well-documented office records into the OR might have prevented this occurrence. Dilating the proper eye as well as marking an “X” above the eye preoperatively also might have helped. Finally, with irreversible procedures such as enucleation, consider examining the eye with indirect ophthalmoscopy before proceeding.

No system is foolproof. However, referring to your office record when you are in the OR, after ensuring that the record matches the patient to be operated on, can be a tremendous help in avoiding surgery on the wrong eye.

Risk Management Issues in Medical Retina Disorders

 By Jerome W. Bettman Sr., MD, and Monica L. Monica, MD, PhD

Digest, Fall, 1994

Malpractice suits involving medical disorders of the retina have become more common, specifically those involving diabetic retinopathy and macular degeneration. Informed consent plays a major role in helping retina patients understand the consequences of failing to receive treatment and accept the sometimes less-than-perfect results of treatment. The following case will help illustrate the problem.

Diabetic Retinopathy

Mrs. Jones was a 65-year-old diabetic who presented to an ophthalmologist complaining of a fuzzy spot in her right eye upon reading. She had been an insulin-dependent diabetic for more than 15 years and was well-controlled on medication. On examination, the ophthalmologist discovered metamorphopsia on Amsler grid testing, and exudates and hemorrhages in the perimacular area of the right eye. A fluorescein angiogram was performed which delineated the problem vessels. The ophthalmologist told Mrs. Jones that leaking blood vessels in her eye were causing the blurred spot and explained how a laser could be used to seal off the leaking blood vessels and help her vision.

Laser therapy was successfully performed and eventually the exudates resorbed and the hemorrhage resolved; however, Mrs. Jones still complained about a blurred spot in her right eye upon reading. She was told that the laser had created a scar and that this scar was causing some visual disturbance, but that her initial problem leaking blood vessels had been solved by the laser. Mrs. Jones did not see it that way, and she sued the ophthalmologist.

This case illustrates a few points. One is that disorders of the retina can be complicated and difficult for patients to understand. Videos and patient reading materials may be helpful, but the patient needs to be given ample time to review these materials and to ask questions. Secondly, patients often do not understand the consequences of laser treatment, or they honestly do not recall those complications that might destroy vision. 1,2,3  

For many, the idea of treatment is synonymous with cure. Mrs. Jones was very upset to discover that she still had blurring from macular degeneration. Many patients view the laser as the restorer of perfect eyesight when that may be far from the case. It may be helpful to have the patient write in the chart what he or she understands the possible result of laser therapy to be. This is evidence that cannot be denied in a courtroom.

Retinopathy of Prematurity

For several decades, retinopathy of prematurity (ROP) has been the source of numerous malpractice suits, although there is little doubt that some ROP cases were misdiagnosed and were actually Familial Exudative Vitreoretinopathy, or Coat’s Disease, Eales Disease, macular ectopia, and the like.

Some historical perspective on this problem is instructional. Early ROP claims were based upon the fact that more than 40% oxygen was given to the neonate. At the time, this was the upper limit that was considered appropriate, and any greater concentration constituted malpractice. This arbitrary limit had no basis in scientific fact. As a result, oxygen was severely curtailed and cerebral palsy, respiratory distress syndrome, and death increased in incidence. It was then decided that oxygen should be administered in whatever concentration and duration was necessary for the neonate’s survival. The incidence of malpractice suits increased again. It is now generally concluded that the prematurity itself is the most significant etiological agent. In addition to the oxygen, a number of factors play a role in the development of retinopathy of prematurity, i.e., pH, CO2, prostaglandins, Vitamin E, and others. If oxygen is used only in necessary amounts, it should not be the basis for a suit.

A major catalyst in ROP claims is failure to adequately communicate the potential problems the baby may face even after treatment. Parents are often stressed by the illness of the baby and do not adequately comprehend all the details at the time. This has led to problems with follow-up on the babies, especially for eye checks. It is helpful to involve the entire nursing team in any discussion of the neonate’s problems and the protocol for follow-up. Hearing these messages repeated by the various health personnel involved in their baby’s treatment will reinforce for the family the importance of follow-up care.

Timely Follow-up Crucial in ROP Cases

Progressive retinopathy of prematurity was once an untreatable condition. Cryotherapy to retard the progress of the disease was first proposed in Japan in 1972. Because of the lack of convincing data and complications of treatment in some cases, cryotherapy was not strongly advocated in the United States. The cryo-retinopathy of prematurity study demonstrated an unfavorable outcome in untreated eyes of 43% compared to 21.8% in treated eyes.4

This positive finding reinforced the need for ophthalmologists to detect and carefully follow babies with retinopathy of prematurity changes even after discharge from the neonatal ICU. Babies with so-called threshold disease (defined as five or more contiguous or eight cumulative 30 sectors, or clock hours, of Stage III retinopathy of prematurity in zone one or two in the presence of “plus” disease) are felt to be candidates for cryotherapy. Failure to treat may result in litigation. Timely follow-up of these infants at regular intervals is crucial.

Retinal Tumors

Misdiagnosis of a retinal tumor has accounted for a low proportion of malpractice suits involving medical retina problems. Melanomas are sometimes diagnosed as retinal detachments. Infrequently, claims have arisen because a large subretinal hemorrhage was misdiagnosed as a melanoma and the eye was enucleated. Ophthalmologists should not be afraid to seek second opinions on those cases which do not conform to the usual axioms of diagnosis.

Conclusion

So often, ophthalmologists focus their attention on surgical cases and complications. While surgical incidents do make up a large part of malpractice claims, claims involving medical diagnoses and treatment, especially of retinal disorders, are becoming more common.

Notes:

1. Priluck IA, et al. What Patients Recall of Preoperative Discussion after Retinal detachment. Am J Ophthal. 1979; 87:620.

2. Robinson G and Merav A. Informed Consent: Recall by Patients Tested Postoperatively. Ann Thorac Surg. 1976; 22:209.

3. Leeb D, et al. Observations on the Myth of “Informed Consent.” Plast Reconstr Surg. 1976; 58:280.

4. Tasman W. Threshold Retinopathy of Prematurity Revisited. Arch Ophthal. 1992; 110:623.

Medical Record Corrections and Alternations

By Kimberly Wittchow, JD, OMIC Staff Attorney, and Anne M. Menke, RN, PhD, OMIC Risk Manager

The medical record serves many purposes: it promotes patient safety and continuity of care by providing a comprehensive account of the patient’s diagnosis and treatment, provides evidence that can be used to defend—or possibly assail— the ophthalmologist’s care during the course of a claim or lawsuit, serves as the basis for coding and billing decisions, and supports medical research. Entries in the medical record should be objective, signed (or initialed), and dated; subjective comments, speculation, blame, and references to incident reports, legal actions, attorneys, or risk management activities should not, therefore, be included.

Policyholders often learn of the importance of the medical record when they are notified of a claim. Faced with a potential lawsuit, a few are so worried that they are tempted to alter or add to their documentation. While it is never proper to alter records deceptively or fraudulently, there are times when you may need to make a correction or addition to a medical record. OMIC’s policy differentiates between these two circumstances to protect you when you make a legitimate change, but also to protect the rest of the policyholders and the company if you make an improper alteration. This article will elaborate on these differences.

Policy Terms

As with all of the terms and conditions of the policy, coverage is contingent upon insureds complying with section Viii.9.e of the policy, which states that: “the Insured must not create, alter, modify, or destroy medical records with the intent to defraud or deceive or otherwise misrepresent or conceal facts pertinent to any professional services incident or Claim.” In other words, records alterations that are not mere corrections are prohibited. Section Viii.9.e continues, however: “this does not preclude coverage where a proper correction or addendum to a medical record has been made, the original entry remains legible, and the correction or addendum is dated and initialed by the insured.”

Corrections to the Medical Record

It is common when documenting care to make “data entry errors.” Correcting these errors as soon as possible when they are discovered improves the accuracy of the medical record and promotes safe care. For example, after noting a new medication order he received over the telephone from the ophthalmologist, the technician realized he had written the wrong dosage in the chart. He crossed out the incorrect number once, making sure it was still legible. Over it, he noted the correct one and added his initials and the date.

Similarly, dictated reports such as operative notes and consultation letters should be reviewed and corrected as needed before being placed in the medical record or sent to referring physicians. Such corrections should always be related to ongoing care and made with the intention of contributing to that care. The former entry should always remain in the record; as a general rule, information should never be deleted. Corrections removed in time from the event, made after learning of poor outcomes or after receiving notice of a claim, are always subject to scrutiny and viewed as self-serving if not fraudulent, and should be avoided.

Addenda to the Medical Record

An addendum should be created when additional information not available at the time of documentation but necessary for ongoing care is received. For example, a surgeon dictated her operative report, noting the absence of complications during the cataract procedure. Minutes after completing the dictation, the nurse clearing out the instruments informed the surgeon that one of the sterility indicators had not changed, alerting the ophthalmologist that the instruments may not have been properly sterilized. After instructing the nurse to sequester the instruments, the physician met with the patient, explained the situation and the possible increased risk of endophthalmitis if the instruments weren’t sterile, advised the patient of symptoms to watch for and report, and later dictated an addendum to the operative report, in which she accurately noted the time sequence of events.

Addenda should begin with an explanation of why one is necessary. Designed to ensure that accurate and timely information is available to properly care for the patient, they should not be used to justify former decisions or actions. Just as with corrections, the timing and motivation behind the addendum will be carefully evaluated in the event of a claim.

When in doubt, contact our Risk Management Hotline for advice before correcting or adding to a record.

Providing Care When Disaster Strikes

By Kimberly Wynkoop

OMIC Legal Counsel

Digest, Winter 2010

When disaster strikes, many physicians want to offer their skill to aid the victims in their recovery. The last thing a physician pursuing such an altruistic mission may consider is claims arising from this care. Nevertheless, prudent physicians will want assurance that what they are undertaking will not expose them to uninsured losses. OMIC would like to explain how its policy covers its insureds for claims that might result from such volunteer services.

Practicing Outside Coverage Area

When insureds look to provide health care outside of the united States, they should be aware of the Coverage Territory provision in their policy (Section VIII.22). It states that, in order for coverage to apply, the insured’s principal place of practice must be the same as that specified in his or her application for insurance. This does not prevent insureds from occasionally practicing outside of this area, it just ensures that they are underwritten and rated appropriately for the majority of their practice. As long as this is the case, coverage will apply to professional services incidents that take place anywhere in the world. However, in order for OMIC to cover the claim,it must be brought within the 50 United States or Washington DC.

Most, if not all, medical professional liability policies contain this language limiting where claims may be brought. This is because insurers are generally unfamiliar with the laws and court systems outside of the U.S. This, coupled with the distance and language barriers posed, makes it extremely difficult to controland manage claims and to find appropriate personnel to oversee and adequately defend them. In addition, the insurer may not legally be permitted to operate in these foreign countries.1 (Note that OMIC’s policy does not cover claims brought in any U.S. territories or possessions. Although the law is not settled on the issue, it appears that risk retention groups are not permitted to operate outside of the 50 states and DC. Additionally, most of the other concerns noted above also apply to these territories and possessions.)

Good Samaritan and Bona Fide Emergency Treatment

In order for coverage to apply, the rest of the policy provisions must also be adhered to. This includes practicing within the scope of one’s licensure and within the ordinary and customary scope of practice of ophthalmologists. OMIC considers ophthalmic or non- ophthalmic treatment provided as a Good Samaritan or in a bona fide emergency to be within the ordinary and customary scope of practice of ophthalmologists. This means providing emergency medical services to an injured person at the scene of an accident without expecting to receive compensation from the injured person for the service. Regarding licensure, insureds will want to check the licensure provisions and requirements in both their state of practice and the location where they will be providing volunteer services.

Responding to emergency medical needs in a disaster zone immediately after the disaster has struck would be considered a bona fide emergency or “Good Samaritan” situation. This could occur, for example, in treating victims and evacuees for non-ophthalmic injuries in the direct aftermath of an earthquake, hurricane, or terrorist incident. Attending to victims’ and evacuees’ non-immediate medical needs after the disaster would not be considered occurring during a bona fide emergency. Therefore, OMIC would cover an ophthalmologist for ophthalmology-related treatment only in this scenario.

If an insured plans to assist in a disaster-stricken or underserved area on a volunteer basis through an organization, the insured should check with that organization, as it might also provide or give access to professional liability coverage for these services. Since the aim of these organizations may be to provide medical care in non-u.S. territories, and they may anticipate that specialists could provide care outside of their specialty, they might offer or provide access to coverage for claims beyond the scope of your OMIC policy.

Documentation of Care

From a risk management perspective, OMIC advises that insureds maintain, to the degree possible, at least basic documentation of any treatments performed, including identifying information of the patient and a short narrative summary of the diagnosed injury/condition and specific medical care delivered by the insured. For easy retrieval, such notes should be arranged alphabetically in a file labeled “Care Provided to [Incident] Disaster Victims.” If resources are available, since it is likely that patients will not be seen again by the insured, the insured should give patients a copy of the visit note, with treatment and follow-up recommendations. For more risk management advice, call (800) 562-6642, ext. 641.

If you plan on spending any significant amount of time providing services outside of your typical practice territory, please inform your OMIC underwriter before doing so.

1. Bregman RA and Gibson JP. “Professional Liability Insurance.” International Risk Management Institute, INc. (Dallas). 2009; Sections VII.B.14 and XXII.E.11.