How to Respond to Early Warnings, steps you can take to mitigate it in the bud

Steps on Warning

If you suspect vulnerability to a malpractice case, or some other reason to focus on a possible problem, there are steps you can take to mitigate it in the bud. The important point here is that you have much more opportunity early to document your good standards of care. After all care has stopped, there are many fewer options.

We discuss this in more detail on other pages, but here are some key points.
1) Sit down at a quiet time and review the records from the point of view of a subsequent remote record review. Look for the things that you believe will be issues. List them and shore them up.

2 ) If you're still taking care of the patient, improve your doctor-patient relationship. This takes time and communication, but it is worthwhile. Also make special efforts to deal with the problems, such as well-chosen consults, general family meetings, and fighting for insurance coverage. And no less important, look at the whole past history of the case carefully, including prior to your involvement. There can be surpising problems in past care, and frustration over that may be now pointed at you, in some emotional manner. Taking that into account and responding in a careful way can resolve the problem.

3) Consider how to make it clear in the records that you have strived to give the best care. This should not be excessive, but short and effective. For example: a documented meeting, a consultation on the case, a requested outside review of films and records from an expert, or an article that supports your approach are all helpful.


4) It is an unpleasant thought, but malpractice cases can lead to other issues such as licensure complaints and billing complaints. Be certain that you have records that support and clarify these risks. For example, don't trust your billing company to hold onto the pertinent records, be sure you have a copy yourself. And over the passage of time hospitals have been known to lose portions of charts. It's probably better if you keep a copy as the chart evolves as a protective measure. Furthermore, should you leave the hospital, ending your credentials before this case has run its legal course, you may find it very difficult to get a copy of the records afterwards. While we take access to the records largely for granted in a malpractice case, for a matter of billing or a matter of licensure you may find that you cannot get a copy.

5) It is wise to notify your malpractice carrier. In preparation for that recheck your policy to be sure that every aspect of the plan or the umbrella coverage is current. Should it be that a responsible party on your team has failed to renew there is often a grace or gray period that will allow you to correct this. With regard to the carrier's notification, they usually take no action after notification until a suit is filed, but it is important to tell them.

6) Checkout your bill, and where it stands in the process. It is an increasing tactic to criticize the bill, even on matters that you take for granted, or that have been commonly taught are standard practice. It's best to be certain that the bill is accurate without small coding errors, corresponds well to the operative note, and follows common billing rules. If rules have changed recently, which is not uncommon, you may want to request a formal opinion from a billing authority that this is correct in meeting the current standards. For any grey area where good people disagree, an outside written opinion, probably easy to get from your professional association, is also helpful. This avoids later problems from a disagreeing witness. Bear in mind that a plaintiff's expert witness may be dramatic in critisizing a clear standard.

7) To find out if a case that worries you is filled, check the courthouse where your hospital is, where you live, and where the patient lives. It will almost certainly be filed in one of these jurisdictions. Usually anyone can walk in and check. Some places allow checking over the internet. Once it is filed, some months, often 3-4, can elapse before it is served, so this gives you a heads up. Filing can occur up to the statute of limitations expiration. But be aware that sometimes a judge can extend it. Lawyers do procrastinate to the last minute, and both lawyers and process servers make mistakes. Therefore be sure to understand the issues in serving in your area, because cases do fail on technicalities at this point.


8) Finally, consider your finances, and their protection. This is always a complex and individual matter. But that means it's appropriate to review, whenever a problem may arise. Far and away, the best solutions and protections are made before the problem arises.