Self-Insurance Program Protection and Reporting

Transcription

1 Self-Insurance Program Protection and Reporting An introduction to the University of Florida J. Hillis Miller Health Center Self-Insurance Program 06/11

2 Self-Insurance Program PROTECTION UF JHMHC Self-Insurance Program 2

3 UFSIP University of Florida JHMHC Self Insurance Program The UFSIP was created by the Board of Governors of the State of Florida (FBOG) to provide comprehensive general and professional liability protection for the University of Florida Board of Trustees (UFBOT) in support of the colleges of the Health Science Center. UFSIP includes: Insurance Services and Underwriting Risk Management Loss Prevention Patient Safety Research Claims and Litigation Management for Medical Malpractice Lawsuits Legal Defense for DOH/AHCA License Investigations UF JHMHC Self-Insurance Program 3

4 Professional Liability How can my professional performance expose UF to claims and litigation? As UF employees with clinical practice responsibilities, your actions as a resident might result in professional liability claims for medical negligence (malpractice). Any time there is an unexpected outcome when providing patient care there is potential for a claim. A claim for medical negligence may include allegations that: The patient was owed a duty of care that was not met. The prevailing standard of care was breached during the patient s care. The breach in care was the proximate cause of injury or death. The injury or death resulted in damages. UF JHMHC Self-Insurance Program 4

5 Protection Professional liability protection is provided to University of Florida Health Science Center faculty, staff, residents, and students by UFSIP. UF JHMHC Self-Insurance Program 5

6 No Need to Apply Do I have to apply for this protection? No. The professional and general liability protection provided by UFSIP begins with and continues throughout your residency. However, for rating purposes, you may be periodically asked by UFSIP to complete questionnaires related to your clinical practice. UF JHMHC Self-Insurance Program 6

7 Occurrence Based Protection Do I need tail coverage when I leave? No. The protection provided by UFSIP is occurrence based, which means that it covers any claim arising out of the performance of your UF duties and assignments, even if the claim is made after your employment ends. UF JHMHC Self-Insurance Program 7

8 Governmental Immunity The State of Florida has limitedly waived its governmental immunity for tort claims arising from the negligent acts or omissions of its employees. However, it has provided personal immunity for its employees (residents) and agents acting within the course and scope of employment. Thus, the University of Florida Board of Trustees is the legal defendant when medical negligence is alleged. Exception: Employees do not have immunity with respect to reckless and wanton acts, such as battery or sexual assault. Such conduct is not considered to be within the scope of employment. UF JHMHC Self-Insurance Program 8

9 Limits of Liability Protection The UFBOT enjoys a limited waiver of sovereign immunity as a state entity. Currently, damages are limited to $100,000 per claimant, with a maximum of $200,000 per occurrence for all claimants. After October 1,, the damages will be limited to $200,000 per claimant, with a maximum of $300,000 per occurrence for all claimants. Amounts above those limits must be approved by the Florida Legislature. UF JHMHC Self-Insurance Program 9

10 Protection Outside of Florida If an employee is working outside the state and within the scope of UF assigned duties, personal immunity is not applicable and the employee can personally be sued. UFSIP protects the employee for up to $2,000,000 in damages per occurrence, with excess coverage for claims above that level. UF JHMHC Self-Insurance Program 10

11 Personal Protection If an employee assists an injured person as a Good Samaritan or provides community service that is preapproved*, the employee can be personally sued but will still have protection through UFSIP. Personal protection is limited to $500,000 per occurrence. *Pre-approved means prior written approval by your department chair, your dean, and the UFSIP Director. UF JHMHC Self-Insurance Program 11

12 Self-Insurance Program REPORTING UF JHMHC Self-Insurance Program 12

13 Reporting Responsibility All UFBOT health care providers are obligated to report to UFSIP any occurrence that has or may have caused harm to patients and environmental factors that unduly expose patients to harm. For Gainesville call: For Jacksonville call: Report patient care occurrences as soon as possible. UF JHMHC Self-Insurance Program 13

14 Events that Need to be Reported to UFSIP Generally, when reporting, the best guideline to follow is that of sound professional judgment, sustained by the awareness of the possibility of a claim. The standard practice should be: WHEN IN DOUBT, ALWAYS REPORT. Any event that has produced an actual, potential, or perceived injury. A practice, situation, premise, or product defect that may produce an injury if left uncorrected. Any other unexpected or untoward outcome or event where established policy or procedure was not followed. Any other conditions you feel may give rise to a claim. You also have a responsibility to report allegations of negligence and asserted claims, which include any assertion by a patient or patient's family that an injury has occurred, that proper consent was not given for treatment, or that there has been sexual misconduct. UF JHMHC Self-Insurance Program 14

15 Events that Need to be Reported to UFSIP Specifically, at a minimum, any event or near miss in the following categories must be reported: Serious Incidents aka Code 15 Total or partial loss of a limb, or loss of the use of a limb Sensory organ or reproductive organ impairment Any injury to a part of the anatomy not undergoing treatment Disability or disfigurement Any assertion by a patient that he/she has been medically injured Any alleged misdiagnosis or delay in diagnosis Injury/death to either child or mother during delivery Any birth of a term baby that is stillborn or expires shortly after delivery Lack of informed consent Any allegation of sexual misconduct Any attempted suicide Any alleged breach of pt confidentiality Any other condition or event that may result in a claim UF JHMHC Self-Insurance Program 15

16 Information Needed At the Time of Reporting When you call, have as much information as reasonably possible on hand: Some form of patient identifier, such as a medical record number The mechanics of the unexpected event or outcome The patient s underlying diagnoses The patient status What is the patient s current condition? If injured, what treatment was and/or will be required? Was patient transferred to higher level of care? It will also be helpful to know: The identity of the patient s family members; Whether or not the patient is insured and by whom Whether disclosure has occurred or will be occurring By whom? How did the patient and family respond? Was there any threat of litigation? UF JHMHC Self-Insurance Program 16

17 Incident Reports Depending on the situation, you may also be required to submit an incident report to the Risk Management or Quality Assurance professionals at your facility. Be familiar with the incident reporting requirements at your facility. However, do not document incident reports in the medical record. UF JHMHC Self-Insurance Program 17

18 Non Clinical Reporting Responsibility Report immediately to UFSIP any legal or regulatory agency communications, including but not limited to: Notices of Intent to initiate litigation for medical negligence. Summons & Complaints. Letters or phone calls from the Agency for Health Care Administration (AHCA) or the Department of Health (DOH). Letters or phone calls from an attorney. UF JHMHC Self-Insurance Program 18

19 Ramifications of Failure to Report Personal As a healthcare provider, failure to report occurrences can result in: Disciplinary action and fines by regulatory and licensing boards. Loss of participation in managed care contracts. Loss of credentials and employment. Facility The facility where the event occurred could be subject to: Adverse action by regulatory, licensing, and accreditation agencies. Loss of managed care contracts. UF JHMHC Self-Insurance Program 19

20 Final Thoughts on Reporting Prompt reporting permits timely investigation of adverse clinical occurrences, enhancing the chances that the immediate needs of patients can be met. Timely reporting permits UFSIP to: Ensure the well being of the patient. Gather facts while memories are fresh. Improve safety initiatives and the provision of healthcare. If you observe or are involved in an adverse occurrence: 1. Meet the patient s needs. 2. Notify supervisor or attending; if you are a student, resident, or fellow, notify your departmental residency program director 3. Call UFSIP; do not use Objectively document clinical facts in the medical record; do not include personal notes, references to mandatory reports, or calls to UFSIP. UF JHMHC Self-Insurance Program 20

21 For More Information Contact us at with any questions you might have about the materials presented here. Ask for the Insurance Services and Underwriting division for questions related to: Answers to liability protection questions, Proof of professional liability insurance protection, or Claims history letters. Our website is UF JHMHC Self-Insurance Program 21