University of California Self-Insured Hospital and Medical Professional Liability Program

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1 TO: FROM: UCSF RESIDENTS, FELLOWS AND ATTENDINGS UCSF RISK MANAGEMENTAT SFGH When you apply for a medical license in another state or for medical staff privileges at another institution, you will be asked to respond to questions about your professional liability insurance coverage and any malpractice claims that you may have been involved in during your residency / employment with UCSF. The following are responses to questions that typically appear on these applications. While you may be asked to complete the information on the application, each institution typically seeks independent verification of this information from the Risk Management office. Name of Professional Liability (Malpractice) Insurance Company University of California Self-Insured Hospital and Medical Professional Liability Program (UC is self-insured through a financial trust that is funded in part by annual contributions from each of the UC campuses. UC does not purchase commercial insurance for basic coverage. The UC coverage extends to all activities within the course and scope of your training / employment at UCSF owned facilities, SFGH, and other affiliated sites where you may have rotated.) Policy Number Not applicable. (Since UC is self-insured, there is no insurance policy.) Policy Limits $7.5 million per occurrence and in the aggregate. Address of Insurance Company University of California Office of the President, Risk Management 1111 Franklin St. Oakland, CA 94607

2 Addresses for Verification of Insurance Coverage and Claims History University of California, San Francisco San Francisco General Hospital Office of Risk Management UCSF Risk Management at SFGH 533 Parnassus Ave., U Potrero Ave., Bldg 20, Rm 2101 San Francisco, CA San Francisco, CA (415) (415) Fax: (415) Fax: (415) (The Risk Management office on each campus where you rotated provides the insurance verification and claims history for the period of time you were on that campus.) Type of Policy Equivalent to an Occurrence-Based policy (Occurrence-based means that coverage applies to any claim that arises from an incident that occurred during your training / employment with UCSF, even if the claim is made years after you have completed your UC training or left your employment with UCSF. This contrasts with a claimsmade type policy which only covers claims made during the term of the policy. Because the UC coverage is occurrence-based when you complete your residency program or employment, you do not need to purchase tail insurance for the period of time you were in training / employed at UCSF. ) Claims Histories The UCSF Risk Management offices at SFGH and at Moffitt/Long/Mt. Zion issue claim histories for their respective campuses. No claim history will be released without your signed authorization (most institutions will include an authorization form for you to sign in their application packets). If you are required to disclose on an application all claims or lawsuits in which you were involved and are uncertain about whether you were involved in a claim, please call the Risk Management office.

3 10 Questions from the resident and fellow affairs Committee legally obligated to review the care provided by trainees, determine if any responsibility should be allocated to them, and then report those findings to the Medical Board as appropriate. In general, UCSF does not allocate responsibility to trainees unless they acted outside the scope of their employment or in direct violation of a policy or instruction. This is one of the reasons trainees should keep communication open with their attendings and allow them to oversee their work. Deputy Campus Counsel in the Office of Legal Affairs answer resident and clini- 1. Can you describe the malpractice insurance coverage cal fellow questions for about UCSF legal trainees? issues that affect Is trainees. there tail 8 Susan Penney, JD, Director of Risk Management and Greta Schnetzler, JD, 1. Can you describe the malpractice insurance coverage for UCSF trainees? Is there tail coverage? The coverage for trainees is the same coverage provided for all other UCSF physicians. The University of California maintains a self-insurance program for professional liability (medical malpractice) which covers trainees at all of the UCSF affiliated sites: UCSF Medical Center, Mt. Zion, VAMC, and SFGH. This program covers UCSF trainees for any patient care activity done while acting in the course and scope of University assigned duties. Because the University policy is occurrence based, tail coverage is not needed. If litigation were to arise after a trainee has left the University, he or she would still be covered for events that occurred during his/her time at UCSF. It s important to note that in exchange for this coverage the trainee has a duty to cooperate in the defense of the case, including meeting with defense counsel and being present for depositions or trial. 2. Isn t the attending ultimately responsible for a patient s care? If so, why are trainees involved in malpractice lawsuits? Patients have a right to name trainees in a lawsuit and as such trainees can and are involved in legal actions. From UCSF s perspective and in accordance with the medical staff bylaws, the attending is responsible for the patient s care. However, the University is 3. Are trainees covered by UCSF malpractice insurance when moonlighting? If not, what sort of coverage should they seek that is also affordable? What about coverage when acting as a Good Samaritan? Moonlighting outside the UCSF system is not covered under the UCSF program. Trainees should ask about coverage as an additional insured at the location where they are moonlighting. Parttime policies with private insurance carriers can be obtained, but the best way to ensure you have coverage is to get it directly from where you will be moonlighting. UC Office of the President is working with its broker to find affordable part-time insurance for those rare situations where trainees cannot obtain coverage by a non-ucsf employer. Moonlighting within the UCSF system is covered under the UCSF program. Trainees who are already paid by UCSF and who moonlight for UCSF are covered under the UCSF insurance program. If a physician acts as a Good Samaritan and gives aid to someone who otherwise would not receive it, there are broad immunities for the physician as long as he or she had no legal duty to the patient and was acting as a volunteer. In the unlikely event that a trainee is involved in a lawsuit related to work as a Good Samaritan, UCSF will cover its employees in any such litigation. 4. Some institutions have training programs or fellowships that require trainees to sign noncompete clauses. What is the legality of this practice?

4 10 Questions...from the RFA Committee Without seeing the specific clause, it is impossible to say whether or not the clause is enforceable. In general though, under California law, non-compete clauses are generally construed quite strictly against the party seeking to limit competition. That is not to say, however, that they are always unenforceable. A trainee who is concerned about signing such a document should consult with his or her own attorney after asking the program director about the intent and scope of the non-compete clause. 5. What are the legal protections for the intellectual property of UCSF trainees? All University employees are required to sign the University s Patent Agreement and abide by its terms with regard to disclosure of inventions created with University resources. The UCSF Office of Technology Management (OTM) has an excellent website with frequently asked questions and links to relevant University policies, including the Patent Policy and the Copyright Policy: otm.ucsf.edu/ Trainees who make patentable discoveries or create copyrighted material using University resources (including paid time) should consult the policies and direct any questions to the OTM. 6. What steps should a trainee take if arrested or apprehended after breaking the law? Who needs to be informed? Does it matter whether it is a misdemeanor or felony? It is important to be forthcoming with your program director as even some minor infractions may have an effect on your ability to become licensed. Additionally, on an annual basis, the Office of Graduate Medical Education requires all trainees to fill out an attestation which asks whether the trainee has any misdemeanor or felony convictions or pending charges. Failing to advise a program director of a relevant incident in advance might, under some circumstances, be seen to reflect badly on the core competency of professionalism. A trainee in this situation may also want to consult with an attorney who is familiar with California medical licensure requirements and legal issues as well as any necessary criminal defense attorney. Certainly, any legal matter which may result in a trainee being unable to be physically present or unable to fulfill his/ her obligations to the program should be reported as soon as possible so that arrangements can be made to cover service obligations. 7. What infractions of the law can result in suspension of a California medical license? This is a difficult question to answer because the California Medical Board does not like to give absolute answers to this question. Standards for what they might accept tend to change over time as the makeup and political tenor of the Board changes. However, it is clear that the current Board has little tolerance for offenses involving drugs or alcohol. We are aware of trainees being denied initial licensure for such offenses even when they have been through extensive rehabilitation and have very good letters of recommendation regarding their recovery. For current licensees certain offenses involving drugs and alcohol can also be problematic. There is currently a heightened desire on the part of the Board to ensure that no patient is injured by an impaired physician. It is extremely important that applicants for licensure fully disclose their criminal, malpractice, and training histories. When reviewing an application the Board pulls information from various government agencies and a condition which normally would not affect an applicant s ability to achieve licensure may become an issue if omitted from the application. In the past, UCSF trainees who failed to fully disclose past experiences have been denied licensure or granted a license with draconian restrictions. Applicants with complex histories may want to consult an attorney with California medical licensing knowledge and experience. 8. What infractions of the law can result in dismissal from a UCSF training program? This is highly dependent upon the circumstances. As noted above, an infraction that results in a license suspension or an inability to become licensed in California in a timely manner, or which make the trainee otherwise unable to meet his or her obligation (continued on page 10) 9

5 10 Questions...from the RFA Committee (continued from page 9) to the program could be grounds for dismissal. However, other types of violations of the law may indicate a lack of professionalism or indicate an inability to exercise appropriate judgment to safely care for patients, which especially if combined with other evaluative factors, may result in academic disciplinary action. 9. Does UCSF provide any legal services for trainees who need an attorney for a personal matter? UCSF does not provide any legal services for personal matters such a creating a will, family disputes, motor vehicle infractions, or reviewing contracts. The Office of Legal Affairs represents the University and cannot advise employees on personal legal matters. 10. How should a trainee involved in a dispute with UCSF about discipline or dismissal obtain legal help? The Office of Legal Affairs serves as counsel for the University and in that role advises the Office of Graduate Medical Education as well as the training programs in such situations. Therefore it would be a conflict of interest for the Office of Legal Affairs to advise trainees specifically involved in such disputes. Trainees seeking specialized legal advice need to ask reliable sources for referrals and do research on attorneys with expertise in the matter at hand. It is also a good idea to ask potential attorneys to provide client referrals. California law requires attorneys to have written fee agreements with their clients, so be sure to get a statement in writing regarding the financial aspects of the representation. 10