Wright State University School of Medicine
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Resident Manual

Item 501
Risk Management
Revised July 1996

All "incidents" related to patient care should be reported promptly to the hospital's Department of Legal Affairs and Risk Management, or its equivalent. Consult the hospital director of medical education for specific direction in this regard.

Definition
The term "incident" includes:

1. any happening which is not consistent with the routine or commonly accepted care of a patient, including an accident or a situation which might result in an accident
2. actual or alleged injury that results from providing professional services when proper diagnostic or therapeutic procedures dictate
3. actual or alleged injury that results from failing to provide professional services when proper diagnostic or therapeutic procedures dictate
4. a claim that no informed consent was obtained from a patient or legal guardian
5. failure to carry out a Medical Staff Committee appointment in a prudent manner

Sensitive Legal Matters
The resident should be sensitive to and report

1. threats of legal action
2. a patient's and/or attorney's request for medical records
3. subpoena for appearance or records
4. request of an attorney to talk to you or any other employee about an "incident" or any potentially litigious issue

Reports
The reporting of an actual or alleged incident should be in typed or handwritten letter form and include the following information:

1. physician's name, address, and specialty
2. patient's name, address, and number
3. narrative with specific details of the incident and resulting injury, including time and date
4. identification of any witnesses to the occurrence
5. status of patient post incident
6. any other comments by physicians relevant to the incident

After discussion with the risk manager, the letter should be sent to the risk manager or equivalent within 48 hours of the incident in an envelope marked "Personal and Confidential." These reports will remain in a locked file and they will not become part of the patient's medical record.

While written documentation is important as potential legal defense in an investigation, some situations may be better handled personally by contacting the Department of Legal Affairs and Risk Management.

Sensitive Medical Issues
Discuss privately with the supervisory physician and program director medical care issues such as

1. unexpected poor result
2. therapeutic misadventures
3. significant misdiagnosis including failure to diagnose

Risk Management Principles
Use risk management principles to minimize the potential for a liability claim. Effective principles include:

Preventing Claims

1. Maintain good rapport and effective communication with the patient.
2. Keep a well-documented medical record, containing all material information relevant to optimum health care services. This point must be emphasized. Always maintain timely, clear and complete records but be particularly precise and attentive when a patient has had an unexpected adverse response.
3. Report immediately any malfunctioning equipment so that it can be repaired. Malfunctioning medical equipment poses substantial risk to patients. Because it is important that the evidence of malfunction is preserved, do not send the equipment back to the manufacturer without approval of the risk manager.
4. Refer all requests for product evaluation from sales representatives of medical equipment companies to the hospital's purchasing department. The purchasing department has established guidelines for evaluating equipment that greatly reduce the potential for liability. If a resident accepts equipment that later injures a patient, the resident could be held liable for that injury.
5. Do not accept newly purchased equipment. All new equipment should be processed through materials management to assure that it is operating properly before being used. Contact the purchasing department if there are questions.
   

NOTE: The Patient Relations Department with support from the medical center attorney handles risk management at Kettering Medical Center.

Handling Claims

1. Direct requests for records or information concerning a claim or claimant to the risk manager or equivalent. Never release any medical information regarding a claimant without the authorization of the Department of Legal Affairs and Risk Management or the Medical Records Department.
2. Direct any correspondence from a claimant, claimant's attorney, or claimant's insurance company immediately to the Department of Legal Affairs and Risk Management.
3. Do not discuss a claim with the claimant or the claimant's representative except as authorized by the Department of Legal Affairs and Risk Management.
4. Deliver correspondence received from a patient alleging substandard medical care immediately to the Department of Legal Affairs and Risk Management. The Department of Legal Affairs and Risk Management must review all responses to inquiries because a resident's response may exacerbate the situation.
5. Send request or subpoena for appearance for deposition or hearing to the Department of Legal Affairs and Risk Management.
6. Forward a Summons and Complaint received by a physician naming the physician as a defendant immediately to the Department of Legal Affairs and Risk Management.

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