self-insurance program protection and reporting · incident reports depending on the ... •...

Self-Insurance ProgramProtection and Reporting

An introduction to the University of Florida

J. Hillis Miller Health Center Self-Insurance Program

06/11

PROTECTIONSelf-Insurance Program

2011UF JHMHC Self-Insurance Program 2

UFSIP

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

2011UF JHMHC Self-Insurance Program

University of Florida JHMHC Self Insurance Program

3

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 thepatient’s care.• The breach in care was the proximate cause of injury ordeath.• The injury or death resulted in damages.


Protection

Professional liability protectionis provided to

University of FloridaHealth Science Center

faculty, staff,residents, and students

by UFSIP.2011UF JHMHC Self-Insurance Program 5

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.


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.


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.


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, 2011, 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.


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.


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.


REPORTINGSelf-Insurance Program


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: 352-273-7006• For Jacksonville call: 904-244-9070

Report patient care occurrences as soon as possible.


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.


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


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?


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.


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.


Ramifications of Failure to Report

PersonalAs 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.

FacilityThe facility where the event occurred could be subject to:• Adverse action by regulatory, licensing, and accreditation

agencies.• Loss of managed care contracts.


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 director3. Call UFSIP; do not use E-mail.4. Objectively document clinical facts in the medical record; do not include

personal notes, references to mandatory reports, or calls to UFSIP.


For More Information

Contact us at 352-273-7006 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 http://www.sip.ufl.edu/.


http://www.sip.ufl.edu/�

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