Minute Clinics: What Providers Can do to Protect Themselves From
Liability
Given the risks
of working with the new limited-service clinics in pharmacies, health
care professionals associated with them should do the following to
protect themselves:
•
Verify coverage for medical malpractice claims
“Any
[supervising physician] would want to make sure the retailer is taking
responsibility either directly or through an indemnity agreement for any
negligence that may arise on their part,” says Leonard Simon, a
medical-malpractice plaintiffs’ attorney in Waltham.
“I’d also avoid holding myself out as an independent
contractor or signing an agreement with a retailer that would allow me
to be thought of as an independent contractor.”
At CVS’s
MinuteClinic, while all collaborating physicians are independent
contractors who maintain their own practices, the company purchases
professional liability insurance for them, Ratner says.
•
Ensure that protocols are in place for nurse-physician
relations
It is critical
for nurse practitioners to make sure there are guidelines for the
relationship between them and any supervising physicians, says Heather
Beattie, a med-mal defense lawyer in Springfield, who practices with
Morrison Mahoney.
Under state
guidelines issued by the Board of Registration in Nursing, the nurse
practitioner is supposed to have written guidelines as to what kinds of
findings dictate that he or she call the physician, send a patient to
the emergency room or call an ambulance.
These
guidelines – if well-crafted and followed – should help
avoid many of the potential liability scenarios that can arise from
supervision issues. Because the board has the power to discipline a
nurse based on insufficient guidelines, says Beattie, he or she should
have the board sign off on them before starting at the
clinic.
Even if
MinuteClinic or another retailer has guidelines in place, Beattie
recommends that the nurse still clear them with the board. She also
suggests that doctors run the guidelines by the Board of Registration in
Medicine.
“This may
put a stumbling block in the contractual agreement between the nurse or
doctor and the company,” she says. “But I’d rather do
that than put my license at risk. This is a new area that will
eventually be tested and I’d want to make sure I was on sure
footing before I jumped in.”
•
Share information with patients’ regular providers
Limited-service
clinics will want to cause as little disruption to their patients’
regular physicians as possible.
As a result,
MinuteClinic, and presumably potential competitors, will be passing
along records of visits to primary care providers.
But primary
care doctors must also do their part to minimize disruption. This means
implementing procedures to ensure that they actually see reports from
the clinics and act on them.
“Keeping
in good contact with other health care providers who see their patients
is a problem that a lot of primary care doctors have,” says
Beattie. “A report from a clinic could be important information
that leads to further workup.”
Simon also
urges primary caregivers to establish systems for fielding calls from
clinics that may seek advice on how to proceed with one of their
patients.
For one thing,
the doctor should avoid giving actual treatment advice. By doing so, the
doctor would be assuming joint liability with someone he does not know
at a time when he has no physical access to the patient.
Karen R.
McAlmon, president of the Massachusetts Chapter of the American Academy
of Pediatrics, agrees.
“That’s why most [physicians] will most likely just
say, ‘I need to see my patient myself.’”
-Eric
Berkman
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