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Legal Issues in Medical Practice: Swimming with the Sharks

Objectives. Discuss employment contractsEnhance awareness of regulatory requirements of individual providersDefine medical malpracticeDiscuss malpractice insurance in terms of types of coverageacceptance of risk. Contract Law: the (Very) Basics. Any contract requiresat least two partiese

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Legal Issues in Medical Practice: Swimming with the Sharks

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    1. Legal Issues in Medical Practice: “Swimming with the Sharks” CDR Dennis L. Hufford, MC, USN Faculty Development Fellowship Madigan Army Medical Center

    2. Objectives Discuss employment contracts Enhance awareness of regulatory requirements of individual providers Define medical malpractice Discuss malpractice insurance in terms of types of coverage acceptance of risk

    3. Contract Law: the (Very) Basics Any contract requires at least two parties each party contributes some form of consideration ex. Doctor provides service and HMO provides salary, benefits, etc. agreement, verifiable

    4. Employment Agreements are NOT Created Equal! There is no such thing as a standard contract! Many variations within and between MCO’s Almost always modifiable easy before you sign... Yes, you probably need a lawyer!

    5. Essentials of Employment Agreements Pay Salary Incentives Stop Loss (pay risk) Profit Sharing

    6. Essentials of Employment Agreements Benefits Sick leave, vacation, and CME Coverage for absences Medical/Dental plan Practice buy-in/ profit share 401k or other retirement plan Family leave, sabbaticals, etc.

    7. Essentials of Employment Agreements Responsibilities Inpatient and clinic duties Supervisory duties PA’s, students, etc Call (how often, scope, etc.) Administrative duties

    8. Essentials of Employment Agreements Commitment Restrictive Covenants How to get in, how to get out Terminations Malpractice coverage Other insurance (liability, disability)

    9. Essentials of Employment Agreements (Summary) Read and understand before you sign. Make sure any “special clauses” are stipulated in writing. Have an experienced attorney review the contract and explain the details/jargon.

    10. Regulatory Issues Licenses Medical (state) DEA (federal) Business (local) Licenses mean: You’ve met requirements. You agree to oversight.

    11. Regulatory Issues Credentials and certifications Board certification Hospital privileges Special regulations CLIA OSHA, etc. Many state and federal regulations

    12. Summary re: Regulations Vary by location, type and size of practice Get advice of experienced attorney in that area. Pay attention to details expirations/renewals documentation requirements

    13. What is Malpractice? Is a Tort (civil law) based on principle of “professional negligence” 4 Essential Elements of Negligence Existence of a duty to provide care Breach of Standard of Care Compensable injury Causal connection

    14. Malpractice and the Military Health Professional Some unique statutes apply Federal Tort Claims Act Feres Doctrine UCMJ Federal Government takes the risk as long as you are practicing within the scope of your military duties

    15. Malpractice Insurance Betting on the financial risks If you get sued and lose (or settle), YOU WIN! The insurer took the risk (and pays the claim). If you don’t get sued, the insurer wins. gets to keep your premium

    16. Malpractice Insurance: Does everyone need it? Virtually all hospitals, managed-care organizations, group practices require it. Herd protection Moonlighters are NOT covered by federal government.

    17. Is all Malpractice Insurance the Same? Basic Types Claims-made Occurrence-made Tail coverage Widely varying levels of coverage Type of practice, location, record

    18. Things to Know about Your Malpractice Insurance: Do I have the right type? Do I have enough for what I’m doing? Is coverage based on pure loss or ultimate net loss? How quickly must I report a claim in order to be covered?

    19. Things to Know about Your Malpractice Insurance: To what extend is the insurer obligated to defend me? compensation for lost time services provided in your defense Am I covered when someone else fills in for me? What is the insurer’s reputation?

    20. Summary Legal issues in medical practice are: many, complex, and interrelated Good legal advice, assistance, and protection minimizes your risk of being BITTEN. Read before you sign, ask questions, and seek advice from an experienced lawyer.

    21. Any Questions?

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