Liability Protection

What is risk management?

The number of malpractice claims brought against dentists has substantially increased, with several adverse results:

• increased costs of malpractice insurance
• costs are passed on to patients in increased fees
• dentists are concerned that they must constantly practice defensively

You can reduce the risk of legal liability by examining several issues: treatment, documentation, and dentist-patient relationships. Reviewing all aspects of dental practice to provide the best possible patient care and to reduce unnecessary legal liability is termed risk management.

The steps in managing risk include identifying, evaluating, eliminating, reducing, and transferring risk. Risk is identified in several ways. The most common is to collect and aggregate data about problems so that patterns can be identified and action taken. The clinic's risk management program should use a number of systems to identify and provide notification of incidents or events that occur involving patients, visitors, staff, equipment, facilities or grounds that are likely to give rise to potential liability, affect the quality of patient care or affect safety. Early identification of such occurrences allows the clinic to immediately investigate the circumstances of the incident, and if necessary, institute corrective action to prevent future occurrences.

In any case, where a patient suffered an injury or adverse outcome as a result of treatment received at the clinic, notify your Professional Liability Insurance carrier immediately. Designate a "risk manager" to report findings to the clinic administrator or Board of Directors. If the investigation of the incident reveals a systems or procedures problem, then take immediate steps to rectify the underlying problem through the clinic's quality assurance/quality improvement (QA/QI) program (see Chapter 5). If provider or staff incompetence is identified as the cause, then the clinic's administration will need to decide whether to provide the individual with additional training or to terminate employment/association with the clinic. If inappropriate staff or provider conduct (rather then competence) is to blame, then termination may be immediately justified.

Sometimes it is possible to avoid malpractice claims and litigation by offering to correct the problem created by the incident. This should only be done with the advice and consent of legal counsel from your malpractice insurance carrier.

Tips for Patient Management as a Risk Management Tool

• Spend enough time talking with and listening to your patients. Make sure each patient’s treatment expectations are realistic.
• Encourage your patients to ask questions and become active participants in decisions regarding their health care.
• Make every effort to eliminate excessive waiting time for patients in the office. This is one of the major criticisms by patients.
• Monitor staff courtesy; discourteous staff may be costly to attracting/retaining patients.
• Maintain a clean and pleasant office. The physical condition of the office may be perceived as an indication of the staff’s feeling toward patients.
• Maintain patient confidentiality.
• Don’t neglect a patient’s complaints. Even if you feel the complaints are not significant, a word of reassurance to the patient may be all he/she needs.
• Remember that most patients will not necessarily evaluate their care by its technical quality, but by the quality of their relationship with those who provide the care.
• The same courtesy that is extended in face-to-face contact should also be extended in telephone conversations with patients. Every message for the dentist should be delivered to him/her and calls should be returned in a timely fashion. Since answering services are an extension of the office, ensure that they are providing good, efficient services. If you use a voice messaging system, make sure it is user-friendly.
• Inform patients of fees and costs.
• Never underestimate the effect of good patient relations on a patient’s decision to sue.

Safety inspections and audits of activities within the clinic are prospective methods to identify problem areas or trends.

Tips for Prospective Risk Management

• Walk around your premises on a regular basis, following the path taken by patients and visitors from the parking lot to the operatory.
• If possible, conduct safety tours with someone who is not an employee and can look at your premises with a fresh eye.
• Look carefully for such problems as parking lot potholes, cracked paving, uneven steps, slippery or un-swept floors, burned-out bulbs, shadowed areas, sharp edges, loose carpeting, flimsy or broken furniture, unstable coat racks or cabinets, heavy objects on high shelves, open file or desk drawers, and electric cords strung across walkways.
• In winter, assign an employee to check daily for icy patches, snow-blocked paths and wet floor areas.
• Document inspections, problems spotted and repairs and other actions taken.
• Be aware of your state’s dental practice act regulations regarding emergency training and equipment.
• Establish a testing schedule for life- support equipment.
• Make sure staff have proper certification in CPR and other first aid techniques, and take refresher classes. Document completion of training.
• Train staff to call for medical assistance immediately in emergency situations; emergency numbers should be prominently posted near the telephone.
• Hold regular drills.
• Develop and post an evacuation plan.
• Make sure that fire exits are unobstructed, easily opened, and well marked and lighted.
• Install smoke detectors and assign a staff member to test detectors and fire alarms regularly.
• Test and recharge fire extinguishers according to manufacturer recommendations.
• Wiring should be inspected periodically especially in older buildings.
• Read your lease carefully. Check how “premises" is defined and which party-landlord or tenant-is responsible for public areas.
• Keep up to date on state laws and federal regulations.
• Establish an emergency plan and accident reporting policy within your practice. Include these policies in the office policy manual, and have all newly hired staff members read and sign them.
• Make sure your staff is aware of safety issues. Discuss your accident prevention programs at staff meetings and encourage staff to ask questions and report any unusual events.
• Read your policy carefully. Check that the correct name of the business entity you wish to insure appears on the declaration page of the policy.
• Know what types of damages are covered and excluded by your general liability policy, as well as the policy limits.
• Notify your insurer immediately in the event of an accident.
• The most important element in any accident prevention program is the commitment, leadership, and example set by the dentist.