1. Protect Your Team From Lawsuits:
Tips for Managing Your
Risk of Claims

2. Overview
• Patient Selection & Screening
• Risks of Emerging Technologies
• Patient Education & Informed Consent
• Surgery & Post Operative Care
• Dissatisfaction & Complaint Management
• Angry, Non-Compliant Patients &
Threats to Sue

3. Medical Screening
• Documentation of Actual Patient
Screening (Medical & Psychological) often
key to defending cases
• Take extra care to document your decision
making process and consultations
whenever you “push the envelop” beyond
published guidelines

4. Psychosocial Screening
• Patient Screening – identify severe
psychosocial problems that may disqualify
• Difficult Patients – Need triage, better to
discharge before surgery. Psychosocial
problems may interfere with post-op care;
may disrupt support group
• Family & Support Systems – involve in
assessment

5. It’s All About Aligning
Expectations:
Patient Education &
Informed Consent

6. Education & Informed Consent
• Mismatched expectations often leads to
lawsuits: 78% lawsuits, no bariatric
specific consent forms
• Education begins with marketing materials
& psychological screening
• Well documented, team based training
reduces the risk of lawsuit

7. Education & Informed Consent
• Mismatched expectations often leads to
lawsuits: 78% lawsuits, no bariatric
specific consent forms
• Education begins with marketing materials
& psychological screening
• Team based education that is well
documented is effective risk management
tool, basis for informed consent

8. Informed Consent
• Bariatric informed consent process
follows mandatory patient education
sessions
• Forms should have checkboxes that
certain key points were reviewed
• Recommend spouse & family attend
classes & sign education form

9. On-line Education & Consent Tools
Improve patient compliance
Increase patient satisfaction
Document informed consent
process

10. Disclosure of Financial Relationships
• The Patient’s Rights Issue: absence of bias in
surgical decision making
• The Relationships:
–Consulting
–Research
–Education support
–Investment
• Organizations starting to require disclosure
• Lawyers starting to use as tactic

11. Evolving Standard on Patient
Disclosure
• If a physician has a material financial
relationship with company that manufactures
permanently implantable medical devices, the
physician must disclose to his/her patients this
financial relationship before obtaining the
patient’s consent. Such disclosure shall be
documented in the patient’s medical record.

12. Care Coordination
• Equal to Patient Education/Informed
Consent as an Effective Risk Management
Strategy
• Making Teams of Experts into
Expert Teams
• Big Impact on Decreasing Dissatisfaction,
Even When Outcome Less Than Expected

13. Managing Individual Patient
Dissatisfaction & Complaints
• Individual dissatisfaction should be
managed by team, recommend use of
patient advocate, follow through is critical
• May include apology, written response and
bill write offs when appropriate

14. Aggregate Complaint
Tracking/Trending
• Patterns of patient complaints may be
predictors of suit
• Facility should have a reliable complaint
tracking system & regularly review
aggregate complaint data to fix delivery
systems
• Complaint review committee

15. Conversations & Interventions
with Angry, Non-Compliant or
Disruptive Patients

16. Crucial Conversations Training
• Resolving “stuck”
complaints through
dialogue, active
listening
• Move to actionable
solutions

17. Crucial Conversations
• Often, dissatisfied patients feel like they
are not being heard, personal issues not
being addressed
• Recommend selected team members
receive conflict resolution or mediation
training. Active listening (what does the
patient/family really want)

18. Behavioral “Contracts”
• Not true contract, a tool for aligning
expectations/behavior when conversation
fails
• For disruptive or non-compliant patients
• Lay out surgeon’s and team’s behavioral
expectations
• Sets up ground work for dismissal

19. Threats to Sue
• When interventions, crucial conversations,
patient advocate have failed
• Damage physician/patient/team
relationship enough that most programs
will dismiss
• May need to comply with insurer’s rules on
dismissal
• IF continue to treat, assure no
disengagement

20. Dismissal From Practice
• To avoid charge of patient abandonment, notify
patient, in writing when surgeon wishes to
discontinue care
– Last day surgical care will be available
– Provide at 15-30 days of emergency
treatment & prescriptions
– How to get copies of medical records
• May need to comply with insurer’s rules on
dismissal

21. Thank you
Questions?