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Broad Regulatory Protection Policy for OMIC Insureds
As a benefit of membership, OMIC has purchased a $25,000 Broad Regulatory Protection
Policy (BRPP) for each of its professional liability policyholders and qualifying
entities for 2007. This policy extends coverage for fraud and abuse claims related
to billing errors and HIPAA privacy proceedings to include fines and penalties
(where allowed by law) as a standard policy feature. Coverage also includes legal
expense reimbursement for alleged violations of EMTALA, DEA, and STARK violations.
Higher coverage limits up to $1 million are available at competitive rates. Non-OMIC
professional liability insureds who are members of the American Academy of Ophthalmology
may purchase the Broad Regulatory Protection Policy at limits of $25,000 to $1
million. Click
here to learn more.
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Coverage Question of the Month
May 2008
I am thinking about employing a plastic surgeon. Will OMIC cover me if I am named in a claim for services he rendered?
Through their respective coverage agreements (A and C), insured ophthalmologists and professional entities are insured for their vicarious liability arising from the acts or omissions of their employees. Ophthalmologists are covered for employees when they are acting within the scope of their training, licensure, and employment; they are also covered for the vicarious liability of others who are acting under the ophthalmologist’s supervision, direction, or control. Entities are covered for anyone whose acts, errors, or omission the entity is legally responsible for, so long as that person was acting within the scope of his or her licensure and training. It is assumed, however, that such health care providers are engaged in ophthalmic practice. Employment of or a contractual relationship with a non-ophthalmologist physician, particularly one in a higher-risk specialty such as ENT or plastic surgery, presents an increased risk from that intended under the standard policy. That risk may be even greater if the employer does not possess the expertise required to appropriately supervise the non-ophthalmic activities being performed. The actual increase in risk is difficult to judge but could be significant. For these reasons, OMIC prefers not to insure the vicarious liability exposure arising from services rendered by physicians other than ophthalmologists, but is willing to consider such requests subject to careful underwriting review.
Insureds who wish to pursue vicarious liability coverage for services arising from physician employees or contractors are asked to provide the non-ophthalmologist’s curriculum vitae, insurance history, current proof of coverage, complete claim history, and scope of services to be provided. The claim history should include a detailed listing of all claims the physician has ever been involved in, including open cases and cases that closed with or without indemnity. In addition, the insured should explain the rationale for hiring the specialist as opposed to establishing a referral relationship. If approved, an additional premium commensurate with the estimated increase in exposure will be charged. If the increase in risk is considered too significant, however, OMIC may endorse the policy to exclude coverage for claims arising from the vicarious liability exposure of non-ophthalmologist physicians employed directly by or independently contracting with the insured.
For more coverage questions, please refer to the Coverage Questions page
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Risk Management Forms and Documents Update
New Informed Consent Documents
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Revised Informed Consent Documents
- The ALT/SLT consent form has been amended to be a “stand-alone” document. The former version was inadvertently attached to the glaucoma filtering surgery consent form.
- The Avastin™ consent form has been revised to better address the possible increased risk of stroke in Lucentis.
- The Cataract Surgery consent form has been significantly revised and shortened at the request of OMIC policyholders. This version contains the information that OMIC recommends the ophthalmologist personally discuss with the patient. See the “Risk Management Recommendations” section below for a patient information sheet and loss prevention advice.
- The Fluorescein Angiography consent form has been revised.
- The LASIK and PRK consent forms have been revised to better address ectasia and pupil size. Click here for LASIK, here for IntraLASIK, here for retreatment, and here for PRK.
- The Lucentis Injection consent form was recently revised
in response to the preliminary report of an increased risk of stroke in patients
with a prior history of stroke who were administered the approved dosage.
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New Risk Management Recommendations
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Amblyopia Risk Reduction: Recommendations, Treatment Agreement, Referral Report
Medical malpractice lawsuits for negligent treatment of amblyopia are infrequent,
but the risk to the pediatric patient’s vision is extreme. If not treated
appropriately by age nine, the child can have permanent vision loss. The main
risk issue is noncompliance with patching and follow-up appointments. Click
here for
recommendations, a treatment agreement, and a referral report.
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Cataract Surgery Risk Reduction Materials
To reduce the ophthalmologist’s exposure to cataract surgery claims,
we offer various materials. The risk management recommendations highlight
the actions physicians can take to reduce the likelihood of claims and increase
their defensibility. The information sheet for patients gives
a detailed explanation of the risks, benefits, and alternatives to cataract
surgery; staff can give it to patients to review prior to the informed consent
discussion with the surgeon. The sample consent form contains
the minimum information OMIC recommends that the surgeon personally disclose
to the patient.
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EMTALA (Emergency Medical Treatment and Active Labor Act) Overview and On-Call Obligations
This federal law governs how patients are treated in emergency rooms and imposes duties on ophthalmologists who serve on-call to hospitals. Click here for an overview of the basic obligations hospitals and physicians have under EMTALA. Click here for information about on-call and follow-up duties.
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Endophthalmitis/TASS Recommendations and AAO/ASCRS Report
While not all adverse events can be prevented, there is much ophthalmologists
can do to reduce the incidence of endophthalmitis and TASS. Based on a review
of OMIC claims experience, these recommendations offer risk management guidance
for more effective prevention, recognition, and response to these sight-threatening
conditions. The AAO and ASCRS have asked ophthalmologists to track and report
TASS cases. This document also contains the necessary reporting form. Dr. Mamalis's
group has developed an Excel-based protocol that can be used for individual or
clustered cases of infectious or sterile endophthalmitis. Click here for this
protocol.
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Fluorescein Angiography: Preventing and Responding to Complications
While generally well tolerated, fluorescein angiography is an invasive procedure with associated risks, including a very rare but notably life-threatening allergic reaction. These risk management recommendations have been compiled to help you and your staff both prevent and better respond to the risks of this procedure. Issues addressed here include delegation of tasks, informed consent, emergency response equipment, and management of complications.
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Giant Cell (Temporal) Arteritis
Allegations of failure to diagnose are common in medical malpractice lawsuits against ophthalmologists. This document focuses on giant cell (temporal) arteritis. These risk management recommendations can help promote patient safety and reduce liability exposure.
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Terminating the Physician-Patient Relationship for Financial Reasons
It is well established that physicians may discharge a patient for a number of reasons, including non-payment. Click here for a discussion of this issue and a sample letter.
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Revised Risk Management Recommendations
- The Avastin risk management recommendations have been revised to better address the possible increased risk of stroke in anti-VEGF drugs.
- The Lucentis risk management recommendations have been revised to better address the possible increased risk of stroke in Lucentis.
- ROP: Creating A Safety Net document was revised to conform to the 2006 AAP/AAO/AAPOS joint statement and errata to the joint statement. Click here for this document.
- ROP: Sample Indemnification Language was revised to conform to the recommendations contained in ROP: Creating A Safety Net. Click here for the new language.
- Telephone Screening of Ophthalmic Problems now contains an updated version of the after-hours contact form.
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New Online Risk Management Courses
- Ophthalmic Anesthesia Liability helps ophthalmologists reduce
the likelihood of anesthesia-related malpractice claims and includes a video
on Sub-Tenon's anesthesia. Please contact Linda Nakamura at (800) 562-6642,
ext. 651 or 652, or email lnakamura@omic.com to
register for the course.
- Responding to Unanticipated Outcomes is nearly complete. OMIC has always encouraged its policyholders to communicate honestly and compassionately with their patients about care outcomes. Using actual calls to our Risk Management Hotline, this course provides recommendations on disclosure discussions, documentation, event analysis, and refunding fees.
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