Policyholder Services

Coverage On-Call

Kimberly Wittchow, JD, OMIC Legal Counsel

Digest, Winter 2008

Taking call or arranging for call in your absence is an important part of most physicians’ practice. However, this situation gives rise to the following questions: (a) When does my medical malpractice liability insurance cover me for taking call and (b) When is it appropriate for me to take call under these circumstances?

Limited Scope Ophthalmologists On-Call

One question that arises is whether an ophthalmologist in a limited coverage class [i.e., Ophthalmology Surgery Class 1 (very limited surgery), Class 2 (limited surgery), or No Surgery] is covered by OMIC for taking call for colleagues who provide a full scope of ophthalmic services, or for a hospital emergency room. Under OMIC’s policy, the ophthalmologist is covered for taking such call as long as she only provides those services permitted under her coverage class when she advises and treats patients. If she cannot feasibly and promptly obtain the services of another ophthalmologist to provide care that is outside her scope of coverage, she should consider discussing with an OMIC risk management specialist whether to continue the on-call activity.

OMIC’s Risk Management Department provides advice on when to take call in order to help our insureds reduce their liability risk and support overall quality of care. Paul Weber, OMIC Vice President of Legal/Risk Management, notes in “Who’s On Call?” (available at www.omic.com) that being “on call” by definition means that a physician is ready and legally able to render medical or surgical care to patients on an urgent or emergent basis. This includes being able to see and treat patients in the office or emergency room and admitting them to a hospital if necessary. Ideally, ophthalmologists who take call for their colleagues or private practice should have a coverage classification sufficient to diagnose and treat patients themselves. By having the full coverage classification of Surgery Class 3 when taking call, an ophthalmologist generally has the ability to not only diagnose the condition but treat it as well, thereby avoiding delays in care. This is especially true when taking ER call, where patients are more likely to present with truly emergent conditions.

The difference between OMIC’s policy coverage and risk management recommendations is that the terms and conditions of the policy are binding upon the insured in order for insurance to cover a claim. Risk management recommendations provide useful tools in managing the risks of medical practice and reinforcing the standard of care for our insureds’ patients. However, it is not mandatory to implement this risk management advice.

Insureds need to decide for themselves whether they will continue to take call when they are in a limited coverage class. They should do so with the understanding that anything that exceeds the limits of their coverage class must be promptly referred to another physician. Only the insured can decide whether such referral can take place in a timely manner, whereby the patient does not suffer a delay that would contribute to a worsening of the injury or medical condition.

Optometrists On-Call

OMIC offers professional liability insurance to optometrists employed by our ophthalmologist and entity insureds. We have had queries about whether employed optometrists are covered by OMIC’s policy for taking call on behalf of their employers or other ophthalmologists. Under the policy, the optometrist is covered for taking call as long as he is acting within the scope of his training, licensure, and employment by the ophthalmologist/entity when he advises and treats patients.

However, in order for the optometrist to be added to an OMIC policy as an insured, his call services must first be analyzed and approved by OMIC’s Underwriting Department during the application process. A detailed explanation of the nature and volume of the calls and scope of responsibilities when on call must be provided. An underwriter will assess the liability risk of the optometrist’s call. There is a lower risk of liability when an optometrist is screening calls and making referrals only, versus the higher risk of personally examining patients and making independent treatment decisions for an ophthalmologist’s patients. The underwriter reviews the protocols in place for handling trauma, surgical complications, emergency call requiring the patient to be seen, and referring or transferring care to a backup ophthalmologist. In order for coverage to be approved, an ophthalmologist must always be available to promptly take patient referrals.

In “Who’s On Call?,” Paul Weber points out that optometrists’ call coverage is more limited than that which can be provided by an ophthalmologist.

Due to state laws limiting the optometric scope of practice, as well as differences in training between optometrists and ophthalmologists, optometrists generally should not take call on behalf of ophthalmologists.

However, their special training and skill does allow them to handle a number of questions or situations that might arise, so limited call with backup resources and referral/transfer protocols in place may be appropriate.

OMIC Can Help

If you are an optometrist covered by OMIC and your call services have changed since you fi rst applied for coverage, you must notify OMIC’s Underwriting Department at (800) 562-6642, ext. 639, so we can assess your liability risk and continue to approve coverage of your practice.

Ophthalmologists should contact their underwriter if they have questions about call coverage. For assistance with decision making about when and how to take or assign call, contact OMIC’s Risk Management Hotline at ext. 641.

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