1 Medical Liabilities in VolunteeringVolunteering your time: benefit vs Risk
2 Doctor at no cost Tens of thousands of physicians, dentists, and other health care providers volunteer their time and skills Physicians volunteer for organizations locally and abroad. We can find many ways to volunteer even at home. Tens of thousands of physicians, dentists, and other health care providers are often asked to volunteer their time and skills to provide free or reduced cost care to uninsured or underinsured community members. Physicians provide such volunteer services in many different settings and under the sponsorship of various organizations.
3 The Classical volunteerVolunteer Opportunities Overseas and International organizations Doctors without borders Project hope Peace Corps International Volunteer HQ When We talk about volunteering, the thoughts of traveling to Ruanda, Fiji or some far off jungle and doing something they’ve never done before. Doctors are able to use their specialized skills and that these skills could give them the ability to serve an at-need community in a way that most volunteers could not. Medical volunteer abroad trips can be extremely rewarding, and are a great chance for people with specialized skills to participate in a volunteer project
4 When We talk about volunteering, the thoughts of traveling to Ruanda, Fiji or some far off jungle and doing something they’ve never done before. Doctors are able to use their specialized skills and that these skills could give them the ability to serve an at-need community in a way that most volunteers could not. Medical volunteer abroad trips can be extremely rewarding, and are a great chance for people with specialized skills to participate in a volunteer project. You can search and find These organizations, but it usually takes a special person to give up everything for a period of time to give back to the World Community.
5 You can search and find These organizations, but it usually takes a special person to give up everything for a period of time to give back to the World Community. There are things that must be sacrificed. many are not willing to give up what we have all worked very hard to obtain. Like running water, electricity, and other fruits of our labor. Most everyone that feels the urge to volunteer usually get involved with Organizations that they already have some form of personal connection, either with local schools, church,
6 The art of helping at homeProviding physician relief for schools or organizations. Volunteer as a mentor Seeing people with sub-standard healthcare coverage –Medicaid No-charge office visit Treating in shelters, city clinics or on the street. Disaster relief situations Most physicians are willing to help, Participation can take many forms, including Volunteer as a mentor for students, residents, or young career physicians. Seeing patients with Medicaid (where seeing patients and the payment may not cover the cost of services provided). Seeing patients free of Service in your own clinic. Treating patients in shelters or in local city clinics, or treating people on the street. Providing care or medical support in Disaster Relief efforts
7 You can even spend a whole week volunteering as a camp DrYou can even spend a whole week volunteering as a camp Dr. I received this from the AOA earlier this month. This is a camp for MDA
8 Summer Camp Doctor Doctors Program . . Summer Camp Doctor There are Christian organizations like Young Life, where over the last 8 years I have been personally volunteering for a week every Summer Opportunities are everywhere Many physicians enjoy giving back to their communities by lending their medical expertise through volunteering. While the benefits of giving back are clear, keep in mind that there are risks as well. From a legal perspective, physicians need to protect themselves while volunteering in their communities or for society at large, whether it be with a local sports team or free clinic, or with larger national or international disaster or medical relief groups.
9 Liability One of the challenges is fear of malpractice liability for these uncompensated services. Protection is important Using your medical skills to help out in the community can be rewarding, but physicians must make sure they consider the liability implications before lending a hand. Malpractice= a word that Strikes fear in the minds of many of us in this room. One of the challenges and potential barriers to greater volunteerism among physicians is the fear of malpractice liability associated with providing such uncompensated services.
10 Legal Perspective Will my workplace insurance cover me?Are there federal or state laws to protect volunteers? Many physicians enjoy giving back to their communities by lending their medical expertise through volunteering. While the benefits of giving back are clear, keep in mind that there are risks as well. From a legal perspective, physicians need to protect themselves while volunteering in their communities or for society at large, whether it be with a local sports team or free clinic “Volunteers can’t assume insurance at their workplace will cover outside activities. It likely would not, unless arrangements are made, What about laws already in effect? Although there are laws that provide a national minimum standard for immunity, laws varies in each state.
11 Good Samaritan Law: Volunteering in an emergency Do I have to respond?Volunteering in emergency Suppose you go to the theater and one of the performers collapse on stage and you hear those words “is there a doctor in house” do you have to volunteer? Declined volunteer is not a crime there is no civil liability for not volunteering. But usually the natural response for people is to overcome their fear. When an emergency or a catastrophe occurs they jump in and sometimes without thinking, to help.
12 Good Samaritan Law: Volunteering in an emergency Do I have to respond?Over the last 20 years, laws have been passed to protect the general public and healthcare workers from the lentiginous.
13 Good Samaritan Law: 3 requirements for qualification 1. An Emergency2. Location not in hospital or clinic 3. Care is voluntary As for the “Good Samaritan” law, it is designed to be applied in situations of immediate danger—such as when a physician helps someone experiencing a heart attack on a hiking trail—and usually these are not intended to cover ongoing volunteering. To qualify for good Samaritan protection you must meet 3 requirements #1 it must be a true emergency, #2 aid was rendered outside of the hospital or place with medical equipment, #3 care must be voluntary (without compensation).
14 Protections for Physician VolunteersState law protections for physician volunteers Physicians who volunteer in free clinics and community settings for charitable organizations may be eligible for liability protection under both state and federal law. Most states had some form of limits of liability or immunity for physician to volunteer professional services and some even subsidize the purchase of malpractice insurance. There is nothing that we can do to stop people from suing us when we volunteer if something bad happens, but, there are laws that help protect or immunize volunteers from litigation.
15 Volunteer Protection ActPassed in 1997 Created to decrease fear of volunteering by decreasing liability Establiishes a minimum level of protection Volunteer protection act Is for volunteers of a nonprofit or government entity This act was enacted to provide minimum protections for volunteers. This Legislation gained support because of concern and uncertainty about potential personal liability; and this might be a deterrent to anyone from volunteering. The federal VPA established a minimum level protection for volunteers and preempts inconsistent state law, unless the state law provides greater protection. A volunteer is someone performing services for a nonprofit organization or government and does not receive compensation; or any other thing of value in lieu of compensation, worth in excess of $500 per year.
16 Volunteer Protection Act ImmunityThe VPA gives immunity if: Someone working at no charge Acting within responsibilities Volunteers Properly licensed Harm was not willful criminal or reckless misconduct, or negligence Not caused by operating a motor vehicle The VPA provide immunity if: -The volunteer was acting within the scope of the responsibilities -The volunteers properly licensed, certified or authorized to act -The harm was not caused by willful criminal or reckless misconduct, or gross negligence -The harm was not caused by a volunteer operating a motor vehicle, vessel, aircraft or other vehicle for which the state requires an operating license and insurance. Volunteers still are subject to state laws and may need to go through training of risk management just as you would if you were employed. This is state dependant. The VPA is not the only federal protection available
17 Federal tort claims act:Volunteers deemed public health service employees Eligible for medical Malpractice Immunity Federal tort claims act: Is another source of federal protection for physician volunteers If all the requirements are met, a healthcare professional volunteering for a qualifying free clinic would be deemed a public health service employee and eligible for medical malpractice coverage under the federal government. This provides a volunteer with immunity from medical malpractice lawsuits resulting from the healthcare professionals activity at the free clinic.
18 Let us bring this Closer to Home -Physicals -Teaching -Camp Doctor -Even on vacation -Sporting Events The easiest way to volunteer is to be available at events. The whole goal is for nothing ever to happen where your medical talents are needed. Sporting events When covering it sporting events check with your insurance carrier, sometimes it can be a tricky issue. The problem is that this is a place where good Samaritan laws and “duty to treat” overlap In a way that can be murky at best.
19 Malpractice #1 A duty to treat#2 A breech at that duty (commonly thought of as standard of care) #3 A harm resulting from that breech For those not familiar with this aspect of malpractice law, here is a 10 second primer. In order to be liable for malpractice, 3 things need to be present #1 A duty to treat #2 A breech at that duty (commonly thought of as standard of care) #3 A harm resulting from that breech
20 Sporting Events What kind of coverage do I have?Do I have a duty to treat? What kind of coverage do I have? How much will it cost me? In every day work to duty is implicit where there is a pre-existing doctor-patient relationship. Being the man on the street situations I’m under no obligation to render assistance that means I can help someone without any fear of being sued under the good Samaritan law. This law that was developed was designed to encourage anyone especially physicians to render aid and immunize general public or medical professionals from malpractice. But, (and this is a large but) if I am asked in advance to be present to provide aid to someone, I am acting as an agent of the event and might meet the definition of “duty to treat”.
21 Sporting Events What kind of coverage do I have?Do I have a duty to treat? What kind of coverage do I have? How much will it cost me? So, this puts doctors and uncomfortable situation we want to support the local organizations whatever they may be, but you have some tough choices to make. You can go without additional insurance, which is not unreasonable especially in Oklahoma, because in most cases, since the actual risks of injury, Let alone getting sued, is very low in most activities. In some sports the risks are higher and many doctors are too afraid of getting sued to run that sort of risk. But at this time, and I doubt in the near future, that low cost Liability insurance will be available.
22 Sporting Events What kind of coverage do I have?Do I have a duty to treat? What kind of coverage do I have? How much will it cost me? Some insurances will cover for volunteering but some insurers won’t allow it at all, and it varies by specialty. Orthopedic groups tend to be covered for local athletics (if nothing else it’s good business and they’re more comfortable viewing this is a necessary business expense). It would be helpful if event malpractice coverage could be provided say for about $50 per event for liability insurance. But at this time, and I doubt in the near future, that low cost Liability insurance will be available.
23 Volunteering ChallengesPracticing outside of comfort zone Access to appropriate support Longitudinal medical problems Follow up healthcare Involving and recruiting physicians We have discussed the challenge of fearing litigation. Volunteering also has the inherent challenges that do not change. Most of the time you are taking care of patients in an uncertain environment. You can see patients anywhere from church basements, football sidelines to mobile vans. The physician is often unfamiliar with patients and their histories and may treat then for conditions or stages of disease that are within the doctors regular scope of practice; for example, mental illness and or substance abuse. Supplies and diagnostic capabilities may be limited or rudimentary Most Medical problems are Longitudinal. “We can not solve a persons hypertension or Diabetes in one visit” Despite taking care of the immediate needs of patients, a important function is to set people up with a standard community healthcare program. It also takes time and energy to even get people to the place to help. There is a talent or spiritual gift that some people have to encourage and entice doctors outside of their comfort zone to get out and help others.
24 Oklahoma Volunteer licenseStatute in effect 2003 A volunteer of a charitable or non-profit organization is not liable but in cases of willful misconduct, however the Organization is Liable Also relieves volunteers of liability for Punitive Damages unless those volunteers are currently offering the same service for profit Most all states have a slight variability in the law associated to physician volunteering. In Oklahoma there are some slight differences, Liability lies on the organization and not the Volunteer. Most states provide protection from liability, even Punitive damages; unless due to gross negligence or willful misconduct.
25 Retired Physicians VolunteeringSection Volunteer Medical License to Treat Indigent and Needy -Issued by state board -No fee for license -No CME requirements -Issued for one year -Renewed yearly Compared to other states Ok has the most volunteer coverage and if retired the License does not have any fee Section Volunteer Medical License to Treat Indigent and Needy – Retired Physicians A. There is established a special volunteer medical license for physicians who are retired from active practice and wish to donate their expertise for the medical care and treatment of indigent and needy persons of the state. The special volunteer medical license shall be: 1. Issued by the State Board of Osteopathic Examiners to eligible physicians; 2. Issued without a payment of an application fee, license fee or renewal fee; 3. Issued or renewed without any continuing education requirements; 4. Issued for a fiscal year or part thereof 5. Renewal annually with board approval
26 ? So are we covered or not ? Are we immune from malpractice claims when providing volunteer services? The answer is “it depends” State and federal laws may provide some protection, and the physician’s current malpractice carrier may also include coverage. So you must check the state laws. Fears of liability should not deter physicians from volunteering. Rather Physicians should ask questions about the opportunity, and investigate what, if any. Type of liability protection their state offers for physician volunteers. So, the big question, Are we immune from malpractice claims when providing volunteer services?
27 “It Depends” ? So are we covered or not ?The answer is “it depends” on the state that you practice. State and federal laws may provide some protection, and the physician’s current malpractice carrier may also include coverage. So you must check the state laws. Fears of liability should not deter physicians from volunteering. Rather Physicians should ask questions about the opportunity, and investigate what, if any. Type of liability protection their state offers for physician volunteers. Oklahoma has the most coverage available, If you still feel that your coverage is not enough, Talk to your insurance carrier, or to the People at PLICO it is possible to get additional Coverage for a low cost.
28 “Only a life lived for others is worthwhile.”The Act of Service “Only a life lived for others is worthwhile.” -Albert Einstein Few things are as strong of a medicine for the soul as the giving of your time to help others. Its amazing how often I hear healthcare workers who volunteer and provide free aid either locally or abroad, say that it is the most rewarding thing that they do.
29 “I slept and I dreamed that life is all joy, I woke and I saw that life is all service, I served and saw that service is all joy” -Mother Teresa If you currently do not volunteer in any way, … I encourage you to step outside of your comfort zone, you wont regret it. Its up to you to determine how far out you go.
30 I had some questions right before my talk so I added them
31 Question : What about informed consent with the good Samaritan law?Usually we have to inform the patient of what we would like to do, discuss the pros and cons of the procedure, and also discuss all other options. Then we provide time for them to make a decision The bottom line is that you’re not required to secure the patient’s consent if any delay would jeopardize the patient. most insurance policies cover medical malpractice liability even in good Samaritan situations and all fees are covered by physicians professional liability insurance.
32 Question: What if you are providing coverage for sporting team and you travel outside your state? A few states allow physicians traveling with a team to maintain coverage involving their own athletes, some allow them to act as consultants to doctors in that state, while in other states prohibited. There are certain laws that apply in each state; we just need to be aware of them. Lawsuits really are uncommon, they occur most with Surgeons, then OBGYN, but different laws apply in different states. We need to take the time and make sure that you’re covered in a particular state if you are practicing medicine.