Tim UnderstandingHospitalProfessionalLiability WEB

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1%

2/11/14%

2%

UNDERSTANDING+HEALTH+CARE+PROVIDERS+PROFESSIONAL+LIABILITY+COVERAGE+Presented%by:%Tim+Northrop,+Vice+President+Chief+Insurance+OperaEons+Ocer%%

Preventable+Medical+Errors%

The%Ins3tute%of%Medicines%(IOM)%seminal%study%of%preventable%medical%errors%es3mated%as%many%as%98,000%people%die%every%year%at%a%cost%of%$29%billion.%

Deaths/Mortality,+2005,+NaEonal+Center+for+Health+Care+StaEsEcs+at+the+Centers+for+Disease+Control,++viewed+at+hSp://www.cdc.gov/nchs/fastats/deaths.htm.%

2/11/14%

3%

%Deaths/Mortality,%2005,%Na3onal%Center%for%Health%Care%Sta3s3cs%at%the%Centers%for%Disease%Control,%

%viewed%at%hPp://www.cdc.gov/nchs/fastats/deaths.htm.%

Leading+Cause+of+Death+in+United+States+

1% Heart%Disease% 652,091%

2% Cancer% 559,312%

3% Stroke% 143,579%

4% Chronic%Lower%Respiratory%Disease% 130,933%

5% Accidents%(uninten3onal%injuries)% 117,809%

Preventable+Medical+Errors+ +98,000+

6% Diabetes% %75,119%

7% Alzheimers%Disease% %71,599%

8% Inuenza/Pneumonia% %63,001%

9% Nephri3s/Nephrosis% %43,901%

10% Sep3cemia% %34,136%Deaths/Mortality,+2005,+NaEonal+Center+for+Health+Care+StaEsEcs+at+the+Centers+for+Disease+Control,++viewed+at+hSp://www.cdc.gov/nchs/fastats/deaths.htm.+

Preventable+Medical+Errors%

AdvenEst+Hospitals%Preventable+Medical+Errors+! PATIENT'S%FAMILY%ALLEGED%MEDICAL%NEGLIGENCE%DURING%SURGERY%bRupture%of%

appendix%b%medical%negligence%! 51%YEAR%OLD%FEMALE%UNDERWENT%LAPOROSCOPIC%CHOLYCYSTECTOMY%AND%

IOTROGENIC%PERFORATION%TO%DUODENUM.%%INFECTION%TREATED%LATER%AS%WERE%PULMONARY%COMPLICATIONS.%Claimant%alleged%medical%mistakes%for%her%condi3on%

! COMPLAINTS%OF%DAMAGE%TO%LEFT%EYE%DURING%LASER%SURGERY.%SURGEON%IS%INSURED%BY%ANOTHER%COMPANY.%

! PATIENT%FELL,%BUTTOCKS%FIRST,%INTO%A%TOILET%(BROKEN%SEAT%ALLEGED).%%NURSING%ATTENDANT%EXTRACTED%HER%FROM%COMMODE%AND%BROKE%HER%COLLARBONE.%

! 72%YEAR%OLD%LADY%WENT%BLIND%AFTER%BILATERAL%CATARACT%SURGERY.%%DOCTOR%TOLD%HER%THAT%AFTER%THE%SURGERY%SHE%WOULD%BE%ABLE%TO%"THREAD%A%NEEDLE".%%SHE%CAN'T.%

! ASTHMA%PATIENT%FELL%GETTING%OUT%OF%BED%TO%GO%TO%THE%BATHROOM.%%BROKEN%ANKLE%LED%TO%DEEP%VEIN%THROMBOSIS.%

2/11/14%

4%

AdvenEst+Hospitals%Preventable+Medical+Errors+! 3%WEEK%PREMATURE%NEWBORN%WAS%GIVEN%MEDICATION%IN%A%MANNER%THAT%

MAY%HAVE%CAUSED%DEATH.%%WAITING%FOR%AUTOPSY%REPORT.%! FALSE%POSITIVE%ON%HIV%BLOOD%TEST.%%24%HOURS%OF%ANXIETY%BEFORE%RETEST%

RESULTS%PROVED%NEGATIVE.%! 45%YEAR%OLD%MOTHER%OF%FOUR%DIED%OF%CYST%AT%BASE%OF%HER%BRAIN%WHILE%

UNDERGOING%A%CT%SCAN.%%ALLEGATIONS%THAT%INJECTIONS%GIVEN%MADE%HER%CONDITION%DETERIORATE%AND%CAUSED%HER%DEATH.%

! INFECTION%POST%LASER%SURGERY%ON%EYES%RESULTED%IN%A%NEED%FOR%CORNEAL%TRANSPLANTS.%

! 49%YEAR%OLD%LADY%PRESENTS%FOR%HEMMOROID%SURGERY.%%DR%NOTICES%SOME%WEBBING%ON%HER%FINGERS%AND%DECIDES%TO%SURGICALLY%SEPARATE%THEM.%BLOOD%SUPPLY%THROUGH%WEBBING%FEED%ENDS%OF%THREE%FINGERS.%THREE%FINGER%TIPS%BECAME%GANGRENOUS%&%WERE%AMPUTATED.%

Medical+errors+kill+enough+people+to+ll+four+jumbo+jets+a+week.+

The+Wall+Street+Journal+September+21,+2012+^+WSJs+Gary+Rosen,+Author+Surgeon+Marty+Makary+

2/11/14%

5%

Four+Jumbo+Jets+a+Week%

THAT+IS+1,884+PEOPLE+

Risk+of+Dying+in+a+Hospital+

1+in+3+Hundred+PaEents+

! The%chance%of%a%hospital%error%is%about%1+in+10+in%most%hospitals%around%the%world,%

! The%chance%of%dying%from%that%error%is%about%1+in+300.%%

Liam+Donalson,+the+WHOs+(World+Health+OrganizaEon)++envoy+for+paEent+safety.+

2/11/14%

6%

Risk+of+Dying+in+an+Air+Crash+

1+in+10+Million+Passengers+1001crash.com+Lessons+learnt+for+aviaEon+safety+^+Liam+Donaldson,+the+WHOs+(World+Health+OrganizaEon)++envoy+for+paEent+safety%

Computer^generated+portrayal+of+collision+between+both+Boeing+747+

2/11/14%

7%

How+to+Stop+Hospitals+From+Killing+Us%

How+to+Stop+Hospitals+From+Killing+Us+

The+Wall+Street+Journal+September+21,+2012+WSJs+Gary+Rosen,+Author+Surgeon+Marty+Makary+

2/11/14%

8%


1. Online%Dashboards%2. Safety%Culture%3. Cameras%4. Open%Notes%5. No%more%Gagging%%

The%Wall%Street%Journal%September%21,%2012%WSJs%Gary%Rosen,%Author%Surgeon%Marty%Makary%

How+to+Stop+Hospitals+From+Killing+Us+1. Online+Dashboards+

That%includes:% Its%rates%for%infec3on% Readmission%(what%we%call%

"bounce%back")% Surgical%complica3ons% Annual%number%and%Types%

of%Surgery%performed% Never%events% Pa3ents%sa3sfac3on%scores%


2/11/14%

9%


2. Safety+Culture+ Speak%Up!!%this%sort%

of%cultural%factor%is%so%important%to%safety.%



3. Cameras+The%notes%in%a%pa3ent's%chart%are%onen%short,%and%they%can't%capture%a%procedure%the%way%a%video%can.%

Wall+Street+Journal+September+21,+2012+WSJs+Gary+Rosen,+Author+Surgeon+Marty+Makary+

2/11/14%

10%


4. Open%Notes%Harvard%doctorbresearchers%Jan%Walker%and%Tom%Delbanco%are%using%"open%notes"%at%Harvard%and%Beth%Israel%Hospital%in%Boston,%%Geisinger%Medical%Center%in%Pennsylvania,%has%begun%giving%pa3ents%online%access%to%their%doctors'%notes.%%



5. No+More+Gagging+Increasingly,%pa3ents%checking%in%to%see%doctors%are%being%asked%to%sign%a%gag%order,%promising%never%to%say%anything%nega3ve%about%their%physician%online%or%elsewhere.%In%addi3on,%if%you%are%the%vic3m%of%a%medical%mistake,%hospital%lawyers%will%make%never%speaking%publicly%about%your%injury%a%condi3on%of%any%sePlement.%

The%Wall+Street+Journal+September+21,+2012+WSJs+Gary+Rosen,+Author+Surgeon+Marty+Makary+

2/11/14%

11%

Health+care+provider+liability+Insurance+Policy+

HOSPITAL+PROFESSIONAL+LIABILITY+GENERAL+LIABILITY++

2/11/14%

12%

HOSPITAL+PROFESSIONAL+LIABILITY+Claims^made%coverages%apply%only%to%claims%arising%from%events%which%occur%on%or%aner%the%retroac3ve%date%stated%in%the%Declara3ons%and%reported%to%Company%while%this%policy%is%in%force.%%%%Occurrence+coverages%apply%only%to%claims%arising%from%events%which%occur%while%this%policy%is%in%force.%

GENERAL+LIABILITY+

RetroacEve+Date+=+July+1,+2002+

ABUSE+OR+MOLESTATION+EXCLUSION+

%These%exclusions%apply%only%to%bodily%injury,%property%damage,%adver3sing%injury%or%personal%injury%arising+out+of+actual+or+alleged+sexual+abuse+or+sexual+molestaEon.+

GICV%906%12%08%

2/11/14%

13%

Hospital+Professional+Liability+

HOSPITAL+PROFESSIONAL+LIABILITY+

We%will%pay%those%sums%that%the%insured%becomes%legally%obligated%to%pay%as%damages%because%of%injury%to%which%this%insurance%applies.%If%the%injury%is%caused%by%a%"medical+incident"+that%takes%place%in%the%"coverage+territory"+

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14%

WHO+IS+AN+INSURED+Examples)

a) Named%Insured%%DIVISION%OWNED%HOSPITALS%b) Partner,%Execu3ve%Ocer,%%%c) Department%Head%(including%department%head%of%

medical%sta)%d) Contract%Physicians%e) Members%of%boards%or%commiPees%%

HOSPITAL+PROFESSIONAL+LIABILITY+Quick)Facts)

Coverage+%Claims%Made%%%Retroac3ve%Date:%July%1,%2002%

Limits+%Each%Medical%Incident%%US$300,000%%Policy%Period %%b%US$3,000,000%

2/11/14%

15%

DEFINITIONS+Medical%Incident%means%any%act%or%omission:%

a. In%the%providing%of%or%failure%to%provide%professional%health%care%services%to%your%pa3ents,%including:%1) The%providing%or%dispensing%of%food,%beverages,%

medica3ons%or%medical%supplies%or%appliances%in%connec3on%with%such%services;%and%

2) The%handling%or%treatment%of%dead%bodies,%including%autopsies,%organ%dona3on%or%other%procedures.%

Medical%incident%means%any%act%or%omission:%b. Arising%out%of%the%service%by%any%person%as%a:%

1) Member%of%a%formal%accredita3on,%standards%review%or%equivalent%professional%board%or%commiPee%of%the%Named%Insured;%or%

2) Person%charged%with%execu3ng%the%direc3ves%of%such%board%or%commiPee.%

DEFINITIONS+

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16%

STANDARD+EXCLUSIONS+This%insurance%does%not%apply%to:%Criminal+Acts+b%Injury%arising%out%of%a%criminal%act,%including%but%not%limited%to%malicious%acts,%sexual%abuse%or%molesta3on%or%fraud,%or%dishonesty%commiPed%by%or%at%the%direc3on%of%the%insured.%Contractual+Liability+b%Any%claim%for%damages%arising%out%of%the%insureds%obliga3on%to%pay%damages%by%reason%of%the%assump3on%of%liability%in%a%wriPen%or%oral%contract%or%agreement.%This%exclusion%does%not%apply%to%liability%for%damages%that%the%insured%would%have%in%the%absence%of%the%contract%or%agreement.%

%

STANDARD+EXCLUSIONS+

%This%insurance%does%not%apply%to:% Breach%of%Contract% Viola3on%Of%An%An3trust%Law%% Workers%Compensa3on%And%Similar%Laws% Employers'%Liability% Aircran,%Auto%Or%Watercran.%(This%exclusion%does%not%

apply%to%loading%or%unloading%of%pa3ents%from%any%ambulance)%

Fines%and%Penal3es%%

2/11/14%

17%

COMMERCIAL+GENERAL+LIABILITY+CONDITIONS+

1. DuEes+In+The+Event+Of++A+Medical+Incident,+Claim+or+Suit+c. You%and%any%other%involved%insured%must:%

1) Immediately%send%us%copies%of%any%demands,%no3ces,%summonses%or%legal%papers%received%in%connec3on%with%the%claim%;%

2) Authorize%us%to%obtain%records%and%other%informa3on;%3) Cooperate%with%us%in%the%inves3ga3on,%or%sePlement%or%defense%

against%the%suit%;%and%4) Assist%us,%upon%our%request,%in%the%enforcement%of%any%right%

against%any%person%or%organiza3on%which%may%be%liable%to%the%insured(s)%because%of%injury%to%which%this%insurance%may%also%apply.%

d. No+insured(s)+will,+except+at+their+own+cost,+voluntarily+make+a+payment,+assume+any+obligaEon,+or+incur+any+expense,+without+our+consent.+

Commercial+General+Liability+

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18%

Commercial+General+Liability+A%standard%insurance%policy%issued%to%business%organiza3ons%to%protect%them%against%THIRD+PARTY+liability%claims%for:%%Bodily%Injury,%%Property%Damage,%%Products,%and%Completed%Opera3ons,%%Adver3sing%and%Personal%Injury,%and%Medical%Payments%%

GICV%925%08%11%Page%1%of%13%

GENERAL+LIABILITY+Quick)Facts)

Coverage+%Occurrence%%

Limits+%Each%Occurrence%%US$1,000,000%%Policy%Period %%b%None%

%

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19%

WHO+IS+AN+INSURED+Examples) Your%employees%and%Volunteers%while%ac3ng%

within%assigned%du3es.% Any%of%your%members,%but%only%with%respect%to%

their%liability%for%your%ac3vi3es%that%are%authorized%by%you%or%any%denomina3onally%employed%person%to%whom%such%authority%has%been%delegated.%

Any%trustee,%ocial,%member%of%the%board%of%governors%or%clergyman%but%only%with%respect%to%their%du3es%as%such.%

DEFINITIONS+

Bodily%Injury%b%%bodily%harm,%sickness,%or%disease,%including%resul3ng%death.%Property%Damage%b%physical%injury%to%tangible%property.%Products,%and%Completed%Opera3onsb%includes%all%bodily%injury%and%property%damage%that%arises%out%of%your%products%if%the%bodily%injury%or%property%damage%occurs%aner%you%have%relinquished%possession%of%those%products.%

%%

2/11/14%

20%

DEFINITIONS+CONTINUED+Adver3sing%and%Personal%Injury%%liability%arising%out%of%the%insured's%adver3sing%of%its%goods%or%services:%libel,%slander,%invasion%of%privacy,%copyright%infringement,%and%misappropria3on%of%adver3sing%ideas%Medical%Payments%b%We%will%make%these%payments%regardless%of%fault.%These%payments%will%not%exceed%the%applicable%limit%of%insurance.%We%will%pay%reasonable%expenses%for:%

1) First%aid%at%the%3me%of%an%accident;%2) Necessary%medical,%surgical,%xbray%and%dental%services,%including%

prosthe3c%devices;%and%3) Necessary%ambulance,%hospital,%professional%nursing%and%funeral%

services.%

%

STANDARD+EXCLUSIONS+

This%insurance%does%not%apply%to:% Expected%or%Intended%Injury% Contractual%Liability% Worker%Compensa3on%and%Similar%Laws% Employer%Liability% Pollu3on%(unless%is%Sudden,%Unintended%and%Unexpected)%

Aircran,%Auto%or%Watercran% Mobile%Equipment% War%

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21%

STANDARD+EXCLUSIONS+This%insurance%does%not%apply%to:% Damage%to%Property%you%own,%rent,%or%occupy% Damage%to%your%Product% Damage%to%your%Work% Damage%to%Impaired%Property%or%Property%Not%Physically%Injured% Recall%of%Products,%Work%or%Impaired%Property% Asbestos% Firearms% Airport%or%Airstrip% Professional%Services% Lead%Paint% Silica%or%SilicabRelated%Dust%

COMMERCIAL+GENERAL+LIABILITY+CONDITIONS+

DuEes+In+The+Event+Of+Occurrence,+Claim+or+Suit+You%and%any%other%involved%insured%must:%

1) Immediately%send%us%copies%of%any%demands,%no3ces,%summonses%or%legal%papers%received%in%connec3on%with%the%claim%or%suit;%

2) Authorize%us%to%obtain%records%and%other%informa3on;%3) Cooperate%with%us%in%the%inves3ga3on,%sePlement%or%defense%of%

the%claim%or%suit;%and%4) Assist%us,%upon%our%request,%in%the%enforcement%of%any%right%against%

any%person%or%organiza3on%which%may%be%liable%to%the%insured(s)%because%of%injury%or%damage%to%which%this%policy%may%also%apply.%%

No+insured(s)+will,+except+at+their+own+cost,+voluntarily+make+a+payment,+assume+any+obligaEon,+or+incur+any+expense,+other+than+for+rst+aid,+without+our+consent.+

2/11/14%

22%

How+to+File+a+Claim++E^mail:+%[email protected]%%%Fax:+(301)%680b6878%%Mail:+Adven3st%Risk%Management%APen3on:%Claims%&%Legal%Services%Department%12501%Old%Columbia%Pike%Silver%Spring,%MD%20904b6600%

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23%

THIS%POWER%POINT%PRESENTATION%AND%ANY%MATERIALS%DISTRIBUTED%ARE%FACT%BASED%GENERAL%INFORMATION%AND% SHOULD% NOT,% UNDER% ANY% CIRCUMSTANCES,% BE% CONSIDERED% SPECIFIC% LEGAL% ADVICE% REGARDING% A%PARTICULAR%MATTER%OR%SUBJECT.%PLEASE%CONSULT%YOUR%LOCAL%ATTORNEY%OR%RISK%MANAGER%IF%YOU%WOULD%LIKE%TO%DISCUSS%HOW%A%LOCAL%JURISDICTION%DEALS%WITH%ANY%SPECIFIC%CIRCUMSTANCES%YOU%MAY%BE%FACING.%

Documents

Tim UnderstandingHospitalProfessionalLiability WEB