0071643192.pdf

LEGAL ISSUES

insurance is not always the best. Insurance companies buy insurance them-

selves, and their coverage may become imperiled. Companies invest the pre-

miums they collect and often make more money on investments than from

the premium versus expense ratio. When the investment cycle is negative,

another malpractice insurance “crisis” follows.

Domestic insurers are inspected and regulated by state insurance commis-

sioners. Offshore companies can be less secure. Some hospitals insist that staff

and contract physicians and physician groups carry U.S. insurance, and usu-

ally at required minimum face amounts.

REPORTING: RESPONSIBILITIES TO THE WHOLE OF SOCIETY

There are no areas of medical practice where a patient’s interests and societal

interest collide more obviously. Both physicians and the public good are

served by encouraging the sick and injured to seek help. But the patient has

the right to confidentiality and privacy. Limited revelations are permitted by

patients and allowed by law. Other disclosures are required by law, which

varies greatly by state.

States structure reporting laws two ways. The state government enacts laws

requiring physicians to report, sometimes specifying conditions or injuries,

and states delegate to regulatory agencies responsibility for identifying what is

to be reported and how. They infrequently carry criminal penalties for failure

to report, but they are a legal requirement.

Communicable and Infectious Disease

This is the germinal type of reportable disease. To report the condition to pub-

lic health authorities and attempt to reduce the spread of the disease, physi-

cians required legal cover to avoid lawsuits regarding breech of confidentiality.

The law takes away any decision-making once the diagnosis is made; even if

the patient demands otherwise, the doctor has to report. Many hospitals iden-

tify lab personnel as reporting officers and admitted patients’ reports are often

handled by inpatient caregivers. But emergency physicians still retain shared

responsibility for compliance with the laws.

Typical State Reporting Lists Include:

■ Sexually transmitted infections, including HIV

■ Community outbreaks, eg, food poisoning

■ Illnesses related to foreign travel, eg, malaria

■ Suspected biological terrorist threats, eg, anthrax

■ Animal bites

Results of Criminal Activities

ASSAULT

Not all injuries that are or could be the result of assault must, or even can,

be reported. At present, five states do not have reporting requirements for

assault-related injuries. Forty-two states connect the report to injuries from

weapons, usually guns only, but knives and even martial arts weapons have

been included.

Claims-made malpractice

insurance should be renewed

or have tail coverage

purchased.

The lists of conditions that

must be reported varies

from state to state.

Penalties and civil liability can

follow failure to report.