Prepare now for more stringent incident reporting laws in your state
Florida case heralds new trend
Any hospital can have an adverse outcome with a patient, but could you, as risk manager, be held criminally responsible for not reporting it?
In Florida, the former risk manager for West Boca Medical Center in Boca Raton, may be facing prison time for not reporting a patient's death immediately to the medical examiner.
A criminal indictment against the former risk manager was handed down last summer after a nurse at West Boca Medical Center accidentally injected a 91-year-old patient with potassium chloride, a drug sometimes used for executions, according to news reports. The risk manager was notified of the late-night death immediately after it occurred but did not call the medical examiner until nine hours later, according to news accounts in the Palm Beach Post.
The hospital did not return telephone calls from Healthcare Risk Management about the incident.
A spokesman for the Volusia County State Attorney's office, which is prosecuting the case, says the risk manager was indicted by a grand jury last summer for not reporting a patient's death in the time required by Florida law.
Although Florida is in the minority of states to legislate the reporting of adverse patient incidents to state health department authorities -- and apparently the only state where risk managers can face criminal penalties for not reporting deaths to the medical examiner in a timely fashion -- risk management experts say that similar requirements could spread across the country. New York also has mandatory reporting requirements, and risk managers in Pennsylvania are expecting their legislature to take up the issue sometime this year. (See story on p. 30 for more information on Florida's and New York's laws, and story on p. 31 for more about potential Florida legislation.)
Risk managers in other parts of the country say they would not be surprised to see mandatory reporting laws in light of the heightened scrutiny of health care systems.
Even if you are not required to report serious incidents to state authorities, risk managers say keeping on top of adverse incidents can be an important way to track and ultimately reduce the number of serious or adverse incidents in your facility. Risk managers who are already subject to such requirements suggest the following ways to prepare for and track adverse-incident reporting:
1. Stay informed.
Risk managers in Florida and New York say information is their most valuable tool in complying with state laws. George Foley, HCRM, director of risk management at University Community Hospital in Tampa, FL, says having enough resources and perspectives on the state's requirements is crucial to being in compliance. In addition to receiving updates from the Florida Hospital Association and the Florida Society for Healthcare Risk Management, Foley subscribes to law firm legal updates.
Vickey Masta-Gornic, director of risk management at Albany (NY) Medical Center Hospital, says her hospital's legal counsel keeps a constant eye out for regulatory changes. As an additional safety net, she subscribes to bulletins released by the New York health department and the New York hospital agency.
2. Educate your staff and revise policies.
No matter how on top of the reporting requirements you may be, if your hospital staff do not know about them, you will be in trouble. Risk managers say educating the hospital staff about what must be reported to state authorities and when the incident reports have to be filed is crucial.
Florida requires all hospital workers to receive one hour of risk management training each year. Foley says this annual session is one way to keep hospital staff abreast of current requirements. To make sure staff attend these sessions, he ties attendance at the risk management sessions into the payroll department. Employees who do not attend cannot receive their merit increases.
When New York's reporting regulations change, and they have changed frequently in the 10 years that the law has been in effect, Joe Conte, MPA, director of risk management at Long Island (NY) Jewish Medical Center, says he issues memorandums to affected departments and holds inservice programs on the updates. He says risk managers should not look at these requirements as merely a regulatory obligation. "If you just look at it that way, you miss the opportunity." Instead, he says any reporting procedures should be implemented with an eye toward quality improvement.
"Have them recognize that resources are scarce and that by having more dialogue and more information exchanged, there will be more of an impact on improving services rather than just worrying about covering your tracks," Conte says.
3. Be available to your staff.
When adverse incidents occur, hospital staff have to know how to report to risk management. Many incidents are not reported or are reported late simply because the unit manager did not know whom to call to report it.
"There have to be clear pathways set up," says Masta-Gornic. She has a member of the risk management staff on-call 24 hours a day so incidents can be reported in a timely fashion.
4. Develop relationships.
While risk managers must rely on the hospital staff to report adverse incidents, Foley says the risk manager can encourage such reporting. "You can't rely on one source of information. Don't sit back and wait for incident reports," he says. "I have relationships all over the hospital. . . . I go out and talk to the people who will be the witnesses to the things you can't find out by sitting behind a desk all day."
Masta-Gornic advises risk managers to build relationships with the regulators in state agencies, as well. By building these relationships, regulators may be more prone to work with rather than against hospital risk managers.
5. Don't fight the requirements.
"The tone that is established at the beginning with the state carries through," Foley says. "Don't be flippant in your responses to the state. You have to tailor your responses accordingly. Just because you don't think something is a big deal, that doesn't mean that the state won't."
Charles Baggett, ARM, FASHRM, director of risk management at Mount Sinai Medical Center in Miami Beach, FL, says he views some of the newest reporting requirements in Florida as positive. In addition to adverse incident reports, Florida risk managers now must report and investigate any allegations of sexual misconduct in the hospital. "It makes sense to me because when something like this happens, we, as an industry, want to ignore it and sweep it under the rug. But we cannot do that," he says.
Baggett has found the newly required sexual misconduct investigations and reports beneficial in the event any subsequent litigation occurs.
6. Have one person report.
While state laws may differ on who must do the reporting, risk managers agree that one person should do the reporting for consistency. Most say that the risk manager also should be the one to report to the state agency because he or she tends to have the most complete information.
Foley cautions risk managers to take a general approach when reporting to the state. Reports that are too clinical or too legal may confuse a regulator who is not trained in that area. *
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