Practice of Medicine

Article

The MagMutual Guide to Incident Reporting - What, When, Who, How, and Why?

August 18, 2016

What is Incident Reporting? As MagMutual uses the term, incident reporting is the practice of notifying MagMutual any time some-thing occurs that has the potential to result in a medical liability claim against you.

How Does it Benefit me? From a purely practical standpoint, incident reporting benefits you immediately because under your individual or group medical professional liability insurance policy, coverage is triggered when you re-port a covered medical incident to us and we have acknowledged its receipt in writing. Beyond that, incident reporting benefits you in several ways:

  • You get access to MagMutual's claims and litigation specialists and patient safety consultants, who can counsel you on dealing with the situation, answer your questions, and provide guid-ance about communicating with the patient.
  • IN THE CASE OF COMPLAINTS TO THE STATE LICENSING BOARD, INCIDENT RE-PORTING WILL ALLOW MAGMUTUAL TO ASSIGN YOU AN ATTORNEY TO ASSIST WITH YOUR RESPONSE. THIS ASSISTANCE CAN HELP YOU AVOID COMMON MIS-STEPS THAT MIGHT OTHERWISE RESULT IN THE COMPLAINT TAKING LONGER TO RESOLVE. If it turns out that a claim cannot be averted, incident reporting allows for early ex-pert review to assess defensibility and/or potential losses.

What Should I Report? Acts that adversely affect patients. For example:

  • Unanticipated foreign bodies left within the patient.
  • Wrong medication or wrong dosage with adverse sequelae.
  • Operation on wrong side or at wrong level.

Major unexpected injuries occurring to patients under your care and resulting from any aspect of that care. The following list illustrates examples, but is not meant to be complete or exhaustive:

  • Any major unanticipated fetal damage.
  • Any unanticipated death (does not include cases where the medical record reflects that death is a likely possibility of the patient’s disease or the medical or surgical care).
  • Any unanticipated major surgical complication or complication of other treatment.
  • Failure to diagnose (occasions when the physician had a clear opportunity to diagnose a serious condition but didn’t, and later learns that the condition existed).

Other situations:

  • When suit papers, notice of suit or notice of intention to sue becomes known to the physician.
  • Whenever a patient or family member expresses extreme anger or threatens to sue.
  • When the physician knows of an attorney request for information or records.
  • Any inquiry from the state medical licensing board regarding your medical care or complaints related to your medical care.

REMEMBER, IT IS THE PATIENT’S PERSPECTIVE OF THE UNEXPECTED OUTCOME THAT CAN DRIVE SUBSE-QUENT LEGAL ACTION OR COMPLAINTS TO THE MEDICAL BOARD.

When Should I Report? To take advantage of the benefits of early reporting, MagMutual expects an incident report within a reasonable time (usually 24 to 72 hours) after the physician becomes aware of the event. IF IN DOUBT, ALWAYS REPORT. We understand there are occasions when the physician—particularly physicians in specialties with limited patient contact or limited ongoing patient relationships—would not immediately be aware of an adverse outcome. Late reporting of incidents can adversely affect your coverage.

How Should I Report?

  • Report the incident yourself—do not delegate this task to nursing, administrative, or clerical staff.
  • Call (800) 282-4882 and state that you wish to report an incident.
  • Have the following information ready: patient identification, date(s) of service, and procedure or medical services provided.
  • A claims specialist will take your call and record the information in MagMutual’s tracking system. DO NOT FAX, MAIL, OR EMAIL YOUR INCIDENT REPORT. If the claims specialist requires additional information, he or she will inform you and provide instructions for transmitting that information to MagMutual.

If your practice setting is a hospital or facility, and protocols require you to report an incident to the facility risk manager first, MagMutual will accept an incident report from that person; however, this does not relieve a physician insured under an individual policy from needing to make an incident report him- or herself.

Discussing an incident in which things turned out significantly differently than one would have hoped might be one of the most challenging and emotional tasks any health care professional faces. MagMutual's claims and litigation specialist and patient safety consultants understand this and take pride in offering caring, knowledgeable service.

What Happens After I Report? We will send you an acknowledgment letter verifying our entry of your verbal report into our system. File this acknowledgment letter in a separate risk management/claims correspondence folder under your private control. DO NOT REFERENCE THE INCIDENT REPORT OR THE ACKNOWLEDGMENT LETTER IN THE MEDICAL RECORD. Because neither the report nor the acknowledgment letter is part of the medical record, no authorization from the patient is required and these materials are not included in a release of records. YOU WON’T BE PENALIZED FOR MAKING INCIDENT REPORTS, AND MAGMUTUAL WILL NOT CONTACT THE PATIENT, FAMILY, OR PLAINTIFF ATTORNEY WITHOUT YOUR CONSENT.

Incident Reporting and HIPAA Some of our insureds have expressed reservations about reporting incidents to MagMutual because of concerns about violating HIPAA. Please note that you DO NOT NEED TO OBTAIN A PATIENT’S CONSENT—written or otherwise—to share HIPAA Protected Health Information (PHI) with MagMutual in an incident report.

Created by MagMutual from materials provided by COPIC as part of MagMutual and COPIC’s alliance to improve patient safety and quality of care for all of our PolicyOwners.

Disclaimer

The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.