Malpractice coverage while treating civilians

[Creflo]

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So I was recently paged to the ED to treat an open wound. After cleaning and closing the wound, when I instructed her to follow up with me in my military clinic, she stated that she was not eligible from an insurance standpoint to be seen in my clinic, but the ED was doing her a favor that night by seeing her. She was employed as a nurse in this ED and knew everybody there. Apparently using her insurance would have been more cumbersome in terms of which facility to use, cost, or something else, so she just went to our ED.

I don't have malpractice insurance but have a basic understanding that I am "covered" while practicing as active duty provider. But for this particular situation, does that "coverage" apply, or was I more exposed from a malpractice standpoint?

 

[Gastrapathy]

If she was checked in, you are covered. If you did a favor under the table, you were not (and committed a crime by using govt supplies). I'd be pissed if they called you down and didn't make it clear. Did you document?

 

[backrow]

You should be fine as it is not your responsibility to validate entitlements; however, it sounds like this was not a workplace injury for which most civilian employees can get initial treatment at the ED. If that's the case then whoever authorized the treatment could have issues, but even that is unlikely to happen as an ED is not able to turn patients away due to EMTALA (or what I know of EMTALA). I believe that applies to military facilities as well; however, they are somewhat protected by the front gate. She had a way past the gate and therefore could make it to the ED for that to kick in.

I wonder what the govt will charge her insurance, and if the ED was "out of network" she might end up with a nice bill because she couldn't figure out her insurance requirements.

 

[HighPriest]

In many (not all) states, your liability is also limited if you offer services with no intention of collecting compensation. But yeah, if you treat a civilian in a military facility, you're covered. Lots of larger MEDCENs are level III or II trauma centers that end up being point-of-first-contact for civilian trauma. The Army isn't going to put you (read: themselves) at risk.

 

[jabreal00]

In many (not all) states, your liability is also limited if you offer services with no intention of collecting compensation. But yeah, if you treat a civilian in a military facility, you're covered. Lots of larger MEDCENs are level III or II trauma centers that end up being point-of-first-contact for civilian trauma. The Army isn't going to put you (read: themselves) at risk.

If they somehow got her into the system and a medical record number was generated then he is covered. It's not the job of physicians to ascertain who is eligible for care or not. However, if he was paged and went down with the assumption that everything was above board but she was not checked into the system then he is exposed. Human nature is if the chit hits the fan (complication), the ED staff will feign like they had no idea that he was doing her a "favor." In the grand scheme of things, it's probably not a big deal if he was just cleaning a wound. It's not like he did an operation where he'd be worried about complications. However, one just has to be careful about given that under the table (hommie hook-up) care to civilian health care providers who work in military treatment centers. The urge is to help a colleague but one can leave themselves exposed.

 

[HighPriest]

If they somehow got her into the system and a medical record number was generated then he is covered. It's not the job of physicians to ascertain who is eligible for care or not. However, if he was paged and went down with the assumption that everything was above board but she was not checked into the system then he is exposed. Human nature is if the chit hits the fan (complication), the ED staff will feign like they had no idea that he was doing her a "favor." In the grand scheme of things, it's probably not a big deal if he was just cleaning a wound. It's not like he did an operation where he'd be worried about complications. However, one just has to be careful about given that under the table (hommie hook-up) care to civilian health care providers who work in military treatment centers. The urge is to help a colleague but one can leave themselves exposed.

Those are some of the scenarios to which I am referring, however. In some states, Texas being one, so long as it is clearly indicated that you are providing free care with no expectation of compensation you are generally not liable for damages so long as you aren't committing frank malpractice (you didn't do something unreasonable). In Texas, you actually do have to have the patient sign a statement indicating that this is the law but other states have stronger (or weaker) regulations.

I know that's not specifically relevant to his point, but it is something to keep in mind if you do plan on handing out pro bono care.

 

[Kingfisher]

The folks that paged you and didn't let you in on the situation suck.

It's professional courtesy to preempt the encounter with "Hey, one of the nurses down here has a wound I was wondering if you could take a look at? Her name is Barbara (or whatever), you know Barbara right? She is not eligible for care, but I was wondering if you could do me a solid?"

This gives you the option to refuse if you are not comfortable with doing that.