Risk Management Publications
Risk Review
The exclusive risk management and patient safety newsletter of Princeton Insurance, produced by the members of the Princeton Insurance Healthcare Risk Services Department. Read our latest articles, or scroll down for archives of past issues.
To submit a question to our Risk Resource Line, or for any questions regarding Risk Review, give us a call at 1-866-Rx-4RISK.
Reducing Risk
These articles cover a wide range of timely topics that will help you reduce risk at your practice. All articles are in PDF form and can be downloaded by right-clicking on the links provided below.
Resource
Resource is a lively program of news, interviews, case studies, and legal reports with the latest thinking in patient safety and medical liability from experts at Harvard and around the world.
Resource is produced every other month by Controlled Risk Insurance Company, Ltd. (CRICO), a part of the Risk Management Foundation (RMF) of the Harvard Medical system, and is provided here through Princeton’s partnership with CRICO/RMF. For your convenience, it is available as an MP3 download.
Resource is produced by CRICO/RMF, the patient safety and medical malpractice company owned by and serving the Harvard medical community since 1976.
RMF Strategies, a division of CRICO/RMF, provides evidence-based risk management services and software solutions to healthcare systems and medical malpractice insurers.
© 2010 CRICO/RMF. All rights reserved.
Past issues of RiskReview are also available in PDF form:
2010: Fall, Summer, Spring, Winter
2009: Fall, Summer, Spring, Winter
2008: November, September, July, May, March, January
2007: November, September, July, May, March, January
2006: November, September
Also available: a listing of previously published articles.
Reducing Risk Documents
The Americans with Disabilities Act (ADA)
Considerations for Ceasing to or Leaving a Practice
Discharging a Patient from your Dental Practice
Discharging a Patient from your Medical Practice
Event Reporting
Guide to Investigating Events in the Physician Practice
HIPAA Privacy Rule
Informed Consent
Lessons Learned from Princeton’s Experience Defending Claims with Pressure Ulcers
Limited English Proficiency Patients Meaningful Access to Healthcare
Medical Record Requests
Protect your practice with your pen: Documentation Tips
Risk Alert- "Anesthesia Care Team"
Risk Alert- "Apparent Authority"
Risk Alert- Cyberterrorism: Are you secure?
Risk Alert- Dental Electric Handpieces: Dangerous Overheating
Risk Alert- Hot Liquids: Avoiding Patient Injury
Risk Alert- Kenalog Injections
Risk Alert- Medical Staff Credentialing Risk Update
Risk Alert- Physician Exams Bring New Opportunities, New Risks, to Chiropractors
Risk Alert- Physician Assistants Performing EMGs
Winter 2012 update: The case mentioned in this Risk Alert was recently appealed, and the supreme court upheld the decision that physician assistants are not legally permitted to perform EMG tests, nor are they authorized to assist a duly licensed physician in performing the procedure if the assistance consisted of actually inserting the needle electrode into the muscle (per EMG statute (N.J.U.S.A. 45:9-5.2(a)).
Risk Alert- Rise in Water Damage Claims at Dental Offices
Subpoenas for Medical Records in New Jersey State Court Civil Actions
Telephone Communication – tips to reduce phone liability
When Patients Don't Return for Follow-up Care
Resource
Resource: Issue 3, 2010  
Study Links Patient Safety, Malpractice Trends [8:13]
Do high scores on patient safety outcome measures mean lower malpractice risk? The answer—according to a new study from the RAND Corporation—is an emphatic “Yes.”
Guest Commentator:
Michael D. Greenberg, JD, PhD
RAND Center for Corporate Ethics & Governance, Pittsburg, PA
Jack Mc Carthy
CRICO/RMF, Cambridge, MA
Case Abstract:
Lack of Empathy Triggers Suit Against Surgeon [9:42]
The patient and his wife felt that the surgeon was not forthcoming with an explanation of what happened and seemed indifferent to the impact on his patient, following conversion to an open procedure and large blood loss.
Guest Commentator:
William Berry, MD, MPH
CRICO/RMF, Cambridge, MA
Part II: Lucian Leape Grades the Patient Safety Movement, 10 Years On [9:38]
The second half of an interview with the “father” of the patient safety movement at its 10-year anniversary, as he reflects upon the present-day challenges and what’s coming next.
Guest Commentator:
Lucian Leape, MD
Harvard School of Public Health, Boston, MA
Legal Report:
Telemedicine Rule Changes and Risk [3:47]
Proposed changes to Medicare rules may ease telemedicine credentialing, but Boston malpractice defense attorney Phil Murray highlights risks still dogging the use of technology to provide care long-distance.
Guest Commentator:
Phillip Murray, JD
Murray, Kelly, & Bertrand, PC, Woburn, MA
Resource: Issue 2, 2010
Filling Holes in Electronic Test Result Follow Up [9:04]
New research points to flaws in relying on computerized reminders to prevent diagnostic delays.
Guest Commentators:
Susan Cornacchio, RN, JD
CRICO/RMF, Cambridge, MA
Hardeep Singh, MD, MPH
Houston Veterans Affairs Medical Center, Houston, TX
Dean Sittig, PhD
University of Texas
Houston, TX
Closed Case Abstract:
Lack of Prostate Discussion Caused Legal Pain
A documented discussion of risks and benefits of PSA testing may have prevented allegation of malpractice.
Guest Commentator:
Saul Weingart, MD, PhD
Dana Farber Cancer Institute, Boston, MA
Legal Report:
ED Informal Phone Consult Risk, Benefits
A physician and a lawyer discuss hazards of increasing the use of telephone advice from specialists.
Guest Commentators:
Ellen Cohen, JD
Adler, Cohen, Harvey, Wakeman, Guekguezian, Boston, MA
Luis Lobon, MD, MS, FACEP
Cambridge Hospital, Cambridge, MA
10 Years On: Lucian Leape Grades Patient Safety Movement
Part I of 2: Error pioneer says medical leaders still need to "own" patient safety, but projects have reduced harm.
Guest Commentator:
Lucian Leape, MD
Harvard School of Public Health, Boston, MA
Resource: Issue 1, 2010  
Helping Clinicians Cope after Adverse Events [10:32]
A health system effort to address the harm to providers exposed to trauma and the normal course of suffering.
Guest Commentators:
Kristin Hahn-Cover, M.D., SACP
University of Missouri Health System, Columbia, MO
Susan Scott, RN
University of Missouri Health System, Columbia, MO
Closed Case Abstract:
Removal of Infant's Healthy Kidney [9:10]
A five-month-old girl was referred to the emergency department for evaluation of intermittent fevers and lethargy.
Guest Commentator:
William Berry, MD
CRICO/RMF, Cambridge, MA
Legal Report:
Should Video Cameras Be in Operating Rooms? [12:09]
Part II in a series from a Harvard patient safety conference with a physician proposal and a defense attorney's words of caution.
Guest Commentators:
Ellen Epstein Cohen, JD
Adler, Cohen, Harvey, Wakeman, Guekguezian, Boston, MA
Caprice Greenberg, MD, MPH
Brigham and Women's Hospital, Boston, MA
The Nitty Gritty of OB Team Training [12:23]
What are facilities learning as they implement a team-based model of OB care? A group of providers met in Boston to review their experiences.
Guest Commentators:
Mark Albini, MD
St. Mary's Hospital, Waterbury, CT
Peter Rotolo, MD
Winchester Hospital, Winchester, MA
Anne Shea-Lewis, RN
St. Charles Hospital, Port Jefferson, NY
Resource: December 2009  
Special Report:
Harvard Patient Safety Summit, June 2009
Diagnostic Failures Prompt Referral Changes [9:23]
Armed with its own malpractice data, a large group practice uses an existing electronic record system to ensure that when its doctors order a referral, the referral actually takes place.
Guest Commentators:
Jessica Bradley, MPH
CRICO/RMF, Cambridge, MA
Richard Lopez, MD
Atrius Health, Newton, MA
Legal Report
Benefits and Risks of Using Guidelines [10:32]
One physician expert argues that wider use of clinical guidelines will improve patient safety, while a seasoned defense attorney offers some cautions.
Guest Commentators:
Mark Graber, MD, FACP
VA Medical Center, Northport, NY
Ellen Epstein Cohen, Esq.
Adler, Cohen, Harvey, Wakeman & Guekguezian, Boston, MA
Think Like a Designer to Make Care Safe [9:15]
An expert in process design describes obstacles and solutions when improving health care delivery.
Guest Commentator:
Peter Coughlan
IDEO, Palo Alto, CA
News Briefs [1:26]
Resource: August 2009  
Legal Report
Curbside Consults in the Digital Age [6:56]
Ease of communication can trip up participants in an informal discussion.
Guest Commentators:
Ellen Epstein Cohen, JD
Adler, Cohen, Harvey, Wakeman, Guekgazian, Boston, MA
Making Care Systems Leaner and Safer [8:49]
Hospitals begin using an automotive process to root out errors.
Guest Commentators:
Dorothy Goulart, MS, RN
Brigham and Women's Hospital, Boston, MA
Linda Bacelis-Bush
GE Healthcare Performance Solutions
Milwaukee, WI
Terry Clemmer, MD
LDS Hospital, Salt Lake City, UT
Zeev Neuwirth, MD
Atrius Health, Newton, MA
Closed Case Abstract
Sent Home Twice Before Baby Born Sick [8:42]
Protocols might have helped move conflict up chain of command, and improved monitoring.
Guest Commentator:
David Acker, MD
Brigham and Women's Hospital, Boston, MA
MDs Reject Prescribing Alarms, Safety Value Persists [5:22]
Some physicians still change behavior, even though they override 90 percent of alerts.
Guest Commentator:
Saul Weingart, MD, PhD
Dana Farber Cancer Institute, Boston, MA
News Briefs [1:13]
Resource: April 2009  
New Decision Tool for Prostate Cancer Testing [8:40]
A consent discussion with patients leads the PSA testing advice in a Harvard-generated document to help primary care MDs manage prostate care.
Guest Commentators:
Marc Garnick, MD
Beth Israel Deaconess Medical Center, Boston, MA
Richard Parker, MD
Beth Israel Deaconess Medical Center, Boston, MA
Closed Case Abstract
Drug Error Reviewed by Non-Healthcare Methods [10:19]
A patient safety audience hears about how outside industry might fix a process breakdown before or after a wrong drug error.
Guest Commentator:
Steven Spear, DBA, MS, MS
MIT, Cambridge, MA
Legal Report
Court Defines a New Harm for Losing a Chance at Survival in Massachusetts [6:21]
Even if negligence didn't cause a patient's death, it may be compensable if it lessened the chance of survival.
Guest Commentator:
Philip Murray, Jr., JD
Murray, Kelly & Bertrand, PC, Woburn, MA
Patient Safety Data Driving Change: A Model Methodology [8:09]
Checklists, automation, simulation, drug abbreviations, or marking the surgical site: it all starts with error data and re-starts with outcome measures.
Guest Commentators:
Robert Hanscom, JD
CRICO/RMF, Cambridge, MA
James Pichert, PhD
Vanderbilt University, Nashville, TN
Luke Sato, MD
CRICO/RMF, Cambridge, MA
Tom Snyder
Princeton Insurance, Princeton, NJ
Resource: October 2008  
Patient Status Changes "Trigger" Call to MD
Strong indicators that telling nurses when to call the doctor to the bedside reduce bad outcomes.
Guest Commentators:
Michael Howell, MD, MPH
Beth Israel Deaconess Medical Center, Boston, MA
Patricia Folcarelli, RN, PhD
Beth Israel Deaconess Medical Center, Boston, MA
Closed Case Abstract:
Sleep Apnea Patient Dies After Eye Surgery
Communication and documentation flaws compromised a case that featured allegations of poor assessment and monitoring both pre-op and post-op.
Guest Commentator:
William Berry, MD, MPH
CRICO/RMF, Cambridge, MA
Legal Report:
A Physician Duty to Non-patients?
MA high court offers mixed ruling on whether a doctor is liable for patients who injure a third party after getting a prescription medication.
Guest Commentator:
Ellen Epstein Cohen, JD
Adler, Cohen, Harvey, Wakeman, Guekguezian, LLP, Boston, MA
New Ambulatory Med Safety Rules
Joint Commission pushes new standards for reconciling lists and dosage of medications as patients change settings.
Guest Commentators:
Peter Angood, MD
Joint Commission on the Accreditation of Healthcare Organizations, Oak Brook Terrace, IL
Nancy Manchester
Atrius Health, Newton, MA
Jeffrey Schnipper, MD, MPH
Brigham and Women's Hospital, Boston, MA
Resource: August 2008  
Special Report:
Health IT Brings Solutions, New Problems
Hundreds of caregivers and health IT experts gather in Boston to consider the bad and the good of using information technology for patient safety.
Part I:
Tech Aids for Decision Making [10:04]
Seeking the benefits for better prescribing, diagnoses, and treatment decisions, while avoiding risks of work-arounds and bad implementation.
Guest Commentators:
David Bates, MD, MSc
Brigham and Women's Hospital, Boston, MA
John Glaser, PhD
Partners HealthCare System, Boston, MA
Judy Murphy, RN
Aurora Healthcare, Milwaukee, WI
Part II:
Electronic Help for Follow Through [7:00]
Reliability for test result and referral management can be accompanied by confusion and conflicting electronics.
Guest Commentators:
John Halamka, MD, MS
CareGroup Health System, Boston, MA
Dan Rosenthal, MD
Massachusetts General Hospital, Boston, MA
Eric Poon, MD, MPH
Brigham and Women's Hospital, Boston, MA
Closed Case Abstract:
Deaths Preventable with Computers [6:45]
Systems could have helped one doctor to consider colon cancer screening, and another doctor to follow up on a referral.
Guest Commentator:
Luke Sato, MD
CRICO/RMF, Cambridge, MA
Legal Report:
Three Risks to Avoid in Health IT [3:32]
Be on the lookout for inaccurate templates, inconsistent records across formats, and missing information from print-outs.
Guest Commentator:
Ellen Epstein Cohen, JD
Adler, Cohen, Harvey, Wakeman, Guekguezian, Boston, MA
Resource: March 2008  
Program Summary:
MD Empathy: The Patient Perspective [10:22]
Physicians who express empathy get higher ratings by their patients on other care issues.
Guest Commentators:
Ronald Epstein, MD
University of Rochester Medical Center , Rochester, NY
Wendy Levinson, MD
University of Toronto Department of Medicine, Toronto, Ontario
Debra Roter, DrPH
Johns Hopkins School of Medicine and School of Nursing, Baltimore, MD
Case Abstract:
Delayed Diagnosis of Post-op Infection [9:34]
Care required better resident supervision, closer follow-up on ordered test.
Guest Commentator:
William Berry, MD, MPH
CRICO/RMF, Cambridge, MA
The Nature of Resident Errors [9:34]
Research points to flawed hand-offs, judgment, and supervision.
Guest Commentators:
Sheila R. Barnett, MD
Beth Israel Deaconess Medical Center, Boston, MA
Aaron S. Kesselheim, MD, JD
Brigham and Women's Hospital Boston, MA
Hardeep Singh, MD, MPH.
Baylor College of Medicine, Houston, TX
Legal Report:
Lost Evidence Loses Cases [6:15]
Fetal monitor strips, family history forms, and other non-medical record documents need to be preserved.
Guest Commentator:
Ellen Epstein Cohen, JD
Adler, Cohen, Harvey, Wakeman, Guekguezian, LLP, Boston, MA
Resource: January 2008  
Program Summary:
Are Intact Surgical Teams Possible for Safety? [10:47]
A gathering of surgeons confronts rotating personnel in operating rooms as a barrier to using team methods for patient safety.
Legal Report:
Openness and Caution in Disclosing Adverse Events [7:48]
A defense attorney's perspective on telling patients what is known after an unexpected adverse event.
Some Real World Solutions for Rising Diagnosis Problems [7:00]
Tracking test results in ambulatory care and responding rapidly to in-patient crises are among the sharings from two health systems.
Closed Case Abstract:
Decreased Fetal Movement In Diagnosis [5:39]
Researcher explores new opportunities to use reduced movement in diagnosing and possibly preventing fetal demise.
News Briefs [1:35]
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